Pilates, Yoga and Tai Chi Exercises' Effect on Balance and Gait in Patients With Multiple Sclerosis

this study will be conducted to compare between the effect of Pilates, Yoga and Tai Chi on balance, gait ability, functional mobility and fatigue in patients with multiple sclerosis

Multiple sclerosis (MS) is a chronic immune-mediated disease involving inflammation, plaques, and demyelination in the central nervous system . MS typically affects people in early adulthood in the 20-40 year range and is two to three times more common in women than men. Exercise therapy is one of the greatest and most well-researched rehabilitation strategies for multiple sclerosis patients. Exercise therapy includes a variety of exercise methods, including resistance training and endurance training, all of which are suitable for multiple sclerosis patients to use. Exercise can alter a wide range of functional and health-related factors as well as the diversity of symptoms displayed by multiple sclerosis patients.Pilates is a method of physical exercise that focuses on core stability, strength, flexibility, posture, muscle control, breathing, and mind-body connection.Yoga therapy is the process of empowering individuals to progress toward improved health and well-being through the application of the philosophy and practice of Yoga. Practicing yoga can provide the tools to help patients with multiple sclerosis cope with the disease and manage everyday tasks in a more beneficial way .Tai Chi is a martial art of Chinese origin that is based on the development of inner energy by practicing predetermined movements softly. It is an intense and complete practice, beneficial at any age. Tai Chi thus falls within a long tradition in Chinese therapies and exercises to improve the individuals' quality of life. 100 patients with multiple sclerosis will be allocated randomly to four groups; group1 will receive pilates plus traditional therapy, group 2 will receive yoga plus traditional therapy, group 3 will receive tai chi plus traditional therapy and group 4 will receive traditional therapy only.

Eligibility Criteria:
Inclusion Criteria:

* A score of 3.5 or less on the Expanded Disability Status Scale (EDSS) because individuals with an EDSS score greater than 3.5 need more assistance, being less independent (Zorina et al.,2020).
* All patients are taking their conventional medical treatment of relapsing-remitting stage
* Age over than 18 years
* All definite multiple sclerosis patients diagnosed as MS according to revised McDonald criteria 2017 .
* Both males and females will be included
* All Patients will be referred from neurologist.

Exclusion Criteria:

Patients will be excluded if their diagnosis is not clearly established, if they suffer from an acute relapse or severe cognitive deficits, or have signs of any psychiatric disease -Brain surgery/trauma/history of brain disease (stroke), other independent neurological history

* Another exclusion criterion is the history of cardiac, pulmonary, orthopedic,or other medical conditions diagnosed before participation
* Rheumatic diseases and other acute or chronic inflammations
* Vascular disease, spinal cord compression, vitamin B 12 deficiency
* Other conditions that affect the smooth progress of the inspection: such as hearing impairment, comprehension impairment, poor compliance
* Alcoholism or drug dependence (addiction)
* Pregnancy