Loss of Balance Trends in Patients With Multiple Sclerosis and Parkinson Disease

As the mature adult male patient walks holding the handrails, the mid adult female therapist guides and encourages him.
Researchers sought to systematically classify loss of balance trends among patients with multiple sclerosis and Parkinson disease.

A loss of balance (LOB) rating scale following manual perturbations was found to be reliable and reproducible among patients with multiple sclerosis (MS) and Parkinson disease, according to study findings published in NeuroRehabilitation.

Both multiple sclerosis (MS) and Parkinson disease (PD) are associated with balance dysfunction. However, it remains unclear whether these patients have similar or differential LOB reactions to everyday types of perturbations. To increase knowledge about LOB in the MS and PD context, researchers sought to systematically classify LOB trends among these populations.

Among a group of 10 healthy volunteers, physical therapists systematically applied manual perturbations in videotaped sessions and rated LOB using a Balance-Based Torso-Weighting (BBTW) assessment. Similar data collected for previous studies were rated using the same approach among healthy controls (n=32), patients with MS (n=64), and PD (n=42). LOB scores were between zero (no LOB) and three (severe LOB). LOB total scores were the sum of scores from 12 manual perturbations.

The reliability of scores across five to six reviewers had intra-class correlation coefficients between 0.56 and 0.77 and percent agreements between 81% and 94%.

Comparing upper and lower body perturbations, the magnitude and prevalence were significant among groups and types of perturbations (all P <.001). LOB was similar in severity among controls and patients with MS for both upper and lower body perturbations. Among the PD cohort, they had greater magnitude and prevalence of LOB than lower areas (all P <.017).

For anterior versus posterior perturbations, the magnitude and prevalence were significant among groups and types of perturbations (all P <.001). Control individuals and patients with MS had more severe LOB when they were nudged backward. The patients with PD had more severe LOB when they were nudged forward.

The type of perturbation had a significant prevalence (P <.05) but not magnitude (P >.05). LOB more frequently occurred in response to right-left nudges compared with anterior-posterior nudges (P <.01).

This study may have been limited by using previously collected data and not having the same clinician apply the manual perturbations.

“A clinically accessible and reliable rating scale 625 revealed differences in patterns of LOB following 626 manual perturbations in people with MS, PD, and 627 HC [healthy controls],” stated the researchers. “Clinicians may help reduce fall risk for people 628 with MS or PD more effectively if they understand 629 and address the differences in LOB following perturbations in these populations,” they concluded.


Allen DD, Gadayan J, Hughes R, et al. Patterns of balance loss with systematic perturbations in Parkinson’s disease and multiple sclerosis. NeuroRehabilitation. Published online November 10, 2021. doi:10.3233/NRE-210200