Effectiveness of neuromuscular rehabilitation in multiple sclerosis patients on balance and walking ability

ABSTRACT

Multiple sclerosis [MS] is a chronic, progressive neurological disease with a clinical course that may result in severe disability. It is characterized by movement, balance and walking impairment. In the past, physical therapy management of MS focused on passive treatment to avoid exacerbating fatigue or the disease process. Current research is demonstrating overwhelming benefits when MS patients perform exercise. The aim of this study was to investigate the effectiveness of neuromuscular rehabilitation program on MS patients with cerebello-pyramidal manifestations. Twenty five patients diagnosed as clinically definite MS were recruited from the out patient Department of Neurology, Kasr El-Aini hospital, Cairo University. They were 14 females and 11 males; their mean age was 41.6 +/- 7.9; mean duration of illness was 4.5 +/- 2.7 years and the mean Expanded Disability Status Scale [EDSS] was 4.9 +/- .912. Assessment was done in the morning before beginning the treatment program and after seven weeks of treatment. Six Spot Step Test is a quantitative assessment of lower extremity function, which is measured in the time domain by digital stop watch. Biodex stability system is an objective assessment of balance. The overall stability index was used as a measure of postural stability. Patients were assessed with bilateral stance at level 8 [most stable] over a period of 20 seconds. The neuromuscular rehabilitation program consisted of rhythmic stabilization of proprioceptive neuromuscular facilitation [PNF], slow reversal of PNF, Frenkel's coordination exercises in supine, sitting and standing positions, static and dynamic balance training in crawling, kneeling and half kneeling positions, static and dynamic balance training by means of external postural perturbation, weight shift to both extremities and to the posterior part of feet while standing with feet together, in tandem stance, single limb support and Cawthorne-Cooksey exercises. Patients received the program three times per week for seven weeks. The results of this study showed the effectiveness of neuromuscular rehabilitation program in improving both the walking ability [p=.001] and balance [p=.001] in MS patients. Moreover weak non significant correlation was found between the tested variables and EDSS