Inojosa Hernan, Schriefer Dirk, Trentzsch Katrin, Klöditz Antonia, Ziemssen Tjalf
MS Center, Department of Neurology, Carl Gustav Carus University Hospital, Technical University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
J Clin Med. 2020 Apr 30;9(5):1291. doi: 10.3390/jcm9051291.
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 ( < 0.001) and average speed of sway ( = 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 ( = 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 ( = 0.405 and = 0.329, respectively) and the MSFC ( = -0.385 and = -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.
由于多发性硬化症患者（pwMS）表现出异质性脱髓鞘病变，可能影响躯体感觉或前庭通路，视觉刺激作为反馈对于实现姿势控制可能特别相关。这对于制定预防措施和康复治疗以避免该群体跌倒和事故具有临床重要性。在我们的研究中，我们客观地评估了视觉反馈对pwMS与健康对照（HC）平衡稳定的影响及其在临床评估中的潜在效用。对99名pwMS患者和30名HC进行了静态姿势描记测试。受试者睁眼和闭眼站在测力平台上。在此过程中，针对两种视觉条件获得了三个平衡参数：平均摆动、平均速度和摆动平均速度。同时还并行进行了神经状态扩展疾病残疾评分（EDSS）和多发性硬化症功能综合评分（MSFC）。进行了一项双向混合重复测量协方差分析，控制性别和年龄，以评估视觉、MS诊断以及两者在静态姿势描记参数中的相互作用的影响。计算每个参数在睁眼和闭眼条件之间的差异，并根据与MS相关的临床变量进一步分析。在划定区域（<0.001）和摆动平均速度（=0.001）方面，视觉和MS诊断之间存在显著相互作用，pwMS和HC之间视觉效应的大小有所不同。闭眼后，这些参数在pwMS中的增加幅度大于HC。对于平均摆动，存在视觉的显著主效应（=0.047）。此外，用划定区域和摆动平均速度评估的睁眼和闭眼条件之间的差异与评估的临床测试EDSS（分别为=0.405和=0.329）和MSFC（分别为=-0.385和=-0.259）中度相关。在我们的研究中，pwMS比HC更依赖视觉反馈来维持姿势控制。这种通过静态姿势描记进行的简单且简短的评估可为pwMS中针对性预防措施和干预措施的制定提供支持。
