Effects Of Comprehensive Rehabilitation Therapy In Adult With Neuromyelitis Optica And Multiple Sclerosis

Objective MS and NMO is a chronic inflammatory and degenerative disease of the central nervous system(CNS)characterized by acute neurological manifestations with variable remission periods.It is the most common cause of acquired non-traumatic neurological disability among young adults,predominantly affecting those between the age of 20–40 years.It displays a relapsing-remitting course,and severe disability remained after immunotherapy with recurring attacks.Despite the availability of advanced disease-modifying and symptomatic therapies that may decrease activity and progression of disease and alleviate complaints to a certain extent,there is still a need for comprehensive rehabilitation interventions in order to reduce symptoms of the disease on personal activities and social participation to achieve the highest possible independence and the best quality of life.Moreover,A large number of studies have shown that patients with MS can benefit from rehabilitation therapy.However,the evidence regarding the benefits of rehabilitation in patients with NMOSD is still insufficient.Hence,the aims of this study were(a)the effectiveness of MDR rehabilitation therapy in stable NMOSD-patients and(b)to explore which FS may benefit more from MDR.(c)To determine the effects of combined robotic-aided gait training(RAGT)and MDR for adults with CNS demyelinate Disorders on improvement of fatigue,disability levels and activities of daily living.to determine any effect of robot-assisted therapy(RAGT)in relieving disability and Spasticity in patients with MS.Methods 1.Thirty-nine NMOSD patients were randomized to MDR or to Usual care(UC).Intervention group received MDR 5 times/week for 4 weeks in hospital and the patients were guided to continue community-or home-based rehabilitation for 3 months,whereas control group did not receive any specific rehabilitation intervention.The disability was assessed using EDSS and FS after 4 weeks rehabilitation and 3 months follow-up.2.71 NMOSD and MS patients were randomly divided into control group,MDR group and MDR+RAGT group.MDR group gives PT,OT and so on;MDR+RAGT group underwent RAGT and MDR 5 times/week for 8 weeks in the hospital,while,control group received routine rehabilitation nursing care only.Primary outcome measure was FSS,and the secondary outcomes were disability and Activities of daily living disability was assessed using EDSS and Modified Barthel Index(MBI)at baseline,and at the end of the trial all groups.3.28 MS patients were randomly divided into a treatment group and a control group.Both groups received routine rebabilitation,while the treatment group additionally underwent RAGT 5 times a week for 4 weeks in the hospital.Both groups were assessed using EDSS and the modified Ashworth scale before and after the treatment.Results 1.After 4 weeks of MDR,the patients in the MDR group showed improvement in their impairment.On further sub-scales analyses,the bowel and bladder,pyramidal,and walking function scores decreased,while sensory function remained unchanged.Three months after rehabilitation,the same trends were observed as at discharge,and else fatigue in the cerebral(or mental)function score had improved.After 4 weeks and 3 months,the patients in the UC group showed improvement in EDSS score and walking ability score,and it showed no significant changes other variables.2.There were no significant differences between the three groups before treatment with FSS,EDSS and MBI.After 8 weeks of RAGT and MDR,the patients in MDR group and MDR + RAGT groups showed improvement in their impairment and fatigue(P<0.05),Moreover,the analysis showed significant differences between the MDR and MDR+RAGT on EDSS,MDR+RAGT was more effective.On the contrary,patients in the control has no significant both at FSS,EDSS and MBI(P>0.05)3.In the treatment group,both measurement significantly improved compared to those before the treatment and compared with those of the control group after the treatment,For the control group,significant differences were observed only by comparing the average EDSS score before and after the treatment.Conclusion 1.The results suggested that early MDR introduced immediately after the attack might improve functional outcome measures,as observed using the EDSS.Among the various FS,the bowel and bladder,pyramidal,and walking functionsmay benefit more from MDR,while sensory dysfunction took the longest to recover.These results should be confirmed in a future large clinical trial study.2.The results of this study suggested that early RAGT and MDR might improve functional outcome measures for adults with MS and Neuromyelitis Optica,as observed using the FSS,EDSS and MBI.3.Routine rehabilitation can relieve disability,but it can hardly alleviate spasticity.However,RAGT combined with routine rehabilitation can improve both disability and spasticity.