Balance, gait, exercise and physical activity in neurological diseases – Franzén Group

Translational research from exploring neuronal mechanisms to clinical interventions and implementation in Parkinson’s disease, Multiple sclerosis, stroke and spinal cord injury.

Research Focus

Research focus is on translational research from exploring neuronal mechanisms to clinical interventions/implementation in the field of neurological and geriatric rehabilitation. Our areas of special interest are balance control, exercise, physical activity and falls in elderly and individuals with neurological diseases (Parkinson’s disease, Multiple sclerosis, stroke and spinal cord injury).

uMOVE Core Facility

uMOVE offers support for the planning, data collection and analysis using a wide range of state-of-the-art motion analysis systems - from lab measurements to free-living assessment of daily activities, including cognition functions and emotions on motor control.

uMOVE Core Facility


Selected publications

Staff and contact

Group leader

All members of the group

Other people connected to the group

  • Steurer, Hanna
  • Agoriwo, Mary

Team Parkinson’s disease

Team Leaders

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Erika Franzén

Professor/Physical Therapist

Project description

The BETA-PD study consists of several steps: method development and laboratory studies, an efficacy study, an effectiveness/implementation study and neuroplasticity studies.

Beta PD study

Method development (Step 1)

We have tested the validity and reliability of the measurement methods that we use. We have also conducted kinematic and kinetic studies in movement laboratories (at KI and at Sunnaas rehabilitation hospital) in which we have investigated straight walking, variability and turning strategies as well as the effect of levodopa on these strategies in individuals with PD (ON and OFF their medication) compared to controls.

Efficacy (Step 2)

We have developed the HiBalance program and showed the program to be feasible and effective to improve balance performance, gait velocity, step length, cognitive performance while dual-tasking, as well as beneficial transfer effects to everyday living, seen as increased physical activity and improved activities of daily living. Analysis of the long-term effects showed that effects on gait, balance and physical activity attenuated after the training period and at 6 months no group effects were evident.

Findings from a qualitative study, suggest that being pushed to the limits of balance capacity provoked people with mild-moderate PD to re-think their individual motor and cognitive resources, a process that was further enabled by the PD-specific group setting.

The implementation/effectiveness (Step 3)

The implementation/effectiveness consists of a clinical effectiveness trial together with implementation research. We are here using a type-1 hybrid design by testing effects of the HiBalance program delivered in clinical setting on relevant patient outcome measures while observing and gathering information on barriers and facilitators to the implementation process We have performed a pilot study in primary care facilities in Stockholm. During spring 2016, we started the full implementation and effectiveness trial. Training and data collection concerning the outcome evaluation of the trial was completed at all clinics in February 2018. Analysis is ongoing. Additionally, we have performed a series of longitudinal focus-group interviews with the trainers in which we have followed their perceptions of implementing the program over two years.

Neuroplasticity study (Step 4)

In this study we compare the HiBalance program with an active control group (HiCommunication) with the aim to characterise and link the effects on physical and cognitive symptoms to structural and functional changes in the brain as well as wet biomarkers after the training. During fall 2017 we performed a feasibility/pilot study of the RCT and during spring 2018 the larger trial started. The aim is also to determine which biomarkers in the central nervous system may explain these changes.

Team Multiple Sclerosis

Team leader

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Sverker Johansson

Senior Lecturer/Physcial Therapist

Development of and effects of a highly challenging balance training program (HiBalance) specific to multiple sclerosis – a randomized controlled study

Method development

We have tested the psychometric properties of the primary measurement methods that we use in the project. Further, we have in the movement laboratory at Karolinska Institutet (uMOVE) conducted studies of cognitive motor interference – i.e., testing of dual task performance of two motor tasks (walking and standing) and a cognitive task. This has been accomplished with the temporal and spatial parameters measured with the APDM Mobility Lab system. This system measures postural sway with and walking with accelerometer technology. For the cognitive testing we have used the auditory Stroop task, a test which has been suggested for the assessment of cognitive motor interference in people with multiple sclerosis (MS).

Study participator, HiBalance program. Photo: Andreas Wallin.


The balance training intervention developed for people with MS is based on a highly challenging balance intervention delivered as a group training (the HiBalance program), previously developed and tested in people with Parkinson´s disease. In the development process we first performed qualitative research in people with MS on the experiences of living with limited balance. To adapt the program to MS, we then employed a series of workshops. with participation of different stakeholders. We have recently performed a feasibility trial of the developed intervention. A full-scale randomized controlled trial is planned to be performed during in the coming year.