title: The effect of balance training on postural control in people with multiple sclerosis using the CAREN virtual reality system: a pilot randomized controlled trial.
abstract: BACKGROUND
  Multiple sclerosis (MS) is a multi-focal progressive disorder of the central nervous system often resulting in diverse clinical manifestations. Imbalance appears in most people with multiple sclerosis (PwMS). A popular balance training tool is virtual reality (VR) with several advantages including increased compliance and user satisfaction. Therefore, the aim of this pilot RCT (Trial registration number, date: ISRCTN14425615, 21/01/2016) was to examine the efficacy of a 6-week VR balance training program using the computer assisted rehabilitation environment (CAREN) system (Motek Medical BV, Amsterdam, Netherlands) on balance measures in PwMS. Results were compared with those of a conventional balance exercise group. Secondary aims included the impact of this program on the fear of falling.
  
  
  METHODS
  Thirty-two PwMS were equally randomized into the VR intervention group or the control group. Each group received balance training sessions for 6 consecutive weeks, two sessions per week, 30 min sessions. Clinical balance tests and instrumented posturography outcome measures were collected upon initiation of the intervention programs and at termination.
  
  
  RESULTS
  Final analysis included 30 patients (19 females, 11 males; mean age, (S.D.) = 45.2 (11.6) years; mean EDSS (S.D.) = 4.1 (1.3), mean disease duration (S.D.) = 11.0 (8.9) years). Both groups showed a main effect of time on the center of pressure (CoP) path length with eyes open (F = 5.278, P = .024), sway rate with eyes open (F = 5.852, P = .035), Functional Reach Test (F = 20.841, P = .001), Four Square Step Test (F = 9.011, P = .031) and the Fear of Falls self-reported questionnaire (F = 17.815, P = .023). In addition, significant differences in favor of the VR program were observed for the group x time interactions of the Functional Reach Test (F = 10.173, P = .009) and fear of falling (F = 6.710, P = .021).
  
  
  CONCLUSIONS
  We demonstrated that balance training based on the CAREN device is an effective method of balance training for PwMS.
authors.affiliation: Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. alkalron@gmail.com.
authors.forename: Alon
authors.initials: A
authors.lastname: Kalron
authors.affiliation: The Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. Ilia.Fonkatz@sheba.health.gov.il.
authors.forename: Ilia
authors.initials: I
authors.lastname: Fonkatz
authors.affiliation: The Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. Lior.Frid@sheba.health.gov.il.
authors.forename: Lior
authors.initials: L
authors.lastname: Frid
authors.affiliation: The Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel-Hashomer, Israel. Hani.Baransi@sheba.health.gov.il.
authors.forename: Hani
authors.initials: H
authors.lastname: Baransi
authors.affiliation: The Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. Anat.Achiron@sheba.health.gov.il.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Anat.Achiron@sheba.health.gov.il.
authors.forename: Anat
authors.initials: A
authors.lastname: Achiron
mesh_terms: D000058:Accidental Falls; D000328:Adult; D005081:Exercise Therapy / Q000379:methods; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D004856:Postural Balance; D011597:Psychomotor Performance; D013813:Therapy, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014584:User-Computer Interface