The relationship of light touch, vibration, muscle strength and endurance with balance, gait and falling in individuals with multiple sclerosis

The aim of this study is to determine whether lower extremity sensory changes, muscle strength and endurance have an impact on balance, gait and fall risk in individuals with MS by evaluating the relationship between light touch, vibration, muscle strength and endurance with balance, gait and falling in individuals with Multiple Sclerosis. 29 individuals with MS, 19 women and 10 men, who could walk independently and had an Expanded Disability Status Scale (EDSS) score between 3 and 5.5, meeting the inclusion criteria, were included in the study. In the evaluation of parameters; Semmes-Weinstein Monofilament Test (SWMT) for light touch sensation, 128 Hz tuning fork for vibration sense, Digital Handheld Dynamotre (DHD) for muscle strength, stabilizing pressure biofeedback device for core muscle endurance, One Leg Standing Test (OLST) for static balance), Y Balance Test (YBT) was used for dynamic balance, footprint method for walking, and International Fall Effectiveness Scale (IFES) was used for falls. A relationship was found between the sense of light touch with the back extensors (r=0,378), abdominals (r=0,416), quadriceps femoris (r=0,382), tibialis anterior (r=0,374) and tibialis posterior (r=0,496) muscles, with the gait parameters step length (r=0,397), double step length (r=0,377), cadence (r=0,529) and dynamic balance(r=0,442) (p<0.05). A relationship was found between the light touch sensation of the posterior lateral foot of the non-dominant extremity and the risk of falling (r= -0,386, p<0.05). A relationship was found between dominant extremity lateral malleolus vibration sensation and dynamic balance forward reaching position (r= 0,380, p<0.05). It was found that back extensors (r=0,403) affected dynamic balance, abdominals affected static balance (r=0,470) and dynamic balance (r=0,430) (p<0.05). The muscles evaluated in the lower extremity affect static [Gluteus maximus (r=0,522), hip flexors (r=0,421), hamstring (r=0,473)] and dynamic balance [Hip flexors (r=-0,423), quadriceps femoris (r=-0,384)] (p<0.05). The muscles evaluated in the lower extremity affect walking parameters such as double step length [Back extensors (r=0,391), gluteus maximus (r=0,406), hamstring (0,410), hip flexors (0,371)], walking speed [Abdominals (r=-0,548), hip flexors (-0,547), gluteus maximus (-0,660), hamstring (-0,517)], step width [Hamstring (0,471)](p<0.05) . Back extensors (r=-0,420), hip flexors (r=-0,379), gluteus maximus (r=-0,447) and hamstring (r=-0,406) muscle strength are associated with the risk of falling (p<0.05). It was found that light touch and vibration sensations did not significantly affect falling, TADT and gait (p>0.05). It was found that the sense of light touch had a significant positive effect on YDT (p<0.05). Evaluation of subcutaneous sensation should not be neglected due to its effects on balance, gait and risk of falling. In order to be able to move more safely in functional and daily life activities, the cause of the balance problem and the factors that negatively affect balance should be known and it is recommended that the rehabilitation program of individuals with MS be planned in a combined way. KeyWords: Gait, Multiple sclerosis, postural balance, sensation.