A Novel Approach to Improve Mobility Measures By Using Multidirectional Reactive Stepping in Individual with Multiple Sclerosis- a Pilot Study

Background: Individuals with multiple sclerosis (MS) commonly experience mobility limitations that pose a serious challenge to achieve independent living. Rehabilitation approaches to improve mobility in individuals with MS are limited.

Objectives: To evaluate the feasibility of the supervised multidirectional reactive stepping training on improvement of mobility in individuals with MS 

Methods: Three individuals with relapsing-remitting MS (mean age 54.6±4 years; mean Expanded Disability Status Scale score 3±0.5) participated in training (30minutes/ session for 3days/week for 4weeks) focused on multidirectional visual cue based reactive stepping. Each session consisted of three10 minutes training sets with 2 min rest in-between. The subjects stood in a central position and were asked to step as quickly as possible into one of the 8 targets, following a randomly appearing visual cue. The eight targets were color marked on the floor with a distance of 18” in forward, right, left, forward-right, forward-left directions and 9” backward, backward-right and backward-left directions. The subjects were required to step with the preferred leg, followed by the other leg, and then returning to the central position as quickly as possible. Initially the visual cues setting was set at 2:4 (ON: OFF) ratio. During the ON period, the light signal (cue) was displayed in front of the subjects and during ‘OFF’ period, the light was off. The progression was made by decreasing the OFF period by 1 sec per week till the subjects can reach 2:2 (ON: OFF) ratio. The subjects were assessed before and after training using reaction time (sec), movement velocity (m/sec) and directional control (%), Tinetti performance oriented mobility assessment (POMA),  distance (cm) reached in  the forward reach test (FRT) and maximal step length (MSL), duration (cm) to complete four square step test (FSST), 10 meter walk  test, and five times sit to stand test.

Results: A significant improvement in POMA gait (p=.037) and balance (p=.031) scores, FSST (p=.027), FRT (.011), MSL (p=.033), five times sit to stand test (p=.042), 10 meter walk test (p=.014) and reaction time composite score (p=.037) were observed after training. No significant differences were found in movement velocity composite score (p=.094) and directional control score (p=.103)

Conclusions: The preliminary results suggest that training involving multidirectional reactive stepping could be beneficial to individuals with MS