Effect of Visually-Guided Gait Training on Balance, Mobility and Risk of Falling in Patients With Multiple Sclerosis

Balance and mobility impairments are the most common deficits in people with multiple sclerosis (MS), arising early in the disease course and gradually progressing over time, leading to loss of independence and quality of life. Moreover, static, and dynamic balance deficits in MS patients have been demonstrated to play a major role in patients' perception of walking ability during daily life and in predicting future falls. Given the strong impact of balance impairments on MS patients' disability.

Also, it was reported that the ability to coordinate visual information with movement is normally important to interact with the environment. Indeed, visually guided walking requires the brain to maintain an accurate relationship (or visuomotor mapping) between the perceived stepping location and the motor command necessary to direct the foot to that position on the ground with minimal error. Besides, previous research reported that people with MS, with neuronal transmission impairment or lesions on somatosensory ways, are more dependent on visual compensation for maintain balance. As lesions on somatosensory ways alter postural stability as this fundamental feedback is impaired, making a postural compensation and the visual feedback often more necessary to maintain balance.

To overcome these highly disabling issues, different rehabilitative approaches have been proposed so far in the literature. However, rehabilitation interventions in individuals with MS are limited to aerobic, resistance, and combined aerobic and resistance exercises and instrumental adapted exercise modalities including body-weight-supported treadmill walking or robotic technology. Few studies have addressed the effects of external sensory stimulations (visual, auditory) during gait training on motor performance in patients with multiple sclerosis.

So, visually-guided gait training could be beneficial for improvement of balance and mobility measures and decrease risk of falling for people with MS.

Inclusion criteria

• Clinically definite MS (relapsing and remitting) patients who are stable for at least three months.
• Expanded Disability Status Scale (EDSS) score of ≤ 4 (fully ambulatory, self-sufficient, and able to stand and walk without any aid or orthosis at least 500 meters) to minimize the impact of motor weakness interfering with their ability to perform the task.
• Normal or corrected to normal vision, wearing eyeglasses.
• The age will range from 20 - 45 years.
• All patients with MS were required to report subjective perceived imbalance or history of falls (in the last year)

Exclusion criteria

• Patients with any other neurological deficits or orthopedics abnormalities.
• Patients with secondary musculoskeletal complications such as fractures, contractures, or deformities.
• Patients with vision problems that impaired walking ability.
• Patients with severe cognitive impairment or psychological disorders impaired the ability to follow the procedures of the study.
• Patients with cardiovascular and respiratory diseases.
• Patients with serious unstable medical condition or Patients had an acute exacerbation of MS within last month.
• Pregnant women.