June 09-41-2.indd - Kma.org.kw

138Effects of Visual Feedback Balance Training by Using Computerized Dynamic Posturography...June 2009Balance deficits in people with MS appear tobe caused by somatosensory and not by cerebellarinvolvement in some MS patients [13] . Some MSpatients had a vestibular dysfunction pattern ora combined visual-vestibular or somatosensoryvestibularimpairment. Posturography mightserve as one method to evaluate the functionalconsequences of a vestibular deficit in patients withMS [19] .In our study, we found impaired balance inpatients with relapsing remitting multiple sclerosis(RRMS). But other authors found that balance in MSpatients is impaired in RRMS, secondary progressiveMS (SPMS) and primary progressive MS (PPMS).There were some differences of balance betweenprevious groups in all the balance tests [20] .Some authors found balance impairmentsincluding minimal balance deficits of the BBS andimpaired center of pressure displacement duringstanding in MS [7] . Achiemere suggests that dynamicposturography can provide useful diagnosticinformation in patients with balance disturbances inMS patients [21] .In contrast to our results, Frzovic et al. reportedthat there were no differences between MS and controlgroups on the ability to maintain standing balance.There was little change in balance from morningto afternoon in participants with MS, despite anincrease in self-rated fatigue [6] . Some authors foundthe MS patients had a vestibular dysfunction patternor a combined visual-vestibular or somatosensoryvestibularimpairment [19] . There is a disruption of theintegration of visual, vestibular, and somatosensoryinformation in patients with early MS and patientswith purely vestibular disorders in posturographytesting in MS [18] .One possible explanation for our findings is thatthe CNS damage, caused by MS is supposed to reflectsome change in the structure of the posture controlsystem such as the impairment of the somatosensorysystem, rather than a specific lesion of vestibularand / or visual modalities [22] . Jackson et al foundpoor performance of balance and abnormalities inposturography testing which indicates a disruptionof the integration of somatosensory, visual orvestibular information in MS [18] .This study briefly describes the results of ourexperience in visual feedback training by usingthe dynamic posturography for MS patients. Thisstudy also represents the first attempt in Kuwait touse the dynamic posturography equipment as anassessment tool to study the effect of visual feedbacktraining in MS patients. Further research in use of theposturography equipment is needed to study variousmechanisms of balance dysfunction in patients withMS.LimitationsThe small number of the study subjects may havesome influence on the outcome and the authors arecontinuing the study by adding more subjects.ACKNOWLEDGMENTSWe acknowledge the help of our colleagues inthe Physical Medicine and Rehabilitation Hospital,Kuwait for their assistance in this study.REFERENCES1. Williams NP, Roland PS, Yellin W. Vestibularevaluation in patients with early multiple sclerosis.Am J Otol 1997; 18:93-100.2. Noseworthy JH, Lucchinetti C, Rodriguez M,Weinshenker BG. Multiple sclerosis. N Engl J Med2000; 343:938-952.3. Shumway-Cook A, Woollacott M. Motor Control:Theory and practical applications. Baltimore,Lippincott Williams and Wilkins, 2001; p163-191.4. Lanska DJ, Goetz CG. Romberg’s sign: development,adoption, and adaptation in the 19th century.Neurology 2000; 55:1201-1206.5. Lipsitz LA, Jonsson PV, Kelley MM, Koestner JS.Causes and correlates of recurrent falls in ambulatoryfrail elderly. J Gerontol 1991; 46:114-122.6. Frzovic D, Morris ME, Vowels L. Clinical tests ofstanding balance: performance of persons withmultiple sclerosis. Arch Phys Med Rehabil 2000;81:215-221.7. Karst GM, Venema DM, Roehrs TG, Tyler AE. Centerof pressure measures during standing tasks inminimally impaired persons with multiple sclerosis.J Neurol Phys Ther 2005; 29:170-180.8. Nashner LM, Peters JF. Dynamic posturography inthe diagnosis and management of dizziness andbalance disorders. Neurol Clin 1990; 8:331-349.9. Chaudhry H, Findley T, Quigley KS, et al. Measuresof postural stability. J Rehabil Res Dev 2004; 41:713-720.10. Poser CM, Brinar VV. Diagnostic criteria for multiplesclerosis. Clin Neurol Neurosurg 2001; 103:1-11.11. Kurtzke JF. Rating neurologic impairment in multiplesclerosis: an expanded disability status scale (EDSS).Neurology 1983; 33:1444-1452.12. Bogle Thorbahn LD, Newton RA. Use of the BergBalance Test to predict falls in elderly persons. PhysTher 1996; 76:576-583.13. Cameron MH, Horak FB, Herndon RR, Bourdette D.Imbalance in multiple sclerosis: a result of slowedspinal somatosensory conduction. Somatosens MotRes 2008; 25:113-122.14. Tesio L, Perucca L, Franchignoni FP, Battaglia MA.A short measure of balance in multiple sclerosis:validation through Rasch analysis. Funct Neurol1997; 12:255-265.15. Cha E, Castro HK, Provance P, Finkelstein J.Acceptance of home telemanagement is high inpatients with multiple sclerosis. AMIA Annu SympProc 2007; 11:893.