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Objective Blood flow restriction (BFR) training, in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb, coupled with low-intensity resistance training (LIRT) has resulted in gains comparable to traditional progressive resistive exercise in healthy populations. The use of BFR with LIRT may enable people with multiple sclerosis (MS) to improve strength without an increase in fatigue. The purpose of this case report is to describe the use of a BFR/LIRT program for a person with MS. Methods (Case Description) The patient was a 54-year-old woman with a 13-year history of primary progressive MS with an Extended Disability Severity Score of 3.0 out of 10. She received a BFR/LIRT program for both lower extremities (LE) biweekly for 12 weeks. Outcomes measured at baseline and at 6 and 12 weeks included the 12-item Multiple Sclerosis Walking Scale (MSWS-12), Fatigue Severity Scale (FSS), Patient-Specific Functional Scale (PSFS) (goals: running for exercise and pleasure for 45 minutes, 100% confidence in negotiating a flight of stairs, confidently and safely drive without restriction), and 14 LE strength tests. Results The intervention was well tolerated without adverse events. After 6 weeks, the MSWS-12 score improved; however, it did not exceed minimum detectable change (MDC). FSS was unchanged. All PSFS goals improved beyond MDC, and improvements in strength exceeded MDC in 2 out of 14 tests. After 12 weeks, MSWS-12 improvements persisted and the FSS score improved, but neither exceeded MDC. The PSFS improvements persisted. There were improvements exceeding MDC for 8 out of 14 strength tests. The remaining 6 strength tests improved but did not exceed MDC. Conclusion The patient had measurable improvements following the use of a BFR/LIRT program. BFR/LIRT may be an option for strength training in people with MS; however, research is needed to determine its safety and effectiveness across the population of people with MS. Impact Traditional physical therapist interventions for people with MS have been shown to be beneficial; however, their usefulness has been limited by fatigue. A growing body of literature has demonstrated the effects of a BFR/LIRT program on strength and other measures of physical function in healthy populations and those with chronic disease. This case report adds missing information to the existing literature and suggests directions for research on the effectiveness of BFR/LIRT in people with primary progressive MS.

Despite the well-known benefits of using standardized outcome measures (OMs) in clinical practice, a variety of barriers interfere with their use. In particular, rehabilitation therapists lack sufficient knowledge in selecting appropriate OMs. The challenge is compounded when working with people with multiple sclerosis (MS) owing to heterogeneity of the patient population and symptom variability in individual patients. To help overcome these barriers, the American Physical Therapy Association appointed the Multiple Sclerosis Outcome Measures Task Force to review and make evidence-based recommendations for OM use in clinical practice, education, and research specific to people with MS. Sixty-three OMs were reviewed based on their clinical utility, psychometric properties, and a consensus evaluation of the appropriateness of use for people with MS. We sought to illustrate use of the recommendations for two cases. The first case involves a 43-year-old man with new-onset problems after an exacerbation. The second case pertains to an outpatient clinic interested in assessing the effectiveness of their MS rehabilitation program. For each case, clinicians identified areas that were important to assess and various factors deemed important for OM selection. Criteria were established and used to assist in OM selection. In both cases, the described processes narrowed the selection of OMs and assisted with choosing the most appropriate ones. The recommendations, in addition to the processes described in these two cases, can be used by clinicians in any setting working with patients with MS across the disability spectrum. Int J MS Care. 2015;17:181-189.

Subjects with MS walked farther, and with less fatigue, when walking intermittently rather than continuously. Persons with MS may be able to tolerate a greater dose of walking training if the walking bouts are intermittent. Further study to determine the benefits of a walking exercise program using intermittent walking is recommended.Video Abstract available for additional insights from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A103).

There is little literature examining the use of maximal strength training (MST) in people with multiple sclerosis (pwMS). This pretest-posttest study examined the effects of a MST program on strength, walking, balance, and fatigue in a sample of pwMS. Seven pwMS (median EDSS 3.0, IQR 1.5) participated in a MST program twice weekly for eight weeks. Strength was assessed with 1-repetition maximum (1RM) on each leg. Walking and balance were measured with the 6-Minute Walk Test (6MWT) and Berg Balance Scale (BBS), respectively. Fatigue was measured during each week of the program with the Fatigue Severity Scale (FSS). The program was well tolerated, with an attendance rate of 96.4%. Participants had significant improvements in right leg 1RM (t(6) = −6.032, P = 0.001), left leg 1RM (t(6) = −5.388, P = 0.002), 6MWT distance (t(6) = −2.572, P = 0.042), and BBS score (Z = −2.371, P = 0.018) after the MST intervention. There was no significant change in FSS scores (F(1, 3.312) = 2.411, P = 0.092). Participants in the MST program experienced improved balance and walking without an increase in fatigue. This MST program may be utilized by rehabilitation clinicians to improve lower extremity strength, balance, and mobility in pwMS.

Background: This pilot study determined the feasibility of a specifically designed 8-week yoga program for people with moderate multiple sclerosis (MS)-related disability. We explored the program's effect on quality of life (QOL) and physical and mental performance. Methods:We used a single-group design with repeated measurements at baseline, postintervention, and 8-week follow-up. Feasibility was examined through cost, recruitment, retention, attendance, and safety. Maximizing physical function and quality of life (QOL) is of paramount importance for the person with multiple sclerosis (MS). Disease progression, severity, and signs and symptoms are unpredictable and vary between people. 1 People with MS may experience fatigue, asthenia, balance and mobility loss, depression, and decreased cognitive function. 2 The QOL is impaired in individuals with MS owing International Journal of MS Care 31Yoga for MS vention models. In general, yoga activities vary widely between types and between instructors within types. More importantly, there is a lack of programs tailored to the needs of people with MS that are scalable to accommodate differing levels and types of disability. Recognizing this limitation, we created a standardized, integrative yoga program for people with moderate MS-related disability through a modified Delphi process. 13 Delphi panel participants included people with MS, certified yoga instructors with experience teaching people with MS, and health-care professionals and researchers with experience and expertise in MS care or yoga. This resulted in a comprehensive program specifically designed to address the needs of people with moderate MS-related disability. Details of this process have been presented elsewhere. 14 The program was designed with scalable difficulty to meet the heterogeneous capabilities of a sample of people with moderate MS-related disability while maximizing program standardization. The first objective of this study was to examine the feasibility of the specifically designed yoga program in people with moderate MS-related disability. The second objective was to examine the immediate and lasting effects of the program on function, activity, and participation. Methods DesignWe conducted a single-group pilot study, approved by the Rutgers University-Newark institutional review board, to assess the safety, feasibility, and effects of a specifically designed yoga program on QOL, physical performance, and mental performance in people with moderate MS-related disability. Repeated measures were obtained at three time points: baseline, after 8 weeks of yoga classes (postintervention), and again 8 weeks later (follow-up). Weekly home practice tracking forms were completed throughout the study.

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Purpose: Distal sensory polyneuropathy (DSP) is the most common neurologic complication of human immunodeficiency virus (HIV) disease. DSP-related symptoms have been associated with disability, reduced quality of life (QOL), and impaired function. Yoga has been shown to improve mental and physical status in people with chronic diseases. We assessed feasibility and measured the effect of a 4-week integrative yoga program in 3 persons with HIV-related DSP in the lower extremities. Case Description: Of 22 patients with DSP scheduled to attend an HIV pain clinic over 6 months, 3 enrolled in and completed the yoga program. Inclusion criteria were diagnosis of HIV disease and DSP in the feet, controlled HIV disease status, average foot pain of at least 4/10 on a numerical scale, sensory symptoms in the lower extremity, and an established regimen of pharmacologic pain management. The age range of participants was 56 to 64 years. Time since HIV disease diagnosis ranged from 15 to 30 years; time with DSP ranged from 7 to 15 years. A battery of QOL, function, disability, pain, and physical performance outcomes was measured at baseline, after the yoga intervention, and at 4-week follow-up. Outcomes: Overall attendance rate at the yoga classes was 88%. No adverse events occurred, and participants were highly satisfied with the program. Pain-related QOL and some gait parameters improved in all cases. It appeared that pain-related QOL improved without concurrent reduction in perceived pain severity or interference. Other outcomes, such a walking endurance, balance, and function, improved in some cases, but changes were inconsistent between individuals. No cases demonstrated improvement in vibration sensation or leg strength, nor reduction in self-reported disability. Conclusions: Although recruitment challenges led to concern regarding feasibility of this intervention, the program appeared to be safe and viewed favorably by the participants. There were inconsistent outcomes between individual participants; however, all experienced improved pain-related QOL and improvement in some gait characteristics. Yoga may be a viable nonpharmaceutical approach to the management of HIV-related DSP, but further research is needed to assess effectiveness, identify optimal format and dosage, and determine characteristics of potential responders.