Use of a Robotic Walking Device for Home and Community Mobility in Parkinson Disease: A Randomized Controlled Trial.

BACKGROUND/PURPOSE: Gait impairments in Parkinson disease (PD) contribute to decreased quality of life. This randomized controlled trial examined immediate- and longer-term effects of a single joint robotic exoskeleton device (EXOD), the Honda Walking Assist device, on gait. METHODS: Participants (n = 45) with PD (Hoehn and Yahr stages 1-3) were randomized to a robotic-assisted gait training (RAGT) group (n = 23) or control (CON) group (n = 22). The RAGT group was tested with and without the EXOD at baseline and then received supervised in-home and community training with the EXOD twice weekly for 8 weeks. The CON group received no interventions. Outcome measures included gait speed (primary), gait endurance (6-minute walk test), perceived ease of walking, and questionnaires and logs assessing performance of daily activities, freezing of gait, and daily activity levels. RESULTS: Forty participants completed the study. No significant immediate impact of EXOD usage on participants' gait measures was found. Differences in gait speed and secondary outcome measures postintervention were not significantly different between the RAGT and CON groups. Participants with greater disease severity (worse baseline motor scores) had greater improvements in stride length during unassisted walking after the intervention than those with lower severity (mean difference: 3.22, 95% confidence interval: 0.05-6.40; P = 0.04). DISCUSSION AND CONCLUSIONS: All RAGT participants could use the EXOD safely. The RAGT treatment used in this mostly low impairment population of people with PD may be ineffective and/or was insufficiently dosed to see a positive treatment effect. Our findings suggest that RAGT interventions in PD may be more effective in individuals with greater motor impairments.

Use of an Errorless Learning Approach in a Person With Concomitant Traumatic Spinal Cord Injury and Brain Injury: A Case Report.

: Individuals with concomitant spinal cord injury and traumatic brain injury have cognitive deficits that may limit the ability to learn novel motor tasks necessary for functional independence. Errorless learning has been shown to improve cognitive task performance in persons with brain injury but little is known about its usefulness for improving novel motor task learning. CASE DESCRIPTION: A 44-year-old man with traumatic spinal cord and brain injuries from a motor vehicle accident was admitted to an inpatient rehabilitation hospital. His spinal cord injury was classified as T4 American Spinal Injury Association Impairment Scale (AIS) A, and his cognitive status was level IV on the Ranchos Los Amigos Scale. Initially, the patient required maximal assistance from 2 clinicians to complete a slide board transfer, propelled his wheelchair 25 ft with minimal assistance, and scored 9/56 on the Function in Sitting Test. INTERVENTION: The therapist applied traditional motor-learning approaches during the first 37 days of the patient's inpatient rehabilitation facility stay without meaningful gains in functional mobility. A subsequent change to errorless learning was made for the following 32 days until discharge. OUTCOMES: After use of errorless learning, the patient performed novel mobility-related tasks of slide board transfers with minimal assistance and wheelchair propulsion without physical assistance up to 150 ft; the Function in Sitting Test score improved to 18/56. His sensorimotor system progressed to an AIS classification of AIS B, while his cognition emerged to a level V on the Ranchos Los Amigos Scale. DISCUSSION: Errorless learning may have facilitated acquisition of novel transfer and mobility skills in this individual with dual diagnoses. This approach may have value for patients with neurologic conditions who have both motor and cognitive impairment.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A201).

Are triage questions sufficient to assign fall risk precautions in the ED?

OBJECTIVES: The American College of Emergency Physicians Geriatric Emergency Department (ED) Guidelines and the Center for Disease Control recommend that older adults be assessed for risk of falls. The standard ED assessment is a verbal query of fall risk factors, which may be inadequate. We hypothesized that the addition of a functional balance test endorsed by the Center for Disease Control Stop Elderly Accidents, Deaths, and Injuries Falls Prevention Guidelines, the 4-Stage Balance Test (4SBT), would improve the detection of patients at risk for falls. METHODS: Prospective pilot study of a convenience sample of ambulatory adults 65 years and older in the ED. All participants received the standard nursing triage fall risk assessment. After patients were stabilized in their ED room, the 4SBT was administered. RESULTS: The 58 participants had an average age of 74.1 years (range, 65-94), 40.0% were women, and 98% were community dwelling. Five (8.6%) presented to the ED for a fall-related chief complaint. The nursing triage screen identified 39.7% (n=23) as at risk for falls, whereas the 4SBT identified 43% (n=25). Combining triage questions with the 4SBT identified 60.3% (n=35) as at high risk for falls, as compared with 39.7% (n=23) with triage questions alone (P<.01). Ten (17%) of the patients at high risk by 4SBT and missed by triage questions were inpatients unaware that they were at risk for falls (new diagnoses). CONCLUSIONS: Incorporating a quick functional test of balance into the ED assessment for fall risk is feasible and significantly increases the detection of older adults at risk for falls.

An acute interprofessional simulation experience for occupational and physical therapy students: Key findings from a survey study.

Due to the fast pace and high complexity of managing patients in intensive and acute care units (ICUs), healthcare students often feel challenged and unprepared to practice in this environment. Simulations and standardised patients provide "hands-on" learning experiences that are realistic and help students to gain competence and confidence. This study examined the impact of an intensive case simulation laboratory using a patient simulator and standardised patients on students' perceptions of their confidence and preparedness to work in acute care settings. Second-year Masters of Occupational Therapy (MOT; n = 127) and Doctor of Physical Therapy (DPT; n = 105) students participated in a three-hour intensive care simulation laboratory comprised of four stations that were designed to simulate common ICU patient care scenarios. Data analysed were student pre- and post-simulation surveys and written comments, and clinical instructors' (CIs; n = 51) ratings on DPT students' preparedness and confidence within the first two weeks of their acute care internships obtained after the laboratory. There was a significant increase for DPT (p < 0.0001) and MOT (p < 0.10) students in median ratings of how prepared they felt to practice in acute care settings following the ICU simulation compared to before the laboratory. CIs rated the DPT students as either prepared or very prepared for and moderately confident or very confident in the acute care setting. The use of simulation training using standardised patients and patient simulators was beneficial in increasing student confidence and preparing OT and PT students to practice in the acute care setting. Health professional educators should consider using an interprofessional simulation experience to improve their students' confidence and preparedness to provide appropriate care in the acute setting.

Reliability and validity of a wireless accelerometer for the assessment of postural sway.

Clinicians are in need of valid and objective measures of postural sway. Accelerometers have been shown to be suitable alternatives to expensive and stationary force plates. We evaluated the test-retest reliability and balance task discrimination capability of a new wireless triaxial accelerometer (YEI 3-Space Sensor). Four testing conditions (eyes open or closed, while on a firm or compliant surface) were used to progressively challenge the static balance of 20 healthy male (n = 8) and female (n = 12) older adults (mean age 81 ± 4.3 y). Subjects completed 2 blocks of three 30-second trials per condition. The accelerometer was positioned on the lower back to acquire mediolateral (M-L) and anterior-posterior (A-P) accelerations. Intraclass correlation coefficients were all good to excellent, with values ranging from .736 to .972 for trial-to-trial and from .760 to .954 for block-to- block. A significant stepwise increase in center of mass acceleration root mean square values was found across the 4 balance conditions (F[1.49, 28.26] = 39.54, P < .001). The new accelerometer exhibited good to excellent trial-to-trial and block-to-block reliability and was sensitive to differences in visual and surface conditions and acceleration axes.

Selecting measures for balance and mobility to improve assessment and treatment of individuals after stroke.

Assessment of individuals with stroke using reliable and valid outcome measures is a key component of the treatment planning process. Health care professionals may have difficulty selecting balance and mobility measures given the large number of measures to choose from. This article utilizes a case-based approach to describe the benefits of using a common set of outcome measures and a process for selecting optimal measures across body structure/function, activity, and participation domains of the International Classification of Functioning, Disability and Health (ICF) model and stages of stroke recovery. Specific measures for use in acute care, rehabilitation, outpatient, and home health care settings are discussed based on StrokEDGE task force recommendations by the Neurology Section of the American Physical Therapy Association.

The role of community paramedicine in fall prevention: A SWOT analysis.

BACKGROUND: Millions of older US adults fall annually, leading to catastrophic injuries, over 32,000 deaths and healthcare costs of over $55 billion. This study evaluated perceived benefits and limitations of using community paramedicine for fall prevention strategies from the lens of older adults, caregivers, and healthcare providers. METHODS: Semi-structured focus groups were held with individuals from three stakeholder groups: (1) community-dwelling older adults (age ≥60), (2) caregivers, and (3) healthcare providers. The Strengths-Weaknesses-Opportunities-Threats (SWOT) framework was used to quantitatively analyze stakeholder perceptions of using community paramedicine for fall prevention strategies. RESULTS: A total of 10 focus groups were held with 56 participants representing older adults (n = 15), caregivers (n = 16), and healthcare providers (n = 25). Community paramedicine was supported as a model of fall prevention by older adults, caregivers, and healthcare providers. Participants identified strengths such as visibility to the home environment, ability to implement home modifications, implicit trust in emergency medical services (EMS), and capacity to redirect resources toward prevention. Additionally, participants acknowledged opportunities such as providing continuity of care across the healthcare spectrum, improving quality and safety of care and potentially reducing unnecessary emergency department use. Participants endorsed weaknesses and threats such as funding, concerns of patients about stigma, and struggles with medical data integration. CONCLUSIONS: The results of this study illuminate the opportunity to leverage community paramedicine to address a variety of perceived barriers in order to design and implement better solutions for fall prevention efforts.

Step Test Evaluation of Performance on Stairs (STEPS): Assessing Stair Function in Older Adults.

BACKGROUND AND PURPOSE: Stair negotiation is crucial for functional independence and is a leading cause of fall-related injuries in older adults. The Step Test Evaluation of Performance on Stairs (STEPS) is a quick and easily administered outcome measure for assessing stair negotiation. This study investigated the reliability and concurrent content validity of the STEPS test to determine its usefulness in older adults. METHODS: Eighty-two community-dwelling older adults (mean age 81.2 years, 51 females) were assessed on the STEPS test, Timed Up and Go (TUG), 5-times sit to stand (5XSTS), stair self-efficacy (SSE) questionnaire, and time to ascend and descend stairs. Participants repeated the STEPS test 7 to 14 days later for intrarater reliability by the same rater. Spearman rank and intraclass correlations were used to determine the association of measures and intrarater reliability. RESULTS AND DISCUSSION: The mean STEPS score was 15.6 (SD = 3.7) out of 20. The STEPS total score demonstrated excellent intra- and interrater reliability. It had moderate to good and significant correlations with TUG, 5XSTS, SSE, and time to ascend and descend measures. Faster performance on the 5XSTS, TUG, and time to ascend and descend correlated with better performance on the STEPS test, indicating validity for assessing balance and mobility during stair negotiation in older adults. Lower SSE correlated with lower observer ratings of performance on stairs (STEPS scores), indicating agreement between participant reports of self-efficacy and observer ratings of performance. Step Test Evaluation of Performance on Stairs items that demonstrated the most frequent loss of points were balance (use of handrail), step continuity, foot placement, and self-propulsion (ascent only). CONCLUSIONS: Assessment of older adults' safety and performance on stairs is vital given the increased difficulty of stair navigation and the high risk for injurious falls in this population. This study demonstrates that the STEPS test is a reliable and valid outcome measure for assessing stair performance in older adults.

Video game play (Dance Dance Revolution) as a potential exercise therapy in Huntington's disease: a controlled clinical trial.

OBJECTIVE: To investigate the feasibility, acceptability, and safety of a supervised video game exercise program administered via Dance Dance Revolution in individuals with Huntington's disease. DESIGN: A cross-over, controlled, single-blinded, six-week trial. SETTING: Home-based. PARTICIPANTS: Eighteen ambulatory individuals with Huntington's disease (seven male, mean age 50.7 SD 14.7). INTERVENTIONS: Participants played the Dance Dance Revolution game with supervision and the handheld game without supervision for 45 minutes, two days per week for six weeks. OUTCOME MEASURES: Game play performance and adherence, participant perceptions of the game, safety (vital signs, adverse health changes), spatiotemporal gait measures, Four-Square Step Test, Tinetti Mobility Test, Activities-Specific Balance Confidence Scale, and World Health Organization Quality of Life - Bref, before and after each intervention. RESULTS: Most participants improved on game play, enjoyed playing the game, and wanted to continue playing after study completion. After playing Dance Dance Revolution, participants showed significant reductions in double support percentage (adjusted mean difference (95% confidence intervals): -2.54% (-4.75, -0.34) for forward walking and -4.18 (-6.89, -0.48) for backward walking) and those with less severe motor symptoms had reductions in heel-to-heel base of support during forward walking. The remaining measures were not significantly impacted by the intervention. CONCLUSION: Dance Dance Revolution appears to be a feasible, motivating, and safe exercise intervention for individuals with Huntington's disease.

Implementing Physiotherapy Huntington's Disease Guidelines in Clinical Practice.

BACKGROUND: The recently published clinical practice guideline for physiotherapy practice for Huntington's disease (HD) should be integrated into practice to develop interventions that enable people with HD to achieve personalised goals. The European Huntington's Disease Network Physiotherapy Working Group aims to support and enable the use of best evidence in physiotherapy for the HD community. Successful implementation of the clinical practice guidelines requires an understanding of facilitators and barriers to therapist implementation. OBJECTIVE: To explore facilitators and barriers to implementing recently published clinical recommendations that guide physiotherapy practice for HD. METHODS: An online survey was distributed globally through HD networks. Data collected included demographic information and agreement/disagreement with a series of named facilitators and barriers to implementation of each of the six physiotherapy guideline recommendations. A consensus level of≥70% agreement was set as indicative of agreement/disagreement. RESULTS: Thirty-two physiotherapists working in a range of settings responded. Support from colleagues (81-91% agreement), an individualised physiotherapy plan (72-88% agreement) and physiotherapist's expertise in HD (81-91% agreement) were reported as facilitators. The main barriers were behavioural (72-81% agreement) and cognitive (75-81% agreement) impairments and low motivation (72-78% agreement) in persons with HD. CONCLUSION: Physiotherapists agree that their expertise in HD and support from colleagues facilitate the development of individualised treatment plans. Further work needs to develop creative ways in which barriers specific to the cognitive and behavioural aspects of HD can be managed to enable treatment plans to be implemented.

Coordination of Care Among Physical Therapists and Neurologists in Huntington Disease.

This study presents a framework for physical therapy through the course of Huntington disease (HD) which includes coordinated care plans with neurologists. HD is an inherited neurodegenerative disorder that leads to impaired strength and coordination and ultimately progressive loss of function. Interdisciplinary HD care teams provide patient-centered, comprehensive evaluations and make recommendations for pharmacologic, healthcare, and lifestyle interventions based on best available evidence. Physical therapists work to improve movement and mobility using specific therapeutic interventions and individualized exercise programs. The proposed framework recommends that neurologists refer persons with HD to physical therapy at all disease stages, ideally beginning in premanifest and early stages, and that they regularly communicate with physical therapists to ensure implementation of a coordinated care plan. Resources are provided for neurologists to facilitate appropriate referral for individuals with HD to physical therapy based on clinical practice guidelines, including a referral decision guide.

Clinical Decision Trees to Guide Physical Therapy Management of Persons with Huntington's Disease.

BACKGROUND: In 2020, our group published physical therapy clinical practice guidelines (CPG) for people with Huntington's disease (HD). The guideline recommendations were categorized according to six primary movement impairment classifications. OBJECTIVE: To facilitate implementation of this CPG, we have developed guideline-based algorithms for physical therapy assessments and interventions and recommendations for therapists to overcome barriers to CPG implementation for people with HD. METHODS: We conducted a literature review of papers that evaluated physical therapy interventions in individuals with HD (n = 26) to identify assessments for each of the primary movement impairment classifications, and then searched for papers (n = 28) that reported their clinometric/psychometric properties in HD. Assessments were evaluated using modified Movement Disorder Society Committee on Rating Scales criteria and other relevant criteria. RESULTS: We identified a "core set" of physical therapy assessments for persons with HD, including the Six Minute Walk Test, Timed Up and Go Test, Berg Balance Scale, and the Medical Outcomes Study Short Form 36 (SF-36). We then developed guideline-based decision trees to assist in decision making and implementation of the CPG into practice for persons with HD across the continuum of care. Finally, we developed strategies for overcoming barriers to implementation, such as seeking specialized training in HD, engaging caretakers or family members to help the person with HD to exercise, and establishing clinical pathways that support early physical therapy referrals. CONCLUSION: Knowledge translation documents such as this are essential to promoting implementation of the physical therapy CPGs into clinical practice.

Immediate effects of treadmill walking in individuals with Lewy body dementia and Huntington's disease.

BACKGROUND: Treadmill training may improve gait disorders associated with neurodegenerative diseases. In Parkinson's disease (PD), treadmill training alters gait patterns after one session, and long-term training improves gait parameters, fall risk, and quality of life. RESEARCH QUESTION: What is the feasibility and safety of using this intervention for people with Lewy body dementia (LBD) or Huntington's disease (HD)? METHODS: In this observational study, 10 individuals with HD, 8 individuals with LBD, and 10 control individuals walked for 20 min on a treadmill using a speed dependent protocol starting at a slow comfortable speed and increasing incrementally toward their normal overground speed. Feasibility was determined by compliance to protocol and safety by no incidents of abnormal vital signs or expressions of distress. Changes in gait measures, Timed Up and Go (TUG) scores and quantitative motor function measures (Q-Motor; precision grasp force variability, finger and foot tapping frequency) before and after treadmill walking were analyzed using linear models. RESULTS: Treadmill training is feasible and safe in LBD and HD; although, participants could not initiate treadmill walking at their comfortable overground speeds, and only 3 participants with HD were able to achieve their overground walking speed within the 20-minute session. No changes in gait measures, TUG times, and Q-Motor measures were found among LBD and HD participants after treadmill walking, although control participants demonstrated significant increases in several gait measures, and foot tap frequency (estimated difference = 0.290; p = 0.026). SIGNIFICANCE: Longer and more frequent treadmill sessions may be needed to see gait and motor function effects in LBD and HD. Motor and cognitive impairments associated with these diseases may make them less amenable to the effects of treadmill training.

Fall risk assessment using the Tinetti mobility test in individuals with Huntington's disease.

The Tinetti Mobility Test (TMT) is a clinical balance and gait test that predicts fall risk in the elderly. This study examined the concurrent validity, usefulness of the TMT as a fall risk screening tool, and the potential ability of the TMT to predict falls in individuals with Huntington's disease (HD). Data from a retrospective review of 94 patient records were used. TMT scores were correlated with Unified Huntington Disease Rating Scale (UHDRS) motor scores. The ability of the TMT to accurately assess fall risk was determined using validity index measures. Logistic regression was used to assess the ability of the TMT to predict falls. TMT scores correlated with UHDRS motor scores (r(s) = -0.751, P < 0.0001). Using a cutoff value of 21, the TMT had a sensitivity of 74% and a specificity of 60% to identify fallers. Lower TMT scores and younger age were significant predictors of falls. The TMT is a valid tool for assessing balance and gait status and fall risk of individuals with HD.

Clinical recommendations to guide physical therapy practice for Huntington disease.

OBJECTIVE: In the past decade, an increasing number of studies have examined the efficacy of physical therapy interventions in people with Huntington disease (HD). METHODS: We performed a mixed-methods systematic review using Joanna Briggs Institute (JBI) methodology and included experimental and observational study designs. The search resulted in 23 quantitative studies and 3 qualitative studies from which we extracted data using JBI standardized extraction tools. Results of this review suggested that physical therapy interventions may improve motor impairments and activity limitations in people with HD. Here, we expand on the review findings to provide specific recommendations to guide clinical practice. RESULTS: We recommend the following specific physical therapy interventions for people with HD: aerobic exercise (grade A evidence), alone or in combination with resistance training to improve fitness and motor function, and supervised gait training (grade A evidence) to improve spatiotemporal features of gait. In addition, there is weak (grade B) evidence that exercise training improves balance but does not show a reduction in the frequency of falls; inspiratory and expiratory training improves breathing function and capacity; and training of transfers, getting up from the floor, and providing strategies to caregivers for involvement in physical activity in the midstages of HD may improve performance. There is expert consensus for the use of positioning devices, seating adaptations, and caregiver training in late stages of HD. CONCLUSIONS: There is strong evidence to support physical therapy interventions to improve fitness, motor function, and gait in persons with HD.

Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS.

BACKGROUND: Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive domains, resulting in impairment in dual-task walking ability. The goal of this study was to compare performance of forward walking and backward walking in single- and dual-task conditions in persons with MS to age- and sex-matched healthy controls. We also examined relationships between forward and backward walking to cognitive function, balance, and retrospective fall reports. METHODS: All measures were collected in a single session. A 2 × 2 × 2 mixed model ANOVA was used to compare differences in forward and backward walking in single- and dual-task conditions between MS and healthy controls. Spearman correlations were used to examine relationships between gait and cognitive function, falls, and balance. RESULTS: Eighteen individuals with relapsing-remitting MS and 14 age- and sex-matched healthy controls participated. Backward walking velocity revealed significant differences between groups for both single-task (p = 0.015) and dual-task (p = 0.014) conditions. Persons with MS demonstrated significant differences between single- and dual-task forward and backward walking velocities (p = 0.023; p = 0.004), whereas this difference was only apparent in the backward walking condition for healthy controls (p = 0.004). In persons with MS, there were significant differences in double support time between single- and dual-task conditions in both backward (p < 0.001) and forward (p = 0.001) directions. More falls at six months were significantly associated with shorter backward dual-task stride length (r = -0.490; p = 0.046) and slower velocity (r = -0.483; p = 0.050). CONCLUSION: Differences in MS and age- and sex-matched healthy controls are more pronounced during backward compared to forward walking under single- and dual-task conditions. Future work with a larger sample size is needed to validate the clinical utility of backward walking and dual-task assessments and mitigate the limited sensitivity of the current dual-task assessments that primarily rely upon forward walking.

The Step Test Evaluation of Performance on Stairs (STEPS): Validation and reliability in a neurological disorder.

BACKGROUND: Individuals with neurological disorders often have difficulty negotiating stairs that can lead to injurious falls. Clinicians lack a clinical tool to identify impairments in stair negotiation and to assist their decision making regarding treatment plans to improve stair performance and safety. We developed a new tool called the Step Test Evaluation of Performance on Stairs (STEPS) that is designed to assess stair performance and safety in neurological populations. OBJECTIVES: This study aimed to determine interrater and intrarater reliability of STEPS and its concurrent content validity to various clinical balance and mobility measures using individuals with Huntington's disease (HD) as the first test population. METHODS: Forty individuals with HD (mean age 50.35) participated. Three observers rated live performances of the STEPS (interrater reliability) and seven observers rated videotaped performances twice (intrarater reliability). STEPS scores correlated with clinical mobility and balance test scores. RESULTS: Excellent inter- and intrarater reliability (ICCs = 0.91 and 0.89 respectively) and good internal consistency (α = 0.83) were found. Better STEPS performance correlated with better performance on co-administered motor and mobility measures and Stair Self-Efficacy scores. Per multivariable regression analysis, the Unified Huntington's Disease Rating Scale modified motor score and descent time were significant predictors of STEPS performance. CONCLUSIONS: The STEPS tool is easy to administer, requires no special devices and can be completed in less than five minutes. In the HD test population, it shows high reliability and validity making it a potentially useful tool for assessing maneuverability and safety on stairs in HD. The results suggest that the STEPS tool warrants further study to determine STEPS cut-off values for fall prediction in HD and may prove useful as an assessment tool for other neurological disorders.

Supplementary motor area connectivity and dual-task walking variability in multiple sclerosis.

BACKGROUND: Despite the prevalence of dual-task (e.g., walking while talking) deficits in people with multiple sclerosis (MS), no neuroimaging studies to date have examined neuronal networks used for dual-task processing or specific brain areas related to dual-task performance in this population. A better understanding of the relationship among underlying brain areas and dual-task performance may improve targeted rehabilitation programs. The objective of this study was to examine relationships between neuroimaging measures and clinical measures of dual-task performance, and reported falls in persons with MS. MATERIALS AND METHODS: All participants completed measures of dual-task performance, a fall history, and neuroimaging on a 3 T MRI scanner. Spearman correlations were used to examine relationships among dual-task performance, falls and neuroimaging measures. RESULTS: Eighteen females with relapsing-remitting MS [mean age = 45.5 ±â€¯8.2 SD; mean symptom duration = 12.3 ±â€¯6.7 years; Expanded Disability Status Scale median 2.25 (range 1.5-4)] participated in this study. Structural imaging measures of supplementary motor area (SMA) interhemispheric connectivity were significantly related to dual-task walking variability. CONCLUSIONS: The SMA interhemispheric tract may play a role in dual-task performance. Structural neuroimaging may be a useful adjunct to clinical measures to predict performance and provide information about recovery patterns in MS. Functional recovery can be challenging to objectively report in MS; diffusion tensor imaging could show microstructural improvements and suggest improved connectivity.