Effect of dual-task training on balance in patients with multiple sclerosis: A systematic review and meta-analysis

Cinnera, Alex Martino; Bisirri, Alessio; Leone, Enza; Morone, Giovanni; Gaeta, Angela

doi:10.1177/02692155211010372

Cited by 22 publications

(9 citation statements)

References 40 publications

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“…The statistical analysis showed that exercise interventions moderately improved the walking distances immediately after the end of treatment, losing effect 4 and 6 weeks later. The addition of tDCS appeared to provide an ameliorative effect, with significant increases in the distances walked by patients in the experimental group at T1, as in a recent review [ 35 ], and significant increases in BBS for people with MS [ 75 ]. At 4 weeks after the end of the treatment, we found a loss of gain compared to T1, considering that it was significantly lower in the experimental group than in the control group.…”

Section: Discussionmentioning

confidence: 81%

Efficacy of Transcranial Direct Current Stimulation (tDCS) on Balance and Gait in Multiple Sclerosis Patients: A Machine Learning Approach

Marotta

Sire

Marinaro

et al. 2022

JCM

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Transcranial direct current stimulation (tDCS) has emerged as an appealing rehabilitative approach to improve brain function, with promising data on gait and balance in people with multiple sclerosis (MS). However, single variable weights have not yet been adequately assessed. Hence, the aim of this pilot randomized controlled trial was to evaluate the tDCS effects on balance and gait in patients with MS through a machine learning approach. In this pilot randomized controlled trial (RCT), we included people with relapsing–remitting MS and an Expanded Disability Status Scale >1 and <5 that were randomly allocated to two groups—a study group, undergoing a 10-session anodal motor cortex tDCS, and a control group, undergoing a sham treatment. Both groups underwent a specific balance and gait rehabilitative program. We assessed as outcome measures the Berg Balance Scale (BBS), Fall Risk Index and timed up-and-go and 6-min-walking tests at baseline (T0), the end of intervention (T1) and 4 (T2) and 6 weeks after the intervention (T3) with an inertial motion unit. At each time point, we performed a multiple factor analysis through a machine learning approach to allow the analysis of the influence of the balance and gait variables, grouping the participants based on the results. Seventeen MS patients (aged 40.6 ± 14.4 years), 9 in the study group and 8 in the sham group, were included. We reported a significant repeated measures difference between groups for distances covered (6MWT (meters), p < 0.03). At T1, we showed a significant increase in distance (m) with a mean difference (MD) of 37.0 [−59.0, 17.0] (p = 0.003), and in BBS with a MD of 2.0 [−4.0, 3.0] (p = 0.03). At T2, these improvements did not seem to be significantly maintained; however, considering the machine learning analysis, the Silhouette Index of 0.34, with a low cluster overlap trend, confirmed the possible short-term effects (T2), even at 6 weeks. Therefore, this pilot RCT showed that tDCS may provide non-sustained improvements in gait and balance in MS patients. In this scenario, machine learning could suggest evidence of prolonged beneficial effects.

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Section: Discussionmentioning

confidence: 81%

Efficacy of Transcranial Direct Current Stimulation (tDCS) on Balance and Gait in Multiple Sclerosis Patients: A Machine Learning Approach

Marotta

Sire

Marinaro

et al. 2022

JCM

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“…The aim of this task is to challenge attentional capacity: The ability to walk and retain information in working memory at the same time. Dual task-exercising has been investigated in several studies, showing benefits on balance outcomes in multiple populations such as older adults and persons with neurological disorders (Fritz et al, 2015 ; Ghai et al, 2017 ; Martino Cinnera et al, 2021 ). The benefits are believed to arise from increased automatization of the motor task, and less need for executive resources (Clark, 2015 ; Fritz et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Theoretical Rationale for Design of Tasks in a Virtual Reality-Based Exergame for Rehabilitation Purposes

Bovim

Valved

Bleikli

et al. 2021

Front. Aging Neurosci.

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Virtual reality games are playing a greater role in rehabilitation settings. Previously, commercial games have dominated, but increasingly, bespoke games for specific rehabilitation contexts are emerging. Choice and design of tasks for VR-games are still not always clear, however; some games are designed to motivate and engage players, not necessarily with the facilitation of specific movements as a goal. Other games are designed specifically for the facilitation of specific movements. A theoretical background for the choice of tasks seems warranted. As an example, we use a game that was designed in our lab: VR Walk. Here, the player walks on a treadmill while wearing a head-mounted display showing a custom-made virtual environment. Tasks include walking on a glass bridge across a drop, obstacle avoidance, narrowing path, walking in virtual footsteps, memory, and selection tasks, and throwing and catching objects. Each task is designed according to research and theory from movement science, exercise science, and cognitive science. In this article, we discuss how for example walking across a glass bridge gives perceptual challenges that may be suitable for certain medical conditions, such as hearing loss, when perceptual abilities are strained to compensate for the hearing loss. In another example, walking in virtual footsteps may be seen as a motor and biomechanical constraint, where the double support phase and base of support can be manipulated, making the task beneficial for falls prevention. In a third example, memory and selection tasks may challenge individuals that have cognitive impairments. We posit that these theoretical considerations may be helpful for the choice of tasks and for the design of virtual reality games.

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“…The volume and quality of research on exercise interventions among people with MS has improved considerably, and there is now more evidence for the benefits of exercise in MS than any other neurological condition [36]; this may be due to the strong evidence for the safety of exercise in MS [37]. For persons with MS, exercise can improve physical fitness [38][39][40], walking mobility [41][42][43], strength [43,44], balance [45,46], cognition [47], fatigue [40,[48][49][50][51][52][53], depressive symptoms [54][55][56] and quality of life [57,58]. There is evidence indicating that exercise has a positive effect on the hippocampus [59,60], sleep quality [61,62] and cardiovascular and metabolic comorbidity [63][64][65].…”

Section: Growth Of Clinical Trials and Expanding Knowledge Of Benefitsmentioning

confidence: 99%

Exercise Training for Multiple Sclerosis: A Narrative Review of History, Benefits, Safety, Guidelines, and Promotion

Learmonth

Motl

2021

IJERPH

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Background: There have been significant advances in the medical treatment and management of multiple sclerosis pathogenesis, relapse and disease progression over the past 30 years. There have been advancements in the symptomatic treatment of multiple sclerosis, including management of secondary multiple sclerosis expressions such as walking, cognitive dysfunction, fatigue and depression. Scientific evidence and expert opinion suggest that exercise may be the single most effective non-pharmacological symptomatic treatment for multiple sclerosis. This article presents the historical context of exercise training within the multidisciplinary management of multiple sclerosis. We guide neurologists and healthcare providers on the recommended prescription of exercise and practical, theoretical methods to overcome barriers to exercise. Method: We undertook a critical search of the historical and current literature regarding exercise and multiple sclerosis from the viewpoint of exercise promotion by neurologists and the multidisciplinary care team. Results: We highlight the ever-strengthening body of research indicating that exercise is safe and effective for improving symptoms of multiple sclerosis. Further, exercise training may be necessary for reducing disease progression. Conclusion: We seek to encourage neurologists and specialists in multidisciplinary healthcare teams to prescribe and promote exercise at diagnosis and across all stages of the disease trajectory using prescriptive guidelines as part of comprehensive MS care. Available tools include clinical education to dispel any historical myths related to exercise in multiple sclerosis, clinical exercise guidelines and behaviour change theory to overcome patients barriers to exercise.

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Effect of dual-task training on balance in patients with multiple sclerosis: A systematic review and meta-analysis

Cited by 22 publications

References 40 publications

Efficacy of Transcranial Direct Current Stimulation (tDCS) on Balance and Gait in Multiple Sclerosis Patients: A Machine Learning Approach

Efficacy of Transcranial Direct Current Stimulation (tDCS) on Balance and Gait in Multiple Sclerosis Patients: A Machine Learning Approach

Theoretical Rationale for Design of Tasks in a Virtual Reality-Based Exergame for Rehabilitation Purposes

Exercise Training for Multiple Sclerosis: A Narrative Review of History, Benefits, Safety, Guidelines, and Promotion

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