Abstract
People with multiple sclerosis (MS) often have poor postural control, which likely underlies their increased risk of falls. Based on several studies of balance and gait in MS, it appears that the primary mechanisms underlying the observed changes are slowed somatosensory conduction and impaired central integration. This review of the published research on balance, gait, and falls in people with MS demonstrates that people with MS have balance impairments characterized by increased sway in quiet stance, delayed responses to postural perturbations, and a reduced ability to move toward their limits of stability. These impairments are likely causes of falls in people with MS and are consistent with the reduced gait speed, as well as decreased stride length, cadence, and joint movement, observed in most studies of gait in MS. Based on these findings, we identify several factors that may be amenable to intervention to prevent falls in people with MS.
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Jackson RT, Epstein CM, De l'Aune WR: Abnormalities in posturography and estimations of visual vertical and horizontal in multiple sclerosis. Am J Otol 1995, 16:88–93.
Soyuer F, Mirza M, Erkorkmaz U: Balance performance in three forms of multiple sclerosis. Neurol Res 2006, 28:555–562.
Nelson SR, Di Fabio RP, Anderson JH: Vestibular and sensory interaction deficits assessed by dynamic platform posturography in patients with multiple sclerosis. Ann Otol Rhinol Laryngol 1995, 104:62–68.
Corradini ML, Fioretti S, Leo T, Piperno R: Early recognition of postural disorders in multiple sclerosis through movement analysis: a modeling study. IEEE Trans Biomed Eng 1997, 44:1029–1038.
Karst GM, DM Venema, TG Roehrs, AE Tyler: Center of pressure measures during standing tasks in minimally impaired persons with multiple sclerosis. J Neurol Phys Ther 2005, 29:170–180.
ML Daley, RL Swank: Quantitative posturography: use in multiple sclerosis. IEEE Trans Biomed Eng 1981, 28:668–671.
National Multiple Sclerosis Society: Multiple Sclerosis Information Sourcebook. New York: National MS Society; 2006.
Pratt CA, Horak FB, Herndon RM: Differential effects of somatosensory and motor system deficits on postural dyscontrol in multiple sclerosis patients. In Posture and Gait: Control Mechanisms, vol 2. Edited by Woollacott M, Horak FB. Portland, OR: University of Oregon Books; 1992:118–121.
Diener HC, Dichgans J, Hulser PJ, et al.: The significance of delayed long-loop responses to ankle displacement for the diagnosis of multiple sclerosis. Electroencephalogr Clin Neurophysiol 1984, 57:336–342.
• Cameron MH, Horak FB, Herndon RR, Bourdette D: Imbalance in multiple sclerosis: a result of slowed spinal somatosensory conduction. Somatosens Mot Res 2008, 25:113–122. This study indicates that slowed spinal somatosensory conduction correlates with impaired balance responses in MS.
Martin CL, Phillips BA, Kilpatrick TJ, et al.: Gait and balance impairment in early multiple sclerosis in the absence of clinical disability. Mult Scler 2006, 12:620–628.
Daley ML, Swank RL: Changes in postural control and vision induced by multiple sclerosis. Agressologie 1983, 24:327–329.
Ramdharry GM, Marsden JF, Day BL, Thompson AJ: De-stabilizing and training effects of foot orthoses in multiple sclerosis. Mult Scler 2006, 12:219–226.
Rougier P, Thoumie P, Cantalloube S, Lamotte D: What compensatory motor strategies do patients with multiple sclerosis develop for balance control? [in French]. Rev Neurol (Paris) 2007, 163:1054–1064.
Chung LH, Remelius JG, Van Emmerik RE, Kent-Braun JA: Leg power asymmetry and postural control in women with multiple sclerosis. Med Sci Sports Exerc 2008, 40:1717–1724.
Cattaneo D, Jonsdottir J: Sensory impairments in quiet standing in subjects with multiple sclerosis. Mult Scler 2009, 15:59–67.
Frzovic D, Morris ME, Vowels L: Clinical tests of standing balance: performance of persons with multiple sclerosis. Arch Phys Med Rehabil 2000, 81:215–221.
Remelius JG, Hamill J, Kent-Braun J, Van Emmerik RE: Gait initiation in multiple sclerosis. Motor Control 2008, 12:93–108.
Williams NP, Roland PS, Yellin W: Vestibular evaluation in patients with early multiple sclerosis. Am J Otol 1997, 18:93–100.
Horak FB, Diener HC: Cerebellar control of postural scaling and central set in stance. J.Neurophysiol 1994, 72:479–493.
Lanzetta D, Cattaneo D, Pellegatta D, Cardini R: Trunk control in unstable sitting posture during functional activities in healthy subjects and patients with multiple sclerosis. Arch Phys Med Rehabil 2004, 85:279–283.
Gehlsen G, Beekman K, Assmann N, et al.: Gait characteristics in multiple sclerosis: progressive changes and effects of exercise on parameters. Arch Phys Med Rehabil 1986, 67:536–539.
Morris ME, Cantwell C, Vowels L, Dodd K: Changes in gait and fatigue from morning to afternoon in people with multiple sclerosis. J Neurol Neurosurg Psychiatry 2002, 72:361–365.
Mevellec E, Lamotte D, Cantalloube S, et al.: Relationship between gait speed and strength parameters in multiple sclerosis [in French]. Ann Readapt Med Phys 2003, 46:85–90.
Benedetti MG, Piperno R, Simoncini L, et al.: Gait abnormalities in minimally impaired multiple sclerosis patients. Mult Scler 1999, 5:363–368.
Thoumie P, Lamotte D, Cantalloube S, et al.: Motor determinants of gait in 100 ambulatory patients with multiple sclerosis. Mult Scler 2005, 11:485–491.
Crenshaw SJ, Royer TD, Richards JG, Hudson DJ: Gait variability in people with multiple sclerosis. Mult Scler 2006, 12:613–619.
Givon U, Zeilig G, Achiron A: Gait analysis in multiple sclerosis: characterization of temporal-spatial parameters using GAITRite functional ambulation system. Gait Posture 2009, 29:138–142.
• Hamilton F, Rochester L, Paul L, et al.: Walking and talking: an investigation of cognitive-motor dual tasking in multiple sclerosis. Mult Scler 2009, 15:1215–1227. This study found greater slowing of gait in people with MS than in healthy controls when concurrently performing a cognitive task, indicating the contribution of impaired central processing to postural control dysfunction in MS.
Motl RW, Snook EM, Agiovlasitis S, Suh Y: Calibration of accelerometer output for ambulatory adults with multiple sclerosis. Arch Phys Med Rehabil 2009, 90:1778–1784.
Remelius JG, Jones SL, House JD, Van Emmerik RE: The influence of walking speed on the spatiotemporal parameters of gait in people with multiple sclerosis. Proc Intl Soc Posture Gait Res 2009.
Cattaneo D, De Nuzzo C, Fascia T, et al.: Risk of falls in subjects with multiple sclerosis. Arch Phys Med Rehabil 2002, 83:864–867.
Finlayson ML, Peterson EW, Cho CC: Risk factors for falling among people aged 45 to 90 years with multiple sclerosis. Arch Phys Med Rehabil 2006, 87:1274–1279.
Peterson EW, Cho CC, Finlayson ML: Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis. Mult Scler 2007, 13:1168–1175.
Peterson EW, Cho CC, von Koch L, Finlayson ML: Injurious falls among middle aged and older adults with multiple sclerosis. Arch Phys Med Rehabil 2008, 89:1031–1037.
• Nilsagard Y, Lundholm C, Denison E, Gunnarsson LG: Predicting accidental falls in people with multiple sclerosis—a longitudinal study. Clin Rehabil 2009, 23:259–269. This is the only prospective study of fall frequency in people with MS; 48 of 76 subjects registered a total of 270 falls over 3 months.
Bronnum-Hansen H, Hansen T, Koch-Henriksen N, Stenager E: Fatal accidents among Danes with multiple sclerosis. Mult Scler 2006, 12:329–332.
Hauer K, Lamb SE, Jorstad EC, et al.: Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing 2006, 35:5–10.
Nilsagard Y, Denison E, Gunnarsson LG, Bostrom K: Factors perceived as being related to accidental falls by persons with multiple sclerosis. Disabil Rehabil 2009, 31:1301–1310.
Gillespie LD, Robertson MC, Gillespie WJ, et al.: Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009, CD007146.
Freeman J, Allison R: Group exercise classes in people with multiple sclerosis: a pilot study. Physiother Res Int 2004, 9:104–107.
Cattaneo D, Marazzini F, Crippa A, Cardini R: Do static or dynamic AFOs improve balance? Clin Rehabil 2002, 16:894–899.
Smedal T, Lygren H, Myhr KM, et al.: Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept. Physiother Res Int 2006, 11:104–116.
•• Cattaneo D, Jonsdottir J, Zocchi M, Regola A: Effects of balance exercises on people with multiple sclerosis: a pilot study. Clin Rehabil 2007, 21:771–781.This study demonstrates that balance rehabilitation to improve sensory as well as motor strategies improves balance and reduces fall frequency more effectively than balance rehabilitation aimed only at improving motor strategies or than nonspecific rehabilitation treatments.
Jeka JJ, Lackner JR: Fingertip contact influences human postural control. Exp Brain Res 1994, 100:495–502.
Rogers MW, Wardman DL, Lord SR, Fitzpatrick RC: Passive tactile sensory input improves stability during standing. Exp Brain Res 2001, 136:514–522.
Menz HB, Lord SR, Fitzpatrick RC: A tactile stimulus applied to the leg improves postural stability in young, old and neuropathic subjects. Neurosci Lett 2006, 406:23–26.
Lord SR, Bashford GM, Howland A, Munroe BJ: Effects of shoe collar height and sole hardness on balance in older women. J Am Geriatr Soc 1999, 47:681–684.
Maki BE, Perry SD, Norrie RG, McIlroy WE: Effect of facilitation of sensation from plantar foot-surface boundaries on postural stabilization in young and older adults. J Gerontol Biol Sci Med Sci 1999, 54:M281–M287.
Ashton-Miller JA, Yeh MW, Richardson JK, Galloway T: A cane reduces loss of balance in patients with peripheral neuropathy: results from a challenging unipedal balance test. Arch Phys Med Rehabil 1996, 77:446–452.
Magee DJ: Orthopedic Physical Assessment. edn 5. St. Louis: Elsevier; 2007.
Acknowledgment
Dr. Cameron was supported in this work by a Sylvia Lawry Fellowship from the National Multiple Sclerosis Society and by a Jacqueline Du Pré award from the Multiple Sclerosis International Federation.
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Cameron, M.H., Lord, S. Postural Control in Multiple Sclerosis: Implications for Fall Prevention. Curr Neurol Neurosci Rep 10, 407–412 (2010). https://doi.org/10.1007/s11910-010-0128-0
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DOI: https://doi.org/10.1007/s11910-010-0128-0