Comprehensive Summary
This study by Monaghan et al. investigates the neural outcomes of forward and backward walking in individuals with multiple sclerosis (MS), a condition often characterized by mobility impairment due to myelin degradation. 43 individuals with relapsing-remitting MS completed walking tests in both directions, and researchers used myelin water imaging (MWI) to examine the myelin in motor tracts, particularly the corpus callosum, the superior and inferior cerebellar peduncles, and the corticospinal tract. Regression models tested the strength of the relationship between these myelin metrics and walking speed (controlling for age and disease severity), revealing that higher myelin water fraction in the superior cerebellar peduncle predicted faster backward walking velocity, while higher myelin water fraction in the corpus callosum predicted faster forward velocity. These results suggested that forward and backward walking patterns rely on different neural pathways, and targeting cerebellar pathways may prove beneficial in improving rehabilitation outcomes in patients with MS.
Outcomes and Implications
This study emphasizes the clinical utility of assessing backward walking speeds in patients with MS, as it may reveal more mobility deficits that are not captured with just forward walking tests. By correlating cerebellar myelin levels with backward walking, clinicians and researchers can point to new rehabilitation targets to help improve gait stability and reduce fall risks in patients with MS. Overall, this study suggests that integrating backward walking tests would help target deficits earlier and emphasize interventions targeting cerebellar pathways to improve motor function.