Department of Sport Sciences, Shahrekord University, Shahrekord, Iran.
Department of Sport Sciences, Shahrekord University, Shahrekord, Iran.
Mult Scler Relat Disord. 2022 Feb;58:103400. doi: 10.1016/j.msard.2021.103400. Epub 2021 Nov 13.
Ambulatory disability and cognitive impairment are common and co-occuring manifestations of multiple sclerosis (MS). Neurofunctional training is a specific intervention performed in realistic environments that may have beneficial effects on ambulatory disability in persons with MS who have cognitive impairment. This pilot sudy investigated the feasibility and efficacy of an eight-week home-based neurofunctional training (HBNFT) program vs. home-based resistance training (HBRT) on ambulatory performance in MS patients with cognitive impairment.
Thirty males/females with MS (age 18-50 years, Expanded Disability Status Scale (EDSS) score ≤ 6, and processing speed score ≤ 41.5 as a marker of cognitive impairment) were randomly assigned into HBNFT and HBRT groups. After one week (three sessions) of center-based, supervised training for learning the programs and maximizing safety, the participants completed eight weeks (three sessions per week) of the home-based training programs. The programs were supported through videos, brochures and Digital Video Discs (DVDs) provided during clinic visits (weeks 1 and 5). Ambulatory performance (tandem stance test; tandem walk test; timed up-and-go (TUG); six-minute walk test (6MWT), 10- meter walking test (10MWT); timed 25 foot walk test (T25FWT); five times sit to stand test (5TSTS); six spot step test (SSST); and hand grip) was measured before and after the exercise programs. Feasibility and acceptability of exercise programs was assessed after the eight-week period.
HBNFT significantly improved tandem walk test (P = 0.018), SSST (P = 0.026), and 6MWT (P = 0.037) compared with HBRT. No significant changes or differences were observed in other outcomes (P ≥ 0.05). HBNFT was well tolerated and resulted in no adverse events, whereas there were reports of pain, muscle cramps, and extreme fatigue among HBRT participant.
The current pilot study provided initial support for HBNFT as a safe and feasible approach for improving some aspects of ambulation in persons with MS who have cognitive impairment. Such a pilot study provides initial proof-of-concept data for the design and implementation of an appropriately-powered randomized controlled trial (RCT) of neuro-functional training vs. traditional resistance exercise in a larger sample of persons with MS who present with co-occurring impairments in mobility and cognition.
行动障碍和认知障碍是多发性硬化症（MS）的常见且共同表现。神经功能训练是在现实环境中进行的特定干预措施，可能对认知障碍的 MS 患者的行动障碍产生有益影响。本研究旨在调查为期八周的家庭神经功能训练（HBNFT）与家庭阻力训练（HBRT）对 MS 认知障碍患者的行动能力的可行性和疗效。
30 名男性/女性 MS 患者（年龄 18-50 岁，扩展残疾状态量表（EDSS）评分≤6，作为认知障碍标志物的处理速度评分≤41.5）被随机分配到 HBNFT 和 HBRT 组。在进行中心监督训练以学习程序并最大程度地保证安全（为期一周，共三次）之后，参与者完成了为期八周（每周三次）的家庭训练计划。该计划通过在诊所就诊期间（第 1 周和第 5 周）提供的视频、手册和数字视频光盘（DVD）提供支持。在训练前后，通过以下测试评估了行动能力（并足站立测试；并足行走测试；计时起立行走测试；6 分钟步行测试；10 米步行测试；计时 25 英尺行走测试；五次坐站测试；六步台阶测试；握力）：6 分钟步行测试。
与 HBRT 相比，HBNFT 显著改善了并足行走测试（P=0.018）、六步台阶测试（P=0.026）和 6 分钟步行测试（P=0.037）。其他结果（P≥0.05）没有明显变化或差异。HBNFT 耐受性良好，无不良事件发生，而 HBRT 参与者则有疼痛、肌肉痉挛和极度疲劳的报告。
本初步研究为 HBNFT 作为一种安全可行的方法提供了初步支持，可改善认知障碍的 MS 患者的某些行动方面。这样的初步研究为在存在移动和认知功能障碍的更大 MS 患者样本中设计和实施神经功能训练与传统阻力训练的适当随机对照试验（RCT）提供了初步的概念验证数据。
