When patients with Multiple Sclerosis—and other chronic debilitating diseases—start losing the motor function of the upper and/or lower extremities, they feel rightly frustrated. The inability to write steadily, grab a cup, walk without falling and similar common activities will limit their interaction with family, friends and co-workers, leading to anxiety and depression. The chronic pain can be managed more efficiently than the forced isolation due to the above.
Some clinical trials have suggested that MS patients might benefit from several rehabilitation techniques, but they were short in duration and did not answer the fundamental question; can the techniques learned in the rehabilitation clinic be transferred to the patients’ homes efficiently? A new study claims that the “Constraint-induced movement therapy” (CIMT) used in the rehab of stroke patients can be useful, even with short practice runs, in the care of MS motor limitations.
VW Mark et al. designed a Phase II randomized clinical trial with 20 participants that had hemiparetic MS and were assigned either to a 35 hours-training in CIMT or alternative medicine. The CIMT intervention, done on ten consecutive days, had the following components:
- Intensive training with the limited extremity for basic activities for three hours/day.
- Training with “behavioral shaping”: try to achieve motor goals progressively and with constant encouragement from the therapist, even for small gains.
- Restraint of the less compromised limb to prod the use of the affected one.
- Use of a “transfer package” to stimulate the practice at home, which included a contract, practice homework, keeping a diary and a 30 minute-daily interview with the therapist.
The participants were evaluated with the “Motor Activity Log” (MAL), a scripted interview to compare the gains from the use of the technique with the previous functional baseline. The participants in the control group did aquatic therapy, yoga and other relaxation techniques. For the group that underwent CIMT there was a mean change in MAL of 2.7 after one year, compared to 0.5 in the control group. A change of 1.0 was considered clinically meaningful for participants; auspiciously, all the CIMT patients and three of the control group reached that clinical goal.
In the second stage of this same study, the researchers studied whether the practice of CIMT could promote changes in the white matter of MS patients with Magnetic Resonance Imaging (MRI) techniques such as T1 weighted scans and whole brain diffusion tensor scans. They found that there were improvements in the white matter of the corticospinal tract, temporal and visual areas. These extraordinary findings were in line with previous data obtained form monkeys in labs. If the neuroplasticity of the nervous tissue can warrant significant clinical changes after just a few days of focused, personalized rehabilitation for MS patients, this technique must be transferred home with a special package. Patients and their families would certainly be more than willing to try it.
Patients with MS should be aware that physical defeat only comes when they “throw the towel into the ring.” They should never, ever give up hope.
What do you think? Please tell us.
Don’t leave me alone.