Expanded Disability Status Scale (EDSS) estimation in multiple sclerosis from posturographic data

Expanded Disability Status Scale (EDSS) is the most widely used clinical scale to evaluate levels of multiple sclerosis (MS). As MS can lead to disruptions in the regulation of balance and the disability can be evaluated by. force platform posturography, we have developed in this study a new strategy to estimate EDSS from posturographic data. 118 volunteers with EDSS ranging from 0 to 4.5 participated in this study, with eyes closed. By using second-order polynomial regression models, EDSS was estimated from two postural sway parameters, respectively, the length and the surface and four recurrence quantification analysis (RQA) parameters: percentage of recurrence (%Rec), Shannon entropy (Ent), mean diagonal line length (LL)and trapping time (TT). In addition, all four RQA parameters were calculated for position, instantaneous velocity and acceleration of the center of pressure. In order to select the most accurate method for estimating EDSS, four statistical indices (percentage of agreement, underestimation and overestimation, as well as Mean error) were calculated comparing clinical and estimated EDSS scores. The results demonstrate that estimations of EDSS from surface, %Rec and LL of position, best agreed with clinical scores. This study emphasizes the possibility of distinguishing EDSS scores using postural sway and RQA parameters. (C) 2012 Elsevier B.V. All rights reserved.