Balance Disorders

Multiple sclerosis (MS) is an inammatory disease of the central nervous system (CNS) that leads to destruction of myelin, oligodendrocytes, and axons. Damage within the CNS can contribute to disorders of coordination, strength, sensation, and balance among people with MS. Often, balance disorders are one of the initial symptoms of the disease.1 Epidemiological studies have found that 23% of people with MS show evidence of cerebellar and brainstem involvement at disease onset and that this „gure increases to 82% after longstanding illness.1 Furthermore, up to 70% of people with MS experience ataxia and sensory system involvement.2 Since balance disorders can negatively affect activities of daily living, participation, and quality of life, understanding the underlying impairments and intervening appropriately is imperative. The present chapter focuses on balance disorders among people with MS who are mobile, with or without an aid, or who, at minimum, are able to stand. After reading this chapter, you will be able to: 1. Review basic principles of balance control, highlighting differences between people with MS and healthy controls, 2. Describe the impact of balance problems on everyday life by summarizing available data about fall frequency, risk factors for falls, and fear of falling in people with MS, 3. Summarize current knowledge about balance assessments and the tools and procedures that can provide appropriate, meaningful data to guide treatment planning during the rehabilitation process, and 4. Offer implementation guidelines for balance rehabilitation interventions that aim to improve balance control in daily life and reduce frequency of falls.