Kalron Alon, Fonkatz Ilia, Frid Lior, Baransi Hani, Achiron Anat
Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
The Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel.
J Neuroeng Rehabil. 2016 Mar 1;13:13. doi: 10.1186/s12984-016-0124-y.
Multiple sclerosis (MS) is a multi-focal progressive disorder of the central nervous system often resulting in diverse clinical manifestations. Imbalance appears in most people with multiple sclerosis (PwMS). A popular balance training tool is virtual reality (VR) with several advantages including increased compliance and user satisfaction. Therefore, the aim of this pilot RCT (Trial registration number, date: ISRCTN14425615, 21/01/2016) was to examine the efficacy of a 6-week VR balance training program using the computer assisted rehabilitation environment (CAREN) system (Motek Medical BV, Amsterdam, Netherlands) on balance measures in PwMS. Results were compared with those of a conventional balance exercise group. Secondary aims included the impact of this program on the fear of falling.
Thirty-two PwMS were equally randomized into the VR intervention group or the control group. Each group received balance training sessions for 6 consecutive weeks, two sessions per week, 30 min sessions. Clinical balance tests and instrumented posturography outcome measures were collected upon initiation of the intervention programs and at termination.
Final analysis included 30 patients (19 females, 11 males; mean age, (S.D.) = 45.2 (11.6) years; mean EDSS (S.D.) = 4.1 (1.3), mean disease duration (S.D.) = 11.0 (8.9) years). Both groups showed a main effect of time on the center of pressure (CoP) path length with eyes open (F = 5.278, P = .024), sway rate with eyes open (F = 5.852, P = .035), Functional Reach Test (F = 20.841, P = .001), Four Square Step Test (F = 9.011, P = .031) and the Fear of Falls self-reported questionnaire (F = 17.815, P = .023). In addition, significant differences in favor of the VR program were observed for the group x time interactions of the Functional Reach Test (F = 10.173, P = .009) and fear of falling (F = 6.710, P = .021).
We demonstrated that balance training based on the CAREN device is an effective method of balance training for PwMS.
多发性硬化症（MS）是一种中枢神经系统的多灶性进行性疾病，常导致多种临床表现。大多数多发性硬化症患者（PwMS）存在平衡失调。一种流行的平衡训练工具是虚拟现实（VR），它具有多种优势，包括更高的依从性和用户满意度。因此，这项初步随机对照试验（试验注册号，日期：ISRCTN14425615，2016年1月21日）的目的是研究使用计算机辅助康复环境（CAREN）系统（Motek Medical BV，荷兰阿姆斯特丹）进行为期6周的VR平衡训练计划对PwMS平衡指标的疗效。将结果与传统平衡运动组的结果进行比较。次要目标包括该计划对跌倒恐惧的影响。
32名PwMS被随机分为VR干预组或对照组。每组连续6周接受平衡训练课程，每周两次，每次30分钟。在干预计划开始时和结束时收集临床平衡测试和仪器化姿势描记术结果指标。
最终分析纳入30名患者（19名女性，11名男性；平均年龄，（标准差）=45.2（11.6）岁；平均扩展残疾状态量表（EDSS）（标准差）=4.1（1.3），平均病程（标准差）=11.0（8.9）年）。两组在睁眼时压力中心（CoP）路径长度（F=5.278，P=0.024）、睁眼时摆动率（F=5.852，P=0.035）、功能性伸展测试（F=20.841，P=0.001）、四方步测试（F=9.011，P=0.031）以及跌倒恐惧自我报告问卷（F=17.815，P=0.023）方面均显示出时间的主效应。此外，在功能性伸展测试（F=10.173，P=0.009）和跌倒恐惧（F=6.710，P=0.021）的组×时间交互作用方面，观察到有利于VR计划的显著差异。
我们证明基于CAREN设备的平衡训练是一种对PwMS有效的平衡训练方法。
