Purpose. The aim of the study was to investigate differences in balance control between individuals with multiple sclerosis (MS) and healthy control subjects using clinical scales and instrumented measures of balance and determine relationships between balance measures, fatigue, and disability levels in individuals with MS with and without a history of falls. Method. Twelve individuals with MS and twelve healthy controls were evaluated using the Berg Balance and Activities-specific Balance Confidence Scales, Modified Clinical Test of Sensory Interaction on Balance, and Limits of Stability Tests as well as Fatigue Severity Scale and Barthel Index. Results. Mildly affected individuals with MS had significant balance performance deficits and poor balance confidence levels ( ). MS group had higher sway velocities and diminished stability limits ( ), significant sensory impairments, high fatigue and disability levels ( ). Sway velocity was a significant predictor of balance performance and the ability to move towards stability limits for the MS group. For the MS-fallers group, those with lower disability levels had faster movement velocities and better balance performance. Conclusion. Implementation of both clinical and instrumented tests of balance is important for the planning and evaluation of treatment outcomes in balance rehabilitation of people with MS. 1. Introduction Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease affecting the central nervous system [1]. Postural imbalance is often described as one of the initial symptoms of MS [2–5]. It is one of the most disabling MS symptoms that affects about 75% of patients during the course of the disease [6, 7]. People with MS also fall frequently [8–12], experiencing injurious falls [10, 13, 14]. Poor balance control is a significant contributing factor to the increased risk of falling in individuals with MS [2, 8–12, 15] and is also associated with lower engagement in physical activity [16]. Likewise, fear of falling is also associated with an increased risk of falls in MS [9, 17], and over 80% of people with fear also report activity curtailment [17]. Furthermore, people with MS identify fatigue as one of the primary reasons for falling [10, 18]. Balance control in people with MS has been commonly assessed through performance-based clinical measures such as the ability to maintain steady stance under conditions of reduced base of support with and without visual inputs [19–21], the ability to move towards stability limits [4, 20, 21], and through clinical measures or tests of balance
References
[1]
C. Bjartmar and B. D. Trapp, “Axonal and neuronal degeneration in multiple sclerosis: mechanisms and functional consequences,” Current Opinion in Neurology, vol. 14, no. 3, pp. 271–278, 2001.
[2]
M. H. Cameron and S. Lord, “Postural control in multiple sclerosis: implications for fall prevention,” Current Neurology and Neuroscience Reports, vol. 10, no. 5, pp. 407–412, 2010.
[3]
O. Findling, J. Sellner, N. Meier et al., “Trunk sway in mildly disabled multiple sclerosis patients with and without balance impairment,” Experimental Brain Research, vol. 213, no. 4, pp. 363–370, 2011.
[4]
C. L. Martin, B. A. Phillips, T. J. Kilpatrick et al., “Gait and balance impairment in early multiple sclerosis in the absence of clinical disability,” Multiple Sclerosis, vol. 12, no. 5, pp. 620–628, 2006.
[5]
N. P. Williams, P. S. Roland, and W. Yellin, “Vestibular evaluation in patients with early multiple sclerosis,” American Journal of Otology, vol. 18, no. 1, pp. 93–100, 1997.
[6]
I. C. A. McDonald, “Symptoms and signs in the course of disease,” in McAlpine's Multiple Sclerosis, A. Compston, I. R. McDonald, J. Noseworthy, et al., Eds., Churchill Livingstone, Philadelphia, Pa, USA, 2005.
[7]
B. Missaoui and P. Thoumie, “How far do patients with sensory ataxia benefit from so-called “proprioceptive rehabilitation”?” Neurophysiologie Clinique, vol. 39, no. 4-5, pp. 229–233, 2009.
[8]
D. Cattaneo, C. De Nuzzo, T. Fascia, M. Macalli, I. Pisoni, and R. Cardini, “Risks of falls in subjects with multiple sclerosis,” Archives of Physical Medicine and Rehabilitation, vol. 83, no. 6, pp. 864–867, 2002.
[9]
M. L. Finlayson, E. W. Peterson, and C. C. Cho, “Risk factors for falling among people aged 45 to 90 years with multiple sclerosis,” Archives of Physical Medicine and Rehabilitation, vol. 87, no. 9, pp. 1274–1279, 2006.
[10]
P. N. Matsuda, A. Shumway-Cook, A. M. Bamer, S. L. Johnson, D. Amtmann, and G. H. Kraft, “Falls in multiple sclerosis,” PM R, vol. 3, no. 7, pp. 624–632, 2011.
[11]
Y. Nilsag？rd, C. Lundholm, E. Denison, and L. G. Gunnarsson, “Predicting accidental falls in people with multiple sclerosis—a longitudinal study,” Clinical Rehabilitation, vol. 23, no. 3, pp. 259–269, 2009.
[12]
J. J. Sosnoff, M. J. Socie, M. K. Boes, et al., “Mobility, balance and falls in persons with multiple sclerosis,” PLoS ONE, vol. 6, no. 11, Article ID e28021, 2011.
[13]
M. H. Cameron, A. J. Poel, J. K. Haselkorn, A. Linke, and D. Bourdette, “Falls requiring medical attention among veterans with multiple sclerosis: a cohort study,” Journal of Rehabilitation Research and Development, vol. 48, no. 1, pp. 13–20, 2011.
[14]
E. W. Peterson, C. C. Cho, L. von Koch, and M. L. Finlayson, “Injurious falls among middle aged and older adults with multiple sclerosis,” Archives of Physical Medicine and Rehabilitation, vol. 89, no. 6, pp. 1031–1037, 2008.
[15]
S. L. Kasser, J. V. Jacobs, J. T. Foley, B. J. Cardinal, and G. F. Maddalozzo, “A prospective evaluation of balance, gait, and strength to predict falling in women with multiple sclerosis,” Archives of Physical Medicine and Rehabilitation, vol. 92, no. 11, pp. 1840–1846, 2011.
[16]
R. W. Motl, E. M. Snook, E. McAuley, and R. C. Gliottoni, “Symptoms, self-efficacy, and physical activity among individuals with multiple sclerosis,” Research in Nursing and Health, vol. 29, no. 6, pp. 597–606, 2006.
[17]
E. W. Peterson, C. C. Cho, and M. L. Finlayson, “Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis,” Multiple Sclerosis, vol. 13, no. 9, pp. 1168–1175, 2007.
[18]
Y. Nilsag？rd, E. Denison, L. G. Gunnarsson, and K. Bostr？m, “Factors perceived as being related to accidental falls by persons with multiple sclerosis,” Disability and Rehabilitation, vol. 31, no. 16, pp. 1301–1310, 2009.
[19]
S. Citaker, A. G. Gunduz, M. B. Guclu, B. Nazliel, C. Irkec, and D. Kaya, “Relationship between foot sensation and standing balance in patients with multiple sclerosis,” Gait and Posture, vol. 34, no. 2, pp. 275–278, 2011.
[20]
D. Frzovic, M. E. Morris, and L. Vowels, “Clinical tests of standing balance: performance of persons with multiple sclerosis,” Archives of Physical Medicine and Rehabilitation, vol. 81, no. 2, pp. 215–221, 2000.
[21]
F. Soyuer, M. Mirza, and ü. Erkorkmaz, “Balance performance in three forms of multiple sclerosis,” Neurological Research, vol. 28, no. 5, pp. 555–562, 2006.
[22]
D. Cattaneo and J. Jonsdottir, “Sensory impairments in quiet standing in subjects with multiple sclerosis,” Multiple Sclerosis, vol. 15, no. 1, pp. 59–67, 2009.
[23]
D. Cattaneo, J. Jonsdottir, and S. Repetti, “Reliability of four scales on balance disorders in persons with multiple sclerosis,” Disability and Rehabilitation, vol. 29, no. 24, pp. 1920–1925, 2007.
[24]
D. Cattaneo, A. Regola, and M. Meotti, “Validity of six balance disorders scales in persons with multiple sclerosis,” Disability and Rehabilitation, vol. 28, no. 12, pp. 789–795, 2006.
[25]
L. Prosperini, D. Fortuna, C. Gianni, L. Leonardi, and C. Pozzilli, “The diagnostic accuracy of static posturography in predicting accidental falls in people with multiple sclerosis,” Neurorehabil Neural Repair, vol. 27, no. 1, pp. 45–52, 2012.
[26]
G. M. Karst, D. M. Venema, T. G. Roehrs, and A. E. Tyler, “Center of pressure measures during standing tasks in minimally impaired persons with multiple sclerosis,” Journal of Neurologic Physical Therapy, vol. 29, no. 4, pp. 170–180, 2005.
[27]
L. Prosperini, A. Kouleridou, N. Petsas et al., “The relationship between infratentorial lesions, balance deficit and accidental falls in multiple sclerosis,” Journal of the Neurological Sciences, vol. 304, no. 1-2, pp. 55–60, 2011.
[28]
R. E. A. Van Emmerik, J. G. Remelius, M. B. Johnson, L. H. Chung, and J. A. Kent-Braun, “Postural control in women with multiple sclerosis: effects of task, vision and symptomatic fatigue,” Gait and Posture, vol. 32, no. 4, pp. 608–614, 2010.
[29]
C. Fjeldstad, G. Pardo, D. Bemben, and M. Bemben, “Decreased postural balance in multiple sclerosis patients with low disability,” International Journal of Rehabilitation Research, vol. 34, no. 1, pp. 53–58, 2011.
[30]
J. F. Kurtzke, “Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS),” Neurology, vol. 33, no. 11, pp. 1444–1452, 1983.
[31]
K. O. Berg, S. L. Wood-Dauphinee, J. I. Williams, and B. Maki, “Measuring balance in the elderly: validation of an instrument,” Canadian Journal of Public Health, vol. 83, no. 2, pp. S7–S11, 1992.
[32]
L. E. Powell and A. M. Myers, “The activities-specific balance confidence (ABC) scale,” Journals of Gerontology Series A, vol. 50, no. 1, pp. M28–M34, 1995.
[33]
L. B. Krupp, N. G. LaRocca, J. Muir-Nash, and A. D. Steinberg, “The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus,” Archives of Neurology, vol. 46, no. 10, pp. 1121–1123, 1989.
[34]
G. Neuberger, “Measures of fatigue. The fatigue questionnaire, fatigue severity scale, multidimensional assessment of fatigue scale, and short form-36 vitality (energy/fatigue) subscale of the short form health survey,” Arthritis Care & Research, vol. 49, no. 5S, pp. S175–S183, 2003.
[35]
C. Jerosch-Herold, “Assessment of sensibility after nerve injury and repair: a systematic review of evidence for validity, reliability and responsiveness of tests,” Journal of Hand Surgery, vol. 30, no. 3, pp. 252–264, 2005.
[36]
F. I. Mahoney and D. W. Barthel, “Functional evaluation: the Barthel index,” Maryland State Medical Journal, vol. 14, pp. 61–65, 1965.
[37]
L. Nicholl, J. Hobart, L. Dunwoody, F. Cramp, and A. Lowe-Strong, “Measuring disability in multiple sclerosis: is the Community Dependency Index an improvement on the Barthel Index?” Multiple Sclerosis, vol. 10, no. 4, pp. 447–450, 2004.
[38]
D. T. Wade and C. Collin, “The Barthel ADL Index: a standard measure of physical disability?” International Disability Studies, vol. 10, no. 2, pp. 64–67, 1988.
[39]
J. G. Remelius, J. Hamill, J. Kent-Braun, and R. E. A. Van Emmerik, “Gait initiation in multiple sclerosis,” Motor Control, vol. 12, no. 2, pp. 93–108, 2008.
[40]
T. Smedal, A. G. Beiske, S. B. Glad et al., “Fatigue in multiple sclerosis: associations with health-related quality of life and physical performance,” European Journal of Neurology, vol. 18, no. 1, pp. 114–120, 2011.
[41]
M. P. Amato, G. Ponziani, F. Rossi, C. L. Liedl, C. Stefanile, and L. Rossi, “Quality of life in multiple sclerosis: the impact of depression, fatigue and disability,” Multiple Sclerosis, vol. 7, no. 5, pp. 340–344, 2001.
[42]
M. G. Benedetti, R. Piperno, L. Simoncini, P. Bonato, A. Tonini, and S. Giannini', “Gait abnormalities in minimally impaired multiple sclerosis patients,” Multiple Sclerosis, vol. 5, no. 5, pp. 363–368, 1999.
[43]
S. M. Moen, E. G. Celius, L. Nordsletten, and T. Holm？y, “Fractures and falls in patients with newly diagnosed clinically isolated syndrome and multiple sclerosis,” Acta Neurologica Scandinavica, vol. 124, no. 191, pp. 79–82, 2011.
