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Influence of Spasticity on Mobility and Balance in Persons With Multiple Sclerosis

Sosnoff, Jacob J. PhD; Gappmaier, Eduard PT, PhD; Frame, Amy PT; Motl, Robert W. PhD

Journal of Neurologic Physical Therapy: September 2011 - Volume 35 - Issue 3 - p 129–132
doi: 10.1097/NPT.0b013e31822a8c40
Research Articles

Background and Purpose: Spasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes that presumably affects mobility and balance. This investigation examined the hypothesis that persons with multiple sclerosis (MS) who have spasticity of the lower legs would have more impairment of mobility and balance compared to those without spasticity.

Methods: Participants were 34 ambulatory persons with a definite diagnosis of MS. The expanded disability status scale (EDSS) was used to characterize disability in the study sample. All participants underwent measurements of spasticity in the gastroc-soleus muscles of both legs (modified Ashworth scale), walking speed (timed 25-foot walk), mobility (Timed Up and Go), walking endurance (6-minute walk test), self-reported impact of MS on walking ability (Multiple Sclerosis Walking Scale-12), and balance (Berg Balance Test and Activities-specific Balance Confidence Scale).

Results: Fifteen participants had spasticity of the gastroc-soleus muscles based on modified Ashworth scale scores. The spasticity group had lower median EDSS scores indicating greater disability (P=0.03). Mobility and balance were significantly more impaired in the group with spasticity compared to the group without spasticity: timed 25-foot walk (P = 0.02, d = −0.74), Timed Up and Go (P = 0.01, d = −0.84), 6-minute walk test (P < 0.01, d = 1.03), Multiple Sclerosis Walking Scale-12 (P = 0.04, d = −0.76), Berg Balance Test (P = 0.02, d = −0.84) and Activities-specific Balance Confidence Scale (P = 0.04, d = −0.59).

Discussion and Conclusion: Spasticity in the gastroc-soleus muscles appears to have negative effect on mobility and balance in persons with MS. The relationship between spasticity and disability in persons with MS requires further exploration.

Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign (J.S., R.W.M.), and Department of Physical Therapy, University of Utah (E.G., A.F.).

Correspondence: Jacob J. Sosnoff, E-mail:

This work was presented in part at the 2010 Consortium for Multiple Sclerosis Centers.

© 2011 Neurology Section, APTA