Balance and Gait in People with Multiple Sclerosis: A Comparison with Healthy Controls and the Immediate Change after an Intervention based on the Bobath Concept.

Abstract

The objective of this study is to compare the balance and gait of 11 people with multiple sclerosis (MS) to 11 healthy controls and to investigate the immediate change after a single intervention based on the Bobath concept on these activities in the MS group. Balance was assessed by ground reaction forces (GRF) and centre of pressure movements during single limb standing (SLS), the Lateral Reach Test (LRT) and the Four Square Step Test (FSST). Gait was evaluated by GRF, ankle kinematics and spatiotemporal measures. Baseline measures in the MS group showed significantly greater vertical GRF variability (p = 0.008) during SLS reached less distance on the LRT (p = 0.001) and were slower completing the FSST (p < 0.001). During gait, the MS group walked slower (p = 0.005) and had less ankle plantarflexion (PF) (p = 0.001) than the control group. Less peak vertical GRF (p < 0.001) and peak propulsive GRF (p = 0.004) at terminal stance and increased vertical GRF in midstance (p = 0.005) were observed. The measures of balance and gait were re-assessed in the MS group immediately after a 20-min intervention based on the Bobath concept delivered to the most impaired foot and ankle. After the intervention, the MS group had significant changes towards the control group values with reduced mediolateral (p = 0.002) and vertical (p = 0.016) GRF variability in the SLS task, faster FSST time (p = 0.006) and increased ankle PF during gait (p = 0.002). This study provides further evidence of balance and gait limitations in people with MS and indicates that a single treatment based on principles of the Bobath concept to the foot and ankle can result in immediate improvements in balance and ankle PF during gait in people with MS. Copyright © 2015 John Wiley & Sons, Ltd.