Balance Testing in Multiple Sclerosis—Improving Neurological Assessment With Static Posturography?

Inojosa, Hernán; Schriefer, Dirk; Klöditz, Antonia; Trentzsch, Katrin; Ziemssen, Tjalf

doi:10.3389/fneur.2020.00135

Cited by 19 publications

(41 citation statements)

References 37 publications

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“…Up to 93% of a group of SPMS patients reported balance or walking difficulties as a symptom ( 33 ). The evaluation of balance could be supported by specific posturography tests, which could detect disability already on early disease phases and with a higher reliability than rather-dependent subjective evaluations ( 65 ).…”

Section: Clinical Assessment Of Disability Progressionmentioning

confidence: 99%

Should We Use Clinical Tools to Identify Disease Progression?

et al. 2021

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The presence of disability progression in multiple sclerosis (MS) is an important hallmark for MS patients in the course of their disease. The transition from relapsing remitting (RRMS) to secondary progressive forms of the disease (SPMS) represents a significant change in their quality of life and perception of the disease. It could also be a therapeutic key for opportunities, where approaches different from those in the initial phases of the disease can be adopted. The characterization of structural biomarkers (e.g., magnetic resonance imaging or neurofilament light chain) has been proposed to differentiate between both phenotypes. However, there is no definite threshold between them. Whether the risk of clinical progression can be predicted by structural markers at early disease phases is still a focus of clinical research. However, several theories and pathological evidence suggest that both disease phenotypes are part of a continuum with common pathophysiological mechanisms. In this case, the clinical evaluation of the patients would play a preponderant role above destruction biomarkers for the early identification of disability progression and SPMS. For this purpose, the use of clinical tools beyond the Expanded Disability Status Scale (EDSS) should be considered. Besides established functional tests such as the Multiple Sclerosis Functional Composite (MSFC), patient's neurological history or digital resources may help neurologists in the decision-taking. In this article, we discuss arguments for the use of clinical markers in the detection of secondary progressive MS and the characterization of progressive disease activity.

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Section: Clinical Assessment Of Disability Progressionmentioning

confidence: 99%

Should We Use Clinical Tools to Identify Disease Progression?

et al. 2021

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“…visual or sensory) and results of the cerebrospinal fluid analysis ( Doshi and Chataway, 2016 ; Deangelis and Miller 2014 ). Also, the static posturography revealed to be valuable in the MS clinic, particularly in the diagnosis of motor dysfunctions related to falls ( Boes et al, 2012 ; Cameron and Lord, 2010 ; Inojosa et al, 2020a , b ; Kalron et al, 2016a , b ; Nilsagård et al, 2009 ; Pau et al, 2017 ; Prosperini et al, 2013 ; Prosperini and Castelli, 2018 ) Simplicity and safety of static posturographic tests make it attractive for use in the neurological clinic. Additionally, static posturography seems very sensitive to every change within the sensory-motor system which may be of key importance in the diagnosis and monitoring of MS (for review see Prosperini and Castelli, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

“…So far, the diagnostic value of static posturography has been proved in the aging of the nervous system, and motor disorders and injuries. Recently, substantial research efforts focus on MS ( Wajda et al, 2016 ; Prosperini et al, 2013 ; Inojosa et al, 2020a , b ; Kalron et al, 2016a , b ) Continuing this line of research we focused here on sway characteristics in MS. Multiple sclerosis signs and symptoms may differ greatly from patient to patient and throughout the disease depending on the location of affected nerve fibers.…”

Section: Introductionmentioning

confidence: 99%

New methods of posturographic data analysis may improve the diagnostic value of static posturography in multiple sclerosis

Błaszczyk

Cieślińska-Świder

Orawiec

2021

Heliyon

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Background Early and accurate diagnosis of multiple sclerosis (MS) is crucial for its effective treatment. In MS diagnostic, neuronal networks that control posture and movement are of particular importance, which performance can be assessed using static posturography. Unfortunately, most of the commercially available posturographic platforms are not equipped with the appropriate procedures. Methods To solve this problem, the postural sway trajectories have been recorded in 55 MS patients while standing quiet with eyes open (EO), and then with eyes closed (EC). The trajectories were analyzed using our novel methods of postural sway parametrization, including sway stability vector (SV), anteroposterior and mediolateral sway indices (DIAP and DIML). Results The results exhibited unique postural sway patterns that may be attributed to MS. Our novel parametrization methods of postural sway showed pathology specific increase of the postural sway velocity in EC tests. Additionally, we documented the abnormal alterations of the anteroposterior (AP) and the mediolateral (ML) sway indices that were also uniquely dependent on visual input. In EC tests, patients exhibited a characteristic pattern of sway increase in both AP and ML directions that correlated with the advance of the disease as measured by the EDSS Kurtzke scale and Functional System Scores. Conclusions The applied in the present study our novel posturographic metrics give the assessment a diagnostic value. It allows us to recommend the static posturography test as a simple and safe supplementary clinical tool in the diagnosis of MS. In the assessment of MS pathology or the effects of its treatment, the impact of vision on the sway stability vector seems the most important factor.

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“…Several neurological-clinical domains should be part of the quantitative assessment of individual neurological FS (e.g., cognition, walking) as eg. imaging (magnetic resonance imaging, ocular coherence tomography) and electrophysiological procedures, patient-reported outcomes (PRO), new molecular (e.g., neurofilament light chain) and digital biomarkers (D'Amico et al, 2019;Ziemssen et al, 2019;Inojosa et al, 2020a). The ability to walk is an important prerequisite to participate autonomously in daily life.…”

Section: Introductionmentioning

confidence: 99%

“…In clinical practice, the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC) are the most established clinical scales that include WI. The EDSS assesses the maximum possible walking distance up to 500 m and the MSFC measures the walking speed for a 7.62 m distance using the timed 25-foot walking (T25FW) test (Kurtzke and Hutchinson, 1983;Cutter et al, 1999;Inojosa et al, 2020a). However, these rather rough and one-dimensional estimates lack sufficient sensitivity for initially very subtle WI (Shanahan et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

The Dresden Protocol for Multidimensional Walking Assessment (DMWA) in Clinical Practice

et al. 2020

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Walking impairments represent one of the most debilitating symptom areas for people with multiple sclerosis (MS). It is important to detect even slightest walking impairments in order to start and optimize necessary interventions in time to counteract further progression of the disability. For this reason, a regular monitoring through gait analysis is highly necessary. At advanced stages of MS with significant walking impairment, this assessment is also necessary to optimize symptomatic treatment, choose the most suitable walking aid and plan individualized rehabilitation. In clinical practice, walking impairment is only assessed at higher levels of the disease using e.g., the Expanded Disability Status Scale (EDSS). In contrast to the EDSS, standardized functional tests such as walking speed, walking endurance and balance as well as walking quality and gait-related patient-reported outcomes allow a more holistic and sensitive assessment of walking impairment. In recent years, the MS Center Dresden has established a standardized monitoring procedure for the routine multidimensional assessment of gait and balance disorders. In the following protocol, we present the techniques and procedures for the analysis of gait and balance of people with MS at the MS Center Dresden. Patients are assessed with a multidimensional gait analysis at least once a year. This enables long-term monitoring of walking impairment, which allows early active intervention regarding further progression of disease and improves the current standard clinical practice.

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Balance Testing in Multiple Sclerosis—Improving Neurological Assessment With Static Posturography?

Cited by 19 publications

References 37 publications

Should We Use Clinical Tools to Identify Disease Progression?

Should We Use Clinical Tools to Identify Disease Progression?

New methods of posturographic data analysis may improve the diagnostic value of static posturography in multiple sclerosis

The Dresden Protocol for Multidimensional Walking Assessment (DMWA) in Clinical Practice

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