Postural Control in Multiple Sclerosis: Implications for Fall Prevention

Abstract

People with multiple sclerosis (MS) often have poor postural control, which likely underlies their increased risk of falls. Based on several studies of balance and gait in MS, it appears that the primary mechanisms underlying the observed changes are slowed somatosensory conduction and impaired central integration. This review of the published research on balance, gait, and falls in people with MS demonstrates that people with MS have balance impairments characterized by increased sway in quiet stance, delayed responses to postural perturbations, and a reduced ability to move toward their limits of stability. These impairments are likely causes of falls in people with MS and are consistent with the reduced gait speed, as well as decreased stride length, cadence, and joint movement, observed in most studies of gait in MS. Based on these findings, we identify several factors that may be amenable to intervention to prevent falls in people with MS.

Medications Are Associated with Falls in People with Multiple Sclerosis

“…9 Fall risk in MS is generally attributed to impairments in the wide range of functions affected by the disease, including balance, cognition, vision, muscle strength and tone, coordination, and sensation. 10,11 Although there are limited interventions available to modify these endogenous fall risk factors, modifiable exogenous factors may also contribute to fall risk in MS. In older people, in whom fall risk is most well understood, the use of multiple medications, 12 particularly psychotropics, has been found to significantly increase fall risk, 13,14 and modifying medication prescription can prevent falls.…”

Effect of Two Different Rehabilitation Training with a Robotic Gait System in Body Weight Support and a Proprioceptive Sensory-motor Exercises on Unstable Platforms in Rehabilitation of Gait and Balance Impairment and Fatigue in Multiple Sclerosis

“…Walking can be seen as a repeated sequence of balance challenges and changes in gait observed in people with MS are largely the result of changes in postural control [72].…”

Functional Movement Analysis in the Differential Diagnosis of a Patient with a Posterolateral Corner Knee Injury

“…This patient was able to demonstrate most of these functional movements without difficulty, ruling down the likelihood of neurologic pathology. [11][12][13] However, pathologies such as multiple sclerosis, demyelinating polyneuropathy or any pathology that could affect joint proprioception could not be ruled out before a formal assessment of the peripheral and central nervous system. With the data gathered during the FMA, the therapist proceeded with an objective table examination to rule up or down the most likely diagnoses on the differential diagnosis list.…”