Eleonora Tavazzi1, Niels Bergsland1,2, Davide Cattaneo1, Elisa Gervasoni1, Maria Marcella Laganà1, Ottavia Dipasquale1,3, Cristina Grosso1, Francesca Lea Saibene1, Francesca Baglio1, Marco Rovaris4. 1. Scientific Institute Santa Maria Nascente, Don C. Gnocchi Foundation ONLUS, Via Capecelatro 66, 20148, Milan, Italy. 2. Department of Neurology, School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo, NY, USA. 3. Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 4. Scientific Institute Santa Maria Nascente, Don C. Gnocchi Foundation ONLUS, Via Capecelatro 66, 20148, Milan, Italy. mrovaris@dongnocchi.it.
Abstract
BACKGROUND: Rehabilitation seems to promote brain plasticity, but objective measures of efficacy are lacking and there is a limited understanding of the mechanisms underlying functional recovery. OBJECTIVE: To study functional and structural brain changes induced by gait rehabilitation. METHODS: We enrolled MS inpatients (EDSS 4.5-6.5) undergoing a 4-week neurorehabilitation. Several clinical measures were obtained, including: 2-min walk test (2MWT), dynamic gait index (DGI), Berg balance scale (BBS). Furthermore, motor-task functional MRI (fMRI) of plantar dorsiflexion, resting state fMRI, and regional diffusion tensor imaging (DTI) metrics were obtained. All the assessments were performed at baseline (T0), after the end of the rehabilitation period (T1) and 3 months later (T2). RESULTS:Twenty-nine patients were enrolled at T0, 26 at T1, and 16 completed all timepoints. At T1, there was a significant improvement of 2MWT, DGI, and BBS scores, along with a reduced extent of the widespread activation related to the motor task at the fMRI and an increased functional connectivity in the precentral and post-central gyrus, bilaterally. None of these changes were maintained at T2. CONCLUSIONS: Our findings show a short-term beneficial effect of motor rehabilitation on gait performances in MS, accompanied by brain functional reorganization in the sensory-motor network.
RCT Entities:
BACKGROUND: Rehabilitation seems to promote brain plasticity, but objective measures of efficacy are lacking and there is a limited understanding of the mechanisms underlying functional recovery. OBJECTIVE: To study functional and structural brain changes induced by gait rehabilitation. METHODS: We enrolled MS inpatients (EDSS 4.5-6.5) undergoing a 4-week neurorehabilitation. Several clinical measures were obtained, including: 2-min walk test (2MWT), dynamic gait index (DGI), Berg balance scale (BBS). Furthermore, motor-task functional MRI (fMRI) of plantar dorsiflexion, resting state fMRI, and regional diffusion tensor imaging (DTI) metrics were obtained. All the assessments were performed at baseline (T0), after the end of the rehabilitation period (T1) and 3 months later (T2). RESULTS: Twenty-nine patients were enrolled at T0, 26 at T1, and 16 completed all timepoints. At T1, there was a significant improvement of 2MWT, DGI, and BBS scores, along with a reduced extent of the widespread activation related to the motor task at the fMRI and an increased functional connectivity in the precentral and post-central gyrus, bilaterally. None of these changes were maintained at T2. CONCLUSIONS: Our findings show a short-term beneficial effect of motor rehabilitation on gait performances in MS, accompanied by brain functional reorganization in the sensory-motor network.
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