Balance In Multiple Sclerosis Research Articles

Study protocol of a randomized controlled trial comparing backward walking to forward walking training on balance in multiple sclerosis: The TRAIN-MS trial

Balance impairment and accidental falls are a pervasive challenge faced by persons with multiple sclerosis (PwMS), significantly impacting their quality of life. While exercise has proven to be an effective intervention for improving mobility and functioning in PwMS, current exercise approaches predominantly emphasize forward walking (FW) and balance training, with variable improvements in balance and fall rates. Backward walking (BW) has emerged as a promising intervention modality for enhancing mobility and strength outcomes; however, significant gaps remain. Specifically, there is limited knowledge about the efficacy of BW interventions on outcomes such as static, anticipatory, and reactive balance, balance confidence, falls, and cognition. This randomized controlled trial aims to determine the feasibility, acceptability, and impact of 8-weeks of backward walking training (TRAIN-BW) as compared to forward walking training (TRAIN-FW). Ninety individuals with MS with self-reported walking dysfunction or ≥ 2 falls in the past 6 months will be randomized in blocks, stratified by sex and disease severity to either the TRAIN-BW or TRAIN-FW intervention groups. Adherence and retention rates will be used to determine feasibility and the Client Satisfaction Questionnaire will be used to assess acceptability. The primary outcomes will be static, anticipatory, and reactive balance. Secondary outcomes include walking velocity, balance confidence, concern about falling, cognition, physical activity, and fall rates measured prospectively for 6 months after post-testing. Additionally, the extent to which cognitive functioning influences response to intervention will be examined. Backward walking training may be an innovative intervention to address balance impairments and falls in persons with MS.

Virtual Reality Applications for Balance Rehabilitation and Efficacy in Addressing Other Symptoms in Multiple Sclerosis—A Review

(1) Background: Since multiple sclerosis (MS) is a neurological pathology known for its disabling effects across many domains, the introduction of virtual reality (VR) usage has been attempted, as it represents a new method of approach to rehabilitation and treatment of chronic neurological pathologies. Encouraging research has explored the use of video game consoles and VR-assisted Robot-Assisted Gait Training (RAGT) to address balance disturbances in this population. (2) Methods: The search involved two databases, Web of Science and PubMed, utilizing a selection of terms including “Virtual reality”, “Multiple sclerosis”, “Balance”, and “Rehabilitation”. Two reviewers initiated and performed the search for articles, subsequently selecting and extracting data from the studies. The PEDro scale was the tool for evaluating the quality of the articles that we introduced in our research. (3) Results: After rigorous scanning, nine articles remained eligible for our study. VR interventions, particularly compared to standard balance training, consistently improved balance in multiple sclerosis. Robotic-assisted technology with 2D VR yielded superior results in balance rehabilitation. VR interventions had varied effects on walking speed. They have shown promise in decreasing the risk of falls and improving patients’ daily lives while reducing fatigue in multiple sclerosis. (4) Conclusions: VR offers comparable or superior benefits to classical exercise and no intervention for balance but does not significantly improve functional mobility. However, it shows the potential to improve quality of life and fatigue in MS patients. Investigation of VR alongside RAGT is important to be performed with larger sample sizes and comprehensive results are needed to fully understand its efficacy in MS rehabilitation.

Physical Telerehabilitation interventions for Gait and balance in Multiple sclerosis: A Scoping review

BackgroundGait and balance impairments affects approximately a quarter of people with multiple sclerosis (pwMS) at onset and increases to almost half by five years. Physical rehabilitation has been recognised as the gold standard method to restore physical function in multiple sclerosis (MS). Emerging evidence in the literature is suggesting that a remote therapy rehabilitation platform (Telerehabilitation) is cost-effective, beneficial, and satisfying for patients and health care practitioners. The overarching aim of this review is to identify and summarise the evidence on the different types of telerehabilitation interventions available to manage gait and balance. MethodsThis review followed a methodological framework for conducting scoping reviews. PubMed,Science Direct and Web of Science were searched in April 2023 for relevant published literature. The inclusion criteria were peer-reviewed journal articles written in English which included telerehabilitation interventions for pwMS. Search keywords included multiple sclerosis and telerehabilitation. A reviewer screened titles and abstracts and eligible articles were fully reviewed. The included studies were categorised based on the type of intervention. ResultsEight studies were included in this review. The participants (n = 355) had an average age of 48 years (SD = 9.9) with 50% who had relapsing remitting multiple sclerosis who were living with MS for 12 years on average. Study designs included randomised control trials (n = 3), pilot studies and feasibility studies (n = 4). Two types of interventions were identified: Exergaming (n = 5) and Web-Based Physical Therapy (n = 2) of which exergaming appeared to be optimal in improving gait and balance. ConclusionThis scoping review identified and summarised the evidence on telerehabilitation interventions used for gait and balance in MS. The evidence is showing that telerehabilitation could be used as an alternative to conventional rehabilitation methods for improving gait and balance. More robust trials with larger sample sizes are needed to build on the current evidence to enable telerehabilitation to be integrated into care pathways in the future.

The acute effect of cervical mobilization on balance in patients with multiple sclerosis: a single-blind, randomized, controlled trial

ABSTRACTThe cervical region plays an important role in providing proprioceptive and vestibular input to the postural control system. Objective. To investigate the effect of cervical mobilization on balance in multiple sclerosis (MS) patients. Methods. The study was undertaken at the neurological rehabilitation unit with 36 MS participants who were assigned randomly to the study (n = 18) and control group (n = 18). While the study group received a single session of 15 minutes of cervical and soft tissue mobilization, no intervention was applied to the control group to investigate the learning effect of the assessment. Patients were evaluated using Computerized Dynamic Posturography (CDP) (Sensory Organization Test (SOT), Limits of Stability (LoS), and Adaptation Test (ADT)), which reflects postural stability. Results. In the study group, a treatment effect was found on the vestibular ratio (VEST) score (p < 0.001) and the composite score of SOT (p = 0.002). Improvements were achieved in all parameters of the LoS and ADT in the study group. There was no statistically significant difference in terms of CDP results in the control group. Conclusion. Cervical mobilization has beneficial effects on balance in MS patients. Our findings support that cervical mobilization can be included in MS balance rehabilitation programs.

Mini-Review: Gait and balance assessment in multiple sclerosis

BACKGROUND: Gait and balance deficiencies are significant concerns for people with multiple sclerosis, resulting in reduced walking capacity, falls and poor quality of life. Issues caused by sensory loss and the inability to properly reweight sensory information are often reported. Even at the early stages of the disease, subclinical gait and balance impairments can be found. AIM: In this article, we review objective measures used to assess gait and postural balance impairment in multiple sclerosis patients. INTERPRETATION: Although scales and clinical tests are important tools for assessing postural instability and walking performance, they can be insensitive to minor disabilities in multiple sclerosis. Instrumented measurements, such as kinematics, kinetics, spatiotemporal gait parameters and center of pressure, play an important role in detecting impairment and evaluating the effects of interventions in people with mild to moderate multiple sclerosis. Thus, objective measurements may be more suitable for tracking deficits in gait and postural balance in multiple sclerosis, contributing to the early detection of disease symptoms, and therefore allowing for the planning of effective interventions to control the speed of disease progression.

Translingual neurostimulation combined with physical therapy to improve walking and balance in multiple sclerosis (NeuroMSTraLS): Study protocol for a randomized controlled trial

IntroductionPhysical rehabilitation restores lost function and promotes brain plasticity in people with Multiple Sclerosis (MS). Research groups worldwide are testing the therapeutic effects of combining non-invasive neuromodulation with physical therapy (PT) to further improve functional outcomes in neurological disorders but with mixed results. Whether such devices enhance function is not clear. We present the rationale and study design for a randomized controlled trial evaluating if there is additional benefit to the synergistic pairing of translingual neurostimulation (TLNS) with PT to improve walking and balance in MS. Methods and analysisA parallel group [PT + TLNS or PT + Sham], quadruple-blinded, randomized controlled trial. Participants (N = 52) with gait and balance deficits due to relapsing-remitting or progressive MS, who are between 18 and 70 years of age, will be recruited through patient registries in Newfoundland & Labrador and Saskatchewan, Canada. All participants will receive 14 weeks of PT while wearing either a TLNS or sham device. Dynamic Gait Index is the primary outcome. Secondary outcomes include fast walking speed, subjective ratings of fatigue, MS impact, and quality of life. Outcomes are assessed at baseline (Pre), after 14 weeks of therapy (Post), and 26 weeks (Follow Up). We employ multiple methods to ensure treatment fidelity including activity and device use monitoring. Primary and secondary outcomes will be analyzed using linear mixed-effect models. We will control for baseline score and site to test the effects of Time (Post vs. Follow-Up), Group and the Group x Time interaction as fixed effects. A random intercept of participant will account for the repeated measures in the Time variable. Participants must complete the Post testing to be included in the analysis. Ethics and disseminationThe Human Research Ethics Boards in Newfoundland & Labrador (HREB#2021.085) & Saskatchewan (HREB Bio 2578) approved the protocol. Dissemination avenues include peer-reviewed journals, conferences and patient-oriented communications.

Mobility and balance rehabilitation in multiple sclerosis: A systematic review and dose-response meta-analysis.

To assess the benefits of neurological rehabilitation and the dose-response relationship for the treatment of mobility and balance in multiple sclerosis. We included studies investigating the effects of neurological rehabilitation on mobility and balance with the following eligibility criteria for inclusion: Population, People with Multiple Sclerosis (PwMS); Intervention, method of rehabilitation interventions; Comparison, experimental (specific balance intervention) vs control (no intervention/no specific balance intervention); Outcome, balance clinical scales; Study Design, randomised controlled trials. We conducted a random effects dose-response meta-analysis to assess linear trend estimations and a one stage linear mixed effects meta-regression for estimating dose-response curves. We retrieved 196 studies from a list of 5020 for full text review and 71 studies (n subjects=3306) were included. One study was a cross-over and 70 studies were randomized controlled trials and the mean sample size per study was 46.5±28.6 (mean±SD) with a mean age of 48.3±7.8years, disease duration of 11.6±6.1years, and EDSS of 4.4±1.4points. Twenty-nine studies (40.8%) had the balance outcome as the primary outcome, while 42 studies (59.1%) had balance as secondary outcome or did not specify primary and secondary outcomes. Thirty-three trials (46.5%) had no active intervention as comparator and 38 trials (53.5%) had an active control group. Individual level data from 20 studies (n subjects=1016) were analyzed showing a medium pooled effect size for balance interventions (SMD=0.41; 95% CIs 0.22 to 0.59). Moreover, we analyzed 14 studies (n subjects=696) having balance as primary outcome and BBS as primary endpoint yielding a mean difference of 3.58 points (95% CIs 1.79 to 5.38, p<0.0001). Finally, we performed meta regression of the 20 studies showing an association between better outcome, log of intensity defined as minutes per session (β=1.26; SEβ=0.51; p=0.02) and task-oriented intervention (β=0.38; SEβ=0.17; p=0.05). Our analyses provide level 1 evidence on the effect of balance intervention to improve mobility. Furthermore, according to principles of neurological rehabilitation, high intensity and task-specific interventions are associated with better treatment outcomes.

Can powered exoskeletons improve gait and balance in multiple sclerosis? A retrospective study.

Multiple sclerosis (MS) is a progressive neurologic disorder that can profoundly influence mobility, independence and quality of life. Gait dysfunction in MS is common, resulting in an increased risk of losing walking ability. Robotic exoskeletons have been developed to offer a new form of locomotor training. The aim of our study was to investigate the effectiveness of the powered exoskeleton (Ekso) in improving gait and balance in patients affected by MS. Twenty patients with MS (mean ± SD: age = 43.7 ± 10.3 years; 66.7% male) were enrolled in this retrospective study. They were divided into two groups, matched for demographic data (age and sex) and medical characteristics (disease duration and Expanded Disability Status Scale), but differing for the type of rehabilitation training performed. Group 1 [experimental group (EG)] received gait training with the Ekso device, whereas group 2 (control group) performed traditional gait training. Although both trainings led to a significant improvement in the ability to walk and balance, only in the EG a significant improvement in walking speed (10 Meter Walk test; P = 0.002), in person's mobility (Timed Up and Go test; P = 0.002), and in the perception of mental well-being (MSQoL-M; P = 0.004), with a good usability and acceptance of the device, was found. Powered exoskeletons could be considered a valuable tool to improve functional outcomes and get the therapeutic goal in patients with MS.

Poster Abstracts from the 10th International Symposium on Gait and Balance in Multiple Sclerosis: The Role of Fatigue and Fatigability.

Poster Abstracts from the 10th International Symposium on Gait and Balance in Multiple Sclerosis: The Role of Fatigue and Fatigability.

Poster Abstracts From the 11th International Symposium on Gait and Balance in Multiple Sclerosis

Baldasso BD, Kirkland MC, Newell CJ, Ploughman MCritch AL, Snow NJ, Alcock LR, Chaves AR, Ploughman MGalperin, I, Mirelman A, Devos H, Regev K, Karni A, Schmitz-Hübsch T, Paul F, Sosnoff JJ, Hausdorff JMZanotto T, Galperi I, Mirelman, A, Yehezkyahu S, Estes J, Chen L, Regev, K, Karni A, Schmitz-Hübsch T, Paul F, Lynch SG, Akinwuntan, AE, Devos H, Hausdorff JM, Sosnoff JJHenning DA, Huisinga JM, Lynch SG, Fritz NEMyers E, Kloos A, Kegelmeyer D, Fritz NEKarpatkin H, Fajardo L, Sullivan C, Chauhan R, Cheuk L, Priyev UMurphy HM, Wadden KP, Kelly LP, Chaytor C, Snow NJ, Ploughman MAnderson MD, Mirkowski M, Ploughman M, Knox KB, Donkers SJVan Liew C, Gudesblatt M, Covey T, Wilken J, Golan D, Zarif M Bumstead B, Buhse MJB, Ofori E, Peterson DSKarpatkin H, Collaku G, Czaplinski A, Heron L, Smith S, Varshansky JCameron M, Hildebrand A, Serdar A, Schlimgen J, Scanlan K, Hugos CHugos CL, Norton J, Silverman S, Joos S, Hildebrand A, Cameron MHLee Y1, Romph E, Dietz M, Van Dyke H, Figurski K, Sander TCMonaghan AS, Huisinga JM, Peterson DSEdwards EM, Wu W, Fritz NEFritz NE, Eloyan A, Keller J, Zackowski KMWooliscroft L, McCoy S, Rooney W, Oken B, Spain R, Kerry K, Bourdette D, Cameron MPotter K, Fritz NE, Matsuda PN, Allen DD, Yorke AM, Widener GL, Cohen ETHenning DA, Quinn L, Cabalang A, Fritz NEKaur R, Levy J, Motl R, Hernandez M, Sowers RAndreopoulou G, Mercer TH, Mahad DJ, van der Linden MLEdwards T, Walker LAS, Pilutti LA

Poster Abstracts from the Ninth International Symposium on Gait and Balance in Multiple Sclerosis: Technology for Assessment and Intervention University of Colorado • Denver, Colorado, USA • October 5, 2019.

Poster Abstracts from the Ninth International Symposium on Gait and Balance in Multiple Sclerosis: Technology for Assessment and Intervention University of Colorado • Denver, Colorado, USA • October 5, 2019.

Effect of Manuel Therapy on Tonus, Proprioseption and Balance in Multiple Sclerosis

Effect of Manuel Therapy on Tonus, Proprioseption and Balance in Multiple Sclerosis

Dalfampridine to Improve Balance in Multiple Sclerosis: Substudy from a Randomized Placebo-Controlled Trial.

This was a substudy of a randomized, double-blind, placebo-controlled trial originally designed to explore the effect of dalfampridine on information processing speed (2013-002558-64 EU Clinical Trials Register) in patients with multiple sclerosis (MS). A total of 120 patients were originally randomized in a 2:1 ratio to receive dalfampridine 10 mg or placebo twice daily for 12 weeks. Here, we sought to explore the effect of dalfampridine on static balance in single-task and dual-task conditions in a subgroup of 41 patients. They underwent static posturography in quiet standing (single-task) and while performing the Stroop test (dual-task) at randomization (baseline), after 12 weeks and after a 4-week wash-out period. Baseline characteristics of active group (n = 27) did not differ from those of placebo group (n = 14). Dalfampridine treatment was associated with better balance control than placebo in both single-task (F = 4.80, p = 0.034) and dual-task (F = 6.42, p = 0.015) conditions, with small-to-moderate effect sizes (Cohen's f2 = 0.122-0.162). The beneficial effect of dalfampridine was not retained 4 weeks after its discontinuation. The rate of accidental falls per month did not differ between the two groups (p = 0.12). Our preliminary findings suggest that dalfampridine can be considered a potential option to treat balance impairment due to MS. Larger sample sizes are needed to verify if the beneficial effect of dalfampridine on balance can be translated into a reduced risk of accidental falls.

Vitamin D Supplementation as Add-on Therapy in Multiple Sclerosis-Balance between Benefit and Risk?: A Commentary on Vitamin D Supplementation in Central Nervous System Demyelinating Disease-Enough Is Enough.

The excellent publication by Häusler and Weber [...].

The development and pilot evaluation of virtual reality balance scenarios in people with multiple sclerosis (MS): A feasibility study.

Balance deficits are considered a risk factor for falls in MS patients. Therefore, developing innovative approaches such as virtual reality (VR) to improve balance in MS is required. The aims of this study were to develop and evaluate feasibility and acceptability of VR scenarios that target balance in MS using a pilot trial. Participants were randomly allocated to either a VR training (i.e. intervention group) (n = 20) or a control group (n = 20). Intervention group received VR training for 6 weeks. Control group received home-based traditional balance exercises without the VR. Participants were assessed at baseline and follow-up on Berg Balance Scale (BBS), Timed Up and Go (TUG), the 10 Meter Walk Test (10-MWT), the 3 Minute Walk Distance (3-MWD), the Modified Fatigue Impact Scale (MFIS) Fall Efficacy Scale- International (FES-I) and the Short Form 36 (SF-36). Six VR scenarios weer developed. Sixteen participants in the intervention and 16 in the control group completed the study. Significant differences between the two groups were observed at on BBS, MFIS and several outcomes of the SF-36 survey (P < 0.05). Participants reported overall level of satisfaction with the developed VR scenarios. Findings demonstrated the feasibility and acceptability of a VR-based program in MS individuals. Our findings support the implementation of a larger trial of longer-term VR program.

Poster Abstracts from the Eighth International Symposium on Gait and Balance in Multiple Sclerosis: Exercise - Symptom Management to Disease Modification World Trade Center • Portland, Oregon, USA • September 15, 2018.

Poster Abstracts from the Eighth International Symposium on Gait and Balance in Multiple Sclerosis: Exercise - Symptom Management to Disease Modification World Trade Center • Portland, Oregon, USA • September 15, 2018.

Circulating exosomes cause loss of immunological balance in multiple sclerosis

Circulating exosomes cause loss of immunological balance in multiple sclerosis

Deregulation of the endocannabinoid system and therapeutic potential of ABHD6 blockade in the cuprizone model of demyelination

Multiple sclerosis (MS) is a chronic demyelinating disease of unknown etiology in which tissue pathology suggests both immune-dependent attacks to oligodendroglia and primary oligodendrocyte demise. The endocannabinoid system has been crucially involved in the control of autoimmune demyelination and cannabinoid-based therapies exhibit therapeutic potential, but also limitations, in MS patients. In this context, growing evidence suggests that targeting the hydrolysis of the main endocannabinoid 2-arachidonoylglycerol (2-AG) may offer a more favorable benefit-to-risk balance in MS than existing cannabinoid medicines. Here we evaluated the modulation of endocannabinoid signaling and the therapeutic potential of targeting the 2-AG hydrolytic enzyme alpha/beta-hydrolase domain-containing 6 (ABHD6) in the cuprizone model of non-immune dependent demyelination. The concentrations of N-arachidonoylethanolamine (anandamide, AEA) and its congener N-palmitoylethanolamine (PEA) were reduced following 6 weeks of cuprizone feeding. Deregulation of AEA and PEA levels was not due to differences in the expression of the hydrolytic and biosynthetic enzymes fatty acid amide hydrolase and N-acylphosphatidylethanolamine-phospholipase D, respectively. Conversely, we measured elevated transcript levels of 2-AG hydrolytic enzymes monoacylglycerol lipase, ABHD6 and ABHD12 without changes in bulk 2-AG concentration. Upregulated CB1 and CB2 receptors expression, ascribed in part to microglia, was also detected in the brain of cuprizone-treated mice. Administration of an ABHD6 inhibitor partially attenuated myelin damage, astrogliosis and microglia/macrophage reactivity associated to cuprizone feeding. However, ABHD6 blockade was ineffective at engaging protective or differentiation promoting effects in oligodendrocyte cultures. These results show specific alterations of the endocannabinoid system and modest beneficial effects resulting from ABHD6 inactivation in a relevant model of primary demyelination.

Balance in multiple sclerosis: relationship to central brain regions.

Dizziness, postural instability, and ataxia are among the most debilitating symptoms of multiple sclerosis (MS), reflecting, in large part, dysfunctional integration of visual, somatosensory, and vestibular sensory cues. However, the role of MS-related supratentorial lesions in producing such symptoms is poorly understood. In this study, motor control test (MCT) and dynamic sensory organization test (SOT) scores of 58 MS patients were compared to those of 72 healthy controls; correlations were determined between the MS scores of 49 patients and lesion volumes within 26 brain regions. Depending upon platform excursion direction and magnitude, MCT latencies, which were longer in MS patients than controls (p < 0.0001), were correlated with lesion volumes in the cortex, medial frontal lobes, temporal lobes, and parietal opercula (r's ranging from 0.20 to 0.39). SOT test scores were also impacted by MS and correlated with lesions in these same brain regions as well as within the superior frontal lobe (r's ranging from - 0.28 to - 0.40). The strongest and most consistent correlations occurred for the most challenging tasks in which incongruent visual and proprioceptive feedback were given. This study demonstrates that supratentorial lesion volumes are associated with quantitative balance measures in MS, in accord with the concept that balance relies upon highly convergent and multimodal neural pathways involving the skin, muscles, joints, eyes, and vestibular system.

Poster Abstracts from the Seventh International Symposium on Gait and Balance in Multiple Sclerosis: Neuroplasticity and Rehabilitation in MS

Poster Abstracts from the Seventh International Symposium on Gait and Balance in Multiple Sclerosis: Neuroplasticity and Rehabilitation in MS