Balance impairment is a common symptom in patients living with Multiple Sclerosis. From an increased fall risk to reduced independence, compromised dynamic stability can place a heavy emotional burden on these individuals.
When developing a balance and fall reduction program for MS clients, research has shown that approaching it from a sensory perspective is the most effective.
Below are the top three sensory stimulation pathways that can be used to optimize balance and stability in your MS clients.
Sensory Gateway #1 – Vision
According to the Multiple Sclerosis Society, vision problems are some of the most common symptoms associated with MS. The most common eye complications include optic neuritis, diplopia, nystagmus and internuclear ophthalmoplegia.
Our eyes are designed to move and accommodate for light, providing us with as much sensory detail about our environment as possible. A decrease in visual acuity has been associated with impaired balance and delayed accuracy in motor patterns.
A 2018 study by Herbert et al. demonstrated the efficacy in the integration of eye movement exercises and visual stimulation in improving balance for those with MS. The study that focused on the BEEMS (balance and eye motion exercises for MS) integrated the following exercises for improved sensory integration and brain balancing.
Sensory Gateway #2 – Vestibular
The first sensory system to develop after conception is the vestibular system. Often referred to as the gateway to the brain, the vestibular system is critical in how our brain and body relates to gravity.
In MS, vestibular disturbances typically present as vertigo, balance disorders, and the presence of nystagmus (rapid involuntary movements of the eyes). When considering the implications of vestibular disturbances it is important to understand if the cause is related to disturbances in the peripheral vs central vestibular system.
The vestibular system can be divided into two main systems: the central system (the brain and brainstem) and the peripheral system (the inner ear and the pathways to the brainstem). A 2008 study by Zeigelboim et al. found that vestibular disturbances related to MS were disruptions in the peripheral system, with a higher prevalence in female patients.
The following exercises are recommended to address the vestibular disturbances associated with MS. You will notice that many of these exercises also integrate the visual system, as all of our sensory systems a linked in function with one input system enhancing the other.
Sensory Gateway #1 – Touch
The final sensory system is one that is quite familiar to those who follow EBFA Global’s work and allows us to tap into the homunculus of the motor cortex.
Our hands and feet are some the most sensitive sensory gateways of the human body and allow us to connect vision with an exteroceptive world. Neuropathies and disruptions in peripheral proprioceptive and vibratory input are often associated with MS and should be addressed before symptoms present.
The skin on the plantar foot and palmar hand contain four main mechanoceptors:
SAI – two-point discrimination & texture
SAII – skin stretch
FAI – low-frequency vibration
FAII – high-frequency vibration
Sensory Stimulation Balance Program for Multiple Sclerosis
The following exercises integrate visual, vestibular and touch sensory stimulation into every exercise. All of the exercises can be progressed from seated to standing to legs crossed and tandem to single leg stance.
Equipment needed: Naboso Barefoot Mat, Ball (Textured), Card
Dr Emily Splichal