Mohammed Sanjak, PhD, PT, with Atrium Health Carolinas Neuromuscular/ALS-MDA Center, is the principle author on the recently reported clinical study that, for the first time, explored specific balance deficits early in patients with Amyotrophic Lateral Sclerois (ALS). The paper, entitled Vestibular Deficits Leading to Disequilibrium and Falls in Ambulatory Amyotrophic Lateral Sclerosis, was published online by Archive of Physical Medicine & Rehabilitation, 2014, June 16 [Epub ahead of print].
Associate Professor Sanjak at the University of North Carolina-Charlotte Department of Kinesiology, along with Mark A. Hirsch, PhD, Elena K. Bravver, MD, William L. Bockenek, MD, H James Norton, PhD, and Benjamin Rix Brooks, MD, all from Atrium Health, evaluated whether the vestibular system, which helps control one’s balance, posture and orientation in space, is indeed compromised early in ALS patients.
Falls are common in patients with ALS- they are reported by approximately 33 percent of patients and may occur even before patients seek medical evaluation leading to the diagnosis of ALS. Despite that high number, scientific clinical physiological studies of the causes of falls in ALS have not previously been undertaken.
For this clinical study, Sanjak and the team observed, using computer-instrumented neurophysiologic techniques, whether the vestibular system is affected in ambulatory individuals with ALS) who exhibit no classical clinical signs of instability or history of falling. The team identified that patients with normal balance scores have decreased ability to use their vestibular system and must rely on visual cues for posture and to maintain balance.
“By demonstrating that ALS does affect the vestibular system, there may now be increased understanding of falls in early ALS and development of improved rehabilitation strategies for ALS patients that might prevent falls from happening,” said Dr. Sanjak.
Associate Professor Marc Weisskopf, PhD, ScD from the Department of Environmental Health and Epidemiology, Harvard School of Public Health, who has extensively studied the epidemiology of falls in ALS patients, commented on the study. “The findings of Sanjak et al are of great importance given the association between trauma and ALS that has been seen by us and others. Traumas are clearly elevated just before and after ALS diagnosis; to the extent that unrecognized vestibular deficits may contribute to this, this offers an important potential intervention opportunity. Understanding the specific neurological mechanisms behind such deficits may provide more insight into ALS neuropathology,” said Dr. Weisskopf.
A further critical finding in the study is that commonly used classical clinical balance scales are not sensitive to detect impairment in balance system in early diagnosed ALS patients. Therefore, relying on these tests for clinical decision making may be inadequate, and may delay needed early interventions to improve balance in such patients.
“In summary, our findings suggest that some patients who are ambulatory early in the ALS process and who performed relatively well in classical balance and mobility tests, could be at risk for falls when visual and somatosensory cues are unreliable or absent,” said Dr. Sanjak. A copy of the paper abstract can be viewed at http://www.ncbi.nlm.nih.gov/pubmed/24946083.
