Postural control in multiple sclerosis: Effects of disability status and dual task

Persons with Multiple Sclerosis (PwMS) have postural control impairments. The simultaneous performance of a cognitive task while maintaining an upright posture (i.e. dual task) negatively influences postural control in PwMS with mild disability. This investigation compares the effect of simultaneous cognitive task performance on postural control in PwMS with mild and moderate disability. Forty-five PwMS were divided into groups based on Expanded Disability Status Scale (EDSS) scores: mild (EDSS: 2.0-3.5) and moderate (EDSS: 4.0-6.5) disbaility. Each participant underwent posturography testing during a quiet baseline condition and a cognitive task condition (i.e. dual task). The cognitive task was a word list generation (WLG) task. Median sway velocity, root mean square displacement, and sway area were calculated for each condition. The moderate disability group had significantly worse postural control than the mild disability group. There was an increase in postural sway in the dual task condition. There were no significant task-by-group interactions on postural control. Postural control declines with disability status and is negatively affected by a concurrent cognitive task in PwMS. The dual task cost during a balance task is not different between disability levels and this conflicts with findings for the effect of dual tasking during walking in PwMS.

[1]  C H Polman,et al.  The Brief Repeatable Battery of Neuropsychological Tests: normative values allow application in multiple sclerosis clinical practice , 2001, Multiple sclerosis.

[2]  Jebb G. Remelius,et al.  Postural control in women with multiple sclerosis: effects of task, vision and symptomatic fatigue. , 2010, Gait & posture.

[3]  R. Motl,et al.  Influence of Spasticity on Mobility and Balance in Persons With Multiple Sclerosis , 2011, Journal of neurologic physical therapy : JNPT.

[4]  B. Trapp,et al.  Axonal and neuronal degeneration in multiple sclerosis: mechanisms and functional consequences , 2001, Current opinion in neurology.

[5]  E. Peterson,et al.  Falls, aging, and disability. , 2010, Physical medicine and rehabilitation clinics of North America.

[6]  M. Morris,et al.  Clinical tests of standing balance: performance of persons with multiple sclerosis. , 2000, Archives of physical medicine and rehabilitation.

[7]  K. McCulloch,et al.  Balance, Attention, and Dual‐Task Performance During Walking After Brain Injury: Associations With Falls History , 2010, The Journal of head trauma rehabilitation.

[8]  Gabriel Pardo,et al.  Decreased postural balance in multiple sclerosis patients with low disability , 2011, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[9]  E. Frohman.  Multiple sclerosis. , 2003, The Medical clinics of North America.

[10]  Carlo Pozzilli,et al.  The relationship between infratentorial lesions, balance deficit and accidental falls in multiple sclerosis , 2011, Journal of the Neurological Sciences.

[11]  M. Faucher,et al.  How proprioceptive impairments affect quiet standing in patients with multiple sclerosis , 2007, Somatosensory & motor research.

[12]  M. Salavati,et al.  The effects of cognitive loading on balance control in patients with multiple sclerosis. , 2011, Gait & posture.

[13]  K. Pierzchala,et al.  Evaluation of postural balance control in patients with multiple sclerosis - effect of different sensory conditions and arithmetic task execution. A pilot study. , 2010, Neurologia i neurochirurgia polska.

[14]  Li-Shan Chou,et al.  Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. , 2009, Archives of physical medicine and rehabilitation.

[15]  B. Kerr,et al.  Cognitive spatial processing and the regulation of posture. , 1985, Journal of experimental psychology. Human perception and performance.

[16]  H. Dawes,et al.  Cognitive motor interference while walking: A systematic review and meta-analysis , 2011, Neuroscience & Biobehavioral Reviews.

[17]  Morgan K. Boes,et al.  Walking and thinking in persons with multiple sclerosis who vary in disability. , 2011, Archives of physical medicine and rehabilitation.

[18]  J. DeLuca,et al.  Cognitive impairment in multiple sclerosis , 2008, The Lancet Neurology.

[19]  R. McClelland,et al.  Incidence and prevalence of multiple sclerosis in Olmsted County, Minnesota, 1985–2000 , 2003, Neurology.

[20]  M. Bove,et al.  Effect of cognitive and motor tasks on postural stability in Parkinson's disease: A posturographic study , 2003, Movement disorders : official journal of the Movement Disorder Society.

[21]  M. Woollacott,et al.  Attention and the control of posture and gait: a review of an emerging area of research. , 2002, Gait & posture.

[22]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[23]  Michelle H Cameron,et al.  Imbalance in multiple sclerosis: A result of slowed spinal somatosensory conduction , 2008, Somatosensory & motor research.

[24]  A M Wing,et al.  Age differences in postural stability are increased by additional cognitive demands. , 1996, The journals of gerontology. Series B, Psychological sciences and social sciences.

[25]  Emilio Portaccio,et al.  Multiple sclerosis-related cognitive changes: A review of cross-sectional and longitudinal studies , 2006, Journal of the Neurological Sciences.

[26]  D. Kaya,et al.  Relationship between foot sensation and standing balance in patients with multiple sclerosis. , 2011, Gait & posture.

[27]  J. DeLuca,et al.  Evidenced-based cognitive rehabilitation for persons with multiple sclerosis: a review of the literature. , 2008, Archives of physical medicine and rehabilitation.

[28]  Meral Mirza,et al.  Balance performance in three forms of multiple sclerosis , 2006, Neurological research.

[29]  Sunghoon Shin,et al.  Multiple sclerosis and postural control: the role of spasticity. , 2010, Archives of physical medicine and rehabilitation.

[30]  Cecilia Lundholm,et al.  Predicting accidental falls in people with multiple sclerosis — a longitudinal study , 2009, Clinical rehabilitation.

[31]  B. E. Maki,et al.  Postural control in the older adult. , 1996, Clinics in geriatric medicine.

[32]  J. Corboy,et al.  Effects of Vestibular Rehabilitation on Multiple Sclerosis–Related Fatigue and Upright Postural Control: A Randomized Controlled Trial , 2011, Physical Therapy.

[33]  G. L. Pellecchia,et al.  Postural sway increases with attentional demands of concurrent cognitive task. , 2003, Gait & posture.

[34]  Z Dvir,et al.  Effect of a cognitive task on postural control in patients with a clinically isolated syndrome suggestive of multiple sclerosis. , 2011, European journal of physical and rehabilitation medicine.

[35]  Chiara Stampatori,et al.  Efficacy and specificity of intensive cognitive rehabilitation of attention and executive functions in multiple sclerosis , 2010, Journal of the Neurological Sciences.