140 likes | 153 Views
Limits of Postural Stability in Myotonic Dystrophy Compared to Normative Values. Mary Pautler, MPH University of Utah, Salt Lake City UT. Prevalence estimated at 1/8,000 Dominantly inherited, multisystem disorder Characterization : Progressive muscle weakness Myotonia
E N D
Limits of Postural Stability in Myotonic Dystrophy Compared to Normative Values • Mary Pautler, MPH • University of Utah, Salt Lake City UT
Prevalence estimated at 1/8,000 • Dominantly inherited, multisystem disorder • Characterization: • Progressive muscle weakness • Myotonia • Early onset cataracts • -Increased risk for falls • Limitations with mobility and gait impact quality of life Myotonic Dystrophy Type 1 (DM1)
Study Design • Aim 1: Compare Limits of Stability via maximum excursion (MXE) scores for DM1 versus normative values. • Aim 2: Compare MXE scores at baseline and 3-months. • Study Visits • Baseline and 3-months • Inclusion Criteria • Age 18-60 • Genetically confirmed DM1 • Onset of symptoms after age 12 • Exclusion Criteria • Mexiletine, Coumadin or other anticoagulants • Other neuromuscular disorder • Significant trauma within one month
Limits of Stability • Voluntary maximum displacement of center of gravity while maintaining a fixed base of support. • Maximum Excursion (MXE): • Measure of maximum movement potential • Illustrates limits of stability • Reduced MXE values indicate: • Reduced limits of stability • Decreased stability during weight shifting • Increased fall risk Balance and Posture, Andrew L. McDonough
Anterior Computerized Posturography Posterior • NeuroCom Balance Manager System NeurCom Clinical Interpretation Guide, Computerized Dynamic Posturography
Anterior Limit of Stability TracingDM1 participant Posterior
Results: Aim 1 • Maximum Excursion (MXE): Comparison of DM1 to Normative Values
Results: Aim 2 • Maximum Excursion (MXE): Comparison of Baseline to 3-Month Visit
MXE vs DF Strength (r = 0.65, p=0.004) MXE vs mDGI (r = 0.60, p=0.008) Results • MXE vs Age (r = -0.64, p=0.004)
Summary • Limits of stability are significantly reduced in DM1 as compared to normal values. • No change in stability limits over 3-months. • Age, dorsiflexion strength and dynamic balance correlate with stability limits. • Evaluate additional contributing factors. • Consider limits of stability for measuring disease progression.
CONTRIBUTORS / SUPPORT • Heather Hayes, PT, DPT, NCS, PhD • Man Hung, PhD • Jerry Bounsanga • Yushan Gu • Deanna DiBella, PT, MPT • Evan Pucillo, PT, DPT • Caren Trujillo, RN, MSN • Missy Dixon, PhD, MS • Russell Butterfield, MD, PhD • Nicholas Johnson, MD
Horak, F. B. (2006). Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing, 35 Suppl 2, ii7-ii11