Evaluation of postural stability in patients with multiple sclerosis using computerized dynamic posturography

Abstract Background Multiple sclerosis (MS) is a chronic condition affecting the central nervous system, marked by damage to nerve cell coverings and degeneration of axons. These factors lead to reduced neural transmission, causing a variety of issues in sensory, motor, and cognitive functions. The severity of these problems is gauged using the Expanded Disability Status Scale (EDSS), which evaluates overall clinical disability. Balance issues frequently manifest as an initial indication of MS, carrying substantial clinical ramifications due to the resultant mobility limitations and heightened fall risks. Computerized Dynamic Posturography (CDP) serves as a valuable resource capable of delivering precise assessments and identifying even subtle balance irregularities in MS patients, as it encompasses evaluations of both static and dynamic balance components. The objective of the study was to evaluate postural stability among individuals with MS in comparison to healthy controls utilizing CDP. Methods The study involved 40 participants, 20 MS patients (15 females and 5 males) aged between 23 and 46 years, free from balance, musculoskeletal anomalies or prior visual or otological conditions. Twenty healthy controls (10 females and 10 males), aged between 21 and 53 years, without any history of neurological disorders, were included. Sensory Organization Test (SOT) was conducted using the Synapsys Posturography System. Participants were examined in six different conditions: Static Eyes Open (EO), Static Eyes Closed (EC), Static Servocontrolled, Foam Eyes Open, Foam Eyes Closed, and Foam Servocontrolled. Sensory Organization Test scores were computed to assess participants' ability to utilize somatosensory, visual, and vestibular inputs for maintaining static balance.The SOT scores were correlated with EDSS scores in MS group. Additionally, Romberg Quotient and Statokinesigram (SKG) surface area were calculated to determine participants' center of pressure displacement during trials and their reliance on visual cues. Fall Risk Assessment was also done. The tests also involved Limits of Stability test; translational ramp test, in addition to sinusoid test. Results All SOT scores were significantly lower among MS patients in comparison to the healthy control group, except for the Visual and preferential scores in the mediolateral planes. The cases group exhibited significantly larger SKG surface areas for EO foam, EC, and Servo Control compared to the control group. In the motor control ramp test, Energy and Recovery Time, MS patients exhibited higher values compared to controls. However, there was no disparity observed in Recovery time in the mediolateral plane. Motor Control sinus test findings revealed a higher gain in MS cases compared to controls. Regarding Fall Risk Assessment, there was no notable difference in the risk of falls between MS patients and healthy controls. However, the fall risk criteria were significantly higher among MS patients. Conclusion MS patients showed lower SOT scores, a higher Romberg Quotient, and larger SKG surface area, indicating impaired postural control. While faller numbers did not differ significantly, MS patients exhibited more faller criteria. The SOT Global balance score correlated strongly with EDSS scores, suggesting its usefulness in assessing clinical disability in MS. CDP could be valuable in evaluating postural stability and fall risk in MS patients, guiding tailored rehabilitation plans.