Effect of Eccentric Strength Training on Elbow Flexor Spasticity and Muscle Weakness in People With Multiple Sclerosis: Proof-of-Concept Single-System Case Series

Manca, Andrea; Martinez, Gianluca; Aiello, Elena; Ventura, Lucia; Deriu, Franca

doi:10.1093/ptj/pzaa055

Cited by 10 publications

(5 citation statements)

References 29 publications

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“…Recently, a small pilot study demonstrated the feasibility, safety and efficacy of eccentric downhill walking in five people with MS affected by ankle contractures [ 37 ]. Additionally, eccentric strength training of the elbow flexors was proven to be feasible as well as beneficial for strength- and function-related parameters in people with MS with spasticity [ 38 ]. Moreover, because of the possible anti-inflammatory effect of eccentric training, this exercise mode seems suitable for the modulation of the immunometabolism, since MS is associated with an altered balance between pro- and anti-inflammatory cytokines [ 39 ].…”

Section: Introductionmentioning

confidence: 99%

Application of eccentric training in various clinical populations: Protocol for a multi-centered pilot and feasibility study in people with low back pain and people with multiple sclerosis

et al. 2022

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Physical activity and exercise are effective approaches in prevention and therapy of multiple diseases. Although the specific characteristics of lengthening contractions have the potential to be beneficial in many clinical conditions, eccentric training is not commonly used in clinical populations with metabolic, orthopaedic, or neurologic conditions. The purpose of this pilot study is to investigate the feasibility, functional benefits, and systemic responses of an eccentric exercise program focused on the trunk and lower extremities in people with low back pain (LBP) and multiple sclerosis (MS). A six-week eccentric training program with three weekly sessions is performed by people with LBP and MS. The program consists of ten exercises addressing strength of the trunk and lower extremities. The study follows a four-group design (N = 12 per group) in two study centers (Israel and Germany): three groups perform the eccentric training program: A) control group (healthy, asymptomatic); B) people with LBP; C) people with MS; group D (people with MS) receives standard care physiotherapy. Baseline measurements are conducted before first training, post-measurement takes place after the last session both comprise blood sampling, self-reported questionnaires, mobility, balance, and strength testing. The feasibility of the eccentric training program will be evaluated using quantitative and qualitative measures related to the study process, compliance and adherence, safety, and overall program assessment. For preliminary assessment of potential intervention effects, surrogate parameters related to mobility, postural control, muscle strength and systemic effects are assessed. The presented study will add knowledge regarding safety, feasibility, and initial effects of eccentric training in people with orthopaedic and neurological conditions. The simple exercises, that are easily modifiable in complexity and intensity, are likely beneficial to other populations. Thus, multiple applications and implementation pathways for the herein presented training program are conceivable. Trial registration: DRKS00020483 (DRKS, German Clinical Trials Register; 24th January 2020 –retrospectively registered; https://www.drks.de/DRKS00020483).

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Section: Introductionmentioning

confidence: 99%

Application of eccentric training in various clinical populations: Protocol for a multi-centered pilot and feasibility study in people with low back pain and people with multiple sclerosis

et al. 2022

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“…While the passive stretching performed at the beginning of each session was limited to only a few repetitions, we applied a stretch and hold movement immediately after each active extension attempt during the Gate game. The possibility of co-contraction of flexors during this stretch would have led to eccentric contraction of flexors, which may decrease hypertonia following neurologic injury (53). Studies with the X-Glove have shown that a 30 min period of cyclic passive stretching can transiently improve active motor performance in stroke patients, with effects carrying over across sessions in subacute stroke (54).…”

Section: Discussionmentioning

confidence: 99%

Pilot Test of Dosage Effects in HEXORR II for Robotic Hand Movement Therapy in Individuals With Chronic Stroke

Chen

Black

Nichols

et al. 2021

Front. Rehabilit. Sci.

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Impaired use of the hand in functional tasks remains difficult to overcome in many individuals after a stroke. This often leads to compensation strategies using the less-affected limb, which allows for independence in some aspects of daily activities. However, recovery of hand function remains an important therapeutic goal of many individuals, and is often resistant to conventional therapies. In prior work, we developed HEXORR I, a robotic device that allows practice of finger and thumb movements with robotic assistance. In this study, we describe modifications to the device, now called HEXORR II, and a clinical trial in individuals with chronic stroke. Fifteen individuals with a diagnosis of chronic stroke were randomized to 12 or 24 sessions of robotic therapy. The sessions involved playing several video games using thumb and finger movement. The robot applied assistance to extension movement that was adapted based on task performance. Clinical and motion capture evaluations were performed before and after training and again at a 6-month followup. Fourteen individuals completed the protocol. Fugl-Meyer scores improved significantly at the 6 month time point compared to baseline, indicating reductions in upper extremity impairment. Flexor hypertonia (Modified Ashworth Scale) also decreased significantly due to the intervention. Motion capture found increased finger range of motion and extension ability after the intervention that continued to improve during the followup period. However, there was no change in a functional measure (Action Research Arm Test). At the followup, the high dose group had significant gains in hand displacement during a forward reach task. There were no other significant differences between groups. Future work with HEXORR II should focus on integrating it with functional task practice and incorporating grip and squeezing tasks.Trial Registration:ClinicalTrials.gov, NCT04536987. Registered 3 September 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04536987.

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“…The possibility of co-contraction of exors during this stretch would have led to eccentric contraction of exors, which may decrease in hypertonia following neurologic injury. 50 Studies with the X-Glove have shown that a 30 min period of cyclic passive stretching can transiently improve active motor performance in stroke patients, with effects carrying over across sessions in subacute stroke. 51 Improvements in subacute stroke subjects were reported in measures of impairment and function following training that included 30 min of passive cyclic stretching followed by active-assisted, task practice.…”

Section: Discussionmentioning

confidence: 99%

Clinical Trial of HEXORR II for Robotic Hand Movement Therapy After Stroke

Ji¹,

Black²,

Nichols³

et al. 2020

Preprint

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BackgroundImpaired use of the hand in functional tasks remains difficult to overcome in many individuals after a stroke. This often leads to compensation strategies using the less-affected limb, which allows for independence in some aspects of daily activities. However, recovery of hand function remains an important therapeutic goal of many individuals, and is often resistant to conventional therapies. In prior work, we developed HEXORR I, a robotic device that allows practice of finger and thumb movements with robotic assistance. In this study, we describe modifications to the device, now called HEXORR II, and a clinical trial in individuals with chronic stroke. MethodsFifteen individuals with a diagnosis of chronic stroke were randomized to 12 or 24 sessions of robotic therapy. The sessions involved playing several video games using thumb and finger movement. The robot applied assistance to extension movement that was adapted based on task performance. Clinical and motion capture evaluations were performed before and after training and again at a 6 month followup. ResultsFourteen individuals completed the protocol. Fugl-Meyer scores improved significantly over the 3 time points, indicating reductions in upper extremity impairment. Flexor hypertonia (Ashworth) also decreased significantly due to the intervention. Motion capture found increased finger range of motion and extension ability when the arm was supported by gravity. However, extension ability did not improve significantly during a reach and grasp task, and there was no change in a functional measure (Action Research Arm Test). At the followup, the high dose group had significant gains in hand displacement during a forward reach task. There were no other significant differences between groups. ConclusionsFuture work with HEXORR II should focus on integrating it with functional task practice and incorporating grip and squeezing tasks. Trial registration: CLINICALTRIALS.GOV, NCT04536987. Registered 3 September 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04536987

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Effect of Eccentric Strength Training on Elbow Flexor Spasticity and Muscle Weakness in People With Multiple Sclerosis: Proof-of-Concept Single-System Case Series

Cited by 10 publications

References 29 publications

Application of eccentric training in various clinical populations: Protocol for a multi-centered pilot and feasibility study in people with low back pain and people with multiple sclerosis

Application of eccentric training in various clinical populations: Protocol for a multi-centered pilot and feasibility study in people with low back pain and people with multiple sclerosis

Pilot Test of Dosage Effects in HEXORR II for Robotic Hand Movement Therapy in Individuals With Chronic Stroke

Clinical Trial of HEXORR II for Robotic Hand Movement Therapy After Stroke

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