Functional Balance Testing in Cervical Spondylotic Myelopathy Patients

Haddas, Ram; Lieberman, Isador H.; Boah, Akwasi; Arakal, Raj; Belanger, Theodore A.; Ju, Kevin L.

doi:10.1097/brs.0000000000002768

Cited by 21 publications

(18 citation statements)

References 18 publications

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“…The existence of poor balance and functional performance in individuals with DCM before surgical intervention has been reported by several studies (Nardone et al, 2008;Yoshikawa et al, 2008;Haddas et al, 2018b). Our study further demonstrated residual balance instability and functional impairments in postoperative individuals with DCM.…”

Section: Residual Balance Instability and Functional Impairment Aftersupporting

confidence: 82%

“…Several studies have reported balance instability in individuals with spinal disease (Boudreau and Falla, 2014;Hsu et al, 2014Hsu et al, , 2019Wong et al, 2019). Compared with healthy controls, a greater postural sway with increased muscle activation in the trunk and lower extremities was observed during quiet standing in individuals with DCM (Yoshikawa et al, 2008;Haddas et al, 2018b). In addition, delayed neuromuscular recruitment and postural unsteadiness under perturbation were reported in individuals with DCM (Nardone et al, 2008).…”

Section: Introductionmentioning

confidence: 96%

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Perturbation-Based Balance Training in Postoperative Individuals With Degenerative Cervical Myelopathy

Cheng

Chien

Lai

et al. 2020

Front. Bioeng. Biotechnol.

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Degenerative cervical myelopathy (DCM) is a common aging condition caused by spinal cord compression. Individuals with DCM often presented with residual balance and functional impairments postoperatively. Perturbation-based balance training (PBT) has been shown to have positive effects on populations with neurological disorders but has yet to be investigated in DCM. The objective of this study was therefore to evaluate the effects of PBT on balance and functional performance in postoperative individuals with DCM. Fifteen postoperative individuals with DCM (DCM group) and 14 healthy adults (healthy control group) were recruited. The DCM group received a 4-weeks PBT using a perturbation treadmill. The outcome measures included mean velocity of center of pressure (COP) during quiet standing; center of mass (COM) variance and reaction time to balance perturbation during standing with forward and backward perturbation; gait speed during level ground walking; Timed Up and Go Test (TUG) and disability questionnaire scores including Visual Analog Scale, Neck Disability Index, and Lower Extremity Function of Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. The assessments were conducted preand post-training postoperatively for the DCM group but only once for the healthy control group. Significant improvements were observed in the mean velocity of COP, COM variance, reaction time, gait speed, and TUG in the DCM group. Disability questionnaire scores were not significantly different after training in DCM group. For between-group comparisons, significant differences that were observed pre-training were not observed post-training. The 4-weeks PBT is a potential rehabilitation strategy for addressing balance and functional impairment in postoperative individuals with DCM. In addition, the post-training performance in the DCM group exhibited trends comparable to those Frontiers in Bioengineering and Biotechnology | www.frontiersin.org 1 February 2020 | Volume 8 | Article 108Cheng et al.Perturbation Training in Cervical Myelopathy of age-matched healthy controls. Furthermore, the training regimens offer a practical reference for future studies on populations with balance disorders. Future studies complemented with neurophysiological assessments could reveal more information of the underlying mechanisms of PBT.

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Section: Residual Balance Instability and Functional Impairment Aftersupporting

confidence: 82%

Section: Introductionmentioning

confidence: 96%

Perturbation-Based Balance Training in Postoperative Individuals With Degenerative Cervical Myelopathy

Cheng

Chien

Lai

et al. 2020

Front. Bioeng. Biotechnol.

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“…The compression of the spinal cord can cause various neurological symptoms, such as paresthesia, muscle weakness, muscle spasm, and gait disturbance [2]. Moreover, patients with CSM exhibited postural instability compared with healthy adults [3]. Postural instability may result from impairment in proprioception and the integration of the somatosensory system, which is controlled by the neural tract in the spinal cord [3, 4].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, patients with CSM exhibited postural instability compared with healthy adults [3]. Postural instability may result from impairment in proprioception and the integration of the somatosensory system, which is controlled by the neural tract in the spinal cord [3, 4]. Postural control is controlled by the sensorimotor system, which is associated with the visual, vestibular, cerebellar, and proprioceptive systems [5] (Fig.…”

Section: Introductionmentioning

confidence: 99%

Reweighting of the sensory inputs for postural control in patients with cervical spondylotic myelopathy after surgery

Lin

Lai

Ding

et al. 2019

J NeuroEngineering Rehabil

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Background Cervical spondylotic myelopathy (CSM) is a degenerative cervical disease in which the spinal cord is compressed. Patients with CSM experience balance disturbance because of impaired proprioception. The weighting of the sensory inputs for postural control in patients with CSM is unclear. Therefore, this study investigated the weighting of sensory systems in patients with CSM. Method Twenty-four individuals with CSM (CSM group) and 24 age-matched healthy adults (healthy control group) were analyzed in this observational study. The functional outcomes (modified Japanese Orthopaedic Association Scale [mJOA], Japanese Orthopaedic Association Cervical Myelopathy Questionnaire [JOACMEQ], Nurick scale) and static balance (eyes-open and eyes-closed conditions) were assessed for individuals with CSM before surgery, 3 and 6 months after surgery. Time-domain and time–frequency-domain variables of the center of pressure (COP) were analyzed to examine the weighting of the sensory systems. Results In the CSM group, lower extremity function of mJOA and Nurick scale significantly improved 3 and 6 months after surgery. Before surgery, the COP mean velocity and total energy were significantly higher in the CSM group than in the control group for both vision conditions. Compared with the control group, the CSM group exhibited lower energy content in the moderate-frequency band (i.e., proprioception) and higher energy content in the low-frequency band (i.e., cerebellar, vestibular, and visual systems) under the eyes-open condition. The COP mean velocity of the CSM group significantly decreased 3 months after surgery. The energy content in the low-frequency band (i.e., visual and vestibular systems) of the CSM group was closed to that of the control group 6 months after surgery under the eyes-open condition. Conclusion Before surgery, the patients with CSM may have had compensatory sensory weighting for postural control, with decreased weighting on proprioception and increased weighting on the other three sensory inputs. After surgery, the postural control of the patients with CSM improved, with decreased compensation for the proprioceptive system from the visual and vestibular inputs. However, the improvement remained insufficient because the patients with CSM still had lower weighting on proprioception than the healthy adults did. Therefore, patients with CSM may require balance training and posture education after surgery. Trial registration Trial Registration number: NCT03396055 Name of the registry: ClinicalTrials.gov Date of registration: January 10, 2018 - Retrospectively registered Date of enrolment of the first participant to the trial: October 19, 2015

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“…In hereditary spastic paraplegia, a myelopathy resembling that in ALD, postural body sway was significantly higher than in healthy controls and was correlated with muscle strength in the legs (Marsden and Stevenson, 2013). In cervical spondylotic myelopathy, the most common myelopathy, postural body sway was also increased (Yoshikawa et al, 2008;Haddas et al, 2019b) and improved after decompressive surgery (Haddas et al, 2019a). Although these conditions do not have the same pathophysiology as ALD, they indicate that postural sway could be a useful way to measure myelopathy.…”

Section: Discussionmentioning

confidence: 99%

Postural Body Sway as Surrogate Outcome for Myelopathy in Adrenoleukodystrophy

et al. 2020

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Background: Myelopathy is the core clinical manifestation of adrenoleukodystrophy (ALD), which is the most common peroxisomal disorder. Development of therapies requires sensitive and clinically relevant outcome measures. Together with spastic paraparesis, balance disturbance is the main cause of disability from myelopathy in ALD. In this cross-sectional study, we evaluated whether postural body sway-a measure of balance-could serve as a surrogate outcome in clinical trials. Methods: Forty-eight male ALD patients and 49 age-matched healthy male controls were included in this study. We compared sway amplitude and sway path of ALD patients to controls. We then correlated the body sway parameters showing the largest between-group differences with clinical measures of severity of myelopathy. To correct for age, we performed multiple linear regression analysis with age and severity of myelopathy as independent variables. Results: All body sway parameters were significantly higher in patients than in controls, with medium to large effect sizes (r = 0.43-0.66, p < 0.001). In the subgroup of asymptomatic patients, body sway amplitude was also higher, but the difference with controls was smaller than for symptomatic patients (effect size r = 0.38-0.46). We found moderate to strong correlations between body sway amplitude and clinical severity of myelopathy (r = 0.40-0.79, p < 0.005). After correction for age, severity of myelopathy was a significant predictor of body sway amplitude in all regression models. Conclusions: These results indicate that postural body sway may serve as a surrogate outcome for myelopathy in ALD. Such outcomes are important to evaluate new therapies in clinical trials. Further longitudinal studies are needed and ongoing in this cohort.

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Functional Balance Testing in Cervical Spondylotic Myelopathy Patients

Abstract: 3.

Cited by 21 publications

References 18 publications

Perturbation-Based Balance Training in Postoperative Individuals With Degenerative Cervical Myelopathy

Perturbation-Based Balance Training in Postoperative Individuals With Degenerative Cervical Myelopathy

Reweighting of the sensory inputs for postural control in patients with cervical spondylotic myelopathy after surgery

Postural Body Sway as Surrogate Outcome for Myelopathy in Adrenoleukodystrophy

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