Multiple Sclerosis Centre, S. Andrea Hospital, University La Sapienza, Rome, Italy.
Mult Scler. 2010 Apr;16(4):491-9. doi: 10.1177/1352458509359923. Epub 2010 Feb 11.
Lack of balance and falls are common and disabling symptoms of multiple sclerosis. The aim of this study was to investigate the effectiveness of a novel visuo-proprioceptive feedback training in ameliorating balance and reducing the risk of falls. Patients with multiple sclerosis with unrestricted walking ability and healthy age/sex-matched controls were recruited. After a baseline clinical evaluation, including a postural assessment in double- (stabilometric test) and single-leg stance (monopodalic test) by a computerized postural recorder device, patients were submitted to a run-in period lasting 6 weeks without any rehabilitative intervention. Two further clinical and postural evaluations before and after a 6-week period of training were performed. The training protocol provided static and dynamic exercises both in double- and single-leg stance, with and without a translating Freeman-like board. Visual feedback was shown on the computer screen during the exercises. We recruited 40 consecutive patients and 12 controls. Patients had significantly poorer postural performances than controls. Twenty-eight patients completed the study follow-up. No significant changes in risk of falls emerged after the run-in period. A significant reduction in the median percentage of risk of falls in single-leg stance (open eyes: 39.3 versus 15.7; closed eyes: 67.3 versus 52.6; p < 0.001, respectively) were observed after rehabilitation. Moreover, an improvement in walking speed (median time: 7.4 s versus 6.3; p = 0.001) was detected in the absence of Expanded Disability Status Scale changes. We conclude that visuo-proprioceptive training improves balance and reduces falls in multiple sclerosis.
平衡和跌倒问题在多发性硬化症患者中较为常见，且会导致其身体残疾。本研究旨在探究一种新型视本体感觉反馈训练在改善平衡和降低跌倒风险方面的有效性。研究招募了具有无障碍行走能力的多发性硬化症患者和健康的年龄/性别匹配对照者。在基线临床评估中，使用计算机姿势记录器设备进行双足（平衡测试）和单腿（单足测试）姿势评估，然后让患者在 6 周内不进行任何康复干预。在 6 周的训练期前后进行了另外 2 次临床和姿势评估。训练方案提供了双足和单足站立的静态和动态练习，包括使用和不使用平移式 Freeman 板。在练习过程中，视觉反馈显示在计算机屏幕上。我们招募了 40 名连续患者和 12 名对照者。患者的姿势表现明显比对照者差。28 名患者完成了研究随访。在无干预的适应期后，跌倒风险没有明显变化。康复后，单腿站立睁眼时（39.3%对 15.7%；p<0.001）和闭眼时（67.3%对 52.6%；p<0.001）的跌倒风险中位数百分比显著降低。此外，在不改变扩展残疾状况量表评分的情况下，患者的步行速度（中位数时间：7.4 秒对 6.3 秒；p=0.001）得到了改善。我们的结论是，视本体感觉训练可以改善多发性硬化症患者的平衡并降低跌倒风险。
