ABSTRACT
BACKGROUND: Impaired postural control is a common symptom in people with multiple sclerosis. Multiple sclerosis frequently presents with asymmetric motor involvement. One measurement yet to be evaluated for asymmetry in people with multiple sclerosis is the soleus Hoffmann reflex. PURPOSE: To measure the soleus Hoffmann reflex between limbs and correlate reflex asymmetry with postural control. MATERIAL AND METHODS: 16 participants completed four sessions of Hoffmann reflex testing and one session of balance testing. RESULTS: Multiple sclerosis participants had significantly greater reflex asymmetry (p = 0.01). The multiple sclerosis group had a significantly lower overall sensory organization testing composite score (p < 0.05), indicating sensory interpretation conflict that resulted in greater postural instability. Multiple sclerosis participants produced a significantly shorter endpoint and maximum excursion (p < 0.01) during limits of stability testing. Hoffmann reflex asymmetry was negatively related to forward endpoint excursion (p < 0.05), maximum excursion (p ≤ 0.01). CONCLUSIONS: Multiple sclerosis participants had greater soleus Hoffmann reflex asymmetry, which appears to significantly influence forward postural control.Implications for rehabilitationSoleus Hoffmann reflex asymmetry appears to influence postural stability.The soleus Hoffmann reflex is capable of adapting to different modes of exercise; therefore, to reduce H-reflex asymmetry it is recommended to individualize physical rehabilitative programming.Assessing the soleus Hoffmann reflex in people with multiple sclerosis during health screenings could be of use to clinical and rehabilitative practitioners.
Subject(s)
H-Reflex , Multiple Sclerosis , Electromyography , Humans , Muscle, Skeletal , Postural BalanceABSTRACT
Lower limb asymmetries have been observed in persons with multiple sclerosis (PwMS), and have been associated with mobility impairment. An incremental cycling test was performed on a cycle ergometer to determine peak power output (PPO) and peak oxygen consumption (VO2peak). Then, participants cycled at 50%, 60%, and 70% of their PPO to assess the contribution of each lower limb to power production. Two-way repeated measures ANOVA was used to detect group × intensity differences in power production asymmetry. Eight PwMS and six healthy individuals (Non-MS) completed the study. No statistically significant (p > 0.05) group × intensity interactions or main effects were present when examining between-limb differences in power production. The current data do not indicate a statistically significant difference in power production asymmetry between groups and exercise intensities. Previous research has established a 10% difference between contralateral limbs as a threshold for asymmetry. The average asymmetry in power production in PwMS exceeded the 10% threshold at all measured outputs, suggesting the presence of asymmetry in power production.
Subject(s)
Bicycling/physiology , Leg/physiology , Multiple Sclerosis/physiopathology , Muscle Strength/physiology , Adult , Case-Control Studies , Exercise Test , Female , Humans , Male , Middle Aged , Oxygen ConsumptionABSTRACT
A prospective, randomized, three-arm, evaluator blinded study to demonstrate the feasibility of a telerehabilitation (TR) program in individuals with ambulatory deficits secondary to Multiple Sclerosis (MS) and evaluate its efficacy when compared to conventional on-site physical therapy (PT) was completed. Thirty participants were evaluated at baseline and randomized to one of three groups with intervention lasting 8 weeks: Group 1 (control)- customized unsupervised home-based exercise program (HEP) 5 days a week; Group 2 (TR)- remote PT supervised via audio/visual real-time telecommunication twice weekly; Group 3 (PT)- in-person PT at the medical facility twice weekly. Outcomes included patient reported outcomes (PROs) obtained through questionnaires, and measurements of gait and balance performed with bedside tests and a computerized system. Functional gait assessment improved from baseline in all three groups. There were no significant differences between the TR and the conventional PT groups for a variety of outcome measures. TR is a feasible method to perform PT in persons with MS and has comparable efficacy to conventional in-person PT as measured by patient reported outcomes and objective outcomes of gait and balance.