A Three-Arm Parallel-Group Exploratory Trial documents balance improvement without much evidence of white matter integrity changes in people with multiple sclerosis following two months ambulatory neuroproprioceptive "facilitation and inhibition" physical therapy
Abstrakt
Changes of white matter integrity in people with multiple sclerosis (MS) were documented following mainly motor/skill acquisitions physical therapy (PT), while following neuroproprioceptive "facilitation, inhibition" (neurofacilitation) PT by only two pilot studies that have investigated only one kind of PT (Motor Program Activating Therapy, MPAT). Neurofacilitation PT have potential to induce white matter changes due to possibility to interfere with the neuronal tactility threshold, but stronger evidence is missing.
Therefore, this study is next one that investigate whether neurofacilitation PTs (three therapy types) induce white matter integrity changes and if they relate to clinical improvement. In the Three-Arm Parallel-Group Exploratory Trial (NCT04355663), 92 MS people with moderate disability were divided into three groups; each group underwent different kind of neurofacilitation PT (MPAT, Vojta's reflex locomotion, VRL and Functional Electric Stimulation in Posturally Corrected Position). 71 finished the program and data from 61 were analysed.
At baseline and after the therapeutic program, magnetic resonance diffusion tensor imaging was acquired and clinical outcomes assessed. Fractional anisotropy maps obtained from diffusion tensor imaging were further analyzed using tract-based spatial statistic exploring the mean values in the whole statistic skeleton.
Moreover, additional exploratory analysis in 48 regions of white matter was done. The neurofacilitation PT (irrespective type of therapy) was resulted in significant improvement on the Berg Balance Scale (p=0.0089), mainly driven by the MPAT.
No statistically significant change in the whole statistic skeleton was observed (only a trend for decrement of FA after VRL). Additional exploratory analysis confirmed significant decrement of FA in the right anterior corona radiata.
Several correlations between clinical improvement and changes of fractional anisotropy were documented. Neuroproprioceptive "facilitation and inhibition" physical therapy improved balance without much evidence of white matter integrity changes in people with multiple sclerosis.