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Looking at MS and balance in a new way: An interview with National MS Society Research Trainee Brett Fling, PhD

June 27, 2013

On July 1, 25 fellows begin research or clinical training fellowships with funding from the National MS Society. The Society funds a spectrum of fellowship programs that allow promising young researchers and clinicians to train with seasoned MS scientists and physicians, facilitating their transitions into independent careers. This training investment has leveraged at least $400 million over the years in MS grant funding from all sources, and launched the careers of some of the most prominent researchers making breakthroughs today.

One of the new fellows is Brett Fling, PhD, whose postdoctoral research fellowship focuses on studying MS and balance with Fay Horak, PhD, an internationally renowned expert in how the brain controls balance, at Oregon Health and Science University.

What can you tell us about balance problems in MS?
Dr. Fling:
A growing body of work suggests that balance impairments in people with early stage MS are primarily the result of deficits in “proprioception.” Proprioception is the ability to determine your body’s position in space in the absence of vision. Imagine closing your eyes and touching your finger to your nose -- this is using your proprioceptive system. Proprioceptive information from the ankles is the primary sensory feedback we use to maintain our balance. Because MS affects the ability of nerves to conduct information, it is likely that problems with transmitting proprioceptive information all the way from the ankles to the brain (and back again) play a big role in deficits in balance control.

What kind of interventions might be helpful to address deficits affecting balance and mobility in people with MS?
Dr. Fling:
It is an exciting time for intervention studies due to all of the advances in technology. Training the proprioceptive system is a novel approach to improving balance and we are attempting to make these interventions interactive and engaging. For example, video games utilizing the Nintendo WiiTM Balance Board allow people to train their proprioceptive system while they are (hopefully!) having a little fun. These balance games require people to shift their weight (right/left and forward/backward) to move their virtual representation on a television screen. In addition to these balance games people can also use the Wii FitTM yoga games to improve balance and train the proprioceptive system.

Please tell us about your personal connection to MS, and how this connection inspires your work.
Dr. Fling:
I have a vested, personal interest in this work because several friends as well as individuals within my own family are living with the debilitating effects of MS.  My mother was diagnosed with MS when I was a teenager and her sister was diagnosed just a few years later. Although both have MS, they have dramatically different symptoms and issues, which always fascinated me. This has been a driving force behind my research and keeps me active and engaged in this field.

Your work seems to span highly scientific areas of MS research like neuroscience andResearch - Restore button imaging, but the results have great clinical impact on balance and mobility – how do you plan to combine these in your long-term career goals?
Dr. Fling:
A variety of balance training interventions have been used in people with MS attempting to improve the 3 sensory systems--(proprioceptive, visual, and vestibular (inner ear)-- that we use to maintain balance. One of the frustrating issues with intervention studies is that some participants improve their balance, while others do not, suggesting that the same balance interventions do not work for everyone. Successful rehabilitation in people with MS requires clinicians to identify the explicit deficits in their patients so that intervention approaches can be specific and effective.  In my career as an MS researcher, I want to use neuroimaging (such as MRI) to identify the specific structural and functional neural deficits underlying symptoms such as balance impairment so that we can provide individualized information for rehabilitation.

Please tell us how the Society fellowships are suited to help you fulfill your career goals.
Dr. Fling:
This fellowship from the Society is an integral step towards achieving my overall research goal -- to better understand the neural bases of sensorimotor impairments in MS.  I believe there is an imperative need to develop rehabilitation approaches that are informed by this research.  It is my goal to establish a laboratory with parallel lines of basic and clinically applied rehabilitation research at a major research university. I am grateful to have the opportunity to implement this research.

Wii Fit and Wii are trademarks of Nintendo.

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system. Symptoms range from numbness and tingling to blindness and paralysis, and there is currently no cure for MS. 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. An estimated 1 million people live with MS in the United States. Most people with MS are diagnosed between the ages of 20 and 50, and it affects women three times more than men.


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