UNRAVELING THE EFFECTS OF NEUROREHABILITATION IN PERSONS WITH NEUROLOGICAL DISORDERS: RECOVERY VERSUS COMPENSATION

This thesis investigates the mechanisms behind motor improvements in people with multiple sclerosis (PwMS), focusing on the concepts of recovery and compensation as outlined in Levin’s theoretical framework. This framework identifies three levels of motor recovery and compensation: functional, motor performance, and neural. Distinguishing between recovery and compensation is crucial for understanding the factors that contribute to rehabilitation advancements. Throughout this PhD program, we applied this theoretical framework to examine gait function in PwMS, aiming to address three critical gaps in the existing literature through three cross-sectional studies. The first gap involves a limited understanding of how physical therapists decide between restitution and compensation for patients, along with the factors that influence this choice. Therefore, the first study identified the factors affecting therapists' decisions to choose restorative approaches (focused on regaining normal gait) versus compensatory approaches (aimed at developing alternative strategies). The study revealed that physical therapists often favor a restorative approach when treating patients perceived to have a higher potential for recovery. This preference was influenced by clinical factors such as the severity of motor impairment and the expected outcomes. The second gap arises from the lack of a standardized index to quantify motor performance quality, which restricts the exploration of relationships among the functional, performance, and neural levels of recovery and compensation. Thus, the second study established a summary index for assessing gait quality, condensing multiple kinematic measures into a single metric that effectively captures movement quality alterations in MS patients. The findings indicated significant alterations in gait, particularly in the knee and ankle joints during the gait cycle, underscoring the necessity of focusing on these areas in clinical evaluations. Lastly, the third gap derives from an inadequate knowledge regarding the interactions between neural integrity, motor performance, and functional gait levels in PwMS. Consequently, the final study examined the relationship between gait function, gait quality, and the integrity of sensorimotor tracts, hypothesizing that sensorimotor network integrity would show a stronger correlation with movement quality than traditional functional measures. The results confirmed this hypothesis, revealing that sensorimotor network integrity is indeed more closely linked to movement quality than functional measures. These findings highlight the importance of considering neural integrity and movement quality in therapeutic decision-making and suggest that integrating data from neural, motor performance, and functional levels could enhance the understanding of compensation mechanisms in MS.