Project R-5576

The effects of oculomotor retraining on upper and lower limb function in progressive MS. A proof of concept study International Progressive MS Alliance. (Research)

Ataxia is seen in approximately two thirds of people with Multiple Sclerosis (MS). People with ataxia have symptoms of tremor, incoordination of eye, arm and leg movements, poor balance and walking. Medication and deep brain surgery have limited effects on ataxia and the mainstay of treatment is rehabilitation. People with ataxia find it difficult to perform tasks such as reading, manipulating tools, balancing, avoiding obstacles. One reason for this is that people with ataxia often move their eyes involuntarily side-to-side and have inaccurate eye movements to stationary and moving targets. The inaccuracy in eye movements means that targets are not seen accurately and vision is blurred. Visual information and information about the position of the eye are crucial in planning forthcoming arm and leg movements. In other patient groups with ataxia we have shown that these inaccurate eye movements directly lead to inco-ordinated arm and leg movements. Ours and other groups have also shown that eye movements can be re-trained and that this can lead to an improvement in activities such as walking and balancing. This project aims to investigate whether eye movement problems in people with MS affect functional tasks such as walking, balancing, reaching and reading. We will also explore whether a 4 week community-based program of eye movement re-training improves these tasks. We will look at 30 people with progressive MS who have symptoms of ataxia. We will initially accurately measure people's eye movements when performing specific functional tasks such as reading, balancing in front of moving visual stimuli (as can occur when walking down a busy street), accurately placing the foot while walking, avoiding obstacles and reaching for objects. We will then randomly divide the group into two; one group will perform a 4 week program of eye movement training and the other group will carry on with their usual care. We will measure people at the beginning and end of the 4 week period to see whether there are any differences between the groups in terms of the specific functional tasks and peoples' views as to whether they feel they have improved. The study will provide essential data on the importance of eye movements in producing functional deficits in people with MS. It will provide preliminary data into the effects of a re-training program. Information gathered from the study such as the rate of recruitment of participants into the study and size of the effect with re-training will be used to plan a larger trial that will provide definite data as to the effectiveness of this program. This will be the first study that will systematically link the control of eye movements to a range of functional tasks in people with MS and explore the effects of eye movement re-training. The re-training package is easy to perform and progress using a DVD and booklet and can be performed at home. It has the potential to improve the ability and quality of life of people with MS and ataxia.

01 August 2014 - 01 March 2016