Difficulties with walking and balance are common among people with multiple sclerosis and strongly affect their quality of life — even when disease progression may not be evident on scans or other measures of MS advance, according to research presented at a meeting last fall and recently reviewed by the National MS Society.
The society used the meeting’s topics to issue a news release reminding MS patients of the importance of exercise and good diet, call attention to the need for greater research into these areas, and to note studies it is supporting on ways to improve gait and balance.
The 7th International Symposium on Gait and Balance in MS held in Portland, Oregon, in September 2017, brought together nearly 100 researchers, clinicians, engineers, and others from various countries with a focus on walking difficulties and rehabilitation strategies for MS. Abstracts from the research presented are available online at the International Journal of MS Care.
Topics discussed included how to improve rehabilitation strategies for gait and motor dysfunction, the news release states. Some 50 MS patients also at the meeting attended an interactive session on rehabilitation approaches.
The society also included a link in its release to research it is supporting — some ongoing and recruiting, some recently completed or nearing an end — into rehabilitation practices that might improve gait, balance, cognition and diet.
Its release also reviewed what it considered research of particular note presented at the meeting, including:
- A study led by Geetanjali Gera, with Oregon Health & Science University, reporting that “postural response” is impaired in MS patients. This response refers to how quickly people correct themselves after a disturbance in walking. Problems were associated with slower conduction of nerve impulses in the cerebellum — a brain area that regulates coordination. The investigators suggest that rehabilitation approaches should focus on improving the timing of “postural responses” to reduce a person’s risk of falling.
- Research led by Valerie Block at University of California, San Francisco looked at “real world” physical activity data on patients, collected using wrist-worn accelerometers. Eighty patients were followed for one year and showed a 10.7 percent decline in their daily step count. This diminishment in step count was noted even in those with stable clinical scores using standard scales thought to capture disease progression.
- A study led by Jessica Gadayan, also at the University of California, San Francisco, compared balance in 64 people with MS and 42 with Parkinson’s disease. MS patients demonstrated a tendency to lose balance more often, regardless of direction of movement. Both MS and Parkinson’s patients struggled with balance when moving left or right more often than forward or backward. These results are valuable to designing tailored strategies for each patient, the researchers observed.
- Research led by Afolasade Fakolade, at Queen’s University in Kingston, Ontario, evaluated the needs and priorities regarding physical activity of MS patients. Via wearable accelerometers, focus groups, and a survey, study results found that MS patients and their caregivers spent 74 percent of their day in sedentary behavior. Both patients and caregivers put as a top priority in a future physical activity programs joint participation of patients and family members.
- Another study from Oregon Health & Science University, led by Bryan D. Loy, analyzed the impact of diet on gait in 38 women with MS. Results showed that an increase in calories consumed correlated with longer stride length, faster gait speed, and less time requiring double supports. But investigators found no particular link between gait and specific nutrients, such as fat, carbohydrates, or proteins.
According to the National MS Society, effective rehabilitation strategies to improve balance and gait in MS patients are essential.
Relevant research it is supporting, detailed here, ranges from studies on eye movement exercises to improve balance (NCT01698086) and resistance training (published results), to diet’s impact on fatigue as well overall health (NCT02986893), and a robotic exoskeleton that might help those who have lost the ability to walk (NCT02519244).