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

Abstract

Introduction: Persons with multiple sclerosis (MS) have deficits in many aspects of physical and cognitive functioning that can impact on mobility and participation in daily life. The effect of a 4 week intensive multimodal treadmill training on functional mobility, balance, executive functions and participation in persons with MS with moderate to severe disability was investigated.Methods: Thirty eight persons with MS admitted to a rehabilitation center participated in a two arm randomized 2:1 controlled trial. Participants in the experimental group received supervised intensive treadmill training including cognitive and motor dual tasks (DT-group, N = 26), 5 sessions per week and a control group received the same amount of supervised strength training (S-group, N = 12). The participants were assessed before and after the rehabilitation period with the 2 Minutes Walking Test (2MWT), speed and, static and dynamic balance measures, the Frontal Assessment Battery and the Short Form-12 questionnaire. The main hypothesis was related to the superiority of the treadmill intervention based on a greater proportion of people making a clinically relevant gain (15% increase on 2MWT) in gait resistance following treatment. ANCOVA (Analysis of covariance) models adjusting for baseline measurement of the respective outcome variable, as well as sex and age, were used to evaluate differences in efficacy for all variables. P was set at 0.05.Results: Nineteen out of 26 persons in the DT-group made a clinically relevant gain and two out of 12 in the S-Group (P = 0.001). The DT-group improved more in gait resistance, speed and mobility (P < 0.01). Balance and executive functions instead improved moderately in both groups following training while perception of health remained similar in both groups.Conclusion: A four week multimodal training on treadmill was highly effective in augmenting gait resistance and mobility in moderately to severely affected persons with MS.

Balance Testing in Multiple Sclerosis—Improving Neurological Assessment With Static Posturography?

“…Future approaches could consider concomitant MS impairments such as cognitive dysfunction and their effect on postural control using static posturography. PwMS could be more unbalanced by adding cognitive tasks and an improvement of balance function after multi-tasking training has been reported (40)(41)(42). All three evaluated parameters were able to differentiate pwMS from HS.…”

Improved Gait of Persons With Multiple Sclerosis After Rehabilitation: Effects on Lower Limb Muscle Synergies, Push-Off, and Toe-Clearance

“…Participants were 11 adults with relapsing-remitting or secondary progressive MS according to the 2005 McDonald criteria ( 27 ) who had volunteered for a larger controlled intervention trial carried out at IRCCS Don Gnocchi Foundation, Milan, Italy, in the period from October 2012 to April 2018 (see Table 1 for demographic information). From the entire dataset only the PwMS who agreed to undergo a complete gait analysis (electromyography, kinematic, and kinetics of the lower limb) pre- and post-intervention on treadmill ( 28 ) were considered for the present study. Of those, we analyzed gait data of 11 participants that had increased their gait speed by more than 15%.…”

“…We collected demographic and clinical variables according to study protocol [see Jonsdottir et al ( 28 )]. All participants with MS were evaluated with the following validated clinical scales: the 2 Minute Walking Test (2MWT) for gait endurance ( 30 ), the 10 meter timed walk (10MTW) for gait speed ( 31 ), and the Berg Balance scale for standing balance ( 32 ).…”

“…All participants with MS were evaluated with the following validated clinical scales: the 2 Minute Walking Test (2MWT) for gait endurance ( 30 ), the 10 meter timed walk (10MTW) for gait speed ( 31 ), and the Berg Balance scale for standing balance ( 32 ). The evaluation was carried out at baseline (T0) and after an intervention period (T1) by physical therapists blinded to the original study's group assignment ( 28 ).…”

Study protocol: improving cognition in people with progressive multiple sclerosis: a multi-arm, randomized, blinded, sham-controlled trial of cognitive rehabilitation and aerobic exercise (COGEx)

“…Such an approach often reflects the clinical reality of PMS where multiple neurological difficulties rather than an isolated problem must be addressed simultaneously. While a powered joint CR and exercise clinical trial has yet to be done in people with MS of any disease course there is tentative evidence from three small studies in people with RRMS that this approach may be more beneficial than either intervention alone [15][16][17]. Thus, a methodologically rigorous, well-powered study is needed now in PMS specifically in an effort to inform clinical practice.…”