The presence of several concurrent disabilities, some significantly associated with high perceived physical and psychological impact, in the majority of PwMS in outpatient clinics highlights the importance to identify disabilities, in particular fatigue and depressed mood, in order to supply health care interventions aiming to improve the life situation of PwMS.

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The BDL Balance Scale can be considered a valid clinical assessment test when evaluating balance training interventions in persons with early PD. It can be recommended as an outcome measure in clinical practice and in clinical research within this population.

This thesis was written for all those who have once lost their foothold in life (as when getting diagnosed with a severe disease), and whose only hope is to keep on fighting.2 ABSTRACT BACKGROUND People with Parkinson's Disease (PD) experience increasing activity limitations in walking, carrying objects, turning around, and dressing. Subtle and often unconscious balance decline may have occurred already at an early stage, even when first diagnosed. At present, no medical treatment can ease the progressive balance impairment. Instead, physical training has become a means to remain physically active and mobile for as long as possible.AIM The overall aim of this thesis was to evaluate if our hypotheses, the training approach of 'Somatosensory Focused Balance Training without Cues', can be effective in supporting people with PD at an early stage (early PD) to maintain their balance ability, so that they can remain physically active, move and walk independently, for as long as possible.METHODS At first, the BDL Balance Scale, a clinical balance assessment, was validated for use in people with early PD. Thereafter, to investigate the effect of 'Somatosensory Focused Balance Training without Cues', people with early PD (n=28) were randomised into two training groups and tested by a blinded assessor before and after the intervention. The training was evaluated with clinical outcomes, laboratory movement outcomes and the result was compared to healthy age-matched controls (n=18). Furthermore, to acquire knowledge of how people with early PD perceived the intervention, an interview study using content analysis was performed. RESULTSThe BDL Balance Scale was found to be valid for use in early PD. It correlated to similar scales and could detect a difference between early PD and healthy controls. The training approach improved balance in the studies population, measured with clinical and movement laboratory outcomes, as well as by participant perceptions. The interviews provided important information on how the group contributed to greater motivation for training and offered a platform for making new friends. CONCLUSION The 'Somatosensory Focused Balance Training without Cues' improves balance in early PD. Notably, the training context is particularly important considering that it can increase the motivation and compliance to the training. In order to understand the underlying mechanisms for the improved balance, further research is needed.

This study sought to investigate the feasibility of the Free Recall and Recognition Test (FRRT) as a practical screening tool for cognitive impairment in multiple sclerosis (MS). Persons with MS (n = 227) were consecutively recruited and assessed with four cognitive tests; FRRT, Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and the Mini-Mental State Examination (MMSE). Disease severity was assessed by the Expanded Disability Status Scale (EDSS). The FRRT, which was completed by 99% of the cohort in approximately 5 minutes per assessment, correlated significantly with the other cognitive tests, as well as with the disease severity rating. A cut-off of 4 for the FRRT recall rendered 90% sensitivity and 25% specificity, and a cut-off of 4.2 for the FRRT recognition resulted in 70% sensitivity and 51% specificity. We conclude that the FRRT proved feasible as a practical screening tool for cognitive impairment in MS within a clinical setting.