ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2021 December;57(6):889-99

DOI: 10.23736/S1973-9087.21.06701-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

A Three-Arm Parallel-group Exploratory Trial documents balance improvement without much evidence of white matter integrity changes in people with multiple sclerosis following two months ambulatory neuroproprioceptive “facilitation and inhibition” physical therapy

Kamila ŘASOVÁ ¹ ✉, Barbora BUČKOVÁ ^{2, 3}, Terezie PROKOPIUSOVÁ ¹, Marie PROCHÁZKOVÁ ¹, Gabriela ANGEL ¹, Magdaléna MARKOVÁ ¹, Natália HRUŠKOVÁ ¹, Ivana ŠTĚTKÁŘOVÁ ⁴, Šárka ŠPAŇHELOVÁ ⁵, Jan MAREŠ ⁶, Jaroslav TINTĚRA ⁷, Petr ZACH ⁸, Vladimír MUSIL ⁹, Jaroslav HLINKA ^{2, 6}

¹ Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic; ² Department of Complex Systems, Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic; ³ Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic; ⁴ Department of Neurology, Third Faculty of Medicine, Charles University, Prague, Czech Republic; ⁵ Department of Rehabilitation and Sport Medicine, Motol University Hospital, Prague, Czech Republic; ⁶ Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany, Czech Republic; ⁷ Department of Radiodiagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; ⁸ Department of Anatomy, Third Faculty of Medicine, Charles University, Prague, Czech Republic; ⁹ Center of Scientific Information, Third Faculty of Medicine, Charles University, Prague, Czech Republic

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.

KEY WORDS: Adaptation, physiological; Neural plasticity; Multiple sclerosis; Physical therapy modalities; Diffusion tensor imaging; Recovery of function