Position Sense, Balance, and Dual Task Performance at the Menstrual Cycle in Females With Multiple Sclerosis
Condition: Multiple Sclerosis; Neurologic Symptoms; Menstrual Cycle
MeSH terms: Multiple Sclerosis; Neurologic Manifestations; Sclerosis
Study type: Observational

Summary: 
      The aim of this study was to investigation of knee position sense, balance, and dual task
      performance in different phases of menstrual cycle in females with multiple sclerosis.

      Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS)
      affecting young people and leading to demyelination and neurodegeneration. MS affects females
      more than males with a ratio approximately of 3:1. Important gender differences in
      progression and inflammatory activity of disease have been observed. Sex hormones have been
      thought to play an important role in this condition. It is worth noting however that sex
      hormones not only affect reproduction (menses/pregnancy), they also have direct effects on
      the nervous and immune system. In the neurologic group, especially in MS patients, it is well
      known that disease activity, course, and symptoms can be influenced by hormonal fluctuations
      in different phases of the menstrual cycle. Previous studies have reported that the variation
      of estrogen and progesterone during the menstrual cycle may have an effect on several
      neurological functions. However, these studies are mostly subjective, in the form of patient
      reports and in limited numbers. Smith and Studd reported that there was a premenstrual
      increase in disease severity as changes in the Th-1 / Th-2 balance occurred in association
      with decreased circulating estrogen. Withdrawal of hormones from damaged tissues that affect
      axonal conduction can explain the change in disease activity, course symptoms during the
      menstrual cycle in female with MS.

      For all these reasons,investigators think that different phases of menstrual cycle change
      position sense, balance, and dual task performance in females with MS. Considering hormonal
      fluctuations occurring in the menstrual cycle, is an important criterion for organizing the
      rehabilitation program and evaluation in terms of physiotherapy.
    

Detailed description: 
      The purpose of this study was to determine the effect of hormonal changes on knee position
      sense, balance and dual task performance throughout the menstrual cycle in females with MS.

      14 females with MS and 13 healthy females with matching ages and genders were included the
      study. A neurologic examination was performed using the EDSS by a neurologist.

      Position sense was measured with Acumar dual digital inclinometer (Acu360, Acumar, Lafayette,
      USA). Balance was measured with Biodex Balance System (Biodex Medical Systems, Shirley, NY,
      USA). Dual task performance was evaluated with Time Up and Go test.
    

Intervention name(s): Position Sense; Balance; Dual Task Performance
Intervention type(s): Other; Other; Other
Intervention description(s): Knee position sense was evaluated with a Acumar dual digital inclinometer. Each participant was asked to wear shorts and to lie down in supine position treatment table. The lower extremity of the participant was positioned in neutral for the knee flexion movement. The placement of the digital inclinometer's attachment was the lateral ridge of the femur and tibia. We actively assisted the participant's knee to the target angle and asked the participant to hold it there for 5 seconds before returning the knee to the starting position. After returning to the starting position, participants attempted to repeat the previously attained angle. Participants indicated verbally when they felt they had reached the angle and held their position. This procedure was repeated 3 times for each limb (non-dominant and dominant). We measured the absolute difference between the target angle and the observed angle and calculated the absolute error score by averaging the 3 trials.; To measure postural stability and Limits of Stability this study used a balance device, the Biodex Balance System.
Postural Stability: The participants were focused on a characteristic dot (COP, centre of pressure) on the monitor screen. The participant's task was to balance the body in such a way that the dot was in the centre of a circle displayed on the monitor at the point of intersection of the coordinate axes. Test consisted of three 20-second trials, each separated by 10-second breaks. Measurements were repeated three times while their eyes were open/close and analyzed by calculating the average value of measurements.
Limits of Stability: The participants are asked to complete the directional tasks displayed on a screen as quickly as possible, with the directions displayed at random. A total of 3 tests were performed, at intervals of 10 s.; The timed up and go test (TUG) was used in the evaluation of dual task performance. For this test, participants were seated on a standard armless chair and a cone was placed 3 meters away from the chair. Participants were instructed to stand up and (1) walk towards the cone, (2) turn around the cone, (3) walk back to the chair, and (4) sit back on the chair. It was stated that patients should walk without running but as fast as possible. TUG test was performed initially without task, and then with cognitive and motor tasks, respectively. Cognitive task given during the test is counting three backwards from 100 or counting the names starting with the letter "A", and motor task given is to carry three glasses of water on a tray. The time elapses between standing up from the chair and sitting back to chair was recorded as the test result. As time increases, dual task performance decreases.
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        having regular menstrual cycle females with MS and healthy females
      
Keywords: Multiple Sclerosis; Proprioception; Postural balance; Task performance and analysis