Visual Feedback and Postural Control in Multiple Sclerosis
Abstract
:1. Introduction
2. Materials and Methods
- PwMS with visual impairment: no visual impairment if visual function system was 0; with visual impairment if the visual function system was ≥1.
- PwMS with cerebellar impairment: no cerebellar impairment if cerebellar function system was 0; with cerebellar impairment if the cerebellar function system was ≥1.
- PwMS with sensory impairment: no sensory impairment if sensory function system was 0; with visual impairment if sensory function system was ≥1.
- Delineated area: total described surface during the measurement of the center of gravity of the subject calculated with 95% confidence interval (measured in cm2).
- Average sway: average distance or fluctuation from the center of all measurements (in mm).
- Average speed: average speed at which the central pressure point of the subjects moves on the platform (measured in mm/s).
Statistical Analysis
3. Results
3.1. Postural Stability According to Visual Stimulus in People with MS and Healthy Controls
3.2. Correlation of Balance Outcomes According to Visual Conditions with Established MS Disability and Function Tests
3.3. Influence of Visual Impairment in Postural Control According to EDSS Function Systems
4. Discussion and Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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PwMS (n = 99) | HC (n = 30) | ||
---|---|---|---|
Mean age in years | 35.01 (SD 8.21) | 34.03 (SD 7.98) | p = 0.892 |
Females | 68 (68.69%) | 21 (70%) | p = 0.563 |
Years Since Diagnosis (mean, SD) | 5.48 (SD 4.62) | n.a. | |
MS Subtype | |||
RRMS | 91.9% | n.a. | |
Transition to SPMS | 7.1% | n.a. | |
SPMS | 1.0% | n.a. | |
EDSS (median, IQR) | 2.0 (IQR 1.50–3.0) | n.a. | |
Visual Function System (median, IQR) | 0 (IQR 0–1) | n.a. | |
PwMS with visual impairment (n, %) | 35 (35.3%) | n.a. | |
Cerebellar Function System (median, IQR) | 1 (IQR 0–1) | n.a. | |
PwMS with cerebellar impairment (n, %) | 57 (57.8%) | n.a. | |
Sensory Function System (median, IQR) | 1 (IQR 0–2) | n.a. | |
PwMS with sensory impairment (n, %) | 70 (70.7%) | n.a. | |
MSFC Z-score (mean, SD) | 0.602 (SD 0.421) | 0.913 (SD 0.164) | p < 0.001 |
Balance Outcome | Total (n = 129) | PwMS (n = 99) | HC (n = 30) |
---|---|---|---|
Delineated Area (cm2) (mean, SD) | |||
Open eyes | 1.78 (SD 1.47) | 1.98 (SD 1.61) | 1.13 (SD 0.54) |
Closed eyes | 4.59 (SD 6.90) | 5.48 (SD 7.65) | 1.67 (SD 0.98) |
Increase | +2.81 (SD 6.06); +158% | +3.50 (SD 6.76); +177% | +0.54 (SD 0.88); +48% |
Average Sway (mm) (mean, SD) | |||
Open eyes | 13.66 (SD 7.33) | 14.14 (SD 7.85) | 12.09 (SD 5.07) |
Closed eyes | 15.31 (SD 7.49) | 16.04 (SD 7.59) | 12.94 (SD 6.75) |
Increase | +1.65 (SD 5.32); +12% | +1.90 (SD 5.62); +13% | +0.84 (SD 4.18); +7% |
Average Speed of Sway (mm/s) (mean, SD) | |||
Open eyes | 14.83 (SD 6.33) | 15.49 (SD 7.00) | 12.66 (SD 2.30) |
Closed eyes | 22.49 (SD 13.42) | 24.40 (SD 14.66) | 16.22 (SD 3.97) |
Increase | +7.67 (SD 8.94); +52% | +8.91 (SD 9.77); +45% | +3.56 (SD 2.75); +28% |
Source | df | Mean Square | F | p | ŋp2 | |
---|---|---|---|---|---|---|
Delineated Area | Vision | 1 | 0.454 | 14.102 | <0.001 | 0.101 |
MS Diagnosis | 1 | 3.303 | 18.140 | <0.001 | 0.127 | |
Vision * MS Diagnosis | 1 | 0.415 | 12.890 | <0.001 | 0.093 | |
Average Sway | Vision | 1 | 0.069 | 4.014 | 0.047 | 0.031 |
MS Diagnosis | 1 | 0.225 | 2.678 | 0.104 | 0.021 | |
Vision * MS Diagnosis | 1 | 0.050 | 2.911 | 0.090 | 0.023 | |
Average Speed of Sway | Vision | 1 | 0.119 | 23.628 | <0.001 | 0.159 |
MS Diagnosis | 1 | 0.451 | 10.892 | 0.001 | 0.080 | |
Vision * MS Diagnosis | 1 | 0.062 | 12.277 | 0.001 | 0.089 |
Balance Parameter | EDSS | Visual Function System | Cerebellar Function System | Sensory Function System | MSFC |
---|---|---|---|---|---|
Open Eyes | |||||
Delineated Area | 0.327 | 0.113 | 0.262 | 0.287 | −0.358 |
p < 0.001 | p = 0.269 | p = 0.009 | p = 0.004 | p < 0.001 | |
Average Sway | 0.266 | 0.116 | 0.060 | 0.166 | −0.342 |
p = 0.008 | p = 0.255 | p = 0.555 | p = 0.101 | p < 0.001 | |
Average Speed of Sway | 0.285 | 0.207 | 0.275 | 0.299 | −0.299 |
p = 0.004 | p = 0.041 | p = 0.006 | p = 0.022 | p = 0.003 | |
Closed Eyes | |||||
Delineated Area | 0.427 | 0.132 | 0.396 | 0.334 | –0.422 |
p < 0.001 | p = 0.194 | p < 0.001 | p < 0.001 | p < 0.001 | |
Average Sway | 0.330 | 0.130 | 0.160 | 0.286 | −0.384 |
p < 0.001 | p = 0.200 | p = 0.114 | p = 0.004 | p < 0.001 | |
Average Speed of Sway | 0.334 | 0.120 | 0.343 | 0.306 | –0.293 |
p < 0.001 | p = 0.241 | p = 0.001 | p = 0.002 | p = 0.003 | |
Difference | |||||
Delineated Area | 0.405 | 0.091 | 0.379 | 0.361 | −0.385 |
p < 0.001 | p = 0.375 | p < 0.001 | p < 0.001 | p < 0.001 | |
Average Sway | 0.042 | –0.034 | 0.118 | 0.090 | 0.0003 |
p = 0.683 | p = 0.741 | p = 0.244 | p = 0.375 | p = 0.997 | |
Average Speed of Sway | 0.329 | 0.002 | 0.284 | 0.297 | −0.259 |
p < 0.001 | p = 0.987 | p = 0.004 | p = 0.003 | p = 0.010 |
Difference after Withdrawal of Visual Stimulus | No Visual Impairment (n = 63) | With Visual Impairment (n = 35) | p (Effect Size) |
---|---|---|---|
Difference Delineated Area (cm2) | 3.18 (SD 5.40) | 4.06 (SD 8.82) | p = 0.963 (0.120) |
Difference Average Sway (mm) | 2.09 (SD 5.53) | 1.53 (SD 5.91) | p = 0.649 (0.097) |
Difference Average Speed of Sway (mm/s) | 8.65 (7.67) | 9.52 (SD 12.93 | p = 0.876 (0.100) |
No cerebellar impairment (n = 42) | With cerebellar impairment (n = 57) | ||
Difference Delineated Area (cm2) | 2.28 (SD 4.18) | 4.40 (SD 8.07) | p = 0.057 (0.329) |
Difference Average Sway (mm) | 1.22 (SD 6.02) | 2.40 (SD 5.30) | p = 0.307 (0.208) |
Difference Average Speed of Sway (mm/s) | 7.39 (SD 8.15) | 10.04 (SD 10.75) | p = 0.031 (0.277) |
No Sensory impairment (n = 29) | With Sensory impairment (n = 70) | ||
Difference Delineated Area (cm2) | 1.55 (SD 2.39) | 4.31 (SD 7.76) | p = 0.004 (0.480) |
Difference Average Sway (mm) | −0.01 (SD 3.98) | 2.69 (SD 6.02) | p = 0.011 (0.851) |
Difference Average Speed of Sway (mm/s) | 6.32 (SD 7.41) | 9.99 (SD 10.46) | p = 0.026 (0.404) |
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Inojosa, H.; Schriefer, D.; Trentzsch, K.; Klöditz, A.; Ziemssen, T. Visual Feedback and Postural Control in Multiple Sclerosis. J. Clin. Med. 2020, 9, 1291. https://doi.org/10.3390/jcm9051291
Inojosa H, Schriefer D, Trentzsch K, Klöditz A, Ziemssen T. Visual Feedback and Postural Control in Multiple Sclerosis. Journal of Clinical Medicine. 2020; 9(5):1291. https://doi.org/10.3390/jcm9051291
Chicago/Turabian StyleInojosa, Hernan, Dirk Schriefer, Katrin Trentzsch, Antonia Klöditz, and Tjalf Ziemssen. 2020. "Visual Feedback and Postural Control in Multiple Sclerosis" Journal of Clinical Medicine 9, no. 5: 1291. https://doi.org/10.3390/jcm9051291