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Sensori-motor Integration Training in Multiple Sclerosis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01040117
Recruitment Status : Completed
First Posted : December 29, 2009
Last Update Posted : March 15, 2012
Information provided by (Responsible Party):
Nicola Smania, Universita di Verona

Brief Summary:
Balance impairment is a common and very disabling disturbance in people with Multiple Sclerosis. The efficacy of pharmacotherapy in treating balance impairment in MS is poorly documented in literature. Although literature dealing with the rehabilitation of balance impairment in MS is very scant, the preliminary data reports show very promising results. The present project could have a positive impact on balance and gait ability, disability, fear of falling, risk of falls and quality of life of patients with Multiple Sclerosis.

Condition or disease Intervention/treatment Phase
Relapsing-remitting Multiple Sclerosis Procedure: Sensory-motor Integration Training Procedure: Conventional neurorehabilitation treatment Early Phase 1

Detailed Description:

Balance impairment is one of the primary causes of disability in people with multiple sclerosis (MS). It increases the risk of falls and contributes to the development of fear of falling (FOF), a vicious cycle that leads to a limitation in daily life activities. The imbalance could be caused by motor and sensorial deficits as well as sensory-motor integration deficits. Despite the disability that balance disorders cause, literature about its' rehabilitation is very scant. To our knowledge two studies have been published on MS balance rehabilitation. The first paper described case reports on MS balance rehabilitation using the "Bobath" approach. The second paper performed a preliminary randomized controlled study describing the effectiveness in restoring balance control and reducing risk of falling using a specific training program aimed at improving sensory-motor integration in people with MS. Considering the several limitations of this study, further trials are warranted to assess the usefulness of specific sensory-motor training on balance impairment in people with MS. The aim of this randomised controlled double blinded clinical trial is to evaluate whether a training program consisting of exercises performed under different sensory conflict conditions can lead to an improvement in postural stability in patients with MS. This in turn might lead to an improvement in walking ability, autonomy in daily life activities and quality of life in people with MS.

The study will include 80 patients (age<65 years) with a diagnosis of MS relapsing remitted according to the McDonald criteria and with an Expanded Disability Status Scale score≤6.0. Patients will be divided into 2 groups, according to a randomization design. The experimental group will undergo a specific training program aimed at increasing balance ability in several sensory conflict conditions. The training program will consist of fifteen 50-minute sessions over a 5 week period (3 sessions/week). The control group will undergo conventional neurorehabilitation treatment following the same pattern of sessions as the study group. At recruitment, after treatment (5 weeks) and in the follow-up (1 month), each patient will be tested with the following clinical and instrumental procedures: Berg Balance Scale, Activities-specific Balance Confidence Scale, Fatigue Severity Scale, Postural Transfers evaluation, Multiple Sclerosis Quality Of Life (MSQOL)-54 instrument, Sensory Organization Test, GAITRite® System and platform stabilometry.

Data will be examined at first reassessment for between group differences. Data from the second reassessment will be analysed for within group differences. Sample characteristics will be summarised using descriptive statistics. Due to the small sample size, non-parametric tests will be applied: Wilcoxon's signed ranks test for within group comparisons and the Mann-withney U test for between group comparisons, both with significance set at p=0.05. Data will be analysed using SPSS v16 software.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 80 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Effects of Sensori-motor Integration Balance Training on Balance Disturbances in Patients With Multiple Sclerosis
Study Start Date : December 2009
Actual Primary Completion Date : October 2011
Actual Study Completion Date : January 2012

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Sensory-motor Integration Training Procedure: Sensory-motor Integration Training
Exercises will be divided into 3 levels. 1 Starting from the patient's most stable and comfortable standing position. 2 Patient will perform a single-step simulation, shifting his/her weight from one foot to the other in a frontal direction. 3 Patient will perform rapid movements, alternating feet in many directions, progressively increasing weight shifting and decreasing the support base amplitude. In the first five sessions exercises will be performed on a stable surface. During the remaining sessions patients will perform exercises on a compliant surface. During the two training periods the patient's visual condition will be progressively changed.

Active Comparator: Conventional neurorehabilitation Procedure: Conventional neurorehabilitation treatment

The treatment will be consist in active joint mobilization, muscle stretching and strengthen and motor coordination exercises. In the first part of each session the active joint mobilization will be carried out while the patient was lying on a carpet in supine, prone. The training will continue with muscle stretching and strengthen exercises performed while patient will be in supine, prone (when possible) and standing.

Motor coordination exercises will be carried out in supine position while sitting on a bench and in the standing position with a front support or with against a wall. The patient will be required to performed a total of 10 exercises with the following sequence: 6 exercises in supine position, 2 exercises in sitting position and 2 in standing position.

Primary Outcome Measures :
  1. Clinical assessment procedures: - Berg Balance Scale (BBS) - Activities-specific Balance Confidence Scale (ABC) Instrumental assessment procedures: - Stabilometric assessment [ Time Frame: At recruitment, after treatment (5 weeks) and in the follow-up (1 month) ]

Secondary Outcome Measures :
  1. Clinical evaluation - Walking evaluation - Multiple Sclerosis Quality Of Life-54 (MSQOL-54) - Fatigue Severity Scale (FSS) - Postural Transfers [ Time Frame: At recruitment, after treatment (5 weeks) and in the follow-up (1 month) ]

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age < 65 years
  • Expanded Disability Status Scale (EDSS) 2.0 > score < 6.0 (24)
  • Mini Mental State Evaluation (MMSE) score ≥ 24
  • Absence of cognitive impairment
  • Absence of heart problems
  • Self-reported sensation of postural instability
  • Ability to maintain standing position without aids for at least 1 minute
  • Ability to walk independently for at least 15 metres

Exclusion Criteria:

  • Disease recurrence that worsens significantly during the 3 months prior to recruitment
  • Pharmacological therapy not well defined
  • Presence of vestibular disorders and/or paroxysmal vertigo
  • Performance of any type of rehabilitation treatment in the month prior to recruitment
  • Presence of other concurrent neurological or orthopaedic diseases involving the lower limbs and/or interfering with standing position and/or walking.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01040117

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Section of Clinical Neurology, Department Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
Verona, Italy, 37124
S.S.O. di Riabilitazione dell'Ospedale Policlinico
Verona, Italy, 37126
Sponsors and Collaborators
Universita di Verona
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Study Chair: Antonio Fiaschi, Professor Department of Neurological and Visual Sciences, University of Verona, Italy
Additional Information:
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Nicola Smania, Prof. Smania Nicola, Universita di Verona Identifier: NCT01040117    
Other Study ID Numbers: FISM-2009
2009/R/27 ( Other Grant/Funding Number: Fondazione Italiana Sclerosi Multipla )
First Posted: December 29, 2009    Key Record Dates
Last Update Posted: March 15, 2012
Last Verified: March 2012
Keywords provided by Nicola Smania, Universita di Verona:
Randomized Controlled Trial
Postural instability
Sensory-motor integration
Additional relevant MeSH terms:
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Multiple Sclerosis
Multiple Sclerosis, Relapsing-Remitting
Pathologic Processes
Demyelinating Autoimmune Diseases, CNS
Autoimmune Diseases of the Nervous System
Nervous System Diseases
Demyelinating Diseases
Autoimmune Diseases
Immune System Diseases