BALANCE ABILITY AND POSTURAL ADJUSTMENTS IN PATIENTS WITH MULTIPLE SCLEROSIS

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.