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MS research update - Could an external skeleton improve mobility and posture in MS? - 15 November 2013

Summary

This small study used an exoskeleton (a whole body external framework) to see if mobility and posture could be improved through training of the body and the brain. Each part of the exoskeleton was designed to prompt good posture and movement, for example, the part that was on the back and hips had a component that could push forward into the small of the back to stimulate appropriate movement of the hips and pelvis.

The researchers found that walking and standing posture improved after using the exoskeleton. All of the participants reported having better balance and feeling lighter in the body. All of them reported being able to do things that they could not do immediately before wearing the exoskeleton such as fast walking and running and being able to walk further.

The authors of the research paper believe that this happens through changes in the prefrontal cortex of the brain allowing better control of movement.

Background

In May 2012, the national news covered the achievement of Claire Lomas who completed the London marathon in 26 days wearing a "bionic" suit. Claire was paralysed from the chest down after she broke her back and neck in a horse-riding accident in 2007. The "bionic" suit is more properly called a robotic exoskeleton and it allowed her to walk for the first time since her accident. You can read more about Claire on her web site.

The research published this week looked at whether an exoskeleton could improve mobility and posture in six people with MS.

How this study was carried out

Six people with relapsing remitting MS and six healthy controls took part in the study. In each group, five were women and the average age was 47. The people with MS had an EDSS score between five and eight indicating moderate to severe difficulties including with walking.

The study used the "Human Body Posturizer" (HBP) system which is cheaper, lighter and more compact than the exoskeleton used by Claire. It can adapt to the person's body shape allowing a more natural posture. It is made from solid plastic and metal, fully jointed, and extends from the head to the legs like an external framework.

Each part of the exoskeleton is designed to prompt good posture and movement, for example, the part that is on the back and hips has a component that can push forward into the small of the back to stimulate appropriate movement of the hips and pelvis. The design is shown in the pictures of the exoskeleton.

The brain's electrical activity was monitored using an EEG (electroencephalograph) to see if the exoskeleton was changing the pattern of brain circuits used as the person learned to move in a different, and more appropriate, way. The researchers monitored, in particular, the prefrontal cortex which is involved in problem solving, decision making and the control of movement.

Participants completed various tasks like pressing a button with the right hand when a target appeared on the screen and not pressing the button when a non-target appeared. This was used as a measure of their ability to respond quickly and accurately.

The results before and after using the exoskeleton were compared.

What was found

Walking and standing posture improved after using the exoskeleton. All of the participants reported having better balance and feeling lighter in their body. All of them also reported being able to do things that they could not do immediately before wearing the exoskeleton such as fast walking and running and being able to walk further. On average the EDSS scores were reduced by half a point although some people showed more benefit than others.

What does it mean?

The authors concluded that the exoskeleton improved accuracy on the tests, walking ability and posture. They believe that this happens through changes in the prefrontal cortex of the brain allowing better control of movement.

Di Russo F, Berchicci M, Perri RL, et al.
A passive exoskeleton can push your life up: application on multiple sclerosis patients. .
PLoS One. 2013 Oct 25;8(10):
abstract
Read the full text of this paper

More about improving posture and movement

Posture

Posture is the position the body adopts in response to the effects of gravity. It is the way people hold themselves when sitting, standing or lying down. 'Good' posture allows movement with the least amount of strain and damage.

Most people have to work at keeping a good posture whether they have MS or not. People with MS often find that keeping a good posture can be more challenging due to, for example, weakness, pain and fatigue. Poor posture can develop gradually, often without someone noticing, until it interferes with every day tasks or causes pain. Simple changes in posture can be beneficial and these can be incorporated into everyday activities.

If you would like to read more about posture, we have an online self-help guide called Understanding and improving your posture

Movement

Physiotherapy can help improve someone's ability to move and to undertake activities that are important to them. Physiotherapy can be valuable for many MS symptoms and is particularly useful for managing stiffness (spasticity), balance, and spasms.

GPs, neurologists or MS nurses can normally make a referral for physiotherapy. Many MS Therapy Centres also provide access to physiotherapy for people with MS.

Exercise is also important although this may have to be balanced against fatigue

Research by topic areas...

Diagnosis

Krahn TM.
Care ethics for guiding the process of multiple sclerosis diagnosis.
J Med Ethics. 2013 Nov 12. [Epub ahead of print]
abstract

Symptoms and symptom management

Calabrò RS, De Luca R, Conti-Nibali V, et al.
Sexual Dysfunction in male patients with multiple sclerosis: A need for counseling!
Int J Neurosci. 2013 Nov 13. [Epub ahead of print]
abstract

Wieder L, Gäde G, Pech LM, et al.
Low contrast visual acuity testing is associated with cognitive performance in multiple sclerosis: a cross-sectional pilot study.
BMC Neurol. 2013 Nov 8;13(1):167. [Epub ahead of print]
abstract
Read the full text of this paper

Disease modifying treatments

Gold R, Comi G, Palace J, et al.
Assessment of cardiac safety during fingolimod treatment initiation in a real-world relapsing multiple sclerosis population: a phase 3b, open-label study.
J Neurol. 2013 Nov 13. [Epub ahead of print]
abstract

Drugs in development

Thöne J, Gold R.
Review of laquinimod and its therapeutic potential in multiple sclerosis.
Expert Opin Pharmacother. 2013 Nov 11. [Epub ahead of print]
abstract

Hutchinson M, Fox RJ, Havrdova E, et al.
Efficacy and safety of BG-12 (dimethyl fumarate) and other disease modifying therapies for the treatment of relapsing-remitting multiple sclerosis: a systematic review and mixed treatment comparison.
Curr Med Res Opin. 2013 Nov 7. [Epub ahead of print]
abstract

Other treatments

Gervasoni E, Cattaneo D, Jonsdottir J.
Effect of treadmill training on fatigue in multiple sclerosis: a pilot study.
Int J Rehabil Res. 2013 Nov 11. [Epub ahead of print]
abstract

Weller M, Marshall K, Lovato JF, et al.
Single-institution retrospective series of gamma knife radiosurgery in the treatment of multiple sclerosis-related trigeminal neuralgia: factors that predict efficacy.
Stereotact Funct Neurosurg. 2013 Nov 8;92(1):53-58. [Epub ahead of print]
abstract

Prugger M, Berger T.
Assessing the long-term clinical benefit of prolonged-release fampridine tablets in a real-world setting: a review of 67 cases.
Patient Relat Outcome Meas. 2013 Oct 23;4:75-85.
abstract

Co-existing conditions

Montgomery S, Hassan A, Bahmanyar S, et al.
Mortality following a brain tumour diagnosis in patients with multiple sclerosis.
BMJ Open. 2013 Nov 11;3(11)
abstract
Read the full text of this paper

Assessment tools

Cameron MH, Thielman E, Mazumder R, et al.
Predicting falls in people with multiple sclerosis: fall history is as accurate as more complex measures.
Mult Scler Int. 2013;2013:496325.
abstract
Read the full text of this paper

Genetics

van Pelt ED, Mescheriakova JY, Makhani N, et al.
Risk genes associated with pediatric-onset MS but not with monophasic acquired CNS demyelination.
Neurology. 2013 Nov 6. [Epub ahead of print]
abstract

Disanto G, Ramagopalan SV.
Similar genetics of adult and pediatric MS: Age is just a number.
Neurology. 2013 Nov 6. [Epub ahead of print]
abstract

Psychological aspects

Filippi M, Rocca MA.
Let's rehabilitate cognitive rehabilitation in multiple sclerosis.
Neurology. 2013 Nov 8. [Epub ahead of print]
abstract

Chiaravalloti ND, Moore NB, Nikelshpur OM, et al.
An RCT to treat learning impairment in multiple sclerosis: The MEMREHAB trial.
Neurology. 2013 Nov 8. [Epub ahead of print]
abstract

Minden SL, Ding L, Cleary PD, et al.
Improving the quality of mental health care in multiple sclerosis.
J Neurol Sci. 2013 Aug 30. [Epub ahead of print]
abstract

Physical activity

Wajda DA, Sandroff BM, Pula JH, et al.
Effects of walking direction and cognitive challenges on gait in persons with multiple sclerosis.
Mult Scler Int. 2013;2013:859323.
abstract
Read the full text of this paper

Coote S, Finlayson M, Sosnoff JJ.
Level of mobility limitations and falls status in persons with multiple sclerosis.
Arch Phys Med Rehabil. 2013 Nov 8. [Epub ahead of print]
abstract

Kalron A, Achiron A.
The relationship between fear of falling to spatiotemporal gait parameters measured by an instrumented treadmill in people with multiple sclerosis.
Gait Posture. 2013 Oct 19. [Epub ahead of print]
abstract

Ortiz-Gutiérrez R, Cano-de-la-Cuerda R, Galán-Del-Río F, et al.
A telerehabilitation program improves postural control in multiple sclerosis patients: a spanish preliminary study.
Int J Environ Res Public Health. 2013 Oct 31;10(11):5697-710.
abstract
Read the full text of this paper

Pathophysiology

Genova HM, Rajagopalan V, Deluca J, et al.
Examination of cognitive fatigue in multiple sclerosis using functional magnetic resonance imaging and diffusion tensor imaging.
PLoS One. 2013 Nov 1;8(11)
abstract
Read the full text of this paper

Review

Gomes Mda M, Engelhardt E.
Jean-Martin Charcot, father of modern neurology: an homage 120 years after his death.
Arq Neuropsiquiatr. 2013 Oct;71(10):815-7.
abstract
Read the full text of this paper

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