Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Helmlinger, B.
Measurement, Rehabilitation, and Neuronal Reorganisation Associated with Walking Function in People with Multiple Sclerosis.
[ Dissertation ] Universität Graz; 2025. pp.98.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Pinter Daniela Theresia
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- Abstract:
- Multiple sclerosis (MS) is a chronic, demyelinating and neurodegenerative disease of the central nervous system and represents one of the most common causes for disability in young adults. Walking impairments are among the most prevalent and debilitating symptoms of this disease. Since even subtle changes of walking function considerably impair patients’ quality of life, the evaluation of monitoring tools is of major relevance. Therefore, the first aim of my dissertation project was to investigate the sensitivity of a short walking test, the timed 25-foot walk (T25FW, Study 1), towards mild walking impairment in a large cohort of people with MS (pwMS; N=650). Our results highlight the ability of the T25FW to detect subtle changes in walking speed and, therefore, support further use of the test in clinical routine. Since disability accrual cannot yet be entirely prevented by disease-modifying treatments, another important research area is the evaluation of complementary rehabilitative treatments. Hence, the second part of my dissertation project was dedicated to evaluating the effects of different gait trainings on walking function in pwMS (Studies 2.A, 2.B). We performed a randomised, double-blind trial within three Austrian centres, in which 132 pwMS were randomised to one of three home-based gait trainings for four weeks. We observed that all three interventions (rhythmic-cued actual gait, motor imagery of gait or a combination thereof) lead to similarly strong improvements in walking speed and endurance. While training-related improvements in walking function are generally assumed to be driven by neuroplasticity, the neuronal mechanisms behind successful rehabilitation are still not fully understood. To investigate this, we performed an imaging sub-study of the larger multi-centre trial in 31 pwMS recruited at the Graz-centre (Study 3). We conducted functional magnetic resonance imaging examinations before and after four weeks of gait training in pwMS. Results showed that people whose walking function improved due to the trainings showed significant reductions in gait-like task-related brain activity within areas involved in complex movement generation. This pattern suggests a more efficient recruitment of gait-related brain areas due to successful walking training in pwMS. Altogether, this dissertation project contributes to a better understanding of monitoring, rehabilitation and adaptive neuronal mechanisms related to walking function in pwMS.