***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To identify measures of balance , gait , and strength that predict falls in women with multiple sclerosis ( MS ) . DESIGN This prospect i ve study followed participants for 1 year . SETTING University research laboratories . PARTICIPANTS A convenience sample of women with MS ( N=99 ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Balance was assessed with the  limits of stability ( LOS ) test  and the  Sensory Organization Test .  Peak force , torque , and power of knee flexors and extensors as well as hip abductors and adductors were also measured . Temporal-spatial parameters of gait  were measured by an instrumented walkway system . For 1 year after baseline assessment s , the participants reported their falls . Participants were then classified based on the number of reported falls for use in logistic regression models to predict either people with at least 1 fall or people with at least 2 falls ( recurrent fallers ) . RESULTS A total of 159 falls were reported by 48 % of the participants .  Exp and ed Disability Status Scale scores , leaning forward to the LOS , and st and ing sway within a visually referenced surround significantly predicted people with at least 1 fall as well as recurrent fallers . Stance-phase asymmetries and base-of-support width during gait , as well as the force and power produced during leg extension or flexion additionally predicted recurrent fallers . The models ' overall predictive accuracy ranged from 69 % to 85 % . CONCLUSIONS This prospect i ve study confirmed the prevalence and multifactorial nature of falls in this MS sample . In addition to advancing disease status , impaired forward LOS and visually dependent sway ( as well as gait asymmetries and leg flexor-extensor weakness for recurrent fallers ) predict future falls in women with MS BACKGROUND Balance impairment and an increased rate of falls are commonly reported in individuals with multiple sclerosis ( MS ) . Force platform-generated center of pressure ( COP ) metrics have previously been recommended as an outcome measure to quantify balance deficits and distinguish between fallers and nonfallers in MS . Information is limited regarding the preservation of postural control in individuals with MS over extended time frames in the absence of an intervention . This report examines the test-retest reliability and magnitude of change of COP motion during st and ing balance over 3 months . METHODS Twenty individuals with MS and a history of falling underwent  testing  on two occasions 3 months apart in the absence of an intervention . On both occasions , participants completed two 30-second trials of three conditions : eyes open , eyes closed , and eyes open with concurrent cognitive challenge ( dual task ) . Measures of COP area , velocity , and temporal structure were calculated and included in the reliability analysis . RESULTS The COP metrics displayed fair-to-excellent reliability over 3 months without an intervention . Reliability was maintained across the three commonly used balance conditions . CONCLUSIONS These results offer insight into the reliability of COP measures over a 3-month period in MS and can inform the use of COP metrics for future study design ( eg , sample size estimates ) and balance outcome assessment during r and omized controlled trials and fall-prevention studies in individuals with MS Background : People with multiple sclerosis ( MS ) experience frequent falls , which are associated with impairments and limitations to activities and participations . Objective : The objective of this paper is to evaluate falls risk factors using robust clinical measures . Methods : A total of 150 individuals ( confirmed MS diagnosis , Exp and ed Disability Status Scale ( EDSS ) 3.5–6.5 ) were recruited , with 148 participants included in the final analysis . Demographic data were collected and performance assessed in eight predictor measures  ( Physiological Profile Assessment ( PPA ) , Brief Ataxia Rating scale , Ashworth scale ( Ashworth ) , Modified Falls Efficacy scale , Symbol Digit Modalities Test , dual-task interference , lying/st and ing blood pressure , static/dynamic visual acuity )  . Participants prospect ively recorded falls over three months using a daily diary . People were classified as “ fallers ” based on reports of ≥ two falls . Results : A total of 104 participants recorded 672 falls ; 78 ( 52.7 % ) reported ≥ two falls . Continence issues , previous falls history and use of prescribed medications were each associated with increased risk of being a “ faller ” . Ashworth and PPA risk score contributed significantly to a logistic regression model predicting faller/non-faller classification . The reduced model ( Ashworth , PPA , EDSS ) showed fair-to-good predictive ability ( ROC c-statistic 0.73 , sensitivity 70 % , specificity 69 % ) . Conclusion : This study confirms the high prevalence of falls in ambulant people with MS . Important potentially modifiable risk factors are identified , suggesting aspects to target in falls interventions INTRODUCTION The attribution of balance or gait disorders to psychogenic origin can be exceedingly challenging , as clinical tests involving distraction maneuvers are prone to subjective bias . We tested the value of biomechanical balance analysis to identify psychogenic balance and gait ( PBG ) disorders . METHODS We quantified and compared the effects of distraction maneuvers on balance based on four stance conditions ( eyes open , EO ; eyes closed , EC ; EO on foam , EOF ; and EC on foam ; ECF ) in subjects with suspected PBG ( n = 12 ) , subjects with balance and gait disorder due to multiple sclerosis ( MS ; n = 12 ) and healthy controls ( n = 12 ) . We measured trunk inclination in transverse plane ( ° )(2 ) and the corresponding body angular velocity ( ° /s ) . Distractibility of postural stability was analysed using ANOVA with repeated measures . RESULTS In evident contrast to the MS group and healthy controls , the PBG group showed increased values of ( ° )(2 ) and ( ° /s ) and significant distractibility in all four stance conditions . CONCLUSIONS Biomechanical balance analysis can help clinicians to get objective , quantified results of distraction maneuvers and confirm a positive diagnosis of PBG disorders . Large prospect i ve studies are needed to confirm these results Background . Quantitative posturography has been reported as a reliable tool to measure balance in people with multiple sclerosis ( MS ) . However , data on its diagnostic accuracy in predicting the occurrence of falls are lacking . Objective . To determine sensitivity , specificity , predictive values , and accuracy of  posturography  in detecting falls  in MS subjects over a 3-month follow-up period . Methods . One hundred consecutive patients with MS were tested by the  Berg Balance Scale ( BBS ) and by  static posturography on a monoaxial platform . Participants recorded the occurrence of accidental falls for the next 3 months . Abnormal cutoff values for static st and ing balance measures were set at 2 st and ard deviations above the mean values obtained from 50 healthy controls ( HC ) . The diagnostic accuracy of the BBS and static posturography was analyzed with respect to the prospect ively collected data on the occurrence of falls . Results . Posturometric measures in participants with MS were significantly worse than in HC ( all P values < .0001 ) ; however , only the center of pressure ( COP ) path with open eyes condition had substantial test – retest reliability .  Static posturography  was more sensitive ( 88 % vs 37 % ) and accurate ( 75 % vs 63 % ) , but slightly less specific ( 67 % vs 81 % ) , than the BBS in predicting accidental falls . A logistic regression analysis revealed that the worse the COP path , the greater the risk for accidental falls ( odds ratio = 1.08 ; P < .0001 ) , even after adjusting for sex , age , disease duration , body mass index , MS subtype , Exp and ed Disability Status Scale , and BBS score . Conclusion . The COP path measurement in static position is a sensitive and accurate tool to identify people with MS who are at risk of accidental falls Background and Purpose Balance impairments are common in persons with multiple sclerosis ( MS ) , but clinical balance tests may not detect subtle deficits in adults with MS who are not yet experiencing functional limitations or disability . The purpose of this study was to determine if center of pressure ( COP ) displacement during st and ing tasks could be a useful performance-based evaluative measure for adults with MS who have minimal or no balance deficits on clinical examination using the Berg Balance Scale ( BBS ) . Subjects and Methods Twenty-one adults with MS were compared with 21 age- and gender-matched healthy adults . Subjects with MS were tested with the  BBS , Mini-mental State Exam , Exp and ed Disability Status Scale ( EDSS ) , and  Multiple Sclerosis Functional Composite ( MSFC ) . They also performed voluntary leaning and reaching movements while kinematic and kinetic data were collected . Control subjects performed the same tasks with the exception of the EDSS and MSFC . Results COP displacement during reaching and leaning was less in adults with MS when compared to control subjects . There were no differences in anthropometric , kinematic , or foot position variables that could account for this difference . Furthermore , there was no difference between groups when COP displacement during reaching was expressed as a percentage of the maximum COP displacement during leaning . Discussion and Conclusion COP measures show clear differences when comparing healthy adults with minimally impaired adults with MS . The lack of between-group differences when COP displacement during reaching was expressed as a percentage of the maximum COP displacement during leaning suggests that the subjects with MS adopt a reaching strategy that allows them to stay within their reduced limits of stability . COP measures during st and ing tasks appear well-suited to quantifying changes in postural control over time or in response to intervention for minimally impaired persons with MS OBJECTIVES To determine whether impaired performance in a range of vision , proprioception , neuropsychological , balance , and mobility tests and pain and fatigue are associated with falls in people with multiple sclerosis ( PwMS ) . DESIGN Prospect i ve cohort study with 6-month follow-up . SETTING A multiple sclerosis ( MS ) physiotherapy clinic . PARTICIPANTS Community-dwelling people ( N=210 ; age range , 21 - 74y ) with MS ( Disease Steps 0 - 5 ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Incidence of falls during 6 months ' follow-up . RESULTS In the 6-month follow-up period , 83 participants ( 39.7 % ) experienced no falls , 57 ( 27.3 % ) fell once or twice , and 69 ( 33.0 % ) fell 3 or more times . Frequent falling ( ≥3 ) was associated with increased postural sway ( eyes open and closed ) , poor leaning balance ( as assessed with the coordinated stability task ) , slow choice stepping reaction time , reduced walking speed , reduced executive functioning ( as assessed with the difference between Trail Making Test Part B and Trail Making Test Part A ) , reduced fine motor control ( performance on the 9-Hole Peg Test [ 9-HPT ] ) , and reported leg pain . Increased sway with the eyes closed , poor coordinated stability , and reduced performance in the 9-HPT were identified as variables that significantly and independently discriminated between frequent fallers and nonfrequent fallers ( model χ(2)3=30.1 , P<.001 ) . The area under the receiver operating characteristic curve for this model was .712 ( 95 % confidence interval , .638-.785 ) . CONCLUSIONS The study reveals important balance , coordination , and cognitive determinants of falls in PwMS . These should assist the development of effective strategies for prevention of falls in this high-risk group OBJECTIVE To determine the prevalence of , and risk factors for , receiving medical attention  for a recent injurious fall among middle-aged and older adults who have multiple sclerosis ( MS ) . DESIGN Survey . SETTING United States . PARTICIPANTS Seven hundred people with MS , age 55 years or older and living in the United States , were r and omly selected from the North American Research Committee on Multiple Sclerosis Registry and invited by mail to participate in the study . A total of 354 people , aged 55 to 94 years , completed the survey . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Participant 's self-report regarding receipt of medical care for a fall-related injury ( received care within the past 6mo , > 6mo ago , or never ) . RESULTS More than 50 % of study participants reported injurious falls ; 12 % , in the 6 months before the interview . Proportional odds models were used to identify factors associated with increased odds of receiving medical attention for a fall-related injury within the past 6 months . Compared with study participants who reported receiving medical attention for a fall-related injury more than 6 months ago or never , participants who reported receiving medical attention for a fall-related injury within the past 6 months were more likely to report fear of falling ( odds ratio [OR]=1.94 ; 95 % confidence interval [ CI ] , 1.27 - 2.96 ) and osteoporosis ( OR=1.65 ; 95 % CI , 1.03 - 2.62 ) . CONCLUSIONS Injurious falls were commonly reported by survey participants . Findings suggest that management of fear of falling and osteoporosis are important components of comprehensive fall-injury prevention programs for people aging with MS 
    Output:
    
RESULTS indicate that regardless of task complexity or sensory condition , people with MS display considerable deficits in postural control in comparison to healthy controls .
The large number of variables and lack of st and ardisation of reporting makes data synthesis challenging , however , people with MS display considerable deficits in postural control compared to healthy controls regardless of task condition or complexity