Instinctive Balance Control in MS
Although each person with MS is unique and the symptoms can vary, sometimes there are subtle things which bind us together as a group. I noticed one such thing when I was fortunate enough to meet with some fellow MS bloggers a couple of years ago. We had each traveled to a centrally located home on the East Coast to meet in person for the first time. We have since met a number of other times. Our host was gracious enough to open her home for us.
Within this small group of four persons living with MS, each of us has relapsing-remitting MS (RRMS). Each of us are ambulatory (can walk) although our host was showing off spanking new three-wheel walker with a basket and seat for out-and-about activities. Two members of the group sometimes use a cane when the MS is acting up quite a bit. So within this small group, we were all able to walk short distances most of the time and look pretty good doing it.
It was after lunch that I noticed our subtle similarity. As we got up from the table, each of us used our hands on the table to steady ourselves. Then we each subconsciously touched the back of a chair or the top of the table while we were standing and talking. This wasn’t the - I need to hang onto walls or furniture to make sure I don’t trip or fall - type of touching, but just a light fingertips on an item touch.
In my weekly research on MS-related topics, I came across an interesting study regarding balance control and the use of fingertips on stationary objects to improve postural stability. It reminded me of our group’s lunch meeting.
Researchers evaluated eleven individuals with RRMS while standing on a force platform with eyes open and closed, feet shoulder width apart and together, and with a light touch contact of the right index finger with a stable surface and without any contact. A force platform is a tool that measures force and movement as objects, or persons, stand or move across them.
Force platforms are often used in rehabilitation settings to measure specific aspects of gait and balance. They have been shown to be sensitive to subtle balance impairments in individuals with MS (Karst, 2005). You might even have a simple force platform in your home as part of the wii gaming system.
In the current study, balance was evaluated using center of pressure (COP) measures under a variety of circumstances. COP measurements can document the amplitude of sway, including direction, distance, speed, and amount of sway over a period of time.
Researchers documented that individuals with MS demonstrated significant postural instability in the absence of visual inputs (with their eyes closed) and with reduced base of support (standing with their feet together). When participants had a light finger touch on a stable surface, their postural sway was reduced in both the sagittal (front to back) and frontal (side to side) planes of motion under each of the experimental conditions (Kanekar, 2013).
Basically, posture and balance was improved when the person living with RRMS lightly touched a stationary object whether or not their eyes were open or their feet were together or apart. This directly reflects what members of our lunch group did naturally. I know that when I need to stand for any period of time, I am much more stable when I’m touching something. Authors suggest that “light finger touch contact is effective in improving postural control in people with MS and can be considered as a useful balance rehabilitative strategy” (Kanekar, 2013).
I find it very interesting when research reveals what we might do naturally and what we might need to do to help improve stability and balance. For example, another study demonstrated that individuals with minimal balance impairment due to MS shifted their weight to a lesser degree than healthy controls when leaning to reach for objects (Karst, 2005). This suggested to researchers that these individuals were instinctively aware of their limitations and were able to find a strategy (deviate less from their center of gravity) to accomplish a task (reaching for objects) while staying within their reduced limits of stability.
Have you worked with a physical therapist to improve your balance or gait? Did you use a force platform as part of your therapy? What do you do instinctively to stay on your feet and maintain balance when living with MS?
Kanekar N, Lee YJ, Aruin AS. Effect of light finger touch in balance control of individuals with multiple sclerosis. Gait Posture 2013 Mar 18. pii: S0966-6362(13)00135-5. doi: 10.1016/j.gaitpost.2013.02.017. [Epub ahead of print]
Karst GM, Venema DM, Roehrs TG, Tyler AE. Center of Pressure Measures during Standing Tasks in Minimally Impaired Persons with Multiple Sclerosis. J Neurol Phys Ther 2005 Dec;29(4):170-80. (pdf)