NeuroRehabilitation - Volume 50, issue 1

Article Type: Editorial

DOI: 10.3233/NRE-218007

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 1-2, 2022

Authors: Mercier, Leah J. | Batycky, Julia | Campbell, Christina | Schneider, Kathryn | Smirl, Jonathan | Debert, Chantel T.

Article Type: Review Article

Abstract: BACKGROUND: Increasing evidence suggests autonomic nervous system (ANS) dysfunction may occur following mild traumatic brain injury (mTBI). Measures of heart rate, heart rate variability, blood pressure and baroreceptor sensitivity can be used to evaluate ANS dysfunction following mTBI. OBJECTIVE: Summarize the evidence for ANS dysfunction in adults following mTBI. METHODS: A search of Embase, MEDLINE, Cochrane Central Register, PsycINFO, CINAHL and SPORTDiscus databases was conducted. Search topics included: mTBI and ANS. Identified abstracts were independently reviewed by 2 reviewers followed by full text screening. Risk of bias was assessed using a modified SIGN checklist. A structured …synthesis was performed. RESULTS: Thirty-nine studies (combined 1,467 participants diagnosed with mTBI) evaluating ANS function were included. ANS function was evaluated under various conditions including: rest, during exertion, cold pressor test, Valsalva maneuver, using face cooling and eyeball pressure paradigms. Short-term or ultra-short-term recordings were most common. The majority of studies (28/39) were rated as “unacceptable” for quality of evidence. CONCLUSIONS: Altered parameters of ANS function have been reported in multiple conditions following mTBI, both acutely and in the post-acute/chronic stages of recovery. However, due to methodological limitations, conclusions regarding the severity and timing of ANS dysfunction following mTBI cannot be drawn. Show more

Keywords: Brain injuries, traumatic, autonomic nervous system diseases, autonomic nervous system, heart rate, baroreflex

DOI: 10.3233/NRE-210243

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 3-32, 2022

Authors: Dimitrova, Rozalina | Kim, Heakyung | Meilahn, Jill | Chambers, Henry G. | Racette, Brad A. | Bonikowski, Marcin | Park, Eun Sook | McCusker, Emily | Liu, Chengcheng | Brin, Mitchell F.

Article Type: Research Article

Abstract: BACKGROUND: Spasticity is common in cerebral palsy and can result in pain and diminished health-related quality of life. OBJECTIVE: To evaluate the safety and efficacy of onabotulinumtoxinA for lower limb spasticity treatment in children with cerebral palsy. METHODS: In this registrational phase 3, multinational, randomized, double-blind, placebo-controlled trial (NCT01603628), children (2–< 17 years) with cerebral palsy and ankle spasticity (Modified Ashworth Scale-Bohannon [MAS] score≥2) were randomized 1 : 1 : 1 to standardized physical therapy and onabotulinumtoxinA (4 or 8 U/kg), or placebo. Primary endpoint was average change from baseline at weeks 4 and 6 in MAS ankle score. Secondary endpoints included …the Modified Tardieu Scale (MTS) and Global Attainment Scale (GAS). RESULTS: 381 participants were randomized. MAS scores averaged at weeks 4 and 6 were significantly reduced with both onabotulinumtoxinA doses (8 U/kg: –1.06, p  = 0.010; 4 U/kg: –1.01, p  = 0.033) versus placebo (–0.8). Significant improvements in average dynamic component of spasticity, measured by MTS, and in function, measured by GAS, were observed at several time points with both onabotulinumtoxinA doses versus placebo. Most adverse events were mild or moderate. CONCLUSIONS: OnabotulinumtoxinA was well tolerated and effective in reducing lower limb spasticity and improving functional outcomes versus placebo in children. Show more

Keywords: Children, lower limb, onabotulinumtoxinA, randomized clinical trial, spasticity

DOI: 10.3233/NRE-210070

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 33-46, 2022

Authors: Medijainen, Kadri | Pääsuke, Mati | Lukmann, Aet | Taba, Pille

Article Type: Research Article

Abstract: BACKGROUND: In the long term, Parkinson’s disease (PD) leads to the development of difficulties in daily functional tasks. There remains a paucity of evidence on the effectiveness of physiotherapy on patient-perceived difficulties regarding basic activities of daily living (ADL). OBJECTIVES: To assess an effect of a versatile physiotherapy intervention on patient-perceived difficulties in basic ADL. METHODS: The study sample included 24 patients (10 men and 14 women) with PD. Participants were randomly assigned into intervention (IG) and control groups (CG). Two assessments were performed with a gap of 10 weeks. Following first assessment, during an 8-week …period, IG participants attended sixteen physiotherapy 60-minutes sessions in groups that were divided into five parts to address the core areas recommended by the European Physiotherapy Guideline for PD (EPGPD): gait, transfers, balance, physical capacity, and manual activities. The main assessment tool was the Modified Patients Specific Functional Scale (ModPSFS), which represents a self-assessment rating on difficulties perceived in 17 different commonly occurring activities. RESULTS: IG members reported a significant reduction in self-perceived difficulties as assessed by ModPSFS (effect size 1.39; 95%CI 5.1, 26.6 points, p  = 0.005). CONCLUSIONS: 2-months conventional physiotherapy with incorporated core areas recommended in EPGPD for PD reduced patient-perceived difficulties in basic ADL. Show more

Keywords: Parkinson’s disease, physiotherapy, guideline, Patient Specific Functional Scale, activities of daily living, patient-centered care

DOI: 10.3233/NRE-210181

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 47-56, 2022

Authors: Jarvis, Charlotte | Sangarapillai, Kishoree | Almeida, Quincy J.

Article Type: Research Article

Abstract: BACKGROUND: Parkinson’s Disease (PD) is a neurodegenerative disorder affecting both motor and cognitive symptoms. While medications show some improvement in motor symptoms, cognitive symptoms can worsen. In-person exercise programs, such as PD SAFEx™, are an important adjunct therapy in improving symptoms. However, coronavirus disease 2019 (COVID-19) limited in-person exercise interventions. Therefore, there is a need to investigate the effectiveness of online exercise delivery. OBJECTIVE: To identify (1) whether an online exercise intervention can achieve similar results to an identical in-person intervention and (2) if online PD SAFEx™ can alter the cognitive decline of PD patients. METHODS: …20 participants with idiopathic PD participated in a 12-week online PD SAFEx™ program and were compared to 73 participants from in-person PD SAFEx™. The primary outcome measure was the Unified Parkinson’s Disease Rating Scale-III measured before/after intervention. Three secondary cognitive measures were collected with the online group. RESULTS: Main effect of time on UPDRS-III scores of both groups were found (F(1,92) = 35.555, p  < 0.001). No interaction was found between in-person and online groups (F(1,1) = 0.052, p  = 0.820). TMT B in the online group showed significant improvements in executive function (F(1,17) = 7.095, p  = 0.016). CONCLUSIONS: Online and in-person PD SAFEx™ both achieved clinically significant UPDRS-III improvement and are statistically equivalent. Online PD SAFEx™ reduced cognitive symptoms seen during COVID-19. Show more

Keywords: Parkinson’s, exercise, rehabilitation, cognition, COVID-19

DOI: 10.3233/NRE-210145

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 57-63, 2022

Authors: Longhurst, Jason K. | Rider, John V. | Eckard, Kameron | Hammar, Ryan | Vukojevic, Franjo | Campbell, Jillian | Landers, Merrill R.

Article Type: Research Article

Abstract: BACKGROUND: Fear of falling avoidance behavior (FFAB) is common in parkinsonisms and results in potentially mitigable downstream consequences. OBJECTIVE: Determine the characteristics of individuals with parkinsonisms most associated with FFAB. METHODS: A retrospective, cross-sectional study was conducted from medical records data of 142 patients with parkinsonisms. These data included: demographics (age, sex), disease severity (Movement Disorders Society –Unified Parkinson’s Disease Rating Scale Part III (MDS-UPDRS III), years since diagnosis), fall history (number of fall injuries in previous year), and gait and balance function (five times sit to stand, MiniBESTest, Timed Up and Go …(TUG), dual-task TUG, ten-meter walk test (10MWT), observed freezing of gait (FOG) (MDS-UPDRS III item 11)). RESULTS: 10MWT (p  < .001) and MDS-UPDRS III item 11 (p  < .014) were significantly associated with FFAB above and beyond disease severity, which also contributed significantly to the overall model (p s < .046). Fall history was not associated with FFAB. CONCLUSION: Our findings suggest that the largest portion of variability in FFAB is explained by gait velocity and FOG; however, disease severity also explains a significant portion of the variability of FFAB. Further investigation into factors predictive of FFAB and mitigation of downstream consequences, using more robust designs, is warranted. Show more

Keywords: Parkinsonism, fear of falling, avoidance behavior, gait velocity, freezing of gait

DOI: 10.3233/NRE-210267

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 65-73, 2022

Authors: Wang, Emily | Chang, Julia H.C. | Plow, Matthew

Article Type: Research Article

Abstract: BACKGROUND: Fatigue is one of the most common and disabling symptoms in people with multiple sclerosis (MS). Fatigue self-management behaviors may be effective in reducing the impact of fatigue in people with MS. However, few studies have examined the factors that influence engagement in fatigue self-management behaviors. OBJECTIVE: Identify factors that directly and indirectly influence fatigue self-management behaviors. METHODS: Participants with MS (n  = 287) completed online questionnaires at baseline and 6-weeks. Guided by the Self- and Family Management Framework, we examined the influence of health status, resources and environment, healthcare utilization, and self-management processes on fatigue …self-management behaviors at 6-weeks. Multiple regression and path analyses were conducted. RESULTS: The final regression model variables accounted for 41.58% of the variance in fatigue self-management behaviors, which included outcome expectations (β= 0.287), disability (β= 0.265), environmental barriers (β= 0.188), self-efficacy (β= 0.153), symptom severity (β= 0.113), living in an urban community (β= –0.108), and living alone (β= 0.103). Path analysis indicated that outcome expectations may mediate the relationship between disability levels and fatigue self-management behavior. CONCLUSIONS: Health status (i.e., disability and symptom severity), environmental factors (e.g., living situation), and self-management processes (i.e., self-efficacy and outcome expectations) may play an important role in influencing engagement in fatigue self-management behaviors. Show more

Keywords: Energy conservation, self-care, fatigue, activity pacing, occupational therapy, MS

DOI: 10.3233/NRE-210179

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 75-87, 2022

Authors: Kovari, Martina | Stovicek, Jan | Novak, Jakub | Havlickova, Michaela | Mala, Sarka | Busch, Andrew | Kolar, Pavel | Kobesova, Alena

Article Type: Research Article

Abstract: BACKGROUND: Anorectal dysfunction (ARD), especially bowel incontinence, frequently compromises the quality of life in multiple sclerosis (MS) patients. The effect of rehabilitation procedures has not been clearly established. OBJECTIVE: To determine the effect of an individualized rehabilitation approach on bowel incontinence and anorectal pressures. METHODS: MS patients with ARD underwent 6-months of individually targeted biofeedback rehabilitation. High resolution anorectal manometry (HRAM) and St. Mark’s Fecal Incontinence Scores (SMIS) were completed prior to rehabilitation, after 10 weeks of supervised physiotherapy, and after 3 months of self-treatment. RESULTS: Ten patients (50%) completed the study. Repeated measures …analysis of variance (ANOVA) demonstrated significant improvement in the SMIS questionnaire over time [14.00 baseline vs. 9.70 after supervised physiotherapy vs. 9.30 after self-treatment (p  = 0.005)]. No significant improvements over time were noted in any HRAM readings: maximal pressure [49.85 mmHg baseline vs. 57.60 after supervised physiotherapy vs. 60.88 after self-treatment (p  = 0.58)], pressure endurance [36.41 vs. 46.89 vs. 49.95 (p  = 0.53)], resting pressure [55.83, vs 52.69 vs. 51.84 (p  = 0.704)], or area under the curve [230.0 vs. 520.8 vs. 501.9 (p  = 0.16)]. CONCLUSIONS: The proposed individualized rehabilitation program supports a positive overall effect on anorectal dysfunction in MS patients. Show more

Keywords: Multiple sclerosis, bowel incontinence, high resolution anorectal manometry, St. Mark’s fecal incontinence score, biofeedback

DOI: 10.3233/NRE-210226

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 89-99, 2022

Authors: Duan, Lei | Wang, Changbao | Wang, Xia | Wang, Aiping | Xu, Tingting | Peng, Xiangrong | Gao, Zhiqiang

Article Type: Research Article

Abstract: BACKGROUND: Studies have shown that hyperbaric oxygen therapy (HBOT) can improve the extraction rate and latency of cortical evoked potential N20 in patients with severe traumatic brain injury, but there are only a few studies on the effect of flash visual evoked potential. OBJECTIVE: This study investigated the effect of hyperbaric oxygen therapy on the P2 wave of flash visual evoked potentials in patients with severe traumatic brain injury. METHODS: In total, we examined 40 TBI patients who received HBOT, in combination with medication, and 38 TBI patients who received medication alone. The FVEPs apparatus was …used to detect the P2 wave extraction rate and the latency of the elicited waveform before and after treatment in both the medicated-only controls and HBOT-treated cohorts. RESULTS: Compared with the control group, the HBOT treatment group showed a higher P2 wave elicitation rate, and the P2 wave latency of the HBOT treatment group was significantly shortened (p  < 0.05, all). CONCLUSIONS: HBOT, in combination with drug therapy, can significantly increase the P2 wave extraction rate and shorten P2 latency in patients with TBI. Show more

Keywords: Hyperbaric oxygen, severe traumatic brain injury, Flash visual evoked potential, P2

DOI: 10.3233/NRE-210165

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 101-104, 2022

Authors: Vatinno, Amanda A. | Schranz, Christian | Simpson, Annie N. | Ramakrishnan, Viswanathan | Bonilha, Leonardo | Seo, N.J.

Article Type: Research Article

Abstract: BACKGROUND: Uncertain prognosis presents a challenge for therapists in determining the most efficient course of rehabilitation treatment for individual patients. Cortical Sensorimotor network connectivity may have prognostic utility for upper extremity motor improvement because the integrity of the communication within the sensorimotor network forms the basis for neuroplasticity and recovery. OBJECTIVE: To investigate if pre-intervention sensorimotor connectivity predicts post-stroke upper extremity motor improvement following therapy. METHODS: Secondary analysis of a pilot triple-blind randomized controlled trial. Twelve chronic stroke survivors underwent 2-week task-practice therapy, while receiving vibratory stimulation for the treatment group and no stimulation for the …control group. EEG connectivity was obtained pre-intervention. Motor improvement was quantified as change in the Box and Block Test from pre to post-therapy. The association between ipsilesional sensorimotor connectivity and motor improvement was examined using regression, controlling for group. For negative control, contralesional/interhemispheric connectivity and conventional predictors (initial clinical motor score, age, time post-stroke, lesion volume) were examined. RESULTS: Greater ipsilesional sensorimotor alpha connectivity was associated with greater upper extremity motor improvement following therapy for both groups (p  < 0.05). Other factors were not significant. CONCLUSION: EEG connectivity may have a prognostic utility for individual patients’ upper extremity motor improvement following therapy in chronic stroke. Show more

Keywords: EEG, stroke, rehabilitation, upper extremity, paresis, subliminal stimulation, physical stimulation, prognosis

DOI: 10.3233/NRE-210171

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 105-113, 2022

Authors: Du, Yupeng | Wei, Li | Lu, Ying | Gao, Hong

Article Type: Research Article

Abstract: BACKGROUND: Swallowing disorders represent one of the most common complications after cerebral infarction. OBJECTIVE: To study the effects of different frequencies of repetitive transcranial magnetic stimulation (rTMS) on swallowing disorders after cerebral infarction. METHODS: Ninety patients with swallowing disorder after cerebral infarction were enrolled and randomly assigned to three groups: the 10 Hz frequency rTMS group (30 patients), the 5 Hz frequency rTMS group (30 patients), and the 1 Hz frequency rTMS group (30 patients); another 90 healthy persons without swallowing disorders were included as the control group. The Kubota’s water-swallow test, the video fluoroscopic swallow study (VFSS), and …the Electroencephalograph (EEG) were analyzed before and after treatment; the EEG of the control group was detected as the baseline. RESULTS: The Kubota’s water-swallow test scores were significantly decreased while the scores of pharynx period and the aspiration degree of VFSS significantly increased in 10 Hz frequency rTMS group than before treatment (P ≤0.05); the amplitudes of C3 of the EEG significantly increased in three frequency groups than before treatment (P ≤0.05). CONCLUSIONS: 10 Hz frequency of rTMS is effective for the treatment of swallowing disorder after cerebral infarction, the excitement of C3 area maybe the therapeutic target of rTMS on swallowing disorder after cerebral infarction. Show more

Keywords: Swallowing disorders after cerebral infarction, Repetitive transcranial magnetic stimulation (rTMS), Electroencephalograph (EEG), Frequency, C3 area

DOI: 10.3233/NRE-210176

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 115-122, 2022

Authors: Donati, Danilo | Brunelli, Stefano | De Santis, Letizia | Mariani, Giorgio | Mariani, Elisabetta | Perrone, Mariada | Benedetti, Maria Grazia

Article Type: Research Article

Abstract: BACKGROUND: The use of a prosthesis is critical to regain the ability to walk in lower limb amputees but the relationship between the use of a prosthesis and chronic pain syndromes (PLS, PLP, RLP), common in amputees patients, is still poorly understood. OBJECTIVE: This long-term follow-up study investigates the possible correlation between prosthesis use and the presence of PLP, PLS and RLP in lower limb amputees. METHODS: Patients undergoing transtibial, transfemoral or hemipelvectomy amputation of any aetiology at the Rizzoli Orthopaedic Institute from 2008 to 2018 were included. The Houghton scale was used …to assess functional use of the prosthesis. The PEQ was used for pain assessment. RESULTS: The results show that, in lower limb amputees, prosthesis use is greater in individuals with below-the-knee amputation and in those who were younger at the time of amputation. No significant correlation between the presence of pain syndromes (PLS, PLP, RLP) and the various items on the Houghton scale was found. CONCLUSIONS: The study found no significant correlation indicating that phantom limb pain syndromes affect amputee use of a prosthesis in the long term follow up. Show more

Keywords: Lower limb amputees, chronic pain, prosthetic use

DOI: 10.3233/NRE-210241

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 123-131, 2022

Authors: Sim, Tae Yong | Kwon, Jae Sung

Article Type: Research Article

Abstract: BACKGROUND: Unilateral neglect in stroke patients is a major obstacle to rehabilitation, which is a great challenge for therapists. OBJECTIVE: This study aimed to compare the effectiveness of bimanual mirror therapy (BMT) and unimanual mirror therapy (UMT), the two protocols of mirror therapy, for the reduction of the symptoms of unilateral neglect in stroke patients. METHODS: Twenty-eight individuals were randomly assigned to the BMT or UMT groups. Both groups received mirror therapy for 30 minutes per day, 5 days a week, for a period of 4 weeks. The Star Cancelation Test (SCT), Line Bisection Test (LBT), …Picture Scanning Test (PST), and Korean Catherine Bergego Scale (K-CBS) were used to measure the change in unilateral neglect, and the Korean version of the Modified Barthel Index (K-MBI) was used to evaluate activities of daily living (ADL). RESULTS: The results of SCT, LBT, PST, and K-CBS showed significant decreases in unilateral neglect in both groups (p  < 0.05). K-MBI improved significantly in both groups (p  < 0.05). There were significant differences between the two groups in the unilateral neglect tests (p  < 0.05), but no significant difference in ADL evaluation (p  > 0.05). CONCLUSIONS: Mirror therapy protocols can be applied to treat unilateral neglect in stroke patients. However, BMT may be more beneficial for reducing the symptoms of unilateral neglect. Show more

Keywords: Stroke, mirror therapy, unilateral neglect, activities of daily living

DOI: 10.3233/NRE-210233

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 133-141, 2022

Authors: Bi, Ranran | Zhang, Yahui | Liu, Xiaochen | Zhang, Shun | Wang, Rui | Liang, Bingyin | Cui, Fang

Article Type: Research Article

Abstract: BACKGROUND: In the healthy body, the fascial system maintains elasticity and coordination of movements. If these functions are destroyed, facial paraly appears. Myofascial induction therapy (MIT), a manual physical therapy method that focuses on restoring altered fascial tissue, is prevalently and widely used in clinical treatment. OBJECTIVE: The study aimed to observe the application of MIT in the rehabilitation of patients with acute facial palsy. METHODS: Sixty-eight patients with acute facial palsy were divided into control group and manual treatment group. The control group received drug treatments, such as prednisone, methylcobalamin, and vitamin B1, and instrumental …physical therapy, such as semiconductor laser, shortwave therapy, and facial muscle training. In addition to these treatments, the manual treatment group received MIT. Both groups were treated for 4 weeks. The patients were assessed using the following methods: the House-Brackmann facial nerve function evaluation, Sunnybrook facial grading system, facial nerve electrophysiological examination compound muscle action potential (CMAP) amplitude, and blink reflex (BR) R1 latency. RESULTS: House-Brackmann and Sunnybrook scores and CMAP amplitude and BRR1 latencies were significantly different between the two groups (p  < 0.05). Furthermore, the manual treatment group showed greater improvement than the control group (p  < 0.05). CONCLUSIONS: Treatment with MIT promoted better recovery of acute facial palsy and thus may be considered a valid rehabilitation intervention that is worthy of clinical application. Show more

Keywords: Bell’s palsy, facial nerve damage, nerve regeneration, a Nonrandomized controlled trial

DOI: 10.3233/NRE-210204

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 143-149, 2022

Authors: Brownlee, Naomi | Wilson, Colin | Curran, David B. | Wright, Gavin | Flannery, Tom | Caldwell, Sheena B.

Article Type: Research Article

Abstract: BACKGROUND: Acoustic Neuroma (AN) is a benign tumour of the eighth cranial nerve. Stereotactic Radiosurgery (SRS) is a common treatment approach. Studies have explored the primary effects of SRS and documented equivalent efficacy for tumour control compared to neurosurgery. OBJECTIVE: Examine the longer term cognitive and psychosocial outcomes of SRS in non-Neurofibromatosis Type II patients utilising both objective and subjective cognitive outcomes associated with quality of life and health related distress. METHODS: Nineteen individuals treated via SRS were assessed using a battery of standardised psychometric tests as well as measures of quality of life and psychological …distress. RESULTS: Participants had largely preserved cognitive function except for processing speed, aspects of attention and visual memory relative to age norms. Self-reported quality of life was better than in other AN population studies. Level of psychological distress was equivalent to general population norms. More than half of participants reported subjective cognitive decline though this was not fully supported by objective testing. Subjective cognitive complaints may be associated with lower reported quality of life. CONCLUSIONS: Results are largely consistent with previous findings on the effects of SRS in other clinical groups, which supports SRS as a targeted radiation treatment for AN. Show more

Keywords: AN, SRS, cognitive outcomes, psychological adjustment

DOI: 10.3233/NRE-210106

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 151-159, 2022

Authors: Amatya, Bhasker | Khan, Fary

Article Type: Other

Abstract: BACKGROUND: A broad range of complementary and alternative medicine (CAM) approaches, including different dietary interventions, alone or in conjunction with conventional medicine are currently trailed in people with multiple sclerosis (MS). Published clinical and experimental data suggest that certain dietary interventions may improve MS-related health outcomes. OBJECTIVE: To assess the effectiveness of dietary interventions to improve MS-related health outcomes. METHODS: To summarize the updated Cochrane Review “Dietary interventions for multiple sclerosis-related outcomes” conducted by Parks et al. Best available evidence was discussed from the rehabilitation perspective. RESULTS: Overall 30 RCTs (with 2335 participants) evaluated a …range of dietary interventions: polyunsaturated fatty acids, antioxidant supplements, dietary programmes and other dietary supplements. All included trials had one or more methodological issues leading to an unknown or high risk of bias. The findings suggest that the evidence is uncertain about the effect of dietary interventions on MS-related health outcomes. CONCLUSIONS: The evidence for dietary interventions in people with MS is sparse and uncertain, and more robust studies are needed. Show more

Keywords: Multiple sclerosis, diet, health outcomes, rehabilitation

DOI: 10.3233/NRE-228000

Citation: NeuroRehabilitation, vol. 50, no. 1, pp. 161-163, 2022