Do The Core Stability and Position Sense of Trunk Affect Balance in Patients with Multiple Sclerosis?

Year 2023, Volume: 13 Issue: 3, 577 - 583, 11.09.2023

Taşkın Özkan , Arzu Güçlü Gündüz , Fatih Soke , Çağla Özkul , Yasemin Apaydın , Kader Eldemir , Ceyla İrkeç

https://doi.org/10.33808/clinexphealthsci.1123209

Cited By: 1

Abstract

Objective: The trunk is known to be the most important key point where sensory inputs are received and motor responses occur, necessary for the maintenance of balance and postural control. The aims of the present study were to investigate the relationship between balance with core stability and position sense of trunk in patients with Multiple Sclerosis (PwMS) and to compare core stability, position sense of trunk and balance in PwMS and healthy controls.
Methods: The study was completed with 45 PwMS and 29 healthy controls with matching age and gender. Balance was assessed with Postural Stability Test (PST) and Modified Sensory Organization Test (MSOT) by using Biodex Balance System®. Core stability was evaluated with core endurance tests according to McGill procedure. Position sense of trunk was evaluated with the lumbosacral (LS) reposition tests by using Dualer IQTM digital inclinometer.
Results: PST, MSOT and LS repositioning tests scores were higher (p<0.001) and the trunk flexor, extensor, right and left lateral endurance tests scores were lower (p<0.001) in PwMS compared to healthy controls. PST and MSOT were found to be correlated with core endurance tests scores (rs=-0.406/-0.602, p<0.05) and LS reposition test scores (rs= 0.357/0.510, p<0.05) in PwMS.
Conclusion: This study suggested that core stability and position sense of trunk were affected and caused imbalance in PwMS. Therefore, clinicians should consider assessments and interventions directed at decreased core stability and trunk position sense in PwMS.

Keywords

Balance, core stability, Multiple Sclerosis, position sense of trunk

References

• Preuss R, Fung J. Musculature and biomechanics of the trunk in the maintenance of upright posture. J Electromyogr Kinesiol. 2008;18(5):815-828. DOI: 10.1016/j.jelekin.2007.03.003.
• Bohannon RW. Lateral trunk flexion strength: Impairment, measurement reliability and implications following unilateral brain lesion. Int J Rehabil Res. 1992;15(3):249-251. PMID: 1428392.
• Cameron MH, Lord S. Postural control in multiple sclerosis: Implications for fall prevention. Curr Neurol Neurosci Rep. 2010;10(5):407-412. DOI: 10.1007/s11910-010-0128-0.
• Genthon N, Vuillerme N, Monnet JP, Petit C, Rougier P. Biomechanical assessment of the sitting posture maintenance in patients with stroke. Clin Biomech. 2007;22(9):1024-1029. DOI: 10.1016/j.clinbiomech.2007.07.011.
• Hodges PW, Richardson CA. Contraction of the abdominal muscles associated with movement of the lower limb. Phys Ther. 1997;77(2):132-142. DOI: 10.1093/ptj/77.2.132.
• Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med. 2006;36(3):189-198. DOI: 10.2165/00007256-200636030-00001.
• Krishnan V, Kanekar N, Aruin AS. Anticipatory postural adjustments in individuals with multiple sclerosis. Neurosci Lett. 2012;506(2):256-260. DOI: 10.1016/j.neulet.2011.11.018.
• Krishnan V, Kanekar N, Aruin AS. Feedforward postural control in individuals with multiple sclerosis during load release. Gait Posture 2012;36(2):225-230. DOI: 10.1016/j.gaitpost.2012.02.022.
• Arntzen EC, Straume BK, Odeh F, Feys P, Zanaboni P, Normann B. Group-based individualized comprehensive core stability intervention improves balance in persons with multiple sclerosis: A randomized controlled trial. Phys Ther. 2019;99(8):1027-1038. DOI: 10.1093/ptj/pzz017.
• Freeman JA, Gear M, Pauli A, Cowan P, Finnigan C, Hunter H, Mobberley C, Nock A, Sims R, Thain J. The effect of core stability training on balance and mobility in ambulant individuals with multiple sclerosis: a multi-centre series of single case studies. Mult Scler. 2010;16(11):1377-1384. DOI: 10.1177/1352458510378126.
• Guclu-Gunduz A, Citaker S, Irkec C, Nazliel B, Batur-Caglayan HZ. The effects of pilates on balance, mobility and strength in patients with multiple sclerosis. NeuroRehabilitation 2014;34(2):337-342. DOI: 10.3233/NRE-130957.
• Bulguroglu I, Guclu-Gunduz A, Yazici G, Ozkul C, Irkec C, Nazliel B, Batur-Caglayan HZ. The effects of mat pilates and reformer pilates in patients with multiple sclerosis: A randomized controlled study. NeuroRehabilitation 2017;41(2):413-422. DOI: 10.3233/NRE-162121.
• Freund JE, Stetts DM, Vallabhajosula S. Relationships between trunk performance, gait and postural control in persons with multiple sclerosis. NeuroRehabilitation 2016;39(2):305-317. DOI: 10.3233/NRE-161362.
• Grace Gaerlan M, Alpert PT, Cross C, Louis M, Kowalski S. Postural balance in young adults: The role of visual, vestibular and somatosensory systems. J Am Acad Nurse Pract. 2012;24(6):375-381. DOI: 10.1111/j.1745-7599.2012.00699.x.
• Shaffer SW, Harrison AL. Aging of the somatosensory system: A translational perspective. Phys Ther. 2007;87(2):193-207. DOI: 10.2522/ptj.20060083.
• Inglis JT, Horak FB, Shupert CL, Jones-Rycewicz C. The importance of somatosensory information in triggering and scaling automatic postural responses in humans. Exp Brain Res. 1994;101(1):159-164. DOI: 10.1007/BF00243226.
• Cholewicki J, Panjabi MM, Khachatryan A. Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture. Spine 1997;22(19):2207-2212. DOI: 10.1097/00007632-199710010-00003.
• Ebenbichler GR, Oddsson LI, Kollmitzer J, Erim Z. Sensory-motor control of the lower back: implications for rehabilitation. Med Sci Sports Exerc. 2001;33(11):1889-1898. DOI: 10.1097/00005768-200111000-00014.
• Hodges PW, Richardson CA. Relationship between limb movement speed and associated contraction of the trunk muscles. Ergonomics 1997;40(11):1220-1230. DOI: 10.1080/001401397187469.
• Ryerson S, Byl NN, Brown DA, Wong RA, Hidler JM. Altered trunk position sense and its relation to balance functions in people post-stroke. J Neurol Phys Ther. 2008;32(1):14-20. DOI: 10.1097/NPT.0b013e3181660f0c.
• Onursal Kılınç Ö, Ayvat E, Ayvat F, Sütçü G, Kılınç M, Aksoy S, Aksu Yıldırım S. The relationship between trunk position sense and postural control in ataxic individuals. Gait Posture 2019;68:258-263. DOI: 10.1016/j.gaitpost.2018.12.007.
• Goldberg A, Hernandez ME, Alexander NB. Trunk repositioning errors are increased in balance-impaired older adults. J Gerontol A Biol Sci Med Sci. 2005;60(10):1310-1314. DOI: 10.1093/gerona/60.10.1310.
• Radebold A, Cholewicki J, Polzhofer GK, Greene HS. Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain. Spine 2001;26(7):724-730. DOI: 10.1097/00007632-200104010-00004.
• Kurtzke JF. Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 1983;33(11):1444-1452. DOI: 10.1212/wnl.33.11.1444.
• Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198. DOI: 10.1016/0022-3956(75)90026-6.
• Hinman MR. Factors affecting reliability of the Biodex Balance System: A summary of four studies. J Sport Rehabil. 2000;9(3):240-252. DOI:10.1123/jsr.9.3.240.
• Cachupe WJ, Shifflett B, Kahanov L, Wughalter EH. Reliability of biodex balance system measures. Meas Phys Educ Exerc Sci. 2001;5(2):97-108. DOI: 10.1207/S15327841MPEE0502_3.
• Eftekharsadat B, Babaei-Ghazani A, Mohammadzadeh M, Talebi M, Eslamian F, Azari E. Effect of virtual reality-based balance training in multiple sclerosis. Neurol Res. 2015;37(6): 539-544. DOI: 10.1179/1743132815Y.0000000013.
• McGill SM, Childs A, Liebenson C. Endurance times for low back stabilization exercises: Clinical targets for testing and training from a normal database. Arch Phys Med Rehabil. 1999;80(8):941-944. DOI: 10.1016/s0003-9993(99)90087-4.
• McGill S. Low back Ddsorders: Evidence-Based Prevention and Rehabilitation. 3rd ed. Champaign: Human Kinetics; 2016.
• Livingston T, Livingston T. Dualer electronic inclinometer. Midvale, UJ: J Tech; 1992.
• Dover G, Powers ME. Reliability of joint position sense and force-reproduction measures during internal and external rotation of the shoulder. J Athl Train. 2003;38(4):304-310. PMID: 14737211.
• Pearcy MJ, Hindle RJ. New method for the non-invasive three-dimensional measurement of human back movement. Clin Biomech. 1989;4(2):73-79. DOI: 10.1016/0268-0033(89)90042-9.
• Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-191. DOI: 10.3758/bf03193146.
• Yoosefinejad AK, Motealleh A, Khademi S, Hosseini SF. Lower endurance and strength of core muscles in patients with multiple sclerosis. Int J MS Care. 2017;19(2):100-104. DOI: 10.7224/1537-2073.2015-064.