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.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mozek diagnostické zobrazování MeSH
- roztroušená skleróza diagnostické zobrazování terapie MeSH
- techniky fyzikální terapie * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
BACKGROUND: Changes of white matter integrity in people with multiple sclerosis (MS) were documented following mainly motor/skill acquisitions physical therapy, while following neuroproprioceptive "facilitation, inhibition" (neurofacilitation) only by two pilot studies. Neurofacilitation has potential to induce white matter changes due to the possibility of interfering with the neuronal tactility threshold. However stronger evidence is missing. AIM: This study investigates whether neurofacilitation (three physical therapy types) induce white matter changes and if they relate to clinical improvement. DESIGN: The Three-Arm Parallel-group Exploratory Trial (NCT04355663). SETTING: Each group underwent different kinds of two months ambulatory therapy (Motor Program Activating Therapy, Vojta's reflex locomotion and Functional Electric Stimulation in Posturally Corrected Position). POPULATION: MS people with moderate disability. METHODS: At baseline and after the program, participants underwent magnetic resonance diffusion tensor imaging (DTI) and clinical assessment. Fractional anisotropy maps obtained from DTI were further analyzed using tract-based spatial statistic exploring the mean values in the whole statistic skeleton. Moreover, additional exploratory analysis in 48 regions of white matter was done. RESULTS: Ninety-two people were recruited. DTI data from 61 people were analyzed. The neurofacilitation (irrespective type of therapy) resulted in significant improvement on the Berg Balance Scale (P=0.0089), mainly driven by the Motor Program Activating Therapy. No statistically significant change in the whole statistic skeleton was observed (only a trend for decrement of fractional anisotropy after Vojta's reflex locomotion). Additional exploratory analysis confirmed significant decrement of fractional anisotropy in the right anterior corona radiata. CONCLUSIONS: Neurofacilitation improved balance without much evidence of white matter integrity changes in people with MS. CLINICAL REHABILITATION IMPACT: The study results point to the importance of neuroproprioceptive "facilitation and inhibition" physical therapy in the management of balance in people with multiple sclerosis; and the potential to induce white matter changes due to the possibility of interfering with the neuronal tactility threshold.
Background: Only few studies have monitored the potential of physical activity training and physical therapy to modulate the reaction of the endocrine system. In this study, the effect of neuroproprioceptive facilitation and inhibition physical therapy on clinical outcomes and neuroactive steroids production in people with multiple sclerosis was evaluated. Moreover, we were interested in the factors that influence the treatment effect. METHODS: In total, 44 patients with multiple sclerosis were randomly divided into two groups. Each group underwent a different kind of two months ambulatory therapy (Motor program activating therapy and Vojta's reflex locomotion). During the following two months, participants were asked to continue the autotherapy. Primary (serum level of cortisol, cortisone, 7α-OH-DHEA, 7β-OH-DHEA, 7-oxo-DHEA, DHEA) and secondary (balance, cognition and patient-reported outcomes) outcomes were examined three times (pre, post, and washout assessments). RESULTS: In both groups, there is a decreasing trend of 7-oxo-DHEA concentration in post-assessment and 7β-OH-DHEA in washout versus pre-assessment. A higher impact on neuroactive steroids is visible after Vojta's reflex locomotion. As for clinical outcomes, the Paced Auditory Serial Addition Test and Multiple Sclerosis Impact Scale significantly improved between post-assessment and washout assessment. The improvement was similar for both treatments. CONCLUSIONS: Neuroproprioceptive facilitation and inhibition improved the clinical outcomes and led to non-significant changes in neuroactive steroids. Trial registration (NCT04379193).
- Publikační typ
- časopisecké články MeSH
Incidence roztroušené sklerózy mozkomíšní ve světě a v České republice stále stoupá. Je jedním z nejčastějších onemocnění, které invalidizuje mladé lidi a vyčleňuje je jak z pracovního, tak sociálního života. Farmakoterapie tohoto onemocnění není pro potlačení progrese dostačující. Ke snížení následků tohoto onemocnění je potřeba komplexní přístup, jehož součástí je i fyzioterapie. Současný výzkum se zabývá možnostmi co nejefektivnějšího využití potenciálu fyzioterapie v léčbě roztroušené sklerózy mozkomíšní a hledá možnosti, jak aktivně a cíleně ovlivňovat plastické a adaptační procesy centrálního nervového systému. V této rešeršní práci shrnujeme problematiku neuroplasticity obecně a specificky u roztroušené sklerózy mozkomíšní. Věnujeme se možnostem zobrazování plastických a adaptačních procesů. Popisujeme současný fyzioterapeutický přístup k nemocným s roztroušenou sklerózou mozkomíšní. Věnujeme se možnostem, kterými fyzioterapie může ovlivnit neuroplasticitu. Shrnujeme výsledky vlastního výzkumu, v němž pomocí různých zobrazovacích metod hodnotíme efekt nového facilitačního fyzioterapeutického přístupu Motorické programy aktivující terapie.
The incidence of multiple sclerosis world-wide and in the Czech Republic continues to rise. It is one of the most common diseases that disables young people and excludes them from work as well as social life. Pharmacotherapy of this disease is insufficient to suppress progression. A comprehensive approach including physiotherapy is needed to reduce the symptoms of this disease. Current research aims to identify options for the most effective use of physiotherapy in the treatment of multiple sclerosis and is exploring the ways to actively and purposefully influence plastic and adaptive processes of the central nervous system. We discuss this theme in the present review article. We summarize the issue of neuroplasticity in general (and specifically in multiple sclerosis) and discuss the options for displaying plastic and adaptation processes (using functional magnetic resonance imaging in particular). Furthermore, we mention current physiotherapy approaches for multiple sclerosis and their potential impact on neuroplasticity. We summarize the results of our own research that monitors (via various imaging methods) the effect of the Motor Programs Activating Therapy, a new facilitation physiotherapy approach.
- Klíčová slova
- difuzní tenzor,
- MeSH
- centrální nervový systém fyziologie MeSH
- lidé MeSH
- longitudinální studie MeSH
- magnetická rezonanční tomografie metody využití MeSH
- motorické dovednosti MeSH
- mozek fyziologie MeSH
- neuroplasticita fyziologie MeSH
- roztroušená skleróza * diagnostické zobrazování patologie terapie MeSH
- techniky fyzikální terapie * využití MeSH
- velký mozek fyziologie MeSH
- Check Tag
- lidé MeSH
Cíl: Užitím inovativní metody analýzy záznamů funkční magnetické rezonance (resp. určení efektivní konektivity) objektivizovat neuroplasticitu po fyzioterapii u nemocných s roztroušenou sklerózou mozkomíšní. Soubor a metodika: Dvanáct nemocných s roztroušenou sklerózou (průměrný věk 44,3 ? 9,2 let, EDSS 3,7 ? 0,9, délky onemocnění 9,3 ? 6,0 let) podstoupilo dvouměsíční fyzioterapii – Motorické programy aktivující terapii. Na začátku a na konci facilitačního fyzioterapeutického programu (2× týdně, 1 hod) bylo provedeno klinické vyšetření zaměřené na funkci horních končetin (hodnocení třesu, diadochokinézy, taxe, kvalitativní svalové síly a spasticity) a vyšetření funkční magnetickou rezonancí během motorické úlohy prstů. Z dat funkční rezonance byly analýzou v programu Statistical parametric mapping určeny síly efektivní konektivity mezi suplementární motorickou areou a primárními motorickými oblastmi. Kontrolní skupinu tvořilo 12 zdravých dobrovolníků (průměrný věk 39,4 ? 12,2 let). Výsledky: Analýza efektivní konektivity ukázala silné spojení mezi suplementární motorickou areou a oběma primárními motorickými oblastmi (pacienti měli většinou silnější konektivitu než zdravé kontroly, významně mezi suplementární motorickou areou a primární motorickou oblastí vlevo; p = 0,005). Efektivní konektivita mezi levou a pravou primární motorickou oblastí byla celkově významně slabší. Po terapii došlo u nemocných ke zlepšení ve všech klinických testech (v indexu pravé ruky p < 0,001, v indexu levé ruky p < 0,001), nebyly ale prokázány signifikantní změny efektivní konektivity. Závěr: Analýza efektivní konektivity je jedna z cest k objektivizaci mozkové plasticity, a to nejenom z anatomického, ale především z funkčního hlediska. Terapie měla jednoznačný pozitivní vliv na klinické funkce, avšak signifikantní změny efektivní konektivity po terapii se neprokázaly.
Aim: The aim was to objectify neuroplasticity after physiotherapy using an innovative method of functional magnetic resonance imaging data analysis (determination of effective connectivity) in multiple sclerosis patients. Material and methods: Twelve patients (mean: age 44.3 ? 9.2 years, EDSS 3.7 ? 0.9, disease duration 9.3 ? 6.0 years underwent Motor program activation therapy (one hour therapy, twice a week). Clinical and fMRI examination during a motoric task for fingers was carried out before and after the therapy. The clinical examination focused on the upper extremity function (evaluation of tremor, diadochokinesis, ataxia, muscle strength and spasticity). Effective connectivity between supplementary motor and right and left primary motor areas was determined using the Statistical Parametric Mapping software. A control group consisted of 12 healthy controls (mean age 39.4 ? 12.2). Results: The analysis of effective connectivity showed strong connection between the supplementary motor area and both primary motor areas (patients had stronger connection in more cases than healthy controls, significant between the supplementary motor area and the left primary motor area, p = 0.005). Effective connectivity between the right and left primary motor areas was significantly weaker. After the therapy, improvement occurred in all the clinical tests (right hand index p < 0.001, left hand index p < 0.001) but no changes were observed in effective connectivity. Conclusion: Effective connectivity represents a possible approach to objectification of brain plasticity. Facilitation physiotherapy had a significant effect on clinical function while significant changes of effective connectivity were not demonstrated. Key words: multiple sclerosis – physiotherapy techniques – functional magnetic resonance imaging – neuroplasticity The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
- Klíčová slova
- efektivní konektivita,
- MeSH
- dospělí MeSH
- horní končetina MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie * statistika a číselné údaje MeSH
- mapování mozku MeSH
- motorické korové centrum MeSH
- neparametrická statistika MeSH
- neuroplasticita MeSH
- pilotní projekty MeSH
- roztroušená skleróza * patofyziologie terapie MeSH
- studie případů a kontrol MeSH
- techniky fyzikální terapie * MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
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.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mozek patologie patofyziologie MeSH
- roztroušená skleróza rehabilitace MeSH
- techniky fyzikální terapie MeSH
- zobrazování difuzních tenzorů MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
