Nonlinear dynamical structure of sway path during standing in patients with multiple sclerosis and in healthy controls is affected by changes in sensory input and cognitive load.

Although several studies have applied traditional linear measures to evaluate postural control of patients with multiple sclerosis (MS), little is known about the nonlinear dynamics of this patient group. In this study, recurrence quantification analysis (RQA), a well documented nonlinear method, was used to compare the nonlinear dynamical structure of postural sway in two groups consisting of MS patients (n=23) and healthy matched controls (n=23). The study focuses on three levels of postural difficulty consisting of (1) standing on a rigid surface (force platform) with eyes open, (2) standing on a rigid surface with eyes closed, and (3) standing on a foam surface with eyes closed. The two levels of cognitive difficulty measured, consisted of a single postural task and a dual postural-cognitive task. It was observed that as the postural conditions became more difficult, the center of pressure (COP) time series of both groups became less regular as recorded in lower recurrence rate, less complex in deterministic structure as reflected in lower RQA entropy, and less nonstationary as reflected in the recording of lower Trend. Moreover, as cognitive conditions became more difficult, COP time series became less regular (lower %Rec in the anteroposterior direction and lower %Det in both directions), less complex in deterministic structure (lower RQA Ent in the anteroposterior direction), and less nonstationary (lower trend in the anteroposterior direction). The analytical results of the research show that there is a similar dynamical structure for both the MS patients and the control group; however, the nonlinear behavior of both groups was different under various experimental conditions.