{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T06:31:17Z","timestamp":1777703477183,"version":"3.51.4"},"reference-count":85,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T00:00:00Z","timestamp":1670284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Multiple Sclerosis Foundation (FISM)","award":["N16\/17\/F14"],"award-info":[{"award-number":["N16\/17\/F14"]}]},{"name":"Italian Multiple Sclerosis Foundation (FISM)","award":["Ricerca Corrente 2022"],"award-info":[{"award-number":["Ricerca Corrente 2022"]}]},{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["N16\/17\/F14"],"award-info":[{"award-number":["N16\/17\/F14"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["Ricerca Corrente 2022"],"award-info":[{"award-number":["Ricerca Corrente 2022"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>The balance of people with multiple sclerosis (PwMS) is commonly assessed during neurological examinations through clinical Romberg and tandem gait tests that are often not sensitive enough to unravel subtle deficits in early-stage PwMS. Inertial sensors (IMUs) could overcome this drawback. Nevertheless, IMUs are not yet fully integrated into clinical practice due to issues including the difficulty to understand\/interpret the big number of parameters provided and the lack of cut-off values to identify possible abnormalities. In an attempt to overcome these limitations, an instrumented modified Romberg test (ImRomberg: standing on foam with eyes closed while wearing an IMU on the trunk) was administered to 81 early-stage PwMS and 38 healthy subjects (HS). To facilitate clinical interpretation, 21 IMU-based parameters were computed and reduced through principal component analysis into two components, sway complexity and sway intensity, descriptive of independent aspects of balance, presenting a clear clinical meaning and significant correlations with at least one clinical scale. Compared to HS, early-stage PwMS showed a 228% reduction in sway complexity and a 63% increase in sway intensity, indicating, respectively, a less automatic (more conscious) balance control and larger and faster trunk movements during upright posture. Cut-off values were derived to identify the presence of balance abnormalities and if these abnormalities are clinically meaningful. By applying these thresholds and integrating the ImRomberg test with the clinical tandem gait test, balance impairments were identified in 58% of PwMS versus the 17% detected by traditional Romberg and tandem gait tests. The higher sensitivity of the proposed approach would allow for the direct identification of early-stage PwMS who could benefit from preventive rehabilitation interventions aimed at slowing MS-related functional decline during neurological examinations and with minimal modifications to the tests commonly performed.<\/jats:p>","DOI":"10.3390\/s22239558","type":"journal-article","created":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T05:50:52Z","timestamp":1670392252000},"page":"9558","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Balance Impairments in People with Early-Stage Multiple Sclerosis: Boosting the Integration of Instrumented Assessment in Clinical Practice"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7486-0706","authenticated-orcid":false,"given":"Ilaria","family":"Carpinella","sequence":"first","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5874-4366","authenticated-orcid":false,"given":"Denise","family":"Anastasi","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6057-591X","authenticated-orcid":false,"given":"Elisa","family":"Gervasoni","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy"}]},{"given":"Rachele","family":"Di Giovanni","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Centro di Recupero e Rieducazione Funzionale (CRRF) \u201cMons. Luigi Novarese\u201d, 13040 Moncrivello, Italy"}]},{"given":"Andrea","family":"Tacchino","sequence":"additional","affiliation":[{"name":"Italian Multiple Sclerosis Foundation, Scientific Research Area, 16126 Genoa, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2026-3572","authenticated-orcid":false,"given":"Giampaolo","family":"Brichetto","sequence":"additional","affiliation":[{"name":"Italian Multiple Sclerosis Foundation, Scientific Research Area, 16126 Genoa, Italy"}]},{"given":"Paolo","family":"Confalonieri","sequence":"additional","affiliation":[{"name":"IRCCS Foundation \u201cCarlo Besta\u201d Neurological Institute, 20133 Milan, Italy"}]},{"given":"Marco","family":"Rovaris","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6713-4623","authenticated-orcid":false,"given":"Claudio","family":"Solaro","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Centro di Recupero e Rieducazione Funzionale (CRRF) \u201cMons. Luigi Novarese\u201d, 13040 Moncrivello, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7797-2399","authenticated-orcid":false,"given":"Maurizio","family":"Ferrarin","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4251-1856","authenticated-orcid":false,"given":"Davide","family":"Cattaneo","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy"},{"name":"Department of Physiopathology and Transplants, University of Milan, 20122 Milan, Italy"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1177\/1352458520970841","article-title":"Rising Prevalence of Multiple Sclerosis Worldwide: Insights from the Atlas of MS","volume":"26","author":"Walton","year":"2020","journal-title":"Mult. Scler. 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