Balance-Based Torso-Weighting Results in Fall Reduction during Sensory Organization Test for People with Multiple Sclerosis

Friday, May 30, 2014: 1:40 PM
Coronado C
Kristin K Horn, BS , Physical Therapy, Samuel Merritt University, Oakland, CA
Cynthia Gibson-Horn, PT , Physical Therapy, Samuel Merritt University, Oakland, CA
Diane D Allen, PT, PhD , Graduate Program in Physical Therapy, University of California San Francisco/San Francisco State University, San Francisco, CA
Gail L Widener, PT, PhD , Physical Therapy, Samuel Merritt University, Oakland, CA

Background: People with multiple sclerosis (MS) fall frequently. Balance-based torso-weighting (BBTW) can improve gait speed and increase time spent in single-limb support while walking. However, the association between BBTW and falls has not yet been examined in people with MS. 

Objectives: Investigate the effects of BBTW on balance and fall frequency recorded by the sensory organization test (SOT) in people with MS.

Methods: 51 people with MS with self-identified gait and balance difficulties (Disease Steps 1-4) completed the SOT on the SMART EquiTest® BalanceMaster twice in a single session, once without weights and a second time following placement of weights using the BBTW method. Data were collected as a part of an extensive testing protocol, generally lasting 3 to 5 hours, in which participants completed additional impairment and mobility testing with and without weights. A mandatory rest break followed BBTW assessment and weighting with additional breaks given as needed. Participant fatigue in two cases resulted in abbreviated testing. The SOT composite score (CS) recorded participants’ quiet standing for 3 trials in each of 6 conditions: eyes open (EO), eyes closed (EC), surround moving (EO), platform moving (EO), platform moving (EC) and platform and surround moving together (EO). The number of falls occurring in all trials of both no weight (NW) and weighted (WT) conditions were tallied. A fall was defined as touching the surround, taking a step, or being caught by an overhead harness. Paired t-tests compared participants’ CS and fall occurrence between conditions with alpha set at 0.05.

Results: A statistically significant change (P=0.0001) occurred in mean (SD) CS from NW to WT trials, 50.9 (15.07) to 60.1 (14.88), respectively. A change of 8 points in the CS is considered a significant difference. Twenty-eight (55%) participants increased their CS by at least 8 points (range 8 to 38), 16 (31.4%) increased by 1 to 7 points, 1 had no change (2%) and 6 (11.8%) decreased their score (range -2 to -6). Fall occurrence differed between weighting conditions (P=0.02). There were 212 (60.7%) falls in the NW and 137 (39.3%) in the WT conditions. No correlation (r=0.014) was found between number of SOT falls and participant age.

Conclusions: A significant decline in fall number and an increase in CS occurred with BBTW during a single testing session despite potential for fatigue. BBTW is a promising intervention that may lead to decreased falls when worn by people with MS.