Moderate exercise using a VGS was safe, feasible and enjoyed as an adjunct to inpatient PR. This modality may encourage patients to maintain physical activity after PR.

BackgroundMultiple sclerosis (MS) patients have central nervous system (CNS) lesions that may impede cognitive and sensorimotor function. Few rehabilitative therapies are available.ObjectivesThe objective of this paper is to study effects of noninvasive tongue stimulation using the Portable Neuromodulation Stimulator (PoNS™) combined with intensive cognitive and physical rehabilitation on working memory, gait, balance and concomitant changes in the brain.MethodsFourteen MS patients, seven each in an active and a sham stimulation group, participated. Participants received intensive physical therapy and working memory training for 14 weeks. Functional magnetic resonance imaging (fMRI) using motor imagery and working-memory tasks were completed prior to and following therapy, as were sensory organization tests (SOT), motor performance measures, and neuropsychological assessment.ResultsOn the SOT, the active group showed significant improvement from baseline. fMRI revealed significant blood oxygen level-dependent signal changes in the left primary motor cortex for the Active Group, while the sham group had increased activity in bilateral premotor cortices. All individuals improved on working-memory tasks, but only the active group showed increased dorsolateral prefrontal cortex activity.ConclusionsIn this cohort of MS patients, the results suggest that PoNS stimulation can enhance motor performance and working memory while also driving neuroplasticity. Further studies are warranted to explore these findings.

In patients with severe COPD, initial 6MWD was predictive of survival. Overall survival at three years was only 58% and was especially poor (34%) in patients with low (<150 m) initial walk distance.

The objectives of our study were to (i) compare, in chronic obstructive pulmonary disease (COPD) patients, acute responses to continuous training at high intensity (CTHI), continuous training at ventilatory threshold (CTVT) and interval training (IT); (ii) examine associations between acute responses and 12-week adherence; and (iii) investigate whether the relationship between acute responses and adherence is mediated/moderated by affect/vigour. Thirty-five COPD patients (forced expiratory volume in 1 second = 60.2 ± 15.8% predicted), underwent baseline assessments, were randomly assigned to CTHI, CTVT or IT, were monitored throughout about before training, and underwent 12 weeks of exercise training during which adherence was tracked. Compared with CTHI, CTVT was associated with lower respiratory exchange ratio, heart rate and respiratory rate (RR), while IT induced higher [Formula: see text], [Formula: see text]maximal voluntary ventilation, RR and lower pulse oxygen saturation. From pre- to post-exercise, positive affect increased (F = 9.74, p < 0.001) and negative affect decreased (F = 6.43, p = 0.005) across groups. CTVT reported greater end-exercise vigour compared to CTHI (p = 0.01) and IT (p = 0.02). IT exhibited lowest post-exercise vigour (p = 0.04 versus CTHI, p = 0.02 versus CTVT) and adherence rate (F = 6.69, p = 0.004). Mean [Formula: see text] (r = -0.466, p = 0.007) and end-exercise vigour (r = 0.420, p = 0.017) were most strongly correlated with adherence. End-exercise vigour moderated the relationship between [Formula: see text] and adherence (β = 2.74, t(32) = 2.32, p = 0.03). In summary, CTHI, CTVT and IT improved affective valence from rest to post-exercise and induced a significant 12-week exercise training effect. However, they elicited different acute physiological responses, which in turn were associated with differences in 12-week adherence to the target training intensity. This association was moderated by acute end-exercise vigour.

Objectives: Translingual neurostimulation (TLNS) studies indicate improved outcomes in neurodegenerative disease or spinal cord injury patients. This study was designed to assess the safety and efficacy of TLNS plus targeted physical therapy (PT) in people with a chronic balance deficit after mild-to-moderate traumatic brain injury (mmTBI).Materials and Methods: This international, multicenter, randomized study enrolled 122 participants with a chronic balance deficit who had undergone PT following an mmTBI and had plateaued in recovery. Randomized participants received PT plus either high-frequency pulse (HFP; n = 59) or low-frequency pulse (LFP; n = 63) TLNS. The primary efficacy and safety endpoints were the proportion of sensory organization test (SOT) responders (SOT composite score improvement of ≥15 points) and fall frequency after five weeks of treatment, respectively.Results: The proportion of SOT responders was significant in the HFP + PT (71.2%) and LFP + PT (63.5%) groups compared with baseline (p < 0.0005). For the pooled population, the SOT responder rate was 67.2% (p < 0.00005), and there were clinically and statistically significant improvements in SOT composite scores after two and five weeks (p < 0.0005). Both groups had reductions in falls and headache disability index scores. Mean dynamic gait index scores in both groups also significantly increased from baseline at weeks 2 and 5.Conclusions: Significant improvements in balance and gait, in addition to headaches, sleep quality, and fall frequency, were observed with TLNS plus targeted PT; in participants who had a chronic balance deficit following an mmTBI and had plateaued on prior conventional physiotherapy.