According to findings from researchers at the University of Alabama at Birmingham, Constraint-Induced Movement Therapy, also known as CI therapy, helped to improve daily activities for patients with MS.
According to findings from researchers at the University of Alabama at Birmingham, Constraint-Induced Movement Therapy, also known as CI therapy, helped to improve daily activities for patients with MS. What’s more, the improvement persisted for at least one year. In a second paper, published in the journal Neurorehabilitation and Neural Repair, the UAB researchers reported improved white matter within the brains of patients with MS following CI therapy. The results showed that the therapy produced determinate changes in the brain by the end of the treatment. “CI Therapy has been shown to be effective following motor deficit. Our findings indicate that it can also be an effective rehabilitation technique in neurodegenerative conditions such as MS” said Victor Mark, lead author of the study and associate professor in the Department of Physical Medicine and Rehabilitation in the UAB School of Medicine.
A game-changing therapy for MS patients
Constraint-Induced Movement Therapy was developed at the University of Alabama at Birmingham by Edward Taub, a behavioral neuroscientist and director of the CI Therapy Research Group and Taub Training Clinic. The therapy was originally planned as a rehab technique for stroke patients. It is a behavioral approach based on learned non-use that works by decreasing the impact of a stroke on the upper-limb function. In turn, stroke patients end up learning to use the unaffected limb for a majority of their daily activities.
Taub hypothesized that following CI therapy, the brain could rewire itself after an injury and the movement of an affected arm or leg can be improved. The approach involves limiting use of the less-affected limb with intensive training of the more-affected limb. Additional techniques are also incorporated in the therapy, including the transfer package – which includes three main strategies:
- Monitoring patients’ performance of target behaviors;
- Identifying obstacles and creating solutions;
- Identifying methods of carrying out normal behaviors (also known as behavioral contracting);
CI therapy has been shown to be effective in enhancing patients’ ability to perform daily activities in a wide range of conditions, including stroke, traumatic brain injury, cerebral palsy, and other neurological injuries. “There is a great deal of interest in improving rehabilitation techniques in multiple sclerosis. The disease often strikes young people — 28 is the median age of onset — and it commonly gets progressively worse. There are drugs that can slow the progression, but we don’t have medications to cure the disease. Rehabilitation is the best option to improve daily living activities for those whose conditions are worsening” said Mark.
Implications in rehabilitation
Mark noted that MS and stroke are similar in that a majority of patients have a greater motor deficit on one side. This, in turn, sets up the condition for learned non-use.
The research study, led by Mark and fellow colleagues, focused on the use of the upper extremity. It involved the participation of 20 patients with MS, who were either assigned to undergo CI therapy or CAM therapy (complementary and alternative medicine). The patients in the CI group underwent 35 hours of intense rehabilitation over a period of 10 days, accompanied by behavioral shaping and the transfer package. The patients in the CAM group, on the other hand, underwent 35 hours of holistic exercises, such as yoga and pool exercise.
Every patient’s functional ability was recorded via a Motor Activity Log taken before and after the therapy. “The CI Therapy group improved more based on the Motor Activity Log than did the CAM group. CI patients improved on average 2.7 points on the scale ranging from 0 to 5 points, while CAM patients saw an improvement of only 0.5 points. These results did not change at one-year follow-up, suggesting that CI Therapy can increase real-world use of the more affected arm in patients with MS for at least a year” said Mark.
The gray aspects of white matter in MS
In their second published paper, Mark and Ameen Barghi, a former student at UAB now attending Harvard Medical School, looked at the white matter within the brains of patients with MS. White matter serves as a fundamental function for learning and other brain-related functions. It also serves to transmit messages between neurons. Generally, patients diagnosed with MS experience a progressive decline in this particular function.
Mark and Barghi used magnetic resonance imaging to analyze 10 patients who underwent CI therapy and 10 patients underwent undergone CAM therapy. “After treatment, the CI Therapy group showed improvement in the movement of water molecules within the brain, a hallmark of healthy white matter. The CAM group, though, "showed no improvement” said Mark. “While certainly preliminary, these findings suggest that the adverse changes in white matter integrity induced by MS might be reversed by CI Therapy” he added.
According to Mark, the next steps include a study on the potential benefit of CI therapy to the lower extremities for patients with MS. He is also interested in identifying how long the effects last and whether additional courses of CI therapy would be beneficial. “Studies over the past 25 years have validated CI Therapy for stroke and other motor deficits, and its use in MS is really just beginning. What is truly fascinating is its effect on a degenerative disease such as MS. We know CI Therapy is effective for stroke and cerebral palsy, which are static diseases — patients don’t get worse. What we are showing here is that CI Therapy can also improve function in patients with a progressively worsening disease” concluded Mark.
The role of rehabilitation in MS
When dealing with MS, there are certain physical and cognitive challenges that present themselves. These include balance and coordination difficulties, impaired speech or vision, thinking and memory problems, muscle stiffness and weakness, heightened fatigue, and even paralysis. Multiple Sclerosis Rehabilitation - which includes physical therapy, occupational therapy, speech therapy, and cognitive retraining – is designed to help reduce such challenges by improving daily function and strengthening neural networks. It can also be complemented with alternative treatment, including yoga, meditation, massage, acupuncture, biofeedback therapy, and relaxation techniques. Different types of exercises may have different effects on MS.
The main objective of Multiple Sclerosis Rehabilitation is to improve and maintain function. From the time of diagnosis onward, MS rehab specialists strive to provide proper education and treatment that will promote good health and general well-being. They address mobility problems, dressing and personal care, exercise techniques, and proper performance techniques both at home and at work. They also provide evaluation and treatment of speech difficulties, swallowing difficulties, as well as thinking and memory problems.
Seeing as how research has shown it can lead to significant improvements in patients’ quality of life, interest in Multiple Sclerosis Rehabilitation has increased in recent years. As patients experience periods of flare-ups, heightened symptoms, and remission; MS rehabilitation can be modified in accordance with the changes. For a majority of patients, medications to manage the disease and symptoms, in combination with rehabilitation, have led to advances in functional recovery. It is considered a fundamental approach to quality healthcare for individuals coping with MS at all stages of the disease.