Effects of External Perturbations on Anticipatory and Compensatory Postural Adjustments in Patients with Multiple Sclerosis and a Fall History

Abstract

Abstract Background: Although previous studies have investigated postural adjustment mechanisms in patients with multiple sclerosis (MS), it seems that no study has yet investigated the relationship between anticipatory and compensatory postural adjustments (APAs and CPAs, respectively) and falls. Methods: Seventeen MS fallers, 17 MS nonfallers, and 15 controls were exposed to a series of expected and unexpected backward pull perturbations applied at the trunk level. The electrical activity of 12 leg and trunk muscles as well as center of pressure displacement were recorded. Results: The MS fallers had delayed muscle activity onsets compared with MS nonfallers and controls. In addition, a significantly lower level of muscle activity during APAs was detected in MS fallers compared with controls. Moreover, in the unexpected condition of perturbation, significantly smaller CPA was observed in MS fallers compared with controls. Both groups of patients with MS required more time to stabilize their center of pressure after both types of perturbations compared with controls. Conclusions: The inability to produce efficient APAs and CPAs during perturbations may explain the high rates of postural instability and falls in patients with MS. Findings from this study provide a background for the development of perturbation-based training programs aimed at balance improvement and fall prevention by restoring mechanisms underlying balance impairments.