Multiple sclerosis: a preliminary study of selected variables affecting rehabilitation outcome

Problem: The diversity of physical and cognitive impairments seen in progre ssive multiple sclerosis (MS), make it difficult to identify, the factors t hat influence neurorehabilitation outcome. Improvements in a motor disabili ty scale must be considered in the context of the patient's physical and co gnitive starting points, if the Process of neurorehabilitation is to be pro perly understood. Method: Data was collected from 38 patients (mean age 41 years, 16 men and 22 women) with clinically definite MS (of whom all but on e were in the progressive phase of the disease), who were consecutively adm itted to a neurorehabilitation unit Patients' Physical disability was asses sed on the motor scale of the Functional Independence Measure (FIM) on admi ssion and discharge. Cognitive and neurological assessments were completed on admission. The cognitive battery comprised the WAIS-R NART, RMT, CVLT CM T, GNT, GDA, and VOSP (some in short form). Emotional measures were the STA I, STAXI and BDI. Results: The mean improvement on the FIM was 6 points. A multiple regression analysis was performed to determine which cognitive and neurological variables related to reduced disability after neurorehabilita tion. To take account of each patient's starting point the model included t heir FIM admission score. This variable, together with vocabulary skills an d cerebellar function accounted for 57% of the variance in the patients' im provements. These results suggest that verbal intelligence and cerebellar f unction ore influential in determining rehabilitation outcome. Although the se findings will be unsurprising to clinicians, this is the first quantitat ive demonstration of these effects.