Stabilometric assessment of context dependent balance recovery in persons with multiple sclerosis: a randomized controlled study.

BACKGROUND: Balance control relies on accurate perception of visual, somatosensory and vestibular cues. Sensory flow is impaired in Multiple Sclerosis (MS) and little is known about the ability of the sensory systems to adapt after neurological lesions reducing sensory impairment. The aims of the present study were to verify whether: 1. Balance rehabilitation administered in a challenging sensory conditions would improve stability in upright posture. 2. The improvement in a treated sensory condition would transfer to a non treated sensory condition. METHODS: Fifty three persons with MS, median (min-max) EDSS score of 5 (2.5-6.5), participated in a RCT and were randomly assigned to two groups. The Experimental group received balance rehabilitation aimed at improving motor and sensory strategies. The Control group received rehabilitation treatment which did not include training of sensory strategies. Persons with MS were blindly assessed by means of a stabilometric platform with eyes open, eyes closed and dome, on both firm surface and foam. Anterior-posterior and medio-lateral sway, velocity of sway and the length of Center of Pressure (CoP) trajectory were calculated in the six sensory conditions. RESULTS: Experimental group showed statistically significant improvement (P < 0.05) in stability in upright posture in eyes closed condition on firm surface, and in eyes open, closed, and dome conditions on foam. No differences were observed between groups in the eyes open condition on firm surface nor in the sensory condition not addressed during the treatment. CONCLUSIONS: After rehabilitation people with MS can recover from sensory impairments thus improving upright balance. Further, the improvement seems to be context-dependent and present just in the treated sensory conditions. TRIAL REGISTRATION: ClinicalTrials NCT02131285.

Task-oriented biofeedback to improve gait in individuals with chronic stroke: motor learning approach.

BACKGROUND: Electromyographic biofeedback (EMG-BFB) has shown equivocal benefits on gait retraining after stroke. OBJECTIVE: The authors evaluated the efficacy of EMG-BFB applied in a task-oriented approach based on principles of motor learning to increase peak ankle power of the affected leg and gait velocity in patients with chronic mild to moderate hemiparesis. METHODS: They assigned 20 participants randomly to the EMG-BFB group or a control group that received conventional therapy for the same duration. Quantitative gait analysis was performed before and after treatment. The EMG-BFB involved the triceps surae during functional gait activities. Treatment was administered with a fading frequency of BFB application and an increasing variability in gait activities. Both groups had 20 treatment sessions of 45 minutes each, including at least 15 minutes of walking-related therapy for the control group. Follow-up (FU) gait analysis was obtained 6 weeks after training. RESULTS: BFB treatment led to significant increases (P < .01) in peak ankle power at push-off (from 0.63 W/kg to 1.04 W/kg) in conjunction with significant increases in velocity (from 28.3 %h/s--normalized to percentage height per second--to 39.6 %h/s) and stride length (from 44.5 %h--normalized to percentage height--to 57.6 %h). Increases remained significant at FU. There were no changes in any gait variable in the control group. CONCLUSION: A task-oriented BFB treatment was effective in increasing peak ankle power, gait velocity, and stride length in a population with hemiparesis. Further studies should compare the combination intervention with either of its components in more impaired patients.

Concepts of motor learning applied to a rehabilitation protocol using biofeedback to improve gait in a chronic stroke patient: an A-B system study with multiple gait analyses.

OBJECTIVE: The impact of electromyographic biofeedback (EMG BFB) applied during functional gait activities and employed in accord with theories on motor learning was investigated in a chronic hemiplegic patient. METHODS: A single-subject A-B design was used. EMG BFB was applied to the triceps surae during gait. A rehabilitation program with a fading frequency of BFB application and an increasing variability in the task training was implemented. Responses to the rehabilitation program were documented via multiple quantitative gait analyses, performed during a baseline, treatment, and at follow-up 6 weeks after the end of treatment. RESULTS: From baseline to end of treatment, there were significant changes in ankle power at push-off, both in amplitude and timing, as well as onset of ankle power at push-off relative to heel strike of the healthy leg. There was a significant increase in gait velocity, step length of the healthy side, stride length, and stride frequency. At follow-up, changes were still significantly different from baseline and the patient had reduced the use of the cane in activities of daily living. CONCLUSIONS: BFB appears to have been effective in promoting positive changes in gait in this pilot study. The rehabilitation protocol also appeared to be effective in promoting learning and the incorporation of trained activities into daily activities.

Validity of six balance disorders scales in persons with multiple sclerosis.

PURPOSE: The aim of this study was to test concurrent and discriminant validity of several tests of static and dynamic balance in a sample of subjects suffering from MS. METHOD: A group of 51 patients were enrolled in the study. The following tests were administered: Berg Balance Scale (BBS), Timed Up and Go Test (TUG), Dynamic Gait Index (DGI), Hauser Deambulation Index (DI), Dizziness Handicap Inventory (DHI), and Activities-specific Balance Confidence (ABC). The scales used in this study were initially translated into Italian. RESULTS: The sample of subjects reported a mean of 0.98 (1.8 SD) falls in the month prior to evaluation. The tests demonstrated good concurrent validity: Higher correlation coefficients among tests tapping the same aspect and lower correlation coefficients among tests tapping slightly different aspects. ABC and DHI tests discriminated better than the others between fallers and non-fallers and appeared the best predictors of fall status. BBS and DGI were not as efficient in discriminating between groups. Conversely all tests showed good difference validity in the prediction of patients who used an assistive device. CONCLUSION: BBS, TUG, DI, DGI, ABC, DHI have acceptable concurrent validity. The scales have poor performance in discriminating between faller and non-faller.