Taking the lessons learned from stroke research (part 1) and moving forward to develop new projects and programs is important for the advancement of research in rehabilitation and symptom management in progressive multiple sclerosis (MS). For this post, I’ll be highlighting areas that garnered interest at the Progressive MS Alliance meeting such as brain stimulation, robotics, exercise, cognition, and patient perspectives.
Brain Stimulation: Dr. Jonathan Downar (University Health Network, Canada)
Promoting brain plasticity is key for the reorganization of connections in the brain cells, as I highlighted in the previous post. A more “plastic” brain may be more receptive and benefit more from rehabilitation. A noninvasive approach to stimulate brain plasticity may be through brain stimulation.
There are two types of brain stimulation: magnetic and direct current. Magnetic stimulation refers to the placement of large coils above the scalp that send short magnetic pulses to nearby brain cells, while direct stimulation requires the placement of electrodes on the desired area of the scalp and stimulates deeper regions of the brain.
Dr. Jonathan Downar from the University Health Network highlighted some studies that have shown the promise of brain stimulation in conditions such as cognitive impairments, anxiety, and depression. Knowledge from these studies has improved the use of brain stimulation technique so that specific regions of interest can be targeted. The goal of research moving forward, particularly in MS, is to better target and stimulate the regions impacted by MS and eventually to tailor treatments to meet individual needs – with the hope of changing the properties of the brain to form new connections to replace old ones that may not work as well.
Robotics: Dr. Shane Saunderson (University of Toronto, Canada)
Chronic conditions such as MS put a lot of pressure on the healthcare system, particularly for long-term care facilities. Dr. Shane Saunderson from the University of Toronto has been developing socially assistive robots with a human-like demeanor to assist in simple chores and supplement support from caregivers with the goal of ultimately improving the quality of life for people affected by MS. These assistive robots help individuals with decision-making, reminders, providing companionship and cognitive stimulation. For example, the team has programmed a robot to help decide the day’s clothing choices through the options available in the wardrobe.
Exercise: Dr. Ulrik Dalgas (Aarhus University, Denmark), Dr. Stefan Gold (Charité – Universitätsmedizin Berlin, Germany), and Dr. Rob Motl (University of Alabama, United States)
Through research in animal models of MS, there is evidence to support the benefits of exercise. Dr. Stefan Gold from Charité – Universitätsmedizin Berlin presented research that indicated that exercise results in the decreased release of inflammatory molecules in the body, reducing clinical score and disruption of the blood-brain barrier in animal models of MS. The caveat of many of these studies in animal models of the disease is that exercise is given prior to induction of MS, making the results of these studies less translatable to the human population.
However, while clinical trials on exercise have been small and heterogeneous in nature, Dr. Dalgas from Aarhus University mentions that exercise can activate nearly every organ and organ system in the human body. Clinical trials looking to the impact of exercising for those diagnosed with relapsing-remitting MS have, in fact, shown an improvement in physical abilities, cognition, and quality of life. While only a handful of studies have been performed in progressive MS, similar and promising effects are witnessed.
Dr. Rob Motl from the University of Alabama shed light on the future of exercise and MS. For one, exercise can be viewed as a powerful “medicine” in progressive MS. However, there is the need to vet other diseases and use them as a guide for the development of new projects in exercise and MS. Furthermore, disability in MS worsens with age, therefore the aging population needs to be kept in consideration when developing exercise paradigms. Finally, when, what and how much exercise needs to be identified for each individual and potentially a synergistic approach of combining exercise and other interventions would be best for optimizing outcomes.
Cognition: Dr. John Deluca (Kessler Rehabilitation Institute, United States) and Dr. James Sumowski (Mt. Sinai School of Medicine, United States)
Cognitive dysfunction affects nearly fifty per cent of individuals living with MS, predominantly impacting information processing and speed, learning and memory, executive function and perceptual processing. Drs. James Sumowski and John Deluca presented on the benefits of rehabilitation strategies on cognitive issues. While small trials for cognitive rehabilitation have shown activation of brain regions important for encoding of memories, and improved behavioural performance on processing speed, memory, and reasoning, there is a need for more randomized clinical trials that predefine their inclusion criteria and outcomes. Furthermore, like exercise, we need to understand and define who, when and what “dosage” of cognitive rehabilitation should be administered.
Patient Reported Outcomes: Dr. Giampaolo Brichetto (Italian MS Society, Italy) and Dr. Robert McBurney (Accelerated Cure Project for MS, United States)
Patient-reported outcomes (PRO) measure aspects of an individual’s health in relation to their quality of life, symptoms, and mental/social health, just to name a few. The goal of PROs is to understand and incorporate patient need and perspectives when developing and delivering therapies aimed at improving care. Whereas clinical trials for disease-modifying therapies are highly regulated, well-funded, with standard outcomes measures such as annualized relapse rates, trials looking at symptom management and rehabilitation require diverse outcome measures. PROs could provide insights on how the intervention contributes to the quality of life from the perspective of an individual with MS. There is a need to develop coordinated, multi-stakeholder, collaborative initiative for harmonization of PROs in MS so that relevant PROs can be incorporated into clinical practice.
Stay tuned for the next and final part of the blog series on the Progressive MS Alliance meeting focused on enhancing well-being.
Have an area of interest from the topics listed above? Let us know by leaving a comment below.