Life with MS

Improve Movement Confidence: Sensory Stimulation

By Dr. Emily Splichal, DPM, MS
Whether we consciously realize it or not, we all want to move better, feel stronger, and stay pain-free. We all seek the ability to do the activities we enjoy - whether that is going for a long walk with a loved one or running in a local 5K. 

For those living with multiple sclerosis, if your balance is compromised and you live with a fear of falling, that can prevent you from participating in the movements you once loved. Balance impairments is one of the most common movment symptoms associated with MS, with peripheral neuropathy and foot drop further adding to a sense of instability. 

Current movement science research and product innovation provides new approaches for improving stabilization and enhancing movement confidence, thereby enhancing quality of life. This article will focus on how approaching balance and movement programs from a sensory perspective can oftentimes be the most effective. 

Below are the top three sensory stimulation pathways, along with the simple exercises that can be used with simple exercises that can be used daily to optimize balance and stability for those living with MS. 

Sensory Gateway #1 - Vision

Vision problems are some of the most common symptoms associated with MS. They are a larger contributor to instability and fall risk. The most common eye complications include:
  • optic neuritis - inflammation of the optic nerve that can cause pain and temporary loss of vision
  • diplopia - more commonly known as double vision, and can occur on one or both eyes
  • nystagmus - rapid, involuntary eye movements that affect vision and depth perception, but also balance and coordination
  • internuclear opthalmoplegia - one eye is slower to make left or right movements than the other, resulting in blurry vision when looking left or right
Our eyes which are designed to move and accommodate for light, provide us the sensory detail about our environment, and allow us to navigate during dynamic movement. A decrease in visual activity has been associated with impaired balance and delayed accuracy in motor patterns. 

A 2018 study showed the benefit of integrating eye movement exercises and visual stimulation in improving balance for those with MS. The study that focused on the BEEMS (balance and eye motion exercises for MS) integrated daily eye movement exercises for improved sensory integration and brain balancing. It is suggested to integrate five minutes of the following exercises into your daily routine.

* Vision Stimulation #1 - Eye Tracking

This exercise may be done seated or standing depending on your level of stability. Begin by holding your finger out in front of your face, about an arm's length away. Slowly move your finger up, down, and side-to-side in front of you, moving just your eyes along with your finger. Try not to move your head and remember to hold a soft gaze as you do this exercise. Perform for 30 seconds with each hand. 

* Vision Stimulation #2 - Peripheral Vision Training 

For this vision exercise, sit somewhere comfortable where you can see something in the distance. As you look into the distance, start to wave your hands quickly to the side of your head to notify your eyes that your peripheral vision exists. Do not look at your hands waving, keep looking into the distance. Perform for one minute. 

* Vision Stimulation #3 - Saccade Training

Saccades are rapid movements of the eyes that abruptly change the point of fixation. Again this exercise may be performed seated or standing. Start by looking straight ahead. Only moving the eyes, look to the left and spot an object. Immediately look to the right and spot another object. Keep moving the eyes to the left object then to the right object, slowly picking up the pace. Perform for 20 seconds. Rest. Repeat three times. 

Sensory Gateway #2 - Vestibular (brain stem and inner ear)

Often referred to as the gateway to the brain, the vestibular system is the first sensory system to develop in utero. This sensory system is critical to how our brain and body relates to gravity. In MS, vestibular disturbances typically present as vertigo, balance disorders, and the presence of nystagmus. When considering the effect of potential vestibular disturbances, it is important to understand if the disturbance is in the peripheral system, with a higher prevalance in female patients. Below are three vestibular exercises which can be integrated into any balance program. 

* Vestibular Stimulation #1 - Head Turning

Similar to some of the exercises for the visual system, vestibular training will involve turning the head with the eyes. Start in a seated or standing position. Turn the head and eyes to the left, spotting an object. Immediately turn the head and eyes to the right, spotting another object. Continue shifting the head and eyes from the left to the right for 20 seconds. Rest and then repeat, but this time looking up and down. Rest again and then perform the exercise on a diagonal. 

* Vestibular Stimulation #2 - Sit to Stand

Start seated in a chair that you can comfortably sit on the edge. Fixate your gaze on an object directly ahead of you. Holding the gaze shift from a seated position to a standing position, and then slowly return to the seated position. Repeat 10 times. 

* Vestibular Stimulation #3 - Sit-Stand-Turn

As a progression from exercise #2, the sit-stand-turn will further challenge the vestibular system by turning the whole body. Similar to exercise #2, fixate the gaze on an object when going from sit to stand. Once standing, slowly turn the entire body clockwise until you make one complete turn. Upon returning to the start position, re-fixate the gaze on the object and slowly return to a seated position. Perform five times clockwise and five times counter clockwise.  

Sensory Gateway #3 - Touch

The final sensory system for improving balance is touch. Our hands and feet are some of the most sensitive areas of the body, allowing us to connect our visual input with the external world. Neuropathies and disruptions in peripheral proprioception are often associated with MS and should be addressed before the onset of symptoms. To fully benefit from touch stimulation, it is important to understand what stimuli our skin responds to. 

The power of touch is associated with the uniqueness in the nerves of the plantar foot. The smooth skin of the feet contain special nerves called mechanoceptors. These mechanoceptors are sensitive to different stimuli including texture, skin stretch, pressure and vibration. By integrating products that feature this stimuli, one can expect an improvement in balance, posture, and gait. Here are some ways to begin to integrate touch into your movement program. 

* Touch Stimulation #1 - Textured Insoles

Texture, or two-point discrimination, is one of the most effective ways for reconnecting your feet. A 2016 study showed an improvement in gait patterns in MS patients wearing textured insoles. When worn daily, subjects have associated textured insoles with improved foot sensation and balance coordination. 

* Touch Stimulation #2 - Whole Body Vibration 

Another stimulation that feet are sensitive to is vibration. Dynamic movement creates vibration upon foot contact, making the simple act of walking an effective means to improve vibratory stimulation. In those that have limited mobility, whole body vibration platforms offer a similar benefit. Mimicking the impact forces of walking. WBV can stimulate the nerves in the feet, build bone density, and enhance muscle strength. 

* Touch Stimulation #3 - Sit-Stand-Turn

Daily release of the feet on a lacrosse ball or foot roller is an easy and effective way to improve balance. A recent study found immediate improvement in balance after foot massage. The foot release can be performed seated or standing, with a slow increase in pressure to the bottom of the foot. Try to roll out all areas of the bottom of the foot for a total of five minutes per foot. 

As you begin to integreate these exercises into your program, remember that consistency is the best kept secret to begin seeing a benefit. Just five to ten minutes a day, every day, of the above exercises will translate to better balance. Try to make all of the above tips a part of your lifestyle and soon you will be on your way to movement confidence.