A personalized, intense physical rehabilitation program improves walking in people with multiple sclerosis presenting with different levels of disability: a retrospective cohort

Abstract

BackgroundPeople with multiple sclerosis (PwMS) endure walking limitations. To address this restriction, various physical rehabilitation programs have been implemented with no consensus regarding their efficacy. Our objective was to report on the efficacy of an integrated tailored physical rehabilitation program on walking in people with multiple sclerosis categorized according to their level of neurological disability.MethodsRetrospective data were examined and analyzed. Specifically, data obtained from all patients who participated in the Multiple Sclerosis Center’s 3 week rehabilitation program were extracted for in depth exploration. The personalized rehabilitation program included three major components modified according to the patient’s specific impairments and functional needs: (a) goal directed physical therapy (b) moderately intense aerobic exercise training on a bicycle ergometer and (c) aquatic therapy chiefly oriented to body structures appropriate to movement. Gait outcome measurements included the 10 meter, 20 meter, Timed up and go and 2 minute walking tests measured pre and post the rehabilitation program. Three hundred and twelve people with relapsing-remitting multiple sclerosis were included in the final analysis. Patients were categorized into mild (n = 87), moderate (n = 104) and severely (n = 121) disabled groups.ResultsAll clinical walking outcome measurements demonstrated statistically significant improvements, however, only an increase in the 2 minute walking test was above the minimal clinical difference value. The moderate and severe groups considerably improved compared to the mild gait disability group. Mean change scores (%) of the pre-post intervention period of the 2 minute walking test were 19.0 (S.E. = 3.4) in the moderate group, 16.2 (S.E. = 5.4) in the severe group and 10.9 (S.E. = 2.3) in the mild gait disability group.ConclusionsWe presented comprehensive evidence verifying the effects of an intense goal-directed physical rehabilitation program on ambulation in people with multiple sclerosis presenting with different neurological impairment levels.

Intensive Multimodal Training to Improve Gait Resistance, Mobility, Balance and Cognitive Function in Persons With Multiple Sclerosis: A Pilot Randomized Controlled Trial

“…This way the persons were training at a high intensity level in all of each session, Further, the training activities were more of the interval type and with variable gait activities, factors that have been shown to be effective in improving cardiovascular parameters and so gait resistance ( 35 – 37 ). Altogether, the results give strength to evidence of treadmill training being preferable to strength training if the goal is to improve walking and walking resistance in persons moderately and severely affected by MS ( 34 , 38 ).…”

Understanding walking activity in multiple sclerosis: step count, walking intensity and uninterrupted walking activity duration related to degree of disability

“…Overall, behavioral interventions can be effective for increasing and sustaining PA in PwMS [34,36], and sometimes even leading to benefits in symptomatic outcomes like fatigue severity, depression and anxiety [37]. For other patients, tailored physical rehabilitation interventions may improve the walking activity in PwMS as well [38]. On a higher ICF level, improving the walking speed of PwMS appears to have important effects on the ability to participate in daily life, as it had a significant impact on health-related QoL and (assistance in) activities of daily living [39].…”

Neuroprotection by central nervous system remyelination: Molecular, cellular, and functional considerations

“…Little is known regarding how myelin plasticity varies with region or neuronal subtype, or how its mechanisms differ from or impact remyelination. However, activity‐dependent myelination may play a role in functional improvement of MS symptoms following physical rehabilitation (Bonzano et al, ; Kalron et al, ). Conversely, new sheaths formed during remyelination may be less responsive to signals that induce myelin plasticity.…”