Nooshin Masoudian - Neurology Ward, Department of Internal Medicine, Kosar Hospital, School of Medicine,Semnan University of Medical Sciences, Semnan, Iran.,
Afshin Samaei - Neurology Ward, Department of Internal Medicine, Kosar Hospital, School of Medicine,Semnan University of Medical Sciences, Semnan, Iran.,
Fatemeh Ehsani - PT, Ph.D., Assistant professor, Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.

Introduction: Multiple sclerosis (MS) is one of the most common neurological disorders. Many studies have shown that MS associated with fear of falling, which increase the rate of falling. The aims of this study were to investigate the short-term and long-term effects of postural training along with transcranial direct electrical stimulation (tDCS) over the cerebellum on fear of falling and the rate of falling in patients with MS. Method and Materials: This randomized clinical trial study was performed on 36 participants with MS. The participants were randomly assigned to three groups (experimental, sham and control). In all groups, the postural training program was progressively conducted on Byodex Balance System during 20 minutes, three sessions per week for four weeks. In the experimental group, 2 mA anodal tDCS (a-tDCS) over the cerebellum was applied along with 20-minute postural training, while in the sham group, cerebellar a-tDCS turned on only for 30 seconds along with the postural training. In the control group, the patients performed the 20-minute postural training, without having tDCS. Fear of falling and the rate of falling were evaluated using valid and reliable questionnaire at baseline, immediately and one-month after the intervention. Results: The results of this study indicated that the reduction of fear of falling and the rate of falling was observed immediately and one-month after intervention in the experimental group (p<0.05). In the control groups, the rate of falling was decreased only during four-week intervention (p<0.05), while this decreasing was not conserved after one-month follow-up (p> 0.05). In addition, fear of falling was not changed immediately and one-month follow-up after intervention in the control groups (p> 0.05).Conclusion: Postural training has only immediate effect on the rate of falling in patients with MS, while it cannot maintain it and also control the fear of falling. The cerebellar a-tDCS along with postural training can increase the lasting effects of this intervention on the reduction of rate of falling and also on decreasing the fear of falling in patients with MS.

Multiple sclerosis, postural training, transcranial direct electrical stimulation, cerebellum, fear of falling, rate of falling