Functional and Structural Brain Plasticity Enhanced by Motor and Cognitive Rehabilitation in Multiple Sclerosis
Table 1
Summary of studies investigating the effect of motor rehabilitation or training on brain plasticity, assessed by nonconventional functional or structural MRI techniques.
Active group: outpatient eclectic sensori-motor learning and adaptation
1-hour sessions, 2 times per week, for 2 months Control group: no special exercise (MS)
The 9-HPT, 25-FWT, PASAT, postural reactions, MS QoL-54, and BDI improved in active group
Mean age: ~43 years Mean MS duration: ~18 years Median EDSS: 4.0 Course: 22 RR, 18 SP
Randomized controlled trial
Active group: outpatient active motor rehabilitation of upper limbs
1-hour sessions, 3 times per week, for about 2 months Control group: outpatient passive motor rehabilitation of upper limbs
1-hour sessions, 3 times per week, for about 2 months
Both groups improved on unimanual motor performance, but bimanual coordination worsened in control group
Reduced FA and increased RD of corticospinal tracts and corpus callosum were found in control group, as detected by DT-MRI measures
Mean age: ~36 years Mean MS duration: ~10 years Median EDSS: 3.0 Course: 26 RR, 1 SP
Randomized two-period cross-over trial
Active group: home-based video game balance board
30-minute sessions, 5 times per week for 12 weeks Control group: no intervention
Static balance detected at static posturography improved in active group
Increased FA and reduced RD of superior cerebellar peduncles were found in active group, as detected by DT-MRI; DTI changes were significantly related to improved static balance
Mean age: ~40 years Mean MS duration: ~7 years Median EDSS: 3.5 Course: 11 RR, 1 PP
Non-randomized uncontrolled comparison trial
Motor programme activating therapy
1-hour sessions, 2 times per week, for about 2 months
The MAS, 25-FWT, 9-HPT, and cerebellar functions improved immediately after and one month apart from the end of rehabilitation
Increased FA and reduced MD of corpus callosum immediately after and one month apart from the end of rehabilitation; no changes were detected with task-related fMRI
9-HPT: 9-hole peg test; 25-FWT: 25-foot walking test; BDI: Beck Depression Inventory; DTI: diffusion tensor imaging; EDSS: Expanded Disability Status Scale; fMRI: functional magnetic resonance imaging; FA: fractional anisotropy; MAS: Modified Ashworth Scale; MD: mean diffusivity; MS QoL-54: 54-item Multiple Sclerosis Quality of Life; N/R: not reported; PASAT: Paced Auditory Serial Addition Test; PP: primary progressive; RR: relapsing-remitting; SP: secondary progressive. The number within parentheses refers to the sample size of healthy subjects.