Volume 28, Issue 2 (4-2025)
J Arak Uni Med Sci 2025, 28(2): 91-98 |
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Tahmasbi Arashloopour H, Khajavi D, Faraji F. Studying the Effectiveness of a Combined Motor and Cognitive – Behavioral Intervention Program on Balance and Balance Confidence in people with Multiple Sclerosis (PwMS). J Arak Uni Med Sci 2025; 28 (2) :91-98
URL: http://jams.arakmu.ac.ir/article-1-7732-en.html
URL: http://jams.arakmu.ac.ir/article-1-7732-en.html
1- Department of Motor Behavior and Sports Psychology, Faculty of Sports Sciences, University of Arak, Arak, Iran
2- Department of Behavioral and Cognitive Sciences in Sport, School of Sport and Health Sciences, University of Tehran, Tehran, AND Department of Motor Behavior and Sports Psychology, Faculty of Sports Sciences, University of Arak, ArakIran ,D-khajavi@araku.ac.ir
3- Department of Neurology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
2- Department of Behavioral and Cognitive Sciences in Sport, School of Sport and Health Sciences, University of Tehran, Tehran, AND Department of Motor Behavior and Sports Psychology, Faculty of Sports Sciences, University of Arak, ArakIran ,
3- Department of Neurology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
Abstract: (844 Views)
Introduction: Multiple sclerosis (MS) is the most common neurological disorder in young adults and balance problems due to MS may result in disturbances in upright posture, limitations in walking and turning, and ultimately falls in patients. The aim of this study was to investigate the effects of a combined physical exercises and cognitive-behavioral stress management intervention program on static, dynamic balance and balance confidence in PwMS.
Methods: The statistical population included MS patients (aged 20–60 years with Expanded Disability Status Scale [EDSS] scores of 2–4) referred to the Arak MS Association. Thirty participants were selected via convenience sampling and randomly assigned to experimental and control groups. Participants underwent pretests using the Timed Up and Go (TUG) test, single-leg stance test, and the Activities-Specific Balance Confidence (ABC) Scale. Then, they participated in the combined motor and cognitive intervention program, and finally performed a post – test. Data were analyzed by Independent and Paired Student T-tests.
Results: According to the results, the mean score of the experimental group in the TUG test (P ≤ 0.002), and standing on one-foot tests increased significantly in the post-test (P ≤ 0.001). There were no significant differences in mean ABC scores between the experimental and control groups on the post-test (P ≤ 0.153).
Conclusions: The findings suggest that a combined motor and cognitive intervention program can effectively improve agility, dynamic and static balance in people with MS. Improving balance confidence may require a longer duration of training due to its subjective nature.
Methods: The statistical population included MS patients (aged 20–60 years with Expanded Disability Status Scale [EDSS] scores of 2–4) referred to the Arak MS Association. Thirty participants were selected via convenience sampling and randomly assigned to experimental and control groups. Participants underwent pretests using the Timed Up and Go (TUG) test, single-leg stance test, and the Activities-Specific Balance Confidence (ABC) Scale. Then, they participated in the combined motor and cognitive intervention program, and finally performed a post – test. Data were analyzed by Independent and Paired Student T-tests.
Results: According to the results, the mean score of the experimental group in the TUG test (P ≤ 0.002), and standing on one-foot tests increased significantly in the post-test (P ≤ 0.001). There were no significant differences in mean ABC scores between the experimental and control groups on the post-test (P ≤ 0.153).
Conclusions: The findings suggest that a combined motor and cognitive intervention program can effectively improve agility, dynamic and static balance in people with MS. Improving balance confidence may require a longer duration of training due to its subjective nature.
References
1. Haki M, Al-Biati HA, Al-Tameemi ZS, Ali IS, Al-Hussaniy HA. Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment. Medicine (Baltimore). 2024;103(8):e37297. pmid: 38394496 doi: 10.1097/MD.0000000000037297
2. Holland NJ. Multiple sclerosis: A self-care guide to wellness. New York, NY: Demos Medical Publishing; 2005.
3. Holland NJ, Northrop DE. Young adults with multiple sclerosis: management in the home. Home Health Care Management & Practice. 2006;18(3):186-95. doi:10.1177/1084822305281952
4. Walton C, King R, Rechtman L, Kaye W, Leray E, Marrie RA, et al. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS. Mult Scler. 2020;26(14):1816-21. pmid: 33174475 doi: 10.1177/1352458520970841
5. Cameron MH, Nilsagard Y. Balance, gait, and falls in multiple sclerosis. Handb Clin Neurol. 2018;159:237-50. pmid: 30482317 doi: 10.1016/B978-0-444-63916-5.00015-X
6. Peine VG, Isaacs LD. Human Motor Development: Lifespan Approach. 5th ed. Boston, MA: McGraw-Hill; 2002.
7. van Emmerik RE, Remelius JG, Johnson MB, Chung LH, Kent-Braun JA. Postural control in women with multiple sclerosis: effects of task, vision and symptomatic fatigue. Gait Posture. 2010;32(4):608-14. pmid: 20943393 doi: 10.1016/j.gaitpost.2010.09.002
8. Simpson JM, Worsfold C, Fisher KD, Valentine JD. The CONFbal scale: a measure of balance confidence--a key outcome of rehabilitation. Physiotherapy. 2009;95(2):103-9. pmid: 19627691 doi: 10.1016/j.physio.2008.12.004
9. Hatch J, Gill-Body KM, Portney LG. Determinants of balance confidence in community-dwelling elderly people. Phys Ther. 2003;83(12):1072-9. pmid: 14640866
10. Nemmers TM, Miller JW. Factors influencing balance in healthy community-dwelling women age 60 and older. J Geriatr Phys Ther. 2008;31(3):93-100. doi: 10.1519/00139143-200831030-00003 pmid: 19856614
11. Kulmala J, Sihvonen S, Kallinen M, Alen M, Kiviranta I, Sipilä S. Balance confidence and functional balance in relation to falls in older persons with hip fracture history. J Geriatr Phys Ther. 2007;30(3):114-20. pmid: 18171495 doi: 10.1519/00139143-200712000-00006
12. Liu-Ambrose T, Khan KM, Eng JJ, Lord SR, McKay HA. Balance confidence improves with resistance or agility training. Increase is not correlated with objective changes in fall risk and physical abilities. Gerontology. 2004;50(6):373-82. pmid: 15477698 doi: 10.1159/000080175
13. Motl RW, Sandroff BM, Kwakkel G, Dalgas U, Feinstein A, Heesen C, et al. Exercise in patients with multiple sclerosis. Lancet Neurol. 2017;16(10):848-56. pmid: 28920890 doi: 10.1016/S1474-4422(17)30281-8.
14. Alphonsus KB, Su Y, D’arcy C. The effect of exercise, yoga and physiotherapy on the quality of life of people with multiple sclerosis: Systematic review and meta-analysis. Complementary therapies in medicine. 2019;43:188-95. pmid: 30935529 doi: 10.1016/j.ctim.2019.02.010
15. Heine M, van de Port I, Rietberg MB, van Wegen EE, Kwakkel G. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database Syst Rev. 2015(9):CD009956. pmid: 26358158 doi: 10.1002/14651858.CD009956.
16. Amato A, Ragonese P, Ingoglia S, Schiera G, Schirò G, Di Liegro CM, et al. Lactate threshold training program on patients with multiple sclerosis: A multidisciplinary approach. Nutrients. 2021;13(12):4284. pmid: 34959834 doi: 10.3390/nu13124284
17. Ahmadi A, Nikbakh M, Arastoo A, Habibi A-H. The effects of a yoga intervention on balance, speed and endurance of walking, fatigue and quality of life in people with multiple sclerosis. J Hum Kinet. 2010;23(1):71-8. doi:10.2478/v10078-010-0009-2
18. Shohani M, Badfar G, Nasirkandy MP, Kaikhavani S, Rahmati S, Modmeli Y, et al. The effect of yoga on stress, anxiety, and depression in women. Int J Prev Med. 2018;9(1):21. pmid: 29541436 doi: 10.4103/ijpvm.IJPVM_242_16
19. Khajavi D. Psychometric properties of persian translated version of activities-specific balance confidence scale (ABC) in Arak community-dwelling older adults [in Persian]. J Arak Uni Med Sci. 2017;20(125):39-48.
20. Khajavi D, Farokhi A, Jaberi Moghadam AA, Kazemnejad A. The impact of a training intervention program on fall-related psychological factors among male older adults in Arak [in Persian]. Salmand: Iranian Journal of Ageing. 2014;9(1):32-9.
21. Shumway-Cook A, Anson D, Haller S. Postural sway biofeedback: its effect on reestablishing stance stability in hemiplegic patients. Arch Phys Med Rehabil. 1988;69(6):395-400. pmid: 3377664
22. Ayvat F, Ayvat E, Doğan M, Onursal Kılınç Ö, Kılınç M. Can timed up and go test discriminate the risk of falling in patients with Multiple Sclerosis with low to moderate impairment? Disabil Rehabil. 1-6. pmid: 39444107 doi: 10.1080/09638288.2024.2419445
23. Kalron A, Dolev M, Givon U. Further construct validity of the Timed Up-and-Go Test as a measure of ambulation in multiple sclerosis patients. Eur J Phys Rehabil Med. 2017;53(6):841-7. pmid: 28290192 doi: 10.23736/S1973-9087.17.04599-3
24. Sebastião E, Sandroff BM, Learmonth YC, Motl RW. Validity of the Timed Up and Go Test as a Measure of Functional Mobility in Persons With Multiple Sclerosis. Arch Phys Med Rehabil. 2016;97(7):1072-7. pmid: 26944709 doi: 10.1016/j.apmr.2015.12.031
25. Aslankhani MA, Farsi A, Fathirezaie Z, Zamani Sani SH, Aghdasi MT. Validity and reliability of the timed up and go and the anterior functional reach tests in evaluating fall risk in the elderly [in Persian]. Salmand: Iranian Journal of Ageing. 2015;10(1):16-25.
26. American Council on Exercise, Bryant CX, Green DJ. Exercise for older adults: ACE's guide for fitness professionals. Monterey, CA: Coaches Choice; 2005.
27. DiBrezzo R, Shadden BB, Raybon BH, Powers M. Exercise intervention designed to improve strength and dynamic balance among community-dwelling older adults. J Aging Phys Act. 2005;13(2):198-209. pmid: 15995265 doi: 10.1123/japa.13.2.198
28. Asgari M, Hāshemi-Nasab B, Faraji F. The effect of cognitive-behavior stress management treatment on quality of life and depression in female multiple sclerosis patients [in Persian]. Clinical Psychology Studies. 2011;2(5):140-64.
29. Bisht B, Darling WG, White EC, White KA, Shivapour ET, Zimmerman MB, et al. Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study. Degener Neurol Neuromuscul Dis. 2017:79-93. pmid: 30050380 doi: 10.2147/DNND.S128872
30. Khorshid Sokhangu M, Ebrahimi Atri A, Hashemi Javaheri SAA, Sarvari F. The effect of resistance exercise on motor control in woman with multiple sclerosis [in Persian]. Qom Univ Med Sci J. 2015;9(9):10-8.
31. Attar Sayyah E, Hoseini Kakhk AR, Hamedi Nia MR, Abbasi Farman Abadi I. Effect of 8-week Combined Training on Muscular performance and Functional and degree of disability in Multiple Sclerosis Patients [in Persian]. Sport Physiology. 2016;8(29):103-18.
32. Khademosharie M, Tadibi V, Behpor N, Hamedinia M. Effect of 12-week endurance-resistance training on motor and muscular function, degree of disability, fatigue, and quality of life in multiple sclerosis patients [in Persian]. Iranian J Epidemiol. 2018; 14(1): e95-e104.
33. Saebi S, Khajavi D, Faraji F. The effect of balance training with educational and motivational self-talk on balance in the women with Multiple Sclerosis [in Persian]. J Arak Uni Med Sci. 2016;19(115):48-58.
34. Reinsch S, MacRae P, Lachenbruch PA, Tobis JS. Attempts to prevent falls and injury: a prospective community study. The Gerontologist. 1992;32(4):450-6. pmid: 1427246 doi: 10.1093/geront/32.4.450
35. Arfken CL, Lach HW, Birge SJ, Miller JP. The prevalence and correlates of fear of falling in elderly persons living in the community. Am J Public Health. 1994;84(4):565-70. pmid: 8154557 doi: 10.2105/ajph.84.4.565
36. Murphy SL, Dubin JA, Gill TM. The development of fear of falling among community-living older women: predisposing factors and subsequent fall events. J Gerontol A Biol Sci Med Sci. 2003;58(10):M943-M7. pmid: 14570863 doi: 10.1093/gerona/58.10.m943
37. Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.
38. Vellas BJ, Wayne SJ, Garry PJ, Baumgartner RN. A two-year longitudinal study of falls in 482 community-dwelling elderly adults. J Gerontol A Biol Sci Med Sci. 1998;53(4):M264-M74. pmid: 18314565 doi: 10.1093/gerona/53a.4.m264
39. Wielinski CL, Erickson-Davis C, Wichmann R, Walde-Douglas M, Parashos SA. Falls and injuries resulting from falls among patients with Parkinson's disease and other parkinsonian syndromes. Mov Disord. 2005;20(4):410-5. pmid: 15580552 doi: 10.1002/mds.20347. .
40. Hatch J, Gill-Body KM, Portney LG. Determinants of balance confidence in community-dwelling elderly people. Phys Ther. 2003;83(12):1072-9. pmid: 14640866
41. Robertson JA, Eng JJ, Hung C. The effect of functional electrical stimulation on balance function and balance confidence in community-dwelling individuals with stroke. Physiother Can. 2010;62(2):114-9. pmid: 21359041 doi: 10.3138/physio.62.2.114
42. Shiri H, Soltanian MA, Asghari N. The effect of 7 weeks of core stability and balance training on motor function and cognitive failures in women with multiple sclerosis [in Persian]. Motor Behavior. 2017;9(27):17-34. doi: 10.22089/mbj.2017.1479.1157
43. DeBolt LS, McCubbin JA. The effects of home-based resistance exercise on balance, power, and mobility in adults with multiple sclerosis. Arch Phys Med Rehabil. 2004;85(2):290-7. pmid: 14966716 doi: 10.1016/j.apmr.2003.06.003
44. White L, McCoy S, Castellano V, Gutierrez G, Stevens J, Walter G, et al. Resistance training improves strength and functional capacity in persons with multiple sclerosis. Mult Scler. 2004;10(6):668-74. pmid: 15584492 doi: 10.1191/1352458504ms1088oa
45. Kraft GH, Alquist AD, de Lateur BJ. Effect of resistive exercise on physical function in multiple sclerosis. J Rehabil Res Dev. 1996;33:328.
46. Broekmans T, Roelants M, Feys P, Alders G, Gijbels D, Hanssen I, et al. Effects of long-term resistance training and simultaneous electro-stimulation on muscle strength and functional mobility in multiple sclerosis. Mult Scler. 2011;17(4):468-77. pmid: 21148266 doi: 10.1177/1352458510391339
47. Rand D, Miller WC, Yiu J, Eng JJ. Interventions for addressing low balance confidence in older adults: a systematic review and meta-analysis. Age Ageing. 2011;40(3):297-306. pmid: 21508204 doi: 10.1093/ageing/afr037
48. Myers AM, Fletcher PC, Myers AH, Sherk W. Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci. 1998;53(4):M287-M94. pmid: 18314568 doi: 10.1093/gerona/53a.4.m287
49. Bandura A, Adams NE. Analysis of self-efficacy theory of behavioral change. Cogn Ther Res. 1977;1(4):287-310. doi: 10.1007/BF01663995.
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