Cerebellar White Matter Damage Is Associated With Postural Sway Deficits in People With Multiple Sclerosis

Published:August 26, 2019DOI:



      To assess how postural sway deficits during eyes open and closed relate to the integrity of cerebellar peduncles in individuals with multiple sclerosis (MS).


      Cross-sectional study.


      Laboratory based setting.


      Twenty-nine adults with MS (Expanded Disability Status Scale: 2-4) and 15 adults without MS were recruited (N=44). Inclusion criteria for all participants were ability to maintain balance independently by standing on toes for 3 seconds, and no known biomechanical conditions affecting balance.


      Not applicable.

      Main Outcome Measures

      Postural sway using body-worn, inertial sensors during quiet standing, integrity of cerebellar peduncles quantified using diffusion-tensor imaging and clinical assessment scales for ataxia and balance.


      Radial diffusivity of the inferior cerebellar peduncle was related to postural sway measures during both eyes open and closed. In contrast, radial diffusivity of the superior cerebellar peduncle was related to postural sway only in stance with eyes open.


      The inferior cerebellar peduncle, which carries somatosensory information to the cerebellum, contributes to control of standing balance with or without visual inputs, consistent with the high dependence on somatosensory information for posture. The superior cerebellar peduncle, which carries cortical information to the cerebellum, contributes to control of standing posture only when vision is available. Radial diffusivity of the inferior cerebellar peduncle was related to reactive balance control, whereas radial diffusivity of the superior cerebellar peduncle was related to the kinetic component of the ataxia rating scale.


      List of Abbreviations:

      AP (anterior-posterior), DTI (diffusion-tensor imaging), EDSS (Expanded Disability Status Scale), FA (fractional anisotropy), ICARS (International Cooperative Ataxia Rating Scale), Mini-BESTest (Miniature Balance Evaluation Systems Test), MS (multiple sclerosis), PwMS (people with multiple sclerosis), RD (radial diffusivity)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cattaneo D.
        • De Nuzzo C.
        • Fascia T.
        • Macalli M.
        • Pisoni I.
        • Cardini R.
        Risks of falls in subjects with multiple sclerosis.
        Arch Phys Med Rehabil. 2002; 83: 864-867
        • Finlayson M.L.
        • Peterson E.W.
        • Cho C.C.
        Risk factors for falling among people aged 45 to 90 years with multiple sclerosis.
        Arch Phys Med Rehabil. 2006; 87: 1274-1279
        • Prosperini L.
        • Petsas N.
        • Raz E.
        • et al.
        Balance deficit with opened or closed eyes reveals involvement of different structures of the central nervous system in multiple sclerosis.
        Mult Scler. 2014; 20: 81-90
        • Fling B.W.
        • Dutta G.G.
        • Schlueter H.
        • Cameron M.H.
        • Horak F.B.
        Associations between proprioceptive neural pathway structural connectivity and balance in people with multiple sclerosis.
        Front Hum Neurosci. 2014; 8: 814
        • Spain R.I.
        • St George R.J.
        • Salarian A.
        • et al.
        Body-worn motion sensors detect balance and gait deficits in people with multiple sclerosis who have normal walking speed.
        Gait Posture. 2012; 35: 573-578
        • Mancini M.
        • Salarian A.
        • Carlson-Kuhta P.
        • et al.
        ISway: a sensitive, valid and reliable measure of postural control.
        J Neuroeng Rehabil. 2012; 9: 59
        • Peterka R.J.
        Chapter 2 - Sensory integration for human balance control.
        in: Day B.L. Lord S.R. Handbook of clinical neurology. Vol. 159. Elsevier, New York2018: 27-42
        • Anderson V.M.
        • Wheeler-Kingshott C.A.
        • Abdel-Aziz K.
        • et al.
        A comprehensive assessment of cerebellar damage in multiple sclerosis using diffusion tractography and volumetric analysis.
        Mult Scler. 2011; 17: 1079-1087
        • Preziosa P.
        • Rocca M.A.
        • Mesaros S.
        • et al.
        Relationship between damage to the cerebellar peduncles and clinical disability in multiple sclerosis.
        Radiology. 2014; 271: 822-830
        • Storey E.
        • Tuck K.
        • Hester R.
        • Hughes A.
        • Churchyard A.
        Inter-rater reliability of the International Cooperative Ataxia Rating Scale (ICARS).
        Mov Disord. 2004; 19: 190-192
        • Franchignoni F.
        • Horak F.
        • Godi M.
        • Nardone A.
        • Giordano A.
        Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest.
        J Rehabil Med. 2010; 42: 323-331
        • Eickhoff S.B.
        • Jbabdi S.
        • Caspers S.
        • et al.
        Anatomical and functional connectivity of cytoarchitectonic areas within the human parietal operculum.
        J Neurosci. 2010; 30: 6409-6421
        • Basser P.J.
        • Pierpaoli C.
        Microstructural and physiological features of tissues elucidated by quantitative-diffusion-tensor MRI.
        J Magn Reson B. 1996; 111: 209-219
        • Gulani V.
        • Webb A.G.
        • Duncan I.D.
        • Lauterbur P.C.
        Apparent diffusion tensor measurements in myelin-deficient rat spinal cords.
        Magn Reson Med. 2001; 45: 191-195
        • Lowe M.J.
        • Beall E.B.
        • Sakaie K.E.
        • et al.
        Resting state sensorimotor functional connectivity in multiple sclerosis inversely correlates with transcallosal motor pathway transverse diffusivity.
        Hum Brain Mapp. 2008; 29: 818-827
        • Pijnenburg M.
        • Caeyenberghs K.
        • Janssens L.
        • et al.
        Microstructural integrity of the superior cerebellar peduncle is associated with an impaired proprioceptive weighting capacity in individuals with non-specific low back pain.
        PLoS One. 2014; 9e100666
        • Gera G.
        • Chesnutt J.
        • Mancini M.
        • Horak F.B.
        • King L.A.
        Inertial sensor-based assessment of central sensory integration for balance after mild traumatic brain injury.
        Mil Med. 2018; 183: 327-332
        • Peterka R.J.
        Sensorimotor integration in human postural control.
        J Neurophysiol. 2002; 88: 1097-1118
        • El-Gohary M.
        • Peterson D.
        • Gera G.
        • Horak F.B.
        • Huisinga J.M.
        Validity of the instrumented push and release test to quantify postural responses in persons with multiple sclerosis.
        Arch Phys Med Rehabil. 2017; 98: 1325-1331
        • Cameron M.H.
        • Horak F.B.
        • Herndon R.R.
        • Bourdette D.
        Imbalance in multiple sclerosis: a result of slowed spinal somatosensory conduction.
        Somatosens Mot Res. 2008; 25: 113-122
        • Horak F.B.
        • Dickstein R.
        • Peterka R.J.
        Diabetic neuropathy and surface sway-referencing disrupt somatosensory information for postural stability in stance.
        Somatosens Mot Res. 2002; 19: 316-326