# Protective Step Training in People with Multiple Sclerosis

> **NIH VA IK2** · PHOENIX VA HEALTH CARE SYSTEM · 2022 · —

## Abstract

PROJECT SUMMARY: About 28,000 Veterans with multiple sclerosis (MS) receive care from the VA each
year. Most of these Veterans have poor balance and fall frequently. These falls significantly affect
Veterans’ quality of life and increase cost of care. Current rehabilitation strategies to prevent falls are
inadequate. Protective step training is a novel and promising treatment in which people are exposed to
repeated slips. This training aims to improve automatic postural control including quick, protective steps,
which are a critical aspect of fall avoidance, and are severely delayed in Veterans with MS. This therapy
has been shown to prevent falls in healthy older adults. However, the effectiveness of perturbation training
in Veterans with MS is unknown. Identifying effective methods of fall prevention in Veterans with MS, such
as perturbation training, can lead to fewer falls in this population.
 Veterans with MS often exhibit considerable variability in their “responsiveness” to rehabilitation. Said
differently, improvement in performance through training is variable across individuals. The ability to predict
responsiveness to treatment would be extremely beneficial for clinicians; improving the efficiency by which
they provide care. Recent work suggests cognitive ability and structural brain connectivity may predict
responsiveness to motor rehabilitation. However, the degree to which these characteristics predict
responsiveness in Veterans with MS is currently unknown.
 Therefore, the overall goals of this project are to understand 1) whether Veterans with MS can improve
postural control and reduce falls through perturbation training, and 2) whether we can predict (via cognitive
testing and neuroimaging), who will benefit most from treatment. We will achieve these goals through three
specific aims. Aim 1: identify whether Veterans with MS can improve protective stepping, a critical skill for
fall prevention, through perturbation training. Aim 2: determine if cognitive capacity predicts postural
improvement through training in Veterans with MS. Aim 3: determine if brain structural connectivity predicts
postural improvements through training. The imaging data collected will also allow us to investigate
whether MS-related changes in brain connectivity contributes to postural response dysfunction.
 The efficacy of perturbation training in Veterans with MS (Aim 1) will be studied by measuring protective
stepping performance before and after a 2-week perturbation training protocol. Changes in performance
over this period will be compared to a 2-week baseline period (occurring prior to training), in which
participants will continue daily routine. In this way, we will conduct a within-subject design study. In
addition, we will gather prospective falls data through a falls calendar over the course of 8 weeks prior to
and 8 weeks after the perturbation training to gain preliminary data regarding the effect of this training on
falls. To determine which b...

## Key facts

- **NIH application ID:** 10201775
- **Project number:** 5IK2RX002341-04
- **Recipient organization:** PHOENIX VA HEALTH CARE SYSTEM
- **Principal Investigator:** Daniel Soren Peterson
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-08-01 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10201775

## Citation

> US National Institutes of Health, RePORTER application 10201775, Protective Step Training in People with Multiple Sclerosis (5IK2RX002341-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10201775. Licensed CC0.

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