IMPACT OF THE BALANCED-BASED TORSO WEIGHTING SYSTEM ON FALLS, GAIT SPEED AND GAIT
QUALITY IN AN INDIVIDUAL WITH MULTIPLE SCLEROSIS: A CASE REPORT
Ann Vivian, Cynthia Gibson-Horn*
Physical Therapy, Mills Health Center, San Mateo, California
BACKGROUND AND PURPOSE:
People with Multiple Sclerosis (MS) often
experience falls and have gait and balance
disorders. Balanced-Based Torso Weighting
(BBTW) is a treatment intervention in which
small amounts of weight are strategically placed
on the torso to improve postural control and
stability. Research in BBTW demonstrates
improvements in gait and balance in people
with balance deficits from MS. (1-4)
This case report describes the use of BBTW to
improve balance, gait, and reduce falls/
risk in an elderly individual with MS.
CASE DESCRIPTION:
67-year-old female with a two year history of
Primary Progressive MS.
Patient Goals: Improve balance, gait speed,
endurance and decrease falls.
TREATMENT: The subject received balance
training in addition to a trial of BBTW for a total
of 12 visits, the last seven of which included
training with BBTW. Two pounds were required
to improve postural control and gait: two 0.5
pound weights anterior trunk, 0.5 pound left of
lumbar spine and 0.5 pound at left posterior
shoulder. The therapy ended soon after the
subject received her own BalanceWear ®Lumbo
Sacral Orthotic (LSO).
BalanceWear® wear time: 9:00 am to 7:00 pm.
Patient contacted at 1 , 6, and 12 months post
discharge to determine continued effectiveness
of the BalanceWear® Therapy.
TREATMENT OUTCOMES
BEFORE THERAPY AND
BBTW
AFTER THERAPY AND
BBTW
FALLS 2 TO 4 TIMES PER WEEK
FALLS 0 TO 3 TIMES PER MONTH
SELF REPORTED WALKING
DIFFICULTY ON UNEVEN SURFACES
AND HILLS WITH BIL. WALKING
STICKS. USES WALLS AND
FURNITURE IN HOUSE, NO DEVICE
SELF REPORTED WALKING
WALKS EASILY ON UNEVEN
SURFACES AND HILLS INCLUDING
COBBLESTONE STREETS WITH BIL.
WALKING STICKS. LESS USE OF
WALLS AND FURNITURE IN HOUSE
CONCLUSION:
This is the first report of long
term outcomes reported in an elderly patient with MS.
GOALS MET: The patient reports significantly less falls
over the year, improvement in endurance and walking
on varied surfaces enabling her to enjoy her vacations
in Croatia and Panama over the past year. This case
report demonstrates that improvements in gait
kinematics and a reduction in fall risk can be made with
strategic weighting of the torso with BBTW and
BalanceWear Therapy™.
Minimal Detectable Changes were shown in gait speed
and the BBS. Of interest, Patient reports losing 10-15
pounds since purchasing her BalanceWear® vest.
GAIT PATTERN WITHOUT BBTW
ASSISTIVE DEVICE (AD):WIDE BOS
PATH DEVIATION GREATER THAN 6
INCHES, UE’S IN HIGH GUARD
GAIT PATTERN WITH BBTW
WITHOUT AD: NARROWER BOS,
LONGER STEP LENGTH, UE’S AT
SIDES WITH RYTHMICAL SWINGING
GAIT PATTERN WITH BBTW
BIL WALKING STICKS: WIDE BOS,
PATH DEVIATION LESS THAN 6
INCHES.
VELOCITY GAIT SPEED
SELF-SELECTED : 0.52 M/SEC.
FAST GAIT SPEED: 0.67 M/SEC.
GAIT PATTERN WITH BBTW
BIL WALKING STICKS: NARROWER
BOS PATH DEVIATION LESS THAN 4
INCHES.
VELOCITY GAIT SPEED
SELF SELECTED: 0.88 M/SEC. *
FAST GAIT SPEED: 1.52 M/SEC. *
BERG BALANCE SCALE 25/56
High Fall Risk
BERG BALANCE SCALE 45/56 *
Less Fall Risk
1.Gibson-Horn C. Balance-based torso weighting in a
person with ataxia and multiple sclerosis: A case report.
J Neurol Phys Ther. 2008;32: 139-146
ENDURANCE
AMBULATES 3 BLOCKS WITH BIL
WALKING STICKS requires 2 - 3
RESTS
ENDURANCE
AMBULATED 3 BLOCKS WITH BIL
WALKING STICKS requires 0 - 1
REST
2.Widener GL, Allen DD, Gibson-Horn C.. Balancedbased torso-weighting may enhance balance in persons
with multiple sclerosis: preliminary evidence. Arch Phys
Med Rehabil. 2009 90: 602-609
Limitations of this study include lack of access to
equipment for measuring more exact gait parameters
such as path deviation, base of support and step length.
The subject did not own the vest until the end of
therapy treatment. She may have shown more gains in
gait speed and improved score on the BBS if she had
been wearing the BBTW device every day for several
weeks.
3.Gorgas AM, Widener GL, Gibson-Horn C, Allen DD.
Gait changes with Balance-Based Torso-Weighting in
people with Multiple Sclerosis. Physiother Res Int. 2014
Jun 14
4.Hunt CM, Widener GL, Allen DD. Variability in postural
control with and without balance-based torsoweighting in people with multiple sclerosis and healthy
controls. Phys Ther. . 2014; 11: 90-100
BalanceWear®
*Cindy Gibson-Horn has a financial interest in Motion
Therapeutics