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Evaluating intervention responsiveness in people with multiple sclerosis

Principal Investigator:
Kathleen
Zackowski

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS). It is characterized by a progressive functional decline although the clinical course of the disease varies considerably from one patient to another, depending in part on the location of plaques. The presently available medications offer protection from new attacks but do not help with recovery; thus in many cases patients rely only on rehabilitation for improvement. Because MS is so variable the details of how and why individuals are responsive (or not responsive) to rehabilitative interventions may be critical for identifying characteristics that are treatable.

In this study we propose to determine whether clinical impairments of strength and sensation and tract specific MRI (i.e., markers of anatomy) when used together can improve our ability to predict who will be most responsive to an exercise intervention and improve functional movement. We will perform a training intervention in a group of people with MS and a group of healthy control subjects. We will measure sensory and motor impairments, walking ability, and other functional tasks before and after the intervention. We will also use MRI to quantify specific tracts in the brain and spinal cord that are typically affected in MS. MRI will be done before treatment to assess the integrity of two of the major motor (Corticospinal) and sensory (Dorsal column-medial lemniscus) tracts across the full extent of the cervical spinal cord and brain.

We hypothesize that a combination of impairment measures and MRI based measures will predict improvement in functional movements following three months of training. To test this hypothesis we are using a rigorous biologic approach that combines clinical evaluation, advanced neuroimaging methods, and measures of impairment and disability to provide a more precise prognosis in terms of physical disability and to predict who is likely to respond to a physical intervention.

The linking of this information will not only be important for better defining disability in MS but it will also help to guide therapists in predicting who is likely to respond to rehabilitative interventions. This approach could prove to be an effective way to understand the complicated pathophysiology of multiple sclerosis and other neurological disorders and improve their treatment.

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