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Associations between Proprioceptive Neural Pathway Structural Connectivity and Balance in People with Multiple Sclerosis.

Fling BW, Dutta GG, Schlueter H, Cameron MH, Horak FB - Front Hum Neurosci (2014)

Bottom Line: We found poorer balance control on proprioceptive-based tasks and reduced white matter microstructural integrity of the cortical proprioceptive tracts in PwMS compared with age-matched healthy controls (HC).Conversely, while white matter integrity of the right hemisphere's proprioceptive pathway was significantly correlated with overall balance performance in HC, there was no such relationship in PwMS.These results augment existing literature suggesting that balance control in PwMS may become more dependent upon (1) cerebellar-regulated proprioceptive control, (2) the vestibular system, and/or (3) the visual system.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, School of Medicine, Oregon Health & Science University , Portland, OR , USA ; Portland VA Medical Center , Portland, OR , USA.

ABSTRACT
Mobility and balance impairments are a hallmark of multiple sclerosis (MS), affecting nearly half of patients at presentation and resulting in decreased activity and participation, falls, injuries, and reduced quality of life. A growing body of work suggests that balance impairments in people with mild MS are primarily the result of deficits in proprioception, the ability to determine body position in space in the absence of vision. A better understanding of the pathophysiology of balance disturbances in MS is needed to develop evidence-based rehabilitation approaches. The purpose of the current study was to (1) map the cortical proprioceptive pathway in vivo using diffusion-weighted imaging and (2) assess associations between proprioceptive pathway white matter microstructural integrity and performance on clinical and behavioral balance tasks. We hypothesized that people with MS (PwMS) would have reduced integrity of cerebral proprioceptive pathways, and that reduced white matter microstructure within these tracts would be strongly related to proprioceptive-based balance deficits. We found poorer balance control on proprioceptive-based tasks and reduced white matter microstructural integrity of the cortical proprioceptive tracts in PwMS compared with age-matched healthy controls (HC). Microstructural integrity of this pathway in the right hemisphere was also strongly associated with proprioceptive-based balance control in PwMS and controls. Conversely, while white matter integrity of the right hemisphere's proprioceptive pathway was significantly correlated with overall balance performance in HC, there was no such relationship in PwMS. These results augment existing literature suggesting that balance control in PwMS may become more dependent upon (1) cerebellar-regulated proprioceptive control, (2) the vestibular system, and/or (3) the visual system.

No MeSH data available.


Related in: MedlinePlus

Total sway area for each of the four conditions tested with the ICTSIB. A significant main effect of group (P < 0.05), but lack of a group × condition interaction, is reflective of PwMS having greater sway area for all conditions compared to HC. Data are mean (± SD).
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Figure 2: Total sway area for each of the four conditions tested with the ICTSIB. A significant main effect of group (P < 0.05), but lack of a group × condition interaction, is reflective of PwMS having greater sway area for all conditions compared to HC. Data are mean (± SD).

Mentions: As expected, PwMS had significantly poorer dynamic balance control (t = 3.3; P < 0.001) than HC as assessed by the Mini-BESTest (Table 1). Particular deficits in PwMS were observed within the anticipatory postural adjustment, sensory orientation, and dynamic gait domains, whereas reactive postural control performance was quite similar between groups. Data obtained during the ICTSIB revealed significant group (F1,35 = 3.9; P < 0.05) and condition (F1,35 = 14.3; P < 0.001) main effects for total sway, but no group × condition interaction (F1,35 = 2.6; P < 0.12) likely due to the large variability in both groups on the eyes-closed conditions (Figure 2). For all conditions, sway area was greater in PwMS, indicative of decreased static balance control. In addition, PwMS had a higher Romberg quotient for both the firm- (PwMS: 2.9; HC: 2.0) and foam-surface conditions (PwMS: 10.4; HC: 9.7), but these differences were not statistically significant (firm surface: P < 0.06; foam surface: P < 0.3).


Associations between Proprioceptive Neural Pathway Structural Connectivity and Balance in People with Multiple Sclerosis.

Fling BW, Dutta GG, Schlueter H, Cameron MH, Horak FB - Front Hum Neurosci (2014)

Total sway area for each of the four conditions tested with the ICTSIB. A significant main effect of group (P < 0.05), but lack of a group × condition interaction, is reflective of PwMS having greater sway area for all conditions compared to HC. Data are mean (± SD).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4202774&req=5

Figure 2: Total sway area for each of the four conditions tested with the ICTSIB. A significant main effect of group (P < 0.05), but lack of a group × condition interaction, is reflective of PwMS having greater sway area for all conditions compared to HC. Data are mean (± SD).
Mentions: As expected, PwMS had significantly poorer dynamic balance control (t = 3.3; P < 0.001) than HC as assessed by the Mini-BESTest (Table 1). Particular deficits in PwMS were observed within the anticipatory postural adjustment, sensory orientation, and dynamic gait domains, whereas reactive postural control performance was quite similar between groups. Data obtained during the ICTSIB revealed significant group (F1,35 = 3.9; P < 0.05) and condition (F1,35 = 14.3; P < 0.001) main effects for total sway, but no group × condition interaction (F1,35 = 2.6; P < 0.12) likely due to the large variability in both groups on the eyes-closed conditions (Figure 2). For all conditions, sway area was greater in PwMS, indicative of decreased static balance control. In addition, PwMS had a higher Romberg quotient for both the firm- (PwMS: 2.9; HC: 2.0) and foam-surface conditions (PwMS: 10.4; HC: 9.7), but these differences were not statistically significant (firm surface: P < 0.06; foam surface: P < 0.3).

Bottom Line: We found poorer balance control on proprioceptive-based tasks and reduced white matter microstructural integrity of the cortical proprioceptive tracts in PwMS compared with age-matched healthy controls (HC).Conversely, while white matter integrity of the right hemisphere's proprioceptive pathway was significantly correlated with overall balance performance in HC, there was no such relationship in PwMS.These results augment existing literature suggesting that balance control in PwMS may become more dependent upon (1) cerebellar-regulated proprioceptive control, (2) the vestibular system, and/or (3) the visual system.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, School of Medicine, Oregon Health & Science University , Portland, OR , USA ; Portland VA Medical Center , Portland, OR , USA.

ABSTRACT
Mobility and balance impairments are a hallmark of multiple sclerosis (MS), affecting nearly half of patients at presentation and resulting in decreased activity and participation, falls, injuries, and reduced quality of life. A growing body of work suggests that balance impairments in people with mild MS are primarily the result of deficits in proprioception, the ability to determine body position in space in the absence of vision. A better understanding of the pathophysiology of balance disturbances in MS is needed to develop evidence-based rehabilitation approaches. The purpose of the current study was to (1) map the cortical proprioceptive pathway in vivo using diffusion-weighted imaging and (2) assess associations between proprioceptive pathway white matter microstructural integrity and performance on clinical and behavioral balance tasks. We hypothesized that people with MS (PwMS) would have reduced integrity of cerebral proprioceptive pathways, and that reduced white matter microstructure within these tracts would be strongly related to proprioceptive-based balance deficits. We found poorer balance control on proprioceptive-based tasks and reduced white matter microstructural integrity of the cortical proprioceptive tracts in PwMS compared with age-matched healthy controls (HC). Microstructural integrity of this pathway in the right hemisphere was also strongly associated with proprioceptive-based balance control in PwMS and controls. Conversely, while white matter integrity of the right hemisphere's proprioceptive pathway was significantly correlated with overall balance performance in HC, there was no such relationship in PwMS. These results augment existing literature suggesting that balance control in PwMS may become more dependent upon (1) cerebellar-regulated proprioceptive control, (2) the vestibular system, and/or (3) the visual system.

No MeSH data available.


Related in: MedlinePlus