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European Journal of Physical and Rehabilitation Medicine 2016 December;52(6):819-26


lingua: Inglese

Effects of rehabilitation treatment of the upper limb in multiple sclerosis patients and predictive value of neurophysiological measures

Viviana NOCITI 1, 2, Luca PROSPERINI 3, Monica ULIVELLI 4, Francesco A. LOSAVIO 1, Simona BARTALINI 4, Marcella CAGGIULA 5, David CIONCOLONI 4, Pietro CALIANDRO 1, 2, Ileana MINCIOTTI 1, Massimiliano MIRABELLA 1, Luca PADUA 1, 2

1 Institute of Neurology, Department of Geriatrics, Neurosciences and Orthopedics, Catholic University, Rome, Italy; 2 Don Carlo Gnocchi Foundation, Milan, Italy; 3 Department of Neurology and Psychiatry, Sapienza University, Rome, Italy; 4 Neurology and Clinical Neurophysiology, Department of Neurological and Neurosensory Sciences, University Hospital of Siena, Siena, Italy; 5 Neurology Unit, Ospedale Vito Fazzi, Lecce, Italy


BACKGROUND: Dysfunctions of the upper limbs occur in the 66% of multiple sclerosis (MS) patients. To date, no data, about the persistence of the effects of a rehabilitation treatment and no prognostic markers of functional improvement, have been established.
AIM: The aim of this study was to define clinical data supporting the efficacy of a rehabilitation treatment in MS patients with upper limb impairment and to find prognostic factors for functional improvement.
DESIGN: Pre-post comparison prospective study.
SETTING: Two tertiary Italian MS centres: Rome and Siena.
POPULATION: Twenty-five consecutive MS patients were tested for eligibility.
METHODS: We multidimensionally evaluated 25 consecutive patients with MS-related upper limbs impairment through clinical objective, patient-oriented and neurophysiological measures pre and post a16-week rehabilitation treatment on upper limb sensorimotor function.
RESULTS: We found a significant improvement in the Nine Hole Peg Test (9-HPT) at either sides, both at an immediate post-training visit (T1) (left: P=0.018, right: P=0.004) and at a 12-week postintervention assessment visit (T2) (left: P=0.033, right: P=0.022). We also found a positive correlation between the 12-week post-training changes in the 9-HPT and the N14-P20 interpeak of the somatosensory evoked potentials, (rho=0.374, P=0.008).
CONCLUSIONS: Our study demonstrates that a rehabilitation treatment can lead to an improvement of the upper limb motor performance in MS patients which continues to persist even after 3 months of treatment-discontinuation suggesting a possible role of rehabilitation in neuroplasticity changes. Moreover, we found, in the latency of the N14-P20 interpeak, a possible prognostic marker for the effects of a upper limb rehabilitation treatment in MS patients.
CLINICAL REHABILITATION IMPACT: The N14-P20 interpeak could be used as a prognostic marker of the effects of rehabilitation of the upper limb.

KEY WORDS: Multiple sclerosis - Rehabilitation - Evoked potentials - Somatosensory - Upper extremity

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