#014- Articles on Stroke and Multiple Sclerosis

Covered Topics:

1. The Effect of Adding Core Stability Exercise to Usual Care after Stroke.

2. Aerobic Exercise and Pilates Improves Cognitive Functions in MS Patients with Cognitive Impairment.

Estimated reading time: 4 minutes, 38 seconds.

Articles

The Effect of Adding Core Stability Exercise to Usual Care after Stroke

Impairment in trunk function is associated with decreased mobility, balance and functional independence.

Trunk function is largely influenced by core stability, which refers to active muscular control of the lumbopelvic-hip regions, which requires specific co-contraction between key muscle groups; including the paraspinals, quadratus lumborum, abdominals, hip girdle musculature, pelvic floor and diaphragm.

This systematic review and meta analysis, investigated the effect of adding core stability exercise to usual care on function, activity and participation after stroke.

11 RCTs included in the meta analysis, 391 participant that had core-stability exercise+usual care.

Core stability exercise (CSE):

• From supine position: transverse abdominis contractions, pelvic tilts, rolling and variations of bridges, curl ups, and push-ups.
• From sitting position: reaching; weight shift; trunk active movements through range; pelvic tilts; perturbation and buttocks shuffling.

Exercise dose ranged from 15 to 60 min/session, 3 to 6 sessions/week, for 2-8 weeks.

Conventional physiotherapy included: tone facilitation, passive and active range, stretching, neuromuscular training, trunk movement, pelvic movements, task-directed training, functional training, reaching, motor relearning strategies and neurodevelopmental training.

Results:

• Active trunk control:
  • Adding CSE improved trunk control, large effect size with low quality evidence.
  • As measured by either Trunk Impairment Scale (or the Spanish version) and Trunk Control Test. Based on 8 trials and 257 participant.
• Dynamic Balance:
  • Adding CSE did not improve dynamic balance as measured by Timed Up and GO test, moderate quality evidence. Based on 4 trials 88 participant.
  • Adding CSE improved functional dynamic balance as measured by Berg Balance Scale and Brunel Balance Assessment, low quality evidence. Based on 4 trials and 165 participant.
• Mobility:
  • Adding CSE did not improve mobility as measured by Functional Ambulation Categories, moderated quality evidence. Based on 3 trials and 85 participant.
• Walking speed:
  • Adding CSE improve walking speed as measured by temp-spatial measurements, low quality evidence, based on 3 trials and 58 participant.
• Global Functions:
  • Adding CSE improved global function as measured by Barthel Index score, based on 1 trial.
  • Adding CSE did not improve global function as measured by Functional Independence Measure, based on 1 trial.

So!

• Adding core stability exercise to usual care can improve trunk control and dynamic balance after stroke.

When should I add core stability exercise?

Stroke patient with low:

• Trunk Impairment Sale score. (Trunk Control)
• Berg Balance Scale and Brunel Balance Assessment scores. (Functional Dynamic Balance)

Aerobic Exercise and Pilates Improves Cognitive Functions in MS Patients with Cognitive Impairment

Cognitive impairments are shown in 43% to 70% of people with MS, these impairments are associated with decline in physical performance.

This RCT (PEDro score of 8/10), Investigated the effect of combined exercise training on different cognitive functions in people with Relapsing-Remitting MS.

Interventions:

17 participant in each group.

Overall dose: 105 minutes/session, 3 sessions/week for 8 weeks.

Exercise group received Aerobic exercise and Pilates.

• Aerobic exercise: walking on a treadmill for 30 minutes at 60%-70% of maximum heart rate (MHR=220-age) for the first 4 weeks then at 70%-80% of MHR in the second 4 weeks.
• Pilates training: started 15 minutes after aerobic exercise.
  • Warm-up with centering and segmental extremity movements in the supine position. (5 minutes)
  • Pilates: (10 repetitions the first 4 weeks, 20 repetitions the next 4 week, 50 minutes session) Single-leg stretch, Double-leg stretch, One leg circle, Shoulder bridge, The hundreds, Chest lift, Oblique Chest Lift, Heels together toes apart, Dead bug, Side bend, Clam, Arm opening, Cobra, Breaststroke, Swimming, Four-point kneeling, Modified Push-up, Plank.
  • Cool-down: Single knee to chest, Double knee to chest, Camel stretch, Cat stretch, Lying, trunk rotation, Relaxation exercise.

Control group: was taught Jacobson’s progressive relaxation exercise to do at home for 15-20 minutes, 3 times/week for 8 weeks, participant did not receive any other intervention.

Results:

The control group improved short-term and long-term verbal memory as measured by Selective Reminding Test (SRT).

Learned

• This RCT provided evidence on the importance of exercise for people with MS.
• A combined Aerobic and Pilates exercise program may improve some aspects of cognitive function, fatigue and walking capacity.
• Keep in mind, this study only included participants with mild Relapsing-Remitting MS, therefore, the results can not be generalized to more sever MS.

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Final Note

• Neuro-Rehabilitation is complicated, we many interventions that are shown to improve one or few limitations imposed by neurological diseases, keeping up with evidence is still confusing and hard.

• In the up coming days, we will be writing more in-depth reports exploring the evidence behind niche subjects such as how to improve walking speed after stroke or MS.

Recommended reads:

• Interventions for preventing falls in people with multiple sclerosis. (Open Access)
• The effect of yoga on the quality of life and fatigue in patients with multiple sclerosis: A systematic review and meta-analysis of randomized clinical trials. (Restricted Access)

References

1. Core Stability Exercises in Addition to Usual Care Physiotherapy Improve Stability and Balance After Stroke: A Systematic Review and Meta-analysis. (Restricted Access)
2. Combined exercise training improves cognitive functions in multiple sclerosis patients with cognitive impairment: A single-blinded randomized controlled trial. (Restricted Access)