EFFECTIVENESS OF A SENSORIMOTOR INTEGRATION TRAINING ON BALANCE DISORDERS IN PATIENTS WITH MULTIPLE SCLEROSIS: A RANDOMIZED CONTROLLED TRIAL

Introduction. Balance disorders (BD) are one of the most frequent and disabling symptoms in Multiple Sclerosis (MS).1 They are reported in the 23% of patients as one of the initial symptoms of the disease and in the 82% of patients after longstanding illness.1 Thus, accidental falls incidence ranged from 48- 63%.1 Literature suggests that BD in MS may have multifactorial causes because different neural pathways throughout the CNS may be disrupted at the same time.2 However, neurophysiological studies highlighted that BD in MS are likely primarily the results of slowed somatosensory conduction and impaired central integration2, which is defined as the inability of the CNS to use the different sensory inputs in order to make up the system of coordinates on which the body’s postural control is based. Pharmacological approaches aimed at ameliorating BD in patients with neurological disease and in particular with MS are often lacking2, while the efficacy of sensory strategies rehabilitation on neurological diseases has been demonstrated.3 To our knowledge only few studies demonstrated the efficacy of a specific balance training in patients with MS. 2 The aim of this study is to compare the effects of a specific training, aimed at improving the ability to integrate sensory inputs during balance, with the effects of a conventional rehabilitation program in patients with Multiple Sclerosis (MS). Materials and methods. 80 outpatients with relapsing remitting MS (Age: 30-60 years; EDSS: 1.5-6.0) were randomly assigned to an experimental (EG=39) or control group (CG=41). The EG underwent to a training consisting of balance exercises performed under different sensory conflict conditions. The CG received physical exercises according to the clinical practice for MS. Both groups received 50-minute treatment sessions within a 5-week period (3/ week). Primary measures were the Berg Balance Scale (BBS) and the Activitiesspecific Balance Confidence Scale (ABC). Secondary measures were Multiple Sclerosis Quality of Life-54 (MSQOL-54 PHC and MSQOL-54 MHC), Fatigue Severity Scale (FSS), number of falls, postural transfer test, stabilometric assessment, Sensory Organization Balance Test (SOT) and gait analysis. Patients were assessed before, after treatment and 1-month after the end of treatment. Results. Compared with the CG, the EG training was more effective in the BBS (p=.001), ABC (p=.033), FSS (p=.026), most of the SOT conditions (p<.05), gait speed (p=.026), heel to hell base of support (p=.027) and double support time (p=.05). Effects in the BBS, ABC, FSS, SOT and gait speed were significant both after treatment and at follow-up, while in heel to heel base of support and double support time only at follow-up. Conclusions. Training aimed at increasing sensory integration under different sensory conflict conditions during balance may reduce balance impairments and improve mobility in patients with MS.