A case-study of a person with multiple sclerosis and cerebellar ataxia synchronizing finger-taps and foot-steps to music and metronomes

Background: Cerebellar ataxia is a hindering impairment, affecting movement and quality of life. Rehabilitation remains an essential part of management of persons presenting with cerebellar ataxia. Coupling steps to auditory stimuli have been shown to improve gait in neurological disorders such as Parkinson's disease and multiple sclerosis (MS), yet it is unclear whether these techniques are applicable for persons with cerebellar damage. We investigate the impact of bilateral cerebellar lesions and marked ataxia on the ability to synchronize finger-taps and foot-steps to music and metronomes. Case description: 55 years old male with MS (Expended Disability Status Scale 6.5) with marked cerebellar ataxia (Scale for the Assessment and Rating of Ataxia 21) but overall preserved muscle strength. Methods: Synchronization of finger-taps and foot-steps to beats in music and metronomes were investigated at tempi ranging from -12% to +12% with respect to the spontaneous tapping tempo and natural walking cadence, in increments of 4% (randomized). Results: During the tapping task, the patient was able to synchronize his finger-taps to both auditory stimuli, with the highest synchronization consistency at the -12% tempo. At this tempo, we observed that his upper extremity movements became more coordinated. During the walking task, the patient was not able to synchronize his foot-steps to music and metronomes across the different tempi, with the exception of walking to metronomes at -12% tempo where he was able to synchronize, yet very poorly. At this tempo, the patient's cadence, stride length and speed also increased compared to his baseline. Conclusion: Sensorimotor synchronization of motor tasks with auditory stimuli was feasible in this case study of a patient diagnosed with MS with marked cerebellar ataxia. Rehabilitation of motor control should consider applying training at frequencies lower than usual movement frequencies of the patient

Cognitive rehabilitation and aerobic exercise for cognitive impairment in people with progressive multiple sclerosis (CogEx): a randomised, blinded, sham-controlled trial

Background Cognitive dysfunction in people with relapsing-remitting multiple sclerosis can improve with cognitive rehabilitation or exercise. Similar effects have not been clearly shown in people with progressive multiple sclerosis. We aimed to investigate the individual and synergistic effects of cognitive rehabilitation and exercise in patients with progressive multiple sclerosis.Methods CogEx was a randomised, sham-controlled trial completed in 11 hospital clinics, universities, and rehabilitation centres in Belgium, Canada, Denmark, Italy, UK, and USA. Patients with progressive multiple sclerosis were eligible for inclusion if they were aged 25-65 years and had an Expanded Disability Status Scale (EDSS) score of less than 7. All had impaired processing speed defined as a performance of 1 center dot 282 SD or greater below normative data on the Symbol Digit modalities Tests (SDMT). Participants were randomly assigned (1:1:1:1), using an interactive web-response system accessed online from each centre, to cognitive rehabilitation plus exercise, cognitive rehabilitation plus sham exercise, exercise plus sham cognitive rehabilitation, or sham exercise plus sham cognitive rehabilitation. The study statistician created the randomisation sequence that was stratified by centre. Participants, outcome assessors, and investigators were blinded to group allocation. The study statistician was masked to treatment during analysis only. Interventions were conducted two times per week for 12 weeks: cognitive rehabilitation used an individualised, computer-based, incremental approach to improve processing speed; sham cognitive rehabilitation consisted of internet training provided individually; the exercise intervention involved individualised aerobic training using a recumbent arm-leg stepper; and the sham exercise involved stretching and balance tasks without inducing cardiovascular strain. The primary outcome measure was processing speed measured by SDMT at 12 weeks; least squares mean differences were compared between groups using linear mixed model in all participants who had a 12-week assessment. The trial is registered with ClinicalTrials.gov, NCT03679468, and is completed.Findings Between Dec 14, 2018, and April 2, 2022, 311 people with progressive multiple sclerosis were enrolled and 284 (91%) completed the 12-week assessment (117/311 [38%] male and 194/311 [62%] female). The least squares mean group differences in SDMT at 12 weeks did not differ between groups (p=0 center dot 85). Compared with the sham cognitive rehabilitation and sham exercise group (n=67), differences were -1 center dot 30 (95% CI -3 center dot 75 to 1 center dot 16) for the cognitive rehabilitation plus exercise group (n=70); -2 center dot 78 (-5 center dot 23 to -0 center dot 33) for the sham cognitive rehabilitation plus exercise group (n=71); and -0 center dot 71 (-3 center dot 11 to 1 center dot 70) for the cognitive rehabilitation plus sham exercise group (n=76). 11 adverse events possibly related to the interventions occurred, six in the exercise plus sham cognitive rehabilitation group (pain, dizziness, and falls), two in the cognitive rehabilitation plus sham exercise group (headache and pain), two in the cognitive rehabilitation and exercise group (increased fatigue and pain), and one in the dual sham group (fall).Interpretation Combined cognitive rehabilitation plus exercise does not seem to improve processing speed in people with progressive multiple sclerosis. However, our sham interventions were not inactive.Studies comparing interventions with a non-intervention group are needed to investigate whether clinically meaningful improvements in processing speed might be attainable in people with progressive multiple sclerosis.Copyright (c) 2023 Elsevier Ltd. All rights reserved