The Impact of Dynamic Balance Measures on Walking Performance in Multiple Sclerosis

Abstract

Background Static posture imbalance and gait dysfunction are common in individuals with multiple sclerosis (MS). Although the impact of strength and static balance on walking has been examined, little is known about the impact of dynamic standing balance on walking in MS. Objective To determine the impact of dynamic balance, static balance, sensation, and strength measures to walking in individuals with MS. Methods 52 individuals with MS (27 females; 26 relapsing-remitting; mean age 45.6±10.3 years; median EDSS 3.5 (range 0-7) participated in testing for dynamic and static posturography (Kistler 9281 force plate), hip flexion, hip extension, and ankle dorsiflexion strength (Microfet2 hand-held dynamometer), sensation (Vibratron II) and walk velocity (Optotrak Motion Analysis System). Mann-Whitney tests, Spearman correlation coefficients, and forward stepwise multiple regression were used to assess statistical significance. Results All measures were significantly abnormal in MS subjects when compared to age and sex-matched norms (p<0.05 for all). Static balance (eyes open, feet together [EOFT]), anterior- posterior (AP) dynamic sway, and hip extension strength were strongly correlated with fast walking velocity (AP sway r=0.68; hip extension strength r=0.73; EOFT r=-0.40). Together, AP dynamic sway (ρr=0.71, p<0.001), hip extension strength (ρr=0.54, p<0.001), and EOFT static balance (ρr=-0.41, p=0.01) explained more than 70% of the variance in fast walking velocity (p<0.001). Conclusions These data suggest that AP dynamic sway impacts walking performance in MS. A combined evaluation of dynamic balance, static balance and strength may lead to a better understanding of walking mechanisms as well as the development of strategies to improve walking.

Glucose uptake heterogeneity of the leg muscles is similar between patients with multiple sclerosis and healthy controls during walking

“…Muscle weakness is common in patients with MS, but is not always present and can vary by muscle group [22, 28, 29, 30]. Asymmetries in muscular strength have also been found, which were associated with motor task deficits [2, 13, 28, 29].…”

Psychometric Properties of a Clinical Strength Assessment Protocol in People with Multiple Sclerosis

“…Compared with MMT, HHD quantifies strength more accurately, 13 is more responsive to small changes in muscle strength, 14 and may be more reliable. 9,11 Although not as common in research as isokinetic dynamometry, HHD has been used in a variety of studies in people with MS. [15][16][17][18][19][20] Handheld dynamometry has adequate concurrent validity to isokinetic dynamometry in both healthy and other neurologic populations and has been proposed as a clinically feasible alternative to isokinetic dynamometry in terms of cost, ease of use, and efficiency. 12 Handheld dynamometry has the potential to be a useful clinical outcome for people with MS; however, little is known about its psychometric properties in this population.…”

Direction-specific impairments of limits of stability in individuals with multiple sclerosis

“…Impairment in balance control could be seen in people with MS with significant clinical symptoms [4], with minimal symptoms [2,5], and even with no clinical symptoms [6]. Balance impairment is a significant contributing factor for fall risk in people with MS [1,7] and is also often associated with mobility limitations and reduced engagement in physical activity [8].…”