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Latest MS research update - Could computer games improve balance and reduce falls in MS? - 11 May 2015

Research update will be taking a break over the summer, so the MS Trust information team can focus on a couple of very exciting projects over the next few months. The research update will return again in September.

The MS Trust runs a weekly search for interesting and relevant research articles relating to multiple sclerosis using Medline, a specialised search engine for medical journals. The original abstracts to each of the articles can be accessed via the links provided.

For further information on any topic please contact the information team at info@mstrust.org.uk.


This week's highlighted research...

Could computer games improve balance and reduce falls in MS?

Research by topic areas...

Causes of MS
Co-existing conditions
Disease modifying treatments
Falls
Other
Paediatric MS
Physical activity
Prognosis
Psychological aspects
Quality of life
Rehabilitation
Self-management
Symptoms and symptom management
Vitamin D


Could computer games improve balance and reduce falls in MS?

Summary

Balance problems are common in MS. Lesions in the areas of the brain responsible for movement and balance or in the sense areas and systems can cause problems with balance, which can result in walking difficulties and sometimes falls.

Step training can be used to improve balance and interactive exercise videogames or "exergaming" can be used to provide step training at home. Previous research has used these step training games with older people and found they could improve stepping ability and balance, this study looked at if these games could also improve balance in people with MS.

50 people with both relapsing remitting and progressive forms of MS took part in the study. Participants were randomly allocated into one of two groups: intervention or control. Those participants in the intervention group had the step training system installed at home. The system consisted of two interactive videogames which used a floor mat containing pressure sensitive pads with direction arrows (front, back, left and right) connected to the television via a console. The two games were used to improve accuracy and speed of responses to instructions given on the television screen. Participants in the control group received no intervention but just continued with their usual level of physical activity.

Participants were assessed at the start and the end of the 12 week study and were followed up for a further six months. In the group that had used the step training system at home, the participants at the end of the study had better balance, walked faster and also had more accurate steps when tested, as well as reporting fewer falls than the control group.

The authors conclude that these are promising preliminary results, showing that the step training system could be a fun, effective and safe from of exercise for people with MS to use at home to improve their balance and reduce their risk of falls. They are planning further larger studies to confirm that this approach does reduce the number of falls in people with MS.


Background

Balance problems are common in MS. Lesions in the areas of the brain responsible for movement and balance or in the sense areas and systems can cause problems with balance, which can result in walking difficulties and sometimes falls.

Step training can be used to improve balance and interactive exercise videogames or "exergaming" can be used to provide step training at home, so someone doesn't need to travel to a clinic or gym to do the exercises. As well as being more convenient, these games can also help keep people motivated and continue with exercises, as they offer greater levels of enjoyment and also provide immediate feedback on how someone is performing.

Previous research has used these step training games with older people and found they could improve stepping ability and balance. This current study investigated whether a 12 week step training programme (compared to no step training) could improve balance, stepping and cognition in people with MS.


How this study was carried out

The study investigated a step training system. The system consisted of two interactive videogames which used a floor mat containing pressure sensitive pads with direction arrows (front, back, left and right) connected to the television via a console. The first game required participants to step as accurately as possible, both in terms of direction and timing, while synchronising their step responses to the instructions presented on the television screen. The second game involved responding as quickly as possible to the instructions. The participants could increase the difficulty of the game if they felt the current game level was not sufficiently challenging or reduce it again if they found it too difficult. The console recorded the timing of foot lift and landing on each pad. A full description of the system and pictures can be seen in the researchers' previous study investigating the use of the system by older people.

50 people with both relapsing remitting and progressive forms of MS took part in the study in Australia. All were aged between 18 and 65 years old and had an EDSS score of between two and six.

Participants were randomly allocated into one of two groups: intervention or control. Participants in the intervention group had the step training system installed at home and were instructed to use it for at least two 30 minutes training sessions every week for 12 weeks. Several participants used their walking frame or stick for safety to steady themselves while using the system. Participants in the control group received no intervention but just continued with their usual level of physical activity.

Participants were assessed at the start and the end of the study and were followed up for a further six months. Assessments included looking at participant's reaction times, accuracy, walking speed, cognitive function and balance. The participants were also asked to keep a falls diary to record how many falls they had. 44 participants completed the study, six had to withdraw because of a relapse, illness or family matters.


What was found

In the group that had used the step training system at home, the participants at the end of the study had faster and more accurate steps when tested. They also had better balance and walked faster. The researchers also found significant improvements to reaction time and in manual dexterity suggesting that the stepping exercises also improve the thinking skills needed to reduce the risk of falling. During the six month follow up period those participants who had done the step training reported fewer falls than those who had been in the control group.


What does it mean?

The authors conclude that these are promising preliminary results, showing that the step training system could be a fun, effective and safe from of exercise for people with MS to use at home to reduce their risk of falls. Further larger studies would be needed to confirm that this approach does reduce the number of falls and investigate the effect on thinking skills further, which the researchers are planning to do.


Hoang P, Schoene D, Gandevia S, et al.
Effects of a home-based step training programme on balance, stepping, cognition and functional performance in people with multiple sclerosis - a randomized controlled trial..
Mult Scler. 2015 Apr 28. pii: 1352458515579442.
abstract

More about balance

MS can affect balance in a number of ways, both directly and indirectly.

Balance problems can be caused by interruptions to the communication between the brain and the rest of the body. A lesion may mean messages coming to and from the brain from other parts of the body do not get through properly and so the brain cannot process the information correctly as it only has part of the picture. A good example of this is dizziness and vertigo. In MS, these symptoms are caused by damage to areas that coordinate perception and the response to visual and spatial information. The damage causes a breakdown in the coordination, which makes it difficult to remain upright, even when standing still and being supported.

Sensory problems may affect the way in which someone walks and therefore affect their balance. For example, numbness can mean an individual cannot tell how their feet are touching the ground, or pain may mean they walk more tentatively or try not to put too much weight through the painful leg, making them walk in an unstable and unbalanced way.

There are also a number of other MS symptoms which can worsen balance and increase the risk of falling. These include, weakness and numbness, muscle stiffness, spasticity and spasms, tremor, visual problems and fatigue.

Because there are a number of factors which can affect balance, it is important that balance problems are investigated thoroughly by a physiotherapist or other health professional. They can then suggest treatments to improve balance.

Balance problems can be managed to some extent by being aware of factors that make balance worse and being aware of potential factors that might increase the risk of a fall. These issues are discussed in the MS Trust's book Falls: managing the ups and downs of MS.

You can also view or download some balance exercises for people with MS, watch our balance and posture exercise videos online or order the free DVD.

Keep up to date

You can sign up to receive an email alert for the MS Trust research update. The email provides links to this page so that you can see the latest published research in MS. You can read our blog on how we choose research to include in this update.

You can also sign up for our News alerts which cover reports about MS on our news page and in the media.

Open Door, the MS Trust's free quarterly newsletter is available both by post and by email. It contains information on all the publications and support that the MS Trust provides, articles on a wide range of topics written by health professionals and people with MS as well as news about MS and recent research. Sign up for Open Door here or call us on 0800 032 38 39 or 01462 476700

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Causes of MS

Cortese M, Riise T, Bjørnevik K, et al.
Timing of use of cod liver oil, a vitamin D source, and multiple sclerosis risk: The EnvIMS study.
Mult Scler. 2015 May 6. [Epub ahead of print]
abstract

Read the full text of this paper

Gunnarsson M, Udumyan R, Bahmanyar S, et al.
Characteristics in childhood and adolescence associated with future multiple sclerosis risk in men: cohort study.
Eur J Neurol. 2015 Apr 27. [Epub ahead of print]
abstract

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Co-existing conditions

Mery V, Kimoff RJ, Suarez I, et al.
High false-positive rate of questionnaire-based restless legs syndrome diagnosis in multiple sclerosis.
Sleep Med. 2015 Mar 6. [Epub ahead of print]
abstract

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Disease modifying treatments

Shirani A, Zhao Y, Petkau J, et al.
Multiple sclerosis in older adults: the clinical profile and impact of interferon Beta treatment.
Biomed Res Int. 2015;2015:451912.
abstract

Read the full text of this paper

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Falls

Bisson EJ, Peterson EW, Finlayson M.
Delayed initial recovery and long lie following a fall among middle-aged and older adults with multiple sclerosis.
Arch Phys Med Rehabil. 2015 Apr 28. [Epub ahead of print]
abstract

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Other

Koffman J, Goddard C, Gao W, et al.
Exploring meanings of illness causation among those severely affected by multiple sclerosis: a comparative qualitative study of Black Caribbean and White British people.
BMC Palliat Care. 2015 Apr 19;14(1):13. [Epub ahead of print]
abstract

Read the full text of this paper (PDF)

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Paediatric MS

Lulu S, Graves J, Waubant E.
Menarche increases relapse risk in pediatric multiple sclerosis.
Mult Scler. 2015 May 6. [Epub ahead of print]
abstract

Voitenkov V, Skripchenko N, Klimkin A.
Visual pathways involvement in clinically isolated syndrome in children.
Int J Ophthalmol. 2015;8(2):382-4.
abstract

Read the full text of this paper

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Physical activity

Learmonth YC, Pilutti LA, Motl RW.
Generalised cognitive motor interference in multiple sclerosis.
Gait Posture. 2015 Apr 28. [Epub ahead of print]
abstract

Sola-Valls N, Blanco Y, Sepúlveda M, et al.
Walking function in clinical monitoring of multiple sclerosis by telemedicine.
J Neurol. 2015 May 10. [Epub ahead of print]
abstract

Sandroff BM, Benedict RH, Motl RW.
Non-significant associations between measures of inhibitory control and walking while thinking in persons with multiple sclerosis.
Arch Phys Med Rehabil. 2015 May 2. [Epub ahead of print]
abstract

Giesser BS.
Exercise in the management of persons with multiple sclerosis.
Ther Adv Neurol Disord. 2015 May;8(3):123-30.
abstract

Read the full text of this paper

Motl RW, Putzki N, Pilutti LA, et al.
Longitudinal changes in self-reported walking ability in multiple sclerosis.
PLoS One. 2015;10(5):e0125002.
abstract

Read the full text of this paper

Güner S, Hagharı S, Inanıcı F, et al.
Knee muscle strength in multiple sclerosis: relationship with gait characteristics.
J Phys Ther Sci. 2015 Mar;27(3):809-13.
abstract

Read the full text of this paper

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Prognosis

Manouchehrinia A, Tanasescu R, Tench CR, et al.
Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios.
J Neurol Neurosurg Psychiatry. 2015 May 2. [Epub ahead of print]
abstract

Damasceno A, Moraes AS, Farias A, et al.
Disruption of melatonin circadian rhythm production is related to multiple sclerosis severity: a preliminary study.
J Neurol Sci. 2015 Apr 7. [Epub ahead of print]
abstract

Maghzi AH, Graves J, Revirajan N, et al.
Retinal axonal loss in very early stages of multiple sclerosis.
Eur J Neurol. 2015 Apr 29. [Epub ahead of print]
abstract

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Psychological aspects

Martins Da Silva A, Cavaco S, Moreira I, et al.
Cognitive reserve in multiple sclerosis: protective effects of education.
Mult Scler. 2015 May 6. [Epub ahead of print]
abstract

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Quality of life

Taheri M, Negahban H, Mostafaee N, et al.
Responsiveness of selected outcome measures of participation restriction and quality of life in patients with multiple sclerosis.
Disabil Rehabil. 2015 May 8:1-5. [Epub ahead of print]
abstract

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Rehabilitation

Hanssen KT, Beiske AG, Landrø NI, et al.
Cognitive rehabilitation in multiple sclerosis: a randomized controlled trial.
Acta Neurol Scand. 2015 May 8. [Epub ahead of print]
abstract

Khan F, Amatya B, Kesselring J, et al.
Telerehabilitation for persons with multiple sclerosis Cochrane Review.
Eur J Phys Rehabil Med. 2015 May 6. [Epub ahead of print]
abstract

Read the full text of this paper

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Self-management

Plow MA, Finlayson M, Gunzler D, et al.
Correlates of participation in meaningful activities among people with multiple sclerosis.
J Rehabil Med. 2015 May 5. [Epub ahead of print]
abstract

Read the full text of this paper

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Symptoms and symptom management

Cameron AP, Rodriguez GM, Gursky A, et al.
The severity of bowel dysfunction in patients with neurogenic bladder.
J Urol. 2015 May 5. [Epub ahead of print]
abstract

van Kessel K, Wouldes T, Moss-Morris R.
A New Zealand pilot randomized controlled trial of a web-based interactive self-management programme (MSInvigor8) with and without email support for the treatment of multiple sclerosis fatigue.
Clin Rehabil. 2015 May 7. [Epub ahead of print]
abstract

Bastani F, Sobhani M, Emamzadeh Ghasemi HS.
Effect of acupressure on fatigue in women with multiple sclerosis.
Glob J Health Sci. 2015 Jan 26;7(4):42021.
abstract

Akkoç Y, Ersöz M, Yüceyar N, et al.
Overactive bladder symptoms in patients with multiple sclerosis: frequency, severity, diagnosis and treatment.
J Spinal Cord Med. 2015 May 3. [Epub ahead of print]
abstract

Cheung J, Rancourt A, Di Poce S, et al.
Patient-identified factors that influence spasticity in people with stroke and multiple sclerosis receiving botulinum toxin injection treatments.
Physiother Can. 2015 Spring;67(2):157-66.
abstract

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Vitamin D

Najafipoor A, Roghanian R, Zarkesh-Esfahani SH, et al.
The beneficial effects of vitamin D3 on reducing antibody titers against Epstein-Barr virus in multiple sclerosis patients.
Cell Immunol. 2015 Mar;294(1):9-12.
abstract