The immediate effects of an intervention based on the Bobath concept on balance and gait in people with multiple sclerosis

Background: The Bobath concept is a physiotherapy approach widely used in the treatment of Multiple sclerosis (MS). Interventions involving treatment of the foot and ankle are a strong focus of the Bobath concept, with the aim of improving postural control at the dynamic interface between the person and the base of support. We were unable to identify any studies investigating the effect of these interventions on postural control, or studies assessing postural control in higher level balance tasks, such as single leg stance, in people with MS. Purpose: (1) To investigate the immediate change after a single intervention based on the Bobath concept on people with MS. (2) To compare the balance and gait of people with MS with healthy controls. Methods: Participants in the study were people with MS with self reported gait and balance deficits. Exclusion criteria included inability to stand in single leg stance (SLS) on the most impaired leg. Participants were age and gender matched with healthy controls. Balance was assessed by ground reaction forces (GRF) and centre of pressure movements during SLS, and two clinical tests, the Lateral Reach Test (LRT) and the Four Square Step Test (FSST). Gait was evaluated by GRF, ankle kinematics and spatiotemporal measures. The Bobath based intervention focused on mobilising and activating the most impaired foot and ankle in sitting. The treatment was tailored for each individual to address their specific impairments of the foot and ankle. Key components were provision of sensory information, stretch of intrinsic muscles of the foot to selectively activate the foot, improving alignment of the talo- crural joint and activation of gastrocnemius. Eleven people with MS were recruited to the study and 11 healthy controls. Baseline measures in the MS group showed significantly greater vertical GRF variability (p = 0.008) during SLS, less distance reached on the LRT (p = 0.001) and slower completion of the FSST (p < 0.001) than healthy controls. Post intervention, significant changes towards the control group values were observed for the SLS task, with reduced mediolateral (p = 0.002) and vertical (p = 0.016) GRF variability, and faster FSST time (p = 0.006). Compared to healthy controls, the people with MS walked slower (p = 0.005), exhibited less peak vertical GRF (p < 0.001) and peak propulsive GRF (p = 0.004) at terminal stance, and increased vertical GRF in midstance (p = 0.005), and had had less ankle plantarflexion (p = 0.001). Post intervention, significant improvement was observed for ankle plantarflexion during gait (p = 0.002).