ABSTRACT
BACKGROUND: Dysfunctions of the upper limbs occur in the 66% of multiple sclerosis (MS) patients. To date, no data, about the persistence of the effects of a rehabilitation treatment and no prognostic markers of functional improvement, have been established. AIM: The aim of this study was to define clinical data supporting the efficacy of a rehabilitation treatment in MS patients with upper limb impairment and to find prognostic factors for functional improvement. DESIGN: Pre-post comparison prospective study. SETTING: Two tertiary Italian MS centres: Rome and Siena. POPULATION: Twenty-five consecutive MS patients were tested for eligibility. METHODS: We multidimensionally evaluated 25 consecutive patients with MS-related upper limbs impairment through clinical objective, patient-oriented and neurophysiological measures pre and post a16-week rehabilitation treatment on upper limb sensorimotor function. RESULTS: We found a significant improvement in the Nine Hole Peg Test (9-HPT) at either sides, both at an immediate post-training visit (T1) (left: P=0.018, right: P=0.004) and at a 12-week postintervention assessment visit (T2) (left: P=0.033, right: P=0.022). We also found a positive correlation between the 12-week post-training changes in the 9-HPT and the N14-P20 interpeak of the somatosensory evoked potentials, (rho=0.374, P=0.008). CONCLUSIONS: Our study demonstrates that a rehabilitation treatment can lead to an improvement of the upper limb motor performance in MS patients which continues to persist even after 3 months of treatment-discontinuation suggesting a possible role of rehabilitation in neuroplasticity changes. Moreover, we found, in the latency of the N14-P20 interpeak, a possible prognostic marker for the effects of a upper limb rehabilitation treatment in MS patients. CLINICAL REHABILITATION IMPACT: The N14-P20 interpeak could be used as a prognostic marker of the effects of rehabilitation of the upper limb.
Subject(s)
Multiple Sclerosis/physiopathology , Multiple Sclerosis/rehabilitation , Psychomotor Performance/physiology , Upper Extremity/physiopathology , Disability Evaluation , Evoked Potentials, Somatosensory/physiology , Female , Humans , Italy , Male , Middle Aged , Prognosis , Prospective Studies , Surveys and Questionnaires , Treatment OutcomeABSTRACT
OBJECTIVE: The aim of this multicentric study was to multidimensionally evaluate the relationship among somatosensory evoked potentials (SEPs) parameters, patient's perspective and clinical measures of the upper limb impairment in patients with multiple sclerosis (MS). METHODS: We consecutively enrolled 39 MS patients. For median nerve SEPs we acquired the N9, P14, N20 responses and the N9-P14 and P14-N20 interpeak latencies on the dominant side. We also used a validated patient-oriented questionnaire (Disabilities of the Arm, Shoulder and Hand - DASH) and a test of dexterity quantification as the 9-Hole Peg Test (9-HPT). RESULTS: A significant longer time to complete the 9-HPT (p<0.00006) was observed in patients with abnormal SEPs. Patients with undetectable N20 or P14 responses performed the 9-HPT in a significant longer time than patients with detectable responses (p<0.0006 and p<0.001 respectively). Concerning the perspective of patient (evaluated with the DASH questionnaire) significant differences in patients with undetectable P14 response (p<0.01) were observed. CONCLUSIONS: Our data provide further information useful for interpretation of SEPs results, being the median nerve SEPs related to the upper limb performance in MS patients. SIGNIFICANCE: These data increase the significance of SEPs both in clinical practice and in experimental studies in MS.
