1. IMPACT OF THE BALANCED-BASED TORSO WEIGHTING SYSTEM ON FALLS, GAIT SPEED AND GAIT QUALITY IN AN INDIVIDUAL WITH MULTIPLE SCLEROSIS: A CASE REPORT Ann Vivian, Cynthia Gibson-Horn* Physical Therapy, Mills Health Center, San Mateo, California TREATMENT OUTCOMES BACKGROUND AND PURPOSE: People with Multiple Sclerosis (MS) often experience falls and have gait and balance disorders. Balanced-Based Torso Weighting (BBTW) is a treatment intervention in which small amounts of weight are strategically placed on the torso to improve postural control and stability. Research in BBTW demonstrates improvements in gait and balance in people with balance deficits from MS. (1-4) This case report describes the use of BBTW to improve balance, gait, and reduce falls/ risk in an elderly individual with MS. CASE DESCRIPTION: 67-year-old female with a two year history of Primary Progressive MS. Patient Goals: Improve balance, gait speed, endurance and decrease falls. TREATMENT: The subject received balance training in addition to a trial of BBTW for a total of 12 visits, the last seven of which included training with BBTW. Two pounds were required to improve postural control and gait: two 0.5 pound weights anterior trunk, 0.5 pound left of lumbar spine and 0.5 pound at left posterior shoulder. The therapy ended soon after the subject received her own BalanceWear ®Lumbo Sacral Orthotic (LSO). BalanceWear® wear time: 9:00 am to 7:00 pm. Patient contacted at 1, 6, and 12 months post discharge to determine continued effectiveness of the BalanceWear® Therapy. CONCLUSION: This is the first report of long term outcomes reported in an elderly patient with MS. GOALS MET: The patient reports significantly less falls over the year, improvement in endurance and walking on varied surfaces enabling her to enjoy her vacations in Croatia and Panama over the past year. This case report demonstrates that improvements in gait kinematics and a reduction in fall risk can be made with strategic weighting of the torso with BBTW and BalanceWear Therapy™. Minimal Detectable Changes were shown in gait speed and the BBS. Of interest, Patient reports losing 10-15 pounds since purchasing her BalanceWear® vest. Limitations of this study include lack of access to equipment for measuring more exact gait parameters such as path deviation, base of support and step length. The subject did not own the vest until the end of therapy treatment. She may have shown more gains in gait speed and improved score on the BBS if she had been wearing the BBTW device every day for several weeks. BEFORE THERAPY AND BBTW AFTER THERAPY AND BBTW FALLS 2 TO 4 TIMES PER WEEKFALLS 0 TO 3 TIMES PER MONTH SELF REPORTED WALKING DIFFICULTY ON UNEVEN SURFACES AND HILLS WITH BIL. WALKING STICKS. USES WALLS AND FURNITURE IN HOUSE, NO DEVICE SELF REPORTED WALKING WALKS EASILY ON UNEVEN SURFACES AND HILLS INCLUDING COBBLESTONE STREETS WITH BIL. WALKING STICKS. LESS USE OF WALLS AND FURNITURE IN HOUSE GAIT PATTERN WITHOUT BBTW ASSISTIVE DEVICE (AD):WIDE BOS PATH DEVIATION GREATER THAN 6 INCHES, UE’S IN HIGH GUARD GAIT PATTERN WITH BBTW WITHOUT AD: NARROWER BOS, LONGER STEP LENGTH, UE’S AT SIDES WITH RYTHMICAL SWINGING GAIT PATTERN WITH BBTW BIL WALKING STICKS: WIDE BOS, PATH DEVIATION LESS THAN 6 INCHES. VELOCITY GAIT SPEED SELF-SELECTED : 0.52 M/SEC. FAST GAIT SPEED: 0.67 M/SEC. GAIT PATTERN WITH BBTW BIL WALKING STICKS: NARROWER BOS PATH DEVIATION LESS THAN 4 INCHES. VELOCITY GAIT SPEED : SELF SELECTED: 0.88 M/SEC. * FAST GAIT SPEED: 1.52 M/SEC. * BERG BALANCE SCALE 25/56 High Fall Risk BERG BALANCE SCALE 45/56 * Less Fall Risk ENDURANCE AMBULATES 3 BLOCKS WITH BIL WALKING STICKS requires 2 - 3 RESTS ENDURANCE AMBULATED 3 BLOCKS WITH BIL WALKING STICKS requires 0 - 1 REST 1.Gibson-Horn C. Balance-based torso weighting in a person with ataxia and multiple sclerosis: A case report. J Neurol Phys Ther. 2008;32: 139-146 2.Widener GL, Allen DD, Gibson-Horn C.. Balanced- based torso-weighting may enhance balance in persons with multiple sclerosis: preliminary evidence. Arch Phys Med Rehabil. 2009 90: 602-609 3.Gorgas AM, Widener GL, Gibson-Horn C, Allen DD. Gait changes with Balance-Based Torso-Weighting in people with Multiple Sclerosis. Physiother Res Int. 2014 Jun 14 4.Hunt CM, Widener GL, Allen DD. Variability in postural control with and without balance-based torso- weighting in people with multiple sclerosis and healthy controls. Phys Ther.. 2014; 11: 90-100 *Cindy Gibson-Horn has a financial interest in Motion Therapeutics BalanceWear®