Araştırma Makalesi
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Contribution of Leg Muscle Strength to Balance in Multiple Sclerosis Patients

Yıl 2025, Cilt: 34 Sayı: 3, 527 - 535, 30.12.2025
https://doi.org/10.34108/eujhs.1686767

Öz

This study aims to compare lower extremity muscle strength, and balance in people with Multiple Sclerosis with mild disability to healthy controls, and determine the relationships between lower extremity muscle strength, and balance. In this study, 34 people with Multiple Sclerosis with mild disability (Expanded Disabilitiy Status Scale: 1.40±0.56) and 16 healthy controls were enrolled. The muscle strength of lower extremity muscles was evaluated with a hand-held dynamometer. The balance of people with Multiple Sclerosis with mild disability was assessed with Biodex Balance System-BioSwayTM. The balance performance and hip abductor, hip adductor, knee flexor, and weakest ankle dorsiflexor muscle strength were lower in people with Multiple Sclerosis with mild disability than in the healthy controls. The results of correlation and multiple regression analysis balance in people with Multiple Sclerosis with mild disability were related to different lower extremity muscle strengths. According to the results, exercise training that aims to improve balance should include these muscles in people with Multiple Sclerosis with mild disability.

Etik Beyan

The approval was given by the Gazi University Ethics Commission (No:2022-293). All procedures performed in the study involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Kaynakça

  • Frzovic D, Morris ME, Vowels L. Clinical tests of standing balance: performance of persons with multiple sclerosis. Arch Phys Med Rehabil. 2000;81(2):215-221. doi:10.1016/S0003-9993(00)90144-8
  • Jawad A, Baattaiah BA, Alharbi MD, Chevidikunnan MF, Khan F. Factors contributing to falls in people with multiple sclerosis: the exploration of the moderation and mediation effects. Mult Scler Relat Disord. 2023;76:104838. doi:10.1016/j.msard.2023.104838
  • Coote S, Comber L, Quinn G, Santoyo-Medina C, Kalron A, Gunn H. Falls in people with multiple sclerosis: risk identification, intervention, and future directions. Int J MS Care. 2020;22(6):247-255. doi:10.7224/1537-2073.2020-014
  • Fjeldstad C, Pardo G, Frederiksen C, et al. Assessment of postural balance in multiple sclerosis. Int J MS Care. 2009;11(1):1-5. doi:10.7224/1537-2073-11.1.1
  • Gebel A, Busch A, Stelzel C, Hortobágyi, T, Granacher U. Effects of physical and mental fatigue on postural sway and cortical activity in healthy young adults. Front Hum Neurosci. 2022;16:871930. doi:10.3389/fnhum.2022.871930
  • Ayan H, Ertekin O, Kahraman, Özakbaş S. Balance and gait impairment in persons with multiple sclerosis with the absence of clinical disability. Turk J Neurol. 2020:26:224-229. doi:10.4274/tnd.2020.36036
  • 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):1833-1842. doi:10.1007/s00221-014-3875-3
  • Cameron MH, Horak FB, Herndon RR, et al. Imbalance in multiple sclerosis: a result of slowed spinal somatosensory conduction. Somatosens Mot Res. 2008;25(2):113-122. doi:10.1080/08990220802131127
  • Nilsagård Y, Carling A, Forsberg A. Activities-specific balance confidence in people with multiple sclerosis. Mult Scler Int. 2012;2012:613925. doi:10.1155/2012/613925
  • White LJ, Dressendorfer RH. Exercise and multiple sclerosis. Sports Med. 2004;34(15):1077-1100. doi:10.2165/00007256-200434150-00005
  • Van der Kamp W, de Noordhout AM, Thompson P, et al. Correlation of phasic muscle strength and corticomotoneuron conduction time in multiple sclerosis. Ann Neurol. 1991;29(1):6-12. doi:10.1002/ana.410290104
  • Kent-Braun J, Ng AV, Castro M, et al. Strength, skeletal muscle composition, and enzyme activity in multiple sclerosis. J Appl Physiol. 1997;83(6):1998-2004. doi:10.1152/jappl.1997.83.6.1998
  • de Haan A, de Ruiter CJ, van der Woude LH, et al. Contractile properties and fatigue of quadriceps muscles in multiple sclerosis. Muscle Nerve. 2000;23(10):1534-1541. doi:10.1002/1097-4598(200010)23:10<1534::aid-mus9>3.0.co;2-d
  • Lambert CP, Archer RL, Evans WJ. Muscle strength and fatigue during isokinetic exercise in individuals with multiple sclerosis. Med Sci Sports Exerc. 2001;33(10):1613-1619. doi:10.1097/00005768-200110000-00001.
  • Hoang PD, Gandevia SC, Herbert RD. Prevalence of joint contractures and muscle weakness in people with multiple sclerosis. Disabil Rehabil. 2014;36(17):1588-1593. doi:10.3109/09638288.2013.854841.
  • Yilmaz S, Ünlüer NÖ. The relationship between concentric and isometric strength of knee flexor and extensor muscles and postural stability in mild stage multiple sclerosis patients. Neurol Res. 2025;47(3):188-194. doi:10.1080/01616412.2025.2462734.
  • Ozkan T, Yasa ME, Unluer NO, Korkmaz B, Uysal I, Vural, G. Investigation of parameters related to lower extremity muscle strength and proprioception in Patients with Multiple Sclerosis: a cross-sectional study. Mult Scler Relat Disord. 2023;79:105042. doi:10.1016/j.msard.2023.105042
  • Ramari C, Moraes AG, Tauil CB, et al. Knee flexor strength and balance control impairment may explain declines during prolonged walking in women with mild multiple sclerosis. Mult Scler Relat Disord. 2018;20:181-185. doi:10.1016/j.msard.2018.01.024
  • Soyuer F, Mirza M. Relationship between lower extremity muscle strength and balance in multiple sclerosis. J Neurol Sci (Turk). 2006;23(4):257-263.
  • Erdeo F, Uca AU, Yılmaz NA, Doğan AF, Şimşek A. Relationship Between Trunk and Lower Extremity Muscles and Balance in Multiple Sclerosis Patients. BSJ Health Sci. 2023;6(3):457-462. doi:10.19127/bshealthscience.1252347
  • Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162-173. doi:10.1016/S1474-4422(17)30470-2
  • 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
  • Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206-207. doi:10.1093/ptj/67.2.206
  • Manago MM, Hebert JR, Schenkman M. Psychometric properties of a clinical strength assessment protocol in people with multiple sclerosis. Int J MS Care. 2017;19(6):253-262. doi:10.7224/1537-2073.2016-078
  • Cachupe WJ, Shifflett B, Kahanov L, Wughalter EH. et al. Reliability of biodex balance system measures. Meas Phys Educ Exerc Sci. 2001;5(2):97-108. doi:10.1207/S15327841MPEE0502_3
  • Dewan BM, Roger James C, Kumar NA, et al. Kinematic validation of postural sway measured by Biodex Biosway (force plate) and SWAY Balance (accelerometer) technology. Biomed Res Int. 2019;2019:8185710. doi:10.1155/2019/8185710
  • 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):145-150. doi:10.1016/j.rehab.2015.04.002
  • Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018;126(5):1763-1768. doi:10.1213/ANE.0000000000002864
  • Chung LH, Remelius JG, Van Emmerik REA, et al. Leg power asymmetry and postural control in women with multiple sclerosis. Med Sci Sports Exerc. 2008;40(10):1717-1724. doi:10.1249/MSS.0b013e31817e32a3
  • Porosińska A, Pierzchała K, Mentel M, et al. Evaluation of postural balance control in patients with multiple sclerosis–effect of different sensory conditions and arithmetic task execution. A pilot study. Neurol Neurochir Pol. 2010;44(1):35-42. doi:10.1016/s0028-3843(14)60405-9.
  • Fjeldstad C, Pardo G, Bemben D, et al. Decreased postural balance in multiple sclerosis patients with low disability. Int J Rehabil Res. 2011;34(1):53-58. doi:10.1097/MRR.0b013e32833d6ccb
  • Soyuer F, Mirza M, Erkorkmaz Ü. Balance performance in three forms of multiple sclerosis. Neurol Res. 2006;28(5):555-562. doi:10.1179/016164105X49373
  • Kanekar N, Aruin AS. The role of clinical and instrumented outcome measures in balance control of individuals with multiple sclerosis. Mult Scler Int. 2013;2013:190162. doi:10.1155/2013/190162
  • Atteya A, Elwishy A, Kishk N, et al. Assessment of postural balance in multiple sclerosis patients. Egypt J Neurol Psychiatr Neurosurg. 2019;55(1):1-5. doi:10.1159/000485958
  • Yahia A, Ghroubi S, Mhiri C, et al. Relationship between muscular strength, gait and postural parameters in multiple sclerosis. Ann Phys Rehabil Med. 2011;54(3):144-155. doi:10.1016/j.rehab.2011.02.004

Multipl Skleroz Hastalarında Alt Ekstremite Kas Kuvvetinin Denge Parametrelerine Katkısı

Yıl 2025, Cilt: 34 Sayı: 3, 527 - 535, 30.12.2025
https://doi.org/10.34108/eujhs.1686767

Öz

Bu çalışmanın amacı, hafif engelli Multipl Sklerozlu bireylerde alt ekstremite kas gücü ve dengeyi sağlıklı kontrollerle karşılaştırmak ve alt ekstremite kas gücü ile denge arasındaki ilişkileri belirlemektir. Bu çalışmaya, hafif engelli (Genişletilmiş Engellilik Durum Ölçeği: 1.40±0.56) 34 Multipl Sklerozlu birey ve 16 sağlıklı control dahil edildi. Alt ekstremite kaslarının kas gücü manuel dinamometre ile değerlendirildi. Hafif engelli Multipl Sklerozlu bireylerin dengesi Biodex Denge Sistemi-Bio Sway TM ile değerlendirildi. Hafif engelli Multipl Sklerozlu bireylerde denge performansı ve kalça abdüktör, kalça adduktör, dizfleksör ve en zayıf ayak bileği dorsifleksör kas gücü, sağlıklı kontrollere gore daha düşüktü. Korelasyon ve çoklu regresyon analizi sonuçları hafif engelli Multipl Sklerozlu bireylerde farklı alt ekstremite kas güçleriyle ilişkiliydi. Sonuçlara göre, hafif engelli Multipl Sklerozlu bireylerde dengeyi geliştirmeyi amaçlayan egzersiz eğitimi bu kasları içermelidir.

Etik Beyan

: Çalışma, Gazi Üniversitesi Etik Kurulu tarafından onaylanmıştır (No: 2022-293). İnsan katılımcıların yer aldığı çalışmada uygulanan tüm işlemler, Kurumsal Araştırma Kurulu’nun etik standartlarına ve 1964 Helsinki Bildirgesi ile onun sonraki ekleri veya benzer etik standartlara uygun olarak gerçekleştirilmiştir.

Kaynakça

  • Frzovic D, Morris ME, Vowels L. Clinical tests of standing balance: performance of persons with multiple sclerosis. Arch Phys Med Rehabil. 2000;81(2):215-221. doi:10.1016/S0003-9993(00)90144-8
  • Jawad A, Baattaiah BA, Alharbi MD, Chevidikunnan MF, Khan F. Factors contributing to falls in people with multiple sclerosis: the exploration of the moderation and mediation effects. Mult Scler Relat Disord. 2023;76:104838. doi:10.1016/j.msard.2023.104838
  • Coote S, Comber L, Quinn G, Santoyo-Medina C, Kalron A, Gunn H. Falls in people with multiple sclerosis: risk identification, intervention, and future directions. Int J MS Care. 2020;22(6):247-255. doi:10.7224/1537-2073.2020-014
  • Fjeldstad C, Pardo G, Frederiksen C, et al. Assessment of postural balance in multiple sclerosis. Int J MS Care. 2009;11(1):1-5. doi:10.7224/1537-2073-11.1.1
  • Gebel A, Busch A, Stelzel C, Hortobágyi, T, Granacher U. Effects of physical and mental fatigue on postural sway and cortical activity in healthy young adults. Front Hum Neurosci. 2022;16:871930. doi:10.3389/fnhum.2022.871930
  • Ayan H, Ertekin O, Kahraman, Özakbaş S. Balance and gait impairment in persons with multiple sclerosis with the absence of clinical disability. Turk J Neurol. 2020:26:224-229. doi:10.4274/tnd.2020.36036
  • 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):1833-1842. doi:10.1007/s00221-014-3875-3
  • Cameron MH, Horak FB, Herndon RR, et al. Imbalance in multiple sclerosis: a result of slowed spinal somatosensory conduction. Somatosens Mot Res. 2008;25(2):113-122. doi:10.1080/08990220802131127
  • Nilsagård Y, Carling A, Forsberg A. Activities-specific balance confidence in people with multiple sclerosis. Mult Scler Int. 2012;2012:613925. doi:10.1155/2012/613925
  • White LJ, Dressendorfer RH. Exercise and multiple sclerosis. Sports Med. 2004;34(15):1077-1100. doi:10.2165/00007256-200434150-00005
  • Van der Kamp W, de Noordhout AM, Thompson P, et al. Correlation of phasic muscle strength and corticomotoneuron conduction time in multiple sclerosis. Ann Neurol. 1991;29(1):6-12. doi:10.1002/ana.410290104
  • Kent-Braun J, Ng AV, Castro M, et al. Strength, skeletal muscle composition, and enzyme activity in multiple sclerosis. J Appl Physiol. 1997;83(6):1998-2004. doi:10.1152/jappl.1997.83.6.1998
  • de Haan A, de Ruiter CJ, van der Woude LH, et al. Contractile properties and fatigue of quadriceps muscles in multiple sclerosis. Muscle Nerve. 2000;23(10):1534-1541. doi:10.1002/1097-4598(200010)23:10<1534::aid-mus9>3.0.co;2-d
  • Lambert CP, Archer RL, Evans WJ. Muscle strength and fatigue during isokinetic exercise in individuals with multiple sclerosis. Med Sci Sports Exerc. 2001;33(10):1613-1619. doi:10.1097/00005768-200110000-00001.
  • Hoang PD, Gandevia SC, Herbert RD. Prevalence of joint contractures and muscle weakness in people with multiple sclerosis. Disabil Rehabil. 2014;36(17):1588-1593. doi:10.3109/09638288.2013.854841.
  • Yilmaz S, Ünlüer NÖ. The relationship between concentric and isometric strength of knee flexor and extensor muscles and postural stability in mild stage multiple sclerosis patients. Neurol Res. 2025;47(3):188-194. doi:10.1080/01616412.2025.2462734.
  • Ozkan T, Yasa ME, Unluer NO, Korkmaz B, Uysal I, Vural, G. Investigation of parameters related to lower extremity muscle strength and proprioception in Patients with Multiple Sclerosis: a cross-sectional study. Mult Scler Relat Disord. 2023;79:105042. doi:10.1016/j.msard.2023.105042
  • Ramari C, Moraes AG, Tauil CB, et al. Knee flexor strength and balance control impairment may explain declines during prolonged walking in women with mild multiple sclerosis. Mult Scler Relat Disord. 2018;20:181-185. doi:10.1016/j.msard.2018.01.024
  • Soyuer F, Mirza M. Relationship between lower extremity muscle strength and balance in multiple sclerosis. J Neurol Sci (Turk). 2006;23(4):257-263.
  • Erdeo F, Uca AU, Yılmaz NA, Doğan AF, Şimşek A. Relationship Between Trunk and Lower Extremity Muscles and Balance in Multiple Sclerosis Patients. BSJ Health Sci. 2023;6(3):457-462. doi:10.19127/bshealthscience.1252347
  • Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162-173. doi:10.1016/S1474-4422(17)30470-2
  • 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
  • Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206-207. doi:10.1093/ptj/67.2.206
  • Manago MM, Hebert JR, Schenkman M. Psychometric properties of a clinical strength assessment protocol in people with multiple sclerosis. Int J MS Care. 2017;19(6):253-262. doi:10.7224/1537-2073.2016-078
  • Cachupe WJ, Shifflett B, Kahanov L, Wughalter EH. et al. Reliability of biodex balance system measures. Meas Phys Educ Exerc Sci. 2001;5(2):97-108. doi:10.1207/S15327841MPEE0502_3
  • Dewan BM, Roger James C, Kumar NA, et al. Kinematic validation of postural sway measured by Biodex Biosway (force plate) and SWAY Balance (accelerometer) technology. Biomed Res Int. 2019;2019:8185710. doi:10.1155/2019/8185710
  • 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):145-150. doi:10.1016/j.rehab.2015.04.002
  • Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018;126(5):1763-1768. doi:10.1213/ANE.0000000000002864
  • Chung LH, Remelius JG, Van Emmerik REA, et al. Leg power asymmetry and postural control in women with multiple sclerosis. Med Sci Sports Exerc. 2008;40(10):1717-1724. doi:10.1249/MSS.0b013e31817e32a3
  • Porosińska A, Pierzchała K, Mentel M, et al. Evaluation of postural balance control in patients with multiple sclerosis–effect of different sensory conditions and arithmetic task execution. A pilot study. Neurol Neurochir Pol. 2010;44(1):35-42. doi:10.1016/s0028-3843(14)60405-9.
  • Fjeldstad C, Pardo G, Bemben D, et al. Decreased postural balance in multiple sclerosis patients with low disability. Int J Rehabil Res. 2011;34(1):53-58. doi:10.1097/MRR.0b013e32833d6ccb
  • Soyuer F, Mirza M, Erkorkmaz Ü. Balance performance in three forms of multiple sclerosis. Neurol Res. 2006;28(5):555-562. doi:10.1179/016164105X49373
  • Kanekar N, Aruin AS. The role of clinical and instrumented outcome measures in balance control of individuals with multiple sclerosis. Mult Scler Int. 2013;2013:190162. doi:10.1155/2013/190162
  • Atteya A, Elwishy A, Kishk N, et al. Assessment of postural balance in multiple sclerosis patients. Egypt J Neurol Psychiatr Neurosurg. 2019;55(1):1-5. doi:10.1159/000485958
  • Yahia A, Ghroubi S, Mhiri C, et al. Relationship between muscular strength, gait and postural parameters in multiple sclerosis. Ann Phys Rehabil Med. 2011;54(3):144-155. doi:10.1016/j.rehab.2011.02.004
Toplam 35 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Fizyoterapi
Bölüm Araştırma Makalesi
Yazarlar

Fettah Saygılı 0000-0001-6450-6666

Çağla Özkul 0000-0001-9367-9910

Kader Eldemir 0000-0002-1167-8971

Sefa Eldemir 0000-0002-2122-5706

Muhammed Şeref Yıldırım 0000-0002-8529-986X

Arzu Güçlü Gündüz 0000-0001-8464-1929

Ceyla İrkeç 0000-0002-4713-8010

Gönderilme Tarihi 29 Nisan 2025
Kabul Tarihi 21 Kasım 2025
Yayımlanma Tarihi 30 Aralık 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 34 Sayı: 3

Kaynak Göster

APA Saygılı, F., Özkul, Ç., Eldemir, K., … Eldemir, S. (2025). Contribution of Leg Muscle Strength to Balance in Multiple Sclerosis Patients. Sağlık Bilimleri Dergisi, 34(3), 527-535. https://doi.org/10.34108/eujhs.1686767
AMA Saygılı F, Özkul Ç, Eldemir K, vd. Contribution of Leg Muscle Strength to Balance in Multiple Sclerosis Patients. JHS. Aralık 2025;34(3):527-535. doi:10.34108/eujhs.1686767
Chicago Saygılı, Fettah, Çağla Özkul, Kader Eldemir, Sefa Eldemir, Muhammed Şeref Yıldırım, Arzu Güçlü Gündüz, ve Ceyla İrkeç. “Contribution of Leg Muscle Strength to Balance in Multiple Sclerosis Patients”. Sağlık Bilimleri Dergisi 34, sy. 3 (Aralık 2025): 527-35. https://doi.org/10.34108/eujhs.1686767.
EndNote Saygılı F, Özkul Ç, Eldemir K, Eldemir S, Yıldırım MŞ, Güçlü Gündüz A, İrkeç C (01 Aralık 2025) Contribution of Leg Muscle Strength to Balance in Multiple Sclerosis Patients. Sağlık Bilimleri Dergisi 34 3 527–535.
IEEE F. Saygılı, Ç. Özkul, K. Eldemir, S. Eldemir, M. Ş. Yıldırım, A. Güçlü Gündüz, ve C. İrkeç, “Contribution of Leg Muscle Strength to Balance in Multiple Sclerosis Patients”, JHS, c. 34, sy. 3, ss. 527–535, 2025, doi: 10.34108/eujhs.1686767.
ISNAD Saygılı, Fettah vd. “Contribution of Leg Muscle Strength to Balance in Multiple Sclerosis Patients”. Sağlık Bilimleri Dergisi 34/3 (Aralık2025), 527-535. https://doi.org/10.34108/eujhs.1686767.
JAMA Saygılı F, Özkul Ç, Eldemir K, Eldemir S, Yıldırım MŞ, Güçlü Gündüz A, İrkeç C. Contribution of Leg Muscle Strength to Balance in Multiple Sclerosis Patients. JHS. 2025;34:527–535.
MLA Saygılı, Fettah vd. “Contribution of Leg Muscle Strength to Balance in Multiple Sclerosis Patients”. Sağlık Bilimleri Dergisi, c. 34, sy. 3, 2025, ss. 527-35, doi:10.34108/eujhs.1686767.
Vancouver Saygılı F, Özkul Ç, Eldemir K, Eldemir S, Yıldırım MŞ, Güçlü Gündüz A, vd. Contribution of Leg Muscle Strength to Balance in Multiple Sclerosis Patients. JHS. 2025;34(3):527-35.