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European Journal of Physical and Rehabilitation Medicine 2020 Sep 16

DOI: 10.23736/S1973-9087.20.06336-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Brain activity changes following neuroproprioceptive “facilitation, inhibition” physiotherapy in multiple sclerosis: a parallel group randomized comparison of two approaches

Marie PROCHAZKOVA 1, Jaroslav TINTERA 2, Sarka SPANHELOVA 3, Terezie PROKOPIUSOVA 1, Jan RYDLO 2, Marketa PAVLIKOVA 1, Antonin PROCHAZKA 4, Kamila RASOVA 1

1 Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic; 2 MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; 3 Department of Rehabilitation, Faculty Hospital in Motol, Prague, Czech Republic; 4 Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, Prague, Czech Republic


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BACKGROUND: Imaging methods bring new possibilities for describing the brain plasticity processes that underly the improvement of clinical function after physiotherapy in people with multiple sclerosis (pwMS). Although these processes have been described mainly in connection with task oriented physiotherapy and aerobic training, they haven’t been properly verified in neuroproprioceptive “facilitation, inhibition” (facilitation) approaches.
AIM: The study determined whether facilitation physiotherapy could enhance brain plasticity, compared two facilitation methods, and looked for any relation to clinical improvement in pwMS.
DESIGN: The study was designed as parallel group (38 outpatients) randomized comparison of two kinds of physiotherapeutic interventions referred to healthy controls.
POPULATION: The study had 80 participants (38 pwMS and 42 healthy controls).
METHODS: PwMS were divided into two groups and underwent a two-month physiotherapy program - Vojta reflex locomotion (VRL) or Motor Program Activating Therapy (MPAT), (1 hour, twice a week). Functional Magnetic Resonance Imaging (fMRI) and clinical examination was performed before and after therapy. Healthy controls underwent one fMRI examination.
RESULTS: Physiotherapy in pwMS leads to extension of brain activity in specific brain areas (cerebellum, suplementary motor areas and premotor areas) in connection with the improvement of the clinical status of individual patients after therapy (p=0.05). Greater changes (p=0.001) were registered after MPAT than after VRL. The extension of activation was a shift to the examined activation of healthy controls, whose activation was higher in the cerebellum and secondary visual area (p=0.01).
CONCLUSIONS: Neuroproprioceptive “facilitation, inhibition” physiotherapy may enhance brain activity and could involve processes connected with the processing of motion activation.
CLINICAL REHABILITATION IMPACT: The study showed that facilitation approach can modulate brain activity. This could be useful for developing of effective physiotherapeutic treatment in MS.


KEY WORDS: Multiple sclerosis; Functional magnetic resonance imaging; Neuronal plasticity; Physical rehabilitation

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