Objective: To evaluate the effects of balance retraining in a sample of people with multiple sclerosis. Design: Randomized controlled trial. Setting: Rehabilitation unit. Subjects: A consecutive sample of 44 subjects was randomized into two experimental groups and one control group. The inclusion criteria were: ability to stand independently more than 30 seconds, ability to walk for 6 m. Interventions: Group 1 received balance rehabilitation to improve motor and sensory strategies. Group 2 received balance rehabilitation to improve motor strategy. Group 3 received treatments not specifically aimed at improving balance. Main outcome measure: Berg Balance Scale, Dynamic Gait Index and fall frequency were used to assess balance impairments. Dizziness Handicap Inventory and Activities-specific Balance Confidence were used to assess handicap and the level of balance confidence. Results: Frequency of falls post treatment was statistically different among groups (P = 0.0001); The Berg Balance Scale showed an overall statistically significant difference (P = 0.0008) among groups. Change pre—post scores were 6.7, 4.6 and 0.8 points for groups 1, 2 and 3. Dynamic Gait Index showed an overall near statistically significant difference among groups (P = 0.14), with change pre—post scores of 3.85, 1.6 and 1.75 points for groups 1, 2 and 3; after the exclusion of drop-outs a statistically significant difference was observed (P = 0.04). The self-administered tests (Activities-specific Balance Confidence and Dizziness Handicap Inventory) did not show clinically relevant improvements. Conclusions: Balance rehabilitation appeared to be a useful tool in reducing the fall rate and improving balance skills in subjects with multiple sclerosis. Exercises in different sensory contexts may have an impact in improving dynamic balance.

Balance rehabilitation is an important component of the retraining program in people with multiple sclerosis (MS). Measuring balance is fundamental for an accurate assessment and therapy selection. The aim of this study was to compare interrater and test-retest reliability of the Berg Balance Scale, the Dynamic Gait Index, the Dizziness Handicap Inventory and the Activities-specific Balance Confidence. A group of 25 persons were enrolled in the study. The group consisted of 8 males and 17 females, mean age 41.7 years (12.5 years, SD). The onset of pathology was 8.7 years (8.8 years SD) before the beginning of the study. To assess the test-retest reliability two consecutive assessments were collected by the same rater. To assess the inter-rater reliability persons were concurrently assessed by two raters. The Intraclass Correlation Coefficients (ICCs) for interrater reliability ranged between 0.94 and 0.96. The ICCs for test-retest reliability ranged between 0.85 and 0.96. The inter-rater reliability of the instruments proved to be satisfactory. Lower but acceptable results were obtained for the test-retest paradigm. The data obtained in this study suggest that these scales are reliable tools for assessing balance function in persons suffering from MS.

Balance disorders and falls are frequently observed in subjects with multiple sclerosis (MS). Along with motor impairment, sensory disorders and integration deficits of sensory inputs lead to inadequate motor responses. The assessment of these sensory disorders in an every day tasks, such as upright stance, increases our knowledge of postural control in this pathology, thus promoting more effective treatments. The aim of the study was to describe sensory impairments and sensory strategies in different sensory conditions. A stabilometric assessment was carried out in a consecutive convenience sample of 53 subjects. The age of the sample was 52.7 (21.1) years; the onset of pathology was 27.20 (14.5) years before the assessment. Balance was assessed in six sensory conditions. The impact of pathology on balance control was shown by the high percentage of abnormal scores: 75% of subjects with MS showed abnormal scores even in the eyes open condition. The alteration of a single sensory input led to an increase of abnormal scores in up to 82% of subjects. Almost all subjects showed abnormal scores in the vestibular conditions where 22% of them fell. The pattern of the subjects’ performance in the six sensory conditions suggests that balance control may be more correlated to the number of reliable sensory inputs than the nature of the sensory input itself.

To determine whether there are demographic, clinical, and instrumental variables useful to detect fall status of patients with multiple sclerosis. PubMed and the Cochrane Library. Eligible studies were identified by two independent investigators. Only studies having a clear distinction between fallers and non-fallers were included and meta-analysed. Odds ratios (ORs) and standard mean differences (SMDs) were calculated and pooled using fixed effect models. Among 115 screened articles, 15 fulfilled criteria for meta-analyses, with a total of 2425 patients included. Proportion of fallers may vary from 30% to 63% in a time frame from 1 to 12 months. No significant publication bias was found, even though 12/15 studies relied on retrospective reports of falls, thus introducing recall biases. Risk factors for falls varied across studies, owing to heterogeneity of populations included and clinical instruments used. The meta-analytic approach found that, compared with non-fallers, fallers had longer disease duration (SMD = 0.14, p = 0.02), progressive course of disease (OR = 2.02, p < 0.0001), assistive device for walking (OR = 3.16, p < 0.0001), greater overall disability level (SMD = 0.74, p < 0.0001), slower walking speed (SMD = 0.45, p = 0.0005), and worse performances in balance tests (Berg Balance Scale: SMD = −0.48, p = 0.002; Timed up-and-go test, SMD = 0.31, p = 0.04), and force-platform measures (postural sway) with eyes opened (SMD = 0.71, p = 0.006) and closed (SMD = 0.83, p = 0.01), respectively. Elucidations regarding risk factors for accidental falls in patients with multiple sclerosis (PwMs) are provided here, with worse disability score, progressive course, use of walking aid, and poorer performances in static and dynamic balance tests strongly associated with fall status.