Balance and Rehabilitation – Firm on the Ground Even with Multiple Sclerosis

Introduction

Balance − the ability to control the body's center of gravity in relation to its base of support − can be divided into static, dynamic (proactive), and reactive. The reactive type (the ability to cope with unexpected shifts in the body's center of gravity) is especially crucial for preventing falls. Maintaining postural control requires complex interaction between the nervous and musculoskeletal systems, including intact afferent inputs to the central nervous system. Given that MS often leads to sensitivity disturbances, muscle strength issues, spasticity, proprioception impairment, or vision problems, postural control deficits are a common and complex symptom in these patients. It’s no surprise that balance and gait disorders are reported in 50–80% of them. Approximately half of MS patients experience at least one fall per year.

Rehabilitation in a Nutshell

A review article by Czech authors from last year summarizes the results of clinical rehabilitation and physiotherapy studies primarily focused on improving balance in people with MS. A total of 183 clinical studies published from 2000 to 2020 were searched, with 104 included. The most frequently evaluated interventions were:

• individual balance training (n = 14)
• strength training (n = 11)
• gait training (n = 10)
• exercise using robotic systems (n = 10)
• exercise using gaming systems (so-called exergaming; n = 10)
• vibration platform training (n = 10)
• group balance training (n = 8)
• home exercise program (n = 7)
• Pilates exercises (n = 6)
• combined training using aerobic and strength exercises (n = 6)
• exercise in a water environment (n = 3)

The described studies varied significantly in their design. However, the vast majority examined the potential of exercise to improve balance in people with mild neurological disabilities, where interventions generally appeared effective. The precise length of exercise and the number of exercise hours required to achieve clinically significant improvement in people with MS are not known. From studies examining the effect of interventions aimed at balance training in seniors, we know that at least 50 therapeutic units are necessary.

Only a small number of studies focused on individuals with moderate to severe deficits according to the Expanded Disability Status Scale (EDSS 4–7). For these patients, a 7-week group balance training involving deep stabilization muscle strengthening along with sensory stimulation dual-task training, an intensive 4-week rehabilitation stay complemented by strength training, vestibular rehabilitation performed 5 times a week for at least 4 weeks, and gait training using robotic systems seem to be effective. Conversely, an educational program about fall issues combined with home exercise education did not lead to changes in observed parameters. Lower limb muscle strengthening combined with electro-gymnastics was also not sufficiently effective for individuals walking with support (EDSS ≥ 6).

Tai Chi − Balance of Body and Soul

Our eastern neighbors were not left behind, living up to their geographical position and focusing on a comprehensive weapon of eastern culture. Over the course of a year, they monitored patients practicing Tai Chi and evaluated the progress in stability (including posturography), mood, cognition, and quality of life. After a year, significant improvement was observed in all tests evaluating balance, the 25 Feet Walk Test, anxiety levels, and cognitive tests.

Sports for Stability

Rehabilitation and regular physical activity are indispensable parts of multiple sclerosis therapy. This also holds true for the therapy of balance disorders. To achieve sufficient effect, however, balance training must be intensive, regular, and long-term.

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Sources:
1. Cameron M. H., Nilsagard Y. Balance, gait, and falls in multiple sclerosis. Handb Clin Neurol 2018; 159: 237−250. doi: 10.1016/B978-0-444-63916-5.00015-X.
2. Menkyová I., Šťastná D., Novotná K. et al. Effect of Tai-chi on balance, mood, cognition, and quality of life in women with multiple sclerosis: a one-year prospective study. Explore (NY) 2023 Aug 6: S1550-8307(23)00171-4, doi: 10.1016/j.explore.2023.07.011.
3. Novotná K., Menkyová I., Janatová M. Balance Disorders in People with Multiple Sclerosis and Rehabilitation Therapy Options – Current Findings from Controlled Clinical Studies. Česká a slovenská neurologie a neurochirurgie 2022; 85 (2): 110−126, doi: 10.48095/cccsnn2022110.