Getting the Balance Right: A randomised controlled trial of physiotherapy and Exercise Interventions for ambulatory people with multiple sclerosis

Department of Physiotherapy, University of Limerick, Limerick, Ireland.
BMC Neurology (Impact Factor: 2.04). 02/2009; 9(1):34. DOI: 10.1186/1471-2377-9-34
Source: PubMed


People with Multiple Sclerosis have a life long need for physiotherapy and exercise interventions due to the progressive nature of the disease and their greater risk of the complications of inactivity. The Multiple Sclerosis Society of Ireland run physiotherapy, yoga and exercise classes for their members, however there is little evidence to suggest which form of physical activity optimises outcome for people with the many and varied impairments associated with MS.
This is a multi-centre, single blind, block randomised, controlled trial. Participants will be recruited via the ten regional offices of MS Ireland. Telephone screening will establish eligibility and stratification according to the mobility section of the Guys Neurological Disability Scale. Once a block of people of the same strand in the same geographical region have given consent, participants will be randomised. Strand A will concern individuals with MS who walk independently or use one stick to walk outside. Participants will be randomised to yoga, physiotherapy led exercise class, fitness instructor led exercise class or to a control group who don't change their exercise habits.Strand B will concern individuals with MS who walk with bilateral support or a rollator, they may use a wheelchair for longer distance outdoors. Participants will be randomised to 1:1 Physiotherapist led intervention, group intervention led by Physiotherapist, group yoga intervention or a control group who don't change their exercise habits. Participants will be assessed by physiotherapist who is blind to the group allocation at week 1, week 12 (following 10 weeks intervention or control), and at 12 week follow up. The primary outcome measure for both strands is the Multiple Sclerosis Impact Scale. Secondary outcomes are Modified Fatigue Impact Scale, 6 Minute Walk test, and muscle strength measured with hand held dynamometry. Strand B will also use Berg Balance Test and the Modified Ashworth Scale. Confounding variables such as sensation, coordination, proprioception, range of motion and other impairments will be recorded at initial assessment.
Data analysis will analyse change in each group, and the differences between groups. Sub group analysis may be performed if sufficient numbers are recruited.


Available from: Maria Kehoe
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    • "The participants in this qualitative study all used at most a stick to walk outdoors (Guy's Neurological Disability Scale [22] mobility section score of 0, 1, or 2) and were block randomised to exercise in groups in the community led by physiotherapists or fitness instructors. The protocol for the RCT has been described in detail previously [18]. Both physiotherapy and fitness instructor interventions consisted of similar combined strength and aerobic exercise, in the community, once weekly for 10 weeks. "
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    ABSTRACT: Purpose . The purpose of this study was to explore the perceptions of people with multiple sclerosis of a community based, group exercise programme. Method . A pragmatic programme evaluation approach using qualitative research design was adopted. Focus groups were used to gather data from 14 participants who had taken part in a RCT of community based exercise interventions for PwMS who used at most a stick to walk outdoors. Data were transcribed verbatim and thematic analysis was used to first identify categories and then to group them into themes. Results . Three themes emerged, psychological benefits, physical benefits, and knowledge gained. The psychological benefits included the role of the group as a social and motivational factor, empowerment, confidence, hope, sense of achievement, and pride. Physical benefits were improved energy and reduced fatigue and improved ability and participation. Knowledge gained caused a shift from thoughts that exercise might do harm, to sufficient knowledge that would give participants confidence to exercise themselves. The role of the group was a key element in the positive outcomes. Conclusions . The qualitative analysis supports the findings of the main trial confirming positive effects of community exercise interventions by reducing the impact of MS and fatigue and improving participation.
    10/2015; 2015:1-7. DOI:10.1155/2015/123494
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    • "Muscle synergies for lower-limb movements are more likely encoded in the spinal cord (Hart and Giszter, 2004, 2010; Cheung et al., 2005; Kargo et al., 2010) and recruited by different neural pathways in the spinal cord, brainstem, and higher brain regions (Roh et al., 2011). By dissociating spatial from temporal aspects of motor coordination, muscle synergy analysis may aid in identifying neural impairments that are not evident in current clinical measures of motor function (Wolf et al., 1997; Coote et al., 2009; Hackney and Earhart, 2010). Such information may be important in identifying specific neural pathways that should be targeted for rehabilitation interventions, as well as for predicting generalized deficits in motor behaviors that are not specific to the particular tasks performed. "
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    ABSTRACT: Little is known about the integration of neural mechanisms for balance and locomotion. Muscle synergies have been studied independently in standing balance and walking, but not compared. Here, we hypothesized that reactive balance and walking are mediated by a common set of lower-limb muscle synergies. In humans, we examined muscle activity during multidirectional support-surface perturbations during standing and walking, as well as unperturbed walking at two speeds. We show that most muscle synergies used in perturbations responses during standing were also used in perturbation responses during walking, suggesting common neural mechanisms for reactive balance across different contexts. We also show that most muscle synergies using in reactive balance were also used during unperturbed walking, suggesting that neural circuits mediating locomotion and reactive balance recruit a common set of muscle synergies to achieve task-level goals. Differences in muscle synergies across conditions reflected differences in the biomechanical demands of the tasks. For example, muscle synergies specific to walking perturbations may reflect biomechanical challenges associated with single limb stance, and muscle synergies used during sagittal balance recovery in standing but not walking were consistent with maintaining the different desired center of mass motions in standing vs. walking. Thus, muscle synergies specifying spatial organization of muscle activation patterns may define a repertoire of biomechanical subtasks available to different neural circuits governing walking and reactive balance and may be recruited based on task-level goals. Muscle synergy analysis may aid in dissociating deficits in spatial vs. temporal organization of muscle activity in motor deficits. Muscle synergy analysis may also provide a more generalizable assessment of motor function by identifying whether common modular mechanisms are impaired across the performance of multiple motor tasks.
    Frontiers in Computational Neuroscience 05/2013; 7:48. DOI:10.3389/fncom.2013.00048 · 2.20 Impact Factor
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    • "Despite the prevalence and adverse impact of falls in PwMS, there have been few investigations of interventions aimed at minimizing fall risk. There is evidence that physiological risk factors can be minimized with exercise training [29], [30], [31], [32] and an exercise intervention may translate into a decrease in fall risk as documented in community-dwelling older adults [33]. Further work is needed to determine if similar interventions will reduce falls in PwMS. "
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    ABSTRACT: There is a lack of information concerning the relation between objective measures of gait and balance and fall history in persons with MS (PwMS). This investigation assessed the relation between demographic, clinical, mobility and balance metrics and falls history in persons with multiple sclerosis (MS). 52 ambulatory persons with MS (PwMS) participated in the investigation. All persons provided demographic information including fall history over the last 12 months. Disease status was assessed with Expanded Disability Status Scale (EDSS). Walking speed, coordination, endurance and postural control were quantified with a multidimensional mobility battery. Over 51% of the participants fell in the previous year with 79% of these people being suffering recurrent falls. Overall, fallers were older, had a greater prevalence of assistive devices use, worse disability, decreased walking endurance, and greater postural sway velocity with eyes closed compared to non-fallers. Additionally, fallers had greater impairment in cerebellar, sensory, pyramidal, and bladder/bowel subscales of the EDSS. The current observations suggest that PwMS who are older, more disabled, utilize an assistive device, have decreased walking coordination and endurance and have diminished balance have fallen in the previous year. This suggests that individuals who meet these criteria need to be carefully monitored for future falls. Future research is needed to determine a prospective model of falls specific to PwMS. Additionally, the utility of interventions aimed at reducing falls and fall risk in PwMS needs to be established.
    PLoS ONE 11/2011; 6(11):e28021. DOI:10.1371/journal.pone.0028021 · 3.23 Impact Factor
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