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

eS176

WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426

Conclusion(s): A blended format curriculum for bridging programs that includes academic content/skills and clinical exposure can allow IEPT learners to attend part-time from their home location. IEPT learners are willing to complete multifaceted bridging programs. The quality of the learning experience is valued by IEPTs. Implications: High quality educational programming is possible with the appropriate mix of learning activities, instructional design and supportive technologies. Bridging programs can be offered in flexible formats that fit within learners’ busy lives. Keywords: IEPT Bridging Program; Blended format; Instructional design Funding acknowledgements: Funding was provided by a grant from Health Canada and administrative support by Alberta Health. Ethics approval: Ethics approval was received by the Ethics Review Board at the University of Alberta. http://dx.doi.org/10.1016/j.physio.2015.03.331 Research Report Poster Presentation Number: RR-PO-08-14-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 THE IMMEDIATE EFFECTS OF AN INTERVENTION BASED ON THE BOBATH CONCEPT ON BALANCE AND GAIT IN PEOPLE WITH MULTIPLE SCLEROSIS P. Ilett 1 , N. Lythgo 2 , C. Martin 3 , K. Brock 1 1 St

Vincent’s Hospital, Melbourne, Physiotherapy, Melbourne, Australia; 2 RMIT University, School of Medical Sciences, Melbourne, Australia; 3 University of Melbourne, School of Physiotherapy, Melbourne, Australia 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. Results: 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). Conclusion(s): This study indicates that a single treatment based on principles of the Bobath concept to the foot and ankle can result in immediate improvements in balance and ankle plantarflexion during gait in people with MS. Implications: This study demonstrated that Bobath based interventions to the foot and ankle can improve performance in balance and gait tasks. Further investigations are warranted to assess the effect of this intervention over longer time periods and in conjunction with Bobath based interventions in standing. Keywords: Multiple sclerosis; Balance; Bobath concept Funding acknowledgements: St Vincent’s Hospital Research Endowment Fund. Ethics approval: Human Research Ethics Committee, St Vincent’s Hospital, Melbourne. http://dx.doi.org/10.1016/j.physio.2015.03.332