Multiple Sclerosis (MS)


Multiple Sclerosis can be a condition which causes only minor difficulties to an individual, or it can have severe effects on an intermittent or continuous basis, usually with a worsening of general levels over time.

Increasingly research is finding that well-stimulated and challenged bodies are better able to withstand the disease.  The main theory for this suggests that, as deterioration in MS is caused by message pathways becoming inactivated (either temporarily or permanently), the more pathways that are kept open and active the less effect a “shutdown” will have. 

Exercise aims to enhance the pathways, maintain muscle strength and function to overcome “shutdowns” and develop balance and co-ordination skills to preserve them against neurological loss of function.  Research into Tai Chi is increasingly showing benefits in all these areas.


Research:

Does Tai Chi/Qi Gong help patients with Multiple Sclerosis?
N. Mills, J. Allen, S. Carey Morgan

Abstract: Tai Chi posture has recently been shown in a number of random controlled trials to improve balance, posture, vigour and general well-being in a variety of client groups. These are problems commonly encountered by people with Multiple Sclerosis. The present study was therefore designed as a pilot evaluation of the usefulness of Tai Chi/Qi Gong for people with Multiple Sclerosis. Eight individuals with Multiple Sclerosis were monitored over a 2-month baseline and 2-month intervention. Statistically significant pre to post improvements for the group as a whole were achieved on measures of depression and balance. A 21-item symptom check-list indicated small improvements over a broad range of other self-rated symptoms.


This pilot study attempted to provide some preliminary data on the usefulness of Tai Chi/Qi Gong for people with Multiple Sclerosis.

Method
An intervention programme was developed based on exercises that are fundamental to most Tai Chi training programmes. The programme did not attempt to teach the complex `forms' associated with long-term practise, but rather focused on the fundamental principles of balance, movement, sensory awareness and breathing that underlie Tai Chi as described by Frantzis (1993). These principles are known as `Qi Gong' which literally, translated means the `cultivation of energy'. Participants were encouraged to make a commitment to a daily homework practise of at least 30 minutes.  

Each participant was required to fill in an assessment battery on three occasions: 2 months prior to the intervention, immediately prior to the intervention and immediately after the intervention. The assessment battery included: 

(i) The Profile of Mood States (POMS)  
(ii) Check-list of physical symptoms relevant to Multiple Sclerosis 
(iii) Balance.  
(iv) The extent of disability was assessed by the Activities of Daily Living (ADL) Questionnaire.

Participants were also asked to keep a record of frequency of duration of homework practise. Participants all completed a minimum of a 2-month baseline.  For some participants this was as long as 6 months as they were waiting for a place to become available in the treatment programme. Intervention took place over a 2-month period.


Results
Profile of Mood States (POMS). Comparisons of the POMS scores for base-pre-post assessments were made using two-way anovas. Tests confirm that significant change occurred for the Depression-Dejection factor between pre(6.25)-post(3.00) measures (t=2.07(7), P50.04 (one tailed). A significant pre(13.88)-post(11.25) decrease in Fatigue-Inertia was obtained (t=2.317(7), P50.03 (one tailed)). However, this difference ceases to be significant when the variability of base pre scores are also included in the analysis. 

Check-list of physical symptoms relevant to Multiple Sclerosis  Participants were asked to indicate improvement on a 3-point scale `little', `some' or `a lot'. Proportion of the participants improvement responses (as percentage of total response rate) were as follows, `little: 16%; some: 9%; lot: 7%'. A summary of a friend/ relatives' independent rating of the same symptoms were as follows: `little 12%; Some 8%; Lot: 7%'. Using a Chi-square Test of Association significant evidence was found for an association between participants and friend/family members differential rating of overall symptom change (Chi=10.13 (2) P50.001).

Balance
Comparison of length of time (seconds) of balance whilst standing on one leg in pre-post measures were made.  A student's t tests shows that there is a significant change occurring between pre(5.63)-post(11.88) measures (t=1.96(7), P50.05 one tailed).

Participant feedback
At the end of the intervention participants were sent a feedback form rating the usefulness of the different components of the Tai Chi/ Qi Gong programme. 

Homework practise time 
Participants were asked to keep a weekly record of how much time they spent doing individual practise. It is notable that participant number 6 who practised for the least amount of time was also the most disabled as assessed by the ADL. This participant also reported the least improvement as measured by the 21-item symptom check-list and was the only subject who did not improve in balance.

Discussion
The fact that this pilot study appears to show improvements in functioning in specific areas points strongly to the need for replication with a larger study and extensive follow-up.  Multiple Sclerosis has an unpredictable course and this factor makes it a very difficult disease in which to evaluate treatment efficacy.

At present there is not one recognized outcome measure that reflects the broad spectrum of symptoms associated with this disorder (Thomson & Hobart 1987). This study therefore had to develop its own symptom rating scale. Since this is a pilot study there was no opportunity to carry out extensive checks as to the reliability and validity of this scale. Not withstanding these difficulties some interesting patterns have emerged from this study which deserve replication. Firstly, is the finding that depression shows a significant improvement. This would be expected from the non-specific factor of `doing something', thus giving a sense of mastery.  None-the-less, the fact that a significant improvement was obtained with a sample size of only eight is indicative of the strength of the effect. Previous studies utilizing
cognitive-behavioural therapy have also produced improvements in levels of depression (e.g. Crawford & McIvor 1987). However this involved considerably more time input, 13 group sessions compared to the six sessions of this study.  Specific changes in physical functioning are harder to explain away by a non-specific effect.  Improvements in balance, as measured by the one leg-standing assessment, were obtained by seven of the eight participants. Most participants doubled the amount of time they were able to stand on one leg. Standing on one leg was not part of the Tai Chi/Qi Gong routine, although two of the exercises did emphasize shifting weight in a controlled way from one leg to the other.  This improvement in balance was accompanied by an improvement in walking as rated by the symptom check-list for distance (four participants) and steadiness (three participants). Difficulties in walking may be determined by factors other than balance, including fatigue as well as afferent and efferent nerve transmission. These factors may well have been more important than balance for the participants reporting no improvement. The participants who felt their spasms and numbness had improved felt they had benefitted in particular from the form of self massage, Tui Na (Mercati 1997). Tui Na massage involves the participant making tiny manipulations of the fingers and toes Two participants felt this had been the most useful part of the whole programme as it enabled them to bring sensation back to their extremities, reducing numbness. The programme as a whole, (including handouts, audio tape, videotape and individual instruction on exercises) seemed to be valued in its entirety.

Conclusion
This pilot study found that an intervention of six sessions of individual Tai Chi/Qi Gong instruction, supplemented by audio and video teaching aides produced significant improvements in depression and balance across the group as a whole. Specific improvements for individuals were also reported on a range of other symptoms including spasms, numbness, bladder control and walking. Proponents of Tai Chi/Qi Gong suggest that benefits often only accrue after sustained practise over a period of months. It would therefore be important to collect further follow-up data. The authors hope to publish follow-up results in the near future.


Edited from the:
JOURNAL OF BODYWORK AND MOVEMENT THERAPIES JANUARY 2000

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Relevant Qualifications:
                                        Modern Pilates Stage 2 Core Stability and Postural Alignment 2006
                                                                             Later Life Training: Exercise for the Prevention of Falls and Injuries in Frailer Older People, 2009
                                                                            Balanced Approach: The Use of Tai Chi & Chi Kung for Falls Prevention and Rehabilitation, 2014