Presented by
Daniel Reich, MD, PhD
Part A: Neuromodulation for Functional Recovery in MS: The Role of Spinal Cord Stimulation
Spinal cord stimulation is a neuromodulation technique that amplifies sensorimotor recovery after neurologic injury. Historically, the need for implantable epidural stimulators limits its use. However, a newer non-invasive approach, transcutaneous spinal cord stimulation, has been developed and recently receives FDA approval for clinical use following traumatic spinal cord injury. In this session, we present evidence supporting spinal cord stimulation for functional recovery after neurologic injury.
First, we provide an overview of the clinical evidence for transcutaneous spinal cord stimulation, including the studies that lead to its FDA approval for improving hand and arm function after traumatic spinal cord injury, as well as the growing body of research demonstrating improvements in sensorimotor and autonomic function across a range of neurological conditions. Next, we present preliminary data on the use of this method to support recovery of sensorimotor function in people living with multiple sclerosis. These findings include results from our pilot randomized two-arm crossover trial evaluating transcutaneous spinal cord stimulation combined with intensive therapy to promote functional recovery of the hand and arm in adults living with multiple sclerosis. We also discuss potential mechanisms, including preclinical data supporting the role of spinal cord stimulation in promoting remyelination and neuroprotection. This session is intended for rehabilitation professionals and neurologists interested in strategies for both functional recovery and central nervous system repair and preservation in people living with multiple sclerosis.
Part B: Fatigue in Multiple Sclerosis: Assessment, Mechanisms, and Treatment
Fatigue is one of the most common and debilitating symptoms experienced by individuals with multiple sclerosis (MS). MS fatigue affects mental functioning, physical functioning, and the ability to engage in daily activities. Its impact is often pervasive, limiting participation, productivity, and overall quality of life.
This session provides an intermediate-level audience with a concise yet thorough synthesis of contemporary knowledge on MS fatigue. The overview includes the epidemiology of MS fatigue, proposed etiologic mechanisms, and the definitional frameworks used in current research and clinical practice. The session explains how fatigue is operationalized and assessed by contrasting self-report questionnaires with performance-based assessments and by clarifying distinctions between fatigue and fatigability.
Evidence-based treatment strategies are reviewed, and the role and influence of physical activity and exercise on MS fatigue are discussed. Findings from two large pragmatic clinical trials conducted by the presenters are summarized. One trial evaluates an occupational therapy-led fatigue management intervention delivered both remotely and in person. The second compares cognitive behavioral therapy and pharmacologic approaches, assesses their independent and combined effects, and incorporates ecological momentary assessments to detect meaningful improvements in daily fatigue.
The session integrates conceptual, methodological, and empirical perspectives to advance understanding of fatigue and fatigability and to identify promising avenues for future clinical practice and research.