Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Effects of Vestibular Rehabilitation on MS-related Fatigue and Upright Postural Control: a Randomized Controlled Trial
Brief Summary: The purpose of this study was to test the feasibility and effectiveness of a novel exercise intervention for individuals who live with multiple sclerosis (MS).


Options:
A: Inclusion Criteria:

* males and females,
* community dwelling,
* age 18 or older
* diagnosis of multiple sclerosis in a stable phase, with relapses \> 3 months prior to study enrollment
* moderate gait impairments referred to Expanded Disability Status Scale (EDSS) between 4 and 5,5

Exclusion Criteria:

* neurologic conditions in addition to multiple sclerosis that may affect motor function
* medical conditions likely to interfere with the ability to safely complete the study
* impaired cognitive functioning: Mini Mental Status Examination \< 24
B: Inclusion Criteria:

* (1) Clinically definite MS confirmed by a board certified Neurologist
* (2) Kurtzke Expanded Disability Status Scale (EDSS) 0.0 to 6.0 (ranges and corresponding ambulatory status: 0.0 to 4.5 fully ambulatory without assistive device; 5.0 to 5.5 impaired ambulatory status without assistive device; 6.0 impaired ambulatory status with intermittent or unilateral constant assistive device)
* (3) Age: 18 to 65 years (65 years has been set as the upper limit of age to decrease the possible age-related changes in physical strength, endurance, and upright postural control)
* (4) Male or Female (MS affects both gender types)
* (5) Comprehension of the general concept of the study and ability to make informed consent (see Section I. Special Consent Issues). (6) Minorities included
* (7) Self-reported fatigue level on the Modified Fatigue Impact Scale (MFIS) of a total score \> 45 (This criterion has been used in previous studies investigating treatment for MS-related fatigue utilizing the MFIS)
* (8) Sensory organization test (SOT) composite score of \< 72

Exclusion Criteria:

* (1) Non-ambulatory
* (2) Utilization of agents to control fatigue: i.e. medications: Amantadine, Pemoline, Dexedrine Amphetamine, Methylphenidate, Provigil, Ritalin, Prokarin.
* (3) Utilization of medication(s) that have known possible side effects of fatigue such as: skeletal muscle relaxants (i.e. Baclofen, Zanaflex), Statin Drugs, pain medication (i.e. Opioids, tricyclic antidepressants (TCAs), anti-epileptic drugs (AEDs)
* (4) Any other possible cause of fatigue: major sleep disorder, clinically diagnosed major depressive disorder, anemia, hypothyroidism, B12 deficiency, cancer
* (5) Other neurological disorder which might contribute to significant balance problems, including cerebral vascular accident, peripheral neuropathy (separate from MS diagnosis, such as diabetes mellitus), peripheral vestibular disorders (unilateral/bilateral vestibular hypofunction: benign positional paroxysmal vertigo, Meniere's disease, acoustic neuroma)
* (6) Change in MS specific medication (for disease modification) in the last three months
* (7) Documented MS-related exacerbation in the last six months
* (8) Any medical diagnosis or condition that is considered to be an absolute or relative contraindication to participating in exercise testing and/or result in limitations for participation in an active exercise program or aerobic exercise program, as recommended by the American College of Sports Medicine (ACSM)
* (9) Participation in an exercise routine specifically designed as a vestibular and/or aerobic exercise program within eight weeks prior to study participation.
C: Inclusion Criteria:

* Clinical diagnosis of MS by McDonald criteria. EDSS level between 4-6.5.

Exclusion Criteria:

* Cardiovascular: recent MI \< 4 wk, uncontrolled HTN \>190/110 mmHg, Uncontrolled diabetes (blood glucose 2X above the upper limit of normal or non-fasting blood drain).
* Symptomatic fall in blood pressure (\>30mm Hg), when upright in the body support apparatus, despite medical therapy.
* Circulatory problems, history of vascular claudication or pitting edema.
* Cognitive impairment MMSE \< 21.
* Body weight over 150 kg (structural limits of the Lokomat).
* Lower extremity injuries that limit range of motion or function.
* Joint problems (hip or leg) that limit range of motion or cause pain with movement despite treatment.
* Unstable fractures.
* Pressure sores with any skin breakdown in areas in contact with the body harness or DGO apparatus.
* Chronic and ongoing alcohol or drug abuse.
* Pre-morbid, ongoing depression or psychosis.
D: Inclusion Criteria:

* Signed informed consent

  -\>18 years
* Primary progressive or secondary progressive MS according to the McDonald criteria
* 6.5 ≤ EDSS ≤ 8.0 and pyramidal score between 1 and 4
* Maximal walking distance ≤ 10m

Exclusion Criteria:

* Patients are excluded if they:
* have dementia,alcoholism, or pacemaker treatment
* any serious medical comorbidities
* are pregnant
* have done systematic endurance training (\>1day/week) within the last 3 months.
* complete less than 80% of the planned training sessions
* medical conditions that exclude performance of a maximal endurance test.

Answer: B