Effects of rehabilitation treatment of the upper limb in Multiple Sclerosis patients and predictive value of neurophysiological measures

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: 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 post- intervention 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 9HPT and the N14-P20 interpeak of the somatosensory evoked potentials (SEPs), (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.