Effect of Dynamic Neuromuscular Stabilization on Balance,Trunk Function,Falling, and Spasticity in People With Multiple Sclerosis: A Randomized Controlled Trial |
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| Affiliation: | 1. From the Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran;2. Rehabilitation Research Center, Department of Basic Sciences in Rehabilitation, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran;1. From the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada;2. KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Canada;3. Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada;4. Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, Australia;5. Department of Medicine & Rehabilitation and Aged Services Program, Kingston Centre, Monash Health, Cheltenham, Australia;6. Epworth-Monash Rehabilitation Medicine Unit, Monash University, Richmond, Australia;7. Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Prahran, Australia;8. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada;9. Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada;10. Praxis Spinal Cord Institute, Vancouver, Canada;11. International Collaboration on Repair Discoveries, Vancouver, Canada;12. Department of Medicine, University of Toronto, Toronto, Canada;13. Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada;14. Division of Neurosurgery, Dalhousie University, Halifax, Canada;15. Division of Orthopaedic Surgery and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada;p. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada;q. Division of Neurosurgery, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Canada;r. Physical Medicine and Rehabilitation, The Ottawa Hospital, Ottawa, Canada;s. Division of Neurosurgery, University of Toronto, Toronto, Canada;t. St. Michael''s Hospital, Toronto, Canada;u. Division of Neurosurgery and Division of Genetics and Development, Krembil Neuroscience Centre, University Health Network, Toronto, Canada;v. Department of Surgery and Epidemiology & Biostatistics, Western University, London, Canada;w. Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada;1. Department of Physical Medicine and Rehabilitation, Sisli Etfal Hamidiye Research Hospital, Istanbul, Turkey;2. Department of Physical Medicine and Rehabilitation, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, Turkey;3. Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul, Turkey;1. From the Department of Physical Medicine and Rehabilitation, University of Pennsylvania—Perelman School of Medicine, Philadelphia, PA;2. Department of Psychiatry, University of Pennsylvania—Perelman School of Medicine, Philadelphia, PA;3. Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, WI;4. Institute for Health and Equity and Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, WI;1. School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan;2. Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan;3. Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan;4. Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA;5. Department of Neurology, Division of Movement Disorders, Keck School of Medicine, University of Southern California, Los Angeles, CA |
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| Abstract: | ObjectiveTo compare the effects of core stabilization (CS) and dynamic neuromuscular stabilization (DNS) on balance, trunk function, mobility, falling, and spasticity, in people with multiple sclerosis (PWMS).DesignTwo-group randomized controlled trial.SettingGeneral community and referral center.ParticipantsA total of 64 PWMS, between 30 and 50 years old, and an expanded disability status scale between 2 and 5, participated in this study (N=64).InterventionsParticipants were randomly assigned to CS (n=32) and DNS (n=32) groups. Both groups received a total of 15 sessions of CS or DNS exercises, 60 minutes per session, 3 times a week during the 5 weeks.Outcome MeasuresBalance function was measured as the primary outcome measure. Trunk function, postural stability, falling rate, fear of falling, falling index, mobility, and spasticity were measured as secondary outcomes.ResultsDNS group had significant improvement in Berg balance scale, trunk impairment scale, postural stability, activities-specific balance confidence, reduced falling rate, the timed Up and Go (TUG), multiple sclerosis walking scale-12, and multiple sclerosis spasticity scale in PWMS compared with the CS group, (P<.0001) after 5 weeks of intervention and 17 weeks of follow-up. Except for the modified Ashworth scale (MAS), significant improvements were seen in all outcome measures in both groups after 5 weeks of intervention.ConclusionThis is the first clinical evidence to support the importance of DNS exercise in improving balance, trunk function, and fall prevention in PWMS. This study provides clinical evidence that DNS may be more effective for PWMS than CS. |
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| Keywords: | Spasticity Falling Or Falls OrAccidental fall Trunk impairment |
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