Iranian Red Crescent Medical Journal

Published by: Kowsar

Comparing the Effectiveness of Vestibular Rehabilitation and Frenkel Exercise on Fatigue Reduction in Patients with Multiple Sclerosis: A Randomized Controlled Trial

Fatemeh Karami 1 , Ardashir Afrasiabifar 1 , * and Shahla Najafi Doulatabad 1
Authors Information
1 Yasuj University of Medical Sciences, Yasuj, Iran
Article information
  • Iranian Red Crescent Medical Journal: December 31, 2018, 20 (12); e68913
  • Published Online: December 17, 2018
  • Article Type: Research Article
  • Received: March 26, 2018
  • Revised: October 9, 2018
  • Accepted: October 11, 2018
  • DOI: 10.5812/ircmj.68913

To Cite: Karami F, Afrasiabifar A, Najafi Doulatabad S . Comparing the Effectiveness of Vestibular Rehabilitation and Frenkel Exercise on Fatigue Reduction in Patients with Multiple Sclerosis: A Randomized Controlled Trial, Iran Red Crescent Med J. 2018 ; 20(12):e68913. doi: 10.5812/ircmj.68913.

Copyright © 2018, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited
1. Background
2. Objectives
3. Methods
4. Results
5. Discussion
  • 1. Rudroff T, Kindred JH, Ketelhut NB. Fatigue in multiple sclerosis: Misconceptions and future research directions. Front Neurol. 2016;7:122. doi: 10.3389/fneur.2016.00122. [PubMed: 27531990]. [PubMed Central: PMC4969300].
  • 2. Hadjimichael O, Vollmer T, Oleen-Burkey M; North American Research Committee on Multiple Sclerosis. Fatigue characteristics in multiple sclerosis: The North American Research Committee on Multiple Sclerosis (NARCOMS) survey. Health Qual Life Outcomes. 2008;6:100. doi: 10.1186/1477-7525-6-100. [PubMed: 19014588]. [PubMed Central: PMC2596785].
  • 3. Fox RJ, Bacon TE, Chamot E, Salter AR, Cutter GR, Kalina JT, et al. Prevalence of multiple sclerosis symptoms across lifespan: Data from the NARCOMS registry. Neurodegener Dis Manag. 2015;5(6 Suppl):3-10. doi: 10.2217/nmt.15.55. [PubMed: 26611264].
  • 4. Induruwa I, Constantinescu CS, Gran B. Fatigue in multiple sclerosis: A brief review. J Neurol Sci. 2012;323(1-2):9-15. doi: 10.1016/j.jns.2012.08.007. [PubMed: 22935407].
  • 5. Newland PK, Lunsford V, Flach A. The interaction of fatigue, physical activity, and health-related quality of life in adults with multiple sclerosis (MS) and cardiovascular disease (CVD). Appl Nurs Res. 2017;33:49-53. doi: 10.1016/j.apnr.2016.09.001. [PubMed: 28096022].
  • 6. Thompson AJ, Toosy AT, Ciccarelli O. Pharmacological management of symptoms in multiple sclerosis: Current approaches and future directions. Lancet Neurol. 2010;9(12):1182-99. doi: 10.1016/S1474-4422(10)70249-0. [PubMed: 21087742].
  • 7. Kunkel A, Fischer M, Faiss J, Dahne D, Kohler W, Faiss JH. Impact of natalizumab treatment on fatigue, mood, and aspects of cognition in relapsing-remitting multiple sclerosis. Front Neurol. 2015;6:97. doi: 10.3389/fneur.2015.00097. [PubMed: 26029156]. [PubMed Central: PMC4426783].
  • 8. Tur C. Fatigue management in multiple sclerosis. Curr Treat Options Neurol. 2016;18(6):26. doi: 10.1007/s11940-016-0411-8. [PubMed: 27087457]. [PubMed Central: PMC4834309].
  • 9. Mackay AM, Buckingham R, Schwartz RS, Hodgkinson S, Beran RG, Cordato DJ. The effect of biofeedback as a psychological intervention in multiple sclerosis: A randomized controlled study. Int J MS Care. 2015;17(3):101-8. doi: 10.7224/1537-2073.2014-006. [PubMed: 26052255]. [PubMed Central: PMC4455862].
  • 10. van den Akker LE, Beckerman H, Collette EH, Eijssen IC, Dekker J, de Groot V. Effectiveness of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: A systematic review and meta-analysis. J Psychosom Res. 2016;90:33-42. doi: 10.1016/j.jpsychores.2016.09.002. [PubMed: 27772557].
  • 11. Langeskov-Christensen M, Bisson EJ, Finlayson ML, Dalgas U. Potential pathophysiological pathways that can explain the positive effects of exercise on fatigue in multiple sclerosis: A scoping review. J Neurol Sci. 2017;373:307-20. doi: 10.1016/j.jns.2017.01.002. [PubMed: 28131211].
  • 12. Peruzzi A, Cereatti A, Della Croce U, Mirelman A. Effects of a virtual reality and treadmill training on gait of subjects with multiple sclerosis: A pilot study. Mult Scler Relat Disord. 2016;5:91-6. doi: 10.1016/j.msard.2015.11.002. [PubMed: 26856951].
  • 13. Scheidler A, Tisha A, Kinnett-Hopkins D, Learmonth Y, Motl R, López-Ortiz C. Targeted dance program for improved mobility in multiple sclerosis. In: Ibá-ez JGVJ, Azorín J, Akay M, Pons J, editors. Converging clinical and engineering research on neurorehabilitation. Biosystems & Biorobotics: Springer, Cham; 2017. p. 1073-7.
  • 14. Tallner A, Waschbisch A, Hentschke C, Pfeifer K, Maurer M. Mental health in multiple sclerosis patients without limitation of physical function: The role of physical activity. Int J Mol Sci. 2015;16(7):14901-11. doi: 10.3390/ijms160714901. [PubMed: 26147422]. [PubMed Central: PMC4519878].
  • 15. Kerling A, Keweloh K, Tegtbur U, Kuck M, Grams L, Horstmann H, et al. Effects of a short physical exercise intervention on patients with multiple sclerosis (MS). Int J Mol Sci. 2015;16(7):15761-75. doi: 10.3390/ijms160715761. [PubMed: 26184173]. [PubMed Central: PMC4519923].
  • 16. Nortvedt MW, Riise T, Maeland JG. Multiple sclerosis and lifestyle factors: The hordaland health study. Neurol Sci. 2005;26(5):334-9. doi: 10.1007/s10072-005-0498-2. [PubMed: 16388368].
  • 17. Motl RW, McAuley E, Snook EM. Physical activity and multiple sclerosis: A meta-analysis. Mult Scler. 2005;11(4):459-63. doi: 10.1191/1352458505ms1188oa. [PubMed: 16042230].
  • 18. Latimer-Cheung AE, Pilutti LA, Hicks AL, Martin Ginis KA, Fenuta AM, MacKibbon KA, et al. Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: A systematic review to inform guideline development. Arch Phys Med Rehabil. 2013;94(9):1800-1828 e3. doi: 10.1016/j.apmr.2013.04.020. [PubMed: 23669008].
  • 19. Heine M, van de Port I, Rietberg MB, van Wegen EE, Kwakkel G. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database Syst Rev. 2015;(9). CD009956. doi: 10.1002/14651858.CD009956.pub2. [PubMed: 26358158].
  • 20. Geddes EL, Costello E, Raivel K, Wilson R. The effects of a twelve-week home walking program on cardiovascular parameters and fatigue perception of individuals with multiple sclerosis: A pilot study. Cardiopulm Phys Ther J. 2009;20(1):5-12. [PubMed: 20467528]. [PubMed Central: PMC2845260].
  • 21. Shepard NT, Telian SA, Smith-Wheelock M. Quociente da sensibilidade motora Ltda. In: Herdman SJ, editor. Reabilitação vestibular. 20. São Paulo: Editora Manole; 2002. 364 p.
  • 22. Szturm T, Ireland DJ, Lessing-Turner M. Comparison of different exercise programs in the rehabilitation of patients with chronic peripheral vestibular dysfunction. J Vestibul Res. 1994;4(6):461-79. doi: 10.3233/VES-1994-4606.
  • 23. Corna S, Nardone A, Prestinari A, Galante M, Grasso M, Schieppati M. Comparison of Cawthorne-Cooksey exercises and sinusoidal support surface translations to improve balance in patients with unilateral vestibular deficit. Arch Phys Med Rehabil. 2003;84(8):1173-84. [PubMed: 12917857].
  • 24. Michael KM, Allen JK, Macko RF. Fatigue after stroke: Relationship to mobility, fitness, ambulatory activity, social support, and falls efficacy. Rehabil Nurs. 2006;31(5):210-7. [PubMed: 16948443].
  • 25. Moreira KLdAF, Dornelas L, Tavares GR, Andrade SM. Physical therapy intervention and acquired immunodeficiency syndrome associated to leukoencephalopathy and neurotoxoplasmosis: Case's relate. Fisioterapia em Movimento. 2007;20(3):35-40.
  • 26. Steib S, Zech A, Hentschke C, Pfeifer K. Fatigue-induced alterations of static and dynamic postural control in athletes with a history of ankle sprain. J Athl Train. 2013;48(2):203-8. doi: 10.4085/1062-6050-48.1.08. [PubMed: 23672384]. [PubMed Central: PMC3600922].
  • 27. Hebert JR, Corboy JR. The association between multiple sclerosis-related fatigue and balance as a function of central sensory integration. Gait Posture. 2013;38(1):37-42. doi: 10.1016/j.gaitpost.2012.10.015. [PubMed: 23200463].
  • 28. Van Emmerik RE, Remelius JG, Johnson MB, Chung LH, Kent-Braun JA. Postural control in women with multiple sclerosis: Effects of task, vision and symptomatic fatigue. Gait Posture. 2010;32(4):608-14. doi: 10.1016/j.gaitpost.2010.09.002. [PubMed: 20943393].
  • 29. Ministry of Health and Medical Education (MOHME); Iran University of Medical Sciences (IUMS). Iranian Registry of Clinical Trials (IRCT). 2018. Available from:
  • 30. Cawthorne T. [The physiological basis for head exercises]. J Char Soc Physiother. 1944;3:106-7. Japanese.
  • 31. Cooksey FS. Rehabilitation in vestibular injuries. Proc R Soc Med. 1946;39(5):273-8. [PubMed: 19993269]. [PubMed Central: PMC2181739].
  • 32. Ojoga F, Marinescu S. Physical therapy and rehabilitation for ataxic patients. Balneo Res. 2013;4(2):81-4. doi: 10.12680/balneo.2013.1044.
  • 33. Fisk JD, Pontefract A, Ritvo PG, Archibald CJ, Murray TJ. The impact of fatigue on patients with multiple sclerosis. Can J Neurol Sci. 1994;21(1):9-14. [PubMed: 8180914].
  • 34. Heidari M, Akbarfahimi M, Salehi M, Nabavi SM. [Validity and reliability of the Persian-version of fatigue impact scale in multiple sclerosis patients in Iran]. Koomesh. 2014;15(3):295-301. Persian.
  • 35. Kierkegaard M, Lundberg IE, Olsson T, Johansson S, Ygberg S, Opava C, et al. High-intensity resistance training in multiple sclerosis - An exploratory study of effects on immune markers in blood and cerebrospinal fluid, and on mood, fatigue, health-related quality of life, muscle strength, walking and cognition. J Neurol Sci. 2016;362:251-7. doi: 10.1016/j.jns.2016.01.063. [PubMed: 26944158].
  • 36. Giesser BS. Exercise in the management of persons with multiple sclerosis. Ther Adv Neurol Disord. 2015;8(3):123-30. doi: 10.1177/1756285615576663. [PubMed: 25941539]. [PubMed Central: PMC4409551].
  • 37. White LJ, Castellano V. Exercise and brain health--implications for multiple sclerosis: Part 1--neuronal growth factors. Sports Med. 2008;38(2):91-100. doi: 10.2165/00007256-200838020-00001. [PubMed: 18201113].
  • 38. Kileff J, Ashburn A. A pilot study of the effect of aerobic exercise on people with moderate disability multiple sclerosis. Clin Rehabil. 2005;19(2):165-9. doi: 10.1191/0269215505cr839oa. [PubMed: 15759531].
  • 39. Pilutti LA, Lelli DA, Paulseth JE, Crome M, Jiang S, Rathbone MP, et al. Effects of 12 weeks of supported treadmill training on functional ability and quality of life in progressive multiple sclerosis: A pilot study. Arch Phys Med Rehabil. 2011;92(1):31-6. doi: 10.1016/j.apmr.2010.08.027. [PubMed: 21187202].
  • 40. Newman MA, Dawes H, van den Berg M, Wade DT, Burridge J, Izadi H. Can aerobic treadmill training reduce the effort of walking and fatigue in people with multiple sclerosis: A pilot study. Mult Scler. 2007;13(1):113-9. doi: 10.1177/1352458506071169. [PubMed: 17294619].
  • 41. Pavan K, Marangoni BE, Schmidt KB, Cobe FA, Matuti GS, Nishino LK, et al. [Vestibular rehabilitation in patients with relapsing-remitting multiple sclerosis]. Arq Neuropsiquiatr. 2007;65(2A):332-5. Portuguese. [PubMed: 17607438].
  • 42. Afrasiabifar A, Karami F, Najafi Doulatabad S. Comparing the effect of Cawthorne-Cooksey and Frenkel exercises on balance in patients with multiple sclerosis: A randomized controlled trial. Clin Rehabil. 2018;32(1):57-65. doi: 10.1177/0269215517714592. [PubMed: 28629268].
  • 43. Ribeiro Ados S, Pereira JS. Balance improvement and reduction of likelihood of falls in older women after Cawthorne and Cooksey exercises. Braz J Otorhinolaryngol. 2005;71(1):38-46. [PubMed: 16446890].
  • 44. Makuła W. Rola i zastosowanie ćwiczeń Frenkla w rehabilitacji ruchowej. Antropomotoryka. 2013;1(23):29-36.
  • 45. Hebert JR, Corboy JR, Manago MM, Schenkman M. Effects of vestibular rehabilitation on multiple sclerosis-related fatigue and upright postural control: A randomized controlled trial. Phys Ther. 2011;91(8):1166-83. doi: 10.2522/ptj.20100399. [PubMed: 21680771].
  • 46. Cohen HS, Kimball KT. Increased independence and decreased vertigo after vestibular rehabilitation. Otolaryngol Head Neck Surg. 2003;128(1):60-70. doi: 10.1067/mhn.2003.23. [PubMed: 12574761].
  • 47. Saini S, DeStefano N, Smith S, Guidi L, Amato MP, Federico A, et al. Altered cerebellar functional connectivity mediates potential adaptive plasticity in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2004;75(6):840-6. [PubMed: 15145996]. [PubMed Central: PMC1739042].
  • 48. Zwecker M, Zeilig G, Ohry A. Professor heinrich sebastian frenkel: A forgotten founder of rehabilitation medicine. Spinal Cord. 2004;42(1):55-6. doi: 10.1038/ [PubMed: 14713947].
  • 49. Sandry J, Genova HM, Dobryakova E, DeLuca J, Wylie G. Subjective cognitive fatigue in multiple sclerosis depends on task length. Front Neurol. 2014;5:214. doi: 10.3389/fneur.2014.00214. [PubMed: 25386159]. [PubMed Central: PMC4209827].
  • 50. Schwartz CE, Coulthard-Morris L, Zeng Q. Psychosocial correlates of fatigue in multiple sclerosis. Arch Phys Med Rehabil. 1996;77(2):165-70. [PubMed: 8607741].

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