Impact of a course dynamic neuromuscular stabilization (DNS) training program on balance and ankle proprioception in female patients with MS

Document Type : Research Paper

Authors

1 Assistant Professor of Sports Physiology, Department of Physical Education and Sports Sciences, Faculty of Humanities, Ragheb Esfahani Institute of Higher Education, Isfahan, Iran (corresponding author)

2 Master of Pathology and Corrective Movements, Department of Physical Education and Sports Sciences, Faculty of Human Sciences, Ragheb Esfahani Institute of Higher Education, Isfahan, Iran

Abstract

Introduction
The aim of this study was to evaluate the impact of a course dynamic neuromuscular stabilization (DNS) training program on balance and ankle proprioception in female patients with MS.
Material and Method
For this study, 24 people were selected who were divided into control (Number: 12 people, Age: 45.50 ± 3.06 years, Height: 1.66 ± 0.02 m, Weight: 58.08 ± 3.05 kg, BMI: 20.99 ± 1.04 Kg/m2, EDSS: 2.05 ± 0.75) and training (Number: 12 people, Age: 43.91 ± 2.84 years, Height: 1.65 ± 0.03 m, Weight: 56.91 ± 4.73 kg, BMI: 20.75 ± 1.17 Kg/m2, EDSS: 1.91 ± 0.51) groups. In this study, static balance was evaluated by Sharpen Romberg test and dynamic balance was evaluated by Timed Up and Go test. Also, ankle proprioception was evaluated in two positions dorsiflexion and plantar-flexion with a goniometer. At the end of the evaluations, the training group performed the exercises for 6 weeks (3 sessions per week). The control group also engaged in their daily activities during this period. Assessments were performed again after the exercises. In this study, Shapiro–Wilk test was used to check the normality of the data. Analysis of covariance and paired t-test, Yu Mann-Whitney and Wilcoxon were also used to analyze the effect of exercise on variables and differences between groups. SPSS24 software was also used to analyze the data in this study.
Results
The results of this study showed that the dynamic neuromuscular stabilization exercise program had a significant effect on improving static balance with open eyes (P=0.001) and (P=0.001), dynamic balance (P=0.001) and proprioception the foot is in dorsiflexion (P=0.01) and plantar flexion position (P=0.001). Also, the results of comparison between the two groups showed a significant difference between the two groups (P≤0.05).
Conclusion
Based on the results of using this exercise program, it is recommended to the therapists involved with these patients.

Keywords


  1. Bansi, J., & Kesselring, J. (2015). Exercise and Sports Therapy in Multiple Sclerosis. Deutsche Zeitschrift für Sportmedizin66(11). 44-65.
  2. Rodgers, S., Manjaly, Z. M., Calabrese, P., Steinemann, N., Kaufmann, M., Salmen, A., ... & Ajdacic-Gross, V. (2021). The effect of depression on health-related quality of life is mediated by fatigue in persons with multiple sclerosis. Brain Sciences, 11(6), 751.
  3. Alonso, A., & Hernán, M. A. (2008). Temporal trends in the incidence of multiple sclerosis A systematic review. Neurology71(2), 129-135.
  4. Clanet, M. (2008). Jean-Martin Charcot: 1825-1893. The International MS Journal15(2), 59-62.
  5. Miller, D. H., & Leary, S. M. (2007). Primary-progressive multiple sclerosis. The Lancet Neurology, 6(10), 903-912.
  6. Niroomand, M., Rezaei Dehnavi, S., Etemadifar, M. The Effectiveness of Captain Log Cognitive Rehabilitation Software on Prospective and Retrospective memory in People with Multiple Sclerosis. Research in Cognitive and Behavioral Sciences, 2021; 10(2): 177-188. doi: 10.22108/cbs.2022.131283.1590
  7. Benedict, R. H., Tomic, D., Cree, B. A., Fox, R., Giovannoni, G., Bar-Or, A., ... & Kappos, L. (2021). Siponimod and cognition in secondary progressive multiple sclerosis: EXPAND secondary analyses. Neurology, 96(3), e376-e386.

 

  1. Amelia, S. E. (2012). Aquatic fitness and rehabilitation at individuals with disabilities. Sports Medicine Journal/Medicina Sportivâ8(4).
  2. Hoang, P., Schoene, D., Gandevia, S., Smith, S., & Lord, S. R. (2016). Effects of a home-based step training programme on balance, stepping, cognition and functional performance in people with multiple sclerosis–a randomized controlled trial. Multiple Sclerosis Journal22(1), 94-103.
  3. Dalgas, U., Stenager, E., Lund, C., Rasmussen, C., Petersen, T., Sørensen, H., ... & Overgaard, K. (2013). Neural drive increases following resistance training in patients with multiple sclerosis. Journal of neurology260(7), 1822-1832.
  4. Jolliffe, E. A., Guo, Y., Hardy, T. A., Morris, P. P., Flanagan, E. P., Lucchinetti, C. F., & Tobin, W. O. (2021). Clinical and radiologic features, pathology, and treatment of baló concentric sclerosis. Neurology, 97(4), e414-e422.
  5. Porosińska, A., Pierzchała, K., Mentel, M., & Karpe, J. (2010). Evaluation of postural balance control in patients with multiple sclerosis–effect of different sensory conditions and arithmetic task execution. A pilot study. Neurologia i Neurochirurgia Polska44(1), 35-42.
  6. Goldlist, S. (2020). Clinical and Laboratory Based Proprioceptive Assessments in Older Adults and People with Multiple Sclerosis(Doctoral dissertation, Université d'Ottawa/University of Ottawa).
  7. Halper, J., Harris, C., & MSCN, N. (2016). Nursing practice in multiple sclerosis: a core curriculum. Springer Publishing Company.
  8. Abbaspour E, Didani Z, Kazem Khodaie M. Investigating the effect of eight weeks of combined exercises on some indicators of physical and mental performance in women with multiple sclerosis. Medical Journal of Tabriz University of Medical Sciences, 42(1), 82-90.(Persian)
  9. Benfiry, N., Ganji, B., & Beigi, S. S. (2018). The Effect of 8 Weeks of Dynamic Neuromuscular Stability (DNS) Exercises on the Performance and Quality of Men and Women's Life with Apoplexy (Stroke). Egyptian Academic Journal of Biological Sciences, E. Medical Entomology & Parasitology10(1), 83-93.
  10. Frank, C., Kobesova, A., & Kolar, P. (2013). Dynamic neuromuscular stabilization & sports rehabilitation. International journal of sports physical therapy8(1), 62.
  11. Zamani Sima, Ganji Behnaz, Shahbeigi Saeed. The effect of eight weeks of DNS exercises on the balance of women with multiple sclerosis. 2015. Available from: https://sid.ir/paper/862256/fa Calafiore, D., Invernizzi, M., Ammendolia, A., Marotta, N., Fortunato, F., Paolucci, T., ... & de Sire, A. (2021). Efficacy of virtual reality and exergaming in improving balance in patients with multiple sclerosis: a systematic review and meta-analysis. Frontiers in neurology, 12, 773459.
  12. Frank, C., Kobesova, A., & Kolar, P. (2013). Dynamic neuromuscular stabilization & sports rehabilitation. International journal of sports physical therapy8(1), 62.
  13. Mahdieh, L., Zolaktaf, V., & Karimi, M. T. (2020). Effects of dynamic neuromuscular stabilization (DNS) training on functional movements. Human Movement Science70, 102568.
  14. Khaje Nemat, Karar; Sadeghi, Haider; Sahib al-Zamani, Mansour. (2013). The effect of eight weeks of strength training on static and dynamic balance of healthy men. Journal of sports medicine. 6 (1). pp. 45-55.(Persian)
  15. Paula, K. Yim Ch. Laura AT. (2000). "Defining and measuring balance in adults".Biol Res Nurs. 1. pp: 321-331.
  16. Westlake, C., Dyo, M., Vollman, M., & Heywood, J. T. (2008). Spirituality and suffering of patients with heart failure. Progress in Palliative Care, 16(5-6), 257-265.
  17. Karimi, Maryam; Moazzami, Mehtab; Rezaian, Najma. (1400). The effect of eight weeks of central stability exercises on some performance indicators in women with multiple sclerosis. Journal of North Khorasan University of Medical Sciences. 13 (1): 1-7.(Persian)
  18. khorshid sokhangu M, rahnama N, etemadifar M, rafeii M. (2018). The Effect of Neuromuscular Exercise on balance and motor functional in Woman with Multiple Sclerosis. Stud Med Sci, 29 (5) :362-371
  19. Kim, D. H., An, D. H., & Yoo, W. G. (2017). Effects of 4 weeks of dynamic neuromuscular stabilization training on balance and gait performance in an adolescent with spastic hemiparetic cerebral palsy. Journal of physical therapy science29(10), 1881-1882.
  20. Mitchell, K. D., Chen, H., & Silfies, S. P. (2018). Test-retest reliability, validity, and minimal detectable change of the balance evaluation systems test to assess balance in persons with multiple sclerosis. International journal of MS care, 20(5), 231-237.
  21. Marotta, N., De Sire, A., Marinaro, C., Moggio, L., Inzitari, M. T., Russo, I., ... & Ammendolia, A. (2022). Efficacy of Transcranial Direct Current Stimulation (tDCS) on Balance and Gait in Multiple Sclerosis Patients: A Machine Learning Approach. Journal of Clinical Medicine, 11(12), 3505.
  22. Davidek, P., Andel, R., & Kobesova, A. (2018). Influence of dynamic neuromuscular stabilization approach on maximum kayak paddling force. Journal of human kinetics61(1), 15-27.
  23. Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., ... & Swain, D. P. (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and science in sports and exercise43(7), 1334-1359.
  24. Amaral-Carvalho, V., & Caramelli, P. (2012). Normative data for healthy middle-aged and elderly performance on the Addenbrooke Cognitive Examination-Revised. Cognitive and Behavioral Neurology, 25(2), 72-76.
  25. Almasi, Sanaz; Shojauddin, Sadruddin; Karimi, Zahra (2018). The effect and durability of eight weeks of central stability exercises and pilates on sensory function, quality of life and pain level of women with non-specific chronic low back pain. Anesthesia and pain. 10 (4): 36-49.(Persian)
  26. Moghadasi, A. N., Mirmosayyeb, O., Barzegar, M., Sahraian, M. A., & Ghajarzadeh, M. (2021). The prevalence of COVID-19 infection in patients with multiple sclerosis (MS): a systematic review and meta-analysis. Neurological Sciences, 42(8), 3093-3099.
  27. Andreu-Caravaca, L., Ramos-Campo, D. J., Manonelles, P., Chung, L. H., Ramallo, S., & Rubio-Arias, J. Á. (2022). The Impact of Resistance Training Program on Static Balance in Multiple Sclerosis Population: A Randomized Controlled Trial Study. Journal of clinical medicine, 11(9), 2405.
  28. Ageberg, E., & Roos, E. M. (2015). Neuromuscular exercise as treatment of degenerative knee disease. Exercise and sport sciences reviews43(1), 14-22.
  29. Zech, A., Hubscher, M., Vogt, L., Banzer, W., Hansel, F., & Pfeifer, K. (2009). Neuromuscular training for rehabilitation of sports injuries: a systematic review. Med Sci Sports Exerc41(10), 1831-1841.
  30. Piirainen, J. M., Cronin, N. J., Avela, J., & Linnamo, V. (2014). Effects of plyometric and pneumatic explosive strength training on neuromuscular function and dynamic balance control in 60–70 year old males. Journal of Electromyography and Kinesiology24(2), 246-252.
  31. Lederman, E. (2010). Neuromuscular rehabilitation in manual and physical therapies: principles to practice. Churchill Livingstone/Elsevier.
  32. Holm, I., Fosdahl, M. A., Friis, A., Risberg, M. A., Myklebust, G., & Steen, H. (2004). Effect of neuromuscular training on proprioception, balance, muscle strength, and lower limb function in female team handball players. Clinical Journal of Sport Medicine14(2), 88-94.