Rehabilitation including walking aid training with real-time feedback can induce motor and neural changes in people with multiple sclerosis

Background and Purpose Gait and balance impairment is common in multiple sclerosis (MS), often leading to walking aids need. Rehabilitation is the most common and effective approach to tackle the burden of these symptoms, but less attention is given to the correct use of an assistive device for ambulation. Here, we aimed to maximise the effect of a rehabilitation program including walking aid training with a sensorized crutch in people with MS (PwMS). Methods 24 PwMS (15 females, age=57.8±9.8 years, all EDSS=6) underwent a 20-session rehabilitation program focusing on gait, balance, and proper assistive device use. The experimental group (FB_group, N=12) used a crutch with real-time feedback based on user support load, whilst the control group (NOFB_group, N=12) used a standard crutch.Assessment included Timed 25 Foot Walk (T25FW), Timed Up and Go (TUG) and Modified Fatigue Impact Scale (MFIS). Moreover, functional Near-Infrared Spectroscopy (fNIRS) was used to investigate cortical activity during linear and curvilinear walking tasks. Results At baseline, no differences were found between groups concerning either clinical or neural evaluations. Following rehabilitation, we observed a reduction in fatigue perception in both groups (p=0.038). Moreover, FB_group performed better than NOFB_group in T25FW and TUG (p=0.028 and p=0.038, respectively). Further, after treatment, FB_group showed increased neural activity in areas involved in cognitive functions (Brodmann Areas-BA 9,10, p<0.01), multisensory integration and body representation (BA39, p=0.01) during both linear and curvilinear walking. Instead, NOFB_group showed increased activity in motor planning areas (BA 6,8, p<0.05). A significant difference was also found between groups in BA9 after treatment (FB_group>NOFBgroup, p=0.04). Discussion A 20-session rehabilitation period effectively reduces fatigue among PwMS. Moreover, a real-time feedback crutch seems to have a positive impact on walking ability. This might be due to a feedback-induced increased attention focusing on the assistive device, as suggested by the fNIRS results.