Effects of External Perturbations on Anticipatory and Compensatory Postural Adjustments in Patients with Multiple Sclerosis and a Fall History

Tajali, Shirin; Rouhani, Mina; Mehravar, Mohammad; Negahban, Hossein; Sadati, Elham; Oskouei, Ali E.

doi:10.7224/1537-2073.2016-098

Cited by 28 publications

(20 citation statements)

References 31 publications

(64 reference statements)

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“…supporting the fact that learning not to fall rely on this interplay between reactive and predictive adaptations (hybrid control theory). In addition to these experimental observations, some laboratory-based measures of postural control (posturography) would be of great interest to reveal subtle deficits in the underlying control mechanisms ( 95 ) as it is aknowledged that the inability to produce APA is related to an increased likelihood of falls if older adults ( 96 ) or multiple sclerosis patients ( 97 ). Finally, a change in central set can also influence the postural response and the outcome ( 98 ).…”

Section: Discussionmentioning

confidence: 99%

An Initial Passive Phase That Limits the Time to Recover and Emphasizes the Role of Proprioceptive Information

et al. 2018

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In the present experiments, multiple balance perturbations were provided by unpredictable support-surface translations in various directions and velocities. The aim of this study was to distinguish the passive and the active phases during the pre-impact period of a fall. It was hypothesized that it should be feasible if one uses a specific quantitative kinematic analysis to evaluate the dispersion of the body segments trajectories across trials. Moreover, a multi-joint kinematical model was created for each subject, based on a new 3-D minimally invasive stereoradiographic X-ray images to assess subject-specific geometry and inertial parameters. The simulations allowed discriminating between the contributions of the passive (inertia-induced properties) and the active (neuromuscular response) components during falls. Our data show that there is limited time to adjust the way one fall from a standing position. We showed that the pre-impact period is truncated of 200 ms. During the initial part of a fall, the observed trajectory results from the interaction between the destabilizing external force and the body: inertial properties intrinsic to joints, ligaments and musculotendinous system have then a major contribution, as suggested for the regulation of static upright stance. This passive phase is later followed by an active phase, which consists of a corrective response to the postural perturbation. We believe that during a fall from standing height, it takes about 300 ms for postural responses to start correcting the body trajectory, while the impact is expected to occur around 700 ms. It has been argued that this time is sufficient to change the way one falls and that this makes it possible to apply safer ways of falling, for example by using martial arts fall techniques. Also, our results imply visual and vestibular information are not congruent with the beginning of the on-going fall. This consequence is to be noted as subjects prepare to the impact on the basis of sensory information, which would be uniquely mainly of proprioceptive origin at the fall onset. One limitation of the present analysis is that no EMG was included so far but these data are the subject of a future study.

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Section: Discussionmentioning

confidence: 99%

An Initial Passive Phase That Limits the Time to Recover and Emphasizes the Role of Proprioceptive Information

et al. 2018

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“…16,20,24,27,28 The perturbation methods used were standardized except in 1 study, 24 unpredictable in timing except in 2 studies, 18,27 but were not unpredictable in magnitude in 6 studies 16,19,[24][25][26][27] and not unpredictable in type or direction in 8 studies. [16][17][18]20,[24][25][26][27] In terms of statistical validity, 1 study 28 did not report values that could be used to calculate effect sizes. In terms of external validity, 1 study 17 did not specify the eligibility criteria, and 5 studies 16,17,19,27,28 had sample sizes smaller than 30.…”

Section: Methodological Qualitymentioning

confidence: 99%

“…The summarized methodology of the included studies is presented in the Supplementary Appendix C. Eight studies were cross-sectional studies, [15][16][17]19,20,[24][25][26] and 3 studies were intervention studies. 18,27,28 Ten studies compared participants with MS with healthy control participants, [15][16][17][18][19][20][24][25][26]28 and 3 studies studied the acute effect of reactive balance training in MS either with or without a comparison group of healthy controls. 18,27,28 Two of these later studies examined retention of the training effect over 2 days in MS and healthy control participants.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

“…18,27,28 Two of these later studies examined retention of the training effect over 2 days in MS and healthy control participants. 18,28 To evoke reactive balance, 6 studies used support surface translations, 15,17,18,20,25,28 2 used pendulum weights, 16,27 1 used a push and release test, 24 1 used a pulley-based system, 26 and 1 used a toe up rotation of the support surface. 19 All perturbations were applied while participants were standing still.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

“…Nine studies (n = 342) [15][16][17][18][19][20]25,26,28 comparing participants with MS and healthy controls in terms of reactive balance assessed by either CoM displacement, margin of stability response or onset latency were included in the meta-analysis ( Figure 2). These results show that reactive balance is significantly worse in people with MS (SMD 0.78, 95% CI 0.44-1.11, P < .0001, I 2 = 47%).…”

Section: Impact Of Ms On Reactive Balancementioning

confidence: 99%

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Reactive Balance Adaptability and Retention in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Suhaimy

Okubo

Hoang

et al. 2020

Neurorehabil Neural Repair

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Aim. To compare reactive balance in people with multiple sclerosis (MS) with healthy controls and to examine the ability of people with MS to adapt their reactive balance and retain training effects. Data Sources. Electronic databases (PubMed, EMBASE, PsychINFO) and reference lists of included articles from inception to February 25, 2019. Study Selection. Case-control and intervention studies that assessed reactive balance using mechanical perturbations in people with a confirmed diagnosis of MS. Results. Meta-analyses of 9 studies (n = 342) showed that people with MS have significantly worse reactive balance than healthy controls (standardized mean difference [SMD] 0.78, 95% CI 0.44-1.11, P < .0001, I2 = 47%). Specifically, people with MS have greater center of mass displacements (SMD 0.41, 95% CI 0.05-0.77, P = .02, I2 = 9%) and longer response times (MD (ms) 31.45, 95% CI 19.91-42.98, P < .0001, I2 = 75%) in response to standing perturbations than healthy controls. Subsequent meta-analyses revealed training comprising repeated exposure to perturbations improved response times ( P < .001) and training effects on response times could be retained for 24 hours ( P < .001) in people with MS. Conclusions. Reactive balance assessments can highlight functional impairments related to falls in people with MS, and perturbation training can acutely improve reactive balance control and such improvements can be retained for 24 hours in this population. Systematic review registration number: CRD42019126130.

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The feasibility of using an auditory cue to elicit anticipatory postural adjustments for a posterior perturbation

2022

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Effects of External Perturbations on Anticipatory and Compensatory Postural Adjustments in Patients with Multiple Sclerosis and a Fall History

Cited by 28 publications

References 31 publications

An Initial Passive Phase That Limits the Time to Recover and Emphasizes the Role of Proprioceptive Information

An Initial Passive Phase That Limits the Time to Recover and Emphasizes the Role of Proprioceptive Information

Reactive Balance Adaptability and Retention in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis

The feasibility of using an auditory cue to elicit anticipatory postural adjustments for a posterior perturbation

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