Check out our interview with Rocky Mountain MS Center at Anschutz Medical Campus Director of Rehabilitation and Human Performance Research, Dr. Jeff Hebert, PhD, PT, MSCS, to learn about his research. Also, don’t miss the most recent edition of InforMS, which is all about research and its many facets.
Given that when we think of clinical trials we tend to think of drugs, it may come as a surprise to some that you, as a physical therapist that specializes in MS, conduct numerous clinical trials. Please tell us about your current research.
Dr. Hebert: The exercise treatment I’ve designed for improving balance in persons with MS —based on over 15 years of clinical experience—was successful in a pilot study. It tries to mimic some of the environmental challenges that may be particularly challenging for a person with MS. The study treatment integrates balance control, head movements—eyes open, eyes closed—multi-tasking while standing on different surfaces, as well as walking and performing head movements and turns on command.
As a follow-up to the pilot study, we are currently working on a three-year, fully funded study to further determine who might benefit the most from the exercise treatment. The primary aim of the study is to determine the effect of the exercise program on balance as a function of central sensory integration. This aspect of balance incorporates input from three senses: visual input, sensory feedback from the legs and the trunk, and feedback from the vestibular system or inner ear, and is the main process that people use to remain stable while standing and walking. We continue to be interested in looking into how these three senses are processed and integrated in the brain of persons with MS, in order to improve their response to imbalance.
Balance is a complex issue. We are looking at who might benefit most from the treatment based on lesion location. For example, comparing people who have lesions in the brain stem and cerebellum to those who do not have involvement in those areas. We are also exploring what causes imbalance, and whether we can improve the upright posture control of balance and at the same time improve the other complaints that may come with imbalance—such as fatigue, dizziness and overall quality of life.
Balance problems are often seen as a more subtle MS issue. People with MS who have a low to moderate disability level and don’t have significant problems with muscle function or spasticity may be undertreated and under-referred for this type of exercise program—even though they can benefit tremendously from it.
What you’re saying is that people who have the more subtle symptoms of MS—such as imbalance, fatigue and dizziness—and may be adjusting their lives accordingly and making modifications, we can actually perhaps make those problems better?
Dr. Hebert: Medical management of the disease process is obviously a priority for MS patients, but a close second is exercise and physical activity. Often people think, “My MS is doing okay. I have no new lesions. I have these other problems—balance, fatigue and dizziness—though, but that’s part of MS, so I just have to adapt.” Individuals who have some balance and gait problems, or other difficulties walking and turning quickly, don’t necessarily have to live with these. This is something that we can help them condition and improve.
Given the importance of physical therapy and the benefits it can provide, what are your suggestions for people who would like to find a physical therapy (PT) to work with?
Dr. Hebert: My suggestion is to search out a PT that has as much experience with MS as possible—a certified MS care specialist, or someone who has some experience with persons with MS. The second choice would be a physical therapist who specializes in neurological issues, rather than one who only specializes in rehabilitating other medical issues such as orthopedic sports injuries and the like.
What if individuals do not have access to the above specialists?
Go to your local MS centers—for us in Colorado that is the Rocky Mountain MS Center (303-788-4030)—or to the National MS Society Information and Referral Center (1-800-344-4867) and get a list of practitioners in your area. At the very least, look for a therapist who is willing to consult with an MS rehabilitation specialist—through email and phone conferences. I frequently consult with clinicians locally and across the nation.
Additional links
- Read last month’s eMS News article – Spinal Taps: A Critical Research Tool.
- Interested in more articles? Subscribe to our quarterly magazine InforMS.