Case-Based Review

Understanding and Treating Balance Impairment in Multiple Sclerosis



Video Game–Assisted Exercises

Novel rehabilitative approaches have taken advantage of advances in virtual reality and visual feedback training to improve balance and mobility deficits in people with MS. Exercise using the general physical activity games on the Nintendo Wii Fit provided short-term improvement in standing balance, strength, gait and physical activity in people with MS [137]. This general exercise offered no significant gains in self-efficacy, fatigue impact or quality of life, and physical activity levels returned to baseline levels 14 weeks after exercising. Subsequent review has, however, highlighted concerns that current commercially available video options for general exercise may not be sufficiently adaptive for people with moderate disability, leading to intimidation and low adherence [138].

Beyond general physical activity, the Wii Balance Board System has also been used to specifically target balance and mobility deficits in MS. Although one study found no significant benefit from Wii Fit balance exercise in balance performance and walking ability [139], other studies have shown positive effects in standing sway, static balance, dynamic stepping, walking speed, and MS impact [140–142].

The evidence, albeit preliminary, thus suggests that the Wii Fit may offer a feasible adjunct to traditional rehabilitation approaches, especially because the exercise can be done at home without the need for continuous support from a practitioner and because the technology aids in overcoming access barriers often associated with community-based physical activity programs [138]. Nonetheless, research shows that Wii Balance Board System training is more specific for static standing balance than for dynamic balance or mobility, the technology is not positively viewed by those with more advanced symptoms, and there exists a risk of adverse affects and training-related injuries associated with home-based use of the Wii [137,140].

Vestibular Rehabilitation Exercise

Vestibular rehabilitation is a specialized treatment approach that strengthens the vestibular sensory system by retraining the brain to recognize and process signals from the vestibular system and coordinate these with visual and proprioceptive inputs. To date, there has only been one RCT investigating the effects of vestibular rehabilitation on balance in adults with MS [143]. In this study, the outcomes of a standard vestibular rehabilitation program to those of an exercise regime as well as to no intervention were compared. The vestibular rehabilitation program consisted of static and dynamic tasks performed with changing bases of support, on various surfaces, with eyes open or closed, and different head movements. The 6-week vestibular rehabilitation program resulted in both statistically significant and clinically relevant change in standing balance under various sensory conditions compared with either of the other two groups, although no significant difference was found in walking capacity across groups.

Weighted Torso Training

Balance-based torso weighting (BBTW) involves strategically placing small weights on the trunk of an individual to decrease balance deviations observed during quiet stance, perturbed standing, walking, and transitioning [144]. While the specific mechanism underlying the therapeutic effect of rehabilitative weighting has been debated [145], various suggestions include joint compression to encourage co-contraction, enhanced conscious awareness of body segments, and biomechanical changes via shifting of the center of mass [146].

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