Evaluating Intervention Responsiveness in People With Multiple Sclerosis
Condition: Multiple Sclerosis
MeSH terms: Multiple Sclerosis; Sclerosis
Study type: Interventional

Summary: 
      The purpose is to see how multiple sclerosis (MS) is associated with strength and sensation
      using MRI, in persons with MS. The investigators will also see whether exercise can improve
      these symptoms for persons with MS.
    

Detailed description: 
      Multiple sclerosis (MS) is a chronic inflammatory disorder that damages myelin sheaths and
      axons in the brain and spinal cord. Within ten years of being diagnosed with MS, a majority
      of people will experience disability, most often walking impairments. The currently available
      pharmacologic treatments offer protection from new attacks but do not help with recovery;
      thus, in many cases the only hope for improvement, is through physical rehabilitation.

      Rehabilitative interventions, such as progressive resistance training (PRT), have been shown
      to improve strength and sometimes walking in many individuals with MS. However, there are
      also many individuals who do not respond, which tends to be ignored in the literature. In
      addition, most intervention studies measure the primary impairment (e.g, strength) with
      little or no consideration for other impairments (e.g., sensory loss) and any effects on more
      complicated movements (e.g. standing, or changing direction). Since MS is so heterogeneous,
      it would be helpful to know which individuals are likely to benefit from rehabilitation.

      Standard MS care uses MRI for diagnosis, identification of inflammatory lesions, and
      determination of treatment efficacy. Conventional rehabilitation relies on clinical judgment,
      rating scales and impairment measures to determine treatment efficacy. The investigators
      would like to understand how behavioral impairments and MRI findings relate to each other,
      and predict rehabilitation potential for people with MS. The investigators have previously
      shown that damage measured using tract specific MRI, specifically magnetization transfer
      (MTI) and diffusion tensor imaging (DTI), correlates with physical impairments in individuals
      with MS. Here the investigators propose to determine whether measures of clinical impairment
      and tract specific MRI can improve our ability to predict who will respond best to a PRT
      exercise intervention by improving functional movement. The investigators will perform a PRT
      intervention. The investigators will measure sensory and motor impairments and walking
      ability before and after the intervention. MRI will be done before treatment to assess the
      integrity of critical motor (corticospinal, CST) and sensory (dorsal column-medial lemniscus,
      DC-ML) tracts across the cervical spinal cord and brain. The investigators hypothesize that a
      combination of impairment measures and MRI measure will predict improvement in functional
      movement following three months of PRT.
    

Intervention name(s): progressive resistance training
Intervention type(s): Behavioral
Intervention description(s): The exercise program uses guided progressive resistance training to provide an individualized program of strength training. The progressive resistance training intervention will consist of 12 weeks of guided resistance training twice weekly; in addition, subjects will be instructed to do one day of progressive resistance training at the home weekly.
Other intervention name(s): strength; exercise training
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment