Practical Balance Training Interventions for Multiple Sclerosis

This brief outlines effective balance training strategies for individuals with Multiple Sclerosis (MS). We focus on practical, evidence-based interventions that you can implement to improve your patients' postural control, mobility, and confidence.

Research: August 2023

This image demonstrates a seated hamstring stretch using a resistance band, an exercise that can be part of a comprehensive balance program for MS by improving flexibility and range of motion in the lower extremities.

Key Findings

1Balance training interventions show a moderate effect on improving balance composite scores and a small effect on mobility tests in people with MS.
2Larger training volume is positively associated with greater improvements in balance.
3Cognitive dual-task training demonstrates a significant positive effect on mobility outcomes.
4No significant effects were found for stepping or gait speed outcomes from the analyzed balance interventions.

Balance impairment is a common and debilitating symptom for people with MS, affecting up to 80% of individuals and significantly increasing fall risk. Fortunately, targeted balance training is a powerful tool to address these deficits. A 2024 systematic review and meta-analysis by Wallin et al. published in Neurorehabilitation and Neural Repair, which synthesized data from 18 randomized controlled trials involving 902 participants, confirmed that balance interventions yield moderate improvements in balance composite scores and mobility tests. The key is consistency and volume. The review found a positive correlation between larger training volumes and better balance outcomes. While various training types (sensory-motor integration, task-oriented, cognitive dual-task) were effective, cognitive dual-task training showed a particularly strong effect on mobility. This involves performing a cognitive task (like counting backward or naming objects) while performing a balance exercise, which mimics real-world demands. For dosing, aim for at least 120 minutes per week of balance-specific training, broken into sessions of 30-60 minutes, 2-3 times per week. The intensity should be challenging enough to induce postural sway but safe enough to prevent falls. Progression is crucial; as the patient improves, you should increase the complexity of the exercises, for example, by narrowing the base of support, moving from static to dynamic exercises, or adding dual-task challenges.

Clinician's Note

In my experience, the biggest challenge with balance training in MS is maintaining patient engagement. It's not always the most exciting work. I've found that framing it as 'pre-hab' for life's unexpected moments really helps with buy-in. We talk about being able to walk on uneven ground at a park, or reacting quickly if they get bumped in a crowd. I also make a point to incorporate activities they enjoy. If a patient likes gardening, we'll practice standing on a foam pad while reaching for pots. It's about making the exercises meaningful to their life. Also, don't underestimate the power of starting with a solid foundation of static balance before progressing to more dynamic and dual-task activities. A patient who feels stable in a simple tandem stance is more likely to have the confidence to try a more complex exercise later on.

Clinic Action Plan

1. Patient Qualification: Individuals with MS, EDSS score of 7.5 or less, who are able to transfer independently. 2. Initial Assessment: Use standardized outcome measures like the Berg Balance Scale, Timed Up and Go (TUG), and Dynamic Gait Index to establish a baseline. 3. Intervention Protocol: Start with static balance exercises (e.g., tandem stance, single-leg stance) on a firm surface, 3 sets of 30-second holds. Progress to compliant surfaces (e.g., foam pad, wobble board). Introduce dynamic exercises like tandem walking, step-ups, and lunges. Incorporate dual-task training by having the patient perform cognitive tasks (e.g., counting, conversation) during the exercises. 4. Dosing: Aim for 30-60 minutes per session, 2-3 times per week, for a total of at least 120 minutes per week. 5. Progression Criteria: When the patient can perform an exercise for the prescribed duration or repetitions with good control and minimal sway, increase the challenge by narrowing the base of support, closing their eyes, adding head movements, or increasing the complexity of the dual-task. 6. Red Flags: Monitor for excessive fatigue, dizziness, or a significant increase in spasticity. Modify or regress the exercises as needed. Ensure a safe environment with appropriate guarding and use of a gait belt.

Common Mistakes to Avoid

•Focusing only on static balance and neglecting dynamic and reactive control.
•Not progressing the exercises as the patient's ability improves.
•Failing to incorporate dual-task challenges to mimic real-world situations.
•Prescribing a generic set of exercises without tailoring them to the individual's specific deficits and goals.

Frequently Asked Questions

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