Mobility, Balance and Falls in Persons with Multiple Sclerosis

Abstract

BackgroundThere is a lack of information concerning the relation between objective measures of gait and balance and fall history in persons with MS (PwMS). This investigation assessed the relation between demographic, clinical, mobility and balance metrics and falls history in persons with multiple sclerosis (MS).Methods52 ambulatory persons with MS (PwMS) participated in the investigation. All persons provided demographic information including fall history over the last 12 months. Disease status was assessed with Expanded Disability Status Scale (EDSS). Walking speed, coordination, endurance and postural control were quantified with a multidimensional mobility battery.ResultsOver 51% of the participants fell in the previous year with 79% of these people being suffering recurrent falls. Overall, fallers were older, had a greater prevalence of assistive devices use, worse disability, decreased walking endurance, and greater postural sway velocity with eyes closed compared to non-fallers. Additionally, fallers had greater impairment in cerebellar, sensory, pyramidal, and bladder/bowel subscales of the EDSS.ConclusionsThe current observations suggest that PwMS who are older, more disabled, utilize an assistive device, have decreased walking coordination and endurance and have diminished balance have fallen in the previous year. This suggests that individuals who meet these criteria need to be carefully monitored for future falls. Future research is needed to determine a prospective model of falls specific to PwMS. Additionally, the utility of interventions aimed at reducing falls and fall risk in PwMS needs to be established.

Medications Are Associated with Falls in People with Multiple Sclerosis

“…The proportions of fallers and injurious fallers found in this study, 58% and 44%, respectively, for the entire sample are consistent with other studies of falls in people with MS. [1][2][3][4]7,11,[22][23][24][25] However, the US sample fell more (72% fallers) than has been found in previous studies and more than the Australian sample, despite on average being less disabled and younger than the Australian sample. The reasons for this difference are uncertain but may be related to younger age, which has been found to be associated with increased fall risk in MS, 26 or to other unmeasured differences in the samples or in health-care delivery between countries.…”

“…9 Fall risk in MS is generally attributed to impairments in the wide range of functions affected by the disease, including balance, cognition, vision, muscle strength and tone, coordination, and sensation. 10,11 Although there are limited interventions available to modify these endogenous fall risk factors, modifiable exogenous factors may also contribute to fall risk in MS. In older people, in whom fall risk is most well understood, the use of multiple medications, 12 particularly psychotropics, has been found to significantly increase fall risk, 13,14 and modifying medication prescription can prevent falls.…”

Three-Month Test-Retest Reliability of Center of Pressure Motion During Standing Balance in Individuals with Multiple Sclerosis

“…The ApEn quantifies the time-dependent structure of a signal and was calculated based on established procedures. 12 These particular COP parameters were selected because they have previously distinguished between fallers and nonfallers in MS 5,13 and distinguished slight changes in COP motion between testing conditions. 7,12 For an individual participant, computed values of COP measures were averaged within each condition.…”

Objective and subjective measures reflect different aspects of balance in multiple sclerosis

“…Clinical experience and extensive research using a variety of measures indicate that balance problems are common in people with multiple sclerosis (PwMS) [1][2][3][4][5]. PwMS subjectively report reduced balance confidence, frequent falls, and an increased fear of falling [6][7].…”

“…While many objective and subjective measures have been used to examine balance in PwMS [2][3]5,10], the best measure of balance in MS has not been established, nor is it known whether it is advantageous to establish a single test. For this study, we used dynamic posturography to objectively quantify balance in PwMS because this is the gold standard objective measure of standing postural control and because this has been used previously to quantify balance in PwMS [3][4][11][12].…”