Journal of Neurology (2018) 265:1393–1401
Eects of motor rehabilitation on mobility and brain plasticity
in multiple sclerosis: a structural and functional MRI study
· Niels Bergsland
· Davide Cattaneo
· Elisa Gervasoni
· Maria Marcella Laganà
· Cristina Grosso
· Francesca Lea Saibene
· Francesca Baglio
· Marco Rovaris
Received: 17 February 2018 / Revised: 3 April 2018 / Accepted: 3 April 2018 / Published online: 7 April 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Background Rehabilitation seems to promote brain plasticity, but objective measures of eﬃcacy are lacking and there is a
limited understanding of the mechanisms underlying functional recovery.
Objective To study functional and structural brain changes induced by gait rehabilitation.
Methods We enrolled MS inpatients (EDSS 4.5–6.5) undergoing a 4-week neurorehabilitation. Several clinical measures
were obtained, including: 2-min walk test (2MWT), dynamic gait index (DGI), Berg balance scale (BBS). Furthermore,
motor-task functional MRI (fMRI) of plantar dorsiﬂexion, resting state fMRI, and regional diﬀusion tensor imaging (DTI)
metrics were obtained. All the assessments were performed at baseline (T0), after the end of the rehabilitation period (T1)
and 3 months later (T2).
Results Twenty-nine patients were enrolled at T0, 26 at T1, and 16 completed all timepoints. At T1, there was a signiﬁcant
improvement of 2MWT, DGI, and BBS scores, along with a reduced extent of the widespread activation related to the motor
task at the fMRI and an increased functional connectivity in the precentral and post-central gyrus, bilaterally. None of these
changes were maintained at T2.
Conclusions Our ﬁndings show a short-term beneﬁcial eﬀect of motor rehabilitation on gait performances in MS, accom-
panied by brain functional reorganization in the sensory-motor network.
Keywords Multiple sclerosis · Rehabilitation · Plasticity · fMRI · DTI
Multiple sclerosis (MS) is a progressive central nervous
system (CNS) disease characterized by long-term disabil-
ity accrual. Available treatments are mainly eﬀective on the
inﬂammatory mechanisms typical of the relapsing–remitting
phase of MS, whereas their impact on the neurodegenerative
process is limited.
Therefore, neuromotor and cognitive rehabilitation are of
crucial importance as they may represent the main approach
for treating the progressive forms of MS . However, data
on their eﬀect in MS are few and often contradictory, lead-
ing to lack of evidence-based practice guidelines [2, 3].
Key issues correspond to the absence of algorithms to pro-
vide tailored treatments and a poor understanding of the
mechanisms underlying recovery. With respect to the latter,
non-conventional MRI techniques such as functional MRI
(fMRI) and diﬀusion tensor imaging (DTI) may be helpful,
as they can investigate brain properties and functionality
Eleonora Tavazzi and Niels Bergsland equally contributed to the
study conduction and analysis.
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s0041 5-018-8859-y) contains
supplementary material, which is available to authorized users.
* Marco Rovaris
Scientiﬁc Institute Santa Maria Nascente, Don C. Gnocchi
Foundation ONLUS, Via Capecelatro 66, 20148 Milan, Italy
Department of Neurology, School of Medicine
and Biomedical Sciences, Buﬀalo Neuroimaging Analysis
Center, University at Buﬀalo, State University of New York,
Buﬀalo, NY, USA
Department of Neuroimaging, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London,