Comparison of changes in center of pressure and reaction time during gait initiation in response to external disturbances in women with multiple sclerosis and healthy

Document Type : Original Article


1 Department of Physical Education and Sports Sciences, Islamic Azad University of Gonabad, Gonabad, Iran.

2 . Full Professor, Faculty of Physical Education and Sport Sciences, Kharazmi University, Teheran, Iran

3 Associate Professor of Sport Biomechanics, Faculty of Sport Sciences, University of Birjand, Iran

4 Associate Professor, Faculty of Ergonomics, Rehabilitation University, Tehran, Iran


Introduction:Multiple sclerosis is an inflammatory disease of the safety system that affects the central nervous system and can lead to changes in walking and often imbalances,Postural imbalance and as a consequence of a change in walking are the main problem of MS patients, which limits their daily activities and increases the risk of falling injuries.The aim of this study was to compare the changes in the center of pressure,reaction time and difference center of pressure with center of mass in gait initiation of20to40 years old women with MS in response to external disturbances.Methodology:10 MS patients and 10 healthy subjects participated in this study and the gait initiation Protocol go from standing to steady-state walking on two force plates.
Results:MS patients had the maximum distance between the center of pressure AP,more changes in the COP-COM diferent in AP and ML direction in feedforward phase,and more changes in COP-COM diferent in feedback phase start their walking.
Conclusion:According to research findings,it seems that the decrease in the center of pressure in both directions and the COP-COM diferent in the feed forward phase in MS patients can be a reason for the relationship between the gait initiation and falling due to reduced reaction time,decreased postural control or both.On the other hand,the increase in the difference between COP-COM diferent in the feedback phase can be considered as a reason for continuous control of the body center of mass within the stability boundary, which emphasizes the need for balance training in lower limbs of MS patients.


1-L. A. C. Nogueira, L. T. Dos Santos, P. G. Sabino, R. M. P. Alvarenga, and L. C. Santos Thuler, “Factors for lower walking speed in persons with multiple sclerosis.,” Mult. Scler. Int.. 2013: 1472-1478.
2-P. Barros and M. J. Sá, “Multiple Sclerosis Management of Motor Symptoms in Multiple Sclerosis,” 2013; 24–29.
3-C. Fjeldstad, G. Pardo, D. Bemben, and M. Bemben, “Decreased postural balance in multiple sclerosis patients with low disability Decreased postural balance in multiple sclerosis patients with low disability,” Int. J. Rehabil. Res. 2011 ; 34( 1): 53–58.
4-S. Coote, N. Hogan, and S. Franklin, “Falls in people with multiple sclerosis who use a walking aid: Prevalence, factors, and effect of strength and balance interventions,” Arch. Phys. Med. Rehabil. 2013; 94( 4): 616–621.
5-S. L. Kasser, J. V Jacobs, J. T. Foley, B. J. Cardinal, and G. F. Maddalozzo, “A Prospective Evaluation of Balance , Gait , and Strength to Predict Falling in Women With Multiple Sclerosis,” YAPMR. 2011;92( 11): 1840–1846,.
6-V. Cimolin, N. Cau, M. Galli, C. Santovito, G. Grugni, and P. Capodaglio, “Gait initiation and termination strategies in patients with Prader-Willi syndrome,” 2017: 1–8.
7-K. L. Roeing, D. A. Wajda, R. W. Motl, and J. J. Sosnoff, “Gait & Posture Gait termination in individuals with multiple sclerosis,” Gait Posture, 2015.
8-D. A. Wajda, Y. Moon, R. W. Motl, and J. J. Sosnoff, “Preliminary investigation of gait initiation and falls in multiple sclerosis,” Arch. Phys. Med. Rehabil. 2015;96( 6): 1098–1102.
9-A. Kalron, “Gait variability across the disability spectrum in people with multiple sclerosis,” J. Neurol. Sci. 2016;361:1–6.
10-J. G. Remelius, J. Hamill, J. Kent-Braun, and R. E. Van Emmerik, “Gait initiation in multiple sclerosis,” Motor Control. 2008;12( 2): 93–108.
11-S. R. Wurdeman, J. M. Huisinga, M. Filipi, and N. Stergiou, “Multiple sclerosis alters the mechanical work performed on the body’s center of mass during gait,” J. Appl. Biomech. 2013;29( 4): 435–442.
12-M. Galli, G. Coghe, P. Sanna, E. Cocco, M. Giovanna, and M. Pau, “Relationship between gait initiation and disability in individuals affected by multiple sclerosis,” Mult. Scler. Relat. Disord., 2015; 4( 6): 594–597.
13-D. A. Winter and L. Gilchrist, “Papers Trajectory of the body COG and COP during initiation and termination of gait,” Gait Posture.1993: 9–22.
14-J. G. Remelius, J. Hamill, J. Kent-braun, and R. E. A. Van Emmerik, “Gait Initiation in Multiple Sclerosis,” 2008: 93–99.
15-T. Caderby, E. Yiou, N. Peyrot, B. Bonazzi, and G. Dalleau, “Detection of swing heel-off event in gait initiation using force-plate data,” Gait Posture. 2013;37(3): 463–466.
16-S. Cameron, S. Urry, J. E. Smeathers, and D. Battistutta, “Technical note A comparison of gait initiation and termination methods for obtaining plantar foot pressures,” 1999; 10: 255–263.
17-R. Khanmohammadi, S. Talebian, M. R. Hadian, G. Olyaei, and H. Bagheri, “Preparatory postural adjustments during gait initiation in healthy younger and older adults: Neurophysiological and biomechanical aspects,” Brain Res. 2015;1629.
18-T. Caderby, E. Yiou, N. Peyrot, M. Begon, and G. Dalleau, “Influence of gait speed on the control of mediolateral dynamic stability during gait initiation,” J. Biomech.2014; 47( 2): 417–423.
19-B. C. Muir, S. Rietdyk, and J. M. Haddad, “Gait initiation: The first four steps in adults aged 20-25 years, 65-79 years, and 80-91 years,” Gait Posture. 2014;39( 1): 490–494.
20-J. M. Huisinga, K. K. Schmid, M. L. Filipi, and N. Stergiou, “Persons With Multiple Sclerosis Show Altered Joint Kinetics During Walking After Participating in Elliptical Exercise %U,” J. Appl. Biomech., 2011;26(2):207-212.
21-C. Massot, E. Simoneau-buessinger, O. Agnani, C. Donze, and S. Leteneur, “Gait & Posture Anticipatory postural adjustment during gait initiation in multiple sclerosis patients : A systematic review,” Gait Posture, 2019;73 : 180–188.
22-C. L. Martin et al., “Gait and balance impairment in early multiple sclerosis in the absence of clinical disability,” 2006; October :620–625.