Exercise Program Based on Ballet Improves Motor Control and Balance in MS Patients, Study Reports

A non-traditional exercise program that incorporates movements used in ballet was found to improve motor control and balance in women with multiple sclerosis, leading its researchers to recommend dance movements be part of such interventions for MS patients.

The study, “Targeted ballet program mitigates ataxia and improves balance in females with mild-to-moderate multiple sclerosis,” was one of the first to evaluate ballet movements in MS and funded by the National Multiple Sclerosis Society. It was recently published in the journal PLOSOne.

A common issue with MS patients is a deficit in sensorimotor function, often resulting in a lack of coordination, loss of static and dynamic balance control, and impaired gait. Mild-to-moderate MS disability ranges from moderate restrictions in movement to an inability to walk more than 20 meters, according to the Expanded Disability Status Scale (EDSS). Such impairment affects a person’s quality of life.

Large-scale analysis shows that physiotherapy interventions focused on balance and walking outcomes are only moderately effective.

Interest, for this reason, is growing in alternative programs like dance. In particular, ballet is known in healthy adults to improve balance, an ability to sense the body’s position and motion, sensorimotor networks, and coordination involving complex movements. Some researchers believe these benefits may extend to MS patients with compromised motor function.

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A study (ISRCTN67916624) used a targeted ballet program designed to improve ataxia (motor control) and balance in women with mild-to-moderate relapsing-remitting MS (RRMS).

It recruited 10 patients, eight of whom finished the program. These women were between the ages of 36 and 65, and had EDSS scores showing mild-to-moderate restriction in movement.

The ballet program involved 16 weeks of training sessions, twice a week for 60 minutes. It incorporated aspects of classical ballet, such as augmented feedback in the form of musical cues, touch, and physical guidance and assistance. Exercises were designed to improve both static and dynamic balance, and movement.

Different clinical scales were used to assess either balance or ataxia. The Mini-BESTest (Mini-Balance Evaluations Systems Test) evaluates six factors: biomechanics, stability limits, postural responses, anticipatory postural adjustments, sensory orientation, and dynamic balance in gait. The International Cooperative Ataxia Rating Scale (ICARS) detects ataxia in five domains: posture, gait, kinetic, speech, and oculomotor function (eye movement).

These two measures were assessed in each participant before and after the ballet program.

Researchers also analyzed participants’ performance regarding the smoothness of movement during a five-meter walk, and their balance in a step-to-stand task.

Results showed improvement in all parameters analyzed at the program’s end. Balance, in particular, improved by 42% as measured by the Mini-BESTest, and the total ICARS scores also showed a significant improvement in movement (of 58%), especially relating to posture and gait domains.

No adverse events were related to taking part in the ballet intervention.

Overall, the team concluded that “TBP [targeted ballet program] was well tolerated, improved balance, and mitigated ataxia,” with clinical improvements seen being “larger than those of previous studies on physical rehabilitation in MS with similar outcome measures.”

The researchers proposed that “dance should be incorporated into rehabilitation programs” for MS patients.