感觉统合治疗对多发性硬化症患者步态变异性和生活质量的影响：一项随机对照试验

有源比较器：常规物理治疗方案

该组患者将接受常规物理治疗方案治疗，每周两次，连续八周（总共16次疗程，每次70分钟，疗程之间有充分休息）。

其他：常规物理治疗方案

该组将接受为期八周、每周两次的常规物理治疗计划（共16次治疗），每次70分钟的治疗包含根据需要安排的休息时间。 每次治疗包括5分钟的热身活动，一个包含个性化中等强度有氧运动（达到最大心率的64-76%）的活跃阶段（如踏步和地面行走，难度逐步增加），以及下肢伸展和强化练习。 每次治疗以5分钟的放松活动结束，采用温和伸展或逐步减少活动强度，以最大限度地减少僵硬和肌肉酸痛。

实验性的：常规物理治疗方案 + 感觉统合疗法

该组患者将接受相同的常规物理治疗方案（30分钟），外加感觉统合治疗方案（SIT）（40分钟）。 最常见的治疗持续时间和频率为70分钟，（每周两次，共16次治疗）连续八周。

其他：常规物理治疗方案

该组将接受为期八周、每周两次的常规物理治疗计划（共16次治疗），每次70分钟的治疗包含根据需要安排的休息时间。 每次治疗包括5分钟的热身活动，一个包含个性化中等强度有氧运动（达到最大心率的64-76%）的活跃阶段（如踏步和地面行走，难度逐步增加），以及下肢伸展和强化练习。 每次治疗以5分钟的放松活动结束，采用温和伸展或逐步减少活动强度，以最大限度地减少僵硬和肌肉酸痛。

其他：感觉统合疗法

该组将接受为期八周（共16次，每次70分钟）、每周两次的常规物理疗法（30分钟）与感觉统合疗法（40分钟）联合治疗方案。 每次治疗包括热身、活跃阶段和整理放松环节。 感觉统合疗法针对本体感觉、视觉和前庭觉输入，通过在多样化感觉条件下（睁眼/闭眼、稳固或柔软表面）进行渐进式挑战性平衡与步态训练，结合外部与内部干扰刺激及赤足步态训练，难度根据个体情况调整，并提供休息时间以防止疲劳。

步态周期变异性

步态周期变异性将在Biodex Gait Trainer 2 TM系统上进行连续行走时测量。 在熟悉阶段后，参与者将以舒适的自选速度行走三分钟。 将进行三次试验，中间有休息间隔，并记录平均变异系数(CV)。 该指标反映了时间步态的一致性。

行走速度变异性

步行速度变异性将使用Biodex Gait Trainer 2 TM系统进行评估。 熟悉操作后，参与者将以舒适的自主选择速度连续行走三分钟。 将进行三次连续试验，试验间设有休息间隔，记录平均变异系数以评估行走过程中的速度一致性。

单支撑时间变异性（每只脚支撑时间）

单支撑时间（步行时每只脚着地的时间）变异性将使用Biodex Gait Trainer 2 TM系统进行评估。 在熟悉跑步机后，参与者将以舒适的速度步行三分钟。 将进行三次试验，试验之间有休息间隔，并计算平均变异系数（CV）以评估步态期间的单肢站立稳定性。

定时25英尺步行测试

Timed 25-Foot Walk（T25FW）测试将用于评估下肢功能，通过测量患者以尽可能快速且安全的速度行走25英尺（7.5米）所需的时间。 患者将进行两次试验，并使用秒表记录平均时间。 遵循标准化的执行和安全程序，将通过将距离除以平均时间来计算步行速度。

Step Length Variability

Step length variability will be assessed using the Biodex Gait Trainer 2 TM system. Participants will walk on the treadmill at a self-selected comfortable pace for three minutes after a familiarization period of 3-5 minutes. Three successive trials will be conducted with 2-3 minutes rest between trials, and the average will be calculated. Lower CV values indicate less gait variability and better gait stability.

Coefficient of Variability of Gait (on each foot)

Coefficient of Variability of Gait (CoV) (This is calculated as the amount of variation occurring between footfalls, expressed as a percentage). Variability will be assessed using the Biodex Gait Trainer 2 TM system. Following familiarization with the treadmill, participants will walk at comfortable speed for three minutes. Three trials will be performed with rest periods between trials, and the average CV will be calculated to evaluate coefficient of variability on each foot during gait. [Time Frame: 20 weeks

Ambulation Index

Ambulation Index (is a composite score relative to 100 based on foot-to-foot time distribution ratio and average step cycle. The goal is 100). Ambulation Index will be assessed using the Biodex Gait Trainer 2 TM system. Following familiarization with the treadmill, participants will walk at comfortable speed for three minutes. Three trials will be performed with rest periods between trials, and the average CV will be calculated to evaluate coefficient of variability on each foot during gait.

Step Length Variability (Smartphone-Based Assessment)

The Timed 25-Foot Walk (T25FW) test will be used to assess lower-limb function by measuring the time required to walk 25 feet (7.5 m) as quickly and safely as possible. Patients will perform two trials, and the mean time will be recorded using a stopwatch. Walking speed will be calculated by dividing the distance by the average time, following standardized administration and safety procedures.subscales will be totaled to provide a summed score for each subscale or dimension. The responses will be scored in standardized fashion and will be scaled from 0 to 100, where (0= represent the poorest health and 100= represent the best health) in each category. Each subscale can be used independently.

Gait Velocity Variability (Smartphone-Based Assessment)

Walking speed will be measured using a smartphone application validated for gait analysis. The smartphone will be positioned at the lumbar spine (L3-L5) using a secure waist band. Participants will complete walking trials over a 7 meter walkway (two trials). The application will automatically calculate walking speed from sensor data collected during each trial. The average of two bouts will be calculated.

Step Time Variability (Smartphone-Based Assessment)

Step time will be assessed using a smartphone-based gait analysis application with the device fixed to the participant's lower lumbar region (L3-L5 vertebral level) via waist band. Following the researcher's "start" command, participants will walk along a 7-meter pathway (two trials). The smartphone's sensors will automatically detect and measure the time taken to complete each stride cycle. The average will be calculated

Step length symmetry (%) (Smartphone-Based Assessment)

Step length symmetry will be assessed using a smartphone-based gait analysis application with the device fixed to the participant's lower lumbar region (L3-L5 vertebral level) via waist band. Following the researcher's "start" command, participants will walk along a 7-meter pathway (two trials). The smartphone's sensors will automatically detect data collected during each trial. The average of two bouts will be calculated

Step time symmetry (%) (Smartphone-Based Assessment)

Step time symmetry will be assessed using a smartphone-based gait analysis application with the device fixed to the participant's lower lumbar region (L3-L5 vertebral level) via waist band. Following the researcher's "start" command, participants will walk along a 7-meter pathway (two trials). The smartphone's sensors will automatically detect data collected during each trial. The average of two bouts will be calculated.

Total Time (sec) (Smartphone-Based Assessment)

Total Time will be assessed using a smartphone-based gait analysis application with the device fixed to the participant's lower lumbar region (L3-L5 vertebral level) via waist band. Following the researcher's "start" command, participants will walk along a 7-meter pathway (two trials). The smartphone's sensors will automatically detect data collected during each trial. The average of two bouts will be calculated.

Short-form 36 quality of life's (SF-36)

The patients will sit in a comfortable relaxed position. The patients will be asked to answer items referring to the activities past 4 weeks. Items within (eight) subscales will be totaled to provide a summed score for each subscale or dimension. The responses will be scored in standardized fashion and will be scaled from 0 to 100, where (0= represent the poorest health and 100= represent the best health) in each category. Each subscale can be used independently.