Smedal Tori, Lygren Hildegunn, Myhr Kjell-Morten, Moe-Nilssen Rolf, Gjelsvik Bente, Gjelsvik Olav, Strand Liv Inger
National Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Physiother Res Int. 2006 Jun;11(2):104-16. doi: 10.1002/pri.327.
Patients with multiple sclerosis (MS) tend to have movement difficulties, and the effect of physiotherapy for this group of patients has been subjected to limited systematic research. In the present study physiotherapy based on the Bobath concept, applied to MS patients with balance and gait problems, was evaluated. The ability of different functional tests to demonstrate change was evaluated.
A single-subject experimental study design with ABAA phases was used, and two patients with relapsing-remitting MS in stable phase were treated. Tests were performed 12 times, three at each phase: A (at baseline); B (during treatment); A (immediately after treatment); and A (after two months). The key feature of treatment was facilitation of postural activity and selective control of movement. Several performance and self report measures and interviews were used.
After intervention, improved balance was shown by the Berg Balance Scale (BBS) in both patients, and improved quality of gait was indicated by the Rivermead Visual Gait Assessment (RVGA). The patients also reported improved balance and gait function in the interviews and scored their condition as 'much improved'. Gait parameters, recorded by an electronic walkway, changed, but differently in the two patients. Among the physical performance tests the BBS and the RVGA demonstrated the highest change, while no or minimal change was demonstrated by the Rivermead Mobility Index (RMI) and Ratings of Perceived Exertion (RPE).
The findings indicate that balance and gait can be improved after physiotherapy based on the Bobath concept, but this should be further evaluated in larger controlled trials of patients with MS.
多发性硬化症（MS）患者往往存在运动困难，针对这组患者的物理治疗效果一直缺乏系统研究。在本研究中，对应用于存在平衡和步态问题的MS患者的基于Bobath概念的物理治疗进行了评估。评估了不同功能测试显示变化的能力。
采用具有ABAA阶段的单受试者实验研究设计，对两名处于稳定期的复发缓解型MS患者进行治疗。测试进行了12次，每个阶段3次：A（基线时）；B（治疗期间）；A（治疗后立即）；以及A（两个月后）。治疗的关键特征是促进姿势活动和选择性控制运动。使用了几种表现和自我报告测量方法以及访谈。
干预后，两名患者的伯格平衡量表（BBS）显示平衡得到改善，里弗米德视觉步态评估（RVGA）表明步态质量有所提高。患者在访谈中也报告平衡和步态功能有所改善，并将自己的状况评为“大有改善”。通过电子步道记录的步态参数发生了变化，但两名患者的变化情况不同。在身体表现测试中，BBS和RVGA显示变化最大，而里弗米德活动指数（RMI）和自觉用力程度分级（RPE）未显示变化或变化极小。
研究结果表明，基于Bobath概念的物理治疗后平衡和步态可以得到改善，但这应在更大规模的MS患者对照试验中进一步评估。
