The effects of locomotive exercise therapy on individuals with Multiple Sclerosis

The training program will consist of 36 ABLE-T training sessions per participant. Each participant will receive training three time per week of across 12 week period. Each session will consist of a warm-up of 20 assisted squats, followed by five times 3 minute intervals of step retrain and two 3 minute intervals of step adapt using the Therastride harness and treadmill system. Step retrain involves the continual increase in weight bearing while maintaining proper posture and positioning of standing by manual facilitation at trunk, pelvis and legs as needed. Step adapt promotes independence by varying the bodyweight support and treadmill speed. Each session is 60 minutes in duration. The harness will be used to reduce body weight and support the individual during the training session.The locomotor leg movements will be assisted by two trainers, each sitting at one side of the individual. For each training session, training variables will be recorded such as walking speed, amount of body weight support, duration of training and heart rate will be recorded. Pre and post intervention, through the measurement of EMG activity, we will examine and provide physiological and neurological evidence on changes in neuroplasticity from the 12 weeks of locomotive exercise (ABLE-T programme) in individuals with Multiple Sclerosis. We will examine the correlation of these changes with step and stride length, 6 minute walk time, 10 m walk time and balance, which will provide secondary outcome measures which are integral components to assessing the effectiveness of our programme, also measured pre and post intervention. Muscle activity assessment Each participant will need to wear shorts. Whilst lying down, electrodes will be placed on the upper and lower legs (bicep femoris, rectus femoris, tibialis anterior and gastrocnemius). The equipment will then be calibrated to zero before proceeding with maximal voluntary contractions (MVC). MVC are performed prior to testing to provide a normalized reference point for each participant. The participants will put on the Therastride harness and will complete two bouts of 3 minutes of assisted walking (1 x bout at 0.5 mph and 1 x bout at 0.9 mph). Following this they will complete a further assisted walk on the Therastride treadmill for 1 minute at a speed of 0.9mph, where a segment of muscle activity will be recorded. Step and stride length assessment Step length is measure of left to right imbalance. You will be asked to walk for 10 steps. Each time your heel strikes the ground a mark will be placed at the heel. The distance will be measured between left and right heel strikes. Stride length is the distance between two successive placements of the same foot. You will be asked to walk for 10 steps. Each time your left foot strikes the ground, a mark will be placed at the heel. The distance will be measured between your left heel strokes. You will be asked to repeat this on your right foot. The distance will be measured between your right heel strokes. Balance measurement Balance will be assessed using the in-ground force plate. You will be asked to stand on the force plate with the feet in a normal parallel position, with eyes open for up to 30 seconds. Second balance position is having the instep of one foot so it is touching the big toe of the other foot, with eyes open for up to 30 seconds. the final stance requires the stance of heel-to-toe with eyes open for up to 30 seconds. 10m Walk Test This is a test of lower limb strength. You will be asked to walk 10m at a comfortable speed. You can use mobility aids if required. The time taken from an average of 3 tests, is used to calculate gait speed. 6-minute walk test The 6-minute walk test will assess your functional exercise capacity. Your blood pressure and heart rate will be measured before the walk. You will be asked to walk up and back long a 30m track for up to 6 minutes. The test can be reduced to 2 minutes if you are finding this difficult. During the test, you are allowed to stop and rest. You can also use mobility aids if required. Your heart rate will also be measured following completion of the walking test. Testing and training will commence at Massey University in The Human Performance Lab and locomotive training room. All testing will be done with one participant, the lead investigator and assistant and the training will include 2 more assistants.