Full length articleSomatosensory impairment and its association with balance limitation in people with multiple sclerosis
Introduction
Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system (CNS) and known as the most common neurological condition in 20 to 50 year-old adults [1]. The impact of pathology on the CNS can result in significant restrictions of mobility due to impairments in the sensory, motor, and cognitive systems [2]. The World Health Organization (WHO) has identified sensory impairments as a prevalent symptom of MS [3]. Up to 80% of people with multiple sclerosis (PwMS) showed degrees of sensory impairment in previous investigations [4], [5], [6]. There is a considerable volume of evidence that the sensory system plays an important role in regulating postural control and human balance [7], [8]. It has also been substantiated in previous studies that poor sensation can be associated with compromised motor control and limited balance in PwMS [9], [10]. Postural control needs the sound functioning of multiple inter-related systems including sensory (vestibular, visual, and somatosensory), motor, and cognitive [11]. Intact somatosensory information is essential to provide feedback for motor activity, human mobility and motor learning [12]. Addressing somatosensory impairments can be an important aspect in the rehabilitation of PwMS [12]. Emerging findings indicate that sensory-based interventions may improve the motor activity of individuals with MS [13], [14]. These studies have indicated that greater improvement in functioning is achieved when sensory strategies were included in the treatment [13]. It is therefore important to pay more attention to the sensory components while tailoring a rehabilitation plan for PwMS.
The assessment of somatosensory impairments is common in clinical practice [15], but there is relatively little research on rehabilitation programs which may positively influence somatosensory abilities in PwMS. One possible reason for this issue is the lack of a precise and clinically accessible method to measure sensory modalities affected in PwMS. Sensory assessment can be a good prognostic tool to either assess the underlying mechanisms of balance limitations [10] or to plan a comprehensive and effective treatment to retrain or compensate for mobility problems. There are many previous studies which have reported aspects of somatosensory impairments in PwMS [4], [5], [6], [9], [16], [17], [18]. However, most studies focused on the sensory measurement of only one body area [9], [16], [17], [18] or only one somatosensory modality [16], [17] in a relatively small group of subjects [5], [9], [16], [18]. Quantitative measurement of somatosensory impairments was lacking in some reports [4], [10]. Study heterogeneity in terms of type of sensory modality measured, body area assessed and study population is such that it is difficult to estimate the prevalence of somatosensory impairments or identify the nature of somatosensory loss in PwMS.
The current study addressed the missing components in these previous studies by assessing across a spectrum of sensory modalities and for multiple body parts in a larger sample group. A group of healthy people were also recruited to examine whether the quantitative somatosensory measures were sufficiently sensitive to detect differences between PwMS and matched controls without neurological impairment. The objective of this study was to undertake a comprehensive investigation to (a) clarify the frequency and type of somatosensory impairments across three modalities, (b) map these disorders in the body extremities and (c) explore any association between somatosensory impairments and limitation of balance outcomes in a larger-scaled sampling of PwMS.
Section snippets
Participants
This cross-sectional study recruited a convenience sample of 89 PwMS and 30 healthy subjects. PwMS were recruited from the outpatients list of a local MS clinic (Neurology Unit, Alzahra Hospital, Isfahan, Iran) which was the main referral center within the province. Participants had relapsing-remitting MS diagnosed by a neurological specialist, according to Mc Donald’s criteria [19]. PwMS were recruited if they had the ability to walk a 10 m distance without assistance of another person or any
Results
82 PwMS and 30 healthy controls were recruited in this study. There was no statistically significant difference in age, gender and BMI between PwMS and their control peers (p p > 0.05˃ 0.05). Means (+/− SD) were calculated to describe the level of impairment across domains: the Fatigue Status Score in PwMS was 45.9 ± 13.9 out of 63, the pain score was 21.9 ± 19 out of 100 mm, ataxia was 5.3 ± 4.7 out of 30, lower limb spasticity score was 4.5 ± 5.2 out of 20 (including plantarflexors = 3.6 ± 2.9, quadriceps =
Discussion
The results of this study show that somatosensory impairments are common in PwMS. There was a large variation in the extent and nature of sensory problems and between different modalities and body area. Somatosensory impairments were found to be independent predictors of balance limitations in PwMS.
According to an extensive literature review carried out by the authors, this is the only study that has assessed such a variety of sensory modalities in PwMS. A small number of participants with MS
Conclusion
Somatosensory impairments were common in PwMS. Proprioception was more frequently impaired than tactile and vibration sensations. The frequency of impairment in the lower limb was higher than the upper limb. Somatosensory impairment was associated with limited balance in PwMS.
Conflict of interest
The authors have no conflicts of interest to disclose.
Acknowledgements
The work completed here was a research project was registered and sponsored by Isfahan University of Medical Sciences (MUI-REC-293063). The contents are the responsibility of the authors and do not reflect the views of the sponsor.
References (42)
- et al.
Paraesthesiae in multiple sclerosis
J. Neurol. Sci.
(1986) - et al.
Relationship between foot sensation and standing balance in patients with multiple sclerosis
Gait Posture
(2011) - et al.
Effect of textured insoles on balance and gait in people with multiple sclerosis: an exploratory trial
Physiotherapy (United Kingdom)
(2014) - et al.
The effect of textured insoles on gait patterns of people with multiple sclerosis
Gait Posture
(2010) - et al.
Quantitative measures detect sensory and motor impairments in multiple sclerosis
J. Neurol. sci.
(2011) - et al.
Relationship between foot vibration threshold and walking and balance functions in people with Multiple Sclerosis (PwMS)
Gait Posture
(2015) An assessment of vibration threshold using a biothesiometer compared to a C128–Hz tuning fork
J. Clin. Neurosci.
(2009)- et al.
Clinical tests of standing balance: performance of persons with multiple sclerosis
Arch. Phys. Med. Rehabil.
(2000) - et al.
Gait impairment and optimizing mobility in multiple sclerosis
Phys. Med. Rehabil. Clin. N Am.
(2013) - et al.
Sensory modalities are not separate modalities: plasticity and interactions
Curr. Opin. Neurobiol.
(2001)
The influence of vibration on the excitability of alpha motoneurones
Electroencephalogr. Clin. Neurophysiol.
Sensory loss and walking speed related factors for gait alterations in patients with peripheral neuropathy
Gait Posture
Effect of light finger touch in balance control of individuals with multiple sclerosis
Gait Posture
Enhancing Postural Stability and Adaptability in Multiple Sclerosis
Drawing on related knowledge to advance multiple sclerosis falls-prevention research
Int. J. MS Care
World Health Organization Atlas: Multiple Sclerosis Resources in the World
Quantitative sensory threshold testing in patients with multiple sclerosis
Electromyogr. Clin. Neurophysiol.
Somatosensory evoked potentials and sensory involvement in multiple sclerosis: comparison with clinical findings and quantitative sensory tests
Mult. Scler.
Postural control in multiple sclerosis: implications for fall prevention
Curr. Neurol. Neurosci. Rep.
How proprioceptive impairments affect quiet standing in patients with multiple sclerosis
Somatosensory Motor Res.
Sensory impairments in quiet standing in subjects with multiple sclerosis
Mult. Scler.
Cited by (37)
Investigation of parameters related to lower extremity muscle strength and proprioception in Patients with Multiple Sclerosis: a cross-sectional study
2023, Multiple Sclerosis and Related DisordersEffects of backward walking training on balance, gait, and functional mobility in people with multiple sclerosis: A randomized controlled study
2023, Multiple Sclerosis and Related DisordersComparison of the immediate effects of plantar vibration of both feet with the plantar vibration of the affected foot on balance in patients with stroke: Preliminary findings
2023, Journal of Bodywork and Movement TherapiesComparison of physical performance, gait, balance, falls efficacy, and step reaction time in individuals with multiple sclerosis
2023, Clinical Neurology and NeurosurgeryDifferential diagnosis in vestibular physiotherapy
2023, KinesitherapieImpaired foot vibration sensitivity is related to altered plantar pressures during walking in people with multiple sclerosis
2023, Multiple Sclerosis and Related Disorders