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Objective: The purpose of this investigation was to explore if a physical therapy program involving strength, flexibility, balance, and walking can improve the uncharacteristic gait variability and overall mobility of persons living with multiple sclerosis (pwMS). Design: Pre-post design to evaluate the mobility improvements after undergoing 6 weeks of a gait and balance physical therapy intervention. Setting: The initial 2 weeks were conducted at a medical center under close supervision of a physical therapist. The remaining 4 weeks were performed by the patient at their home and monitored via teleconferences. Participants: Fifteen pwMS with relapsing-remitting (N=11) or secondary progressive multiple sclerosis (N=4) were enrolled in this study (7 women; mean age: 54.8±9 years; Kurtzke Expanded Disability Status Score range: 3.0-6.5). A group of healthy age-matched controls (N=15) were used for comparisons. Interventions: The 6-week physical therapy intervention included exercises that targeted strength, flexibility, balance, and walking. The initial 2 weeks of the intervention were performed on-site with the remaining 4 weeks home-based. The therapy was performed twice-a-day for 5 consecutive days each week. Each session was 45 minutes in length. Main Outcome Measures: Preferred walking speed, spatiotemporal gait kinematics, and a 6-minute walk test were completed before and after therapy. The standard deviation (SD) and sample entropy were used to evaluate the amount of variability and the regularity of the time-dependent variations in the center of mass (COM) accelerations during the 6-minute walk test. Results: Before the intervention, the SD of the COM was reduced, and the time-dependent variations were less regular in the pwMS than the control group. After therapy, the SD was 12% larger, and the time-dependent variations were more 7% regular in the pwMS. The effect size for these changes were large (0.91 and 0.94, respectively), suggesting these changes were meaningful. The changes in the regularity of the COM were related to the mobility improvements in the preferred walking velocity and 6-minute walk test. Conclusions: The results suggest that pwMS have altered COM variability during gait, which can be improved with a similar physical therapy program. These changes appear to be linked with the extent of the mobility improvements.

Abstract Objective Our prior magnetoencephalographic (MEG) investigations demonstrate that persons with cerebral palsy (CP) have weaker somatosensory cortical activity than neurotypical (NT) controls, which is associated with reduced muscular strength and mobility. Power training can improve lower extremity isokinetic strength, muscular power, and walking performance of youth with CP. Potentially, these clinically relevant improvements are partially driven by changes in somatosensory processing. The objective of this investigation was to determine if power training has complementary changes in muscular function and somatosensory cortical activity in youth with CP. Methods A cohort of youth with CP (N = 11; age = 15.90 ± 1.1 years) and NT controls (N = 10; Age = 15.93 ± 2.48 years) participated in this investigation. Youth with CP underwent 24 power training sessions. Pre‐post bilateral leg press 1‐repetition maximum (1RM), peak power production, 10‐m walking speed, and distance walked 1‐min were used as outcome measures. MEG neuroimaging assessed the changes in somatosensory cortical activity while at rest. NT controls only underwent a baseline MEG assessment. Results Youth with CP had a 56% increase in 1RM (p

Objective: To utilize magnetoencephalographic (MEG) brain imaging to examine potential changes in sensorimotor cortical oscillations after therapeutic power training in individuals with cerebral palsy (CP). Design: Cohort. Setting: Academic medical center. Participants: Individuals with CP (N=11; age=15.9±1.1 years; Gross Motor Function Classification System I- III) and neurotypical controls (NTs; N=16; age=14.6±0.8 years). Interventions: Participants with CP underwent 24 (8 weeks; 3 days a week) sessions of high-velocity lower extremity power training on a leg press. The NTs underwent single baseline MEG assessments. Main Outcome Measures: Pre-post bilateral leg press 1-repetition maximum and peak power production were used to assess the muscular performance changes. The 10-m walk and 1-minute walk tests were used to assess mobility changes. During MEG recordings, participants used their right leg to complete a goal-directed isometric target-matching task. Advanced beamforming methods were subsequently used to image the strength of the sensorimotor beta oscillatory power. Results: Before the therapeutic power training, the participants with CP had stronger beta sensorimotor cortical oscillations compared with the NT controls. However, the beta sensorimotor cortical oscillations were weaker and approximated the controls after the participants with CP completed the therapeutic power training protocol. There also was a link between the amount of improvement in leg peak power production and the amount of reduction in sensorimotor cortical oscillations seen after therapy. Conclusions: Therapeutic power training appears to optimize the sensorimotor cortical oscillations of individuals with CP, and these neuroplastic changes partly contribute to improvements in the leg peak power production of individuals with CP. Therapeutic power training might provide the key ingredients for beneficial neuroplastic change.