Decreased postural balance in multiple sclerosis patients with low disability (original) (raw)
Related papers
Expanded Disability Status Scale (EDSS) estimation in multiple sclerosis from posturographic data
Gait & Posture, 2013
Expanded disability status scale (EDSS) is the most widely used clinical scale to evaluate levels of multiple sclerosis (MS). As MS can lead to disruptions in the regulation of balance and the disability can be evaluated by force platform posturography, we have developed in this study a new strategy to estimate EDSS from postural data. 118 volunteers with EDSS ranging from 0 to 4.5 participated in this study, with eyes closed. By using second-order polynomial regression models, EDSS was estimated from two postural sway parameters, respectively, the length and the surface and four recurrence quantification analysis (RQA) parameters: percentage of recurrence (%Rec), Shannon entropy (Ent), mean diagonal line length (LL) and trapping time (TT). In addition, all four RQA parameters were calculated for position, instantaneous velocity and acceleration of the center of pressure. In order to select the most accurate method for estimating EDSS, four statistical indices (percentage of agreement, underestimation and overestimation, as well as mean error) were calculated comparing clinical and estimated EDSS scores. The results demonstrate that estimations of EDSS from surface, %Rec and LL of position, best agreed with clinical scores. This study emphasizes the possibility of distinguishing EDSS scores using postural sway and RQA parameters.
Gait & Posture, 2013
Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system which can affect sensory and motor systems [1-7] crucial for balance control during stance [8-10] and gait [11]. The Expanded Disability Status Scale (EDSS) is the most widely accepted clinical rating scale for the evaluation of neurological impairment and disability in MS. It is primarily based on the individual scores of seven functional systems including the visual, brainstem, pyramidal, cerebellar, sensory, bowel/bladder, and cerebral systems as well as on the walking range and the assistance needed to ambulate. EDSS scores of MS patients have been shown to be correlated to slower gait parameters [12-14]. This slowing may be a compensation strategy to improve balance and the feeling of safety [13,15]. When considering balance alone, most studies focus on the MS population in general, and not the subjectively felt and objectively recorded balance deficits of MS patients with different grades of disability. Such a focus might provide suggestions for improved diagnostics for balance problems in the early phase of MS. Improved diagnostics are needed as clinical tests used to examine balance control disability in MS patients, for example, the Romberg test, Berg Balance Scale and EDSS, are based on clinical observations by a clinician. In addition, these clinical tests are most sensitive to moderately and severely disabled patients. Therefore, minor balance deficits might not be detected in mildly disabled patients, even though evidence exists that MS patients can suffer from balance impairment, even when the Romberg tests and tandem gait are normal [4,16]. Based on these considerations, the main goal of this study was to investigate which measures of balance control from stance and gait tests are best correlated with disease severity according to patients' EDSS scores and whether these measures were also
Multiple Sclerosis Journal, 2000
Kurtzke's EDSS remains the most widely-used measure for clinical evaluation of MS patients. However, several studies have demonstrated the limited reliability of this tool. We introduce a computerized instrument, MS-CANE (Multiple Sclerosis Computer-Aided Neurological Examination), for clinical evaluation and follow up of patients with multiple sclerosis (MS) and to compare its reliability to that of conventional Expanded Disability Status Scale (EDSS) assessment. We developed a computerized interactive instrument, based on the following principles: structured gathering of neurological findings, reduction of compound notions to their basic components, use of precise definitions, priority setting and automated calculations of EDSS and functional systems scores. An expert panel examined the consistency of MS-CANE with Kurtzke's specifications. To determine the effect of MS-CANE on the reliability of EDSS assessment, 56 MS patients underwent paired conventional EDSS and MS-CANE...
Walking has a critical role in performing physical activities in patients with multiple sclerosis (MS). The biggest cause of disability in MS patients is gait dysfunction. The Expanded Disability Status Scale (EDSS) is a well-established clinical measurement for assessing disability in MS. In the low range (0 – 3.5), the EDSS is based on the change in one or more of the functional systems. Above 4.0, gait dysfunction is primarily considered for scoring. However, gait dysfunction is very common in MS patient even in mild MS (EDSS 0 – 4). Therefore, it is needed to determine if the low EDSS scores are correlated with the walk tests. The aim of this study was to investigate the relationship between low Expanded Disability Status Scale (EDSS) scores (0-4) and the walk tests used in the clinical settings. 63 clinically defined MS patients were included in the crosssectional study. Disability level was evaluated with the EDSS by the same neurologist. Walking distance and speed were evalua...
Journal of Sport and Health Science
Background: Postural control has been associated with the functional impairment in persons with multiple sclerosis (pwMS). However, there is a need for reliable methods to assess postural control in early stages of the disease, when subtle changes can be difficult to detect. The aims of this study were to assess the absolute and relative reliability of a standing and a sitting posturographic protocol in minimally (Expanded Disability Status Scale 2) and moderately (2.5 Expanded Disability Status Scale 4) impaired pwMS, and to analyze relationships among postural control and functional mobility and gait performance. Methods: To assess postural control in an upright stance, 14 minimally and 16 moderately impaired pwMS performed six 70 s trials in tandem stance, 3 with their weaker leg behind (TS WL) and 3 with their stronger leg behind (TS SL). Additionally, participants completed five 70 s trials using an unstable sitting protocol (US) to assess trunk stability. The mean radial errors of TS WL , TS SL , and US trials were calculated as postural control indexes. Furthermore, participants performed the Timed Up and Go test (TUG) and the Timed 25-foot Walk test (T25FW) to measure their functional mobility and gait speed, respectively. Reliability was evaluated using the intraclass correlation coefficient (ICC 3,1) and the standard error of measurement (SEM). Analyses of variances were carried out to assess between-group differences. Hedges' g index (d g) was used to estimate the effect size of differences. Pearson correlation analyses (r) were performed to examine the relationships among the postural control and the functional tests. Results: Posturographic tests showed a high reliability in both minimally (0.87 ICC 0.92; 9.32% SEM 11.76%) and moderately (0.80 ICC 0.92; 10.33% SEM 15.33%) impaired pwMS. Similarly, T25FW and TUG displayed a high consistency in minimally (0.89 ICC 0.94; 3.43% SEM 5.17%) and moderately (0.85 ICC 0.93; 5.57% SEM 6.56%) impaired individuals. Minimally impaired pwMS showed a better performance on the TUG, T25FW, and TS WL than moderately impaired individuals (p < 0.05; d g 0.8). The TS WL , TS SL , and US variables correlated with TUG scores (0.419 r 0.604; p < 0.05), but TS WL also correlated with T25FW scores (r = 0.53; p < 0.01). Furthermore, US scores correlated with both tandem stance parameters (TS WL : r = 0.54, p < 0.01; TS SL : r = 0.43, p < 0.05). Conclusion: Tandem and sitting posturographic tests provide reliable measures of postural control in pwMS, even in individuals with a homogeneous disease profile. Gait speed, functional mobility, and weaker leg status seem decisive in assessing the degree of physical activity limitation in pwMS. Finally, although trunk stability does not seem to be so affected by the course of the disease, it remains relevant for postural control and functional capacity.
Physiotherapy, 2017
Background: The Balance Evaluation Systems Test (BESTest) measures various aspects of postural control, but little data exist in persons with multiple sclerosis (MS). The purpose of this study was to determine the psychometrics of the BESTest in MS. Design: Observational study. Methods: 21 ambulatory subjects with MS participated. In the first session, demographic data was collected; each subject completed a questionnaire of self-perceived disability level and the BESTest. The BESTest was re-administered one week later. Results: Test-retest reliability (ICC 3,1) for the total BESTest was 0.94, ranging 0.66 to 0.93 for the subsections. Internal consistency (Chronbach's alpha) for the total BESTest was 0.97; subsections scores ranged 0.79 to 0.96. Minimal detectable change (MDC) scores ranged from 2.25 to 4.58 for subsections with 9.47 points for total BESTest. Weak to moderate correlations were found between individual subsection scores (0.12 to 0.78), and BESTest total and subsection scores to fall (-0.08 to-0.62) frequency and self-perceived disability level (-0.24 to-0.64). Strongest correlations were found between BESTest total and individual subsection scores. No floor effects were found; five BESTest subsections had ceiling effects. Conclusions: The BESTest is reliable and valid in individuals with MS. Total BESTest scores demonstrated higher reliability and a lack of a ceiling effect as compared to subsection scores, suggesting that clinicians use the BESTest in its entirety. The correlations among subsection 3 scores indicate that each assesses a unique aspect of balance, supporting its construct validity. The MDC scores will assist clinicians in assessing patient change. Contributions of Paper: Individuals with multiple sclerosis demonstrate impairments of various systems important for balance control. The Balance Evaluation Systems Test can be used to identify the postural control systems underlying balance performance, yet little evidence exists to support its use in persons with multiple sclerosis. This study provides evidence that the Balance Evaluation Systems Test is reliable and valid in persons with multiple sclerosis; the minimal detectable change scores can assist clinicians in determining the effectiveness of a patient's plan of care.
2013
Background and purpose: Multiple sclerosis (MS) is a demyelinating disease, usually with multifocal symptoms and multiphasic course that is emerging as a result of inflammation and the formation of foci of myelin breakdown in the central nervous system as a consequence of not fully known harmful external factors. The aim of this study was to analyze the results of tests allowing to detect imbalances in patients with multiple sclerosis. Material and Methods: A 38 year old male with MS diagnosed in 2006 was examined. The study used three tests of balance: "Timed Up & Go" test, Tinetti test and Berg Balance Scale. The results of the scale were analyzed, which consisted in a variety of motor tasks assessing balance and gait. Tests were repeated every month for 10 months. Results: The results in each test over 10 months significantly change. Changes in response to the increase of the number of tasks and the difficulty of the test occured. As a consequence of impaired balance co...