Bladder function and falls in individuals with multiple sclerosis

Purpose: To examine the association between bladder function and falls while controlling for mobility in individuals with multiple sclerosis (MS).

Methods: A total of 92 ambulatory individuals with MS (mean age?±?SD?=?59.1?±?7.3 years, female n?=?69) were divided into two groups based on self-reported bladder function (none-mild n?=?43 versus moderate-severe n?=?49). The main outcome measure was a number of self-reported falls in the previous 3 months. Participants’ demographic information (age, type of MS, gender, use of the assistive device) was also collected. The balance was quantified with the Berg balance scale, and walking speed was indexed with the timed 25-foot walk test. Negative binomial regression analysis was used to examine the association between bladder function and falls in individuals with MS while controlling for balance and walking.

Results: The median number of self-reported falls in the previous 3 months was 2 (interquartile range, 0–4). The severe bladder dysfunction group was more likely (incidence rate ratio?=?1.84) to have a greater number of self-reported falls compared to mild bladder dysfunction group when balance and walking were taken into account.

Conclusion: Bladder dysfunction is related to falls history independently of mobility in individuals with MS. Future research examining whether bladder management programmes have an impact on fall incidence in MS is warranted.

• Implications for rehabilitation

• Bladder dysfunction and falls are common health concerns in individuals with multiple sclerosis.

• Bladder dysfunction was associated with the number of falls in individuals with MS, and this association was independent of mobility.

• Bladder management should be included in fall prevention strategies in individuals with MS.

     

2nd International Symposium on Gait and Balance in Multiple Sclerosis: interventions for gait and balance in MS

Abstract

Purpose: To provide a review of the 2nd International Symposium on Gait and Balance in Multiple Sclerosis (MS), emphasizing interventions in gait and balance for people with MS. Method: Review of current research on interventions used with people having MS and with people having other disorders that may provide novel insights into improving gait and balance and preventing falls in people with MS (pwMS). Results: Nine speakers provided evidence-based recommendations for interventions aimed at improving gait and balance dysfunction. Speaker recommendations covered the following areas: balance rehabilitation, self-management, medications, functional electrical stimulation, robotics, sensory augmentation, gait training with error feedback and fall prevention. Conclusions: The causes of gait and balance dysfunction in pwMS are multifactorial and therefore may benefit from a wide range of interventions. The symposium provides avenues for exchange of evidence and clinical experience that is critical in furthering physical rehabilitation including gait and balance dysfunction in MS.

• Implications for Rehabilitation

• Approaches to improve Gait and Balance dysfunction in Multiple Sclerosis.

• Balance exercises that include training of sensory strategies.

• Self-management and self-management support.

• Pharmacologic intervention, such as Dalfampradine.

• Functional electrical stimulation that may provide the extra stimulation to influence coordinated leg movements needed for walking.

     

The development of an observational screening tool to assess safe,effective and appropriate walking aid use in people with multiple sclerosis

Purpose: The purpose of this study was to identify potential items for an observational screening tool to assess safe, effective and appropriate walking aid use among people with multiple sclerosis (MS). Such a tool is needed because of the association between fall risk and mobility aid use in this population.

Methods: Four individuals with MS were videotaped using a one or two straight canes, crutches or a rollator in different settings. Seventeen health care professionals from Canada, Ireland and the United States were recruited, and viewed the videos, and were then interviewed about the use of the devices by the individuals in the videos. Interview questions addressed safety, effectiveness and appropriateness of the device in the setting. Data were analyzed qualitatively. Coding consistency across raters was evaluated and confirmed.

Results: Nineteen codes were identified as possible items for the screening tool. The most frequent issues raised regardless of setting and device were “device used for duration/abandoned”, “appropriate device”, “balance and stability”, “device technique”, “environmental modification” and “hands free.”

Conclusion: With the identification of a number of potential tool items, researchers can now move forward with the development of the tool. This will involve consultation with both healthcare professionals and people with MS.

• Implications for rehabilitation

• Falls among people with multiple sclerosis are associated with mobility device use and use of multiple devices is associated with greater falls risk.

• The ability to assess for safe, effective and efficient use of walking aids is therefore important, no tools currently exist for this purpose.

• The codes arising from this study will be used to develop a screening tool for safe, effective and efficient walking aid use with the aim of reducing falls risk.

     

Effects of line dancing on physical function and perceived limitation in older adults with self-reported mobility limitations

Introduction: Older adults with mobility limitations are at greater risk for aging-related declines in physical function. Line dancing is a popular form of exercise that can be modified, and is thus feasible for older adults with mobility limitations.

Purpose: The purpose of this study was to assess the effects of 8 weeks of line dancing on balance, muscle strength, lower extremity function, endurance, gait speed, and perceived mobility limitations.

Methods: An experimental design randomly assigned older adults to either an 8-week line dancing or usual care group. The convenience sample consisted of 23 participants with mobility limitations (age range: 65–93?years). The intervention used simple routines from novice line dance classes. At baseline and at 8 weeks, balance, knee muscle strength, lower extremity function, endurance, gait speed, and mobility limitations were measured. ANCOVA tests were conducted on each dependent variable to assess the effects of the intervention over time.

Results: Results found significant positive differences for the intervention group in lower extremity function (p?p?p?p?Conclusions: Eight weeks of line dancing significantly improved physical function and reduced self-reported mobility limitations in these individuals. Line dancing could be recommended by clinicians as a potential adjunct therapy that addresses mobility limitations.

• Implications for Rehabilitation

• Line dancing may be an alternative exercise for older adults who need modifications due to mobility limitations.

• Line dancing incorporates cognitive and motor control.

• Line dancing can be performed alone or in a group setting.

• Dancing improves balance which can reduce risk of falls.

     

A simple test of choice stepping reaction time for assessing fall risk in people with multiple sclerosis

Purpose To determine (a) the discriminant validity for established fall risk factors and (b) the predictive validity for falls of a simple test of choice stepping reaction time (CSRT) in people with multiple sclerosis (MS). Method People with MS (n?=?210, 21–74y) performed the CSRT, sensorimotor, balance and neuropsychological tests in a single session. They were then followed up for falls using monthly fall diaries for 6 months. Results The CSRT test had excellent discriminant validity with respect to established fall risk factors. Frequent fallers (≥3 falls) performed significantly worse in the CSRT test than non-frequent fallers (0–2 falls). With the odds of suffering frequent falls increasing 69% with each SD increase in CSRT (OR?=?1.69, 95% CI: 1.27–2.26, p?=?<0.001). In regression analysis, CSRT was best explained by sway, time to complete the 9-Hole Peg test, knee extension strength of the weaker leg, proprioception and the time to complete the Trails B test (multiple R² = ^?0.449, p?Conclusions A simple low tech CSRT test has excellent discriminative and predictive validity in relation to falls in people with MS. This test may prove useful in documenting longitudinal changes in fall risk in relation to MS disease progression and effects of interventions.

• Implications for rehabilitation

• Good choice stepping reaction time (CSRT) is required for maintaining balance.

• A simple low-tech CSRT test has excellent discriminative and predictive validity in relation to falls in people with MS.

• This test may prove useful documenting longitudinal changes in fall risk in relation to MS disease progression and effects of interventions

     

Pilates for people with multiple sclerosis who use a wheelchair: feasibility,efficacy and participant experiences

Abstract

Purpose: This mixed methods study aimed to explore the feasibility, efficacy and the participants’ experiences of a Pilates programme for people with Multiple Sclerosis (pwMS) who use a wheelchair. Method: Fifteen pwMS took part in the 12-week Pilates programme. At baseline and after 6 and 12 weeks of the programme, sitting stability, measured as maximum progression of the Centre of Pressure when leaning sideways (COPmax), posture, pain on a Visual Analogue Scale, function, fatigue and the impact of MS (MSIS29) were assessed. Ten participants took part in two focus groups within six weeks of the completion of the programme. Results: Significant improvements at the 12-week assessment were found in COPmax (p?=?0.046), sitting posture (p?=?0.004), pain in the shoulders (p?=?0.005) and back (p?=?0.005) and MSIS29 (p?=?0.006). The majority of participants described various physical, functional, psychological and social benefits from participation that reflected increased confidence in activities of daily living. Enjoyment of the classes was expressed by all, and most wished to continue participation. Conclusions: Pilates appears to be efficacious in improving sitting stability and posture and decreasing pain and was also well tolerated by wheelchair users with MS. Further mixed methods studies are warranted.

• Implications for Rehabilitation

• Group-based core stability exercise or Pilates for people with MS who use wheelchair is a feasible and safe way of exercising for this patient group.

• Pilates exercises for people moderately to severely affected by MS resulted in a decrease in back and shoulder pain and improvement in sitting balance.

• Future appropriately powered randomised controlled studies into Pilates for people with MS reliant on wheelchair are warranted.

     

Falls prevention and balance rehabilitation in multiple sclerosis: a bi-centre randomised controlled trial

Purpose: People with Multiple Sclerosis (PwMS) have a high incidence of accidental falls that have a potentially detrimental effect on their daily life participation. The effect of balance specific rehabilitation on clinical balance measures and frequency of falls in PwMS was studied.

Method: A bi-centre randomised rater-blinded controlled trial. Participants in both groups received 20 treatment sessions. Participants in the intervention group received treatment aimed at improving balance and mobility. Participants in the control group received treatments to reduce limitations at activity and body function level.

Primary measures were frequency of fallers (>1 fall in two months) and responders (>3 points improvement) at the Berg Balance Scale (BBS). Data was analysed according to an intention to treat approach.

Results: One hundred and nineteen participants were randomised. Following treatment frequency of fallers was 22% in the intervention group and 23% in the control group, odds ratio (OR) and (confidence limits): 1.05 (0.41 to 2.77). Responders on the BBS were 28% in the intervention group and 33% in the control group, OR?=?0.75 (0.30 to 1.91). At follow up ORs for fallers and responders at BBS were 0.98 (0.48 to 2.01) and 0.79 (0.26 to 2.42), respectively.

Conclusions: Twenty sessions 2–3 times/week of balance specific rehabilitation did not reduce fall frequency nor improve balance suggesting the need for more frequent and challenging interventions.

• Implications for Rehabilitation

• Programs for balance rehabilitation can improve balance but their effects in fall prevention are unclear.

• Twenty treatments sessions 2/3 times per week did not reduced frequency of falls in MS.

• The comparison with similar studies suggests that higher intensity of practice of highly challenging balance activities appears to be critical to maximizing effectiveness.

     

Patient-centered mobility outcome preferences according to individuals with stroke and caregivers: a qualitative analysis

Purpose: To explore the mobility-related preferences among stroke survivors and caregivers following post-acute rehabilitation at inpatient or skilled nursing facilities.

Methods: In this cross-sectional study; semi-structured, qualitative interviews of stroke survivors (n?=?24) and informal caregivers (n?=?15) were conducted. The participants were recruited from the community.

Results: Comparative content analysis was used to identify themes by two independent coders. The survivors (68 years) and caregivers (58 years) mentioned mobility-related consequences including inability to walk, balance, drive, and transfer; and increased falls. The survivors (63%) and caregivers (73%) also mentioned the use of assistive devices. The common rehabilitation activities included: walking (62%); followed by standing and mobility; strength and balance; and wheelchair skills. Some stroke survivors were dissatisfied as their rehabilitation was not patient-centered. Frequently mentioned outcome preferences by survivors were ability to walk (88%), move, and balance. They also wanted to acquire assistive devices to move independently. Caregivers were concerned with the survivor’s safety and wanted them to drive (53%), prevent falls, have home accommodations, and transfer independently. Caregivers (40%) also expressed the importance of receiving realistic information.

Conclusions: This study suggests a need to consider the stroke survivors’ and caregivers’ mobility outcome preferences to improve the patient-centered rehabilitation care.

• Implications for Rehabilitation

• Stroke survivors and caregivers tend to differ in their outcome preferences.

• Caregivers expressed concern for transfers, driving, fall prevention, home modifications, and wished for realistic information.

• Incorporating stroke survivors and their families’ perspectives during rehabilitation may enhance patient-centered outcomes.

     

Maximizing gait and balance: behaviors and decision-making processes of persons with multiple sclerosis and physical therapists

Purpose: To describe the behavioral decisions used by persons with multiple sclerosis (MS) and physical therapists to maximize gait and balance following outpatient physical therapy.

Methods: A multi-method case series with seven matched pairs (persons with MS–physical therapists). Quota sampling maximized variability among persons with MS (disease steps score range 3–6). Three of the four physical therapists were MS or neurology certified. Persons with MS completed a phone survey, follow-up interview, and standardized questionnaires. Physical therapists completed an interview. Data were collected 2–8 weeks following discharge. Content and constant comparison analyses were used for thematic development and triangulation.

Results: Core themes arose exemplifying the decision-making processes and actions of persons with MS (challenging self by pushing but respecting limits) and physical therapists (finding the right fit). One overarching theme, keeping their lived world large, or participation in valued life roles, emerged integrating both perspectives driving decision-making.

Conclusions: Participants have a shared goal of maximizing gait and balance so persons with MS can participate in valued life roles. Understanding the differences in the behavioral decisions and optimizing skill sets in shared decision-making and self-management may enhance the therapeutic partnership and engagement in gait- and balance-enhancing behaviors.

• Implications for Rehabilitation

• Persons with MS and physical therapists have a shared goal of maximizing gait and balance so persons with MS can participate in valued activities and life roles, or more poetically, keep their lived world large.

• Knowledge that persons with MS aim to challenge themselves by pushing but respecting limits can provide physical therapists with greater insight in helping persons with MS resolve uncertainty, set meaningful goals, and build the routines and resilience needed for engagement in gait- and balance-enhancing behaviors.

• Enriching skill sets in shared decision-making, behavior change and self-management may optimize the physical therapist toolbox.

     

Therapists’ perspectives on adapting the Stepping On falls prevention programme for community-dwelling stroke survivors in Singapore

Abstract

Purpose: This study investigates the perspectives of rehabilitation therapists on the implementation of fall prevention programmes with community-dwelling stroke survivors in the Singapore context, and elicits recommendations to adapt the Stepping On programme with stroke survivors.

Method: Qualitative data were elicited during 4 focus groups with 23 rehabilitation therapists (15 occupational therapists [OTs]; 8 physiotherapists [PTs]) who had received training to deliver the original Stepping On programme, and had experienced delivery of fall-prevention intervention programmes locally. Collected data were analysed using thematic analysis method.

Results: Three themes emerged from the focus groups describing: (a) limitations of existing falls prevention intervention for stroke clients; (b) the need to adapt the Stepping On programme to use with stroke clients; and (c) challenges in implementing fall prevention programmes in the stroke context. A series of new components were suggested to be included as part of the Stepping On after stroke (SOAS) programme, including involvement of family members and caregivers, and tailored community reintegration sessions (such as taking public transport and shopping).

Conclusions: Rehabilitation therapists describe challenges in addressing fall prevention within a stroke context, and findings highlight the need for a structured, stroke-specific fall prevention programme rather than a more general approach to education and training. Contextual components identified provide valuable inputs towards the development of a culturally relevant fall prevention programme for stroke survivors in Singapore.

• Implications for Rehabilitation

• Stroke survivors living in the community are at a high risk of falls.

• A structured and culturally relevant fall prevention programme for community-living stroke survivors is needed.

• Falls prevention for community-living stroke survivors should be multi-dimensional and targeting the modifiable risk factors for falls in this group.

• Both stroke survivors and caregivers should be involved in any fall prevention after stroke programmes.

     

Effects of balance-specific exercises on balance,physical activity and quality of life in adults with multiple sclerosis: a pilot investigation

Abstract

Objective: To evaluate the efficacy of functional balance exercises on balance impairment, physical activity and quality of life (QOL) in adults with multiple sclerosis (MS). Design: A multiple-baseline time-series design with an uncontrolled intervention. Method: Ten subjects with MS completed assessments twice before and once after a 10-week balance intervention. ANOVA were used to evaluate the effects of testing session on the Brief-BESTest, instrumented stance and gait recordings by inertial motion sensors, lower-limb strength recorded by force transducers, accelerometry-based activity, the 12-item MS Walking Scale (MSWS-12), the Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaire, the Modified Fatigue Impact scale (MFIS) and the Activity-specific Balance Confidence (ABC) scale. Results: The intervention associated with significantly improved scores on the MSQOL-54 mental component, MFIS, MSWS-12 and Brief-BESTest. Sway amplitude significantly decreased and jerk significantly increased during instrumented standing on foam with eyes closed. Instrumented gait recordings of sagittal trunk range of motion also significantly decreased. ABC scores, strength measures and activity measures were not significantly changed. Conclusions: Ten weeks of functional balance exercises provided a feasible intervention for individuals with MS that improved components of balance, mental well-being and perceived fatigue impact and ambulation disability. A future randomized, controlled clinical trial should confirm these preliminary findings.

• Implications for Rehabilitation

• A balance-specific exercise program is both safe and feasible for individuals with mild-to-moderate MS.

• Comprehensive exercise interventions that are conceptually driven and employ well-designed progressive exercise across multiple contexts of balance control can facilitate improvements in balance impairments associated with MS.

• Functional balance exercises can positively impact clinical and objective measures of balance control and favorably influence perceptions of ambulation disability and fatigue as well as perceived quality of life in people with MS.

     

Progressive resistance training for community-dwelling women aged 90 or older; a single-subject experimental design

Abstract

Purpose: To examine the effect and feasibility of a 12-week programme of progressive resistance exercise on a group of nonagenarian (≥90 years) community-dwelling women. Method: An A–B single-subject experimental design was applied. Visual analyses were used for estimating the effect of the intervention. Outcome measurements were: Timed Up and Go (TUG), comfortable walking speed and 30-s chair stands. The programme comprised four exercises, following the principle of overload, aiming at improving strength in the main muscle groups. Feasibility of the progressive resistance intervention was assessed by recording the recruitment of participants, adherence to the intervention and adverse events. Results: Twenty-seven women were invited; eight women aged 90 and above agreed to participate and six completed the study. They suffered from one to 10 chronic medical conditions. All improved their performance in the TUG test. Five of the six participants achieved a higher walking speed (11–59%) and four of them improved on the 30-s chair-stand test with five to 10 stands. No major adverse events were reported. Conclusion: Progressive resistance training was a safe and efficient method to enhance mobility and increase lower body strength in this heterogeneous group of nonagenarian community-dwelling women.

• Implications for Rehabilitation

• Progressive resistance (PRT) training was found to be a safe and efficient method to enhance mobility and increase lower body strength in a group of community-dwelling women 90+.

• Participants with the poorest initial functional performance had great benefits, and the improvements appeared already after a few weeks of PRT.

• PRT might be useful in the rehabilitation field and could be implemented in facilities such as day care and senior centres frequented by very old persons with mobility limitations.

     

Is there a relationship between pain and psychological concerns related to falling in community dwelling older adults? A systematic review

Abstract

Purpose: To systematically review and synthesise the research evidence linking pain to psychological concerns about falling in community dwelling older adults. Methods: A systematic review was conducted in accordance with the preferred reporting items of systematic reviews and meta-analysis statement (PRISMA). Major electronic databases were searched from inception until June 2013. Two authors independently conducted the searches, extracted data and completed methodological quality assessments. Articles were included if they measured one of the psychological concerns related to falling in a sample of community dwelling older adults with pain, or explored the association between the two. Results: Of a potential 892 articles, 12 met the eligibility criteria (n?=?3398). The methodological quality of the included studies was variable and none of the included studies primary aim was to investigate the relationship between pain and psychological concerns related to falls. Two studies found significant differences in psychological concerns related to falls in older adults with pain and a control group. Nine out of 10 studies reported a significant correlation between pain and psychological concerns related to falls in their sample. Conclusion: This review provides provisional evidence that pain is associated with fear of falling (FOF), avoidance of activities due to FOF and falls efficacy in community dwelling older adults.

• Implications for Rehabilitation

• Pain is a common and pervasive problem in community dwelling older adults and can affect an individual’s mobility, levels of physical activity and increase their falls risk.

• Psychological concerns related to falls, such as fear of falling (FOF), falls efficacy and balance confidence are also common and troublesome issues in older adults, yet the association with pain has not been investigated with a systematic review.

• This review provides provisional evidence that pain may increase older adult’s risk of developing FOF, avoiding activities due to a FOF and impact their falls efficacy.

• In recognition of the findings of this review, clinicians working with older adults with pain should consider assessing psychological concerns related to falls and if necessary intervene if they identify an individual at risk.

     

Perceptions of using videogames in rehabilitation: a dual perspective of people with multiple sclerosis and physiotherapists

Abstract

Purpose: Our aim was to describe experiences of using Nintendo Wii Fit? for balance exercise, from the perspectives of patients with multiple sclerosis (MS) and their physiotherapists (PT). Methods: Individual interviews with 15 patients with MS were conducted, recruited from a multi-centre study investigating the effects of balance exercising using Wii Fit. We also conducted a single focus group interview with nine PT involved in the study. The interviews were audio-recorded, transcribed, and analysed using content analysis. Results: Both patients and PT said that exercising with Wii Fit games was fun, and that it challenged the patients’ physical and cognitive capacities. The competitive content in the games provided motivation to continue playing. Patients and PT reported improved body control and, more importantly, positive effects on balance and walking in daily life. The PT regarded Wii training as an effective alternative to other balance training, but some felt unsure in how to manage the video game. The patients regarded Wii training as a possible home training solution. Conclusions: Patients with MS and their PT considered Wii Fit exercises to be fun, challenging, and self-motivating. Exercising with Wii games can address balance impairments in MS, and can be performed at home as well as in rehabilitation settings.

• Implications for Rehabilitation

• Nintendo Wii Fit? can be used as a fun and challenging way to perform balance exercises.

• The competitive content embedded in the games triggers continued playing and exercising.

• The positive effect on balance control can improve standing and walking in everyday activities.

     

Do tilt-in-space wheelchairs increase occupational engagement: a critical literature review

Purpose: A wheelchair can enhance the quality of life of an individual with limited mobility, poor trunk control and stability, by enabling activity and participation and so occupational engagement. High specification wheelchairs which can tilt-in-space enable the position of users to be altered to suit activity and context. Despite tilt-in-space wheelchairs being expensive little is known about their therapeutic value. Methods: A critical literature review of the evidence was undertaken to evaluate whether the use of tilt-in-space increases occupational engagement. A wide ranging search strategy identified 170 articles which were screened using inclusion criteria. The eligible literature (n?=?6) was analysed thematically using open coding. Results: The majority of the participants used tilt-in-space but the data was too heterogeneous to combine. Measures of occupational engagement were not used so the therapeutic value could not be assessed. Conclusion: There is a lack of high quality evidence about the therapeutic benefits of tilt-in-space wheelchairs. Given the expense associated with providing these wheelchairs, and the increase in their provision, research is needed to justify provision of high specification wheelchairs to meet the occupational needs of users within the limited resources of health and social care.

• Implications for Rehabilitation

• Tilt-in-space wheelchairs.

• Wheelchairs are an important and essential assistive device for promoting independence and function.

• Suggests there are benefits for tilt-in-space wheelchairs.

• Identifies the need for additional large scale research.

     

Use of the Xbox Kinect virtual gaming system to improve gait,postural control and cognitive awareness in an individual with Progressive Supranuclear Palsy

Purpose: The purpose of this report is to describe an intervention using the Xbox Kinect virtual gaming system to improve gait, postural control and cognitive awareness in order to reduce falls and improve the quality of life for an individual with Progressive Supranuclear Palsy. Methods: A 65-year-old woman with a five-year history of PSP and frequent falls presented for physical therapy. Her case was complicated by poor ability to visually track objects, axial rigidity, retropulsion, poor postural control with reaching and declines in cognitive awareness. Intervention was provided using the Xbox Kinect for 12 one-hour sessions over six weeks in an outpatient setting. Games were selected to challenge functional motor and cognitive tasks based on patient enjoyment. Results: The Xbox Kinect intervention may have contributed to a decline in falls and maintenance of scores on the BBS, TUG and 10 Meter Walk Tests above fall risk values. A decline in quality of life measures, PDQ-39 and FFABQ, may be attributed to an increase in cognitive awareness of deficits promoted by the intervention structure. Conclusion: Implementation of a gaming intervention using the Xbox Kinect is feasible for reducing fall risk, maintaining function and improving cognitive awareness when used in an outpatient setting.

• Implications for Rehabilitation

• Progressive Supranuclear Palsy is a rare and rapidly progressive neurodegenerative disease wherethere is a lack of long-term rehabilitation options to help slow their rapid progressions.

• Our case demonstrates the feasibility of an intervention using a virtual gaming system to helpmaintain functional mobility, balance and independence for an individual with PSP.

• Collaborative interactions between game companies and physical therapists will improve theability of virtual games to address rehabilitation goals within neurodegenerative populations.

     

Is walking symmetry important for ambulatory patients with spinal cord injury?

Purpose: To assess and compare the levels of walking symmetry in ambulatory participants with spinal cord injury (SCI) who had different degrees of lesion severity, levels of walking ability, and fall history. In addition, the study explored the relationship between the levels of walking symmetry and variables related to the ability of well-controlled walking of the participants.

Study design: Cross-sectional study.

Methods: Sixty-six eligible participants were assessed and interviewed for levels of walking symmetry, walking speed, functional endurance, symmetrical lower limb support ability, balance control, and fall history over the last 6 months.

Results: Participants walked asymmetrically (85%) similar to those with unilateral impairments (i.e., patients with stroke and amputee, 79–93%). The levels of walking symmetry were significantly correlated to walking speed, functional endurance and balance ability of the participants (p?r?=?0.613–0.765, p?Conclusions: The findings confirm problems of asymmetrical walking and the importance of walking symmetry for the ability of well-controlled walking and a risk of multiple falls in ambulatory participants with SCI. Therefore, apart from the levels of independence, the improvement of walking symmetry is crucial for these individuals.

• Implications for Rehabilitation:

• Ambulatory individuals with spinal cord injury walked asymmetrically at the same level as those with unilateral impairments such as patients with stroke and amputee.

• Their levels of walking symmetry were significantly related to the ability of well-controlled walking, particularly in those with the history of multiple falls.

• The finding confirmed the importance of walking symmetry as a crucial parameter to detect walking improvement and fall risk reduction.

• Apart from the levels of independence, rehabilitation professionals also need to emphasize on the improvement of symmetrical walking for these patients.