Visuo-proprioceptive training reduces risk of falls in patients with multiple sclerosis

Lack of balance and falls are common and disabling symptoms of multiple sclerosis. The aim of this study was to investigate the effectiveness of a novel visuo-proprioceptive feedback training in ameliorating balance and reducing the risk of falls. Patients with multiple sclerosis with unrestricted walking ability and healthy age/sex-matched controls were recruited. After a baseline clinical evaluation, including a postural assessment in double- (stabilometric test) and single-leg stance (monopodalic test) by a computerized postural recorder device, patients were submitted to a run-in period lasting 6 weeks without any rehabilitative intervention. Two further clinical and postural evaluations before and after a 6-week period of training were performed. The training protocol provided static and dynamic exercises both in double- and single-leg stance, with and without a translating Freeman-like board. Visual feedback was shown on the computer screen during the exercises. We recruited 40 consecutive patients and 12 controls. Patients had significantly poorer postural performances than controls. Twenty-eight patients completed the study follow-up. No significant changes in risk of falls emerged after the run-in period. A significant reduction in the median percentage of risk of falls in single-leg stance (open eyes: 39.3 versus 15.7; closed eyes: 67.3 versus 52.6; p < 0.001, respectively) were observed after rehabilitation. Moreover, an improvement in walking speed (median time: 7.4 s versus 6.3; p = 0.001) was detected in the absence of Expanded Disability Status Scale changes. We conclude that visuo-proprioceptive training improves balance and reduces falls in multiple sclerosis.