Graduate Teaching Assistant, South Dakota State University
Multiple Sclerosis (MS) is a chronic neurodegenerative disease that currently affects over 2.3 million people worldwide. Common symptoms include postural imbalance, postural asymmetry, and muscular weakness. The purpose of this study is to determine if a 10-week exercise training program combining balance, flexibility, and PRT will improve balance in PwMS. We hypothesized that the intervention would reduce sway velocities, ranges, and loading asymmetry (LA) during sit-to-stand movements and a hand-washing simulation (HW). Subjects: Twelve participants (54±8 yrs; 1.68±0.1m; 80.5±22.2kg; EDSS 4.3±1.9) diagnosed with relapsing-remitting MS participated in this study. Participants experiencing a flare-up or change in medication within the last 3 months, receiving steroid injections within the past 60 days, or having other musculoskeletal or neurological conditions were excluded from this study. Postural and strength data were collected pre- and post-intervention. Intervention: Participants completed 10-weeks of supervised exercise training that included PRT, static stretching, and balance training. Sessions occurred twice/week, began with a 5-minute warm-up, followed by light static stretching, balance training, and PRT. Static stretches were held for 2-sets of 30s on all major muscle groups. Balance training involved resisting perturbations to an outstretched fitness ball while standing on a foam pad. Two sets of 10-repetitions were completed for all PRT exercises targeting all major muscle groups. Resistance was increased once participants successfully completed all repetitions for a particular exercise over 2 sessions. Results: Significant changes were seen in isokinetic strength measures for both dominant and non-dominant legs. For postural measures, LA during HW decreased significantly, but no other changes were observed. The principle of specificity may help explain why improvements were only seen in the HW task as our balance training most closely resembled the HW task. It is also important to note that LA values were higher for HW compared to STS. This may be due to the dual-task nature of HW. As our sample size is small, future studies with larger sample sizes are needed to confirm our findings. Future interventions may also want to incorporate greater exercise variety. Current recommendations often include video game based programs, dual-task training, or the use of supplementary tactile feedback.
Abstract: Strength training is an aspect of gait rehabilitation, which complements balance control and weight-bearing training. However, conventional strength training does not show positive gait outcomes, due to lack of task specificity. Therefore, the aims of this study were to investigate the effects of a resistance force applied at the center of mass (CoM) and to investigate whether this exercise can be used for effective task-specific gait training. Using a novel robotic walker, a consistent resistive force was applied to the CoM of subjects in the posterior direction. Eleven healthy subjects were instructed to walk under five walking conditions with increasing forces, based on each subject's body weight (BW), at 0, 2.5, 5, 7.5, and 10% BW. Joint kinematics and mean amplitude and frequency of electromyography signals from nine major muscles were measured. The application of resistance resulted in significantly increased flexion angles at ankle, knee, and hip joints. A large amount of motor unit activation with lower firing rates was found at knee and hip joints, indicating that this type of resistance training can improve muscular strength and endurance in a task-specific manner. The long-term effects of the resistance training on neurologically challenged patients will be investigated in the future.
Pub.: 23 Mar '17, Pinned: 04 Jul '17
Abstract: This study examined the effectivenss of a balance-focused training program (i.e., Exercise for Balance Improvement Program, ExBP) in improving functional fitness of older nonfallers at risk of falling. Sixty-one participants were randomly assigned to receive 16 weeks of ExBP or Tai Chi (TC) training, or no treatment (CON) with an 8-week follow-up. The Senior Fitness Test battery was applied to assess functional fitness. After the intervention, results revealed significant improvements in all fitness components in the ExBP group. Compared with the CON group, the ExBP group demonstrated more improvements in lower extremity muscle strength, agility and balance, and aerobic endurance. The ExBP group also displayed more improvements in aerobic endurance than the TC group in posttest and follow-up test. Therefore, the balance-focused exercise can be applied as an effective way in improving overall functional fitness among older nonfallers who are at risk of falling.
Pub.: 01 Apr '17, Pinned: 04 Jul '17
Abstract: Individuals with multiple sclerosis (MS) report fatigue, pain, depression, cognitive difficulties, and other symptoms. It is often difficult to compare symptoms across studies and populations because scales used to measure individual symptoms or quality of life indicators (QOLI) use different metrics and often do not provide norms. PROMIS and Neuro-QOL measures, developed with modern psychometric methods, use a common metric and provide population norms.
Pub.: 21 Apr '17, Pinned: 04 Jul '17
Abstract: We undertook a qualitative study that explored the needs of healthcare providers for promoting exercise behaviour among persons with mild or moderate multiple sclerosis (MS).We used interpretive description methodology, and conducted semi-structured interviews with Neurologists (n = 13), occupational therapists (n = 10), physical therapists (n = 11), and nurses (n = 10). The interviews were analysed using thematic analysis.We identified three themes with multiple subthemes regarding exercise promotion by healthcare providers. The first theme was "opportunities for exercise promotion" through the healthcare system, healthcare team, and clinical appointment. The second theme was "healthcare provider education" that included professional training, training among healthcare providers, and clear and defined exercise promotion protocols. The third theme was "patient tools/strategies" that should be delivered among persons with MS as part of the exercise prescription.Providers in MS healthcare consider the patient-provider interaction within the healthcare system, healthcare team, and clinical appointment as a novel opportunity for exercise promotion. Such an opportunity requires education of healthcare providers and provision of tools and strategies for exercise promotion among persons with MS. Implications for rehabilitation Healthcare providers are interested in and motivated for promoting exercise participation among persons with multiple sclerosis. Successful exercise promotion must consider opportunities at three different organisational levels, namely the healthcare system, the local healthcare team, and clinical appointment. Healthcare providers need further training for promoting exercise among persons with multiple sclerosis. The promotion of exercise among persons with multiple sclerosis will require resources and strategies that can be readily offered by providers.
Pub.: 20 May '17, Pinned: 04 Jul '17
Abstract: There is increasing recognition of the benefits of exercise in individuals with multiple sclerosis (MS), yet the MS population does not engage in sufficient amounts of exercise to accrue health benefits. There has been little qualitative inquiry to establish the preferred format and source for receiving exercise information from health-care providers among persons with MS.We sought to identify the desired and preferred format and source of exercise information for persons with MS that can be delivered through health-care providers.Participants were adults with MS who had mild or moderate disability and participated in a range of exercise levels. All participants lived in the Midwest of the United States.Fifty semi-structured interviews were conducted and analysed using thematic analysis.Two themes emerged, (i) approach for receiving exercise promotion and (ii) ideal person for promoting exercise. Persons with MS want to receive exercise information through in-person consultations with health-care providers, print media and electronic media. Persons with MS want to receive exercise promotion from health-care providers with expertise in MS (ie neurologists) and with expertise in exercise (eg physical therapists).These data support the importance of understanding how to provide exercise information to persons with MS and identifying that health-care providers including neurologists and physical therapists should be involved in exercise promotion.
Pub.: 18 May '17, Pinned: 04 Jul '17
Abstract: The relationship between postural instability and subcortical structure in AD has received less attention. The aims of this study were to assess whether there are differences in the ability to control balance between Alzheimer's disease (AD) and controls, and to investigate the association between subcortical gray matter volumes and postural instability in AD.We enrolled 107 consecutive AD patients and 37 controls. All participants underwent detailed neuropsychological evaluations, T1-weighted MRI at 3 T, and posture assessment using computerized dynamic posturography. We segmented the volumes of 6 subcortical structures of the amygdala, thalamus, caudate nucleus, putamen, globus pallidus and nucleus accumbens, and of hippocampus, using the FMRIBs integrated registration and segmentation tool.All subcortical structures, except for the globus pallidus, were smaller in AD compared with controls on adjusting for age and gender. Falling frequencies in unilateral stance test (UST) and composite scores in sensory organization test (SOT) were worse in AD than in controls. The motor control test did not reveal any differences between groups. On subgroup analyses in AD, the groups with poor performance in UST or SOT exhibited significantly reduced nucleus accumbens and putamen volumes, and nucleus accumbens volume, respectively. The smaller volume of the nucleus accumbens was associated with postural instability in AD (OR [95% CI] 17.847 [2.59-122.80] for UST, 42.827[6.06-302.47] for SOT, all P < .05).AD patients exhibited reduced ability to control balance compared with controls, and this postural instability was associated with nucleus accumbens volume loss. Furthermore, cognitive dysfunction was more prominent in the group with severe postural instability.
Pub.: 24 Jun '17, Pinned: 04 Jul '17