Solomon Andrew J, Jacobs Jesse V, Lomond Karen V, Henry Sharon M
Department of Neurological Sciences, University of Vermont College of Medicine, University Health Center - Arnold 2, 1 South Prospect Street, Burlington, VT, 05401, USA.
Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA.
J Neuroeng Rehabil. 2015 Sep 1;12:74. doi: 10.1186/s12984-015-0066-9.
Common clinical neurological exams can be insensitive to balance and mobility impairment at the early stages of multiple sclerosis (MS) and may not correspond with patient reports. Instrumented measurement of standing postural sway with inertial motion sensors may provide sensitive measures of balance impairment and better correspond with patient reports.
While wearing wireless inertial sensors, 20 subjects with MS - Expanded Disability Status Scale of less than 3.0 and a Timed 25 Foot Walk of 5 sec or less - and 20 age- and sex-matched control subjects stood with eyes open and eyes closed on a foam surface. Forty-six outcome measures of postural sway were derived. A stepwise logistic regression model determined which measures of instrumented sway provide independent predictors of group status. Subjects with MS also completed the Activities-Specific Balance Confidence (ABC) scale and the 12-Item MS Walking Scale (MSWS-12) as measures of subject-reported balance and mobility impairment.
The regression model identified medio-lateral sway path length and medio-lateral range of sway acceleration amplitude, each in the eyes-open condition, as the only two significant independent predictors to differentiate subjects with MS from those without MS (model chi-squared = 34.55, p < 0.0001): accuracy = 87.5 %, positive likelihood ratio = 6 (2.09-17.21), negative likelihood ratio = 0.12 (0.03-0.44). Range of sway acceleration amplitude significantly correlated with both ABC (Spearman's r = -0.567, p = 0.009) and MSWS-12 scores (Spearman's r = -0.590, p = 0.006).
Postural sway abnormalities in subjects with MS who are minimally disabled were detected using wireless inertial sensors and may signify a superior sensitivity to identify balance impairment prior to developing clinically evident disability or impaired gait speed. Further study is needed to confirm the clinical significance and predictive value of these objectively identified balance impairments.
常见的临床神经学检查可能对多发性硬化症（MS）早期的平衡和活动能力损害不敏感，且可能与患者报告不一致。使用惯性运动传感器对站立姿势摆动进行仪器测量，可能会提供平衡损害的敏感指标，并与患者报告更相符。
20名MS患者（扩展残疾状态量表小于3.0且25英尺定时步行时间为5秒或更短）以及20名年龄和性别匹配的对照受试者在佩戴无线惯性传感器的情况下，睁眼和闭眼站在泡沫表面。得出了46项姿势摆动的结果指标。逐步逻辑回归模型确定了哪些仪器测量的摆动指标可作为分组状态的独立预测因素。MS患者还完成了特定活动平衡信心（ABC）量表和12项MS步行量表（MSWS - 12），作为患者报告的平衡和活动能力损害的指标。
回归模型确定，在睁眼条件下，左右摆动路径长度和左右摆动加速度幅度范围是区分MS患者与非MS患者的仅有的两个显著独立预测因素（模型卡方值 = 34.55，p < 0.0001）：准确率 = 87.5%，阳性似然比 = 6（2.09 - 17.21），阴性似然比 = 0.12（0.03 - 0.44）。摆动加速度幅度范围与ABC量表得分（斯皮尔曼相关性r = -0.567，p = 0.009）和MSWS - 12得分（斯皮尔曼相关性r = -0.590，p = 0.006）均显著相关。
使用无线惯性传感器检测到了轻度残疾的MS患者的姿势摆动异常，这可能表明在出现临床明显残疾或步态速度受损之前，该方法在识别平衡损害方面具有更高的敏感性。需要进一步研究来证实这些客观识别出的平衡损害的临床意义和预测价值。
