Stabilometric assessment of context dependent balance recovery in persons with multiple sclerosis: a randomized controlled study

Davide Cattaneo, Johanna Jonsdottir, Alberto Regola, Roberta Carabalona, Davide Cattaneo, Johanna Jonsdottir, Alberto Regola, Roberta Carabalona

Abstract

Background: Balance control relies on accurate perception of visual, somatosensory and vestibular cues. Sensory flow is impaired in Multiple Sclerosis (MS) and little is known about the ability of the sensory systems to adapt after neurological lesions reducing sensory impairment. The aims of the present study were to verify whether: 1. Balance rehabilitation administered in a challenging sensory conditions would improve stability in upright posture. 2. The improvement in a treated sensory condition would transfer to a non treated sensory condition.

Methods: Fifty three persons with MS, median (min-max) EDSS score of 5 (2.5-6.5), participated in a RCT and were randomly assigned to two groups. The Experimental group received balance rehabilitation aimed at improving motor and sensory strategies. The Control group received rehabilitation treatment which did not include training of sensory strategies. Persons with MS were blindly assessed by means of a stabilometric platform with eyes open, eyes closed and dome, on both firm surface and foam. Anterior-posterior and medio-lateral sway, velocity of sway and the length of Center of Pressure (CoP) trajectory were calculated in the six sensory conditions.

Results: Experimental group showed statistically significant improvement (P < 0.05) in stability in upright posture in eyes closed condition on firm surface, and in eyes open, closed, and dome conditions on foam. No differences were observed between groups in the eyes open condition on firm surface nor in the sensory condition not addressed during the treatment.

Conclusions: After rehabilitation people with MS can recover from sensory impairments thus improving upright balance. Further, the improvement seems to be context-dependent and present just in the treated sensory conditions.

Trial registration: ClinicalTrials NCT02131285.

Figures

Figure 1
Figure 1
Median and 25° − 75° percentiles of Transformed Post-Transformed Pre (i.e., Delta) values for experimental and control group. Panel a - eyes open-firm surface and eyes closed-firm surface sensory conditions. Panel b - eyes open-compliant surface and eyes closed-compliant surface sensory conditions. Panel c - sway referenced-firm surface and sway referenced-firm surface sensory conditions. P-Values are also superimposed in correspondence to a statistically significant post-hoc comparison. EXP: Experimental Group, CTRL: Control Group. TSwayAP [expressed in mm-1]: reciprocal of the SwayAP of the CoP trajectory. TSwayML [expressed in mm-1]: reciprocal of the SwayML of the CoP trajectory. TVelAP [expressed in (mm/s)−1]: reciprocal of the VelAP of the CoP trajectory. TVelML [expressed in (mm/s)−1]: reciprocal of the VelML of the CoP trajectory. TLength [expressed in mm-1]: reciprocal of the length of the CoP trajectory.
Figure 2
Figure 2
30 seconds CoP path of a representative subject in the experimental and in the control group before and after rehabilitation. EXP: Experimental Group, CTRL: Control Group. The center of the base of support is represented by a red asterisks; The blue lines with dots represent pre-assessment, the green lines with diamonds represent post-assessment. Data were sampled at 20 Hz.

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Source: PubMed

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