Effect of vestibular rehabilitation on kinetic and kinematic parameters of gait in patients with Multiple Sclerosis

[The aim of our study was to evaluate the effect of a vestibular rehabilitation programme compared to a conventional exercise programme on kinetic and kinematic parameters of gait and dual-task gait in patients with Multiple Sclerosis (MS). The study included 22 volunteer patients with MS (age range 25-60 years, 3.5≤EDSS≤6.5). Participants were randomly divided into two groups: vestibular rehabilitation (VR) group and conventional exercise (CE) group. The VR group received a vestibular physiotherapy programme including adaptation, habituation, substitution, postural control, mobility and balance exercises, while the CE group received a conventional physiotherapy programme including stretching, strengthening, posture and balance exercises. The treatment of both groups continued for eight weeks, two days in a week for 45 minutes under the supervision of a physiotherapist in the clinic and one day in a week as a home programme. Gait assessment of the participants, the primary outcome measure of the study, was performed with 3D Gait Analysis. Before and after treatment, the gait of participants was evaluated in three different ways single task, motor task, and cognitive task. In addition, 2 Minute Walking Test (2MWT), 10 Meter Walking Speed Test, One-leg Standing Test (OLST), Visual Acuity Test and Dizziness Handicap Inventory were also applied in the evaluation of the participants as a secondary assessments. SPSS version 29.0 was used in statistical analysis and p<0.05 was considered significant in all statistical tests. The mean age of the participants in the VR group was 44.45±3.56 years and EDSS level was 3.95±0.14; the mean age of the participants in the CE group was 45.90±2.67 years and EDSS level was 4.18±0.20 (p>0.05). In temporospatial parameters, step length increased in all three gait types in the VR group, while cadence, double step length, and walking speed increased in motor and cognitive task gait (p<0.05). In the CE group, there was a decrease in double support time in single task and motor task walking (p=0.05), while there was an increase in walking speed in single task walking (p=0.02) and cadence in cognitive task walking (p=0.03). In terms of kinematic parameters, there were significant differences between the groups in pelvic tilt range of motion (p=0.02), knee varus- valgus range of motion (p=0.04) and ankle rotation angles (p=0.03) in single task and motor task gaits, while there were significant differences in knee varus - valgus (p=0.05) and ankle rotation (p=0.03) angles in cognitive task gait. When kinetic parameters were compared between the groups, peak knee extension moment in the 30-60% cycle of gait decreased in the VR group and increased in the CE group (p=0.04). When 2 DYT (p=0.03) and dominant side TADT (p=0.05) times were compared between the two groups, a significant improvement was found in favour of the VR group. According to results of our study, VR therapy applied for eight weeks is more effective on knee extension moment, which is one of the kinetic components of gait, and pelvic tilt, knee varus valgus and ankle rotation, which are kinematic components of gait, than conventional physiotherapy treatment. It was concluded that supporting the rehabilitation programs of MS patients with VR exercises contributed to the improvement of various kinetic and kinematic parameters of gait.