New Rehab Techniques in Motion at the AAN Meeting

I recently joined the MS Society’s research team and in this new role, I am really excited to attend my first annual meeting of the American Academy of Neurology (AAN) in Boston. I am a scientist in the field of neuroscience and rehabilitation, and while this meeting has not traditionally focused on rehabilitation, I’ve been pleasantly surprised at the number of studies being presented that explore rehabilitation approaches and symptom management. This research area speaks to questions around how to improve a person’s wellbeing and quality of life, and it’s very close to my heart.

Here are just a few studies that caught my eye:

Lots of people use canes, walkers and other devices that help them keep mobile and reduce falls. It’s weird but these same devices have been shown to sometimes increase a person’s likelihood of falling—maybe because of the tripping hazard. To try to overcome this problem, doctors and researchers at the VA system, Oregon Health & Science University and other institutions have led research to address the problem (read more about this research by clicking here).

They recruited 40 people living with MS. Half of them were assigned to a waiting list and half to a group that received training in the use of their device for 6 weekly one-on-one sessions with a physical therapist. The results were impressive. After 3 months, there were fewer falls in the group who received training than the wait-list group.The team hopes to repeat the study for a longer period of time with more people to help verify these findings.

I was intrigued by a small study from Italy that looked at the value of video therapy—also known as action observation training—to improve problems with hand function in people with MS. The idea behind this therapy is just like it sounds: If I am sitting and watching a video of someone perform an action, like reaching for an object or running up a hill, the same brain circuits that control those actions are activated in my brain as I sit there! Watching the video activates brain circuits, then physical therapy sessions reinforce that activation and movements improve. This approach has been studied in people with stroke with some success, so it makes a lot of sense to try to apply this to MS.  

The team at the San Raffaele University in Milan wanted to see if the video aspects of the therapy could enhance physical therapy. So they conducted a study involving 41 people with MS who had disability in their right hands, and also in 46 people who didn’t have MS or hand problems. These groups were divided so that half of each group received video therapy and physical therapy for hand movement (the active group) and the other half received physical therapy but just watched videos of landscapes.

The active groups received 10 sessions over two weeks. The team did MRI and functional testing before and after the training, and found that action observation training produced improvements in hand function, especially strength, and associated changes in brain signals during hand movement as well. This is a first step toward understanding the link between hand function and brain activations—further study is needed to understand how to maximize potential improvements (read more about this study here).

There is a lot of research going on in exercise in MS. Gone are the days when doctors advised people to go home and rest. Although we now know that exercise is good for mood, cognition, endurance, mobility and fatigue, there are still a lot of questions to answer around what’s the “right type” of exercise to improve a functional problem, what is the proper dose of exercise, and of course, what is the best way to stay motivated to continue an exercise plan.

People are always asking me, “How can I exercise when I feel so tired all the time?” It’s a valid question. My answer is to start slowly, work your way up and get guidance from a rehabilitation therapist to ensure you are exercising safely and optimally. Remember: “A journey of 1,000 miles begins with one step.”
If you’re interested in exploring results that were presented at the AAN, browse here for more summaries.

And be sure to read Bruce Bebo's blog from AAN on progressive MS!
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Kathleen Zackowski

Dr. Kathleen Zackowski has conducted research on rehabilitation approaches for MS and other disorders for more than 15 years. She just joined the Society’s research team as senior director of patient management, care and rehabilitation research after working as a clinician and researcher at the Kennedy Krieger Institute and Johns Hopkins University School of Medicine. She is working to grow the Society’s research focused on clinical care and rehabilitation, and wellness strategies.