{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T17:59:28Z","timestamp":1770746368936,"version":"3.49.0"},"reference-count":33,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2022,8,9]],"date-time":"2022-08-09T00:00:00Z","timestamp":1660003200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institutes of Health grants from the National Institute on Aging","award":["#R44AG055388"],"award-info":[{"award-number":["#R44AG055388"]}]},{"name":"National Institutes of Health grants from the National Institute on Aging","award":["#R43AG044863"],"award-info":[{"award-number":["#R43AG044863"]}]},{"name":"National Institutes of Health grants from the National Institute on Aging","award":["# W81XWH-18-1-0425"],"award-info":[{"award-number":["# W81XWH-18-1-0425"]}]},{"DOI":"10.13039\/100000005","name":"Department of Defense","doi-asserted-by":"publisher","award":["#R44AG055388"],"award-info":[{"award-number":["#R44AG055388"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"Department of Defense","doi-asserted-by":"publisher","award":["#R43AG044863"],"award-info":[{"award-number":["#R43AG044863"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"Department of Defense","doi-asserted-by":"publisher","award":["# W81XWH-18-1-0425"],"award-info":[{"award-number":["# W81XWH-18-1-0425"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>This study investigates the potential of passive monitoring of gait and turning in daily life in people with multiple sclerosis (PwMS) to identify those at future risk of falls. Seven days of passive monitoring of gait and turning were carried out in a pilot study of 26 PwMS in home settings using wearable inertial sensors. The retrospective fall history was collected at the baseline. After gait and turning data collection in daily life, PwMS were followed biweekly for a year and were classified as fallers if they experienced &gt;1 fall. The ability of short-term passive monitoring of gait and turning, as well as retrospective fall history to predict future falls were compared using receiver operator curves and regression analysis. The history of retrospective falls was not identified as a significant predictor of future falls in this cohort (AUC = 0.62, p = 0.32). Among quantitative monitoring measures of gait and turning, the pitch at toe-off was the best predictor of falls (AUC = 0.86, p &lt; 0.01). Fallers had a smaller pitch of their feet at toe-off, reflecting less plantarflexion during the push-off phase of walking, which can impact forward propulsion and swing initiation and can result in poor foot clearance and an increased metabolic cost of walking. In conclusion, our cohort of PwMS showed that objective monitoring of gait and turning in daily life can identify those at future risk of falls, and the pitch at toe-off was the single most influential predictor of future falls. Therefore, interventions aimed at improving the strength of plantarflexion muscles, range of motion, and increased proprioceptive input may benefit PwMS at future fall risk.<\/jats:p>","DOI":"10.3390\/s22165940","type":"journal-article","created":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T04:20:32Z","timestamp":1660105232000},"page":"5940","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Fall Prediction Based on Instrumented Measures of Gait and Turning in Daily Life in People with Multiple Sclerosis"],"prefix":"10.3390","volume":"22","author":[{"given":"Ishu","family":"Arpan","sequence":"first","affiliation":[{"name":"Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA"},{"name":"Advanced Imaging Research Center, Oregon Health & Science University Portland, OR 97239, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8626-1089","authenticated-orcid":false,"given":"Vrutangkumar V.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA"},{"name":"APDM Wearable Technologies-A Clario Company, 2828 S Corbett Ave, Ste 135, Portland, OR 97201, USA"}]},{"given":"James","family":"McNames","sequence":"additional","affiliation":[{"name":"APDM Wearable Technologies-A Clario Company, 2828 S Corbett Ave, Ste 135, Portland, OR 97201, USA"},{"name":"Department of Electrical and Computer Engineering, Portland State University, 1825 SW Broadway, Portland, OR 97201, USA"}]},{"given":"Graham","family":"Harker","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5794-4155","authenticated-orcid":false,"given":"Patricia","family":"Carlson-Kuhta","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA"}]},{"given":"Rebecca","family":"Spain","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA"}]},{"given":"Mahmoud","family":"El-Gohary","sequence":"additional","affiliation":[{"name":"APDM Wearable Technologies-A Clario Company, 2828 S Corbett Ave, Ste 135, Portland, OR 97201, USA"}]},{"given":"Martina","family":"Mancini","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7704-5459","authenticated-orcid":false,"given":"Fay B.","family":"Horak","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA"},{"name":"APDM Wearable Technologies-A Clario Company, 2828 S Corbett Ave, Ste 135, Portland, OR 97201, USA"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.neuron.2006.09.011","article-title":"The neurobiology of multiple sclerosis: Genes, inflammation, and neurodegeneration","volume":"52","author":"Hauser","year":"2006","journal-title":"Neuron"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1146\/annurev.neuro.30.051606.094313","article-title":"Multiple sclerosis: An immune or neurodegenerative disorder?","volume":"31","author":"Trapp","year":"2008","journal-title":"Annu. Rev. Neurosci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1177\/1352458514538884","article-title":"Falls in people with MS\u2014An individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States","volume":"21","author":"Gunn","year":"2015","journal-title":"Mult. Scler. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1177\/0269215508095087","article-title":"Predicting accidental falls in people with multiple sclerosis\u2014A longitudinal study","volume":"23","author":"Lundholm","year":"2009","journal-title":"Clin. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1177\/0269215517748714","article-title":"The ability of clinical balance measures to identify falls risk in multiple sclerosis: A systematic review and meta-analysis","volume":"32","author":"Quinn","year":"2018","journal-title":"Clin. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.msard.2018.01.027","article-title":"Predicting falls in multiple sclerosis: Do electrophysiological measures have a better predictive accuracy compared to clinical measures?","volume":"20","author":"Chinnadurai","year":"2018","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sosnoff, J.J., Socie, M.J., Boes, M.K., Sandroff, B.M., Pula, J.H., Suh, Y., Weikert, M., Balantrapu, S., Morrison, S., and Motl, R.W. (2011). Mobility, balance and falls in persons with multiple sclerosis. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0028021"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"504","DOI":"10.2522\/ptj.20120231","article-title":"Identification of risk factors for falls in multiple sclerosis: A systematic review and meta-analysis","volume":"93","author":"Gunn","year":"2013","journal-title":"Phys. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/j.apmr.2012.11.027","article-title":"Fall attributions among middle-aged and older adults with multiple sclerosis","volume":"94","author":"Peterson","year":"2013","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Mazumder, R., Murchison, C., Bourdette, D., and Cameron, M. (2014). Falls in people with multiple sclerosis compared with falls in healthy controls. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0107620"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.gaitpost.2011.11.026","article-title":"Body-worn motion sensors detect balance and gait deficits in people with multiple sclerosis who have normal walking speed","volume":"35","author":"Spain","year":"2012","journal-title":"Gait Posture"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1212\/CPJ.0000000000000382","article-title":"Wearable biosensors to monitor disability in multiple sclerosis","volume":"7","author":"Bradshaw","year":"2017","journal-title":"Neurol. Clin. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1159\/000369095","article-title":"Wearable sensor-based in-home assessment of gait, balance, and physical activity for discrimination of frailty status: Baseline results of the Arizona frailty cohort study","volume":"61","author":"Schwenk","year":"2015","journal-title":"Gerontology"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bernhard, F.P., Sartor, J., Bettecken, K., Hobert, M.A., Arnold, C., Weber, Y.G., Poli, S., Margraf, N.G., Schlenstedt, C., and Hansen, C. (2018). Wearables for gait and balance assessment in the neurological ward-study design and first results of a prospective cross-sectional feasibility study with 384 inpatients. BMC Neurol., 18.","DOI":"10.1186\/s12883-018-1111-7"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.2196\/mhealth.8815","article-title":"Smartphone App-Based Assessment of Gait During Normal and Dual-Task Walking: Demonstration of Validity and Reliability","volume":"6","author":"Manor","year":"2018","journal-title":"JMIR mHealth uHealth"},{"key":"ref_16","first-page":"1","article-title":"Sensor-based gait analyses of the six-minute walk test identify qualitative improvement in gait parameters of people with multiple sclerosis after rehabilitation","volume":"269","author":"Moen","year":"2022","journal-title":"J. Neurol."},{"key":"ref_17","first-page":"496325","article-title":"Predicting falls in people with multiple sclerosis: Fall history is as accurate as more complex measures","volume":"2013","author":"Cameron","year":"2013","journal-title":"Mult. Scler. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1186\/s12984-020-00781-4","article-title":"Laboratory versus daily life gait characteristics in patients with multiple sclerosis, Parkinson\u2019s disease, and matched controls","volume":"17","author":"Shah","year":"2020","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.gaitpost.2020.11.024","article-title":"Does gait bout definition influence the ability to discriminate gait quality between people with and without multiple sclerosis during daily life?","volume":"84","author":"Shah","year":"2021","journal-title":"Gait Posture"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"356","DOI":"10.3390\/s140100356","article-title":"Continuous monitoring of turning in patients with movement disability","volume":"14","author":"Pearson","year":"2013","journal-title":"Sensors"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1007\/s00415-020-09696-5","article-title":"Quantity and quality of gait and turning in people with multiple sclerosis, Parkinson\u2019s disease and matched controls during daily living","volume":"267","author":"Shah","year":"2020","journal-title":"J. Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"805","DOI":"10.2147\/IJGM.S32651","article-title":"Analyzing the problem of falls among older people","volume":"5","author":"Dionyssiotis","year":"2012","journal-title":"Int. J. Gen. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1093\/geront\/46.3.367","article-title":"Defining a fall and reasons for falling: Comparisons among the views of seniors, health care providers, and the research literature","volume":"46","author":"Zecevic","year":"2006","journal-title":"Gerontologist"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1007\/s11910-021-01101-6","article-title":"Digital Technology in Movement Disorders: Updates, Applications, and Challenges","volume":"21","author":"Adams","year":"2021","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"216","DOI":"10.3389\/fneur.2018.00216","article-title":"Editorial: New Advanced Wireless Technologies for Objective Monitoring of Motor Symptoms in Parkinson\u2019s Disease","volume":"9","author":"Irrera","year":"2018","journal-title":"Front. Neurol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"22473","DOI":"10.1038\/s41598-021-01694-5","article-title":"The mechanisms and mechanical energy of human gait initiation from the lower-limb joint level perspective","volume":"11","author":"Zhao","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_27","first-page":"3541","article-title":"Mechanical and energetic consequences of reduced ankle plantar-flexion in human walking","volume":"218","author":"Huang","year":"2015","journal-title":"J. Exp. Biol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ong, C.F., Geijtenbeek, T., Hicks, J.L., and Delp, S.L. (2019). Predicting gait adaptations due to ankle plantarflexor muscle weakness and contracture using physics-based musculoskeletal simulations. PLoS Comput. Biol., 15.","DOI":"10.1101\/597294"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e1743","DOI":"10.1002\/pri.1743","article-title":"Associations between gait speed and well-known fall risk factors among community-dwelling older adults","volume":"24","author":"Kyrdalen","year":"2019","journal-title":"Physiother. Res. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1002\/lio2.252","article-title":"Balance and gait in the elderly: A contemporary review","volume":"4","author":"Osoba","year":"2019","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"427","DOI":"10.3233\/THC-174736","article-title":"Comparison of gait patterns in elderly fallers and non-fallers","volume":"26","author":"Kwon","year":"2018","journal-title":"Technol. Health Care"},{"key":"ref_32","first-page":"677","article-title":"Are the spatio-temporal parameters of gait capable of distinguishing a faller from a non-faller elderly?","volume":"50","author":"Mortaza","year":"2014","journal-title":"Eur. J. Phys.Rehabil. Med."},{"key":"ref_33","first-page":"3040","article-title":"The Impact Of Freezing Of Gait On Balance Perception And Mobility In Community-Living With Parkinson\u2019S Disease","volume":"2018","author":"Mancini","year":"2018","journal-title":"Annu. Int. Conf. IEEE Eng. Med. Biol. Soc."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/22\/16\/5940\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:06:10Z","timestamp":1760141170000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/22\/16\/5940"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,9]]},"references-count":33,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["s22165940"],"URL":"https:\/\/doi.org\/10.3390\/s22165940","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,9]]}}}