{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T03:14:37Z","timestamp":1774149277972,"version":"3.50.1"},"reference-count":47,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,2,6]],"date-time":"2024-02-06T00:00:00Z","timestamp":1707177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000890","name":"National Multiple Sclerosis Society","doi-asserted-by":"publisher","award":["JF-1907-34355"],"award-info":[{"award-number":["JF-1907-34355"]}],"id":[{"id":"10.13039\/100000890","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Most people with multiple sclerosis (PwMS) experience significant gait asymmetries between their legs during walking, leading to an increased risk of falls. Split-belt treadmill training, where the speed of each limb is controlled independently, alters each leg\u2019s stepping pattern and can improve gait symmetry in PwMS. However, the biomechanical mechanisms of this adaptation in PwMS remain poorly understood. In this study, 32 PwMS underwent a 10 min split-belt treadmill adaptation paradigm with the more affected (MA) leg moving twice as fast as the less affected (LA) leg. The most noteworthy biomechanical adaptation observed was increased peak propulsion asymmetry between the limbs. A kinematic analysis revealed that peak dorsiflexion asymmetry and the onset of plantarflexion in the MA limb were the primary contributors to the observed increases in peak propulsion. In contrast, the joints in the LA limb underwent only immediate reactive adjustments without subsequent adaptation. These findings demonstrate that modulation during gait adaptation in PwMS occurs primarily via propulsive forces and joint motions that contribute to propulsive forces. Understanding these distinct biomechanical changes during adaptation enhances our grasp of the rehabilitative impact of split-belt treadmill training, providing insights for refining therapeutic interventions aimed at improving gait symmetry.<\/jats:p>","DOI":"10.3390\/s24041067","type":"journal-article","created":{"date-parts":[[2024,2,6]],"date-time":"2024-02-06T12:38:24Z","timestamp":1707223104000},"page":"1067","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Propulsive Force Modulation Drives Split-Belt Treadmill Adaptation in People with Multiple Sclerosis"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0935-2649","authenticated-orcid":false,"given":"Andrew C.","family":"Hagen","sequence":"first","affiliation":[{"name":"Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523-1582, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8830-1892","authenticated-orcid":false,"given":"Christopher M.","family":"Patrick","sequence":"additional","affiliation":[{"name":"Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523-1582, USA"},{"name":"Molecular, Cellular and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO 80523-1617, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isaac E.","family":"Bast","sequence":"additional","affiliation":[{"name":"Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523-1582, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1815-3681","authenticated-orcid":false,"given":"Brett W.","family":"Fling","sequence":"additional","affiliation":[{"name":"Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523-1582, USA"},{"name":"Molecular, Cellular and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO 80523-1617, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"104103","DOI":"10.1016\/j.msard.2022.104103","article-title":"The Age at Onset of Relapsing-Remitting Multiple Sclerosis Has Increased over the Last Five Decades","volume":"68","author":"Bau","year":"2022","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"146","DOI":"10.7224\/1537-2073.2012-053","article-title":"Natural History of Multiple Sclerosis Symptoms","volume":"15","author":"Kister","year":"2013","journal-title":"Int. J. MS Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.apmr.2007.10.043","article-title":"Injurious Falls among Middle Aged and Older Adults with Multiple Sclerosis","volume":"89","author":"Peterson","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1177\/1352458508088916","article-title":"Patient Perception of Bodily Functions in Multiple Sclerosis: Gait and Visual Function Are the Most Valuable","volume":"14","author":"Heesen","year":"2008","journal-title":"Mult. Scler."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1123\/jab.2012-0208","article-title":"The Relationship Between Spatiotemporal Gait Asymmetry and Balance in Individuals with Chronic Stroke","volume":"30","author":"Lewek","year":"2014","journal-title":"J. Appl. Biomech."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2883","DOI":"10.1523\/JNEUROSCI.5359-07.2008","article-title":"Motor Adaptation as a Process of Reoptimization","volume":"28","author":"Izawa","year":"2008","journal-title":"J. Neurosci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1097\/WCO.0b013e328315a293","article-title":"Understanding Sensorimotor Adaptation and Learning for Rehabilitation","volume":"21","author":"Bastian","year":"2008","journal-title":"Curr. Opin. Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1016\/j.pmr.2015.06.010","article-title":"The Split-Belt Walking Paradigm: Exploring Motor Learning and Spatiotemporal Asymmetry Poststroke","volume":"26","author":"Helm","year":"2015","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/B978-0-444-53752-2.00013-8","article-title":"Locomotor Adaptation","volume":"191","author":"Vasudevan","year":"2011","journal-title":"Prog. Brain Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2403","DOI":"10.1152\/jn.00089.2005","article-title":"Interlimb Coordination during Locomotion: What Can Be Adapted and Stored?","volume":"94","author":"Reisman","year":"2005","journal-title":"J. Neurophysiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.conb.2006.08.016","article-title":"Learning to Predict the Future: The Cerebellum Adapts Feedforward Movement Control","volume":"16","author":"Bastian","year":"2006","journal-title":"Curr. Opin. Neurobiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1177\/1545968313505912","article-title":"Spatial and Temporal Asymmetries in Gait Predict Split-Belt Adaptation Behavior in Stroke","volume":"28","author":"Malone","year":"2014","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1177\/15459683211011226","article-title":"The Effect of Split-Belt Treadmill Interventions on Step Length Asymmetry in Individuals Poststroke: A Systematic Review with Meta-Analysis","volume":"35","author":"Dzewaltowski","year":"2021","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.gaitpost.2019.01.032","article-title":"Split-Belt Treadmill Walking in Patients with Parkinson\u2019s Disease: A Systematic Review","volume":"69","author":"Seuthe","year":"2019","journal-title":"Gait Posture"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.neuroscience.2013.01.038","article-title":"Split-Belt Locomotion in Parkinson\u2019s Disease with and without Freezing of Gait","volume":"236","author":"Snijders","year":"2013","journal-title":"Neuroscience"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Hagen, A.C., Acosta, J.S., Geltser, C.S., and Fling, B.W. (2023). Split-Belt Treadmill Adaptation Improves Spatial and Temporal Gait Symmetry in People with Multiple Sclerosis. Sensors, 23.","DOI":"10.3390\/s23125456"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1177\/1545968312474118","article-title":"Repeated Split-Belt Treadmill Training Improves Poststroke Step Length Asymmetry","volume":"27","author":"Reisman","year":"2013","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.3109\/09638280903464497","article-title":"The Characterisation of Gait Patterns of People with Multiple Sclerosis","volume":"32","author":"Kelleher","year":"2010","journal-title":"Disabil. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1177\/1352458516658137","article-title":"The Use of Laboratory Gait Analysis for Understanding Gait Deterioration in People with Multiple Sclerosis","volume":"22","author":"Khan","year":"2016","journal-title":"Mult. Scler."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1093\/brain\/awm035","article-title":"Locomotor Adaptation on a Split-Belt Treadmill Can Improve Walking Symmetry Post-Stroke","volume":"130","author":"Reisman","year":"2007","journal-title":"Brain"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/0141-1195(86)90098-7","article-title":"A Fortran Package for Generalized, Cross-Validatory Spline Smoothing and Differentiation","volume":"8","author":"Woltring","year":"1986","journal-title":"Adv. Eng. Softw. (1978)"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1152\/jn.00323.2021","article-title":"Joint-Level Coordination Patterns for Split-Belt Walking across Different Speed Ratios","volume":"129","author":"Kambic","year":"2023","journal-title":"J. Neurophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.gaitpost.2017.02.006","article-title":"Gait Ground Reaction Force Characteristics in Deaf and Hearing Children","volume":"53","author":"Jafarnezhadgero","year":"2017","journal-title":"Gait Posture"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1177\/1352458516680749","article-title":"Identification and Validation of Clinically Meaningful Benchmarks in the 12-Item Multiple Sclerosis Walking Scale","volume":"23","author":"Goldman","year":"2017","journal-title":"Mult. Scler."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2342","DOI":"10.1016\/j.apmr.2013.07.011","article-title":"Objectively Quantified Physical Activity in Persons with Multiple Sclerosis","volume":"94","author":"Klaren","year":"2013","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1123\/jab.29.3.303","article-title":"Gait Mechanics Are Different Between Healthy Controls and Patients with Multiple Sclerosis","volume":"29","author":"Huisinga","year":"2013","journal-title":"J. Appl. Biomech."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.clinbiomech.2009.04.004","article-title":"During Walking Elders Increase Efforts at Proximal Joints and Keep Low Kinetics at the Ankle","volume":"24","author":"Monaco","year":"2009","journal-title":"Clin. Biomech."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"668","DOI":"10.3389\/fneur.2020.00668","article-title":"Improved Gait of Persons with Multiple Sclerosis After Rehabilitation: Effects on Lower Limb Muscle Synergies, Push-Off, and Toe-Clearance","volume":"11","author":"Jonsdottir","year":"2020","journal-title":"Front. Neurol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"60","DOI":"10.3389\/fphys.2019.00060","article-title":"Large Propulsion Demands Increase Locomotor Adaptation at the Expense of Step Length Symmetry","volume":"10","author":"Sombric","year":"2019","journal-title":"Front. Physiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s12984-020-00698-y","article-title":"Augmenting Propulsion Demands during Split-Belt Walking Increases Locomotor Adaptation of Asymmetric Step Lengths","volume":"17","author":"Sombric","year":"2020","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1214967","DOI":"10.3389\/fnhum.2023.1214967","article-title":"Effects of Backward-Directed Resistance on Propulsive Force Generation during Split-Belt Treadmill Walking in Non-Impaired Individuals","volume":"17","author":"Moradian","year":"2023","journal-title":"Front. Hum. Neurosci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"5673","DOI":"10.1113\/JP271996","article-title":"Error Signals Driving Locomotor Adaptation: Cutaneous Feedback from the Foot Is Used to Adapt Movement during Perturbed Walking","volume":"594","author":"Choi","year":"2016","journal-title":"J. Physiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1097\/JES.0b013e31819c2df6","article-title":"It Pays to Have a Spring in Your Step","volume":"37","author":"Sawicki","year":"2009","journal-title":"Exerc. Sport Sci. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2454","DOI":"10.1080\/09638288.2019.1702726","article-title":"Ankle Dysfunction in Multiple Sclerosis and the Effects on Walking","volume":"43","author":"Massot","year":"2021","journal-title":"Disabil. Rehabil."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/j.1748-1716.1980.tb06534.x","article-title":"The Locomotion of the Low Spinal Cat. II. Interlimb Coordination","volume":"108","author":"Forssberg","year":"1980","journal-title":"Acta Physiol. Scand."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"9107","DOI":"10.1523\/JNEUROSCI.2622-06.2006","article-title":"Cerebellar Contributions to Locomotor Adaptations during Splitbelt Treadmill Walking","volume":"26","author":"Morton","year":"2006","journal-title":"J. Neurosci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1093\/brain\/awn333","article-title":"Walking Flexibility after Hemispherectomy: Split-Belt Treadmill Adaptation and Feedback Control","volume":"132","author":"Choi","year":"2009","journal-title":"Brain"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1007\/s12311-020-01116-8","article-title":"Locomotor Adaptation Is Associated with Microstructural Properties of the Inferior Cerebellar Peduncle","volume":"19","author":"Jossinger","year":"2020","journal-title":"Cerebellum"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s12311-020-01190-y","article-title":"White Matter Microstructure of the Cerebellar Peduncles Is Associated with Balance Performance during Sensory Re-Weighting in People with Multiple Sclerosis","volume":"20","author":"Odom","year":"2021","journal-title":"Cerebellum"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1177\/135245859900500307","article-title":"Sensory Symptoms of Multiple Sclerosis: A Hidden Reservoir of Morbidity","volume":"5","author":"Eckert","year":"1999","journal-title":"Mult. Scler."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1177\/10738584211013723","article-title":"Neural Control of Human Locomotor Adaptation: Lessons about Changes with Aging","volume":"28","author":"Sato","year":"2022","journal-title":"Neuroscientist"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.gaitpost.2010.11.019","article-title":"Combined Effects of Fast Treadmill Walking and Functional Electrical Stimulation on Post-Stroke Gait","volume":"33","author":"Kesar","year":"2011","journal-title":"Gait Posture"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/j.apmr.2013.12.012","article-title":"Targeting Paretic Propulsion to Improve Poststroke Walking Function: A Preliminary Study","volume":"95","author":"Awad","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1093\/cercor\/bhq263","article-title":"Human Locomotor Adaptive Learning Is Proportional to Depression of Cerebellar Excitability","volume":"21","author":"Jayaram","year":"2011","journal-title":"Cerebral Cortex"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.nicl.2015.04.023","article-title":"Functional Connectivity Underlying Postural Motor Adaptation in People with Multiple Sclerosis","volume":"8","author":"Fling","year":"2015","journal-title":"Neuroimage Clin."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.conb.2005.03.004","article-title":"Reorganization and Plasticity in the Adult Brain during Learning of Motor Skills","volume":"15","author":"Doyon","year":"2005","journal-title":"Curr. Opin. Neurobiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1016\/j.apmr.2021.12.010","article-title":"Cerebellar Contributions to Motor and Cognitive Control in Multiple Sclerosis\u2730\u2730\u2730","volume":"103","author":"Fritz","year":"2022","journal-title":"Arch. Phys. Med. Rehabil."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/4\/1067\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:56:04Z","timestamp":1760104564000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/4\/1067"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,6]]},"references-count":47,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["s24041067"],"URL":"https:\/\/doi.org\/10.3390\/s24041067","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,6]]}}}