Range of motion abnormalities in the lower limb joints during gait in youth with multiple sclerosis.

BACKGROUND: The major objective of this study was to examine whether differences occur in the joint angles of the major lower limb joints while walking in youth with multiple sclerosis (YwMS) compared to age-gender-matched healthy youngsters. METHODS: Gait analysis was collected using a six-camera Cartesian Optoelectronic Dynamic Anthropometer (CODA) 3D motion analysis system. To determine the gait normality in the YwMS group, we compared our results to reference gait data from normal youngsters. Gait data was divided according to gender and age subgroups (8-14, 15-18 years old). RESULTS: The total sample included 26 YwMS (12 girls, 14 boys), 11 in the 8-14 age subgroup, and 15 in the 15-18 age subgroup. The mean expanded disability status scale score was 1.3 (S.D=1.0), indicating minimal disability. The total range of hip motion was significantly less in the YwMS group aged 15-18 (both genders) compared with the normative values. Additionally, the maximum flexion in the knee joint during gait was significantly less in boys in the 15 to 18 age subgroup (p<0.001). No differences were found in the hip and knee joint angles in the 8-14 age subgroup. CONCLUSIONS: YwMS experience modifications in their gait pattern compared with age-gender-matched healthy youngsters. The MS teenagers demonstrated less range of movement in the hip joints and walked slower at a decreased pace than the healthy teenagers. By tracking gait patterns, healthcare providers can identify subtle changes that might facilitate timely interventions to prevent further mobility impairment in this young population.

A Novel Treatment of Fear of Flying Using a Large Virtual Reality System.

BACKGROUND: Fear of flying (FoF), a common phobia in the developed world, is usually treated with cognitive behavioral therapy, most efficiently when combined with exposure methods, e.g., virtual reality exposure therapy (VRET). We evaluated FoF treatment using VRET in a large motion-based VR system. The treated subjects were seated on a moving platform. The virtual scenery included the interior of an aircraft and a window view to the outside world accompanied by platform movements simulating, e.g., takeoff, landing, and air turbulence. Relevant auditory stimuli were also incorporated. CASE REPORT: Three male patients with FoF underwent a clinical interview followed by three VRETs in the presence and with the guidance of a therapist. Scores on the Flight Anxiety Situation (FAS) and Flight Anxiety Modality (FAM) questionnaires were obtained on the first and fourth visits. Anxiety levels were assessed using the subjective units of distress (SUDs) scale during the exposure. All three subjects expressed satisfaction regarding the procedure and did not skip or avoid any of its stages. Consistent improvement was seen in the SUDs throughout the VRET session and across sessions, while patients' scores on the FAS and FAM showed inconsistent trends. Two patients participated in actual flights in the months following the treatment, bringing 12 and 16 yr of avoidance to an end. DISCUSSION: This VR-based treatment includes critical elements for exposure of flying experience beyond visual and auditory stimuli. The current case reports suggest VRET sessions may have a meaningful impact on anxiety levels, yet additional research seems warranted.

The effect of balance training on postural control in people with multiple sclerosis using the CAREN virtual reality system: a pilot randomized controlled trial.

BACKGROUND: Multiple sclerosis (MS) is a multi-focal progressive disorder of the central nervous system often resulting in diverse clinical manifestations. Imbalance appears in most people with multiple sclerosis (PwMS). A popular balance training tool is virtual reality (VR) with several advantages including increased compliance and user satisfaction. Therefore, the aim of this pilot RCT (Trial registration number, date: ISRCTN14425615, 21/01/2016) was to examine the efficacy of a 6-week VR balance training program using the computer assisted rehabilitation environment (CAREN) system (Motek Medical BV, Amsterdam, Netherlands) on balance measures in PwMS. Results were compared with those of a conventional balance exercise group. Secondary aims included the impact of this program on the fear of falling. METHODS: Thirty-two PwMS were equally randomized into the VR intervention group or the control group. Each group received balance training sessions for 6 consecutive weeks, two sessions per week, 30 min sessions. Clinical balance tests and instrumented posturography outcome measures were collected upon initiation of the intervention programs and at termination. RESULTS: Final analysis included 30 patients (19 females, 11 males; mean age, (S.D.) = 45.2 (11.6) years; mean EDSS (S.D.) = 4.1 (1.3), mean disease duration (S.D.) = 11.0 (8.9) years). Both groups showed a main effect of time on the center of pressure (CoP) path length with eyes open (F = 5.278, P = .024), sway rate with eyes open (F = 5.852, P = .035), Functional Reach Test (F = 20.841, P = .001), Four Square Step Test (F = 9.011, P = .031) and the Fear of Falls self-reported questionnaire (F = 17.815, P = .023). In addition, significant differences in favor of the VR program were observed for the group x time interactions of the Functional Reach Test (F = 10.173, P = .009) and fear of falling (F = 6.710, P = .021). CONCLUSIONS: We demonstrated that balance training based on the CAREN device is an effective method of balance training for PwMS.

Gait and jogging parameters in people with minimally impaired multiple sclerosis.

Increasing awareness of the significance of ambulatory limitations in people with multiple sclerosis (MS) requires a regular assessment of walking ability in order to monitor disease dynamics. However, it is questionable whether the standard tools are sufficiently sensitive to detect mobility deficits in patients who are minimally impaired. Therefore, the main objective of this study was to examine an extended assessment tool characterizing spatio-temporal parameters of gait and jogging in people with minimally impaired MS. Twenty relapsing remitting patients diagnosed with MS, 8 women and 12 men, aged 36.3 ± 9.2 y, EDSS mean score 1.8 ± 1.2, were recruited from the Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel to participate in the study. Twenty apparently healthy subjects (10 women and 10 men), aged 34.3 ± 7.4 years served as controls. Balance-, gait- and jogging-related spatio-temporal parameters were obtained using the Zebris FDM-T Treadmill (Zebris(®) Medical GmbH, Germany). Each subject completed a sequence of 3 jogging tests under different conditions. Gait and balance tests were performed prior and after jogging trials. When comparing gait evaluation, jogging revealed additional abnormalities in the MS group vs. the healthy controls. In addition to step time asymmetry and larger step width, jogging was associated with a slower self-selected velocity, shorter step length, longer stance phase and a prolonged double support phase. People minimally affected by MS have the ability to jog. However, clinician's should be aware of the possible deficits accompanying this popular activity.