Ehlers-Danlos Syndrome (EDS) comprises a group of disorders marked
by abnormal collagen function. In EDS Hypermobility Type (EDS-HT), major
diagnostic findings involve joint hypermobility and chronic pain. Physical
therapy has been recognized for its benefits to patients with joint
hypermobility. Evidence suggests that mechanical interventions may improve
pain, strength and stability [1,4]. Pilot findings
suggest that an intensive exercise intervention (IEI) may lead to improved
joint control, loading, and symmetry [3,4]. The
purpose of this study was to assess postural stability (PS) in patients before
and after participation in the IEI.

 
Methods:

Seventeen
adolescents with EDS-HT made an initial visit immediately prior to starting the
IEI, and a second visit within five days of completing the IEI (a 10-day
program focused in neuromuscular re-education, flexibility, strengthening,
joint stabilization, and endurance). During each visit, participants underwent
PS testing under Eyes Open (EO) and Eyes Closed (EC) conditions. For each
trial, ground reaction force data were processed to obtain center of pressure
(COP) information. Measures of interest included linear and nonlinear metrics
in the A/P and M/L directions.
Results:

Findings indicated reduced M/L position
variability between the EO Pre and EO Post conditions (Fig 1). Significant
increases in nonlinear postural control metrics were also observed in the M/L
direction, indicating changes in the structure of the M/L position variability
(Fig 2). These findings suggest improved ability to stabilize in the M/L
direction, with patterns of balance demonstrating increased complexity. This
may point to an increase in patients’ postural adaptability.

Figure 1:  Linear measures of COP
excursion (SD standard deviation, Exc
excursion, Vel velocity). Star
indicates significant difference (p<0.05).

Figure 2:  Approximate entropy (ApEn) and sample entropy (SaEn).
Star indicates significant difference (p<0.01).

 
Conclusion:

Significant improvements in PS were observed
in adolescents with EDS-HT following the IEI. Further study is warranted to
learn how these changes are affected by patients’ baseline characteristics
(e.g. pain level, fitness level, etc.) Additional stratification by age and
gender may also be useful in delineating the most appropriate intervention
strategy for subsets of this population.

 
<>References:

[1] 
Hakim A et al. Best Prac Rsch Clin
Rheum 17, 989-1004, 2003.

[2] 
Sacheti A et
al. J Pain Symp Mgt 14,
88-93, 1997.

[3] 
Simmonds JV et al. Man Ther 13, e1-e11, 2008.

[4] 
Greenwood NL et al. Man Ther 16, 623-628, 2011.