Abstract
Impaired mobility is amongst the most debilitating symptoms reported by people with
multiple sclerosis (MS). Historically, it has been viewed that walking impairments
in people with MS are directly caused by the physical damage to the neurons in the
central nervous system (CNS) which results from the immunopathology of MS. However,
research from over the past 4 decades has revealed that physical function in people
with MS is also affected by skeletal muscle dysfunction characterized by a reduced
capacity to produce, regulate, and sustain the force-generating muscle contractions
that propel human movement. While the immediate CNS damage caused by MS can alter
the neural activation of muscle by disrupting neuromotor transmission, chronic reductions
in mobility and extreme fatigue can lead to physically inactive lifestyles that negatively
affect skeletal muscle through mechanisms of deconditioning. Consequently, people
with MS can experience alterations in activation patterns, muscle mass and tissue
composition, contractility, metabolism, and perfusion that contribute to reductions
in muscle function that ultimately impair key physical functions such as walking.
This article provides an overview of the cellular mechanisms that contribute to skeletal
muscle dysfunction in people with MS and a discussion of the current evidence suggesting
that skeletal muscle may be a key physiological target for interventions aiming to
improve mobility in this population. We specifically highlight recent evidence demonstrating
the potential for rehabilitation and exercise interventions to induce muscle plasticity
in people with MS who have moderate to severe levels of disability. In conclusion,
we discuss future directions in basic science and clinical research that may advance
our understanding of muscle dysfunction in MS and lead to the development of more
precise and effective treatment strategies.
Keywords
List of abbreviations:
BWSTT (body weight supported treadmill training), CNS (central nervous system), EMG (electromyography), FES (functional electrical stimulation), MS (multiple sclerosis), MVC (maximal voluntary contraction), NIRS (near infrared spectroscopy), RAGT (robot-assisted gait training)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 17, 2022
Accepted:
October 25,
2022
Received in revised form:
October 19,
2022
Received:
January 5,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
This work was funded by the Eula C. and Andrew C. Carlos Multiple Sclerosis Rehabilitation and Wellness Program at Shepherd Center
Disclosures: K.M. is the president of InfraredRX. The other authors have nothing to disclose.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
