study published in 2011 showed
improvements in balance,
fatigue and disability due to
dizziness or imbalance after six
weeks of vestibular rehab. More
research is needed to confirm
the benefits observed.
Getting physical
Physical therapy can be an
important part of the equation
in treating imbalance.
The first step is to pinpoint
the factors that increase
imbalance in an individual, says
Kim Kobata, physical therapist
at the MS Center at Seattle’s
Swedish Neuroscience Institute.
involved in maintaining an
upright posture. “Even if you
use a wheelchair, specific
strengthening exercises can help
maintain or improve your sitting
balance,” she says.
“We also make recommendations
on assistive devices, and train
people how to use them,”
says Kobata, who notes that
the range of assistive devices
available includes single-point
and four-point canes; walkers,
with and without wheels;
crutches; ankle-foot orthotics;
and manual and motorized
wheelchairs. Kobata likes her
patients to experiment with
improving her confidence as
well as her strength and balance.
“The security of knowing what
to do to help myself is a big
deal for me.” After a recent
exacerbation, she noticed her
balance was affected, “but
physical therapy helped me
bounce back right away.”
“Even if you use a wheelchair, specific
strengthening exercises can help maintain or
improve your sitting balance.”
“Is it due to decreased
strength? Poor alignment?
Decreased sensation? Reduced
range of motion?” Kobata
asks. “Once we’ve identified
those factors, we develop an
individualized exercise program
to address specific areas,” she
says. For people with
decreased range of motion
or spasticity, stretching is
particularly important. Other
exercises may be geared toward
reducing reliance on vision
and strengthening other
systems to help with balance,
or strengthening the muscles
various devices to see which
ones may be most helpful in
specific situations. “If someone
is using a single-point cane, for
instance, I may try them with
Canadian (forearm) crutches to
see if that feels more secure, or if
the crutches might be beneficial
on days when the person is not
feeling as well.”
Kobata adds, “We teach
compensatory strategies when
necessary, such as breaking
down a task and practicing its
parts.” Wideman-Williams, who
attends physical therapy sessions
with Kobata, credits PT with
Staying active
It’s now well established that
exercise supports overall health
and quality of life, and helps
with MS-related symptoms,
such as fatigue and depression.
But what exercises are
appropriate for those who have
existing balance problems?
Kobata recommends
incorporating four kinds
of exercise: stretching,
strengthening, cardiovascular
activity and balance practices,
all at a level safe and appropriate
for the individual’s experience
and ability.
Dr. Mayadev emphasizes the
importance of exercises that
strengthen the core muscles
most critical to better balance.
“It’s important to strengthen
the deep muscles of the back,
such as the back extensor
muscles. This is especially
important for someone who uses
a wheelchair.”
Dr. Mayadev recommends
practicing balance exercises
daily for maximum benefit, or
at least five times a week. These
may be as simple as standing
