Visual Feedback and Postural Control in Multiple Sclerosis.

Hernan Inojosa,Tjalf Ziemssen,Antonia Klöditz,Katrin Trentzsch,Dirk Schriefer

doi:10.3390/jcm9051291

Hernan Inojosa, Tjalf Ziemssen + Show 3 more

Open Access

https://doi.org/10.3390/jcm9051291

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Abstract

As people with multiple sclerosis (pwMS) manifest heterogeneous demyelinating lesions that could affect somatosensory or vestibular ways, visual stimulus as feedback could be especially relevant to achieve postural control. This has clinical importance for the development of preventive measures and rehabilitation therapies in order to avoid falls and accidents in this group. In our study, we objectively evaluated the influence of visual feedback on the stabilization of balance in pwMS versus healthy controls (HC) and its potential utility in clinical evaluation. Static posturography tests were performed in 99 pwMS and 30 HC. Subjects stood on a force platform with open and closed eyes. During this procedure, three balance parameters were obtained for both vision conditions: average sway, average speed, and average speed of sway. Neurostatus-Expanded Disease Disability Score (EDSS) and Multiple Sclerosis Functional Composite (MSFC) were performed in parallel as well. A two-way mixed repeated measures ANCOVA, controlling for sex and age, was performed to evaluate the effect of vision, MS diagnosis, and the interaction of both in static posturography parameters. The difference between both closed and open eyes conditions was calculated for each parameter and further analyzed according to MS-relevant clinical variables. The magnitude of the vision effect differed between pwMS and HC as a significant interaction between the vision and the MS diagnosis in the delineated area (p < 0.001) and average speed of sway (p = 0.001) was seen. These parameters had a greater increase in pwMS than in HC after closing eyes. For the average sway, a significant main effect of vision was present (p = 0.047). Additionally, the differences obtained between open and closed eyes conditions assessed with the delineated area and average speed of sway were moderately correlated to the assessed clinical tests EDSS (r = 0.405 and r = 0.329, respectively) and the MSFC (r = −0.385 and r = −0.259, respectively). In our study, pwMS were more dependent of visual feedback than HC to maintain postural control. This easy and short evaluation by static posturography could support the development of targeted preventive measures and interventions in pwMS.

Highlights

Postural control is an essential neurological function for the execution of daily activities
We demonstrated a relationship between the visual feedback and postural control in people with multiple sclerosis (pwMS) and in healthy controls using objective outcomes obtained with static posturography
Both groups had higher balance parameters standing with closed eyes than with open eyes

Summary

Introduction

Postural control is an essential neurological function for the execution of daily activities. It can be defined as the act of maintaining, achieving, or restoring a state of balance [1]. Function loss in one of these systems could alter the capacity of maintaining postural control, increasing the patient’s risk of falling with further social and economic impact [3,4]. Such a damage is observed especially among people with multi-systemic neurological diseases. Lesions on somatosensory ways alter postural stability as this fundamental feedback is impaired, making a postural compensation and the visual feedback often more necessary to maintain balance [12,13,14,15]

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