BACKGROUND: Imaging methods bring new possibilities for describing the brain plasticity processes that underly the improvement of clinical function after physiotherapy in people with multiple sclerosis (pwMS). Although these processes have been described mainly in connection with task-oriented physiotherapy and aerobic training, they have not been properly verified in neuroproprioceptive "facilitation, inhibition" (facilitation) approaches. AIM: The study determined whether facilitation physiotherapy could enhance brain plasticity, compared two facilitation methods and looked for any relation to clinical improvement in pwMS. DESIGN: The study was designed as parallel group randomized comparison of two kinds of physiotherapeutic interventions referred to healthy controls. SETTING: Thirty-eight outpatients were involved in the study. POPULATION: The study had 80 participants (38 pwMS and 42 healthy controls). METHODS: PwMS were divided into two groups and underwent a two-month physiotherapy program: Vojta reflex locomotion (VRL) or Motor program activating therapy (MPAT), (1 hour, twice a week). Functional magnetic resonance imaging (fMRI) and clinical examination was performed before and after therapy. Healthy controls underwent one fMRI examination. RESULTS: Physiotherapy in pwMS leads to extension of brain activity in specific brain areas (cerebellum, supplementary motor areas and premotor areas) in connection with the improvement of the clinical status of individual patients after therapy (P=0.05). Greater changes (P=0.001) were registered after MPAT than after VRL. The extension of activation was a shift to the examined activation of healthy controls, whose activation was higher in the cerebellum and secondary visual area (P=0.01). CONCLUSIONS: Neuroproprioceptive "facilitation, inhibition" physiotherapy may enhance brain activity and could involve processes connected with the processing of motion activation. CLINICAL REHABILITATION IMPACT: The study showed that facilitation approach can modulate brain activity. This could be useful for developing of effective physiotherapeutic treatment in MS.

Department of Rehabilitation Medicine 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Rehabilitation Motol Faculty Hospital Prague Czech Republic

Institute of Biophysics and Informatics 1st Faculty of Medicine Charles University Prague Czech Republic

MR Unit Department of Diagnostic and Interventional Radiology Institute for Clinical and Experimental Medicine Prague Czech Republic

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