Reactive Balance Adaptability and Retention in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Suhaimy, Mohamed Suhair Bin Mohamed; Okubo, Yoshiro; Hoang, Phu; Lord, Stephen R.

doi:10.1177/1545968320929681

Cited by 13 publications

(7 citation statements)

References 48 publications

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“…To date, PBT has been studied primarily in healthy community-dwelling older adults. However, there is also emerging evidence for the effectiveness of PBT in ‘high risk' older adults (for example assisted living residents, or older adults with a history of falls or balance problems), and people with Parkinson's disease, stroke and multiple sclerosis ( 121 – 123 , 156 , 158 , 159 , 172 – 176 ). PBT trials have also been conducted in people with chronic obstructive pulmonary disorder ( 152 ) and incomplete spinal cord injury ( 165 ), but due to limited findings will not be discussed in detail in this article.…”

Section: Implementation In Practicementioning

confidence: 99%

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice

McCrum

Bhatt

Gerards

et al. 2022

Front. Sports Act. Living

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Since the mid-2000s, perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults. It has been suggested that this task-specific training approach may present a paradigm shift in fall prevention. In this review, we discuss key concepts and common issues and questions regarding perturbation-based balance training. In doing so, we aim to provide a comprehensive synthesis of the current evidence on the mechanisms, feasibility and efficacy of perturbation-based balance training for researchers and practitioners. We address this in two sections: “Principles and Mechanisms” and “Implementation in Practice.” In the first section, definitions, task-specificity, adaptation and retention mechanisms and the dose-response relationship are discussed. In the second section, issues related to safety, anxiety, evidence in clinical populations (e.g., Parkinson's disease, stroke), technology and training devices are discussed. Perturbation-based balance training is a promising approach to fall prevention. However, several fundamental and applied aspects of the approach need to be further investigated before it can be widely implemented in clinical practice.

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Section: Implementation In Practicementioning

confidence: 99%

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice

McCrum

Bhatt

Gerards

et al. 2022

Front. Sports Act. Living

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“…A recent meta-analysis has shown that pwMS have worse reactive balance compared to healthy controls across a range of measures (eg, shorter reactive step, more recovery steps needed), which might be caused by a considerably longer response time to initiate balance recovery. 43 Critically, the meta-analysis also indicated that adaptability of reactive balance is still intact in pwMS, mainly via improved “feedforward” mechanisms (ie, using prior knowledge to predict and fine tune motor commands).…”

Section: Solutionmentioning

confidence: 99%

“…Regarding fall prevention, agility seems to be critical, as situations predisposing a fall never occur pre-planned. In this context “perception-action coupling,” (ie, feedback mechanisms 43 ) might be as important to evade a fall, as it is to evade a defender in football. It has been shown that kinematic and kinetic variables differ when comparing planned versus unplanned side-stepping, suggesting different motor control strategies when reacting to a stimulus.…”

Section: Solutionmentioning

confidence: 99%

“…Component III specifically includes fast locomotion, including fast gait, and running, if possible. Tasks here also involve the highest amount of reactive balance with demands for feedback control mechanisms (ie, exposure to perturbations that remain highly unpredictable), 43 such as in passing and stopping a soccer ball with a moving partner. Further, the Modules also provide the highest cardiovascular challenge with an interval training-like stimulus, which can be regulated via the duration of a drill.…”

Section: Solutionmentioning

confidence: 99%

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Multimodal Agility-Based Exercise Training for Persons With Multiple Sclerosis: A New Framework

Wolf

Eschweiler

Rademacher³

et al. 2022

Neurorehabil Neural Repair

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Introduction Multimodal agility-based exercise training (MAT) has been described as a framework for fall prevention in the elderly but might also be a valuable concept for exercise training in persons with Multiple Sclerosis (pwMS). The Problem Current recommendations advise pwMS to perform a multitude of different exercise training activities, as each of these has its separate evidence. However, pwMS struggle even more than the general population to be physically active. Additionally, Multiple Sclerosis often leads to co-occurring mobility and cognitive dysfunctions, for which simultaneous, time-efficient, and engaging training approaches are still limited in clinical practice and healthcare. The solution The MAT framework has been developed to integratively improve cardiovascular, neuromuscular, and cognitive function by combining aspects of perception and orientation, change of direction, as well as stop-and-go patterns (ie, agility), in a group-training format. For pwMS, the MAT framework is conceptualized to include 3 Components: standing balance, dynamic balance (including functional leg strength), and agility-based exercises. Within these Components sensory, cognitive, and cardiovascular challenges can be adapted to individual needs. Recommendations We recommend investigating multimodal exercise interventions that go beyond easily standardized, unimodal types of exercise (eg, aerobic or resistance exercise), which could allow for time-efficient training, targeting multiple frequent symptoms of persons with mild disability at once. MAT should be compared to unimodal approaches, regarding sensor-based gait outcomes, fatigue-related outcomes, cognition, as well as neuroprotective, and (supportive) disease-modifying effects.

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“…Delayed and inappropriate generation of corrective forces from the postural muscles may result in falling and injuries [ 3 ]. Reactive balance control is supported by visual, vestibular, or somatosensory feedback, and it can be improved by repeated exposure to perturbations not only in healthy young and older adults, but individuals with neurological diseases, such as multiple sclerosis [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Catching and throwing exercises to improve reactive balance: A randomized controlled trial protocol for the comparison of aquatic and dry-land exercise environments

et al. 2022

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Reactive balance, a critical automatic movement pattern in response to a perturbation, is directly linked to fall prevention in older adults. Various exercise interventions have been broadly performed to improve reactive balance and thus prevent falls. Curiously, aquatic exercises have been suggested as an effective balance intervention and a safer alternative to exercises on dry land yet the efficacy of aquatic exercises on reactive balance has not been formally investigated. The present clinical trial aims to identify if skills acquired during aquatic exercise are more effectively transferred to a reactive balance task than land exercise. This study is designed as a double-blinded, randomized controlled clinical trial. Forty-four older adults aged 65 years or above who meet the eligibility criteria will be recruited and randomized into an aquatic exercise group or land exercise group. Each group will participate in the same single bout intervention that includes a ball throwing and catching task. A modified lean-and-release test will be implemented on land immediately before, after, and one week after the single bout intervention. The outcomes will include reaction time, rapid response accuracy, and mini-BESTest scores obtained from stepping and grasping reactions. All statistical analyses will be conducted using an intention-to-treat approach. Our conceptual hypothesis is that participants in the aquatic exercise group will demonstrate more improved outcome scores in the lean-and-release test when compared to those in the land exercise group. The results of the present study are expected to provide evidence to support the benefits of aquatic exercises for improving reactive balance in older adults. Further, participants may find aquatic exercises safer and more motivating, thus encouraging them to participate in further aquatic exercise programs.

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Reactive Balance Adaptability and Retention in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Cited by 13 publications

References 48 publications

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice

Multimodal Agility-Based Exercise Training for Persons With Multiple Sclerosis: A New Framework

Catching and throwing exercises to improve reactive balance: A randomized controlled trial protocol for the comparison of aquatic and dry-land exercise environments

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