IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy.
Department of Rehabilitation, Centro di Recupero e Rieducazione Funzionale (CRRF) "Mons. Luigi Novarese", 13040 Moncrivello, Italy.
Sensors (Basel). 2022 Dec 6;22(23):9558. doi: 10.3390/s22239558.
The balance of people with multiple sclerosis (PwMS) is commonly assessed during neurological examinations through clinical Romberg and tandem gait tests that are often not sensitive enough to unravel subtle deficits in early-stage PwMS. Inertial sensors (IMUs) could overcome this drawback. Nevertheless, IMUs are not yet fully integrated into clinical practice due to issues including the difficulty to understand/interpret the big number of parameters provided and the lack of cut-off values to identify possible abnormalities. In an attempt to overcome these limitations, an instrumented modified Romberg test (ImRomberg: standing on foam with eyes closed while wearing an IMU on the trunk) was administered to 81 early-stage PwMS and 38 healthy subjects (HS). To facilitate clinical interpretation, 21 IMU-based parameters were computed and reduced through principal component analysis into two components, sway complexity and sway intensity, descriptive of independent aspects of balance, presenting a clear clinical meaning and significant correlations with at least one clinical scale. Compared to HS, early-stage PwMS showed a 228% reduction in sway complexity and a 63% increase in sway intensity, indicating, respectively, a less automatic (more conscious) balance control and larger and faster trunk movements during upright posture. Cut-off values were derived to identify the presence of balance abnormalities and if these abnormalities are clinically meaningful. By applying these thresholds and integrating the ImRomberg test with the clinical tandem gait test, balance impairments were identified in 58% of PwMS versus the 17% detected by traditional Romberg and tandem gait tests. The higher sensitivity of the proposed approach would allow for the direct identification of early-stage PwMS who could benefit from preventive rehabilitation interventions aimed at slowing MS-related functional decline during neurological examinations and with minimal modifications to the tests commonly performed.
多发性硬化症患者（PwMS）的平衡通常在神经学检查中通过临床 Romberg 和串联步态测试进行评估，但这些测试通常不够敏感，无法揭示早期 PwMS 患者的细微缺陷。惯性传感器（IMUs）可以克服这一缺点。然而，由于包括难以理解/解释提供的大量参数以及缺乏确定可能异常的截止值等问题，IMUs 尚未完全纳入临床实践。为了克服这些限制，对 81 名早期 PwMS 患者和 38 名健康受试者（HS）进行了改良 Romberg 测试（ImRomberg：闭眼站立，同时在躯干上佩戴 IMU）。为了便于临床解释，计算了 21 个基于 IMU 的参数，并通过主成分分析将其简化为两个分量，即摆动复杂性和摆动强度，描述了平衡的独立方面，具有明确的临床意义，并与至少一个临床量表具有显著相关性。与 HS 相比，早期 PwMS 的摆动复杂性降低了 228%，摆动强度增加了 63%，分别表示平衡控制的不那么自动（更有意识）和直立姿势时躯干运动的幅度更大、速度更快。得出了用于识别平衡异常的截止值，以及这些异常是否具有临床意义。通过应用这些阈值并将 ImRomberg 测试与临床串联步态测试相结合，可以在 58%的 PwMS 患者中识别出平衡障碍，而传统 Romberg 和串联步态测试仅检测到 17%的患者。所提出方法的更高敏感性可以直接识别出早期 PwMS 患者，他们可以从旨在减缓与 MS 相关的功能下降的预防性康复干预中受益，而对通常进行的测试进行最小的修改。
