• Reactive balance training can be safely provided to people with MS in a laboratory setting.
• Study results showed the intervention resulted in fewer trip-induced falls.
• Further research will determine if the training can translate to reduced trip-induced falls in daily life.

What was the aim of the research?

People with MS are at high risk of falls, but effective fall prevention strategies have yet to be established.

Reactive balance training involves the application of unanticipated trip and slip hazards to train rapid balance recovery responses.

Reactive balance training has been shown to reduce fall rates in daily life by 40-50% in healthy older adults and people with Parkinson’s disease.

Using a blinded randomised controlled trial, Professor Lord and his team have investigated whether reactive balance training can be given to people with MS and whether the training is effective in reducing laboratory-induced slip and trip falls.

What did the researchers do?

In this MS Australia-funded study, published in the Journal of Multiple Sclerosis and Related Disorders, 30 people with a confirmed diagnosis of MS were recruited to participate in the trial.

All participants underwent a baseline assessment for their ability to recover from trips and slips in the laboratory by having participants walk through a specially designed 10-metre Trip and Slip Walkway that had hidden trip and slip hazards.

All participants wore a full-body safety harness to prevent them from falling to the floor. A fall was defined as the harness supporting more than 30% of the person’s body weight.

Participants were then randomly allocated to either the intervention group (14 participants) or the control group (16 participants).

The intervention group was exposed to trips and slips, with progressive unpredictability in slip and trip location, on the Trip and Slip Walkway. The group received two 50-minute training sessions over a one-week period. The training focused on recovering from slips and trips (without falling) using reactive stepping responses.

The control group undertook two 50-minute sessions of training that involved stepping over visible foam obstacles on the inactive Trip and Slip Walkway. No specific recovery training or training in reactive stepping responses was provided.

Both groups were assessed again post-training on the active Trip and Slip Walkway (comprising 51 slips and 50 trips) to assess their ability to recover from slip and trip hazards. Results were compared to baseline measurements to establish whether there was any reduction in slip and trip falls in the intervention group compared to the control group.

What did the study find?

The results showed that the intervention group had significantly fewer trip-induced falls compared to the control group, indicating that reactive balance training with unpredictable trips may enhance balance recovery in individuals with MS. There was no significant difference in the rate of slip-induced falls between the two groups.

Further analysis of the data suggested that the trip and slip training also led to improved dynamic stability, increased limb support and reduced trunk sway during some trip recovery steps.

The intervention group had a 14% drop-out rate, suggesting that adjustments may be needed to make this form of reactive balance training more acceptable for people with MS.

What does this mean for people with MS?

Studies have revealed that more than 50% of people with MS fall one or more times over a three-month period, with trips and slips being the common causes. Reactive balance is a particular challenge for people with MS.

This study demonstrates that providing reactive balance training to people with MS can improve their balance recovery responses to sudden trips. This is an encouraging finding because trips are the most commonly reported cause of falls in people with MS.

Even though they may walk more slowly, people with MS are four times more likely to fall following a trip compared to individuals free from MS. In addition to the improved balance recovery responses, the study revealed improved trip-induced dynamic stability, limb support and trunk control. These benefits all aid in improved walking stability and a lower fall risk.

While more research is required to refine the training protocol and determine its long-term effects, the potential benefits of reactive balance training are significant.

Future clinical interventions encompassing reactive balance training may contribute to reduced fall rates, lower injury-related costs, reduced fear of falls, and an overall improved quality of life for people with MS.