## 4 Discussion  
Both the duration of sessions and the ease of stimulus administration were well received by the participant within the context of the individualized WBV protocol. Its potential for clinical applications or integration into rehabilitation programs may be facilitated by its adaptability. The participant reported an overall improvement in his ability to perform activities of daily living, such as climbing stairs, manual dexterity, removing the plantar orthosis, and feeling more stable during gait, which suggest that the improvement in the various outcomes has a positive impact on his functional independence. The present case report investigated the effects of five-year individualized WBV intervention on locomotion, postural control and handgrip strength in PwRRMS. The main results during walking include the ability to walk at higher speeds (2 km/h and 3 km/h) compared to the baseline assessment in which the participant was unable  
Figure 6: Patient’s brain MRI. 1.5 tesla brain MRI obtained before (**A**) and after (**B**) multi-year WBV intervention. T2 axial MRI showed the presence of multiple demyelinating lesions in the periventricular and hemispheric white matter. to walk at speeds greater than 1 km/h; and the ability to walk effectively without the plantar orthosis by improving his ankle dorsiflexion. The angle-angle diagrams revealed an improvement in the locomotion at all speeds of both legs (W-Leg and S-Leg). The results of the angle-angle diagrams indicated specific adaptations of the walking modalities in relation to the speed. At low speed, the participant increased the range of motion (ROM) of the lower limbs over time. Considering that a decreased ROM characterizes the gait in PwMS [5; 12], this adaptation is appropriate to counteract their gait alterations. Conversely, the ROM decreased over time at a higher speed, but the effect was counterbalanced by an increase in the step frequency, which was consistent with the increase in the imposed speeds on the treadmill. This adaptation over time could be also related to an improvement in conjoint coordination revealed by the shape of the angle-angle diagrams. Although the absolute value of the shape cannot be associated with a specific geometry, it has the potential to underline the shape changes described by an angle-angle diagram. Thus, when the coordination in a movement improves, the value quantifying the shape tends to decrease [69]. These kinematic adaptations are reflected in the normalized sEMG activity recorded in the leg muscles during the stance phase. Although the changes have not been significant over time, at the end of the WBV intervention (T4), the VL-normalized sEMG reduced its activity in the weakest leg (\(\Delta\) average = \(-\)48.3%) more than in the strongest leg (\(\Delta\) average = \(-\)28.6%), whereas the BF-normalized sEMG values had higher \(\Delta\) in the strongest leg (\(\Delta\) average = 81.3%) than in the weakest leg (\(\Delta\) average = 22%). The shank muscles (TA and LG), involved in ankle flexion-extension, increased mostly in the weakest leg; in particular, the activation of the TA muscle increased in the weakest leg (\(\Delta\) from 10 to 68%). The improvements in muscle activation could explain the reason why the participant began to walk without the orthosis as the TA muscle is directly involved in the ankle dorsiflexion function. Although the participant was able to walk at higher speeds over time, the SI values seem to indicate that during walking at a speed of 3 km/h, motor impairments persisted. The preferable gait speed for the participant seems to be 2 km/h, as the overall SI of the area, perimeter and shape was <10%; additionally, the normalized sEMG activity showed a better SI than the other speeds', with nearly perfect symmetry of the LG muscles. Improved locomotion facilitates daily activities, including the ascent of stairs and the traversing of uneven terrain, thereby enhancing independence and decreasing the necessity for assistance [75].