Balance problems during standing and walking are crucial issues in children with cerebral palsy (CP). Although balance problems have been recognized more in recent decades, the underlying causes of poor balance performance remain unclear. This consequently leads to mixed results regarding the effects of different balance training programs.

Therefore, we will specifically highlight and investigate various aspects of balance. In addition, we will also examine which aspects can influence balance. At a central level, a pre- or perinatal brain lesion can affect the systems that determine good balance. Although it is known that the sensory system, particularly proprioception, is an important factor for good balance control, this is relatively under-researched in CP.

At a peripheral level, prolonged physical activity can increase balance problems due to muscle fatigue.

Multi-dimensional movement and neurophysiological research of gait-related fatigue in individuals with multiple sclerosis.

Multiple sclerosis (MS) is a disease characterized by the induction of various symptoms, including fatigue. Fatigue is common among people with MS (pwMS) and is one of the most debilitating symptoms reported by this population (e.g., nearly 90% experience or have experienced fatigue as a result of MS). Similarly, fatigability, which is defined as a decrease in performance during a particular task, is also more frequent in pwMS and affects both motor and cognitive domains. There is also no research on rehabilitation programs to reduce motor fatigability in pwMS.

Using various biomechanical and neurophysiological approaches, the project aims to i) investigate how motor fatigability influences biomechanical adaptations using a virtual reality environment (GRAIL), what the relationship is with cognition, and what the relationship is with neurophysiological measurements during walking while negotiating virtual obstacles; ii) examine the relationship of neurophysiological domains with fatigability during step movements (fNIRS) and the exertion of attentional control using simple tasks (e.g., vigilance tasks).

Gait Fatigability in Individuals with MS: Psychometric Properties of Measurement for Cognitive and Coordination Fatigability and Proof-of-Concept of a Rehabilitation Intervention.

Fatigability is a change in performance over time according to tasks and situations. Preliminary research from our team has shown that individuals with MS exhibiting gait fatigability showed a significant decrease in movement amplitude during a coordination task of the lower limbs in a seated position. A pilot study conducted by our research group has demonstrated that dance therapy significantly improved the impact on fatigue. However, the effect of dance therapy on performance fatigability is still unknown. The first goal of this research is to examine the reliability of lower limb coordination tasks and cognitive fatigability. Additionally, it aims to investigate the effect of an eight-week choreo-based dance intervention on fatigue and fatigability in MS through a randomized controlled pilot study. Thirty pwMS will be assigned to a dance group or a control group (focused on stretching and balance exercises). Clinical coordination parameters will be collected at baseline and after the intervention.

This project is supported by the MS Liga Vlaanderen and the Claire Fouconnier Fund (King Baudouin Foundation).

Research on the Precision in Predictive Coding during Walking to Music and Metronome in Individuals with Progressive Multiple Sclerosis and Cerebellar Disorders..

Walking is essential in daily life but difficult to train for individuals with progressive multiple sclerosis (MS) and cerebellar disease due to common symptoms of fatigability and ataxia. Additionally, cognitive skills such as attention are also required for walking. This poses an extra challenge when training walking in this population, where cognitive impairments often occur.

In this project, we propose the use of auditory-motor coupling, embedded in the theoretical framework of predictive coding. First, we will examine the precision of synchronizing steps to beats of music and metronomes in patients with progressive MS and cerebellar disorders compared to healthy control subjects. We will also investigate how beats are perceived in the brain by using electroencephalography during a tapping task on auditory stimuli.

Secondly, we want to investigate the precision of predictive coding by examining how participants adjust their synchronization to changing music and metronomes. Thirdly, we will explore whether music and metronomes specifically tailored to the participant’s gait pattern have a positive effect on fatigability and gait dynamics in patients with progressive MS and cerebellar ataxia. Finally, we aim to create a model using the collected data to better understand the precision of synchronization in the context of predictive coding theory.

This study is conducted in close collaboration with Prof. Marc Leman from IPEM UGent.

Insight into the Effect of Variables on Precision in Predictive Coding during Walking to Music in Individuals with Multiple Sclerosis with Progressive Subtypes and Cerebellar Lesions.

Walking is essential for daily activity, but is a challenge to train in individuals with multiple sclerosis (pwMS) with progressive subtypes and in pwMS with cerebellar lesions, given the prevalence of symptoms of fatigability and ataxia in these diseases. Walking requires not only motor but also cognitive functions, such as attention.

This poses an extra challenge to train walking in pwMS with progressive subtypes and pwMS with cerebellar lesions, where cognitive disorders are prevalent. In this project, we propose the use of gait tasks with auditory-motor coupling – synchronized walking to music – embedded in the theoretical framework of predictive coding.

The overall aim of the project is to understand how disruptions in motor, cognitive, and perceptual timing systems (and in particular fatigability and cerebellar lesions) influence precision in pwMS compared to healthy controls. This study is conducted in close collaboration with Prof. Marc Leman from IPEM UGent.

There are several balance control mechanisms during standing and walking. One of these balance control mechanisms is the ankle mechanism, whereby muscles around the ankles are activated to generate an ankle moment. These ankle moments cause a shift in the point of application of the ground reaction force, in English ‘Center of Pressure’ (‘CoP’). Another balance control mechanism that can be used is foot placement.

Foot placement determines the size of the support base and thus limits the location of the point of application of the ground reaction force. Another mechanism that can be used to accelerate the center of mass is the counter-rotation mechanism. This mechanism is based on adjusting the angular momentum of segments around the center of mass so that the direction of the ground reaction force changes. Rotation of the trunk and pelvis around the hip, as well as accelerations of the arms and head, are examples of the counter-rotation mechanism.

Children and older adults fall more often than young adults. Therefore, it would be interesting to investigate the influence of age on the use of balance control mechanisms. In children, the sensory systems and the integration of sensory input are not yet fully developed, while in older adults, all components of the sensorimotor system decline with aging, which limits the ability to control balance.

Sensory Interaction and Balance Control During Standing and Walking under Challenging Conditions in Healthy Young and Older Adults: Static and dynamic balance control depend on the seamless integration of inputs from the visual, somatosensory, and vestibular systems.

While there are tests that effectively evaluate static balance, most falls in daily life occur during dynamic activities like walking underlining the need for a test that assesses sensory integration during locomotion. Furthermore, dual-task scenarios, which challenge both cognitive and motor functions, highlight how cognitive-postural interference can weaken balance. To address these real-world challenges, this study introduces a new test that evaluates sensory integration during walking (SensIWalk). Additionally, the study incorporates sensory integration in walking, dual tasks, and perturbations, offering a more comprehensive approach to understanding balance control and predicting fall risks in everyday situations.

Task-specific training for fall prevention in older adults.

Falls are a significant concern for older adults. It has consequences not only on a personal but also on a societal level, increasing hospital costs. While general exercise programs can reduce falls, their impact in the real world is often limited due to low dose and adherence. Task-specific training, such as perturbation-based balance training and gait adaptability training, has shown promise in reducing falls by up to 50%.

Our project focuses on three key fall-resisting skills: proactive gait adaptability (avoiding balance threats), gait robustness (resisting small disturbances), and reactive gait recovery (recovering balance after a perturbation). We aim to investigate whether training one skill improves the others and if these improvements last over time. This research could help design practical and effective fall prevention strategies for older adults.