BALANCE ABILITY AND POSTURAL ADJUSTMENTS IN PATIENTS WITH MULTIPLE SCLEROSIS
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Date
2024-12
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University of Miami
Abstract
Maintaining balance is essential for performing daily activities, requiring the
body’s center of mass (COM) to stay within the base of support (BOS) during both static
and dynamic tasks. Individuals with multiple sclerosis (PwMS) often face impairments in
balance due to neurological dysfunctions that affect anticipatory (APAs) and
compensatory (CPAs) postural adjustments, increasing the risk of falls. While previous
studies have examined balance mechanisms using shoulder-level perturbations in PwMS,
the impact of base-of-support perturbations on postural adjustments remains inadequately
explored. This dissertation aimed to comprehensively characterize the balance ability and
postural adjustments in PwMS compared to healthy controls and evaluate the
effectiveness of targeted training interventions designed to enhance these capabilities.
The research objectives included three main aims: first, to characterize differences
in balance ability and postural adjustments between PwMS and age and sex matched
healthy adults using clinical and instrumented measures; second, to systematically review
the literature to identify the most effective intervention modes for improving balance in
PwMS; and third, to investigate the impact of a targeted training program focusing on
postural adjustments and functional strength on clinical and instrumented balance
measures.
Results revealed significant balance impairments in PwMS compared to controls,
with lower scores on the BESTest, particularly in sensory orientation, anticipatory
postural adjustments, and reactive postural responses. The LOS test indicated delayed
reaction times and reduced directional control in PwMS. A systematic review of balance
interventions identified postural adjustments targeted and functional strength training as
the most effective approaches. Consequently, a targeted training program was
implemented, leading to significant improvements in total BESTest scores, faster reaction
times, greater endpoint excursions, and enhanced directional control on the LOS test. In
conclusion, this dissertation provides a detailed understanding of balance impairments
and postural adjustment deficits in PwMS, demonstrating that targeted training
interventions can significantly enhance balance ability. These findings support the
development of rehabilitation strategies aimed at reducing fall risk and improving quality
of life for PwMS.
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Keywords
Balance, Multiple Sclerosis, Postural Adjustments, Intervention