Just published in the MS Journal, conducted by Dr Phu Hoang and his colleagues and funded by MS Research Australia, this study showed promising results with a stepping exercise directly targeting critical balance issues that contribute to falls risk for people with MS.
Dr Phu Hoang said, ‘This work is extremely exciting because it now shows it is possible to modify key physical and cognitive risk factors for falls in people with MS.’
Studies have shown that at least 50% of people with MS experience frequent falls1. And of those who fall, 50% sustain injuries that require medical care2. As a result, the fear of falling can cause people with MS to restrict their daily activities, with significant impacts on quality of life and general health.
MS Research Australia Chief Executive Officer, Dr Matthew Miles said, ‘The promising results from this innovative project are a result of combining Dr Hoang’s extensive experience working with people with MS with the NeuRA team’s unique expertise in falls prevention for the elderly.’
The research study utilised an electronic sensor mat placed on the floor and connected to a console and TV screen. The system was programmed to deliver two types of ‘games’ that involve following stepping cues presented on the TV screen, and requiring coordination and thinking skills. These games were performed for 30 minutes at least twice per week over a 12 week period. The study involved 50 participants with both relapsing remitting and progressive forms of MS with mild to moderate levels of disability and, ranging in age from 18 – 65 years.
The first task involved a rhythm video game that required participants to step as accurately as possible, both in terms of direction and timing. The second game involved responding as quickly as possible to step instructions. The mat was designed to measure reaction time, stepping speed and stepping accuracy, which were tracked over time to assess any improvements. The difficulty level of both games was increased as participants gained confidence and ability in the exercise. Individuals more severely affected by MS were also able to use a walker or cane for support.
Following a range of tests to measure balance, thinking skills and functional abilities, the participants were randomly assigned to either receive the stepping exercise training (23 people) or to receive no additional therapy (22 people). A physiotherapist ‘blinded’ to the individual’s assigned group conducted these tests before and after three months of training.
The tests showed the individuals who had received the training improved significantly in their performance on the game, showing faster and more accurate steps and increases in the difficulty level. They also showed improvements in real-world measures of balance, posture, and walking speed compared to the non-intervention group.
The significant improvements to reaction time, together with a very interesting improvement in upper limb dexterity, suggest that the stepping exercise also improves the thinking skills needed to reduce the risk of falling.
NeuRA’s Professor Stephen Lord, co-investigator said, ‘The fact that people with MS can also improve cognitively was a welcome result and consistent with recent studies in older people that suggest cognitive-motor training can produce better attention and faster central processing speed.’
Based on these promising preliminary results, the researchers will soon be rolling out a large-scale clinical trial, as part of Dr Hoang’s MS Research Australia Fellowship, to examine the full potential of this innovative program to reduce falls risk.
People with MS in the Sydney area who may be interested in this study can contact Dr Hoang at email@example.com or 02 9646 0686.
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1. Nilsagard Y, Gunn H, Freeman J, Hoang P, Lord S, Mazumder R, et al. Falls in people with MS-an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States. Mult Scler 2014;doi: 10.1177/1352458514538884.
2. Peterson EW, Cho CC, von Koch L, Finlayson ML. Injurious falls among middle aged and older adults with multiple sclerosis. Arch Phys Med Rehabil 2008; 89:1031-7