Multiple Sclerosis and Postural Control: The Role of Spasticity

doi:10.1016/j.apmr.2009.09.013

Archives of Physical Medicine and Rehabilitation

Volume 91, Issue 1, January 2010, Pages 93-99

https://doi.org/10.1016/j.apmr.2009.09.013 Get rights and content

Abstract

Sosnoff JJ, Shin S, Motl RW. Multiple sclerosis and postural control: the role of spasticity.

Objectives

To examine the association between spasticity and postural control in subjects with multiple sclerosis (MS).

Design

Cross-sectional.

Setting

Motor control laboratory.

Participants

Subjects with MS (n=16, 2 male) and age and sex-matched subjects (n=16) participated in the investigation. All subjects with MS had Expanded Disability Status Scale scores between 0 and 4.5 and modified Ashworth scale scores between 1 and 3.

Interventions

Not applicable.

Main Outcome Measures

Postural control was measured with a force platform that quantifies ground reaction forces and moments in mediolateral and anteroposterior directions. Postural control was indexed with anterior-posterior sway range, medial-lateral sway range, 95% elliptical area of the deviations of center of pressure (COP), velocity of COP sway, and the frequency at which 95% of spectral profile was contained. Participants with MS further underwent assessment of the soleus Hoffman reflex (H-reflex) as an index of spasticity.

Results

Cluster analysis on H-reflex data identified groups of MS participants with high spasticity (n=7) and low spasticity (n=9). There were no differences in age, duration of MS, and disease severity between MS groups. There were no differences in anterior-posterior sway range between any of the groups. The high spasticity group had greater COP area, velocity, and mediolateral sway compared with the low spasticity and control group, and the low spasticity group had postural control values between the high spasticity and control groups.

Conclusions

The pattern of results suggests that spasticity contributes to postural deficits observed in MS.

Section snippets

Participants

Sixteen subjects with MS (2 males) and 16 age- and sex-matched controls participated in the investigation. All subjects with MS had Expanded Disability Status Scale scores between 0 and 4.5 and modified Ashworth Scale scores between 1 and 3. The MS group included 16 subjects with either relapsing-remitting (n=14), primary progressive (n=1), or secondary progressive (n=1) MS. On average, it had been 7.8 years since the diagnosis of MS, with a range between 0.5 and 22 years. All subjects

Descriptive Characteristics

The descriptive characteristics of the high spasticity, low spasticity, and control groups are provided in table 1 as mean scores ± SD. The independent samples t tests did not identify any significant differences in the demographic variables of age, duration of MS, and EDSS scores between high spasticity and low spasticity groups.

Spasticity: Maximal H wave/Maximal M wave Ratio

The maximal H wave/maximal M wave ratio data are provided in table 1. The univariate ANOVA on maximal H wave/maximal M wave ratio values identified a statistically

Discussion

Persons with MS exhibit decreased postural control,8, 12 and these postural deficits are paramount in dynamic movement tasks.9, 10 The reduction in postural control, in part, increases the risk of falls in subjects with MS.17, 18 This investigation examined the relation between spasticity and postural control in subjects with MS, and we observed 2 novel findings: (1) subjects with elevated spasticity have significantly greater postural sway compared with healthy controls and subjects with MS

Conclusions

The current investigation supported previous reports that subjects with MS have postural dysfunction. Two novel findings involving postural control and MS were revealed. First, subjects with MS were found to have increased ML sway compared with healthy controls. Second, subjects with MS with increased levels of spasticity had the greatest amount of ML sway. The association between ML sway and fall risk makes this observation of the utmost importance. Overall, the findings indicate that

Acknowledgments

We thank Jean Samson, MS, Erin Snook, PhD, and Stefani Voudrie, MS, for assistance with data collection and subject recruitment.

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Citation Excerpt :
The three common symptoms in patients with MS, include fatigue, imbalance, and spasticity. Spasticity has been reported in 84% of MS patients (Sosnoff and Shin, 2010). There is a direct relationship between the degree of spasticity and the level of disability and the lower limbs more likely to be affected by spasticity than the upper limb (Cramer, 2004).
Spasticity is one of the most common and disabling symptoms in Multiple sclerosis (MS). The is a clinical tool for assessing spasticity. This study aimed to investigate the inter- and intra-rater reliability of the modified Tardieu scale for assessing knee extensors spasticity in MS patients.
Twenty-six patients with MS (12 females and 14 males) with a mean age of 40 ± 11.39 years participated in this study. The extensor muscles of both knees were evaluated using the MTS in two sessions. At first session, two examiners randomly assessed the knee extensor spasticity to study the inter-rater reliability and 3–4 days later the first examiner assessed the patients again, to determine intra-rater reliability. Intra-class Correlation Coefficient (ICC) analysis, two-way random effect model was used to determine the reliability of various components of the modified Tardieu scale.
The inter-rater reliability for quality of muscle reaction of knee extensor muscles was very good (ICC = 0.89) and for the difference between the angle of muscle response (R1) and full range(R2) of movement (R2- R1), as spasticity intensity criterion, was good (ICC = 0.73). ICC values for R2-R1 and muscle response quality assessments by one rater were 0.73 and 0.82, respectively.
The findings of the current study showed that the MTS has good to very good inter- and intra-rater reliability for assessing knee extensors spasticity in MS patients.

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: Supported by a Pilot Research Award from the National Multiple Sclerosis Society (grant no. PP1099).

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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Original articleMultiple Sclerosis and Postural Control: The Role of Spasticity

Abstract

Objectives

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Participants

Descriptive Characteristics

Spasticity: Maximal H wave/Maximal M wave Ratio

Discussion

Conclusions

Acknowledgments

Arch Phys Med Rehabil

Electroencephalogr Clin Neurophysiol

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Lancet Neurol

Neurosci Lett

Pediatr Neurol

Prevalence and treatment of spasticity reported by multiple sclerosis patients

Mult Scler

Immunopathogenesis and immunotherapy of multiple sclerosis

Nat Clin Pract Neurol

Axonal and neuronal degeneration in multiple sclerosis: mechanisms and functional consequences

Curr Opin Neurol

The control of muscle tone, reflexes, and movement: Robert Wartenberg Lecture

Neurology

Neurophysiological methods for the assessment of spasticity: the Hoffmann reflex, the tendon reflex, and the stretch reflex

Disabil Rehabil

Sensorimotor integration in human postural control

J Neurophysiol

Original article
Multiple Sclerosis and Postural Control: The Role of Spasticity