Rehabilitation exercise during acute attacks of neuromyelitis optica spectrum disorder (NMOSD) involving the spinal cord significantly improved motor function, balance, and performance of activities of daily living (ADLs), according to findings published in Multiple Sclerosis and Related Disorders.

Researchers evaluated the safety and efficacy of rehabilitation exercise initiated during an acute NMOSD attack because most available research describes the effects of rehabilitation during disease remission. They hypothesized that rehabilitation during acute attacks of transverse myelitis would optimize neuroplasticity potential by facilitating “recovery of motor control . . . [and engaging] residual neural networks to improve movement and function.”

Investigators conducted the prospective cohort study from January 2015 to December 2020, enrolling 73 patients with NMOSD who were admitted to Huashan Hospital and Jing’an District Centre Hospital of Fudan University in Shanghai, China, with 36 in the rehabilitation group and 37 in the control group.

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Passive rehabilitation included stretching to maintain joint range of motion, joint positioning using a posture orthosis to prevent contractures, and massage and pressure therapy. Active rehabilitation involved strength training, aerobic exercise, ambulation, transfers, and balance training. Moderate intensity sessions lasting 30 to 60 minutes occurred 5 times per week during hospitalization, for an average of 19 days.

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Outcome measures included the Extended Disability Status Scale (EDSS), Berg Balance Scale (BBS), Barthel Index (BI), total motor score (TMS), American Spinal Injury Association Impairment Scale (AIS), pin prick score, and light touch score.

Rehabilitation significantly improved EDSS scores in 2 subgroups. Ninety percent of patients with lower baseline EDSS scores (4.5-6.0) and 100% of patients with higher baseline EDSS scores (6.5-10.0) reached the minimal clinically important difference, compared with 27.78% and 78.95% in the control group, respectively.

Improvement in balance measured by the BBS differed significantly between rehabilitation and control groups (15.53 vs 10.49, respectively). TMS and BI scores improved significantly in both groups, with larger improvements seen in the rehabilitation group, indicating improved motor function and ADL performance.

No significant differences occurred in light touch, pin prick, or AIS scores, although AIS scores improved in 11 rehabilitation patients compared with only 3 control patients.

Two patients experienced weakness and worsening fatigue during early rehabilitation, requiring adjustments in exercise intensity, which resolved the adverse response.

Rehabilitation exercise “should be regarded as a necessary treatment in addition to medication and/or [plasma exchange] in the acute phase to prevent the accumulation of neurological defects if the conditioning allows,” the authors said.


Li Q, Wang B, Cheng B, et al. Efficacy and safety of rehabilitation exercise in neuromyelitis optica spectrum disorder during the acute phase: a prospective cohort study. Mult Scler Relat Disord. Published online March 5, 2022. doi:10.1016/j.msard.2022.103726