The main focus of this research collaboration between the Mellen Center and Physical Medicine and Rehabilitation is to gather evidence regarding the usefulness of rehabilitation and symptomatic treatments to improve gait and balance in individuals with multiple sclerosis and other central nervous system disorders. We are involved in various projects, including the following:
- Clinical trials of physical therapy, exercise (including technology-enhanced exercise), assistive devices and orthotics, medications for muscle spasms, and other symptomatic medications that improve walking.
- Clinical trials of non-conventional interventions, such as neuro-music therapy.
- Analysis of data from large clinical registries.
- Validation studies of measurement tools to assess neurologic performance, and focusing on walking and balance.
Interactive Rhythmic Auditory Stimulation Device for Gait Training in Individuals with Multiple Sclerosis
We are conducting a study involving individuals with MS that have symptoms that make walking difficult. The effects of rhythmic auditory stimulation (RAS) on gait and walking have been studied across a range of neurologic injuries and diseases. RAS can be defined as the use of rhythmic auditory cues, such as music and beats, to facilitate voluntary movement. There is evidence suggesting that RAS can be helpful for people with MS, but this low-cost, safe, and easy to use neuro-music therapy technique has not been fully tested in the MS patient population.
We plan to evaluate the effect of 1 hour, bi-weekly supervised gait/walking training sessions consisting of continuous over ground walking on a track for 30 minutes, with or without RAS, in this group of patients. We plan to use a system currently in development, the MR-004 (MedRhythms Inc, Portland, ME), which includes a sensor that clips onto the shoe to measure the user’s walking pattern, and an ear piece to provide select music with or without the auditory help. We will examine the quality of a person’s walking, their endurance, and walking speed to assess improvements in physical function. In addition, we will assess their adherence and satisfaction with the program along with questionnaires that evaluate their perceived improvements in walking.
Comparing the Delivery of an MS Exercise Intervention through Telerehabilitation and Conventional Mode
This study for individuals with MS involves exercising for about one hour three times per week for 16 weeks, and four test sessions. If you agree to participate in this study, you will be randomly put into one of two groups. People in one group will exercise using a program at home, and another will exercise at the Mellen Center. Both programs require that you exercise by yourself using the exercise instructions given to you. You will also meet regularly with a coach. If you are in the home exercise program, you will talk with your coach using video conferencing or on the phone. If you are in the program that comes to the Mellen Center, you will meet with your coach in person.
To be eligible to participate in this study you must be between 18 and 65 years old, have a confirmed MS diagnosis, and have a technological platform (i.e. computer and internet, DVD player and TV, or Smartphone).
Stroke Patient Research Registry
The purpose of this registry is to connect stroke survivors with stroke related research studies occurring at Cleveland Clinic and area hospitals. Participants will provide researchers with contact information so they may be given details about ongoing and future research studies.
To be eligible to be included in the registry, a person must be over 18 years of age, diagnosed with a stroke, and able to understand study risks and provide informed consent.
If you wish to participate click on the link below to sign an electronic informed consent for this research registry. The consent will go over your rights as a participant and will explain the registry in more detail.
- Linder S, Davidson S, Rosenfeldt A, Lee J, Koop MM, Bethoux F, Alberts JL. Forced and voluntary aerobic cycling interventions improve walking capacity in individuals with chronic stroke. Arch Phys Med Rehabil 2020; in press
- Abbatemarco J, Griffin A, Jones N, Hartman J, McKee K, Wang Z, Nagel SJ, Machado AG, Bethoux FA. Long-Term Outcomes of Intrathecal Baclofen in Ambulatory Multiple Sclerosis Patients: A Single Center Experience. Multiple Sclerosis Journal. Online First publication July 14, 2020.
- Plow M, Packer T, Mathiowetz VG, Preissner K, Ghahari S, Sattar A, Bethoux F, Finlayson M. REFRESH protocol: A noninferiority randomized clinical trial comparing internet and teleconference to in-person “Managing Fatigue” interventions on the impact of fatigue among persons with multiple sclerosis. Accepted for publication in BMJ Open June 2020.
- Plow M, Motl RW, Finlayson M, Bethoux F. Intervention Mediators in a Randomized Controlled Trial to Increase Physical Activity and Fatigue Self-management Behaviors Among Adults With Multiple Sclerosis. Ann Behav Med. 2020;54(3):213-21. PMID: 31595300
- Motl RW, Backus D, Neil WN, Cutter G, Palmer L, McBurney R, Schmidt H, Bethoux F, Hebert J, Ng A, McCully K, Plummer P. Rationale and design of the STEP for MS Trial: Comparative effectiveness of Supervised versus Telerehabilitation Exercise Programs for Multiple Sclerosis. Contemp Clin Trials 2019;81:110-22. PMID: 31022481.
- Streicher MC, Alberts JL, Sutliff MH, Bethoux F. Effects of Physical Therapy Training in an Immersive Virtual Reality System or Traditional Physical Therapy Training in MS Patients: a Case Series. Int J Ther Rehabil 2018;25(10):522-8.
- Bethoux F, Varsanik JS, Chevalier TW, Halpern EF, Stough D, Kimmel ZA. Walking Speed Measurement by an Ambient Measurement System (AMS) Correlates with Standard Gait Assessments in Multiple Sclerosis. Gait Posture 2018;61:393-97. PMID: 29454289.
- Lee BS, Jones J, Lang M, Achey R, Dai L, Lobel DA, Nagel SJ, Machado AG, Bethoux F. Early outcomes after intrathecal baclofen therapy in ambulatory patients with multiple sclerosis. J Neurosurg 2018;129(4):1056-62. doi: 10.3171/2017.5.JNS162925. PMID: 29192855.Gallagher LM, Bethoux F. Therapeutic use of the arts for Patients with Multiple Sclerosis. US Neurology 2017;13(2):82–9.
- Bethoux F, Fatemi A, Fowler E, Marciniak C, Mayadev A, Waksman J, Zackowski K, Suarez G, Blight AR, Rabinowicz AL, and Carrazana E. Safety, tolerability, and sensorimotor effects of extended-release dalfampridine in adults with cerebral palsy: A pilot study. Clin Ther 2017;39(2):337-46.
- Yang F, Finlayson M, Bethoux F, Su X, Dillon L, Maldonado HM. Effects of controlled whole-body vibration training in improving fall risk factors among individuals with multiple sclerosis: A pilot study. Disabil Rehabil 2018;40(5):553-60. doi: 10.1080/09638288.2016.1262466.