Group physiotherapy targeting core stability and balance in individuals with multiple sclerosis. ‘Movement analyses and individualisations: potent change-making tools’

Abstract

Introduction: Individualisation is a prevailing principle in physiotherapy for individuals with multiple sclerosis because it may enhance movement quality and thereby promote functional recovery. Less is known regarding how physiotherapists (PTs) implement these principles in group settings when the exercises target core stability and balance.Materials and methods: Three qualitative non-participating observations were videotaped during a 5-week, new, group-based intervention (GroupCoreSIT) involving three ambulatory individuals with secondary progressive MS. A content analysis was performed using integrated perspectives in the movement quality model.Results: Individual tailoring of exercises is possible in groups of three and is necessary to enhance movement quality as opposed to compensatory strategies. The PTs continuous movement analysis was, combined with a dynamic hands-on/hands-off interplay, vital for nonverbal guidance and to adapt the exercises, although limitations to hands-on interaction were noted. Systematic movement sequencing including knowledgeable explanations enhanced the prerequisites for postural control, enabled exercise progression and promoted understanding of how the exercises could improve activities in daily living. All three participants exhibited improvement in movement quality while walking, although gait training was not part of the intervention.Conclusion: In small groups, sequenced, movement analysis-based instructions and individual hands-on adaptations are change-making tools that can promote improvements in movement quality.