A comparison of two physiotherapy treatment approaches to improve walking in multiple sclerosis: A pilot randomized study

Rivermead Rehabilitation Centre, Oxford, UK.
Clinical Rehabilitation (Impact Factor: 2.24). 12/1998; 12(6):477-86. DOI: 10.1191/026921598675863454
Source: PubMed

ABSTRACT To use a pilot study to compare two physiotherapy approaches to improve walking in patients with gait disturbance due to multiple sclerosis (MS).
Patients were assessed and then randomly assigned to one of two groups using a block randomization technique. They were treated by the research physiotherapist for a minimum of 15 treatments over a 5-7-week period and then reassessed by an independent therapist one week after treatment.
Both assessment and treatment were undertaken at a specialist rehabilitation centre.
Outpatients with clinically stable MS (chronic progressive or relapsing-remitting types) who were referred for physiotherapy to improve their mobility.
Comparison was between a facilitation (impairment-based) approach and a task-oriented (disability-focused) approach.
Mobility was assessed using four measures: the 10-metre timed walk, the Rivermead Mobility Index, stride length and the Rivermead Visual Gait Assessment. Balance was assessed using the Berg Balance Test.
Twenty-three patients were entered, and 10 in each group completed the study. The groups were similar on all measured items both before and after treatment. There was no significant difference in improvement between the two approaches. Following treatment, patients in both groups showed a significant overall improvement (p < 0.05) in both impairment and disability measures.
No significant differences in effectiveness between the two methods were demonstrated. Both a task-oriented approach and a facilitation approach to the treatment of MS outpatients were associated with improved mobility.

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    • "Until now, only a few studies have defined their intervention as a neurofacilitation approach and evaluated its effectiveness (Lord et al., 1998; Smedal et al., 2006). This restricted conclusive scientific evidence is caused by a lack of clear and detailed information on the contents of the delivered intervention in studies. "
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    ABSTRACT: There is still little scientific evidence for the efficacy of neurofacilitation approaches and their possible influence on brain plasticity and adaptability. In this study, the outcome of a new kind of neurofacilitation approach, motor programme activating therapy (MPAT), was evaluated on the basis of a set of clinical functions and with MRI. Eighteen patients were examined four times with standardized clinical tests and diffusion tensor imaging to monitor changes without therapy, immediately after therapy and 1 month after therapy. Moreover, the strength of effective connectivity was analysed before and after therapy. Patients underwent a 1-h session of MPAT twice a week for 2 months. The data were analysed by nonparametric tests of association and were subsequently statistically evaluated. The therapy led to significant improvement in clinical functions, significant increment of fractional anisotropy and significant decrement of mean diffusivity, and decrement of effective connectivity at supplementary motor areas was observed immediately after the therapy. Changes in clinical functions and diffusion tensor images persisted 1 month after completing the programme. No statistically significant changes in clinical functions and no differences in MRI-diffusion tensor images were observed without physiotherapy. Positive immediate and long-term effects of MPAT on clinical and brain functions, as well as brain microstructure, were confirmed.
    International Journal of Rehabilitation Research 10/2014; 38(1). DOI:10.1097/MRR.0000000000000090 · 1.14 Impact Factor
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    • "The alteration of a single sensory input (e.g., eyes closed) led to an increase in the frequency of abnormal performances for 80% of subjects, while alteration of two sensory inputs (e.g., eyes closed on foam) led to a sharp increase in abnormal performance for almost all subjects and many of them fell during the test. Balance rehabilitation is an important component of the retraining program in people with MS [11-13]. Although the impact of MS on balance has been studied, little is known about the ability of the sensory systems to improve after neurological lesions and consequently improve balance functions and sensory integration [13]. "
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    ABSTRACT: Balance control relies on accurate perception of visual, somatosensory and vestibular cues. Sensory flow is impaired in Multiple Sclerosis (MS) and little is known about the ability of the sensory systems to adapt after neurological lesions reducing sensory impairment. The aims of the present study were to verify whether:1.balance rehabilitation administered in a challenging sensory conditions would improve stability in upright posture 2.the improvement in a treated sensory condition would transfer to a non treated sensory condition METHODS: Fifty three persons with MS, median (min-max) EDSS score of 5 (2.5-6.5), participated in a RCT and were randomly assigned to two groups. The Experimental group received balance rehabilitation aimed at improving motor and sensory strategies. The Control group received rehabilitation treatment which did not include training of sensory strategies. Persons with MS were blindly assessed by means of a stabilometric platform with eyes open, eyes closed and dome, on both firm surface and foam. Anterior-posterior and medio-lateral sway, velocity of sway and the length of Center of Pressure (CoP) trajectory were calculated in the six sensory conditions.
    Journal of NeuroEngineering and Rehabilitation 06/2014; 11(1):100. DOI:10.1186/1743-0003-11-100 · 2.62 Impact Factor
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    • "Because gait problems can lead to an increased risk of falling, it is important to include balance and walking training in the therapy program [13]. Physiotherapy in chronic MS patients is associated with improved mobility compared with no treatment [10] [14] [15], but the benefit may only last a few weeks [14] [15]. Beside over-ground gait training, different types of gait rehabilitation on a treadmill are possible, such as, treadmill training (TT) with manual assistance and support, treadmill training in combination with body weight support (BWS), and treadmill training with BWS in combination with robot assistance (RA). "
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    ABSTRACT: Purpose. This systematic review critically analyzes the literature on the effectiveness of treadmill training (TT), body-weight-supported TT (BWSTT), and robot-assisted TT (RATT) in persons with multiple sclerosis (MS), with focus on gait-related outcome measurements. Method. Electronic databases (Pubmed, Pedro, Web of Science, and Cochrane Library) and reference lists of articles and narrative reviews were searched. Pre-, quasi- and true-experimental studies were included if adult persons with MS were involved in TT, BWSTT, or RATT intervention studies published before 2012. Descriptive analysis was performed and two researchers scored the methodological quality of the studies. Results. 5 true- and 3 preexperimental studies (mean quality score: 66%) have been included. In total 161 persons with MS were involved (TT, BWSTT, or RATT, 6-42 sessions; 2-5x/week; 3-21 weeks). Significant improvements in walking speed and endurance were reported. Furthermore, improvements of step length, double-support time, and Expanded Disability Status Scale were found. Conclusions. There is a limited number of published papers related to TT in persons with MS, concluding that TT, BWSTT, and RATT improve the walking speed and endurance. However, it is not clear what type of TT is most effective. RCTs with larger but more homogeneous populations are needed.
    05/2012; 2012:240274. DOI:10.1155/2012/240274
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