Postural control deficits in people with Multiple Sclerosis: A systematic review and meta-analysis

Comber, Laura; Sosnoff, Jacob J.; Galvin, Rose; Coote, Susan

doi:10.1016/j.gaitpost.2018.02.018

Cited by 87 publications

(63 citation statements)

References 68 publications

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“…Individuals with multiple sclerosis (MS) often have balance problems in both the initial and later phases of the disease (Aruin, Kanekar, and Lee, 2015;Huisinga et al, 2014;Kalron et al, 2016) due to a variety of somatosensory, motor, postural control and vision impairments (Cameron and Lord, 2010;Krishnan, Kanekar, and Aruin, 2012). Balance dysfunctions are associated with an increased risk of falling (Comber, Sosnoff, Galvin, and Coote, 2018) and less participation in daily activities (Cameron and Lord, 2010;Cattaneo et al, 2017), and can influence aspects of self (Normann, Sørgaard, Salvesen, and Moe, 2013). Individual exercise therapy is associated with improvements in walking (Dalgas, Stenager, and Ingemann-Hansen, 2008;Hogan and Coote, 2009;Snook and Motl, 2009) and balance (Gunn et al, 2015;Paltamaa, Sjogren, Peurala, and Heinonen, 2012;Rietberg, Brooks, Uitdehaag, and Kwakkel, 2005); and the same association has been reported for group-based interventions for individuals with MS (Arntzen et al, 2019;Forsberg, von Koch, and Nilsagård, 2016;Tarakci et al, 2013).…”

Section: Introductionmentioning

confidence: 73%

Group-based, individualized exercises can provide perceived bodily changes and strengthen aspects of self in individuals with MS: a qualitative interview study

Arntzen

Øberg

Gallagher

et al. 2019

Physiotherapy Theory and Practice

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Background: Group-based physiotherapy is effective for individuals with MS; nevertheless individualization within groups is questioned and little is known regarding individuals´experiences with individualization in small groups. Objective: We aimed to explore the short-and long-term experiences of individuals with MS participating in a 6-week, group-based, individualized physiotherapy-intervention. Methods: Within a randomized controlled trial (RCT), 25 in-depth interviews with a strategic sample of 13 people (9 women; age 25-79 years old; European Disability Status Scale (EDSS) 1-6.5) were conducted at weeks 7 and 30 using systematic text condensation, with dynamic systems theory and phenomenology as analytical frameworks. Results: The main categories were: 1) movement control, orientation and insights: Bodily improvements were associated with targeted exercises, specific adjustments by the physiotherapist, emotional engagement and re-access to activities; and 2) the individual within the group: Equal distributions of one-to-one interactions and attention were important for experiencing success. Less attention and improvements turned attention toward own disability. Physical changes felt particularly emotional short term, implying that individuals' feelings of ownership and control of body and movement, new views of themselves and changed affordances in daily life were involved. Conclusion: Equally distributed attention and engagement, targeted exercises and hands-on adjustments resulting in visible and perceived bodily changes were experienced as key factors of individualization in small groups.

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Section: Introductionmentioning

confidence: 73%

Group-based, individualized exercises can provide perceived bodily changes and strengthen aspects of self in individuals with MS: a qualitative interview study

Arntzen

Øberg

Gallagher

et al. 2019

Physiotherapy Theory and Practice

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“…Patients with ataxic symptoms, including individuals with multiple sclerosis, display deficits in postural control including a greater magnitude and speed of postural sway [97,114], which is attributed to a reduced range of motion at the knee (‘locked knees’) and a delayed response in muscle activity [115]. To compensate for this poor postural control, people with ataxia often widen their stance (base of support) to stabilise the head and trunk [116].…”

Section: Section Ii: Distinguishing Features Of Gait and Postural mentioning

confidence: 99%

The Role of Movement Analysis in Diagnosing and Monitoring Neurodegenerative Conditions: Insights from Gait and Postural Control

et al. 2019

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Quantifying gait and postural control adds valuable information that aids in understanding neurological conditions where motor symptoms predominate and cause considerable functional impairment. Disease-specific clinical scales exist; however, they are often susceptible to subjectivity, and can lack sensitivity when identifying subtle gait and postural impairments in prodromal cohorts and longitudinally to document disease progression. Numerous devices are available to objectively quantify a range of measurement outcomes pertaining to gait and postural control; however, efforts are required to standardise and harmonise approaches that are specific to the neurological condition and clinical assessment. Tools are urgently needed that address a number of unmet needs in neurological practice. Namely, these include timely and accurate diagnosis; disease stratification; risk prediction; tracking disease progression; and decision making for intervention optimisation and maximising therapeutic response (such as medication selection, disease staging, and targeted support). Using some recent examples of research across a range of relevant neurological conditions—including Parkinson’s disease, ataxia, and dementia—we will illustrate evidence that supports progress against these unmet clinical needs. We summarise the novel ‘big data’ approaches that utilise data mining and machine learning techniques to improve disease classification and risk prediction, and conclude with recommendations for future direction.

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“…1– 3 These dysfunctions are due to a variety of neurological impairments, such as somatosensory deficits, paresis, coordination and visual problems, impaired activation of core/trunk muscles, and impaired anticipatory and compensatory postural adjustments. 4,5 Learned nonuse and inexpedient compensatory movement patterns are developed over time and can also interfere with balance. 6 Optimal core/trunk muscle activation is a prerequisite for anticipatory postural adjustments and compensatory postural adjustments.…”

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confidence: 99%

Group-Based Individualized Comprehensive Core Stability Intervention Improves Balance in Persons With Multiple Sclerosis: A Randomized Controlled Trial

et al. 2019

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Background Balance and trunk control are often impaired in individuals with multiple sclerosis (MS). Interventions addressing these issues are needed. Objective The objective of this study was to compare the immediate and long-term effects of a 6-week individualized, group-based, comprehensive core stability intervention (GroupCoreDIST) with standard care on balance and trunk control in individuals with MS. Design This study was a prospective, assessor-masked, randomized controlled trial. Setting The GroupCoreDIST intervention was conducted by 6 physical therapists in 6 municipalities in Norway. Standard care included the usual care for individuals with MS in the same municipalities. Assessments at all time points took place at a Norwegian hospital. Participants Eighty people with Expanded Disability Status scores of 1 to 6.5 participated in this trial. Intervention Randomized, concealed allocation was used to assign the participants to the GroupCoreDIST intervention (n = 40) or to standard care (n = 40). The GroupCoreDIST intervention was conducted with groups of 3 participants (1 group had 4 participants), for 60 minutes 3 times per week. Measurements Assessments were undertaken at baseline and at weeks 7, 18, and 30. Outcomes were measured with the Trunk Impairment Scale–Norwegian Version, Mini Balance Evaluation Systems Test, and Patient Global Impression of Change–Balance. Repeated-measures mixed models were used for statistical analysis. Results One individual missed all postintervention tests, leaving 79 participants in the intention-to-treat analysis. GroupCoreDIST produced significant between-group effects on the mean difference in the following scores at 7, 18, and 30 weeks: for Trunk Impairment Scale–Norwegian Version, 2.63 points (95% confidence interval [CI] = 1.89–3.38), 1.57 points (95% CI = 0.81–2.33), and 0.95 point (95% CI = 0.19–1.71), respectively; for Mini Balance Evaluation Systems Test, 1.91 points (95% CI = 1.07–2.76), 1.28 points (95% CI = 0.42–2.15), and 0.91 points (95% CI = 0.04–1.77), respectively; and for Patient Global Impression of Change–Balance, 1.21 points (95% CI = 1.66–0.77), 1.02 points (95% CI = 1.48–0.57), and 0.91 points (95% CI = 1.36–0.46), respectively. Limitations Groups were not matched for volume of physical therapy. Conclusions Six weeks of GroupCoreDIST improved balance and trunk control in the short and long terms compared with standard care in individuals who were ambulant and had MS. The intervention is an effective contribution to physical therapy for this population.

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Postural control deficits in people with Multiple Sclerosis: A systematic review and meta-analysis

Abstract: The large number of variables and lack of standardisation of reporting makes data synthesis challenging, however, people with MS display considerable deficits in postural control compared to healthy controls regardless of task condition or complexity.

Cited by 87 publications

References 68 publications

Group-based, individualized exercises can provide perceived bodily changes and strengthen aspects of self in individuals with MS: a qualitative interview study

Group-based, individualized exercises can provide perceived bodily changes and strengthen aspects of self in individuals with MS: a qualitative interview study

The Role of Movement Analysis in Diagnosing and Monitoring Neurodegenerative Conditions: Insights from Gait and Postural Control

Group-Based Individualized Comprehensive Core Stability Intervention Improves Balance in Persons With Multiple Sclerosis: A Randomized Controlled Trial

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