Introductıon: Multiple Sclerosis is the leading cause of no traumatic disability in young people. Nowadays, neurorehabilitation is commonly prescribed in patients with MS, but there are still some issues to be explored further. In this review, we discuss the following topics: 1) the neuroscientific basis of neurorehabilitation in multiple sclerosis; 2) what would be the ideal set of rehabilitative treatment: inpatients, outpatient or home-based therapy? Methods: A systematic search was made, using combination of the following terms: rehabilitation, multiple sclerosis, disability, plasticity, motor learning, cognitive rehabilitation, quality of life. Results: A growing amount of evidence suggest that motor and cognitive rehabilitation may enhance functional and structural brain plasticity in patients with multiple sclerosis. Improvement of function seems to be correlated with functional Magnetic Resonance Imaging changes in brain. Moreover, several studies show the effectiveness of cognitive rehabilitation to improve some domains of neuropsychological functions, such as attention, information processing and executive functions. Regarding the rehabilitative setting, it should be chosen taking into account the personal needs of each patient. All the studies, performed in different setting, demonstrated the effectiveness of rehabilitation in Persons affected by multiple sclerosis. Conclusion: Rehabilitation is effective in mitigating disability and improving QoL in persons with MS. Setting for rehabilitation treatment should be chosen taking into account many personal needs and desires of each patient.
Multiple sclerosis; Rehabilitation; Disability; Quality of life; Brain plasticity
Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system. Approximately 2.5 million persons are affected worldwide . In young adults, MS is the leading cause of non traumatic disability. The impact on the Health Related Quality of Life (HRQoL) can be very heavy and dramatic [2–6].
MS is a disease with a remarkable heterogeneity in clinical course, neuroradiological features and involvement of susceptibility gene loci. MS phenotypes can be categorized as relapsing or progressive in the context of current medical status and history .
The pathological processes involve several functional systems and consequently, the disability is a variegated world, in which the patient builds up a multiplicity of neurological deficits. In addition, the disease has an unpredictable and progressive course, which aggravates the disability over the time . The variety of MS impairments and the relative disabilities determine a comprehensive medical intervention, which could be only provided by multidisciplinary programmes . Within these programmes, rehabilitation can be highly useful in person with MS (PwMS). While immunomodulating drugs aim to decrease exacerbations and slow down disease progression, rehabilitative intervention has mainly different goals, which can be shortly summarised: a) improving or maintaining general health; b) mitigating impairment of function such as loss of strength; c) minimising the effects of impairment such as spasticity; d) providing adaptive strategies to minimise disability; e) providing adaptive equipment and devices, such as orthoses, canes and wheelchairs, in order to reduce functional dependence; f) training skills to improve vocational capabilities; g) giving counselling to enhance strategies of coping with the changes brought on by the disease; h) providing symptomatic management [10–12]. All these aims should be included within a multidisciplinary rehabilitation project. Lastly but not least, rehabilitation has to determine a positive impact on either mental or physical components of HRQoL .
For many physicians, neurorehabilitation is a difficult and fascinating challenge which, at first glance, may seem rather arduous and invincible. The first obstacle facing MS rehabilitation consists of the lingering scepticism of some neurologists, who are convinced of its relative ineffectiveness. Execution of clinical trials focused on the rehabilitation is difficult, because of the contrast between the habitually empirical philosophies of rehabilitation and the rules of evidence– based medicine. These difficulties are due to several factors, such as heterogeneity of MS patients, lack of control group, quantitative and qualitative disparity of rehabilitative intervention, concomitant treatment with either disease modifying or symptomatic medications, lack of appropriate and sensitive outcome instruments.
The effects of rehabilitation on patients with MS were studied as early as the 50s [14–20]. However, the neuroscientific basis of neurorehabilitation are not completely established. Besides, the neural substrates underlying the recovery and the functional compensation are incompletely understood in MS.
This review will address the following questions:
a) May motor and cognitive rehabilitation induce functional and structural plasticity into the brain of people with MS?
b) What would be the most appropriate and effective set of rehabilitation to minimize impairment, reduce disability or improve HRQoL?