Movement compensations during a step ascent task are associated with stair climbing performance in people with multiple sclerosis

Paul W Kline; Cory L Christiansen; Emily R Hager; Enrique Alvarez; Mark M Mañago

doi:10.1016/j.gaitpost.2021.04.022

Movement compensations during a step ascent task are associated with stair climbing performance in people with multiple sclerosis

Gait Posture. 2021 Jun:87:27-32. doi: 10.1016/j.gaitpost.2021.04.022. Epub 2021 Apr 15.

Authors

Paul W Kline¹, Cory L Christiansen², Emily R Hager², Enrique Alvarez³, Mark M Mañago⁴

Affiliations

¹ Department of Physical Therapy, High Point University, High Point, NC, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA. Electronic address: pkline@highpoint.edu.
² Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA.
³ Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁴ Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

Abstract

Background: The biomechanical mechanisms underlying stair climbing limitations are poorly understood in people with multiple sclerosis (MS).

Research questions: Are trunk and pelvis motion and lower extremity joint moments during step ascent different between MS and control groups? Are step ascent biomechanics and stair climbing performance associated in people with MS?

Methods: 20 people with MS (49 ± 12 years, EDSS range: 1.5-5.5) and ten control participants (48 ± 12 years) underwent three-dimensional motion analysis while ascending a 15.2-cm step and also completed a timed Functional Stair Test. Main effects of group (MS vs Control) and limb (Stronger/Dominant vs Weaker/Non-dominant) and interactions were assessed using two-way analyses of variance. Associations between movement patterns during the step ascent and Functional Stair Test performance were performed using Pearson's correlations and backward stepwise linear regression.

Results: Significant group main effects were observed in greater sagittal pelvis excursion (p < 0.001), greater sagittal (p = 0.013) and frontal (p = 0.001) trunk excursion, and lower trail limb peak ankle plantar flexion moment (p < 0.001) of the MS group. Significant limb main effects were observed with greater sagittal trunk excursion (p = 0.037) and peak trail limb ankle plantar flexion moment (p = 0.037) in the stronger/dominant limb. A significant interaction was observed in peak knee extensor moment (p = .002). Stair climbing performance in the MS group correlated with sagittal (r = .607, p=<0.001) and frontal pelvis excursions (r = 0.385, p = 0.014), sagittal trunk excursion (r = .411, p = 0.008), and ankle plantar flexion moments (r=-0.415, p = 0.008). Sagittal and frontal pelvis excursion and bilateral handrail use explained a significant amount of variability in stair climbing performance (Adj R² = 0.775).

Significance: In conclusion, despite the presence of proximal and distal lower extremity movement pattern compensations during a step ascent task, larger pelvis angular excursions are associated with impaired stair climbing performance in people with MS and may serve as targets for future rehabilitation interventions.

Keywords: Biomechanics; Kinetic; Moment; Multiple sclerosis; Stair.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Biomechanical Phenomena
Humans
Knee Joint
Middle Aged
Movement
Multiple Sclerosis*
Stair Climbing*

Abstract

Publication types

MeSH terms

Grants and funding