Case Series on Neurological Rehabilitation in Patients with Relapsing-Remitting Multiple Sclerosis

Presentation: Four patients, all females between the ages of 59 and 68 years, presented to Plasticity Brain Centers of Orlando for evaluation and treatment of relapsing-remitting multiple sclerosis (RRMS). All patients reported numbness and tingling, and balance issues, as symptoms.

Findings: When asked to rate their numbness and tingling on a graded symptom checklist (GSC) (Simon 2017), on a scale of 0 to 6 (with 0 being none and 6 being very severe), the average intensity was calculated as 4.25. A Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing each patient's balance and stability, on both a solid and foamed surface, with their eyes opened, eyes closed, and with multiple head positions. Their average balance score on intake was calculated as 26.14975%.

Methods: A 5-day, multi-modal program of neurological exercises was administered in 10 one-hour treatment sessions (Carrick 2017). Each session consisted of repetitive peripheral somatosensory stimuli, neuromuscular reeducation exercises, vestibular rehabilitation exercises (Herbert 2011) (Ozgen 2015), orthoptic exercises, and off-vertical axis rotation (Gdowski 1999) utilizing a multi-axis rotational chair (MARC).

Outcome: Upon exit, average numbness and tingling ratings were calculated as 1 (-74.71%), with two patients reporting complete resolution (a score of 0) (-100.00%). Stability scores improved, with the average stability score calculated as 33.2065% (+ 28.1925%).

Conclusion: The authors suggest that multi-modal program of neurological exercise may be a viable intervention to address stability and paresthesia in patients with RRMS. The authors also suggest further investigation into multi-modal, intensive neurological approaches for patients with RRMS.

References:

1. Carrick FR, Clark JF, Pagnacco G, Antonucci MM, Hankir A, Zaman R and Oggero E (2017) Head–Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients. Front. Neurol. 8:414. doi: 10.3389/fneur.2017.00414
2. Gdowski GT, McCrea RA. Integration of vestibular and head movement signals in the vestibular nuclei during whole-body rotation. J Neurophysiol (1999) 82:436–49
3. Herbert JR, Corboy JR, Manago MM, Schenkman M. Effects of vestibular rehabilitation on multiple sclerosis related fatigue and upright postural control: a randomized controlled trial. Physical therapy (2011) Aug; 91(8): 1166-83. Doi: 10.2522/ptj.20100399. Epub 2011 Jun 16.
4. Ozgen G, Karapolat H, Akkoc Y, Yuceyar N. Is customized vestibular rehabilitation effective in patients with multiple sclerosis? A randomized controlled trial. European journal of physical and rehabilitation medicine (2016) Aug;52(4): 466-78. Epub 2016 Apr 6.
5. Pagnacco G, Carrick FR, Wright CH, Oggero E. In-situ verification of accuracy, percision and resolution of force and balance platforms. Biomed Sciences instrumentation (2014) 50:171-8
6. Simon M, Maerlender A, Metzger K, Decoster L, Hollingworth A, McLeod TV. Reliability and Concurrent Validity of Select C3 Logix Test Components. Developmental Neuropsychology (2017) Oct; 0: 1-14. Doi: 10.1080/87565641.2017.1383994. Epub 2017 Oct 25.