Transcript Document

Fall Reduction during the Sensory Organization Test with and without BalanceBased Torso-Weighting in People with Multiple Sclerosis
Gail L
1Samuel
Introduction
• Several recent studies have found that people with
multiple sclerosis (PwMS) fall frequently.1-3
• Impairments in sensory systems or motor control
systems that affect balance may result in falls.4
• Balance-based torso weighting (BBTW) has proven
effective in improving static balance,5 but the impact
on falling is unknown.
• The sensory organization test objectively measures
the contribution of sensory system to postural control
• The purpose of this study was to investigate the
effects of BBTW on balance and fall frequency
recorded by the sensory organization test (SOT) in
PwMS and healthy age and bin matched control
participants.
Merritt
1
Horn,
Cynthia
2
University, Graduate
1
Gibson-Horn, Diane
Methods
Subjects: 60 PwMS with self-identified gait or balance
problems, 10 bin-matched healthy controls
Program in Physical Therapy UCSF/SFSU,
CDP tests
• Sensory organization test
• Motor control test
Sensory Organization Test (SOT)
Healthy Controls
n=10
Clinical tests
• Timed up and go test
• 25 Foot timed walk
• Dynamic gait index
Discussion
Statistical Analysis
• Comparisons of the means for each variable
based on the averaged values of the trial
without weights versus with weights
• Paired t-tests to evaluate differences in gait
parameters between the 2 conditions
• Alpha value set at 0.05
PwMS (relapsing remitting, secondary and
primary progressive) showed immediate
statistically significant changes with weighting
compared with no weight in:
• SOT composite score
• Equilibirum scores (trial 1 removed for NW)
conditions 2-6
• Number of falls during SOT testing
P value
(Indep t-test,
α=.05)
CS NW
Mean (SD)
http://www.resourcesonbalance.com/neurocom/protocols/sensoryImpairment/SOT.aspx
CS WT
Mean (SD)
PwMS showed immediate statistically
significant changes with weighting compared
with HC in:
•SOT composite scores
•Equilibirum scores (conditions 4-6)
•Number of falls during SOT testing
Averaged
Equilibrium Scores
Averaged
Equilibrium
Scores (ES)
Trial 1 removed
from prep=.048
weight condition
★p=.017
Two-tailed
P value
★p=.022
★p=0.022
Sex number male
(%)
Disease Steps
mean (range)
Self-report falls past
6 mon mean (SD)
Weighting amount
pounds (% body wt)
53.7 (12.1)
0.43
13.8 (8.4)
28 (17%)
★p=0.017
1.9 (1.3%)
59.7
(14.5)
HC
n=10
1 (10%)
73.9
(6.0)
Two-tailed
P value
0.0
1.1 (0.8%)
0.003
★p<0.001
★p=.004
*0.626
**0.001
★p=0.004
★p<.000
• BBTW shows promise for fall reduction in PwMS
70
----
MSNW trials 2,3
60
MSWT trials 1-3
HCNW trials 2,3
50
HCWT trials 1-3
Acknowledgement:
This study was supported by Award Number R15HD066397 from the
Eunice Kennedy Shriver National Institute of Child Health and Human Development. The content is
solely the responsibility of the authors and does not necessarily represent the official views of the
Eunice Kennedy Shriver National Institutes of Child Health and Human Development or the National
Institutes of Health.
40
30
20
10
60
References
0
1
2
3
4
5
6
SOT Conditions
★Significant difference MS NW/WT, α =0.05; Significant difference HC NW/WT, α =0.05
50
★Significant difference MS NW/WT, α =0.05; Significant difference HC NW/WT, α =0.05
NW
# falls
(% total #
trials)
WT
# falls
(% total #
trials)
P value
MS
n=60
140
(19.4%)
91
(12.7%)
*<0.001
HC
n=10
3
(0.03%)
2
(0.02%)
**0.484
40
Percentage
Procedure
• Informed consent explained and signed
• Medical questionnaire prior to data recording
• Order of testing (not randomized)
• Computerized platform posturography (CDP)
tests
• Clinical tests (randomized)
• BBTW weighting
• Repeat CDP tests
• Repeat clinical tests (same order as first time)
• Impairment tests (not randomized)
Conclusion
90
CS=composite score; NW=no weight; WT=weighted;
MS=multiple sclerosis; HC=healthy controls; SD = standard
deviation;* Dependent t-test; ** Independent t-test
Indep = independent; SD = standard deviation; %=percent; mon=month;
wt=weight
30
MS
HC
20
10
0
≤0
1 to 7
Future Research
• Investigate if BBTW can reduce falls in people with
MS living in the community.
p=0.048
*<0.001
75.2
(9.5)
**<0.001
• Composite scores were significantly improved for
PwMS while weighted, over 64% changed 7 points
or more
• The SEM of the SOT calculated is lower for PwMS
than Wrisley et al. minimal detectable change found
for healthy young adults with repeated testing of the
SOT over 2 weeks.
• Even after removing the first SOT trial to reduced the
learning effect, there was a significant reduction in
falls and CS NW to WT in PwMS and MS to HC
• These improvements occurred even when
participants were fatigued due to lengthy testing
• Number of falls for MS were significantly reduced
with weighting during SOT; this did not happen in HC
★p<.000
★p<0.001
80
2.6 (1-4)
1.8 (2.3)
50.5
(14.6)
ES (percentage)
Years with MS
Mean (SD)
54.4 (11.1)
MS
n=60
Results
• The standard error of the measurement was
calculated to be 6.23 for the SOT for our population
of 60 PwMS.
100
Age mean (SD)
D.
2
Allen
Results
BBTW
orthotic and
weights
People with MS
n=60
1
Widener, Kristin
≥8
Change in Composite Score
CS= composite score; NW=no weight; WT=weighted; MS=multiple sclerosis; HC=healthy controls; *Dependent t-test; ** Independent ttest
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