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.
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