SfN: Ballet Improves Ataxia in MS

I bet your doctor will never suggest this solution for your ataxia from your stroke. It is too damned difficult to translate an intervention for MS to one for stroke.
http://www.medpagetoday.com/mastery-of-medicine/neurology-mastery-in-ms/61506?
A rehabilitative dance program based on classical ballet improved ataxia among multiple sclerosis (MS) patients in a pilot study, researchers reported here.
Among the six patients enrolled in the program, all had significant improvements on most measures of the International Cooperative Ataxia Rating Scale (ICARS), Citlali Lopez-Ortiz, PhD, of the University of Illinois at Urbana-Champaign, and colleagues reported at the Society for Neuroscience meeting here.
"Animal models have shown that exercise increases myelination," Lopez-Ortiz told MedPage Today. "We think this sort of more heavily loaded, whole body exercise might be pushing some of the mechanisms that are improving conduction in MS so that we see improved coordination and reduction in ataxia."
The benefit of exercise and rehabilitation has been established, but there has been little focus on improving agility and smoothness of movement in exercise interventions for those with MS, the researchers said.
So they developed a targeted exercise intervention based on classical ballet training with the goal of improving agility, balance, ataxia, and smoothness of movement in MS. The program relies on knowledge about the nature of motor impairment and sensory processing as well as on the whole body movement associated with conservatory training in classical ballet, Lopez-Ortiz said.
"We think dance is important because it uses music, and research has identified that there is an effect of entrainment facilitation of movement when a rhythm is given to you. Dance couples music and movement intrinsically. Also, classical ballet has a high cognitive demand, involving the entire body all the time. Of all possible forms of dance, it is the most demanding, but it creates the most dexterous people on the planet. It's a technique that has been developed over 500 years, and over that time people have been able to identify what really works in training the motor system."
The researchers enrolled six patients with MS, ages 49 to 65, with Expanded Disability Status Scale (EDSS) scores ranging from 4.5 to 6.5 -- indicating walking impairment -- into the 16 week pilot study that involved two hour long classes per week.
The primary investigator, who has a Bolshoi Ballet Academy Teacher Certification and neuromuscular rehabilitation expertise, led the classes.
Balance was assessed using the Mini-BESTest, and ataxia was measured on the International Cooperative Ataxia Rating Scale.
Smoothness of gait was measured by calculating s-indexes of 29 reflective markers placed on anatomical landmarks of the body in a 5 meter walk test.
Overall, the researchers found that gait smoothness significantly improved on all measures at all locations, including the upper arm, elbow, upper leg, and knee.
Patients also had a significant, 42%, improvement on the Mini-BESTest, which Lopez-Ortiz noted far surpassed results in the literature for other exercise interventions.
"Previous literature on exercise interventions in MS shows improvements of about 10% to 15% in balance and walking ability in early-stage disease," she told MedPage Today. "In this study, although it's a pilot and we're still collecting data, we see improvement of 42% in balance and walking ability combined."
The team also found a benefit for ataxia, with significant improvement on all measures of ICARS (including posture and gait and kinetic), with the exception of the oculomotor test.
Lopez-Ortiz noted that dance provides motivation, social interactions, emotional expression, music, and targeted physical tasks in a single program centered on movement rehabilitation. Also, the cost of dance is a fraction of that of traditional pharmacological interventions for MS, she pointed out.
Next steps include doing a larger clinical trial, as well as digging further into the potential mechanisms behind the benefits.
Lopez-Ortiz said that the team has also tested this dance program in children with cerebral palsy and adults with Parkinson's disease, and has seen improvements in movement quality as well as clinical improvements "that make a difference in peoples' lives. Most commonly, it improves balance, but it also improves measures of coordination and movement in general."

The study was supported by the National Multiple Sclerosis Society.
Lopez-Ortiz disclosed no financial relationships with industry.

• Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

• Primary Source

  Society for Neuroscience Meeting

  Source Reference: Lopez-Ortiz C, et al "Ataxia rehabilitation in multiple sclerosis through a targeted dance class" SFN 2016; Abstract 533.16/BBB1.