Graduation Date

Spring 5-7-2016

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Max J. Kurz

Abstract

One main purpose was to explore the compensatory gait strategies of individuals with multiple sclerosis (MS). To address this purpose, we quantified the mechanical work generated by the lower extremity joints during walking. The outcomes from this investi­gation suggested that individuals with MS redistribute positive mechanical work during walking to the hip in order to compensate for a reduced ability of the ankle to generate positive mechanical work. Additionally, we also explored the motor control of the ankle as a potential contributing factor to the mobility limitations of individuals with MS. The outcomes from this investigation indicated that individuals with MS have reduced ankle control, which is related to the reductions in walking ability. These results suggest that poor ankle motor control may be a limiting factor to the mobility of individuals with MS.

Another main purpose was to evaluate whether novel physical therapy interven­tions could promote improvements in the postural control and mobility of individuals with MS. The first therapeutic intervention specifically targeted the ankle musculature with motor adaptation exercises. After completion of this program, our subjects with MS dis­played clinically relevant improvements in their postural balance and mobility as well as im­proved ankle motor control, which was related to the improved postural balance. The second therapeutic intervention sought to interrogate whether these improvements were influenced by the type of activities performed or the unusually high dosage at which they were performed. The outcomes from this investigation found that both types of therapeutic interventions promoted similar improvements in the balance and mobility of indi­viduals with MS. Moreover, the second therapeutic intervention promoted improve­ments in the control of trunk accelerations during walking. These results suggest that potentially the level of activity is more important than the type of activi­ties being per­formed to at­taining clinically relevant improvements. Altogether this dissertation provides novel in­formation about the compensatory gait strategies of individuals with MS and the influ­ence of therapeutic interventions upon these strategies. Both will be useful for the devel­opment of superior treatment options for these individuals.

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