- Email: [email protected]
Aerobic training enhances cognition and functional status in depressive multiple sclerosis patients. A case-control study. Pilot study
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
First affected are fast systems with high level of integration. “Dual tasking” often leads to a poorer performance. Aim of the study is to verify the value of early rehabilitation in reducing the impact of these symptoms on daily living. Material and method We conducted a case-control study including 15 patients with EDSS < 3, divided into three groups: 5 underwent 10 sessions of adapted physical activity (APA); 5 had 10 cognitive-motor training sessions (individual rehabilitation project-IRP), 5 not underwent rehabilitation treatment (control). Patients had initial and final motor-cognitive assessments using Berg Balance Scale (BBS), Ten Meter Walking Test (TMWT) at different speeds and performing a cognitive task (Word List Generation-WLG), Brief Repeatable Battery of Neuropsychological Tests (BRB-NT), Trail Making Test (TMT) and Digit Span. Results TMWT final evaluation showed variations in IRP and APA. The number of words generated in usual and quick speed, not changed in Control, was reduced in APA, increased in IRP. BBS score variation was statistically significant in IRP and APA (IRP initial median score: 52, final median score: 55). At BRB-NT, after cognitive training, results a significant improvement in IRP (t-test: p 0,005). Conclusion IRP and APA show a greater ability in balance control and global fluidity; IRP has better performance in “dual tasking”, probably related to an exercise focused on individual specific impairments. These data support the value of individualized rehabilitation treatment, since the early stage of the disease, moreover APA could represent a good tool in the maintenance phase. Keywords Multiple sclerosis; Early rehabilitation; Dual tasking Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.573 ISPR8-0521
Respiratory rehabilitation in multiple sclerosis: A narrative review of rehabilitation techniques J. Levy 1,2,∗ , H. Prigent 1,3 , D. Bensmail 1,2 Université de Versailles St-Quentin-en-Yvelines, Inserm UMR-1179, Neuromuscular handicap, Montigny-le-Bretonneux, France 2 AP–HP, Hôpital Raymond-Poincaré, Department of Physical and Rehabilitation Medicine, Garches, France 3 AP–HP, Hôpital Raymond-Poincaré, Physiology and Functional Testing, Garches, France ∗ Corresponding author. E-mail address: [email protected] (J. Levy)
1
Introduction/Background Respiratory disorders in multiple sclerosis (MS) are an important issue. They can occur early during the course of the disease, are associated with the neurological impairment, and can lead to pneumonia and respiratory failure, which are the main causes of death in advanced MS. Prevailing impaired expiratory muscles and cough abilities has been demonstrated in this population and might constitute a specific target for rehabilitation interventions. However, international guidelines lack recommendations regarding respiratory rehabilitation in MS. We performed a systematic review of literature assessing respiratory rehabilitation in MS. Material and method We searched the databases MEDLINE, PEDro and Cochrane Library for reports of clinical trials and well-designed cohorts published from inception to December 2016, by using the search terms “multiple sclerosis”, “respiratory rehabilitation”, “respiratory muscle training”, “lung volume recruitment”, “cough assistance”, and “mechanical in-exsufflation”. Literature reviews, case reports and physiological studies were excluded. The Maastricht criteria were used to assess the quality of trials. We followed the Oxford Centre for Evidence-Based Medicine guidelines to determine level of evidence and grade of recommendations.
e247
Results Among the 21 studies initially selected, 11 were retained for review. Seven studies were randomized controlled trials (RCTs), 2 were non-RCTs, and 2 were observational studies. Respiratory muscle training (inspiratory and/or expiratory) by use of a portable resistive mouthpiece was the most frequently evaluated technique, with 2 level-1 RCTs. Another level-1 RCT evaluated deep-breathing exercises. All reviewed studies evaluated home-based rehabilitation programs and focused on spirometric outcomes. The disparities in outcome measures among published studies did not allow for a meta-analysis. Cough assistance devices were not evaluated in this population. Conclusion Although respiratory muscle training can improve maximal respiratory pressure in MS and lung volume recruitment can slow the decline in vital capacity, evidence is lacking to recommend specific respiratory rehabilitation programs adapted to the level of disability induced by the disease. Keywords Respiratory rehabilitation; Multiple sclerosis; Respiratory muscle training Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.574 ISPR8-0552
Aerobic training enhances cognition and functional status in depressive multiple sclerosis patients. A case-control study. Pilot study
E. Miller ∗ , M. Niwald , J. Redlicka Medical University of Lodz, Physical Medicine Chair of Rehabilitation, Lodz, Poland ∗ Corresponding author. E-mail address: [email protected] (E. Miller) Introduction/Background Multiple sclerosis (MS) is a complex disease manifested by a wide range of symptoms. Depression is one of the most important problems in individuals with MS. Depressive symptoms are strictly associated with lower quality of their life. Recent studies suggest that aerobic training (AT) alleviates depressive symptoms. Therefore, the aims of this study were to study the effects of aerobic training (AT) on depression, cognition and functional status in 2 groups of multiple sclerosis (MS) patients: with depression syndrome (MS-D) and without depression (MS). Moreover, we analyzed the mean delta values with their confidence intervals and examined the changes in baseline values using covariance analysis. Material and method A sample of 31 individuals with MS and 28 MS-D performed 30 minutes of AT using lower-extremity ergometer 3 × 10 min. per day with 60 min. break for 6 weeks. Both groups were matched for age and sex. All examined parameters were assessed before and after the series of AT using the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), Activity Daily Living Scale (ADL) and the Expanded Disability Status Scale (EDSS). We analyzed the dropout rate as a measure of feasibility. Results In both groups, the AT sessions induced a significant improvement in reducing depression (BDI) and cognition impairment (MoCA). However, the changes observed in MS-D patients were significantly greater than those observed in MS patients, especially in the BDI and MoCA. There were no statistically significant correlations of EDSS, MOCCA, BDI, ADL and age or gender. Conclusion AT appears to be effective easy tool in improving cognition and functional status in patients with MS. This study indicated that aerobic training is feasible and could be beneficial for patients with progressive MS. Keywords Aerobic training; Multiple sclerosis; Mental status
e248
Disclosure of interest peting interest.
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
The authors declare that they have no com-
https://doi.org/10.1016/j.rehab.2018.05.575 ISPR8-1003
Aquatic exercise training increases serum brain-derived neurotrophic factor in patients with multiple sclerosis: A randomized controlled study M. Kargarfard 1,∗ , A. Shariat 2 University of Isfahan, Department of Exercise Physiology, Faculty of Sport Sciences, Isfahan, Iran 2 Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran ∗ Corresponding author. E-mail address: kargar [email protected] (M. Kargarfard)
1
ISPR8-1307
Fampridine-PR (prolonged released 4-aminopyridine) improves upper limb dysfunction in multiple sclerosis patients: Clinical and kinematic analysis C. Cheiney-Kulak 1,∗ , P. Revol 2 , F. Durand-Dubief 3 , I. Ionescu 3 , S. Roggerone 3 , A. Benoit 3 , L. Delporte 2 , L. Roche 4 , M. Rabilloud 4 , S. Vukusic 3 , Y. Rossetti 2 , S. Jacquin-Courtois 1 1 Hospices Civils de Lyon, Physical Medicine and Rehabilitation, Saint-Genis-Laval, France 2 Hospices Civils de Lyon, Mouvement et Handicap Platform, Saint-Genis-Laval, France 3 Hospices Civils de Lyon, Neurology, Bron, France 4 Hospices Civils de Lyon, Biostatistics, Lyon, France ∗ Corresponding author. E-mail address: [email protected] (C. Cheiney-Kulak)
Background and aims Brain-derived neurotrophic factor (BDNF) is neurotrophic factor for MS pathogenesis. However, the impact of acute exercise on BDNF factor is less clear in patients with MS and no study to date has examined this assumption. The purpose of this study was to examine the effects of 12-weeks supervised aquatic exercise on serum concentration BDNF, balance, functional exercise capacity, and fatigue in patients with multiple sclerosis. ¯ ± SD = 37 ± 9 Methods Twenty-eight patients MS (mean age X years) were randomly assigned to either aquatic exercise group (EX: n = 13), or the control group (CON: n = 15). The patients Ex group exercised 3 times per week, 30 to 60 minutes per session for 12 weeks and included aerobic exercises, strength, flexibility, balance exercise training and walking activities, and the subjects in CON group were asked to maintain normal daily life pattern for the duration of the study. Balance, functional exercise capacity, fatigue, and BDNF serum concentration were measured at before and after intervention. Results The results showed that 12 weeks of aquatic exercise increased BDNF and improved balance, functional exercise capacity, and fatigue in the EX group. In CON group, the serum BDNF level slightly decreased, and fatigue level increased significantly after 12 weeks, but balance and functional exercise capacity did not change. Also, there were significantly differences in serum BDNF, balance, functional exercise capacity, and fatigue between Ex and CON groups after intervention (P < 0.05). Conclusions The study showed that aquatic exercise more effective than treatment in increase BNDF levels of the subjects with MS. This type of activity is a beneficial training method to maintain functional parameters and also to increase the rate of BDNF in the MS. Disclosure of interest The authors declare that they have no competing interest.
Introduction/Background Multiple sclerosis often results in upper limb dysfunction which significantly affects patients’ quality of life. However, little support is currently proposed for this deficit. Fampridine-PR is validated to improve walking speed but only few studies indicate that this drug may also be effective on upper limb function, with no detailed functional movement analysis. The aim of this study is to assess efficacy of fampridine-PR on improving grasping abilities in persons with Multiple Sclerosis (PwMS) by using a global analysis including both clinical and kinematic criteria. Material and method We included 14 consecutive PwMS with EDSS > 5 and we performed Jebsen Hand Function Test (JHFT) before treatment and under treatment. Patients showing a consistent improvement at D14 (n = 11 patients showing at least 12% reduction between D0 and D14) continued the treatment and the JHFT score were measured after 30 and 90 days under treatment. We also quantified upper force using dynamometers after 14, 30 and 90 days of treatment. In addition 3D kinematic analyses (grasping a glass) were realized with each arm on each assessment. Results JHFT score dropped from day 0 to day 14 by more than 20% and remained stable up to day 90. Individual analysis highlighted that improvement of JHFT score varied from 12.4% to 59.3% from initial score. The evolution of testing score followed the same trend. The hand dynanometer score remained heterogeneous. The kinematic analysis showed a better opening of the grip and a smoothing of the arm movement with less velocity peaks. Conclusion The results suggest that Fampridine-PR can significantly improve grasping function during at least the 90 days of our follow-up. Keywords Fampridine; Upper limb function; Jebsen Hand Function Test Disclosure of interest The authors declare that they have no competing interest.
https://doi.org/10.1016/j.rehab.2018.05.576
https://doi.org/10.1016/j.rehab.2018.05.577
First affected are fast systems with high level of integration. “Dual tasking” often leads to a poorer performance. Aim of the study is to verify the value of early rehabilitation in reducing the impact of these symptoms on daily living. Material and method We conducted a case-control study including 15 patients with EDSS < 3, divided into three groups: 5 underwent 10 sessions of adapted physical activity (APA); 5 had 10 cognitive-motor training sessions (individual rehabilitation project-IRP), 5 not underwent rehabilitation treatment (control). Patients had initial and final motor-cognitive assessments using Berg Balance Scale (BBS), Ten Meter Walking Test (TMWT) at different speeds and performing a cognitive task (Word List Generation-WLG), Brief Repeatable Battery of Neuropsychological Tests (BRB-NT), Trail Making Test (TMT) and Digit Span. Results TMWT final evaluation showed variations in IRP and APA. The number of words generated in usual and quick speed, not changed in Control, was reduced in APA, increased in IRP. BBS score variation was statistically significant in IRP and APA (IRP initial median score: 52, final median score: 55). At BRB-NT, after cognitive training, results a significant improvement in IRP (t-test: p 0,005). Conclusion IRP and APA show a greater ability in balance control and global fluidity; IRP has better performance in “dual tasking”, probably related to an exercise focused on individual specific impairments. These data support the value of individualized rehabilitation treatment, since the early stage of the disease, moreover APA could represent a good tool in the maintenance phase. Keywords Multiple sclerosis; Early rehabilitation; Dual tasking Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.573 ISPR8-0521
Respiratory rehabilitation in multiple sclerosis: A narrative review of rehabilitation techniques J. Levy 1,2,∗ , H. Prigent 1,3 , D. Bensmail 1,2 Université de Versailles St-Quentin-en-Yvelines, Inserm UMR-1179, Neuromuscular handicap, Montigny-le-Bretonneux, France 2 AP–HP, Hôpital Raymond-Poincaré, Department of Physical and Rehabilitation Medicine, Garches, France 3 AP–HP, Hôpital Raymond-Poincaré, Physiology and Functional Testing, Garches, France ∗ Corresponding author. E-mail address: [email protected] (J. Levy)
1
Introduction/Background Respiratory disorders in multiple sclerosis (MS) are an important issue. They can occur early during the course of the disease, are associated with the neurological impairment, and can lead to pneumonia and respiratory failure, which are the main causes of death in advanced MS. Prevailing impaired expiratory muscles and cough abilities has been demonstrated in this population and might constitute a specific target for rehabilitation interventions. However, international guidelines lack recommendations regarding respiratory rehabilitation in MS. We performed a systematic review of literature assessing respiratory rehabilitation in MS. Material and method We searched the databases MEDLINE, PEDro and Cochrane Library for reports of clinical trials and well-designed cohorts published from inception to December 2016, by using the search terms “multiple sclerosis”, “respiratory rehabilitation”, “respiratory muscle training”, “lung volume recruitment”, “cough assistance”, and “mechanical in-exsufflation”. Literature reviews, case reports and physiological studies were excluded. The Maastricht criteria were used to assess the quality of trials. We followed the Oxford Centre for Evidence-Based Medicine guidelines to determine level of evidence and grade of recommendations.
e247
Results Among the 21 studies initially selected, 11 were retained for review. Seven studies were randomized controlled trials (RCTs), 2 were non-RCTs, and 2 were observational studies. Respiratory muscle training (inspiratory and/or expiratory) by use of a portable resistive mouthpiece was the most frequently evaluated technique, with 2 level-1 RCTs. Another level-1 RCT evaluated deep-breathing exercises. All reviewed studies evaluated home-based rehabilitation programs and focused on spirometric outcomes. The disparities in outcome measures among published studies did not allow for a meta-analysis. Cough assistance devices were not evaluated in this population. Conclusion Although respiratory muscle training can improve maximal respiratory pressure in MS and lung volume recruitment can slow the decline in vital capacity, evidence is lacking to recommend specific respiratory rehabilitation programs adapted to the level of disability induced by the disease. Keywords Respiratory rehabilitation; Multiple sclerosis; Respiratory muscle training Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.574 ISPR8-0552
Aerobic training enhances cognition and functional status in depressive multiple sclerosis patients. A case-control study. Pilot study
E. Miller ∗ , M. Niwald , J. Redlicka Medical University of Lodz, Physical Medicine Chair of Rehabilitation, Lodz, Poland ∗ Corresponding author. E-mail address: [email protected] (E. Miller) Introduction/Background Multiple sclerosis (MS) is a complex disease manifested by a wide range of symptoms. Depression is one of the most important problems in individuals with MS. Depressive symptoms are strictly associated with lower quality of their life. Recent studies suggest that aerobic training (AT) alleviates depressive symptoms. Therefore, the aims of this study were to study the effects of aerobic training (AT) on depression, cognition and functional status in 2 groups of multiple sclerosis (MS) patients: with depression syndrome (MS-D) and without depression (MS). Moreover, we analyzed the mean delta values with their confidence intervals and examined the changes in baseline values using covariance analysis. Material and method A sample of 31 individuals with MS and 28 MS-D performed 30 minutes of AT using lower-extremity ergometer 3 × 10 min. per day with 60 min. break for 6 weeks. Both groups were matched for age and sex. All examined parameters were assessed before and after the series of AT using the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), Activity Daily Living Scale (ADL) and the Expanded Disability Status Scale (EDSS). We analyzed the dropout rate as a measure of feasibility. Results In both groups, the AT sessions induced a significant improvement in reducing depression (BDI) and cognition impairment (MoCA). However, the changes observed in MS-D patients were significantly greater than those observed in MS patients, especially in the BDI and MoCA. There were no statistically significant correlations of EDSS, MOCCA, BDI, ADL and age or gender. Conclusion AT appears to be effective easy tool in improving cognition and functional status in patients with MS. This study indicated that aerobic training is feasible and could be beneficial for patients with progressive MS. Keywords Aerobic training; Multiple sclerosis; Mental status
e248
Disclosure of interest peting interest.
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
The authors declare that they have no com-
https://doi.org/10.1016/j.rehab.2018.05.575 ISPR8-1003
Aquatic exercise training increases serum brain-derived neurotrophic factor in patients with multiple sclerosis: A randomized controlled study M. Kargarfard 1,∗ , A. Shariat 2 University of Isfahan, Department of Exercise Physiology, Faculty of Sport Sciences, Isfahan, Iran 2 Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran ∗ Corresponding author. E-mail address: kargar [email protected] (M. Kargarfard)
1
ISPR8-1307
Fampridine-PR (prolonged released 4-aminopyridine) improves upper limb dysfunction in multiple sclerosis patients: Clinical and kinematic analysis C. Cheiney-Kulak 1,∗ , P. Revol 2 , F. Durand-Dubief 3 , I. Ionescu 3 , S. Roggerone 3 , A. Benoit 3 , L. Delporte 2 , L. Roche 4 , M. Rabilloud 4 , S. Vukusic 3 , Y. Rossetti 2 , S. Jacquin-Courtois 1 1 Hospices Civils de Lyon, Physical Medicine and Rehabilitation, Saint-Genis-Laval, France 2 Hospices Civils de Lyon, Mouvement et Handicap Platform, Saint-Genis-Laval, France 3 Hospices Civils de Lyon, Neurology, Bron, France 4 Hospices Civils de Lyon, Biostatistics, Lyon, France ∗ Corresponding author. E-mail address: [email protected] (C. Cheiney-Kulak)
Background and aims Brain-derived neurotrophic factor (BDNF) is neurotrophic factor for MS pathogenesis. However, the impact of acute exercise on BDNF factor is less clear in patients with MS and no study to date has examined this assumption. The purpose of this study was to examine the effects of 12-weeks supervised aquatic exercise on serum concentration BDNF, balance, functional exercise capacity, and fatigue in patients with multiple sclerosis. ¯ ± SD = 37 ± 9 Methods Twenty-eight patients MS (mean age X years) were randomly assigned to either aquatic exercise group (EX: n = 13), or the control group (CON: n = 15). The patients Ex group exercised 3 times per week, 30 to 60 minutes per session for 12 weeks and included aerobic exercises, strength, flexibility, balance exercise training and walking activities, and the subjects in CON group were asked to maintain normal daily life pattern for the duration of the study. Balance, functional exercise capacity, fatigue, and BDNF serum concentration were measured at before and after intervention. Results The results showed that 12 weeks of aquatic exercise increased BDNF and improved balance, functional exercise capacity, and fatigue in the EX group. In CON group, the serum BDNF level slightly decreased, and fatigue level increased significantly after 12 weeks, but balance and functional exercise capacity did not change. Also, there were significantly differences in serum BDNF, balance, functional exercise capacity, and fatigue between Ex and CON groups after intervention (P < 0.05). Conclusions The study showed that aquatic exercise more effective than treatment in increase BNDF levels of the subjects with MS. This type of activity is a beneficial training method to maintain functional parameters and also to increase the rate of BDNF in the MS. Disclosure of interest The authors declare that they have no competing interest.
Introduction/Background Multiple sclerosis often results in upper limb dysfunction which significantly affects patients’ quality of life. However, little support is currently proposed for this deficit. Fampridine-PR is validated to improve walking speed but only few studies indicate that this drug may also be effective on upper limb function, with no detailed functional movement analysis. The aim of this study is to assess efficacy of fampridine-PR on improving grasping abilities in persons with Multiple Sclerosis (PwMS) by using a global analysis including both clinical and kinematic criteria. Material and method We included 14 consecutive PwMS with EDSS > 5 and we performed Jebsen Hand Function Test (JHFT) before treatment and under treatment. Patients showing a consistent improvement at D14 (n = 11 patients showing at least 12% reduction between D0 and D14) continued the treatment and the JHFT score were measured after 30 and 90 days under treatment. We also quantified upper force using dynamometers after 14, 30 and 90 days of treatment. In addition 3D kinematic analyses (grasping a glass) were realized with each arm on each assessment. Results JHFT score dropped from day 0 to day 14 by more than 20% and remained stable up to day 90. Individual analysis highlighted that improvement of JHFT score varied from 12.4% to 59.3% from initial score. The evolution of testing score followed the same trend. The hand dynanometer score remained heterogeneous. The kinematic analysis showed a better opening of the grip and a smoothing of the arm movement with less velocity peaks. Conclusion The results suggest that Fampridine-PR can significantly improve grasping function during at least the 90 days of our follow-up. Keywords Fampridine; Upper limb function; Jebsen Hand Function Test Disclosure of interest The authors declare that they have no competing interest.
https://doi.org/10.1016/j.rehab.2018.05.576
https://doi.org/10.1016/j.rehab.2018.05.577