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Neurorehabilitation in Multiple Sclerosis-A Review of Present Approaches and Future Considerations. J Clin Med 2022; 11:jcm11237003. [PMID: 36498578 PMCID: PMC9739865 DOI: 10.3390/jcm11237003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Multiple sclerosis is an increasingly prevalent disease, representing the leading cause of non-traumatic neurological disease in Europe and North America. The most common symptoms include gait deficits, balance and coordination impairments, fatigue, spasticity, dysphagia and an overactive bladder. Neurorehabilitation therapeutic approaches aim to alleviate symptoms and improve the quality of life through promoting positive immunological transformations and neuroplasticity. The purpose of this study is to evaluate the current treatments for the most debilitating symptoms in multiple sclerosis, identify areas for future improvement, and provide a reference guide for practitioners in the field. It analyzes the most cited procedures currently in use for the management of a number of symptoms affecting the majority of patients with multiple sclerosis, from different training routines to cognitive rehabilitation and therapies using physical agents, such as electrostimulation, hydrotherapy, cryotherapy and electromagnetic fields. Furthermore, it investigates the quality of evidence for the aforementioned therapies and the different tests applied in practice to assess their utility. Lastly, the study looks at potential future candidates for the treatment and evaluation of patients with multiple sclerosis and the supposed benefits they could bring in clinical settings.
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Karpatkin HI, Benson A, Gardner N, Leb N, Ramos N, Xu H, Cohen ET. Pilot trial of speed-intensive gait training on balance and walking in people with multiple sclerosis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2020.0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background/Aims Diminished walking speed and endurance is commonly experienced by individuals with multiple sclerosis. Speed-intensive gait training has led to improvements in walking speed and endurance in other neurological populations; however, its effect in persons with multiple sclerosis is unknown. This pilot study examined the feasibility, safety and efficacy of speed-intensive gait training in a sample of people with multiple sclerosis. Methods A total of eight participants (five women, median Expanded Disability Status Scale 3.5) underwent a 6-week, twice weekly speed-intensive gait training programme. Walking speed and endurance, balance and fatigue were measured pre- and post-intervention. Results Speed-intensive gait training was feasible, with excellent adherence and safety. It proved effective, with improvements in walking speed (P=0.05), walking endurance (P=0.036) and balance (P=0.041) without an increase in fatigue. Conclusions The intermittent design of speed-intensive gait training may enable individuals with multiple sclerosis to achieve higher training volumes than traditional models. Although further study is warranted, rehabilitation clinicians should consider adding speed-intensive gait training as an intervention to improve walking and balance in this patient group.
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Affiliation(s)
- Herb I Karpatkin
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Allison Benson
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Nolan Gardner
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Naomi Leb
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Nicole Ramos
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Huiman Xu
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Evan T Cohen
- Department of Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, Blackwood, NJ, USA
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Combining Russian stimulation with isometric exercise improves strength, balance, and mobility in older people with falls syndrome. Int J Rehabil Res 2018; 42:41-45. [PMID: 30325756 DOI: 10.1097/mrr.0000000000000321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
One of the main causes of falls in older people is muscle strength loss associated with aging. Russian stimulation can improve muscle strength in healthy individuals, but the effect has never been tested in older individuals with falls syndrome. The aim of this study was to evaluate the usefulness of Russian stimulation plus isometric exercise to improve muscular strength, balance, and mobility in older people with falls syndrome. The recruited participants (older than 60 years, at least one fall in the past year) were evaluated by a physiatrist, who collected clinical data and performed baseline and final evaluations (muscle strength, Berg balance scale, Tinetti mobility test, get up and go test, and 6-min walk test). A physical therapist applied the 10/50/10 protocol for Russian stimulation, stimulating the quadriceps and tibialis anterior muscles separately; simultaneously, the participants performed isometric exercise at a frequency of three sessions per week for 12 weeks. Descriptive statistics, the paired-sample t-test, and the χ-test were performed. The study included 25 participants (96% women, mean age 65.2±5.5 years). After the intervention, there was a significant improvement in the strength of the quadriceps (~30%) and tibialis anterior (~40%) muscles as well as the results of the balance (Tinetti 22%, Berg 10%) and mobility (get up and go 25%, 6-min distance 20%) tests. On the basis of the improvements in the Tinetti and Berg scores, significantly fewer participants were classified as being at increased risk for falls. The muscle strength correlated with several clinical evaluation results, but not with the Tinetti test score. Russian stimulation plus isometric exercise improves strength, balance, and mobility, which may decrease the fall risk.
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Masaki M, Ikezoe T, Fukumoto Y, Minami S, Aoyama J, Ibuki S, Kimura M, Ichihashi N. Association of walking speed with sagittal spinal alignment, muscle thickness, and echo intensity of lumbar back muscles in middle-aged and elderly women. Aging Clin Exp Res 2016; 28:429-34. [PMID: 26319656 DOI: 10.1007/s40520-015-0442-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 08/14/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Age-related change of spinal alignment in the standing position is known to be associated with decreases in walking speed, and alteration in muscle quantity (i.e., muscle mass) and muscle quality (i.e., increases in the amount of intramuscular non-contractile tissue) of lumbar back muscles. Additionally, the lumbar lordosis angle in the standing position is associated with walking speed, independent of lower-extremity muscle strength, in elderly individuals. However, it is unclear whether spinal alignment in the standing position is associated with walking speed in the elderly, independent of trunk muscle quantity and quality. The present study investigated the association of usual and maximum walking speed with age, sagittal spinal alignment in the standing position, muscle quantity measured as thickness, and quality measured as echo intensity of lumbar muscles in 35 middle-aged and elderly women. METHODS Sagittal spinal alignment in the standing position (thoracic kyphosis, lumbar lordosis, and sacral anterior inclination angle) using a spinal mouse, and muscle thickness and echo intensity of the lumbar muscles (erector spinae, psoas major, and lumbar multifidus) using an ultrasound imaging device were also measured. RESULTS Stepwise regression analysis showed that only age was a significant determinant of usual walking speed. The thickness of the lumbar erector spinae muscle was a significant, independent determinant of maximal walking speed. CONCLUSIONS The results of this study suggest that a decrease in maximal walking speed is associated with the decrease in lumbar erector spinae muscles thickness rather than spinal alignment in the standing position in middle-aged and elderly women.
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Affiliation(s)
- Mitsuhiro Masaki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Tome Ikezoe
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshihiro Fukumoto
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Hyogo, 518 Arise, Ikawadani-cho, Nishi-ku, Kobe, 651-2180, Japan
| | - Seigo Minami
- Department of Occupational Therapy, Faculty of Allied Health Sciences, Yamato University, Osaka, 2-5-1 Katayama-cho, Suita, 564-0082, Japan
| | - Junichi Aoyama
- Department of Rehabilitation, Kyoto Yawata Hospital, Kyoto, 61 Kawaguchi-Bessho, Yawata, 614-8114, Japan
| | - Satoko Ibuki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Misaka Kimura
- Faculty of Health and Medical Science, Kyoto Gakuen University, Kyoto, 1-1 Nanjyo-Otani, Sogabe-cho, Kameoka, 621-8555, Japan
| | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Gawel J, Vengrow D, Collins J, Brown S, Buchanan A, Cook C. The short physical performance battery as a predictor for long term disability or institutionalization in the community dwelling population aged 65 years old or older. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x11y.0000000050] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Magistro D, Liubicich ME, Candela F, Ciairano S. Effect of ecological walking training in sedentary elderly people: act on aging study. THE GERONTOLOGIST 2013; 54:611-23. [PMID: 23682170 DOI: 10.1093/geront/gnt039] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY This study aims to investigate the effects of a walking program on aerobic endurance and function in a sample of sedentary elderly people. DESIGN AND METHODS For this study, 126 sedentary individuals were recruited: 63 individuals (mean age = 74.1±6.0 years) for the control group and 63 (mean age = 72.0±4.5 years) for the intervention group. The intervention consisted of walking training including balance exercises and lower limb strength activities twice a week for 4 months. We collected baseline and post-test measurements of aerobic endurance, lower limb strength, and mobility. We also measured aerobic endurance at increments of 4, 8, and 12 weeks between the baseline and the post-test. We used analyses of covariance with baseline value, gender, age, and body mass index scores as covariates (p < . 05) and calculated the effect size for the effects of the intervention. The changeover time of aerobic endurance was also analyzed with the repeated analysis of variance (p < .05). RESULTS The intervention group showed steady and significant improvements with respect to the 6-min walk (aerobic endurance) from 447.89 m (SD 73.87) to 561.51 m (SD 83.96), as well as the 30-s chair stand (lower limb strength) from 10 (SD 3) to 13 (SD 3) number of times and the Timed Up and Go Test (mobility) from 8.53 s (SD 2.86) to 7.13 s (SD 1.76) at the post-test, whereas the control group showed significant decrease in all measurements. IMPLICATION These results underline that an ecological walking training program can be used to improve physical functioning among sedentary elderly people.
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Affiliation(s)
- Daniele Magistro
- Motor Science Research Center, University School of Motor and Sport Science (SUISM), University of Torino, Italy.
| | - Monica Emma Liubicich
- Motor Science Research Center, University School of Motor and Sport Science (SUISM), University of Torino, Italy
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Gallagher NA, Clarke PJ, Ronis DL, Cherry CL, Nyquist L, Gretebeck KA. Influences on neighborhood walking in older adults. Res Gerontol Nurs 2012; 5:238-50. [PMID: 22998660 DOI: 10.3928/19404921-20120906-05] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 12/16/2011] [Indexed: 11/20/2022]
Abstract
The purpose of this cross-sectional survey study was to examine the influence of self-efficacy, outcome expectations, and environment on neighborhood walking in older adults with (n = 163, mean age = 78.7, SD = 7.96 years) and without (n = 163, mean age = 73.6, SD = 7.93 years) mobility limitations, controlling for demographic characteristics. Multiple regression revealed that in mobility-limited older adults, demographic characteristics, self-efficacy, and outcome expectations explained 17.4% of variance in neighborhood walking, while environment (neighborhood destinations and design) explained 9.4%. Destinations, self-efficacy, sex, and outcome expectations influenced walking. In those without mobility limitations, demographic characteristics, self-efficacy, and outcome expectations explained 15.6% of the variance, while environment explained 5.6%. Self-efficacy, sex, and design influenced walking. Neighborhood walking interventions for older adults should include self-efficacy strategies tailored to mobility status and neighborhood characteristics.
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Affiliation(s)
- Nancy A Gallagher
- College of Nursing, Michigan State University, East Lansing, MI, USA.
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Morris GS, Landry CL, Grubbs EG, Jimenez C, Busaidy NL, Perrier ND. Greater than age-predicted functional deficits in older patients with primary hyperparathyroidism. Endocr Pract 2012; 18:450-5. [PMID: 22784831 DOI: 10.4158/ep11206.or] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the functional capacity of "asymptomatic" patients with primary hyperparathyroidism (PHPT) with normative values of healthy age-matched subjects. METHODS Eighteen asymptomatic patients with PHPT met the study inclusion criteria: age >55 years, serum calcium concentration elevated ≤1 mg/dL above normal, inappropriate elevation of parathyroid hormone (PTH) level, and no objective symptoms of PHPT. Functional capacity was assessed by (1) a 6-minute walk test, (2) time to complete 2 sit-to-stand maneuvers, (3) gait velocity, and (4) forward reach. Serum calcium, 25-hydroxyvitamin D, and PTH levels were measured by standard laboratory assays. Functional outcomes of the study patients were compared with age-matched normative values (unpaired t test) and correlated with these biomarkers. Because these patients often have weakness, fatigue, and malaise, we hypothesized that their functional capacity would be compromised relative to that of healthy, age-matched persons. RESULTS The mean age of the patients was 65.6 years, and the mean serum calcium, PTH, and 25-hydroxyvitamin D levels (and standard deviations) were 10.36 ± 0.37 mg/dL, 122.22 ± 39.54 pg/mL, and 44.4 ± 14.27 ng/mL, respectively. Relative to normative values of healthy, age-matched subjects, these patients had comparable 6-minute walk distances but required a 37% longer time to complete a repeated sit-to-stand maneuver (P<.05), demonstrated a 52% slower gait speed (P<.001), and had a greater forward reach (P=.05). CONCLUSION Our findings suggest that older asymptomatic patients with PHPT may have significant functional deficits that can affect their safety and quality of life. Therefore, their functional capacity should be routinely evaluated, and identified deficits should be treated with appropriate interventions.
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Affiliation(s)
- G Stephen Morris
- Department of Rehabilitation Services, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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Tikkanen P, Nykänen I, Lönnroos E, Sipilä S, Sulkava R, Hartikainen S. Physical activity at age of 20-64 years and mobility and muscle strength in old age: a community-based study. J Gerontol A Biol Sci Med Sci 2012; 67:905-10. [PMID: 22396477 DOI: 10.1093/gerona/gls005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physical activity in midlife has been related to lower mortality and better health in old age. The present study evaluated whether physical activity at age of 20-64 years was associated with mobility and muscle strength in old age. METHODS A random sample of 1,000 persons was extracted from all the ≥75-year-old people living in Kuopio, Finland, and 679 community-dwelling participants were included in the present analyses. Data on health status, ability to walk outside or 400 m, and physical activity level were obtained through structured interviews. Participants' walking speed, grip strength, and knee extension strength were measured by physiotherapists. Relationship between physical activity at age of 20-64 years and old-age mobility and strength was assessed using logistic regression and covariance analyses. RESULTS Of the 679 participants (mean age 80.8 years), 58.8% had been physically active at age of 20-64 years. Physical activity at that age was positively associated with ability to walk 400 m independently in old age (adjusted odds ratio 2.17, 95% confidence intervals: 1.25-3.77). Men who had been physically active at age of 20-64 years had greater walking speed (adjusted p = .01) and grip strength (adjusted p = .02) compared with physically inactive men. In women, the results did not differ statistically significantly. CONCLUSIONS Physical activity at age of 20-64 years was associated with better mobility in old age. It was also linked to better grip strength and walking speed in older men but not in women.
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Affiliation(s)
- Päivi Tikkanen
- Institute of Public Health and Clinical Nutrition, Department of Public Health, University of Eastern Finland, Kuopio, Finland.
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Bowden MG, Embry AE, Gregory CM. Physical therapy adjuvants to promote optimization of walking recovery after stroke. Stroke Res Treat 2011; 2011:601416. [PMID: 22013549 PMCID: PMC3195278 DOI: 10.4061/2011/601416] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 07/06/2011] [Accepted: 07/13/2011] [Indexed: 11/20/2022] Open
Abstract
Stroke commonly results in substantial and persistent deficits in locomotor function. The majority of scientific inquiries have focused on singular intervention approaches, with recent attention given to task specific therapies. We propose that measurement should indicate the most critical limiting factor(s) to be addressed and that a combination of adjuvant treatments individualized to target accompanying impairment(s) will result in the greatest improvements in locomotor function. We explore training to improve walking performance by addressing a combination of: (1) walking specific motor control; (2) dynamic balance; (3) cardiorespiratory fitness and (4) muscle strength and put forward a theoretical framework to maximize the functional benefits of these strategies as physical adjuvants. The extent to which any of these impairments contribute to locomotor dysfunction is dependent on the individual and will undoubtedly change throughout the rehabilitation intervention. Thus, the ability to identify and measure the relative contributions of these elements will allow for identification of a primary intervention as well as prescription of additional adjuvant approaches. Importantly, we highlight the need for future studies as appropriate dosing of each of these elements is contingent on improving the capacity to measure each element and to titrate the contribution of each to optimal walking performance.
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Affiliation(s)
- Mark G Bowden
- Rehabilitation Research and Development Service, Ralph H. Johnson VA Medical Center, Department of Health Science and Research and Division of Physical Therapy, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC 29425, USA
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Freiberger E, Sieber C, Pfeifer K. Physical activity, exercise, and sarcopenia - future challenges. Wien Med Wochenschr 2011; 161:416-25. [PMID: 21792532 DOI: 10.1007/s10354-011-0001-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Accepted: 05/19/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Numerous studies have demonstrated that the etiology of sarcopenia is multi-causal and very complex process. The degradation of muscle mass leads to a loss of strength, later on to a decreased functional status, impaired mobility, a higher risk of falls, and eventually an increased risk of mortality. Present guidelines state that physical inactivity or a decreased physical activity level is a part of the underlying mechanisms of sarcopenia and therefore physical activity can be seen as an important factor to reverse or modify the development of sarcopenia. TOPIC Results in the area of physical activity and aging have not always been homogeneous. The inconsistent findings in this research area are related to the different understanding of terms and underlying constructs along with different population, type of intervention, or measurement methods. These aspects will be discussed in the paper. With regard to the formulated future role of physical activity this article will discuss in addition different barriers and challenges in the prevention and treatment of sarcopenia. A multitude of studies shows that structured exercise programs including progressive resistance or power training have positive effects on sarcopenia and sarcopenia-related outcomes but less or inconclusive information is available for the transfer to functional outcomes. CONCLUSIONS Both physical activities and exercise have shown to decrease risk of sarcopenia and onset of functional limitations in older persons. Unfortunately the cohort of older persons is the one with the highest percentage of individuals classified as inactive or sedentary. Therefore motivating older persons to increase their physical activity level as well as providing safe access to exercise programs seems to be a mandatory task.
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Affiliation(s)
- Ellen Freiberger
- Institute of Sport Science and Sports, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
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