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Conference Explores Walking Difficulties and Rehabilitation Strategies in People with MS

January 31, 2018

SUMMARY
  • Nearly 100 clinicians, researchers, engineers and others from around the world gathered in Portland, Oregon in September for the 7th International Symposium on Gait and Balance in MS. People living with MS also attended an interactive session on rehabilitation strategies.
  • The purpose of the meeting was to share current knowledge about gait difficulties and rehabilitation. Healthcare professionals working in MS as well as scientists studying MS discussed how to improve the effectiveness of rehabilitation approaches relating to gait and how to improve motor function in people with MS.
  • Research teams presenting included researchers supported by the National MS Society.
  • The presentations summaries (abstracts) from the meeting are published online in the International Journal of MS Care (2017;19(6):329-330).
 
DETAILS
Background: Difficulty in walking — also known as problems with gait —  is among the most common mobility issues for people with MS.  Walking difficulties are related to several factors, including balance, spasticity, fatigue and weakness. Gait problems can also put individuals at significant risk for falls and the potentially life-changing consequences of fall-related injuries. Research that uncovers strategies to address gait and balance problems is important to improve quality of life for people with MS.
 
The Meeting: Nearly 100 clinicians, researchers, engineers and others from around the world gathered in Portland, Oregon in September for the 7th International Symposium on Gait and Balance in MS. This annual conference is convened by the Oregon Health & Science University MS Center and the MS Center of Excellence West at the VA Portland Health Care System.
 
The purpose of the meeting was to share current knowledge about gait difficulties and rehabilitation. Healthcare professionals working in MS as well as scientists studying MS discussed how to improve the effectiveness of rehabilitation approaches relating to gait and how to improve motor function in people with MS. Research teams presenting included researchers supported by the National MS Society. For the first time, the meeting included an interactive session attended by 50 people with MS focusing on rehabilitation strategies.
 
Here are a few highlights:
  • Geetanjali Gera, PhD, PT (Oregon Health & Science University) and colleagues investigated highly specific mechanisms that affect gait. They found that “postural response” – or how quickly people correct themselves after experiencing a disturbance in walking – was flawed in 16 people with MS. These flaws were related to delayed nerve impulse conduction and myelin damage in an area of the brain responsible for coordination, the cerebellum. The team suggests that rehabilitation strategies be geared toward improving the timing of postural responses to reduce a person’s risk of falling.
  • Valerie Block, PT (University of California San Francisco) and colleagues sought to collect “real world” information about physical function in people with MS, unlike data obtained from standard clinical scales. They gave wrist-worn accelerometers to 100 people with MS. Eighty of these completed one year, with the daily step count decreasing 10.7% overall. Even in people whose clinical scores remained stable, the step count increased by as much as 814, or decreased by as much as 3,718, indicating significant changes in physical activity that were not captured by standard scales.
  • Jessica Gadayan (University of California, San Francisco) and colleagues looked at differences in balance between 64 people with MS and 42 people with Parkinson’s disease. People with MS tended to lose their balance more often and in all directions (e.g., forward, or to the left) compared to people with Parkinson’s disease. In both groups, people lost their balance to the right or left more than forward or backward. These differences/similarities provide important information for developing strategies that meet each individual’s needs for maintaining balance and preventing falls.
  • Afolasade Fakolade, PhD (Queen’s University, Kingston, Ontario) and colleagues used focus groups, wearable accelerometers, and a survey to determine the needs and priorities related to physical activity among people with MS, who participated along with their carepartners. The findings showed that people with MS and carepartners spent 74% of their day engaged in sedentary (non-active) behavior. Both groups reported that, in considering a physical activity program, it was a top priority that the program involve joint participation of people with MS and family members. The team is using this study as the first step to designing a physical activity intervention that addresses the priorities of both people with MS and their carepartners.
  • Bryan D. Loy, PhD (Oregon Health & Science University) and colleagues looked at how diet affects gait in 38 women with MS. They found that increases in the number of calories per kilogram of body weight per day were significantly associated with faster gait speed, longer stride length, and less time using double supports. There was no relation between gait and specific nutrients such as proteins, carbohydrates or fat. This study indicates the importance of making sure diet enables you to live your best life.
Next Steps: Identifying rehabilitation strategies to improve gait and balance in MS is critical to identifying solutions for people living with MS. The National MS Society is funding such efforts, including a trial to test a rehabilitation strategy that addresses walking and thinking issues, as well as a trial testing an electromechanically-assisted gait training system in people with progressive MS.
 
Read More:
Read more about walking difficulties in MS
 

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.

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