Abstract
Maintaining balance is essential for performing daily activities, requiring the body’s center of mass to stay within the base of support during both static and dynamic tasks. Individuals with multiple sclerosis (PwMS) often face impairments in balance due to neurological dysfunctions that affect anticipatory (APAs) and compensatory (CPAs) postural adjustments, increasing the risk of falls. The impact of base-of-support perturbations on postural adjustments remains inadequately explored. This dissertation aimed to comprehensively characterize the balance ability and postural adjustments in PwMS compared to healthy controls and evaluate the effectiveness of targeted training interventions designed to enhance these capabilities. The research objectives included three main aims: 1) to characterize differences in balance ability and postural adjustments between PwMS and age and sex matched healthy adults using clinical and instrumented measures; 2) to systematically review the literature to identify the most effective intervention modes for improving balance in PwMS; 3) to investigate the impact of a targeted training program focusing on postural adjustments and functional strength on clinical and instrumented balance measures. Results revealed significant balance impairments in PwMS compared to controls, with lower scores on the BESTest, particularly in sensory orientation, APAs, and CPAs. The LOS test indicated delayed reaction times and reduced directional control in PwMS. A systematic review of balance interventions identified postural adjustments targeted and functional strength training as the most effective approaches. Consequently, a targeted training program was implemented, leading to significant improvements in total BESTest scores, faster reaction times, greater endpoint excursions, and enhanced directional control on the LOS test. In conclusion, this dissertation provides a detailed understanding of balance and postural adjustment deficits in PwMS, demonstrating that targeted interventions can significantly enhance balance ability.