Gaze and Postural Stability in Multiple Sclerosis



Status:Recruiting
Conditions:Neurology, Neurology, Neurology, Multiple Sclerosis
Therapuetic Areas:Neurology, Other
Healthy:No
Age Range:20 - 75
Updated:6/29/2018
Start Date:May 29, 2018
End Date:September 30, 2020
Contact:Lee Dibble, PhD, PT
Email:Lee.Dibble@hsc.utah.edu
Phone:801-581-4637

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Gaze and Postural Stability in People With MS: Characterizing Deficits and Response to Treatment

In order to provide information that will improve therapy, the goals of this project are to
determine if persons with MS with complaints of dizziness and at risk for falls can improve
their balance and vision stability as a result of a bout of specific treatment. This project
seeks to do this by conducting an experiment where people with MS are randomly assigned to a
group that practices activities known to help improve inner ear function or a group that
practices activities known to improve endurance and strength but that should not change inner
ear function. Such a comparison will allow us to gain understanding of how the inner ear
system is affected in MS and how it responds to treatment.

A variety of sources of evidence suggest altered vestibular function in people diagnosed with
MS (PwMS). These sources of evidence include [a] subjective complaints of dizziness /
vertigo, [b] altered subjective visual vertical, [c] altered vestibular evoked myogenic
potentials, [d] altered performance on the vestibular dominant components of the sensory
organization test, and [e] pilot reports of gaze stabilization deficits during vestibular
ocular reflex (VOR) testing from the investigator's research group. These findings suggest
vestibular deficits are present in PwMS. Epidemiological studies document cerebellar and
brainstem involvement in 23% of PwMS at disease onset, increasing to 82% after longstanding
illness. These vestibular deficits contribute to motion sensitivity, dizziness, imbalance,
and falls. Regardless, dizziness and falls have a significant negative impact on quality of
life. Multiple studies show that falls are a major disabling symptom in MS affecting
approximately 75% of PwMS. The high incidence of falls in MS, is an important health concern
due to its associations with injury-related morbidities, mortality and financial costs.

The vestibular pathways responsible for gaze and postural stability, as well as sensory
integration reside in the brainstem, cerebellum and spinal cord. Demyelination of the
pathways involving the vestibular nuclei complex within the brainstem and cerebellum
adversely affect angular vestibulo-ocular reflex,vestibulo-spinal reflex function and sensory
integration in PwMS. While evidence reports impairments in posturography and otolith mediated
responses (vestibular evoked myogenic potentials), the responses mediated by the semicircular
canal end organs and vestibular pathways have not been examined. Specifically, the learning
and retention of gaze and postural stability as a result of task specific training program
has not been studied in a well controlled clinical trial.

This proposal seeks to examine gaze and postural stability outcomes utilizing outcome
measures that span the World Health Organization's International Classification of Function,
Disability, and Health. Following completion of the baseline examination, PwMS will be
randomized to one of two interventions: An Experimental Gaze and Postural Stability Training
Group (GPS) or a Standard Care Aerobic Exercise Control Group (SCA). The two groups differ
only by the presence of the GPS program in the experimental group. Both groups will
participate in supervised exercise 3 times per week for 6 weeks followed by a post
intervention testing period . After one month of no training, both groups will be brought
back for a final follow-up examination to determine the retention of any training induced
changes.

Inclusion Criteria:

- Neurologist-diagnosed, clinically definite MS

- Expanded Disability Severity Scale (EDSS) score of less than 6.0

- Current complaints of dizziness (DHI > 0)

- At risk of falls (determined by > 2 falls in past year or Dynamic Gait Index <19 or
Activity Specific Balance Confidence Scale <80

- Ability to tolerate repetitive 5 min bouts of angular head motions.

Exclusion Criteria:

- Central or Peripheral Nervous System disorders (other than MS)

- Otologic, Cervical spine, or lower extremity injury in last 12 months

- Exercise or alcohol use in last 48 hours

- Currently taking vestibular suppressant medications

- Peripheral Vestibular Pathology (BPPV, hypofunction, Meniere's disease

- Internuclear Opthalmoplegia

- MS exacerbation within last 8 weeks

- Orthopedic, neurologic, or cognitive comorbidities that would limit participation in
the study procedures
We found this trial at
1
site
201 Presidents Circle
Salt Lake City, Utah 84108
801) 581-7200
Phone: 801-581-4637
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