Balance-based torso-weighting in a patient with ataxia and multiple sclerosis: a case report.

OBJECTIVE The use of external body weights, although controversial, is occasionally employed to improve balance or mobility in patients with ataxia or tremor. This case report describes the effect of torso-weighting to counteract directional balance loss in a woman with relapsing/remitting multiple sclerosis. CASE DESCRIPTION Clinical examination of a 40-year-old woman after multiple sclerosis exacerbation revealed loss of balance in the posterior direction during quiet standing as well as loss of dynamic balance in the posterior and lateral directions. The patient's standing posture was with her trunk posterior to her pelvis. She exhibited decreased strength in both extremities and trunk, diminished sensation in the right lower extremity and palms, and an unstable ataxic gait. Difficulty with walking and severe fatigue and dizziness were also reported. Standing balance and alignment were examined during (1) quiet standing with eyes open and eyes closed, (2) transitional movements, and (3) multidirectional trunk perturbations. The patient demonstrated a loss of balance and alignment in the posterior direction in all tests. INTERVENTION Based on balance examination results, the patient was fitted with a 0.5-lb vest containing 1.5-lb of additional weight placed anteriorly on the torso at the level of the umbilicus. Progressive balance, gait, and functional activities were repeated both with and without weighting the torso over six weeks. OUTCOME Immediately on weighting, the patient demonstrated less sway in quiet standing, increased stability when perturbed, improved body alignment, and less ataxia during gait. The patient was able to accomplish more challenging activities with better balance while weighted. Functional improvement in walking and improved control during balance activities were demonstrated in later treatment sessions without weighting. CONCLUSION Placing small amounts of weight asymmetrically on the torso, based on directional loss of balance and alignment, seemed to assist this patient in maintaining balance during static and dynamic activities. Additional research may help determine whether this intervention is applicable to others with directional losses of balance, ataxia, or multiple sclerosis to improve balance control.