MULTİPL SKLEROZLU BİREYLERDE STABİLİTE LİMİTLERİ VE DÜŞME RİSKİ ARASINDAKİ İLİŞKİNİN İNCELENMESİ

Öz

Amaç: Bu çalışmanın amacı, Multipl Skleroz (MS)’lu bireylerde stabilite limitleri (SL) ile düşme riski arasındaki ilişkiyi incelemektir. Yöntem: Çalışmaya 18-50 yaş aralığında, Expanded Disability Status Scale (EDSS) skoru ≤ 4, son 6 ay içerisinde atak geçirmeyen ve son 6 ay içerisinde düşme hikâyesi olan 30 MS’li birey dâhil edildi. Bireylerin demografik bilgileri kaydedildi. Dört yöndeki (anterior, posterior, lateral- sol, sağ) SL, Bertec Balance Check ScreenerTM (Model BP5050; Bertec Corporation, Columbus, OH, USA) ile değerlendirildi. Düşme riski ise Zamanlı Kalk ve Yürü Testi (ZKYT) ile değerlendirildi. Dört yöndeki SL ile ZKYT skoru arasındaki ilişkileri incelemek için Spearman korelasyon testi kullanıldı. Sonuçlar: Çalışmaya katılan 30 bireyin (18 kadın, 12 erkek) yaş ortalaması 37,66±8,86 yıl idi. Anterior-posterior SL ile ZKYT skorları arasında negatif yönde iyi derecede (r =-0,616), lateral solsağ SL ile ZKYT skorları arasında negatif yönde orta derecede (r =-0,463) anlamlı bir ilişki bulundu (p<0,05). Stabilite Limitleri Stabilite Skoru (SLSS) ile ZKYT skorları arasında ise negatif yönde iyi derecede (r =-0,683) anlamlı bir ilişki bulundu (p<0,05). Tartışma: MS’li bireylerde SL, düşme için önemli bir faktördür. Biyomekanik yeterliliğin ve dinamik dengenin önemli bir göstergesi olan SL azaldıkça düşme riski artmaktadır. Düşme yaşayan MS’li bireyler SL açısından mutlaka değerlendirilmeli ve rehabilitasyon programında SL’nin geliştirilmesine de yer verilmelidir.

Anahtar Kelimeler

• Düşmeler
• Multipl Skleroz
• Postural Denge

AN INVESTIGATION OF THE ASSOCIATION BETWEEN LIMITS OF STABILITY AND RISK OF FALL IN INDIVIDUALS WITH MULTIPLE SCLEROSIS

Abstract

Purpose: To investigate the association between Limits of Stability (LoS) and risk of fall in patients with Multiple Sclerosis (MS). Methods: Thirty patients with an age range of 18-50 years, Expanded Disability Status Scale (EDSS) score ≤4, who did not have an attack in the last 6 months and had a history of falls in the last 6 months were included. Demographic information of the patients was recorded. Fourdirectional (anterior, posterior, lateral – left, right) LoS were measured with Bertec Balance Check ScreenerTM (Model BP5050; Bertec Corporation, Columbus, OH, USA). The risk of fall was measured with Timed Up and Go Test (TUG). Spearman correlation test was used to examine the association between four-directional LoS and TUG. Results: The mean age of 30 patients (18 Female, 12 Male) who participate in the study was 37.66±8.86 years. It was found that a good negative correlation (r=-0.616) between anteriorposterior LoS and TUG, a moderate negative correlation (r=-0.463) between left-right LoS and TUG (p<0.05). A good negative correlation (r=-0.683) was found between LoS Stability Score (LoSSS) and TUG (p<0.05). Conclusion: LoS is an important factor for falls in patients with MS. As the LoS, which are an important indicator of biomechanical competence and dynamic balance, decrease, the risk of falls increases in patients with MS. MS patients who experience falls should be evaluated in terms of LoS and the improvement of LoS should be included in the rehabilitation program.

Keywords

• Falls
• Multiple Sclerosis
• Postural Balance

References

1. 1. Cameron MH, Nilsagard Y. Balance, gait, and falls in multiple sclerosis. In: Brian L. Day, Stephen R. Lord eds. Handbook of Clinical Neurology. Portland: Elsevier; 2018: p. 237-50.
2. 2. Nilsagård Y, Gunn H, Freeman J, Hoang P, Lord S, Mazumder R, et al. Falls in people with MS—an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States. Mult Scler. 2015;21(1):92-100.
3. 3. Matsuda PN, Shumway-Cook A, Bamer AM, Johnson SL, Amtmann D, Kraft GH. Falls in multiple sclerosis. PM & R. 2011;3(7):624-32.
4. 4. Quinn G, Comber L, Galvin R, Coote S. The ability of clinical balance measures to identify falls risk in multiple sclerosis: a systematic review and meta-analysis. Clin Rehabil. 2018;32(5):571-82.
5. 5. Prosperini L, Pozzilli C. The clinical relevance of force platform measures in multiple sclerosis: a review. Mult Scler Int. 2013;2013.
6. 6. Ivanenko Y, Gurfinkel VS. Human Postural Control. Front Neurosci. 2018;12(171).
7. 7. Huisinga JM, St George RJ, Spain R, Overs S, Horak FB. Postural response latencies are related to balance control during standing and walking in patients with multiple sclerosis. Arch Phys Med Rehabil. 2014;95(7):1390-7.
8. 8. Faraldo-García A, Santos-Pérez S, Crujeiras R, Soto-Varela A. Postural changes associated with ageing on the sensory organization test and the limits of stability in healthy subjects. Auris Nasus Larynx. 2016;43(2):149-54.

9. 9. Johansson J, Jarocka E, Westling G, Nordström A, Nordström P. Predicting incident falls: Relationship between postural sway and limits of stability in older adults. Hum Mov Sci. 2019;66:117-23.
10. 10. Cattaneo D, Jonsdottir J, Coote S. Targeting dynamic balance in falls-prevention interventions in multiple sclerosis: recommendations from the International MS Falls Prevention Research Network. Int J MS Care. 2014;16(4):198-202.
11. 11. Gunn H, Creanor S, Haas B, Marsden J, Freeman J. Frequency, characteristics, and consequences of falls in multiple sclerosis: findings from a cohort study. Arch Phys Med Rehabil. 2014;95(3):538-45.
12. 12. Gunn HJ, Newell P, Haas B, Marsden JF, Freeman JA. Identification of risk factors for falls in multiple sclerosis: a systematic review and meta-analysis. Phys Ther. 2013;93(4):504-13.
13. 13. Carling A, Forsberg A, Nilsagård Y. Falls in people with multiple sclerosis: experiences of 115 fall situations. Clin Rehabil. 2018;32(4):526-35.
14. 14. Comber L, Sosnoff JJ, Galvin R, Coote S. Postural control deficits in people with multiple sclerosis: a systematic review and meta-analysis. Gait Posture. 2018;61:445-52.
15. 15. Ganesan M, Kanekar N, Aruin AS. Direction-specific impairments of limits of stability in individuals with multiple sclerosis. Ann Phys Rehabil Med. 2015;58(3):145-50.
16. 16. Kanekar N, Aruin AS. The role of clinical and instrumented outcome measures in balance control of individuals with multiple sclerosis. Mul Scler Int. 2013;2013.
17. 17. Denommé LT, Mandalfino P, Cinelli ME. Understanding balance differences in individuals with multiple sclerosis with mild disability: an investigation of differences in sensory feedback on postural control during a Romberg task. Exp Brain Res. 2014;232(6):1833-42.
18. 18. Soke F, Eldemir S, Ozkan T, Ozkul C, Ozcan Gulsen E, Gulsen C, et al. The functional reach test in people with multiple sclerosis: a reliability and validity study. Physiother Theory Pract.2021:1-15.
19. 19. Sebastião E, Sandroff BM, Learmonth YC, Motl RW. Validity of the Timed Up and Go Test as a Measure of Functional Mobility in Persons With Multiple Sclerosis. Arch Phys Med Rehabil. 2016;97(7):1072-7.
20. 20. Kalron A, Dolev M, Givon U. Further construct validity of the Timed Up-and-Go Test as a measure of ambulation in multiple sclerosis patients. Eur J Phys Rehabil Med. 2017;53(6):841-7.
21. 21. Sosnoff JJ, Socie MJ, Boes MK, Sandroff BM, Pula JH, Suh Y, et al. Mobility, balance and falls in persons with multiple sclerosis. PLoS One. 2011;6(11):e28021.
22. 22. Cameron MH, Huisinga J. Objective and subjective measures reflect different aspects of balance in multiple sclerosis. J Rehabil Res Dev. 2013;50(10).
23. 23. Finlayson ML, Peterson EW, Cho CC. Risk factors for falling among people aged 45 to 90 years with multiple sclerosis. Arch Phys Med Rehabil. 2006;87(9):1274-9.
24. 24. Gianni C, Prosperini L, Jonsdottir J, Cattaneo D. A systematic review of factors associated with accidental falls in people with multiple sclerosis: a meta-analytic approach. Clin Rehabil. 2014;28(7):704-16.
25. 25. Matsuda PN, Shumway-Cook A, Bamer AM, Johnson SL, Amtmann D, Kraft GH. Falls in multiple sclerosis. PM&R. 2011;3(7):624-32.
26. 26. Coote S, Hogan N, Franklin S. Falls in people with multiple sclerosis who use a walking aid: prevalence, factors, and effect of strength and balance interventions. Arch Phys Med Rehabil. 2013;94(4):616-21.
27. 27. Workbook B. Program Documentation. Bertec Corporation, Version.1(0).
28. 28. Hayran M. [Fundamental Statistics for Health Research] Sağlık Araştırmaları için Temel İstatistik. 1. Baskı. Ankara: Omega Araştırma; 2011.
29. 29. Quinn G, Comber L, McGuigan C, Galvin R, Coote S. Discriminative ability and clinical utility of the Timed Up and Go (TUG) in identifying falls risk in people with multiple sclerosis: a prospective cohort study. Clin Rehabil. 2019;33(2):317-26.
30. 30. Massot C, Simoneau-Buessinger E, Agnani O, Donze C, Leteneur S. Anticipatory postural adjustment during gait initiation in multiple sclerosis patients: A systematic review. Gait Posture. 2019;73:180-8.
31. 31. Wajda DA, Moon Y, Motl RW, Sosnoff JJ. Preliminary investigation of gait initiation and falls in multiple sclerosis. Arch Phys Med Rehabil. 2015;96(6):1098-102.
32. 32. Jacobs JV, Kasser SL. Effects of dual tasking on the postural performance of people with and without multiple sclerosis: a pilot study. J Neurol. 2012;259(6):1166-76.
33. 33. Mazumder R, Murchison C, Bourdette D, Cameron M. Falls in people with multiple sclerosis compared with falls in healthy controls. PLoS One. 2014;9(9):e107620.