Identifying Those at Risk of Falling in Multiple Sclerosis

Ishu Arpan, PT, PhD

A recent study presented virtually at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2021, February 25-27, found that a quick and simple postural sway test may be an important tool in identifying patients with mild to moderate multiple sclerosis (MS) at risk of falling.^1,2

Presenter Ishu Arpan, PT, PhD, senior research associate, neurology department, Oregon Health & Science University, and colleagues found that instrumented postural sway measures that differentiate people with MS from healthy controls (HC) can also differentiate fallers from non-fallers with MS.

Arpan and colleagues confirmed established findings that people with MS performed significantly worse on the instrumented postural sway test compared to HC. They isolated MS-specific measures, such as increased jerk, range, and the root mean square of sway, that were then used to successfully differentiate fallers from non-fallers in the MS group. The sway measures were significantly higher in people with MS that reported falls in the last 6 months compared to those who did not.

NeurologyLive reached out to Arpan to learn more about the dangers of falls in MS. She also gave an overview of her study’s findings.

NeurologyLive: Can you talk about the dangers of falls in MS?

Ishu Arpan, PT, PhD: Balance impairment is an early and common symptom in people with MS. Balance control depends upon accurate somatosensory information from the feet up the spinal cord as well as motor control systems that are affected, even early in MS. Poor balance control leads to an increased risk of falling. In fact, fall rates in people with MS are even higher than for much older adults without MS. Falling reduces the quality of life in people with MS as it limits functional independence, can lead to physical injury, and places an emotional and financial burden on the faller and their families. Studies have shown that even fear of falling, associated with the increased risk of falls, can decrease participation in society and impact emotional and physical health. For example, fear of falling and high risk of falling may prevent young adults with MS from actively engaging in the workforce and pursuing their careers. Early identification of people with MS at high risk of falling will allow earlier interventions for fall prevention.

Can you give an overview of your study and its findings?

Standing balance was measured in 22 people with MS and 20 age-matched controls without MS using an instrumented postural sway test. Participants were instructed to stand on a firm surface for 30 seconds with eyes open wearing a wireless inertial sensor (Opal sensors by APDM) on the lower back. We found that postural sway measures (jerk, range, and area) were greater in people with MS compared to controls indicating poor standing balance control in the MS group. When participants in the MS group were categorized as fallers or non-fallers based on prior history of falls in the past 6 months, we found that balance control in non-fallers with MS was similar to the controls, whereas balance control was significantly worse in the MS group with the history of previous falls.

I would like to add that even though in this abstract we only talked about the balance impairments during the standing task, the overall goal of our project was to predict falls from both balance and gait impairments. The unpublished results from our study indicate that a prediction model consisting of both postural sway range (a standing balance measure) and local dynamic stability (a gait measure; Arpan et al. 2020) account for approximately 93% of the variance separating fallers from non-fallers.

Transcript edited for clarity. For more coverage of ACTRIMS Forum 2021, click here.

REFERENCES

1. Rude A, Prewitt AL, Horak F, Arpan I. Feasibility of postural sway measures to predict falls in multiple sclerosis. Presented at ACTRIMS Annual Forum; February 25-27, 2021. Abstract P027
2. Arpan I, Fino PC, Fling BW, Horak F. Local dynamic stability during long-fatiguing walks in people with multiple sclerosis. Gait Posture. 2020 Feb;76:122-127. doi: 10.1016/j.gaitpost.2019.10.032.