Repository logo

Browsing by Author "Fling, Brett, advisor"

Now showing 1 - 2 of 2
  • Thumbnail Image
    ItemOpen Access
    Movement for mobility: associations between physical activity, postural control, and gait in people with multiple sclerosis
    (Colorado State University. Libraries, 2021) Bandera, Victoria Maria, author; Fling, Brett, advisor; Leach, Heather, advisor; Diehl, Manfred, committee member
    Background: Approximately 80% of people with multiple sclerosis (PwMS) experience impaired balance and mobility. The optimal duration, type and intensity of physical activity (PA) to improve balance and gait is not well understood. Purpose: Examine associations between PA duration, type and intensity with balance and gait in PwMS and neurotypical controls. Methods: Twenty-four PwMS and twenty-one neurotypical controls reported their typical PA routine, including duration [(days/week)x(minutes/bout)], type (aerobic, resistance and/or plyometric (R/P) and yoga), and intensity (rating of perceived exertion (RPE) 6-20). Balance was assessed by the mini Balance Evaluation Systems Test (Mini-BESTest). Gait speed was measured by the two-minute walk test at a normal pace and a fast pace. Pearson's and Spearman's correlations examined associations among PA variables, balance, and gait speed. Independent t-tests and Mann-Whitney U tests examined differences in gait speeds and balance, between participants who did vs. did not perform each PA type. MANOVA and Kruskal-Wallis tests compared gait and balance performance in participants who reported ≥150 PA minutes/week, and vigorous PA (RPE > 14) vs. those who did not. Results: No significant associations were found between PA duration and any outcomes in either group. Conversely, PA intensity was significantly associated with reactive postural control, rs(24) = .458, p < .05, sensory orientation, rs (24) = .487, p < .05, and dynamic gait, rs(24) = .429, p < .05, and anticipatory postural control in neurotypical controls, rs(21) = .476, p < .05. As for PA type, self-reported habitual R/P was associated with nearly significantly superior dynamic gait performance in PwMS, p = .07, but significantly lower normal gait speed in neurotypical controls, p < .05. Participants who met and/or exceeded the 150-minute per week PA guideline did not have differences in any outcomes. Habitually vigorous PA was associated with significantly improved anticipatory postural control, H(1) = 5.86, p < .05, and nearly significantly improved Mini-BEST scores in neurotypical participants H(1) = 3.273, p = 0.07. Minimally clinically important differences in fast gait speed (> 0.10 m/s) were found in neurotypical participants habitually performing vigorous PA compared to light-to-moderate PA. Conclusions: These findings suggest PA intensity and participation in R/P and yoga are associated with better balance and gait performance. Future studies should reevaluate these associations incorporating PA intensity measured by self-report perceived intensity and objectively measured, and incorporating R/P training into PA routines to improve balance and gait outcomes in PwMS.
  • Thumbnail Image
    ItemOpen Access
    The transcallosal highway: the ipsilateral silent period as a neural biomarker for impaired corpus callosum communication and gait asymmetry in people with multiple sclerosis
    (Colorado State University. Libraries, 2023) Acosta, Jordan, author; Fling, Brett, advisor; Rudolph, Alan, committee member; Miravalle, Augusto, committee member; Schmid, Arlene, committee member
    Multiple sclerosis is a neurodegenerative disease that damages the myelin sheath within the central nervous system. Axonal demyelination, particularly in the corpus callosum, impacts communication between the brain's hemispheres in persons with multiple sclerosis (PwMS). Changes in transcallosal communication impairs the coordination of gait which requires constant communication across the corpus callosum to excite and inhibit specific muscle groups. To further evaluate the functional role of transcallosal communication in gait and mobility, this study assessed the ipsilateral silent period (iSP), an indirect marker of transcallosal inhibition in PwMS. This study utilizes transcranial magnetic stimulation (TMS) to assess the inhibitory capacity between the brain's hemispheres. There is a lack of research analyzing directionality data between the more and less affected hemisphere in PwMS. Therefore, we evaluated outcome metrics dependent upon the individual's more affected hemisphere calculated from the subject's more affected limb observed during walking assessments and self-report. We hypothesize that the iSP may serve as a neural biomarker for transcallosal impairments evaluated by directionality differences between the hemispheres and highlight transcallosal inhibition as an underlying neural mechanism for gait asymmetries in PwMS. From twenty-nine PwMS, metrics such as depth iSP% average, duration, depth iSP% max, and onset latency were collected. No statistically significant differences were found between the two hemispheres. This suggests that PwMS may be able to preserve their interhemispheric inhibitory capacity irrespective of their more affected hemisphere. Additionally, another component of the study investigated gait coordination utilizing a split-belt treadmill training paradigm. Limb excursion asymmetry (LEA) measures, pre and post-training, were analyzed for spatial coordination and as a measurement of locomotor adaptability in PwMS. The relationship between LEA change and dSP% average highlighted a significant correlation (r=0.46, p= 0.02). Thus, showing that less interhemispheric inhibition corresponds with more spatial adaptability leading to a more symmetric gait. These findings may help determine the potential of iSPs as a neural biomarker to address gait asymmetries and stratify participants into mobility rehabilitation protocols.