Original article
Postural Response Latencies Are Related to Balance Control During Standing and Walking in Patients With Multiple Sclerosis

https://doi.org/10.1016/j.apmr.2014.01.004Get rights and content

Abstract

Objective

To understand and examine the relation between postural response latencies obtained during postural perturbations and representative measures of balance during standing (sway variables) and walking (trunk motion).

Design

Cross-sectional.

Setting

University medical center.

Participants

Persons with multiple sclerosis (MS) (n=40) were compared with similar aged control subjects (n=20). There were 20 subjects with MS in the normal walking velocity group and 20 subjects with MS who had slow walking velocity based on a timed 25-foot walk (T25FW) of <5 seconds.

Interventions

None.

Main Outcome Measures

Postural response latency, sway variables, trunk motion variables.

Results

We found that subjects with MS with both slow or normal walking velocities had significantly longer postural response latencies than the healthy control group. Postural response latency was not correlated with the T25FW. Postural response latency was significantly correlated with center of pressure sway variables during quiet standing (root mean square: ρ=.334, P=.04; range: ρ=.385, P=.017; mean velocity: ρ=.337, P=.038; total sway area: ρ=.393, P=.015). Postural response latency was also significantly correlated with motion of the trunk during walking (sagittal plane range of motion: ρ=.316, P=.05; SD of transverse plane range of motion: ρ=−.43, P=.006).

Conclusions

These findings clearly indicate that slow postural responses to external perturbations in patients with MS contribute to disturbances in balance control during both standing and walking.

Section snippets

Participants

A total of 40 subjects with MS (mean age, 45.6±11.7y; height, 166.4±18.4cm; weight, 78.1±19.9kg) and 20 healthy controls subjects (mean age, 41.8±10.7y; height, 167.9±15.5cm; weight, 78.7±17.7kg) participated in the study.

Patients with MS (n=40), recruited through the Oregon Health Science University's MS clinic, and healthy control subjects (n=20), recruited through the community, provided informed consent. The research protocol was approved by the university's institutional review board.

Relation between postural response latency and COP sway variables

Within the individual normal walking velocity MS and slow walking velocity MS groups, there were no significant correlations between postural response latency and COP displacement root mean square, range, mean velocity, or total sway area. Across all subjects with MS, postural response latency was significantly correlated with COP displacement root mean square (r=.363, P=.025), range (r=.37, P=.022), mean velocity (ρ=.349, P=.032), and total sway area (r=.353, P=.03). Within the healthy control

Discussion

The purpose of this study was to examine the relation between postural response latencies and balance dysfunction during standing and walking in patients with MS. Postural response latency was measured in subjects with MS who had no clinical gait deficits (normal walking velocity MS group), in subjects with MS with slow gait velocity (slow walking velocity MS group), and in similar-aged healthy control subjects. The automatic postural responses of the healthy controls to these moderate

Conclusions

Persons with MS have delayed responses to postural perturbation, and these responses contribute to disturbances in postural control during both standing and walking. However, it is not clear how other factors (eg, loss of strength, spasticity, fatigue) impact gait and postural control. It will be necessary to examine postural response latency and gait and balance variables across a larger and broader spectrum of disability levels in subjects with MS to better understand whether postural

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    Supported by the National Multiple Sclerosis Society (grant no. MB 0011) and the National Institutes of Health (grant no. AG006457).

    No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.

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