Improving mobility and functional independence in persons with multiple sclerosis

Persons with multiple sclerosis (MS) commonly experience restrictions in mobility and everyday functional activities. A wide range of factors including physical, psychological, environmental and economic issues may contribute to these difficulties. This is particularly the case as the disease evolves, and the impairments and disabilities become more numerous, inter-related and hence more complex. Effective management of these complex problems requires assessment and intervention from a variety of different perspectives by using a coordinated, goal-oriented, multi-disciplinary management approach. Crucially, it requires management to be considered from a long-term perspective rather than as a fragmented series of isolated “quick-fixes”. Received: 31 October 2000, Accepted: 6 November 2000     

Locomotor training using body weight support on a treadmill improves mobility in persons with multiple sclerosis: a pilot study

RATIONALE: The purpose of this protocol was to investigate the potential benefits and tolerability of locomotor training using body weight support on a treadmill (LTBWST) in persons with multiple sclerosis (MS). METHODS: Four persons with primarily spinal cord MS and severely impaired ambulation (Expanded Disability Status Scale score 7.0-7.5) were enrolled in LTBWST. Subjects completed an average of 40 training sessions over several months. RESULTS: Subjects showed improvement in muscle strength, spasticity, endurance, balance, walking speed, and quality of life at the end of the training sessions, and could tolerate training without fatigue or other adverse effects. CONCLUSIONS: LTBWST is well tolerated by persons with MS and may produce improvements in parameters related to functional mobility.     

Resistance training and aerobic training improve muscle strength and aerobic capacity in chronic inflammatory demyelinating polyneuropathy

Introduction: We investigated the effects of aerobic and resistance exercise in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Methods: Eighteen CIDP patients treated with subcutaneous immunoglobulin performed 12 weeks of aerobic exercise and 12 weeks of resistance exercise after a run‐in period of 12 weeks without exercise. Three times weekly the participants performed aerobic exercise on an ergometer bike or resistance exercise with unilateral training of knee and elbow flexion/extension. Primary outcomes were maximal oxygen consumption velocity (VO₂‐max) and maximal combined isokinetic muscle strength (cIKS) of knee and elbow flexion/extension. Results: VO₂‐max and muscle strength were unchanged during run‐in (?4.9% ± 10.3%, P = 0.80 and ?3.7% ± 10.1%, P = 0.17, respectively). Aerobic exercise increased VO₂‐max by 11.0% ± 14.7% (P = 0.02). Resistance exercise resulted in an increase of 13.8% ± 16.0% (P = 0.0004) in cIKS. Discussion: Aerobic exercise training and resistance exercise training improve fitness and strength in CIDP patients. Muscle Nerve 57 : 70–76, 2018     

Exercise training improves depressive symptoms in people with multiple sclerosis: Results of a meta-analysis

Objective

There is a high prevalence, yet under-treatment of depressive disorder and symptoms by conventional therapy in people with multiple sclerosis (MS). We conducted a meta-analysis examining the overall effect of exercise training on depressive symptoms in MS.

Methods

We searched PubMed for randomized controlled trials (RCT) of exercise training and depression as an outcome in samples with MS. There were 13 RCTs that met inclusion criteria and yielded data for effect size (ES) generation (Cohen's d). An overall ES was calculated using a random effects model and expressed as Hedge's g.

Results

The weighted mean ES was small, but statistically significant (Hedge's g = 0.36, SE = 0.09, 95% CI = 0.18–0.54, z = 3.92, p < .001) indicating the exercise training resulted in an improvement in depressive symptoms compared to control. The overall effect was not heterogeneous (Q = 16.46, df = 12, p = 0.17, I² = 27.08); and post-hoc, exploratory analyses only identified depression symptom scale as a potential moderator variable (p = 0.04).

Conclusion

The cumulative evidence indicates that exercise training can yield a small, yet statistically significant and reliable reduction in depressive symptoms for people with MS.     

Disability management and rehabilitation for persons with multiple sclerosis

Multiple sclerosis is the commonest cause of chronic neurological disability in young adults. Patients typically have a normal life span, though with accrued time multiple disabilities with a significant impact on quality of life. This article presents the current literature on symptomatic treatment and rehabilitation for persons with multiple sclerosis. A comprehensive multidisciplinary approach addresses the acute, intermediate and long-term medical, psychological and social issues faced by these individuals. Prevention of medical complications, maintenance and restoration of functional independence, addressing psychosocial factors and issues relating to quality of life are integral to the rehabilitation processes.     

A functional application of the spacing effect to improve learning and memory in persons with multiple sclerosis

The present study examined the utility of using spaced learning trials (when trials are distributed over time) versus massed learning trials (consecutive learning trials) in the acquisition of everyday functional tasks. In a within-subjects design, 20 participants with multiple sclerosis (MS) and 18 healthy controls (HC) completed two route learning tasks and two paragraph reading tasks. One task in each area was presented in the "spaced" condition, in which the task was presented to the participants three times with 5-minutes break between each trial, and the second task in each area was presented in the "massed" condition, in which the task was presented three consecutive times to the participants. The dependent variables consisted of recall and recognition of the paragraphs and routes both immediately and 30 minutes following initial learning. Results showed that for paragraph learning, the spaced condition significantly enhanced memory performance for this task relative to the massed condition. However, this effect was not demonstrated in the route learning task. Thus, the spacing effect can be beneficial to enhance recall and performance of activities of daily living for individuals with MS; however, this effect was significant for verbal tasks stimuli, but not for visual tasks stimuli. It will be important during future investigations to better characterize the factors that maximize the spacing effect.     

Botulinum toxin improves dysphagia associated with multiple sclerosis

Objective: To evaluate the efficacy of botulinum neurotoxin type A (BoNT/A) for severe oro‐pharyngeal dysphagia associated with multiple sclerosis (MS). Patients and methods: BoNT/A was injected percutaneously into the hyperactive cricopharyngeal muscle of 14 dysphagic MS patients under electromyographic control. Patients were evaluated by videofluoroscopic and electromyographic examinations and by the Penetration/Aspiration Scale (PAS), at week 1, 4, 12, 16, 18, and 24 after BoNT/A injection. Results: All patients showed a significant improvement in all the swallowing outcome measures. Conclusion: No specific treatment for oro‐pharyngeal dysphagia related to MS has been described to date. Our preliminary findings suggest a potential benefit from BoNT/A treatment in MS patients with dysphagia associated with upper esophageal sphincter hyperactivity.     

Normal functional capacity of blood lymphocytes in multiple sclerosis measured by stimulation with mitogens.

The effect of phytohemagglutinin (PHA) and pokeweed mitogen (PWM) on blood lymphocytes was studied in multiple sclerosis, patients with acute CNS infections, and healthy controls. No significant differences in lymphocyte proliferation were registered between the group of MS patients and the two other groups, irrespective of mitogen used. The ratio between the PWM and PHA responses did not differ significantly from the ratios in the two other groups. The lymphocyte proliferation with PWM was significantly lower in the group with acute CNS infections compared with controls. The results indicate that alterations in cell-mediated immunity, if present in MS, are not confined to lymphocytes outside the CNS.     

The scope and nature of pain in persons with multiple sclerosis

Much remains unknown about the scope, nature, and impact of pain on the lives of persons with multiple sclerosis (MS). In the present study, 180 community dwelling adults with MS completed a postal survey that included demographic measures, MS disease measures, and several standardized measures of pain, including pain intensity, variability, location, and pain-related interference. Some 66% of the sample reported pain, 25% of whom reported severe pain. Persons with pain reported an average of 6.6 distinct pain sites. Using the Brief Pain Inventory Interference Scale, the average level of overall pain interference was 3.33 (0-10 scale) in the group reporting pain. The highest levels of pain interference were reported for sleep, recreational activities, and work in and outside the home. Persons with pain were more likely to report greater MS disease severity, poorer psychological functioning, and poorer health than persons with MS but not pain. Persons with pain were also less likely to be employed. These findings are consistent with previous research that shows that pain is common in MS, that it is severe in a substantial subset of these individuals and has the potential to negatively impact physical and psychosocial functioning over and above the effects of MS itself.