title: Effects of different exercise modalities on ataxia in multiple sclerosis patients: a randomized controlled study.
abstract: OBJECTIVE
  To investigate the effects of different exercise protocols on ataxia in patients with multiple sclerosis (MS).
  
  
  METHODS
  A total of 42 MS patients, 17 male and 25 female (Expanded Disability Status Scale (EDSS): 3-5), were enrolled in this randomized controlled study. The patients were divided into three groups: a balance training (BT) group, a lumbar stabilization (LS) group and a task-oriented training (TT) group. All groups received balance training; additionally, the LS group received lumbar stabilization exercises, and the TT group received task-oriented training. The Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS), Functional Reach Test (FRT), 2-Minute Walk Test (2MWT), Sensory Organization Test (SOT), and measurement of Somatosensory Evoked Potentials (SSEPs) were performed before and at the end of the 18 training sessions.
  
  
  RESULTS
  The BBS, ICARS, FRT, 2MWT, and composite balance score of the SOT were improved in all groups. The ICARS kinetic function sub-score and the left limb cortical onset amplitudes of SSEPs were increased significantly in both the TT and the LS groups. The ICARS total score, composite balance score, and 2MWT were different between groups (p < 0.05). According to multiple comparison analyses of the ICARS total score and the composite balance score, the LS, and the TT group were different from the BT group (p < 0.005), while the LS and the TT groups improved similarly (p > 0.005). The 2MWT results were better for the LS group than the BT group, while the BT and the TT groups improved similarly.
  
  
  CONCLUSIONS
  Balance training alone is not sufficient for rehabilitation of ataxic MS patients. A combination of lumbar stabilization exercises or task-oriented training increases the success of balance rehabilitation. Implications for rehabilitation Multiple sclerosis is a chronic inflammatory and autoimmune disease of central nervous system and ataxia is one of the most challenging symptoms of this disease. Different exercise modalities are commonly employed to control ataxic symptoms in MS patients. Lumbar stabilization exercises or task-oriented training should be considered as complementary approach to improve balance and coordination in ataxic multiple sclerosis patients.
authors: a Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences , Hacettepe University , Ankara , Turkey.
authors: Yeliz
authors: Y
authors: Salcı
authors: a Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences , Hacettepe University , Ankara , Turkey.
authors: Ayla
authors: A
authors: Fil
authors: a Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences , Hacettepe University , Ankara , Turkey.
authors: Kadriye
authors: K
authors: Armutlu
authors: b Department of Neurology, Faculty of Medicine , Hacettepe University , Ankara , Turkey.
authors: F Gökçem
authors: FG
authors: Yildiz
authors: b Department of Neurology, Faculty of Medicine , Hacettepe University , Ankara , Turkey.
authors: Aslı
authors: A
authors: Kurne
authors: c Department of Audiology, Faculty of Health Sciences , Hacettepe University , Ankara , Turkey.
authors: Songül
authors: S
authors: Aksoy
authors: b Department of Neurology, Faculty of Medicine , Hacettepe University , Ankara , Turkey.
authors: Gülay
authors: G
authors: Nurlu
authors: b Department of Neurology, Faculty of Medicine , Hacettepe University , Ankara , Turkey.
authors: Rana
authors: R
authors: Karabudak
mesh_terms: D000328:Adult; D001259:Ataxia / Q000503:physiopathology / Q000534:rehabilitation*; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000534:rehabilitation*; D004856:Postural Balance / Q000502:physiology; D011446:Prospective Studies
keywords: Multiple sclerosis; balance training; lumbar stabilization exercise; rehabilitation; task-oriented training