Neurorehabilitation strategies focusing on ankle control improve mobility and posture in persons with multiple sclerosis

Brenda L. Davies, David J. Arpin, Kathleen Gerri Volkman, Bradley B Corr, Heidi Reelfs, Regina T. Harbourne, Kathleen Healey, Rana K Zabad, Max J Kurz

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background and Purpose: The neuromuscular impairments seen in the ankle plantarflexors have been identified as a primary factor that limits the mobility and standing postural balance of individuals with multiple sclerosis (MS). However, few efforts have been made to find effective treatment strategies that will improve the ankle plantarflexor control. Our objective was to determine whether an intensive 14- week neurorehabilitation protocol has the potential to improve the ankle plantarflexor control of individuals with MS. The secondary objectiveswere to determinewhether the protocolwould also improve postural control, plantarflexion strength, and mobility. Methods: Fifteen individuals withMSparticipated in a 14-week neurorehabilitation protocol, and 20 healthy adults served as a comparison group. The primary measure was the amount of variability in the submaximal steady-state isometric torque, which assessed plantarflexor control. Secondary measures were the Sensory Organization Test composite score, maximum plantarflexion torque, and the spatiotemporal gait kinematics. Results: There was less variability in the plantarflexion torques after the neurorehabilitation protocol (preintervention, 4.15% ± 0.5%; postintervention, 2.27%±0.3%). In addition, therewere less postural sway (preintervention, 51.87 ± 0.2 points; postintervention, 67.8 ± 0.5 points), greater plantarflexion strength (preintervention, 0.46 ± 0.04 Nm/kg; postintervention, 0.57 ± 0.05 Nm/kg), and faster walking speeds (preferred preintervention, 0.71 ± 0.05 m/s; preferred postintervention, 0.81 ± 0.05 m/s; fast-as-possible preintervention, 0.95 ± 0.06 m/s; postintervention, 1.11 ± 0.07 m/s). All of the outcome variables matched or trended toward those seen in the controls. Discussion and Conclusions: The outcomes of this exploratory study suggest that the neurorehabilitation protocol employed in this investigation has the potential to promote clinically relevant improvements in the ankle plantarflexor control, standing postural balance, ankle plantarflexion strength, and the mobility of individuals with MS.

Original languageEnglish (US)
Pages (from-to)225-232
Number of pages8
JournalJournal of Neurologic Physical Therapy
Volume39
Issue number4
DOIs
StatePublished - Oct 1 2015

Fingerprint

Posture
Ankle
Multiple Sclerosis
Torque
Postural Balance
Gait
Biomechanical Phenomena
Outcome Assessment (Health Care)
Neurological Rehabilitation
Therapeutics

Keywords

  • Gait
  • Motor control
  • Postural balance
  • Rehabilitation
  • Torque
  • Walking

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Clinical Neurology

Cite this

Neurorehabilitation strategies focusing on ankle control improve mobility and posture in persons with multiple sclerosis. / Davies, Brenda L.; Arpin, David J.; Volkman, Kathleen Gerri; Corr, Bradley B; Reelfs, Heidi; Harbourne, Regina T.; Healey, Kathleen; Zabad, Rana K; Kurz, Max J.

In: Journal of Neurologic Physical Therapy, Vol. 39, No. 4, 01.10.2015, p. 225-232.

Research output: Contribution to journalArticle

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abstract = "Background and Purpose: The neuromuscular impairments seen in the ankle plantarflexors have been identified as a primary factor that limits the mobility and standing postural balance of individuals with multiple sclerosis (MS). However, few efforts have been made to find effective treatment strategies that will improve the ankle plantarflexor control. Our objective was to determine whether an intensive 14- week neurorehabilitation protocol has the potential to improve the ankle plantarflexor control of individuals with MS. The secondary objectiveswere to determinewhether the protocolwould also improve postural control, plantarflexion strength, and mobility. Methods: Fifteen individuals withMSparticipated in a 14-week neurorehabilitation protocol, and 20 healthy adults served as a comparison group. The primary measure was the amount of variability in the submaximal steady-state isometric torque, which assessed plantarflexor control. Secondary measures were the Sensory Organization Test composite score, maximum plantarflexion torque, and the spatiotemporal gait kinematics. Results: There was less variability in the plantarflexion torques after the neurorehabilitation protocol (preintervention, 4.15{\%} ± 0.5{\%}; postintervention, 2.27{\%}±0.3{\%}). In addition, therewere less postural sway (preintervention, 51.87 ± 0.2 points; postintervention, 67.8 ± 0.5 points), greater plantarflexion strength (preintervention, 0.46 ± 0.04 Nm/kg; postintervention, 0.57 ± 0.05 Nm/kg), and faster walking speeds (preferred preintervention, 0.71 ± 0.05 m/s; preferred postintervention, 0.81 ± 0.05 m/s; fast-as-possible preintervention, 0.95 ± 0.06 m/s; postintervention, 1.11 ± 0.07 m/s). All of the outcome variables matched or trended toward those seen in the controls. Discussion and Conclusions: The outcomes of this exploratory study suggest that the neurorehabilitation protocol employed in this investigation has the potential to promote clinically relevant improvements in the ankle plantarflexor control, standing postural balance, ankle plantarflexion strength, and the mobility of individuals with MS.",
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AU - Arpin, David J.

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AU - Reelfs, Heidi

AU - Harbourne, Regina T.

AU - Healey, Kathleen

AU - Zabad, Rana K

AU - Kurz, Max J

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N2 - Background and Purpose: The neuromuscular impairments seen in the ankle plantarflexors have been identified as a primary factor that limits the mobility and standing postural balance of individuals with multiple sclerosis (MS). However, few efforts have been made to find effective treatment strategies that will improve the ankle plantarflexor control. Our objective was to determine whether an intensive 14- week neurorehabilitation protocol has the potential to improve the ankle plantarflexor control of individuals with MS. The secondary objectiveswere to determinewhether the protocolwould also improve postural control, plantarflexion strength, and mobility. Methods: Fifteen individuals withMSparticipated in a 14-week neurorehabilitation protocol, and 20 healthy adults served as a comparison group. The primary measure was the amount of variability in the submaximal steady-state isometric torque, which assessed plantarflexor control. Secondary measures were the Sensory Organization Test composite score, maximum plantarflexion torque, and the spatiotemporal gait kinematics. Results: There was less variability in the plantarflexion torques after the neurorehabilitation protocol (preintervention, 4.15% ± 0.5%; postintervention, 2.27%±0.3%). In addition, therewere less postural sway (preintervention, 51.87 ± 0.2 points; postintervention, 67.8 ± 0.5 points), greater plantarflexion strength (preintervention, 0.46 ± 0.04 Nm/kg; postintervention, 0.57 ± 0.05 Nm/kg), and faster walking speeds (preferred preintervention, 0.71 ± 0.05 m/s; preferred postintervention, 0.81 ± 0.05 m/s; fast-as-possible preintervention, 0.95 ± 0.06 m/s; postintervention, 1.11 ± 0.07 m/s). All of the outcome variables matched or trended toward those seen in the controls. Discussion and Conclusions: The outcomes of this exploratory study suggest that the neurorehabilitation protocol employed in this investigation has the potential to promote clinically relevant improvements in the ankle plantarflexor control, standing postural balance, ankle plantarflexion strength, and the mobility of individuals with MS.

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