If you overhear a research meeting at the Swedish MS Center, it may come up that the rehabilitation studies are not sub-listed under, "disease modifying therapy trials." That is when I usually pipe up and say, "Rehabilitation is disease modifying in MS!" In fact, it is one the of proven disease modifiers in progressive MS. Below is a summary of the recent article from the Italian MS group that reviewed improvements in brain plasticity from motor and cognitive rehabilitation in patients with MS. The Italian researchers do an excellent job in quantifying outcome measures from rehabilitation interventions using imaging.
The group used searches of key words to narrow the field to 16 research papers that looked at evidence of motor and cognitive rehabilitation and functional and structural brain plasticity in patients with MS. This was assessed by clinical improvement and neuroimaging techniques. Traditional MRI is not good at looking at plasticity, so they looked at studies that included diffusion tensor imaging (DTI) and task-related and resting-state functional MRI (fMRI). The type of motor or cognitive rehabilitation differed among studies as well as control groups (which is one of the problems in rehabilitation research).
High-intensity, repetitive training of motor functions involving the lower limbs and task-oriented exercises aimed at improving upper limb functions resulted in specific brain changes. Cognitive training of specific areas resulted in improvements in those areas of the brain that control cognitive processing. These were improvements that correlated to changes on DTI and fMRI.
Overall, this provides a glimpse into evidence that rehabilitation does modify the course of MS, not just improvement of symptoms.
(Click here to read the full article.)
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