Effects of motor rehabilitation on mobility and brain plasticity in multiple sclerosis: a structural and functional MRI study
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Rehabilitation seems to promote brain plasticity, but objective measures of efficacy are lacking and there is a limited understanding of the mechanisms underlying functional recovery.
To study functional and structural brain changes induced by gait rehabilitation.
We enrolled MS inpatients (EDSS 4.5–6.5) undergoing a 4-week neurorehabilitation. Several clinical measures were obtained, including: 2-min walk test (2MWT), dynamic gait index (DGI), Berg balance scale (BBS). Furthermore, motor-task functional MRI (fMRI) of plantar dorsiflexion, resting state fMRI, and regional diffusion tensor imaging (DTI) metrics were obtained. All the assessments were performed at baseline (T0), after the end of the rehabilitation period (T1) and 3 months later (T2).
Twenty-nine patients were enrolled at T0, 26 at T1, and 16 completed all timepoints. At T1, there was a significant improvement of 2MWT, DGI, and BBS scores, along with a reduced extent of the widespread activation related to the motor task at the fMRI and an increased functional connectivity in the precentral and post-central gyrus, bilaterally. None of these changes were maintained at T2.
Our findings show a short-term beneficial effect of motor rehabilitation on gait performances in MS, accompanied by brain functional reorganization in the sensory-motor network.
KeywordsMultiple sclerosis Rehabilitation Plasticity fMRI DTI
This study was supported by a grant from Fondazione Italiana Sclerosi Multipla (FISM) (Grant # 2013/R/26).
Compliance with ethical standards
Conflicts of interest
All authors report no disclosures.
The study has been approved by the local ethics committee and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
All the subjects recruited in the study gave their written informed consent prior to their inclusion in the study.
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