title: Neurorehabilitation Strategies Focusing on Ankle Control Improve Mobility and Posture in Persons With Multiple Sclerosis.
abstract: OBJECTIVE
  The neuromuscular impairments seen in the ankle plantarflexors have been identified as a primary factor that limits the mobility and standing postural balance of individuals with multiple sclerosis (MS). However, few efforts have been made to find effective treatment strategies that will improve the ankle plantarflexor control. Our objective was to determine whether an intensive 14-week neurorehabilitation protocol has the potential to improve the ankle plantarflexor control of individuals with MS. The secondary objectives were to determine whether the protocol would also improve postural control, plantarflexion strength, and mobility.
  
  
  METHODS
  Fifteen individuals with MS participated in a 14-week neurorehabilitation protocol, and 20 healthy adults served as a comparison group. The primary measure was the amount of variability in the submaximal steady-state isometric torque, which assessed plantarflexor control. Secondary measures were the Sensory Organization Test composite score, maximum plantarflexion torque, and the spatiotemporal gait kinematics.
  
  
  RESULTS
  There was less variability in the plantarflexion torques after the neurorehabilitation protocol (preintervention, 4.15% ± 0.5%; postintervention, 2.27% ± 0.3%). In addition, there were less postural sway (preintervention, 51.87 ± 0.2 points; postintervention, 67.8 ± 0.5 points), greater plantarflexion strength (preintervention, 0.46 ± 0.04 Nm/kg; postintervention, 0.57 ± 0.05 Nm/kg), and faster walking speeds (preferred preintervention, 0.71 ± 0.05 m/s; preferred postintervention, 0.81 ± 0.05 m/s; fast-as-possible preintervention, 0.95 ± 0.06 m/s; postintervention, 1.11 ± 0.07 m/s). All of the outcome variables matched or trended toward those seen in the controls.
  
  
  CONCLUSIONS
  The outcomes of this exploratory study suggest that the neurorehabilitation protocol employed in this investigation has the potential to promote clinically relevant improvements in the ankle plantarflexor control, standing postural balance, ankle plantarflexion strength, and the mobility of individuals with MS. Video abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A110).
authors.affiliation: Department of Physical Therapy (B.L.D., D.J.A., B.C., H.R., R.T.H., M.J.K.), Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska; Department of Physical Therapy Education (K.G.V.), School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska; and Department of Neurology (K.H., R.Z.), College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Davies
authors.forename: David J
authors.initials: DJ
authors.lastname: Arpin
authors.forename: Kathleen G
authors.initials: KG
authors.lastname: Volkman
authors.forename: Bradley
authors.initials: B
authors.lastname: Corr
authors.forename: Heidi
authors.initials: H
authors.lastname: Reelfs
authors.forename: Regina T
authors.initials: RT
authors.lastname: Harbourne
authors.forename: Kathleen
authors.initials: K
authors.lastname: Healey
authors.forename: Rana
authors.initials: R
authors.lastname: Zabad
authors.forename: Max J
authors.initials: MJ
authors.lastname: Kurz
mesh_terms: D000328:Adult; D000368:Aged; D000842:Ankle / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000534:rehabilitation*; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology*; D000066530:Neurological Rehabilitation / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D004856:Postural Balance / Q000502:physiology