The Effect of Cervical Mobilization on Balance and Spasticity in Multiple Sclerosis Individuals

Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating, and neurodegenerative disease of the central nervous system (CNS). The etiology of the disease is not fully known. It is thought that both autoimmune and neurodegenerative mechanisms can play a role in MS. Genetic and environmental factors are also influenced by the emergence of the disease. Although the factors that trigger MS are not fully known, autoreactive T cells and antibodies against SSS are thought to have a major pathogenic role in the development of inflammation and tissue damage. The same mechanism is held responsible for the progression of neurological disorders and functional deficits.

MS can severely limit the quality of life in patients due to the accumulation of sequelae following the attacks or the development of a progressive degenerative process, leading to progressive disability.

The disease has marked clinical heterogeneity. This difference may be in the age of onset, onset, frequency, severity and sequelae of exacerbations, worsening prevalence and cumulative impairment over time. Although there are differences in clinical and pathologic findings, variable clinical features reflect multifocal SSS destruction. In patients, somatosensory findings (burning, numbness, tingling, deep and superficial sensory deficits), motor findings (spasticity due to corticospinal involvement, muscle strength losses), postural control and coordination disorders, bladder-bowel problems, visual, cognitive and psychiatric manifestations, fatigue and sleep disorders.

Spasticity is one of the most common physical disorders in MS. It is known that 60-90% of individuals with MS develop spasticity. MS-associated spasticity; generalized, focal (which affects a part of the extremity) or multifocal (which affects more than one part of the extremities or extremities). Spasticity; due to force imbalance between agonist and antagonist muscles, affecting static joint positions and dynamic limb movements, resulting in abnormal postural conditions and stiffness. Spasticity is directly related to disease progression and muscle weakness leads to secondary fatigue due to increased energy expenditure. Depending on the spasticity, structural changes of muscles, tendons and joints affect the movements and functions of the extremities.

Equilibrium losses are one of the other important symptoms seen in MS patients, affecting about 75% of patients. Balance; the ability to keep the center of gravity of the body within the limits of the support surface. The sensory components of the balance; visual, vestibular and somatosensory system information. The feeling of proprioception, which is part of the somatosensory system; joints and extremities, which are formed by receptors located in the joints and tissues and provided by neural inputs. Proprioceptors are specific receptors that are located at different rates in different structures and tissues of the body. It is known that the cervical region is very rich in these receptors. In this respect, the neck plays a very important role in maintaining the right orientation, balance, and accordingly motor coordination of the whole body. For example; In the impaired proprioceptive processes of the lower extremities, compensation is provided by proprioceptive inputs from the cervical region to maintain body balance. The cervical region is closely related to the vestibular system, which is another sensory component of balance. This relationship is extremely important in the activity of cervico-colic (CCR) and vestibulo-colic reflexes (VCR). VCR is semicircular canal and macular origin. They are effective on the receptors on the inner ear and on the muscular extensor muscles. In one study, when vestibular stimulation accompanied the tension of the neck muscles, the sagittal VCR in the semispinalis capitis muscle increased about three-fold normally. Strengthening of the VCR reflex with tongue proprioceptive afferents is the result of summing up of CCR and VCR induced by stretching of the neck muscles. The interaction between the two reflexes showed that not only the vestibular stimulation but also the length of the neck muscles were important in the normal movement of the head over the neck.