Impact of pathological conditions on postural reflex latency and adaptability following unpredictable perturbations: A systematic review and meta-analysis

Abstract

Background: Pathological conditions can impair responses to postural perturbations and increase risk of falls.

Research question: To what extent are postural reflexes impaired in people with pathological conditions and can exercise interventions shorten postural reflexes?

Methods: MEDLINE, EMBASE, Scopus, SportDiscus and Web of Science were systematically searched for articles comparing muscle activation onset latency in people with pathological conditions to healthy controls following unpredictable perturbations including the effect of exercise interventions (registration: CRD42020170861).

Results: Fifty-three articles were included for systematic review. Significant delays in muscle activity onset following perturbations were evident in people with multiple sclerosis (n = 7, mean difference [MD]: 22 ms, 95% confidence interval [CI]: 11, 33), stroke (n = 10, MD: 34 ms, 95% CI: 19, 49), diabetes (n = 2, MD: 19 ms, 95% CI: 10, 27), HIV (n = 3, MD: 9 ms, 95% CI: 4, 14), incomplete spinal cord injury (n = 2, MD: 57 ms, 95% CI: 33, 80) and back and knee pain (n = 7, MD: 12 ms, 95% CI: 6, 18), but not in people with Parkinson's disease (n = 10) or cerebellar dysfunction (n = 4). Following exercise interventions, the paretic limb of stroke survivors (n = 3) displayed significantly faster muscle activation onset latency compared to pre-exercise (MD: -13 ms, 95% CI: -24, -4), with no significant changes in Parkinson's disease (n = 3).

Conclusions: This systematic review demonstrated that postural reflexes are significantly delayed in people with multiple sclerosis (+22 ms), stroke (+34 ms), diabetes (+19 ms), HIV (+9 ms), incomplete spinal cord injury (+57 ms), back and knee pain (+12 ms); pathological conditions characterized by impaired sensation or neural function. In contrast, timing of postural reflexes was not impaired in people with Parkinson's disease and cerebellar dysfunction, confirming the limited involvement of supraspinal structures. The meta-analysis showed exercise interventions can significantly shorten postural reflex latencies in stroke survivors (-14 ms), but more research is needed to confirm this finding and in people with other pathological conditions.

Keywords: Balance; Multiple sclerosis; Pain; Parkinson’s disease; Postural reflex; Stroke.