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Hennesy HM, Gravely ME, Alambarrio DA, Brannen SR, McDonald JJ, Devane SA, Turner KK, Stelzleni AM, O'Quinn TG, Gonzalez JM. Ability of Nicotinamide Riboside to Prevent Muscle Fatigue of Barrows Subjected to a Performance Test. Metabolites 2024; 14:424. [PMID: 39195520 DOI: 10.3390/metabo14080424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/29/2024] Open
Abstract
The objective of this study was to determine the daily dietary nicotinamide riboside (NR) dose required to maximize the delay of subjective muscle fatigue onset. Barrows (N = 100) were assigned to one of five treatments: a conventional swine finishing diet containing 0 (CON), 15 (15NR), 30 (30NR), 45 (45NR) mg·kg body weight-1·d-1 NR, or CON supplemented with 45 mg·kg body weight-1·d-1 NR by drench or cookie dough (DRE). All treatments were administered for the final 11 days of feeding. On supplementation d 10, barrows individually experienced a performance test at 1.09 m/s until they were subjectively exhausted. Wireless electromyography (EMG) sensors were affixed to the biceps femoris (BF), tensor fascia latae (TFL), and semitendinosus (ST) to measure real-time muscle activity. There were no treatment effects for barrow speed (p = 0.57), a tendency for a treatment effect (p = 0.07) for distance, and a treatment effect (p = 0.04) on time to exhaustion. Barrows of the 15NR and DRE treatments had greater (p = 0.05) distances to exhaustion than CON barrows but did not differ from other NR barrows (p > 0.11). Barrows in the 45NR treatment did not differ (p = 0.11) in distance from 30NR barrows but tended to have a greater (p = 0.07) distance compared to CON barrows. All other treatment comparisons did not differ (p > 0.27). Barrows in the DRE treatment moved for longer (p < 0.01) than CON barrows, but all other treatments did not differ from each other (p > 0.15). There was no treatment × period interaction for all muscles' root mean square (RMS) values (p > 0.16), but there were Period effects for all muscles (p < 0.01) and a Treatment effect (p = 0.04) in the TFL. For all muscles, period 4 had greater RMS values than all other periods (p < 0.01), who did not differ from each other (p > 0.29). In the TFL, CON barrows had greater RMS values during the performance test compared to all NR treatments (p < 0.02), who did not differ from each other (p > 0.18). Overall, NR demonstrates potential in being a useful tool in fatigue prevention, but efficient administration of the compound needs further investigation.
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Affiliation(s)
- Hanna M Hennesy
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602, USA
| | - Morgan E Gravely
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602, USA
| | - Daniela A Alambarrio
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602, USA
| | - Savannah R Brannen
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602, USA
| | - Jonathan J McDonald
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602, USA
| | - Sarah A Devane
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602, USA
| | - Kari K Turner
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602, USA
| | - Alexander M Stelzleni
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602, USA
| | - Travis G O'Quinn
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS 66506, USA
| | - John M Gonzalez
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602, USA
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2
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Rodriguez-Torres RS, Uher D, Gay EL, Coratti G, Dunaway Young S, Rohwer A, Muni Lofra R, De Vivo DC, Hirano M, Glynn NW, Montes J. Measuring Fatigue and Fatigability in Spinal Muscular Atrophy (SMA): Challenges and Opportunities. J Clin Med 2023; 12:jcm12103458. [PMID: 37240564 DOI: 10.3390/jcm12103458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Fatigue, a common symptom, together with the characteristic of performance fatigability, are well-documented features of SMA that impact quality of life and function. Importantly, establishing associations between multidimensional self-reported fatigue scales and patient performance has proven difficult. This review was conducted to evaluate the various patient-reported fatigue scales applied in SMA, with the objective of considering the limitations and advantages of each measure. Variable use of fatigue-related nomenclature, including conflicting terminology interpretation, has affected assessment of physical fatigue attributes, specifically perceived fatigability. This review encourages the development of original patient-reported scales to enable perceived fatigability assessment, providing a potential complementary method of evaluating treatment response.
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Affiliation(s)
- Rafael S Rodriguez-Torres
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - David Uher
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10115, USA
| | - Emma L Gay
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Giorgia Coratti
- Pediatric Neurology Unit, Catholic University, 00135 Rome, Italy
- Centro Clinico Nemo, U.O.C. Neuropsichiatria Infantile Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Sally Dunaway Young
- Department of Neurology and Clinical Neurosciences, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Annemarie Rohwer
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Robert Muni Lofra
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 7RU, UK
| | - Darryl C De Vivo
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Michio Hirano
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Nancy W Glynn
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jacqueline Montes
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
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3
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Kruse T, Shamai S, Leflerovà D, Wirth B, Heller R, Schloss N, Lehmann HC, Brakemeier S, Hagenacker T, Braumann B, Wunderlich G. Objective measurement of oral function in adults with spinal muscular atrophy. Orphanet J Rare Dis 2023; 18:103. [PMID: 37138365 PMCID: PMC10155305 DOI: 10.1186/s13023-023-02688-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/02/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Impairment of bulbar function in adult individuals with spinal muscular atrophy (SMA) usually is not assessed by established motor scores. Measurements of oral function including quantitative muscle and endurance tests are able to detect subtle changes. The aim of this study was to systematically evaluate the measurement of maximum bite force and endurance, maximum tongue pressure and endurance, as well as maximum mouth opening in adult individuals with SMA types 2 and 3. METHODS Data from oral function tests in 43 individuals were analyzed. Differences in oral function between individuals with different SMA types and numbers of SMN2 copies were tested. Spearman´s rho correlations among oral function measures themselves as well as with established clinical outcome scales were analyzed. RESULTS The absolute maximum measures of oral function (maximum bite force, maximum tongue pressure, maximum mouth opening) were able to discriminate between individuals with different SMA types, individuals with a different number of SMN2 copies and with different walking abilities. The pairwise correlations of the absolute maximum measures of oral function were fair to moderate in size; the same was true for their correlations with the established motor scores. All correlations assessing endurance measures of oral function were weaker and statistically insignificant. CONCLUSIONS Among the oral function tests maximum tongue pressure and maximum mouth opening are particulary promising as clinical and sensitive outcome measures for clinical trials. Oral function tests may supplement existing motor scores, in particular concerning specific questions about bulbar function or in severely affected non-ambulatory individuals where mild (treatment-related) changes would otherwise remain undetected. Trial registration DRKS, DRKS00015842. Registered 30 July 2019, https://drks.de/search/de/trial/DRKS00015842.
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Affiliation(s)
- T Kruse
- Department of Orthodontics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50931, Cologne, Germany.
- Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany.
| | - S Shamai
- Department of Orthodontics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50931, Cologne, Germany
| | - D Leflerovà
- Department of Orthodontics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50931, Cologne, Germany
- Department of Prosthetic Dentistry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50931, Cologne, Germany
| | - B Wirth
- Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
- Institute of Human Genetics, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - R Heller
- Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
- Institute of Human Genetics, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- Genetic Health Service NZ-Northern Hub, Auckland District Health Board, Auckland City Hospital, 90-102 Grafton Rd, Grafton, NZ-Auckland, 1010, New Zealand
| | - N Schloss
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - H C Lehmann
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Brakemeier
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - T Hagenacker
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - B Braumann
- Department of Orthodontics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50931, Cologne, Germany
- Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
| | - G Wunderlich
- Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Kennedy RA, de Valle K, Adams J, Ryan MM, Fitzgerald AK, Carroll K. Characterising gait in paediatric neuromuscular disorders: an observational study of spatio-temporal gait in a clinical cohort. Disabil Rehabil 2022; 44:7023-7029. [PMID: 34546805 DOI: 10.1080/09638288.2021.1977399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM Few studies have characterised the relationship between disease and gait function in children and young people with rare neuromuscular disorders (NMDs). This study aimed to describe the relationship between disease and gait in a large paediatric cohort from a neuromuscular outpatient clinic. METHODS A prospective, cross-sectional study of gait in independently ambulant children and young people aged 4-21 years with a clinical or genetically confirmed NMD. Participants traversed an electronic walkway barefoot and in footwear at self-selected and fast pace. Analysis of disease included a typically developing (TD) reference group. RESULTS A sample of 113 participants with NMD, mean age 9.5 years (SD 3.1), 28% female, grouped into nine diagnostic subgroups. Eighty percent reported limitations to functional mobility. Children with NMD walked slower, with a shorter and wider step compared to a TD reference group, with moderate to large effect sizes for each of these gait parameters indicative of the clinical significance of these gait deviations. Children with Duchenne muscular dystrophy (DMD) walked slowest with a markedly wide gait pattern. Footwear had little overall effect on gait in children with NMDs. All children could accelerate over short distances. CONCLUSIONS Gait, notably speed, step length, and width are clinically significant biomarkers of disease in paediatric NMDs, affording objective functional measures in clinical settings and research.Implications for rehabilitationGait should be considered a functional biomarker of disease in children and young people with neuromuscular disorders (NMDs).Comparison of gait in a paediatric neuromuscular cohort indicates that children with Duchenne muscular dystrophy (DMD) walk slowest with a shorter step length and a wider step width which increases with age and disease progression.Measurement of gait speed is a simple, pragmatic tool to monitor disease progression in the outpatient clinical environment and relates to everyday function.In clinical research, gait can be measured as a functional outcome to demonstrate change from disease-modifying interventions and treatments in NMDs.
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Affiliation(s)
- Rachel A Kennedy
- Clinical Sciences Group, Murdoch Children's Research Institute, Parkville, Australia.,Department of Neurology, The Royal Children's Hospital, Parkville, Australia
| | - Katy de Valle
- Clinical Sciences Group, Murdoch Children's Research Institute, Parkville, Australia.,Department of Neurology, The Royal Children's Hospital, Parkville, Australia
| | - Justine Adams
- Clinical Sciences Group, Murdoch Children's Research Institute, Parkville, Australia
| | - Monique M Ryan
- Clinical Sciences Group, Murdoch Children's Research Institute, Parkville, Australia.,Department of Neurology, The Royal Children's Hospital, Parkville, Australia
| | - Alisha K Fitzgerald
- Physiotherapy Department, Donvale Rehabilitation Hospital, Donvale, Australia
| | - Kate Carroll
- Clinical Sciences Group, Murdoch Children's Research Institute, Parkville, Australia.,Department of Neurology, The Royal Children's Hospital, Parkville, Australia
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Krosschell KJ, Dunaway Young S, Peterson I, Curry M, Mazzella A, Jarecki J, Cruz R. Clinical and Research Readiness for Spinal Muscular Atrophy: The Time Is Now for Knowledge Translation. Phys Ther 2022; 102:6651754. [PMID: 35904447 DOI: 10.1093/ptj/pzac108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/05/2022] [Accepted: 06/08/2022] [Indexed: 11/12/2022]
Abstract
UNLABELLED Disease-modifying therapies for spinal muscular atrophy (SMA) are rapidly changing the outlook for many individuals by substantially altering the clinical course, phenotypic expression, and functional outcomes. Physical therapists have played critical roles in the effective conduct and execution of clinical trials leading to the approval of these therapies. Given the treatment landscape, educating practicing clinicians to understand best practice is of great importance, and a timely call to action to facilitate knowledge translation from SMA researchers to clinicians is necessary. The SMA Clinical Trial Readiness Program engaged clinical and research centers, identified physical therapy knowledge gaps related to evaluation and outcomes assessment, and provided educational resources, including the development of a SMA Best Practices Clinical Evaluator Toolkit. Toolkit content synthesizes evidence and covers a breadth of issues relevant to practice, including background on SMA and the drug pipeline; therapist roles and responsibilities related to research; clinical and research evaluation; and useful materials and resources for additional education, training, and professional development. Surveys and telephone interviews were conducted with physical therapists managing individuals with SMA to determine their SMA practice experience and educational needs. Their recommendations, along with synthesized SMA research evidence, provided input into toolkit content development and assisted in identifying gaps important to address. Impact was assessed over time via utilization feedback surveys downloaded by clinicians across various settings. Open-ended feedback supported beneficial use of the toolkit for clinicians and researchers working with individuals with SMA. Next steps should include timely dissemination to bring this resource and others into practice in a systematic, efficacious, and engaging manner. As the treatment landscape for SMA evolves, the therapist's role in multidisciplinary care and research is of great importance, and a call to action for the development, implementation, evaluation and reporting of informed knowledge using evidence-based knowledge translation strategies is critical. IMPACT Partnership among patient advocacy groups, industry collaborators, and key opinion leaders/experts can optimize essential resource development to address the knowledge gap for best practices in physical therapy. This partnership model can be replicated for other diseases, providing an efficient way to support clinical trial readiness and target early development of evidence-based content and resources related to both research and best practice clinical evaluation for physical therapist researchers, clinicians, and patients. While identifying knowledge gaps and resource development are initial steps toward change in SMA practice, a rapidly changing rehabilitation outlook warrants a call to action for enhanced efforts aimed at improving rehabilitation evaluation, assessment, and care for this population. It is critical to forge a timely path forward for development, implementation, and sustainability of effective knowledge translation to practice for SMA.
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Affiliation(s)
- Kristin J Krosschell
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sally Dunaway Young
- Department of Neurology, Stanford University School of Medicine, Stanford, California, USA
| | - Ilse Peterson
- Faegre Drinker Biddle and Reath LLP, Washington, DC, USA
| | - Mary Curry
- Cure SMA, Elk Grove Village, Illinois, USA
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6
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Abstract
Spinal muscular atrophy (SMA) is a neurodegenerative disorder caused by mutations in SMN1 (encoding survival motor neuron protein (SMN)). Reduced expression of SMN leads to loss of α-motor neurons, severe muscle weakness and often early death. Standard-of-care recommendations for multidisciplinary supportive care of SMA were established in the past few decades. However, improved understanding of the pathogenetic mechanisms of SMA has led to the development of different therapeutic approaches. Three treatments that increase SMN expression by distinct molecular mechanisms, administration routes and tissue biodistributions have received regulatory approval with others in clinical development. The advent of the new therapies is redefining standards of care as in many countries most patients are treated with one of the new therapies, leading to the identification of emerging new phenotypes of SMA and a renewed characterization of demographics owing to improved patient survival.
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7
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Bortolani S, Brusa C, Rolle E, Monforte M, De Arcangelis V, Ricci E, Mongini TE, Tasca G. Technology-outcome measures in neuromuscular disorders: a systematic review. Eur J Neurol 2021; 29:1266-1278. [PMID: 34962693 DOI: 10.1111/ene.15235] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Portable and wearable devices can monitor a number of physical performances and have been lately applied to patients with neuromuscular disorders (NMD). METHODS We performed a systematic search of literature databases following PRISMA principles, including all studies reporting the use of technological devices for motor function assessment in NMDs from 2000 to 2021. We also summarized the evidence on measurement properties (validity, reliability, responsiveness) of the analyzed technological outcome measures. RESULTS One-hundred studies fulfilled the selection criteria, most of them published in the last ten years. We defined four categories that gathered similar technologies: gait analysis tools, for clinical assessment of pace and posture; continuous monitoring of physical activity with inertial sensors, that allow "unsupervised" activity assessment; upper limb evaluation tools, including Kinect-based outcome measures to assess the reachable workspace; and new muscle strength assessment tools, such as Myotools. Inertial sensors have the evident advantage of being applied in the "in-home" setting, which has become especially appealing with the Covid-19 pandemic, although poor evidence from psychometric property assessment and results of the analyzed studies may limit their research application. Both Kinect-based outcome measures and Myotools have been already validated in multicenter studies and different NMDs, showing excellent characteristics for application in clinical trials. CONCLUSION This overview is intended to raise awareness on the potential of the different TOMs in the neuromuscular field and be an informative source for the design of future clinical trials, particularly in the era of telemedicine.
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Affiliation(s)
- Sara Bortolani
- Department of Neuroscience, Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.,Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Brusa
- Department of Neuroscience, Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Enrica Rolle
- Department of Neuroscience, Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Mauro Monforte
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valeria De Arcangelis
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enzo Ricci
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Enrica Mongini
- Department of Neuroscience, Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Giorgio Tasca
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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8
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Vuillerot C. State of the art for motor function assessment tools in spinal muscular atrophy (SMA). Arch Pediatr 2021; 27:7S40-7S44. [PMID: 33357597 DOI: 10.1016/s0929-693x(20)30276-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Spinal muscular atrophy (SMA) is a progressive disease characterized by a degeneration of the spinal cord motor neurons. Many clinical trials - planned, in progress, or completed - have chosen motor function as the primary or secondary outcome because motor function assessment tools appeared to be more reliable than quantitative muscle testing in monitoring the course of the disease. Reliable, valid, and responsive outcome measures are needed to be able to capture the effectiveness of the therapeutic approach during clinical trials. Medical staff involved in neuromuscular diseases is faced with increasing pressure regarding the complex issue of choosing the right outcome measure for the objectives they have to assess. This paper provides a narrative literature review of available and validated motor function assessment tools in SMA population based on SMA subtypes, age and ambulant status. © 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- C Vuillerot
- Service de Médecine Physique et Réadaptation Pédiatrique L'Escale, CHU Lyon, Université de Lyon, France; INMG, Inserm U1217, CNRS UMR5310, Université Lyon 1, Université de Lyon, Lyon, France.
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9
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Bartels B, de Groot JF, Habets LE, Wadman RI, Asselman FL, Nieuwenhuis EES, van Eijk RPA, Goedee HS, van der Pol WL. Correlates of Fatigability in Patients With Spinal Muscular Atrophy. Neurology 2020; 96:e845-e852. [PMID: 33219141 DOI: 10.1212/wnl.0000000000011230] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/02/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the associations between fatigability and muscle strength, motor function, neuromuscular junction (NMJ) function, and perceived fatigue in spinal muscular atrophy (SMA), we assessed 61 patients with SMA. METHODS Fatigability was defined as the inability to continue a 20-minute submaximal repetitive task of either walking or proximal or distal arm function and expressed as drop-out on the Endurance Shuttle Test Combined Score (ESTCS). We assessed muscle strength with the Medical Research Council (MRC) sum score, motor function with the Hammersmith Functional Motor Scale Expanded (HFMSE) and Motor Function Measure (MFM), NMJ function with repetitive nerve stimulation of the accessory and ulnar nerve, and perceived fatigue with the PROMIS Fatigue Short Form questionnaire in 61 children and adults with SMA types 2-4. We applied Cox regression analysis to explore the associations between fatigability and these factors. RESULTS The hazard of drop-out on the ESTCS decreased 0.8%, 2%, and 1.3% for each point increase in the MRC sum score, the HFMSE score, and the MFM percentual score, respectively. However, we observed prominent fatigability with preserved muscle function and vice versa in 13%-16% of patients. We did not find an association between NMJ dysfunction of the accessory (p = 0.37) and ulnar nerve (p = 0.063) and fatigability, which could be due to a large number of missing values. Perceived fatigue in SMA was comparable to reference values and was not associated with fatigability (p = 0.52). CONCLUSION Fatigability in SMA is associated with, yet not equivalent to, muscle strength and motor function.
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Affiliation(s)
- Bart Bartels
- From the Child Development and Exercise Center (B.B., L.E.H.) and Department of Pediatric Gastroenterology (E.E.S.N.), Wilhelmina Children's Hospital, and UMC Utrecht Brain Center (R.I.W., F.-L.A., R.P.A.v.E., H.S.G., W.L.v.d.P.), University Medical Center Utrecht; Knowledge Institute for Medical Specialists (J.F.d.G.), University of Applied Sciences; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands.
| | - Janke F de Groot
- From the Child Development and Exercise Center (B.B., L.E.H.) and Department of Pediatric Gastroenterology (E.E.S.N.), Wilhelmina Children's Hospital, and UMC Utrecht Brain Center (R.I.W., F.-L.A., R.P.A.v.E., H.S.G., W.L.v.d.P.), University Medical Center Utrecht; Knowledge Institute for Medical Specialists (J.F.d.G.), University of Applied Sciences; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - Laura E Habets
- From the Child Development and Exercise Center (B.B., L.E.H.) and Department of Pediatric Gastroenterology (E.E.S.N.), Wilhelmina Children's Hospital, and UMC Utrecht Brain Center (R.I.W., F.-L.A., R.P.A.v.E., H.S.G., W.L.v.d.P.), University Medical Center Utrecht; Knowledge Institute for Medical Specialists (J.F.d.G.), University of Applied Sciences; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - Renske I Wadman
- From the Child Development and Exercise Center (B.B., L.E.H.) and Department of Pediatric Gastroenterology (E.E.S.N.), Wilhelmina Children's Hospital, and UMC Utrecht Brain Center (R.I.W., F.-L.A., R.P.A.v.E., H.S.G., W.L.v.d.P.), University Medical Center Utrecht; Knowledge Institute for Medical Specialists (J.F.d.G.), University of Applied Sciences; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - Fay-Lynn Asselman
- From the Child Development and Exercise Center (B.B., L.E.H.) and Department of Pediatric Gastroenterology (E.E.S.N.), Wilhelmina Children's Hospital, and UMC Utrecht Brain Center (R.I.W., F.-L.A., R.P.A.v.E., H.S.G., W.L.v.d.P.), University Medical Center Utrecht; Knowledge Institute for Medical Specialists (J.F.d.G.), University of Applied Sciences; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - Edward E S Nieuwenhuis
- From the Child Development and Exercise Center (B.B., L.E.H.) and Department of Pediatric Gastroenterology (E.E.S.N.), Wilhelmina Children's Hospital, and UMC Utrecht Brain Center (R.I.W., F.-L.A., R.P.A.v.E., H.S.G., W.L.v.d.P.), University Medical Center Utrecht; Knowledge Institute for Medical Specialists (J.F.d.G.), University of Applied Sciences; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - Ruben P A van Eijk
- From the Child Development and Exercise Center (B.B., L.E.H.) and Department of Pediatric Gastroenterology (E.E.S.N.), Wilhelmina Children's Hospital, and UMC Utrecht Brain Center (R.I.W., F.-L.A., R.P.A.v.E., H.S.G., W.L.v.d.P.), University Medical Center Utrecht; Knowledge Institute for Medical Specialists (J.F.d.G.), University of Applied Sciences; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - H Stephan Goedee
- From the Child Development and Exercise Center (B.B., L.E.H.) and Department of Pediatric Gastroenterology (E.E.S.N.), Wilhelmina Children's Hospital, and UMC Utrecht Brain Center (R.I.W., F.-L.A., R.P.A.v.E., H.S.G., W.L.v.d.P.), University Medical Center Utrecht; Knowledge Institute for Medical Specialists (J.F.d.G.), University of Applied Sciences; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - W Ludo van der Pol
- From the Child Development and Exercise Center (B.B., L.E.H.) and Department of Pediatric Gastroenterology (E.E.S.N.), Wilhelmina Children's Hospital, and UMC Utrecht Brain Center (R.I.W., F.-L.A., R.P.A.v.E., H.S.G., W.L.v.d.P.), University Medical Center Utrecht; Knowledge Institute for Medical Specialists (J.F.d.G.), University of Applied Sciences; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
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10
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Bartels B, de Groot JF, Habets LE, Wijngaarde CA, Vink W, Stam M, Asselman FL, van Eijk RPA, van der Pol WL. Fatigability in spinal muscular atrophy: validity and reliability of endurance shuttle tests. Orphanet J Rare Dis 2020; 15:75. [PMID: 32293503 PMCID: PMC7092552 DOI: 10.1186/s13023-020-1348-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/03/2020] [Indexed: 12/27/2022] Open
Abstract
Background To determine construct validity and test-retest reliability of Endurance Shuttle Tests as outcome measures for fatigability of remaining motor functions in children and adults with Spinal Muscular Atrophy (SMA) across the severity spectrum. Results We assessed the Endurance Shuttle - Nine Hole Peg Test (ESNHPT), − Box and Block Test (ESBBT) and – Walk Test (ESWT) in 61 patients with SMA types 2–4, 25 healthy controls (HC) and 15 disease controls (DC). Convergent validity, discriminative validity and test-retest reliability were investigated. Additionally, we compiled the Endurance Shuttle Combined Score (ESTCS) by selecting the most relevant endurance test of each individual. 54, 70 and 73% of patients with SMA demonstrated increased fatigability on the ESNHPT, ESBBT and the ESWT. Endurance response in SMA was characterized by a decrease in muscle strength, an increase in muscle fatigue and an increase in motor adaptions, thereby confirming convergent validity. Patients with SMA showed increased drop-out rates and a shorter endurance time compared to HC and DC demonstrating good discriminative validity. Test-retest reliability was moderate to excellent (ICC’s ranging from .78 to .91) with a trend towards better performance on retest. The ESTCS increased sample size and drop-out rate up to 100 and 85%. Conclusions Fatigability is an important additional dimension of physical impairments across the severity spectrum in children and adults with SMA. The EST’s are reliable and valid to document fatigability of walking, proximal- and distal arm function in SMA and thus are promising outcome measures for use in clinical trials.
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Affiliation(s)
- Bart Bartels
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Child Development and Exercise Center, Lundlaan 6, Internal mailbox no. KB 02.056.0, Utrecht, 3508, AB, The Netherlands.
| | - Janke F de Groot
- Research Group Lifestyle and Health, HU University of Applied Health Sciences Utrecht, Utrecht, The Netherlands
| | - Laura E Habets
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Child Development and Exercise Center, Lundlaan 6, Internal mailbox no. KB 02.056.0, Utrecht, 3508, AB, The Netherlands
| | - Camiel A Wijngaarde
- University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - Wendy Vink
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
| | - Marloes Stam
- University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - Fay-Lynn Asselman
- University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - Ruben P A van Eijk
- University Medical Center Utrecht, Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands and University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - W Ludo van der Pol
- University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht, The Netherlands
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11
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Kennedy RA, Carroll K, McGinley JL, Paterson KL. Walking and weakness in children: a narrative review of gait and functional ambulation in paediatric neuromuscular disease. J Foot Ankle Res 2020; 13:10. [PMID: 32122377 PMCID: PMC7052968 DOI: 10.1186/s13047-020-0378-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/18/2020] [Indexed: 12/18/2022] Open
Abstract
Background Weakness is the primary impairment in paediatric neuromuscular diseases, impacting gait and gait-related functional activities in ambulant children affected by these rare and often degenerative diseases. Gait speed is an indicator of health and disability, yet gait is a complex, multi-faceted activity. Using the International Classification of Function, Health and Disability (ICF) model, assessment of gait and functional ambulation should consider the impairments, activity limitations and participation restrictions due to disease, and factors related to the environment and the individual person. Methods This narrative review involved a literature search of databases including Medline, Embase and Pubmed from 1946 to October 2019. Inclusion criteria included assessments of gait, endurance and ambulatory function in paediatric (0–18 years) neuromuscular diseases. Results Fifty-two papers were identified reporting assessments of gait speed, timed function, endurance and ambulatory capacity, gait-related balance and qualitative descriptive assessments of gait function and effect of disease on gait and gait-related activities. Gait speed is an indicator of disability and children with neuromuscular disease walk slower than typically developing peers. Increasing disease severity and age were associated with slower walking in children with Duchenne muscular dystrophy and Charcot-Marie-Tooth disease. The six-minute walk test is used widely as a test of endurance and ambulatory capacity; six-minute walk distance was substantially reduced across all paediatric neuromuscular diseases. Endurance and ambulatory capacity was more limited in children with spinal muscular atrophy type 3, congenital muscular dystrophy and older boys with Duchenne muscular dystrophy. Only a few papers considered normalisation of gait parameters accounting for the effect on gait of height in heterogeneous groups of children and linear growth in longitudinal studies. Balance related to gait was considered in five papers, mainly in children with Charcot-Marie-Tooth disease. There was limited investigation of factors including distance requirements and terrain in children’s typical environments and personal factors related to self-perception of disease effect on gait and gait-related function. Conclusion Assessments of gait and functional ambulation are important considerations in documenting disease progression and treatment efficacy in the clinical setting; and in clinical trials of disease-modifying agents and physiotherapeutic interventions in paediatric neuromuscular diseases. There is a need for expert consensus on core gait and functional ambulation assessments for use in clinical and research settings.
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Affiliation(s)
- Rachel A Kennedy
- Department of Neurology, The Royal Children's Hospital, Parkville, Vic, Australia. .,Murdoch Children's Research Institute, Parkville, Vic, Australia. .,Department of Physiotherapy, The University of Melbourne, Parkville, Vic, Australia.
| | - Kate Carroll
- Department of Neurology, The Royal Children's Hospital, Parkville, Vic, Australia.,Murdoch Children's Research Institute, Parkville, Vic, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Vic, Australia
| | - Jennifer L McGinley
- Murdoch Children's Research Institute, Parkville, Vic, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Vic, Australia
| | - Kade L Paterson
- Department of Physiotherapy, The University of Melbourne, Parkville, Vic, Australia
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12
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Dunaway Young S, Montes J, Kramer SS, Podwika B, Rao AK, De Vivo DC. Perceived Fatigue in Spinal Muscular Atrophy: A Pilot Study. J Neuromuscul Dis 2020; 6:109-117. [PMID: 30562906 DOI: 10.3233/jnd-180342] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fatigue is a common complaint in spinal muscular atrophy (SMA). Fatigability is well described in ambulatory SMA but the relationship to perceived fatigue has not been evaluated. Understanding this relationship has proven challenging for most disorders. OBJECTIVE To assess the relationship of perceived fatigue to fatigability, function, and quality of life in SMA. METHODS Thirty-two participants with SMA (21.9% type 2, 78.1% type 3) were recruited. Perceived fatigue and fatigability, function, and quality of life were assessed using standardized questionnaires and assessments. Associations were analyzed using Pearson correlation coefficients (p = 0.05). Also, the effects of age, type, and ambulatory status were determined on perceived fatigue. RESULTS All SMA participants reported fatigue. Perceived fatigue was not associated with function, quality of life, or fatigability in ambulatory SMA patients. Neither age, type, nor ambulatory status influenced perceived fatigue. CONCLUSIONS Perceived fatigue can be quantified in SMA. Interestingly, perceived fatigue did not correlate with fatigability or function, suggesting that cognitive, homeostatic, or psychologic factors may be more relevant as co-morbid factors. Clinical trials targeting perceived fatigue in SMA should focus on these patient-reported assessments. A multilevel approach is required to separate the various mechanisms involved in perceived fatigue.
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Affiliation(s)
- Sally Dunaway Young
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.,Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA
| | - Jacqueline Montes
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.,Department of Rehabilitation & Regenerative Medicine, Program in Physical Therapy, Columbia University, New York, NY
| | - Samantha S Kramer
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Bernadette Podwika
- Department of Rehabilitation & Regenerative Medicine, Program in Physical Therapy, Columbia University, New York, NY
| | - Ashwini K Rao
- Department of Rehabilitation & Regenerative Medicine, Program in Physical Therapy, Columbia University, New York, NY
| | - Darryl C De Vivo
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
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13
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Griffon P, Vie B, Weber JP, Jammes Y. Effect of 4 Weeks of Foot Orthosis Intervention on Ambulatory Capacities and Posture in Normal-Weight and Obese Patients. J Am Podiatr Med Assoc 2020; 110:Article2. [PMID: 32073326 DOI: 10.7547/16-161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Several works have shown the benefits of foot orthosis intervention on postural stability in healthy individuals and patients with foot malalignment. However, the effects of foot orthoses on the daily ambulatory activities explored by the Six-Minute Walk Test (6MWT) were never examined. We hypothesized that foot orthoses could increase the gait distance and attenuate the post-6MWT posture alterations already reported in healthy individuals. METHODS In ten normal-weight (NW) and ten obese patients with foot malalignment and/or abnormal foot arch, we examined the benefits of 4 weeks of custom-molded orthosis intervention (D30) on 6MWT gait distance, fatigue sensation scores, ankle plantarflexion force, and post-6MWT sway of the center of pressure (COP) measured by a pedobarographic platform. Data were compared with those measured in two control-matched groups of ten NW and ten obese individuals, explored at study inclusion and at D30. RESULTS At study inclusion, the post-6MWT changes in COP surface and the medial and lateral COP deviations were significantly higher in obese participants who needed to wear the foot orthoses compared with obese control subjects. The foot orthosis intervention significantly improved the ambulatory performances of NW and obese individuals during the 6MWT, attenuated the bodily fatigue sensation after the 6MWT, and reduced the post-6MWT COP deviations, with the benefits of insoles being significantly accentuated in obese participants. CONCLUSIONS Four weeks of foot orthosis intervention significantly increases gait distance and is an effective means to reduce postural sway after walking.
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Affiliation(s)
| | - Bruno Vie
- School of Podiatry, Marseille, France
| | | | - Yves Jammes
- Faculty of Medicine, Aix-Marseille University, Marseille, France
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14
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Exercise Combined with Electrotherapy Enhances Motor Function in an Adolescent with Spinal Muscular Atrophy Type III. Case Rep Neurol Med 2019; 2019:4839793. [PMID: 31428487 PMCID: PMC6679856 DOI: 10.1155/2019/4839793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/08/2019] [Accepted: 07/09/2019] [Indexed: 11/30/2022] Open
Abstract
Background Electrotherapy is widely used in physical therapy to increase muscle mass, improve motor function, and assist physical activity in several neurologic conditions. However, concerning Spinal Muscular Atrophy (SMA), limited evidence exists on the role of electrotherapy as an adjunct for improving muscle strength and function. Case Report An adolescent (13 y.o.) with SMA type III underwent an 18-week strengthening program divided into two stages. During Phase I (weeks: 1-8), a home-based program for quadriceps strengthening through neuromuscular electrical stimulation (NMES) was provided. In Phase II (weeks: 9-18), at-home NMES was combined with functional electrical stimulation (FES) assisting volitional cycling for a broader, systemic conditioning. The treatment improved patient's structural and functional motor outcomes (quadriceps circumference and strength, Tinetti scale, and Hammersmith scale) as well as independence in stair climbing. Clinical Rehabilitation Impact The purpose of this report is to raise awareness of the potential role of electrotherapy to help improving motor performance in SMA patients and, secondly, to foster further research aimed at assessing the actual contribution this intervention may have as an add-on therapy to existing care.
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15
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Montes J, Dunaway Young S, Mazzone ES, Pasternak A, Glanzman AM, Finkel RS, Darras BT, Muntoni F, Mercuri E, De Vivo DC, Bishop KM, Schneider E, Bennett CF, Foster R, Farwell W. Nusinersen improves walking distance and reduces fatigue in later-onset spinal muscular atrophy. Muscle Nerve 2019; 60:409-414. [PMID: 31298747 PMCID: PMC6771553 DOI: 10.1002/mus.26633] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 12/25/2022]
Abstract
Introduction Ambulatory individuals with spinal muscular atrophy (SMA) experience muscle weakness, gait impairments, and fatigue that affect their walking ability. Improvements have been observed in motor function in children treated with nusinersen, but its impact on fatigue has not been studied. Methods Post hoc analyses were used to examine changes in 6‐minute walk test (6MWT) distance and fatigue in children and adolescents with SMA type II and III who received their first dose of nusinersen in the phase Ib/IIa, open‐label CS2 study and were ambulatory during CS2 or the extension study, CS12. Results Fourteen children performed the 6MWT. Median (25th, 75th percentile) distance walked increased over time by 98.0 (62.0, 135.0) meters at day 1050, whereas median fatigue changed by −3.8% (−19.7%, 1.4%). Discussion These results support previous studies demonstrating clinically meaningful effects of nusinersen on motor function in children and adolescents with later‐onset SMA.
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Affiliation(s)
- Jacqueline Montes
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, New York.,Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Sally Dunaway Young
- Department of Neurology, Stanford University School of Medicine, Palo Alto, California
| | - Elena S Mazzone
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Amy Pasternak
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Allan M Glanzman
- Department of Physical Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Richard S Finkel
- Division of Neurology, Department of Pediatrics, Nemours Children's Hospital, Orlando, Florida
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health and NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Eugenio Mercuri
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Darryl C De Vivo
- Department of Neurology, Columbia University Irving Medical Center, New York, New York.,Department Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Kathie M Bishop
- Clinical Development and Antisense Research, Ionis Pharmaceuticals, Inc, Carlsbad, California
| | - Eugene Schneider
- Clinical Development and Antisense Research, Ionis Pharmaceuticals, Inc, Carlsbad, California
| | - C Frank Bennett
- Clinical Development and Antisense Research, Ionis Pharmaceuticals, Inc, Carlsbad, California
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16
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Swanson CW, Haigh ZJ, Fling BW. Two-minute walk tests demonstrate similar age-related gait differences as a six-minute walk test. Gait Posture 2019; 69:36-39. [PMID: 30660949 DOI: 10.1016/j.gaitpost.2019.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/10/2019] [Accepted: 01/12/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The six-minute walk test (6MWT) is used within clinical and research settings to assess gait performance across a variety of conditions and populations. Commonly, the test is used to identify specific aspects of gait that affect functional mobility. With the advancement of new technologies such as wireless inertial sensors, it has become possible to collect reliable, sensitive, and objective measures of gait. While the 6MWT has been accepted and used for many years, a more concise, while still objective gait analysis would likely benefit clinicians, researchers and patients. RESEARCH QUESTION Does a concise 2-minute walk test (2MWT) provide similar information regarding gait performance and gait differences as the 6MWT in healthy young (YA) and older adults (OA)? METHODS A total of thirty-one participants (sixteen young adults and fifteen older adults) conducted a continuous 6MWT at their self-selected pace. All participants wore six wireless inertial sensors which were placed on each foot, at the lumbar, sternum, and on each wrist. Once completed the 6MWT data was spliced into three, distinct two-minute segments. Spliced data was analyzed and compared between groups and segments. RESULTS Results demonstrate significant age-related differences in several gait metrics, primarily with older adults showing increased spatiotemporal variability. Additionally, no significant differences were observed between the three, two-minute segments and the continuous 6MWT, with the exception of total number of strides completed. SIGNIFICANCE These results demonstrate that the 2MWT may provide a preferable alternative to assessing gait performance by reducing confounds such as fatigue while maintaining sensitivity of measuring gait performance. These improvements may be particularly beneficial when studying populations of advanced age or with neurological disorder.
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Affiliation(s)
- Clayton W Swanson
- Department of Health & Exercise Science, Colorado State University, CO, USA
| | - Zachary J Haigh
- School of Biomedical Engineering, Colorado State University, USA
| | - Brett W Fling
- Department of Health & Exercise Science, Colorado State University, CO, USA; Molecular, Cellular, and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO, USA.
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17
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Bartels B, Habets LE, Stam M, Wadman RI, Wijngaarde CA, Schoenmakers MAGC, Takken T, Hulzebos EH, van der Pol WL, de Groot JF. Assessment of fatigability in patients with spinal muscular atrophy: development and content validity of a set of endurance tests. BMC Neurol 2019; 19:21. [PMID: 30738436 PMCID: PMC6368708 DOI: 10.1186/s12883-019-1244-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/29/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Fatigability has emerged as an important dimension of physical impairment in patients with Spinal Muscular Atrophy (SMA). At present reliable and valid outcome measures for both mildly and severely affected patients are lacking. Therefore the primary aim of this study is the development of clinical outcome measures for fatigability in patients with SMA across the range of severity. METHODS We developed a set of endurance tests using five methodological steps as recommended by the 'COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). In this iterative process, data from multiple sources were triangulated including a scoping review of scientific literature, input from a scientific and clinical multidisciplinary expert panel and three pilot studies including healthy persons (N = 9), paediatric patients with chronic disorders (N = 10) and patients with SMA (N = 15). RESULTS Fatigability in SMA was operationalised as the decline in physical performance. The following test criteria were established; one method of testing for patients with SMA type 2-4, a set of outcome measures that mimic daily life activities, a submaximal test protocol of repetitive activities over a longer period; external regulation of pace. The scoping review did not generate suitable outcome measures. We therefore adapted the Endurance Shuttle Walk Test for ambulatory patients and developed the Endurance Shuttle Box and Block Test and the - Nine Hole Peg Test for fatigability testing of proximal and distal arm function. Content validity was established through input from experts and patients. Pilot testing showed that the set of endurance tests are comprehensible, feasible and meet all predefined test criteria. CONCLUSIONS The development of this comprehensive set of endurance tests is a pivotal step to address fatigability in patients with SMA.
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Affiliation(s)
- Bart Bartels
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, KB 02.056.0, 3508 AB Utrecht, The Netherlands
| | - Laura E. Habets
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, KB 02.056.0, 3508 AB Utrecht, The Netherlands
| | - Marloes Stam
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Renske I. Wadman
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Camiel A. Wijngaarde
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marja A. G. C. Schoenmakers
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, KB 02.056.0, 3508 AB Utrecht, The Netherlands
| | - Tim Takken
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, KB 02.056.0, 3508 AB Utrecht, The Netherlands
| | - Erik H.J. Hulzebos
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, KB 02.056.0, 3508 AB Utrecht, The Netherlands
| | - W. Ludo van der Pol
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Janke F. de Groot
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, KB 02.056.0, 3508 AB Utrecht, The Netherlands
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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18
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McKay MJ, Baldwin JN, Ferreira P, Simic M, Vanicek N, Wojciechowski E, Mudge A, Burns J. Spatiotemporal and plantar pressure patterns of 1000 healthy individuals aged 3-101 years. Gait Posture 2017; 58:78-87. [PMID: 28763713 DOI: 10.1016/j.gaitpost.2017.07.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/07/2017] [Accepted: 07/03/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to establish normative reference values for spatiotemporal and plantar pressure parameters, and to investigate the influence of demographic, anthropometric and physical characteristics. METHODS In 1000 healthy males and females aged 3-101 years, spatiotemporal and plantar pressure data were collected barefoot with the Zeno™ walkway and Emed® platform. Correlograms were developed to visualise the relationships between widely reported spatiotemporal and pressure variables with demographic (age, gender), anthropometric (height, mass, waist circumference) and physical characteristics (ankle strength, ankle range of motion, vibration perception) in children aged 3-9 years, adolescents aged 10-19 years, adults aged 20-59 years and older adults aged over 60 years. RESULTS A comprehensive catalogue of 31 spatiotemporal and pressure variables were generated from 1000 healthy individuals. The key findings were that gait velocity was stable during adolescence and adulthood, while children and older adults walked at a comparable slower speed. Peak pressures increased during childhood to older adulthood. Children demonstrated highest peak pressures beneath the rearfoot whilst adolescents, adults and older adults demonstrated highest pressures at the forefoot. Main factors influencing spatiotemporal and pressure parameters were: increased age, height, body mass and waist circumference, as well as ankle dorsiflexion and plantarflexion strength. CONCLUSION This study has established whole of life normative reference values of widely used spatiotemporal and plantar pressure parameters, and revealed changes to be expected across the lifespan.
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Affiliation(s)
- Marnee J McKay
- The University of Sydney, Musculoskeletal Health, Faculty of Health Sciences, Sydney, New South Wales, Australia.
| | - Jennifer N Baldwin
- The University of Sydney, Musculoskeletal Health, Faculty of Health Sciences, Sydney, New South Wales, Australia.
| | - Paulo Ferreira
- The University of Sydney, Musculoskeletal Health, Faculty of Health Sciences, Sydney, New South Wales, Australia.
| | - Milena Simic
- The University of Sydney, Musculoskeletal Health, Faculty of Health Sciences, Sydney, New South Wales, Australia.
| | - Natalie Vanicek
- Department of Sport, Health and Exercise Science, School of Life Sciences, University of Hull, United Kingdom.
| | - Elizabeth Wojciechowski
- Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), New South Wales, Australia.
| | - Anita Mudge
- Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), New South Wales, Australia.
| | - Joshua Burns
- The University of Sydney, Musculoskeletal Health, Faculty of Health Sciences, Sydney, New South Wales, Australia; Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), New South Wales, Australia.
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19
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Pera MC, Luigetti M, Pane M, Coratti G, Forcina N, Fanelli L, Mazzone ES, Antonaci L, Lapenta L, Palermo C, Ranalli D, Granata G, Lomonaco M, Servidei S, Mercuri E. 6MWT can identify type 3 SMA patients with neuromuscular junction dysfunction. Neuromuscul Disord 2017; 27:879-882. [DOI: 10.1016/j.nmd.2017.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/07/2017] [Accepted: 07/12/2017] [Indexed: 01/15/2023]
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20
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Montes J, Zanotto D, Dunaway Young S, Salazar R, De Vivo DC, Agrawal S. Gait assessment with solesound instrumented footwear in spinal muscular atrophy. Muscle Nerve 2017; 56:230-236. [DOI: 10.1002/mus.25484] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/13/2016] [Accepted: 11/16/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Jacqueline Montes
- SMA Clinical Research Center; Department of Neurology, Columbia University Medical Center; 180 Fort Washington Avenue, 5th Floor New York New York 10032 USA
- Department of Rehabilitation and Regenerative Medicine; Columbia University; New York New York USA
| | - Damiano Zanotto
- Department of Mechanical Engineering; Columbia University; New York New York USA
| | - Sally Dunaway Young
- SMA Clinical Research Center; Department of Neurology, Columbia University Medical Center; 180 Fort Washington Avenue, 5th Floor New York New York 10032 USA
- Department of Rehabilitation and Regenerative Medicine; Columbia University; New York New York USA
| | - Rachel Salazar
- SMA Clinical Research Center; Department of Neurology, Columbia University Medical Center; 180 Fort Washington Avenue, 5th Floor New York New York 10032 USA
| | - Darryl C. De Vivo
- SMA Clinical Research Center; Department of Neurology, Columbia University Medical Center; 180 Fort Washington Avenue, 5th Floor New York New York 10032 USA
| | - Sunil Agrawal
- Department of Rehabilitation and Regenerative Medicine; Columbia University; New York New York USA
- Department of Mechanical Engineering; Columbia University; New York New York USA
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Blumenschine M, Montes J, Rao AK, Engelstad K, De Vivo DC. Analysis of Gait Disturbance in Glut 1 Deficiency Syndrome. J Child Neurol 2016; 31:1483-1488. [PMID: 27511993 DOI: 10.1177/0883073816661662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/05/2016] [Indexed: 01/16/2023]
Abstract
Anticipating potential therapies for Glut 1 deficiency syndrome (Glut1DS) emphasizes the need for effective clinical outcome measures. The 6-minute walk test is a well-established outcome measure that evaluates walking ability in neurological diseases. Twenty-one children with Glut 1 deficiency syndrome and 21 controls performed the 6-minute walk test. Fatigue was determined by comparing distance walked in the first and sixth minutes. Gait was analyzed by stride length, velocity, cadence, base of support, and percentage time in double support. Independent sample t-tests examined differences between group. Repeated-measures analysis of variance evaluated gait parameters over time. Glut 1 deficiency syndrome patients walked less (P < .05), had slower velocities (P < .0001), had shorter stride lengths (P < .0001), spent more time in double support (P < .001), and had increasing variability in base of support (P = .009). Glut 1 deficiency syndrome patients have impaired motor performance, walk more slowly, and have poor balance. The 6-minute walk test with gait analysis may serve as a useful outcome measure in clinical trials in Glut 1 deficiency syndrome.
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Affiliation(s)
| | - Jacqueline Montes
- Department of Neurology, Columbia University Medical Center, New York, NY, USA Department of Rehabilitation Medicine, Columbia University Medical Center, New York, NY, USA
| | - Ashwini K Rao
- Department of Rehabilitation Medicine, Columbia University Medical Center, New York, NY, USA
| | - Kristin Engelstad
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Darryl C De Vivo
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
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Vie B, Griffon P, Bijoux A, Cadiere J, Weber JP, Jammes Y. Effect of the 6-minute walk test on plantar loading and capability to produce ankle plantar flexion forces. Gait Posture 2016; 49:61-66. [PMID: 27371784 DOI: 10.1016/j.gaitpost.2016.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 02/16/2016] [Accepted: 03/24/2016] [Indexed: 02/02/2023]
Abstract
The six-minute walk test (6MWT) is used to evaluate the ambulatory capacity of patients suffering from respiratory disorders, obesity or neuromuscular diseases. Our primary aim was to evaluate the effects of the 6MWT on the postural sway and the ankle plantar flexion forces in healthy subjects. We measured the ankle plantar flexion forces and the plantar contact area before and after a 6MWT in normal weight and overweight subjects with no history of respiratory, cardiac, and neuromuscular disorders. A post-6MWT sensation of bodily fatigue was evaluated by Multidimensional Fatigue Inventory (MFI) and Pichot fatigue scales. A computerized pedobarographic platform was used to collect the mean plantar contact area, the changes of the center of pressure (CoP) surface and its medial and lateral deviations. In a limited number of subjects, the reproducibility of all the measurements was explored. In both groups, the 6MWT elicited a sensation of bodily fatigue. It also significantly reduced the ankle plantar flexion forces, and increased both the mean plantar contact area and the CoP surface, the changes being not apparent after 10min. The post-6MWT lateral CoP deviations were accentuated in normal weight subjects, while an increase in medial CoP deviations occurred in overweight ones. The 6MWT-induced changes in the plantar flexion force and pedobarographic variables were reproducible. Because this study clearly showed some post-6MWT alterations of the subjects' posture sway of our subjects, we questioned the possible mechanisms occurring that could explain the altered muscle force and the transient destabilization of posture after the 6MWT.
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Affiliation(s)
- Bruno Vie
- School of Podiatry, Marseille, France
| | | | | | | | | | - Yves Jammes
- MD DS-ACI UMR MD2, Aix-Marseille University, Marseille, France.
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Dunaway Young S, Montes J, Kramer SS, Marra J, Salazar R, Cruz R, Chiriboga CA, Garber CE, De Vivo DC. Six-minute walk test is reliable and valid in spinal muscular atrophy. Muscle Nerve 2016; 54:836-842. [PMID: 27015431 DOI: 10.1002/mus.25120] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The Six-Minute Walk Test (6MWT) was adopted as a clinical outcome measure for ambulatory spinal muscular atrophy (SMA). However, a systematic review of measurement properties reported significant variation among chronic pediatric conditions. Our purpose was to assess the reliability/validity of the 6MWT in SMA. METHODS Thirty participants performed assessments, including the 6MWT, strength, and function. Reproducibility was evaluated by intraclass correlation coefficients. Criterion/convergent validity were determined using Pearson correlation coefficients. RESULTS Test-retest reliability was excellent. The 6MWT was associated positively with peak oxygen uptake, Hammersmith Functional Motor Scale Expanded (HFMSE), lower extremity manual muscle testing, knee flexion hand-held dynamometry, and inversely with 10-m walk/run. The 6MWT discriminates between disease severity, unlike the HFMSE. CONCLUSIONS This study documents measurement properties of reproducibility, positive criterion validity, and convergent validity with established clinical assessments and reaffirms the value of the 6MWT as a pivotal outcome measure in SMA clinical trials. Muscle Nerve 54: 836-842, 2016.
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Affiliation(s)
- Sally Dunaway Young
- Department of Neurology, Columbia University Medical Center, New York, New York, USA. .,Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, New York, USA.
| | - Jacqueline Montes
- Department of Neurology, Columbia University Medical Center, New York, New York, USA.,Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, New York, USA
| | - Samantha S Kramer
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Jonathan Marra
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - Rachel Salazar
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - Rosangel Cruz
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - Claudia A Chiriboga
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - Carol Ewing Garber
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Darryl C De Vivo
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
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Montes J, Glanzman AM, Mazzone ES, Martens WB, Dunaway S, Pasternak A, Riley SO, Quigley J, Pandya S, De Vivo DC, Kaufmann P, Chiriboga CA, Finkel RS, Tennekoon GI, Darras BT, Pane M, Mercuri E, Mcdermott MP. Spinal muscular atrophy functional composite score: A functional measure in spinal muscular atrophy. Muscle Nerve 2015; 52:942-7. [PMID: 25846132 DOI: 10.1002/mus.24670] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/06/2015] [Accepted: 03/25/2015] [Indexed: 01/30/2023]
Abstract
INTRODUCTION With clinical trials underway, our objective was to construct a composite score of global function that could discriminate among people with spinal muscular atrophy (SMA). METHODS Data were collected from 126 participants with SMA types 2 and 3. Scores from the Hammersmith Functional Motor Scale-Expanded and Upper Limb Module were expressed as a percentage of the maximum score and 6-minute walk test as percent of predicted normal distance. A principal component analysis was performed on the correlation matrix for the 3 percentage scores. RESULTS The first principal component yielded a composite score with approximately equal weighting of the 3 components and accounted for 82% of the total variability. The SMA functional composite score, an unweighted average of the 3 individual percentage scores, correlated almost perfectly with the first principal component. CONCLUSIONS This combination of measures broadens the spectrum of ability that can be quantified in type 2 and 3 SMA patients.
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Affiliation(s)
- Jacqueline Montes
- Department of Neurology, Columbia University Medical Center, 180 Ft. Washington Avenue, Fifth Floor, New York, New York, 10032, USA.,Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, New York, USA
| | - Allan M Glanzman
- Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elena S Mazzone
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - William B Martens
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Sally Dunaway
- Department of Neurology, Columbia University Medical Center, 180 Ft. Washington Avenue, Fifth Floor, New York, New York, 10032, USA
| | - Amy Pasternak
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan O Riley
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Janet Quigley
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shree Pandya
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Darryl C De Vivo
- Department of Neurology, Columbia University Medical Center, 180 Ft. Washington Avenue, Fifth Floor, New York, New York, 10032, USA
| | - Petra Kaufmann
- Department of Neurology, Columbia University Medical Center, 180 Ft. Washington Avenue, Fifth Floor, New York, New York, 10032, USA
| | - Claudia A Chiriboga
- Department of Neurology, Columbia University Medical Center, 180 Ft. Washington Avenue, Fifth Floor, New York, New York, 10032, USA
| | - Richard S Finkel
- Division of Neurology, Nemours Children's Hospital, Orlando, Florida, USA
| | - Gihan I Tennekoon
- Division of Neurology, Children's Hospital of Philadelphia and Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marika Pane
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Eugenio Mercuri
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Michael P Mcdermott
- Department of Neurology, University of Rochester, Rochester, New York, USA.,Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
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Abstract
Spinal muscular atrophies (SMAs) are hereditary degenerative disorders of lower motor neurons associated with progressive muscle weakness and atrophy. Proximal 5q SMA is caused by decreased levels of the survival of motor neuron (SMN) protein and is the most common genetic cause of infant mortality. Its inheritance pattern is autosomal recessive, resulting from mutations involving the SMN1 gene on chromosome 5q13. Unlike other autosomal recessive diseases, the SMN gene has a unique structure (an inverted duplication) that presents potential therapeutic targets. Although there is currently no effective treatment of SMA, the field of translational research in this disorder is active and clinical trials are ongoing. Advances in the multidisciplinary supportive care of children with SMA also offer hope for improved life expectancy and quality of life.
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Affiliation(s)
- Basil T Darras
- Division of Clinical Neurology, Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Fegan 11, Boston, MA 02115, USA.
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Dunaway S, Montes J, Garber CE, Carr B, Kramer SS, Kamil-Rosenberg S, Strauss N, Sproule D, De Vivo DC. Performance of the timed "up & go" test in spinal muscular atrophy. Muscle Nerve 2014; 50:273-7. [PMID: 24375426 DOI: 10.1002/mus.24153] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/16/2013] [Accepted: 12/20/2013] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The timed "up & go" (TUG) test is a quick measure of balance and mobility. TUG scores correlate with clinical, functional, and strength assessment and decline linearly over time. Reliability and validity have not been tested in spinal muscular atrophy (SMA). METHODS Fifteen ambulatory SMA participants performed TUG testing and strength, functional, and clinical assessments. Intraclass correlation coefficients quantified test-retest reliability. Convergent validity was determined using Pearson correlation coefficients. RESULTS Test-retest reliability was excellent for all participants. TUG was associated significantly with total leg and knee flexor strength, as well as the Hammersmith Functional Motor Scale Expanded, the 10-meter walk/run, and 6-minute walk tests. TUG findings were not associated with knee extensor strength, pulmonary function, or fatigue. CONCLUSIONS In SMA, the TUG test is easily administered, reliable, and correlates with established outcome measures. TUG testing is a potentially useful outcome measure for clinical trials and a measure of disability in ambulatory patients with SMA.
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Affiliation(s)
- Sally Dunaway
- Department of Neurology, Columbia University Medical Center, 180 Fort Washington Avenue, 5th Floor, New York, New York, 10032, USA
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Montes J, Dunaway S, Garber CE, Chiriboga CA, De Vivo DC, Rao AK. Leg muscle function and fatigue during walking in spinal muscular atrophy type 3. Muscle Nerve 2014; 50:34-9. [PMID: 24122959 DOI: 10.1002/mus.24081] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/06/2013] [Accepted: 09/10/2013] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Spinal muscular atrophy (SMA) causes muscle weakness and fatigue. Better understanding of the relationship between weakness and fatigue may help identify potential targets for rehabilitation. METHODS Gait and surface electromyography (EMG) from 4 muscle groups were measured during the Six-Minute Walk Test (6MWT) in 10 ambulatory participants, aged 9-49 years. Average root mean square amplitude (RMS) of muscle activity was calculated. Strength was assessed using manual and quantitative methods. RESULTS RMS, stride length, and velocity decreased during the 6MWT. Knee flexor and hip abductor strength was associated with fatigue-related changes; overall strength correlated with disease duration; and leg strength was associated with 6MWT distance. CONCLUSIONS Clinical measures are valid in assessing fatigue and function in SMA, and these assessments can be enhanced by use of gait analysis and EMG. Disease duration and strength measures may represent further stratification refinements when enrolling patients in clinical trials.
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Affiliation(s)
- Jacqueline Montes
- Department of Neurology, Columbia University, 180 Fort Washington Avenue, 5th Floor, New York, NY, USA
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Impact of exercise-induced fatigue on the strength, postural control, and gait of children with a neuromuscular disease. Am J Phys Med Rehabil 2014; 93:649-55. [PMID: 24743453 DOI: 10.1097/phm.0000000000000091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Children with a neuromuscular disease are prone to early muscular fatigue. The objective of the present study was to evaluate the effects of fatigue induced by a walking exercise on the strength, postural control, and gait of children with a neuromuscular disease. DESIGN Maximal isometric knee strength (extension and flexion), quiet standing postural control, and gait were evaluated in 12 children (8.8 [1.4] yrs) with a neuromuscular disease before and after a walking exercise. The participants were asked to stop walking when they considered themselves "very fatigued." RESULTS After the exercise-induced fatigue, a significant increase in range of motion in pelvis obliquity, hip abduction and adduction, and ankle flexion and extension during gait was reported along with an increase in stride length variability. Fatigue also reduced the knee flexor strength and had a detrimental effect on postural control. CONCLUSIONS Fatigue affects the strength, postural control, and gait of children with a neuromuscular disease and could notably increase the risks of falling and the occurrence of serious injuries.
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Monani UR, De Vivo DC. Neurodegeneration in spinal muscular atrophy: from disease phenotype and animal models to therapeutic strategies and beyond. FUTURE NEUROLOGY 2014; 9:49-65. [PMID: 24648831 DOI: 10.2217/fnl.13.58] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Of the numerous inherited diseases known to afflict the pediatric population, spinal muscular atrophy (SMA) is among the most common. It has an incidence of approximately one in 10,000 newborns and a carrier frequency of one in 50. Despite its relatively high incidence, SMA remains somewhat obscure among the many neurodegenerative diseases that affect humans. Nevertheless, the last two decades have witnessed remarkable progress in our understanding of the pathology, underlying biology and especially the molecular genetics of SMA. This has led to a genuine expectation within the scientific community that a robust treatment will be available to patients before the end of the decade. The progress made in our understanding of SMA and, therefore, towards a viable therapy for affected individuals is in large measure a consequence of the simple yet fascinating genetics of the disease. Nevertheless, important questions remain. Addressing these questions promises not only to accelerate the march towards a cure for SMA, but also to uncover novel therapies for related neurodegenerative disorders. This review discusses our current understanding of SMA, considers the challenges ahead, describes existing treatment options and highlights state-of-the-art research being conducted as a means to a better, safer and more effective treatment for the disease.
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Affiliation(s)
- Umrao R Monani
- Department of Pathology & Cell Biology, 630 West 168th Street, Columbia University Medical Center, New York, NY 10032, USA ; Department of Neurology, 630 West 168th Street, Columbia University Medical Center, New York, NY 10032, USA ; Center for Motor Neuron Biology & Disease, 630 West 168th Street, Columbia University Medical Center, New York, NY 10032, USA
| | - Darryl C De Vivo
- Department of Neurology, 630 West 168th Street, Columbia University Medical Center, New York, NY 10032, USA ; Center for Motor Neuron Biology & Disease, 630 West 168th Street, Columbia University Medical Center, New York, NY 10032, USA ; Department of Pediatrics, 630 West 168th Street, Columbia University Medical Center, New York, NY 10032, USA
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Montes J, Blumenschine M, Dunaway S, Alter AS, Engelstad K, Rao AK, Chiriboga CA, Sproule DM, De Vivo DC. Weakness and fatigue in diverse neuromuscular diseases. J Child Neurol 2013; 28:1277-83. [PMID: 23847297 DOI: 10.1177/0883073813493663] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Weakness and fatigue are captured by the 6-minute walk test, but the relationship between these symptoms is uncertain. Comparison across neuromuscular diseases has not been examined. A cohort study of 114 patients with spinal muscular atrophy, Duchenne/Becker muscular dystrophy, myasthenia gravis, and energy failure syndromes were included. Percent-predicted distance on the 6-minute walk test was computed from normative values to determine weakness. Fatigue was determined by the decrement in distance from the first to sixth minute. Weakness was seen across all groups (61.9%) but significant fatigue was seen only in spinal muscular atrophy (21.0%). Other groups showed little fatigue. Correlation between weakness and fatigue was significant only in spinal muscular atrophy (R = -0.71; P < .001). Longitudinally, distance walked declined only in Duchenne/Becker muscular dystrophy. In spinal muscular atrophy, weakness did not change, but fatigue increased significantly. These findings suggest independent mechanisms underlying weakness and fatigue in diverse neuromuscular conditions.
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Affiliation(s)
- Jacqueline Montes
- 1Department of Neurology, Columbia University Medical Center, New York, NY, USA
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Montes J, Mcisaac TL, Dunaway S, Kamil-Rosenberg S, Sproule D, Garber CE, De vivo DC, Rao AK. Falls and spinal muscular atrophy: Exploring cause and prevention. Muscle Nerve 2012; 47:118-23. [DOI: 10.1002/mus.23656] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2012] [Indexed: 11/09/2022]
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Abstract
Bench to bedside progress has been widely anticipated for a growing number of neurodegenerative disorders. Of these, spinal muscular atrophy (SMA) is perhaps the best poised to capitalize on advances in targeted therapeutics development over the next few years. Several laboratories have achieved compelling success in SMA animal models using sophisticated methods for targeted delivery, repair, or increased expression of the survival motor neuron protein, SMN. The clinical community is actively collaborating to identify, develop, and validate outcome measures and biomarkers in parallel with laboratory efforts. Innovative trial design and synergistic approaches to maximize proactive care in conjunction with treatment with one or more of the promising pharmacologic and biologic therapies currently in the pipeline will maximize our chances to achieve meaningful outcomes for patients. This review highlights recent promising scientific and clinical advances bringing us ever closer to effective treatment(s) for our patients with SMA.
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