Case-Based Review

Understanding and Treating Balance Impairment in Multiple Sclerosis



The one RCT examining the effectiveness of BBTW in people with MS found immediate and significant effects of BBTW on postural control and upright mobility [146]. The research confirmed preliminary investigations of BBTW in MS [144,147], demonstrating that BBTW can improve walking speed as well as functional tasks involving standing, walking, turning, and sitting down.

Whole Body Vibration

Whole body vibration (WBV) has been employed across a variety of neurological populations as a means of improving muscle tone, sensation, strength, stability, and functional performance. In WBV, multidimensional vibrations are transferred to an individual performing static or dynamic movements on an oscillating platform. The vibrations are believed to facilitate both neuroendocrine responses as well as motor unit recruitment [148–150].

Results have been inconsistent regarding the effectiveness of WBV as a way of improving postural control and functional mobility in individuals with MS. A few studies have shown significant positive effects of WBV lasting from 1 to 4 weeks on functional mobility [151–153], strength [151,153,154], walking speed [152,155], and standing balance [152]. Walking endurance has also been affected by vibration training designed to improve muscular endurance [156]. Although there have been noted benefits of WBV, these benefits were not significantly more advantageous than those offered by a vibration program in conjunction with lower-limb stretching and strengthening exercises [157] or in addition to a traditional rehabilitation program [154].

There has also been some evidence to show that prolonged WBV does not improve postural stability or functional mobility in individuals with MS after training [155,156,158]. Likewise, there is contradictory evidence supporting the use of WBV in improving walking speed [157], functional reaching [152,153] or overall quality of life [152].

While WBV does not appear to have a detrimental effect on symptoms of MS, there is insufficient evidence regarding its beneficial effects on balance, gait, muscle strength and quality of life compared to other interventions. Future research is necessary to examine various protocols in terms of vibratory parameters and length of intervention before specific prescriptions can be offered [159].


Although aquatic exercise has often been recommended for individuals with MS, much of the research employing this therapeutic modality has focused on outcomes of pain, fatigue, cardiorespiratory fitness, gait, and quality of life [160–164]. Research focused on aquatic exercise for improved balance is limited. Nonetheless, significant improvements in standing balance and functional mobility have been shown for individuals with MS following aquatic exercise [165,166]. Similar results on standing balance and functional mobility have also been shown from Ai Chi, a program in which Tai Chi is combined with other techniques and performed standing in shoulder-depth water using a combination of deep breathing and slow, broad movements of the arms, legs, and torso [167]. These methods of intervention, however, still lack evidence from rigorous designs involving control groups and randomization.


Yoga has also been explored as a means to improve physical and mental health outcomes in MS. While an initial study showed no significant changes in one-leg stance from an Iyengar yoga program [168], more recent research found Ananda yoga practice effective in improving standing balance [169]. Likewise, other research has shown that static and dynamic standing balance improved after yoga practice, although not significantly better than that from treadmill exercise training [170].


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