Case Series on Neurological Rehabilitation in Patients with Relapsing-Remitting Multiple Sclerosis
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1
Plasticity Brain Centers, United States
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2
University of Central Florida, United States
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3
Carrick Institute, United States
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.
Acknowledgements
The authors would like to thank and acknowledge the contribution of the clinical team at Plasticity Brain Centers, including Dr. Derek Barton, Dr. Paul Link, as well as the administrative support team. The authors would also like to thank the Carrick Institute for providing the education utilized to create the multi-modal treatments implemented in this case series.
References
Carrick FR, Clark JF, Pagnacco G, Antonucci MM, Hankir A, Zaman R and Oggero E (2017) Head–Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients. Front. Neurol. 8:414. doi: 10.3389/fneur.2017.00414
Gdowski GT, McCrea RA. Integration of vestibular and head movement signals in the vestibular nuclei during whole-body rotation. J Neurophysiol (1999) 82:436–49
Herbert JR, Corboy JR, Manago MM, Schenkman M. Effects of vestibular rehabilitation on multiple sclerosis related fatigue and upright postural control: a randomized controlled trial. Physical therapy (2011) Aug; 91(8): 1166-83. Doi: 10.2522/ptj.20100399. Epub 2011 Jun 16.
Ozgen G, Karapolat H, Akkoc Y, Yuceyar N. Is customized vestibular rehabilitation effective in patients with multiple sclerosis? A randomized controlled trial. European journal of physical and rehabilitation medicine (2016) Aug;52(4): 466-78. Epub 2016 Apr 6.
Pagnacco G, Carrick FR, Wright CH, Oggero E. In-situ verification of accuracy, percision and resolution of force and balance platforms. Biomed Sciences instrumentation (2014) 50:171-8
Simon M, Maerlender A, Metzger K, Decoster L, Hollingworth A, McLeod TV. Reliability and Concurrent Validity of Select C3 Logix Test Components. Developmental Neuropsychology (2017) Oct; 0: 1-14. Doi: 10.1080/87565641.2017.1383994. Epub 2017 Oct 25.
Keywords:
Multiple Sclerosis,
Vestibular Rehabilitation,
Neurorehabilitation,
Orthoptics,
Physical Therapy Modalities,
chiropractic neurology,
balance,
Paresthesia,
posturography,
non-invasive neuromodulation
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Kalambaheti
ER,
Manno
MM and
Antonucci
MM
(2018). Case Series on Neurological Rehabilitation in Patients with Relapsing-Remitting Multiple Sclerosis.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00004
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Received:
22 Feb 2018;
Published Online:
14 Dec 2018.
*
Correspondence:
Dr. Emily R Kalambaheti, Plasticity Brain Centers, Orlando, FL, United States, Emily.Kalambaheti@gmail.com