The Relationship Between Trunk Control and Disability in Persons with Early Relapsing Multiple Sclerosis

Year 2025, Volume: 12 Issue: 3, 816 - 828, 31.12.2025

Arzucan Toksal Uçar , Bilge Piri Cinar , Güngör Beyza Özvar Şenöz , Mustafa Açıkgöz , Hasret Uçar , Nursena Ceylan , Serkan Ozakbas

Abstract

Objectives: This study aims to investigate the relationship between physical disability and trunk control, balance, and gait parameters in persons with Relapsing Remitting Multiple Sclerosis (RRMS) who have a low Expanded Disability Status Scale (EDSS) score.
Materials and Methods: Twenty-three RRMS patients with an age range of 18-50 years, EDSS score ≤ 3 were included in this study. The patients' level of disability (EDSS), trunk control) Trunk Impairment Scale - TIS), lower extremity functionality (Timed 25-Foot Walk Test - T25FW), upper extremity functionality (Nine Hole Peg Test- 9HPT), balance (Biodex Balance System) and gait (Zebris® FDM 2) were evaluated.
Results: The mean EDSS score of 23 patients who participate in the study was 2,10±0,67. A moderate, negative correlation (r= -0.429) was found between EDSS and TIS-dynamic parameter, while a moderate, positive correlation (r= 0.608) was found with T25FW (p<0.05). A moderate, positive correlation was also found between EDSS and dominant and non-dominant 9HPT scores (respectively, r= 0.423, r= 0.498) (p<0.05).
Conclusion: EDSS, is not sufficient alone in terms of functionality, especially in patients with low disability. In these early stage patients, trunk, upper extremity, gait and balance assessments should be included in routine assessments.

Keywords

Multiple Sclerosis , Disability , Trunk control , Functionality

References

• Arntzen, E. C., Straume, B., Odeh, F., Feys, P., & Normann, B. (2020). Group‐based, individualized, comprehensive core stability and balance intervention provides immediate and long‐term improvements in walking in individuals with multiple sclerosis: A randomized controlled trial. Physiotherapy Research International, 25(1), e1798. https://doi.org/10.1002/pri.1798
• Arntzen, E. C., Straume, B. K., Odeh, F., Feys, P., Zanaboni, P., & Normann, B. (2019). Group-based individualized comprehensive core stability intervention improves balance in persons with multiple sclerosis: A randomized controlled trial. Physical Therapy, 99(8), 1027–1038. https://doi.org/10.1093/ptj/pzz017
• Aruin, A. S. (2016). Enhancing anticipatory postural adjustments: A novel approach to balance rehabilitation. Journal of Novel Physiotherapies, 6(2), e144. https://doi.org/10.4172/2165-7025.1000e144
• Aruin, A. S., Kanekar, N., & Lee, Y.-J. (2015). Anticipatory and compensatory postural adjustments in individuals with multiple sclerosis in response to external perturbations. Neuroscience Letters, 591, 182–186. https://doi.org/10.1016/j.neulet.2015.02.050
• Bethoux, F. A., Palfy, D. M., & Plow, M. A. (2016). Correlates of the timed 25-foot walk in a multiple sclerosis outpatient rehabilitation clinic. International Journal of Rehabilitation Research, 39(2), 134–138. https://doi.org/10.1097/MRR.0000000000000157
• Bollens, B., Crevecoeur, F., Nguyen, V., Detrembleur, C., & Lejeune, T. (2010). Does human gait exhibit comparable and reproducible long-range autocorrelations on level ground and on treadmill? Gait & Posture, 32(3), 369–373. https://doi.org/10.1016/j.gaitpost.2010.06.011
• Brownlee, W. J., Hardy, T. A., Fazekas, F., & Miller, D. H. (2017). Diagnosis of multiple sclerosis: Progress and challenges. The Lancet, 389(10076), 1336–1346. https://doi.org/10.1016/S0140-6736(16)30959-X
• Cachupe, W. J., Shifflett, B., Kahanov, L., & Wughalter, E. H. (2001). Reliability of Biodex Balance System measures. Measurement in Physical Education and Exercise Science, 5(2), 97–108. https://doi.org/10.1207/S15327841MPEE0502_3
• Cameron, M. H., & Lord, S. (2010). Postural control in multiple sclerosis: Implications for fall prevention. Current Neurology and Neuroscience Reports, 10, 407–412. https://doi.org/10.1007/s11910-010-0128-0
• Cattaneo, D., Gervasoni, E., Anastasi, D., Di Giovanni, R., Brichetto, G., Carpinella, I., et al. (2022). Prevalence and patterns of subclinical motor and cognitive impairments in non-disabled individuals with early multiple sclerosis: A multicenter cross-sectional study. Annals of Physical and Rehabilitation Medicine, 65(1), 101491. https://doi.org/10.1016/j.rehab.2021.101491
• Comber, L., Galvin, R., & Coote, S. (2017). Gait deficits in people with multiple sclerosis: A systematic review and meta-analysis. Gait & Posture, 51, 25–35. https://doi.org/10.1016/j.gaitpost.2016.09.026
• Comber, L., Sosnoff, J. J., Galvin, R., & Coote, S. (2018). Postural control deficits in people with multiple sclerosis: A systematic review and meta-analysis. Gait & Posture, 61, 445–452. https://doi.org/10.1016/j.gaitpost.2018.02.018 Crevecoeur, F., Bollens, B., Detrembleur, C., & Lejeune, T. (2010). Towards a “gold-standard” approach to address the presence of long-range autocorrelation in physiological time series. Journal of Neuroscience Methods, 192(1), 163–172. https://doi.org/10.1016/j.jneumeth.2010.07.017
• ECTRIMS. (2022). ePoster. Multiple Sclerosis, 28(3_suppl), 692–945. Erdeo, F., Salci, Y., Ali, U. U., & Armutlu, K. (2019). Examination of the effects of coordination and balance problems on gait in ataxic multiple sclerosis patients. Neurosciences (Riyadh), 24(4), 269–277. https://doi.org/10.17712/nsj.2019.4.20190038
• Feys, P., Lamers, I., Francis, G., Benedict, R., Phillips, G., LaRocca, N., et al. (2017). The Nine-Hole Peg Test as a manual dexterity performance measure for multiple sclerosis. Multiple Sclerosis, 23(5), 711–720. https://doi.org/10.1177/1352458517690824
• Fritz, N. E., Marasigan, R. E. R., Calabresi, P. A., Newsome, S. D., & Zackowski, K. M. (2015). The impact of dynamic balance measures on walking performance in multiple sclerosis. Neurorehabilitation and Neural Repair, 29(1), 62–69. https://doi.org/10.1177/1545968314532835
• Goldberger, A. L., Amaral, L. A. N., Hausdorff, J. M., Ivanov, P. C., Peng, C.-K., & Stanley, H. E. (2002). Fractal dynamics in physiology: Alterations with disease and aging. Proceedings of the National Academy of Sciences of the United States of America, 99(Suppl. 1), 2466–2472. https://doi.org/10.1073/pnas.012579499
• Hayran, M., & Hayran, M. (2011). Fundamental statistics for health research. Omega Research.
• Kalron, A., Nitzani, D., & Achiron, A. (2016). Static posturography across the EDSS scale in people with multiple sclerosis: A cross-sectional study. BMC Neurology, 16, 1–8. https://doi.org/10.1186/s12883-016-0603-6
• Karst, G. M., Venema, D. M., Roehrs, T. G., & Tyler, A. E. (2005). Center of pressure measures during standing tasks in minimally impaired persons with multiple sclerosis. Journal of Neurologic Physical Therapy, 29(4), 170–180. https://doi.org/10.1097/01.NPT.0000282314.40230.40
• Kibler, W. B., Press, J., & Sciascia, A. (2006). The role of core stability in athletic function. Sports Medicine, 36, 189–198. https://doi.org/10.2165/00007256-200636030-00001
• Korkmaz, N., Akman, C., Oren, T. C., G. K., & Bir, L. S. (2018). Trunk control: The essence for upper limb functionality in patients with multiple sclerosis. Multiple Sclerosis and Related Disorders, 24, 101–106. https://doi.org/10.1016/j.msard.2018.06.013
• Krieger, S. C., Antoine, A., & Sumowski, J. F. (2022). EDSS 0 is not normal: Multiple sclerosis disease burden below the clinical threshold. Multiple Sclerosis, 28(14), 2299–2303. https://doi.org/10.1177/13524585221108297
• Kurtzke, J. F. (1983). Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology, 33(11), 1444–1452. https://doi.org/10.1212/WNL.33.11.1444
• Langeskov-Christensen, D., Feys, P., Baert, I., Riemenschneider, M., Stenager, E., & Dalgas, U. (2017). Performed and perceived walking ability in relation to the Expanded Disability Status Scale in persons with multiple sclerosis. Journal of the Neurological Sciences, 382, 131–136. https://doi.org/10.1016/j.jns.2017.09.049
• Lee, Y.-J., Chen, B., Liang, J.-N., & Aruin, A. S. (2018). Control of vertical posture while standing on a sliding board and pushing an object. Experimental Brain Research, 236, 721–731. https://doi.org/10.1007/s00221-017-5166-2
• Lipp, I., & Tomassini, V. (2015). Neuroplasticity and motor rehabilitation in multiple sclerosis. Frontiers in Neurology, 6, 59. https://doi.org/10.3389/fneur.2015.00059
• Martin, C. L., Phillips, B. A., Kilpatrick, T., Butzkueven, H., Tubridy, N., McDonald, E., et al. (2006). Gait and balance impairment in early multiple sclerosis in the absence of clinical disability. Multiple Sclerosis, 12(5), 620–628. https://doi.org/10.1177/1352458506070658
• Miyake, Y., Kobayashi, R., Kelepecz, D., & Nakajima, M. (2013). Core exercises elevate trunk stability to facilitate skilled motor behavior of the upper extremities. Journal of Bodywork and Movement Therapies, 17(2), 259–265. https://doi.org/10.1016/j.jbmt.2012.06.003
• Nilsagård, Y., Carling, A., Davidsson, O., Franzén, L., & Forsberg, A. (2017). Comparison of trunk impairment scale versions 1.0 and 2.0 in people with multiple sclerosis: A validation study. Physiotherapy Theory and Practice, 33(10), 772–779. https://doi.org/10.1080/09593985.2017.1346025
• Peebles, A. T., Bruetsch, A. P., Lynch, S. G., & Huisinga, J. M. (2018). Dynamic balance is related to physiological impairments in persons with multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 99(10), 2030–2037. https://doi.org/10.1016/j.apmr.2017.11.010
• Raats, J., Arntzen, E. C., Lamers, I., Feys, P., & Normann, B. (2022). What is the distribution of trunk impairments and its relationship with disability level in individuals with multiple sclerosis? Multiple Sclerosis and Related Disorders, 57, 103325. https://doi.org/10.1016/j.msard.2021.103325
• Rooney, S., Riemenschneider, M., Dalgas, U., Jørgensen, M.-L. K., Michelsen, A.-S., Brønd, J. C., et al. (2021). Physical activity is associated with neuromuscular and physical function in patients with multiple sclerosis independent of disease severity. Disability and Rehabilitation, 43(5), 632–639. https://doi.org/10.1080/09638288.2019.1634768
• Shiba, Y., Obuchi, S., Saitou, C., Habata, T., & Maeda, M. (2001). Effects of bilateral upper-limb exercise on trunk muscles. Journal of Physical Therapy Science, 13(1), 65–67. https://doi.org/10.1589/jpts.13.65
• Skjerbæk, A. G., Dalgas, U., Stenager, E., Boesen, F., & Hvid, L. G. (2023). The six spot step test is superior in detecting walking capacity impairments compared to short- and long-distance walk tests in persons with multiple sclerosis. Multiple Sclerosis Journal – Experimental, Translational and Clinical, 9(4). https://doi.org/10.1177/20552173231218127.
• Solaro, C., Cattaneo, D., Brichetto, G., Castelli, L., Tacchino, A., Gervasoni, E., et al. (2019). Clinical correlates of 9-hole peg test in a large population of people with multiple sclerosis. Multiple Sclerosis and Related Disorders, 30, 1–8. https://doi.org/10.1016/j.msard.2019.01.043
• Sosnoff, J. J., Gappmaier, E., Frame, A., & Motl, R. W. (2011). Influence of spasticity on mobility and balance in persons with multiple sclerosis. Journal of Neurologic Physical Therapy, 35(3), 129–132. https://doi.org/10.1097/NPT.0b013e31822a8c40
• Verheyden, G., Nuyens, G., Nieuwboer, A., Van Asch, P., Ketelaer, P., & De Weerdt, W. (2006). Reliability and validity of trunk assessment for people with multiple sclerosis. Physical Therapy, 86(1), 66–76. https://doi.org/10.1093/ptj/86.1.66