Abstract: Quantifying Balance and Its Relationship To Walking In Multiple Sclerosis (The 27th Annual Meeting of the CMSC and the 5th Cooperative Meeting of the CMSC-ACTRIMS)

Saturday, June 1, 2013

Scott D Newsome, D.O. , Neurology, Johns Hopkins School of Medicine, Baltimore, MD

Rhul Marasigan, B.A. , Motion Analysis Laboratory, Kennedy Krieger Institute, Baltimore, MD

Peter A Calabresi, MD, FAAN , Neurology, Johns Hopkins School of Medicine, Baltimore, MD

Kathleen M Zackowski, PhD, OT , Motion Analysis Laboratory, Kennedy Krieger Institute, Baltimore, MD

Background:

Gait dysfunction is common among individuals with MS. Previous studies have shown that weakness and balance dysfunction contribute to slow walking, and recent studies implicate these same factors as indicators of fall risk in MS. However, balance measures have not been well studied longitudinally in MS.

Objectives:

To determine the relationship of quantitative balance and lower extremity sensorimotor measures over time and their relationship to walking velocity in individuals with MS.

Methods:

57 MS subjects (28,RRMS; 25,SPMS; 4,PPMS) were evaluated longitudinally. Dynamic and static posturography was assessed under six conditions using a Kistler 9281 force plate and walking velocity was assessed with an Optotrak Motion Analysis System. Ankle dorsiflexion, hip flexion, and hip extension strength was quantified by a hand-held dynamometer and vibration thresholds at the great toe were quantified using a Vibratron-II device. Other measures recorded included EDSS and timed 25-foot walk. Pearson’s correlations were used to assess statistical significance and mixed effects regression models were used to model longitudinal outcomes.

Results:

Our cohort’s age was 47±10 (mean±SD), follow up time 1-5 years, EDSS 0-7.5, and 55% were females. All measures were significantly worse for MS subjects when compared to age and sex-matched controls (p<0.001 for all). Ankle dorsiflexion, hip flexion, hip extension, and anterior-posterior (AP) dynamic sway correlate best with walking velocity (r>0.5, p<0.001). AP dynamic sway was the only balance measure that correlated with a change in walking velocity over time. Walking speed was affected most by hip flexion and extension strength.

Conclusions:

These data suggest that strength and AP dynamic sway are both important contributors to walking performance in MS. Past studies show these two measures are also important indicators of fall risk in MS. Evaluating dynamic balance coupled with strength may lead to a more quantitative means of determining fall risk and to the development of rehabilitative strategies to decrease that risk.

P21 Quantifying Balance and Its Relationship To Walking In Multiple Sclerosis