The effect of vibrotactile biofeedback of trunk sway on balance control in multiple sclerosis

Abstract Objective The mini-BESTest is a balance measure for assessment of the underlying physiological systems for balance control in adults. Evaluations of test–retest reliability of the mini-BESTest in larger samples of people with multiple sclerosis (MS) are lacking. The purpose of this study was to investigate test–retest reliability of the mini-BESTest total and section sum scores and individual items in people with mild to moderate overall MS disability. Methods This study used a test–retest design in a movement laboratory setting. Fifty-four people with mild to moderate overall MS disability according to the Expanded Disability Status scale (EDSS) were included, with 28 in the mild subgroup (EDSS 2.0–3.5) and 26 in the moderate subgroup (EDSS 4.0–5.5). Test–retest reliability of the mini-BESTest was evaluated by repeated measurements taken 1 week apart. Reliability and measurement error were analyzed. Results Test–retest reliability for the total scores were considered good to excellent, with intraclass correlation coefficients of .88 for the whole sample, .83 for the mild MS subgroup, and .80 for the moderate MS subgroup. Measurement errors were small, with standard error of measurement and minimal detectable change of 1.3 and 3.5, respectively, in mild MS, and 1.7 and 4.7, respectively, in moderate MS. The limits of agreement were − 3.4 and 4.6. Test–retest reliability for the section scores were fair to good or excellent; weighted kappa values ranged from .62 to .83. All items but 1 showed fair to good or excellent test–retest reliability, and percentage agreement ranged from 61% to 100%. Conclusions The mini-BESTest demonstrated good to excellent test–retest reliability and small measurement errors and is recommended for use in people with mild to moderate MS. Impact Knowledge of limits of agreement and minimal detectable change contribute to interpretability of the mini-BESTest total score. The findings of this study enhance the clinical usefulness of the test for evaluation of balance control and for designing individually customized balance training with high precision and accuracy in people with MS.

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Measurements of Trunk Sway for Stance and Gait Tasks 2 Years after Vestibular Neurectomy

Audiology and Neurotology ◽

10.1159/000494965 ◽

2018 ◽

Vol 23 (5) ◽

pp. 298-308 ◽

Cited By ~ 1

Author(s):

Dominique Vibert ◽

John H.J. Allum ◽

Martin Kompis ◽

Simona Wiedmer ◽

Christof Stieger ◽

...

Keyword(s):

Balance Control ◽

Recovery Period ◽

Subjective Assessment ◽

Vestibular Neurectomy ◽

Eyes Closed ◽

Before And After ◽

Task Durations ◽

Trunk Sway ◽

Central Compensation ◽

Balance Problems

The aim of this study was to investigate changes in balance control for stance and gait tasks in patients 2 years before and after vestibular neurectomy (VN) performed to alleviate intractable Meniere’s disease. Amplitudes of trunk sway in roll and pitch directions were measured for stance and gait tasks in 19 patients using gyroscopes mounted at the lower-back. Measurements before VN and 2 years later were compared to those of healthy age-matched controls (HC). We also examined if changes in trunk sway amplitudes were correlated with patients’ subjective assessment of disability using the AAO-HNS scale. For patients with low AAO-HNS scores 0–2 (n = 14), trunk roll and pitch sway velocities, standing eyes closed on foam, increased 2 years post VN compared to HC values (p < 0.01). Trunk sway amplitudes remained at levels of HC for simple gait tasks, but task durations were longer and therefore gait slower. For complex gait tasks (stairs), balance control remained impaired at 2 years. In patients with AAO-HNS high scores level 6 (n = 5), balance control remained abnormal, compared to HC, 2 years postoperatively for all stance, several simple and all complex gait tasks. Trunk sway in the pitch and roll directions for stance tasks was correlated with clinical (AAO-HNS) scores (p ≤ 0.05). These results indicate that VN leads to chronic balance problems for stance and complex gait tasks. The problems are greater for patients with high compared to low AAO-HNS scores, thereby explaining the different symptoms reported by these patients. The lack of balance recovery in VN patients to levels of HCs after 2 years contrasts with the 3 months average recovery period for acute vestibular neuritis patients and is indicative of the effects of neurectomy on central compensation processes.

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Deficits in medio-lateral balance control and the implications for falls in individuals with multiple sclerosis

Gait & Posture ◽

10.1016/j.gaitpost.2016.06.036 ◽

2016 ◽

Vol 49 ◽

pp. 148-154 ◽

Cited By ~ 14

Author(s):

S. Morrison ◽

C.A. Rynders ◽

J.J. Sosnoff

Keyword(s):

Multiple Sclerosis ◽

Balance Control

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The Role of Clinical and Instrumented Outcome Measures in Balance Control of Individuals with Multiple Sclerosis

Multiple Sclerosis International ◽

10.1155/2013/190162 ◽

2013 ◽

Vol 2013 ◽

pp. 1-10 ◽

Cited By ~ 6

Author(s):

Neeta Kanekar ◽

Alexander S. Aruin

Keyword(s):

Multiple Sclerosis ◽

Balance Control ◽

Clinical Test ◽

Balance Performance ◽

Performance Deficits ◽

Clinical Scales ◽

Balance Confidence ◽

High Fatigue ◽

Healthy Control ◽

Stability Limits

Purpose. The aim of the study was to investigate differences in balance control between individuals with multiple sclerosis (MS) and healthy control subjects using clinical scales and instrumented measures of balance and determine relationships between balance measures, fatigue, and disability levels in individuals with MS with and without a history of falls.Method. Twelve individuals with MS and twelve healthy controls were evaluated using the Berg Balance and Activities-specific Balance Confidence Scales, Modified Clinical Test of Sensory Interaction on Balance, and Limits of Stability Tests as well as Fatigue Severity Scale and Barthel Index.Results. Mildly affected individuals with MS had significant balance performance deficits and poor balance confidence levels (P<0.05). MS group had higher sway velocities and diminished stability limits (P<0.05), significant sensory impairments, high fatigue and disability levels (P<0.05). Sway velocity was a significant predictor of balance performance and the ability to move towards stability limits for the MS group. For the MS-fallers group, those with lower disability levels had faster movement velocities and better balance performance.Conclusion. Implementation of both clinical and instrumented tests of balance is important for the planning and evaluation of treatment outcomes in balance rehabilitation of people with MS.

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Sensory impairments in quiet standing in subjects with multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458508096874 ◽

2009 ◽

Vol 15 (1) ◽

pp. 59-67 ◽

Cited By ~ 113

Author(s):

D Cattaneo ◽

J Jonsdottir

Keyword(s):

Multiple Sclerosis ◽

Sensory Input ◽

Balance Control ◽

Motor Impairment ◽

Quiet Standing ◽

Convenience Sample ◽

Sensory Inputs ◽

Sensory Disorders ◽

Sensory Impairments ◽

The Impact

Balance disorders and falls are frequently observed in subjects with multiple sclerosis (MS). Along with motor impairment, sensory disorders and integration deficits of sensory inputs lead to inadequate motor responses. The assessment of these sensory disorders in an every day tasks, such as upright stance, increases our knowledge of postural control in this pathology, thus promoting more effective treatments. The aim of the study was to describe sensory impairments and sensory strategies in different sensory conditions. A stabilometric assessment was carried out in a consecutive convenience sample of 53 subjects. The age of the sample was 52.7 (21.1) years; the onset of pathology was 27.20 (14.5) years before the assessment. Balance was assessed in six sensory conditions. The impact of pathology on balance control was shown by the high percentage of abnormal scores: 75% of subjects with MS showed abnormal scores even in the eyes open condition. The alteration of a single sensory input led to an increase of abnormal scores in up to 82% of subjects. Almost all subjects showed abnormal scores in the vestibular conditions where 22% of them fell. The pattern of the subjects’ performance in the six sensory conditions suggests that balance control may be more correlated to the number of reliable sensory inputs than the nature of the sensory input itself.

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Trunk sway in mildly disabled multiple sclerosis patients with and without balance impairment

Experimental Brain Research ◽

10.1007/s00221-011-2795-8 ◽

2011 ◽

Vol 213 (4) ◽

pp. 363-370 ◽

Cited By ~ 47

Author(s):

Oliver Findling ◽

Johann Sellner ◽

Niklaus Meier ◽

John H. J. Allum ◽

Dominique Vibert ◽

...

Keyword(s):

Multiple Sclerosis ◽

Balance Impairment ◽

Trunk Sway ◽

Multiple Sclerosis Patients

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Association of Postural Sway with Disability Status and Cerebellar Dysfunction in People with Multiple Sclerosis

International Journal of MS Care ◽

10.7224/1537-2073.2014-003 ◽

2015 ◽

Vol 17 (3) ◽

pp. 146-151 ◽

Cited By ~ 20

Author(s):

James McLoughlin ◽

Christopher Barr ◽

Maria Crotty ◽

Stephen R. Lord ◽

Daina L. Sturnieks

Keyword(s):

Multiple Sclerosis ◽

Postural Sway ◽

Balance Control ◽

Knee Extension ◽

Ankle Dorsiflexion ◽

Sensory Function ◽

Sensory Loss ◽

Cerebellar Dysfunction ◽

Exercise Interventions ◽

Disability Status

Background: The aims of this study were 1) to examine postural sway in the eyes open (EO) and eyes closed (EC) conditions in people with multiple sclerosis (MS) with moderate levels of disability compared with controls and 2) to examine relationships between postural sway and total Expanded Disability Status Scale (EDSS) scores, functional system subscores, and clinical measures of strength and spasticity in the MS group. Methods: Thirty-four people with moderate MS and ten matched controls completed measures of postural sway with EO and EC, knee extension and ankle dorsiflexion isometric strength, EDSS total score and subscores, and spasticity levels. Results: Participants with MS swayed significantly more with EO and EC and had reduced knee extension and ankle dorsiflexion strength compared with controls (P < .001). In the MS group, increased sway was associated with higher total EDSS scores and cerebellar function subscores, whereas increased sway ratio (EC/EO) was associated with reduced sensory function subscores. Postural sway was not significantly associated with strength or spasticity. Conclusions: Participants with MS swayed more and were significantly weaker than controls. Cerebellar dysfunction was identified as the EDSS domain most strongly associated with increased sway, and sensory loss was associated with a relatively greater dependence on vision for balance control. These findings suggest that exercise interventions targeting sensory integration and cerebellar ataxia may be beneficial for enhancing balance control in people with MS.

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