1
|
Kaddoura R, Faraji H, Othman M, Abu Hijleh A, Loney T, Goswami N, Benamer HTS. Exploring Factors Associated with Falls in Multiple Sclerosis: Insights from a Scoping Review. Clin Interv Aging 2024; 19:923-938. [PMID: 38803468 PMCID: PMC11129740 DOI: 10.2147/cia.s460475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory condition that causes demyelination of the central nervous system accompanied by a wide range of symptoms. The high prevalence of falls among patients diagnosed with MS within the initial six months highlights the importance of this issue. The objective of this study is to identify factors associated with falls in MS patients in order to increase awareness and reduce the risk of falls. This scoping review used specific Mesh terms to formulate the literature search around falls and MS using Medline, Google Scholar, Scopus, and Embase search engines. English papers published between 2012 and 2022, studies with a clear definition of falls, McDonald's diagnostic criteria for MS, and those with Expanded Disability Status Scale (EDSS) or Patient Determined Disease Steps (PDDS) scores were included. Critical data from the selected articles were extracted and classified according to the different factors associated with falls in MS patients. Eighteen articles were included in this review. The most important factors associated with falls in MS patients identified were the severity and progression of the disease, mobility and balance problems, bladder dysfunction, fear of falling, fatigue, and cognitive dysfunction. In conclusion, this scoping review yielded the most common factors associated with falls in patients with MS. Study findings can be used to develop future interventions focusing on improving mobility, proprioception, and balance to decrease fall risk and injury amongst MS patients.
Collapse
Affiliation(s)
- Rachid Kaddoura
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Hanan Faraji
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Malek Othman
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Amin Abu Hijleh
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Tom Loney
- Department of Basic Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Nandu Goswami
- Division of Physiology and Pathophysiology, Medical University of Graz, Graz, Austria
- Center for Space and Aviation Health, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Hani T S Benamer
- Department of Clinical Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| |
Collapse
|
2
|
Alharthi HM, Almurdi MM. Association between cognitive impairment and motor dysfunction among patients with multiple sclerosis: a cross-sectional study. Eur J Med Res 2023; 28:110. [PMID: 36864515 PMCID: PMC9979523 DOI: 10.1186/s40001-023-01079-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Previous studies have shown that there is a relationship between cognitive impairment (CI) and motor dysfunction (MD) in neurological diseases, such as Alzheimer's and Parkinson's disease. However, there whether CI and MD are associated in patients with multiple sclerosis (MS) is unknown. Here we studied the association between CI and MD in patients with MS and examined if muscle weakness or incoordination, balance impairment, gait abnormalities, and/or increased fall risk are indicators of CI in patients with MS. METHODS Seventy patients with MS were included in this cross-sectional study. Cognitive impairment was assessed using the Montreal Cognitive Assessment Scale (MoCA), muscle strength using a hand-held dynamometer, and balance, gait, and fall risk assessment using the Tinetti scale. Motor coordination was assessed using the timed rapid alternating movement test for the upper extremity and the timed alternate heel-to-knee test for the lower extremity. RESULTS There was a significant association between CI and motor coordination, balance, gait, and risk of fall (p < 0.005) but not muscle strength. Stepwise multiple linear regression showed that 22.7% of the variance in the MoCA was predicted by the fall risk and incoordination of the upper extremities in the MS population. CONCLUSIONS CI is significantly associated with motor incoordination, balance impairment, gait abnormality, and increased fall risk. Furthermore, the risk of fall and upper extremity incoordination appeared to be best indicators of CI in patients with MS.
Collapse
Affiliation(s)
- Hanadi Matar Alharthi
- Rehabilitation of Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Muneera Mohammed Almurdi
- grid.56302.320000 0004 1773 5396Rehabilitation of Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Abasıyanık Z, Kahraman T, Veldkamp R, Ertekin Ö, Kalron A, Feys P. Changes in Gait Characteristics During and Immediately After the 6-Minute Walk Test in Persons With Multiple Sclerosis: A Systematic Review. Phys Ther 2022; 102:6556167. [PMID: 35358308 DOI: 10.1093/ptj/pzac036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 01/02/2022] [Accepted: 02/24/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE There is limited information about gait patterns during prolonged walking in people with multiple sclerosis (PwMS). The aim of this review was to report on gait metrics during and immediately after the 6-Minute Walk Test (6MWT) in PwMS with different levels of disability. METHODS The systematic search was performed in 3 databases (PubMed, Web of Science, and SCOPUS) using keywords related to multiple sclerosis and 6MWT. Studies that reported on quantitative gait outcomes before and after the 6MWT or multiple time points during the 6MWT were included. The Hedges g effect size (ES) was calculated to determine the magnitude of change in each gait parameter. RESULTS Fourteen studies (n = 534 PwMS; n = 166 healthy controls) were eligible. Five studies investigated gait parameters prior to and immediately after the 6MWT. Nine studies collected gait measures during the 6MWT. Speed (ES = -0.43 to 0.19), cadence (ES = -0.46 to 0.16), step length (ES = -0.46 to 0.14), stability (ES = -0.35 to 0.33), and regularity (ES = -0.25 to -0.15) decreased in most studies. In the majority of included studies, step time (ES = 0 to 0.35), stance period (ES = 0.12 to 0.58), double support phase (ES = 0.03 to 0.62), variability (ES = -0.19 to 1.13), and asymmetry (ES = -0.79 to 0.62) increased following the 6MWT. The kinetic and kinematic (mainly in dorsiflexion angle [ES = -0.08 to -0.36]) features of gait were also negatively changed after 6 minutes of walking. Walking speed, cadence, step length, stride length, and stride time after 6MWT at a comfortable speed all increased. Changes in the majority of spatiotemporal parameters were more pronounced in PwMS with moderate-to-severe disability compared with PwMS with mild disability. CONCLUSION Most quantitative gait parameters deteriorated during the 6MWT, especially in PwMS with moderate-to-severe disability. IMPACT The deterioration of gait patterns should be considered when designing therapeutic interventions to increase sustained walking capacity.
Collapse
Affiliation(s)
- Zuhal Abasıyanık
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Graduate School of Health Sciences Dokuz Eylül University, Izmir, Turkey.,Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Renee Veldkamp
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,UMSC, Hasselt-Pelt, Belgium
| | - Özge Ertekin
- Department of Neurological Physiotherapy-Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,UMSC, Hasselt-Pelt, Belgium
| |
Collapse
|
4
|
Salchow-Hömmen C, Skrobot M, Jochner MCE, Schauer T, Kühn AA, Wenger N. Review-Emerging Portable Technologies for Gait Analysis in Neurological Disorders. Front Hum Neurosci 2022; 16:768575. [PMID: 35185496 PMCID: PMC8850274 DOI: 10.3389/fnhum.2022.768575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/07/2022] [Indexed: 01/29/2023] Open
Abstract
The understanding of locomotion in neurological disorders requires technologies for quantitative gait analysis. Numerous modalities are available today to objectively capture spatiotemporal gait and postural control features. Nevertheless, many obstacles prevent the application of these technologies to their full potential in neurological research and especially clinical practice. These include the required expert knowledge, time for data collection, and missing standards for data analysis and reporting. Here, we provide a technological review of wearable and vision-based portable motion analysis tools that emerged in the last decade with recent applications in neurological disorders such as Parkinson's disease and Multiple Sclerosis. The goal is to enable the reader to understand the available technologies with their individual strengths and limitations in order to make an informed decision for own investigations and clinical applications. We foresee that ongoing developments toward user-friendly automated devices will allow for closed-loop applications, long-term monitoring, and telemedical consulting in real-life environments.
Collapse
Affiliation(s)
- Christina Salchow-Hömmen
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matej Skrobot
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Magdalena C E Jochner
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Schauer
- Control Systems Group, Technische Universität Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Charité-Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases, DZNE, Berlin, Germany
| | - Nikolaus Wenger
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
5
|
Chee JN, Ye B, Gregor S, Berbrayer D, Mihailidis A, Patterson KK. Influence of Multiple Sclerosis on Spatiotemporal Gait Parameters: A Systematic Review and Meta-Regression. Arch Phys Med Rehabil 2021; 102:1801-1815. [PMID: 33460576 DOI: 10.1016/j.apmr.2020.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To quantify the effect of multiple sclerosis (MS) on spatiotemporal gait characteristics accounting for disability severity and fall classification. DATA SOURCES MEDLINE (1946-August 2018), Allied and Complementary Medicine Database (1985-2018 August), and PsycINFO (1806-August 2018) were searched for terms on MS and gait. STUDY SELECTION Dual independent screening was conducted to identify observational, cross-sectional studies that compared adults with MS grouped according to Expanded Disability Status Scale (EDSS) level or fall history, reported on spatiotemporal gait characteristics, and were published in English. The search retrieved 5891 results, of which 12 studies satisfied the inclusion criteria. DATA EXTRACTION Two authors worked independently to extract and verify data on publication details, study methodology, participant characteristics, gait outcomes, conclusions, and limitations. Risk of bias was assessed using the QualSyst critical appraisal tool. A random-effects meta-regression and meta-analysis were conducted on pooled data. DATA SYNTHESIS All studies received quality ratings of very good to excellent and collectively examined 1513 individuals with MS. With every 1-point increase in EDSS, significant changes (P<.05) were observed in gait speed (-0.12 m/s; 95% confidence interval (CI), 0.08-0.15), step length (-0.04 m; 95% CI, 0.03-0.05), step time (+0.04 seconds; 95% CI, 0.02-0.06), step time variability (+0.009 seconds; 95% CI, 0.003-0.016), stride time (+0.08 seconds; 95% CI, 0.03-0.12), cadence (-4.4 steps per minute; 95% CI, 2.3-6.4), stance phase duration (+0.8% gait cycle; 95% CI, 0.1-1.5), and double support time (+3.5% gait cycle; 95% CI, 1.5-5.4). Recent fallers exhibited an 18% (95% CI, 13%-23%) reduction in gait speed compared with nonfallers (P<.001). CONCLUSIONS This review provides the most accurate reference values to-date that can be used to assess the effectiveness of MS gait training programs and therapeutic techniques for individuals who differ on disability severity and fall classification. Some gait adaptations could be part of adopting a more cautious gait strategy and should be factored into the design of future interventions.
Collapse
Affiliation(s)
- Justin N Chee
- Faculty of Medicine, University of Toronto, Rehabilitation Sciences Institute, Toronto, Ontario; Sunnybrook Health Sciences Centre, Hurvitz Brain Sciences Program, Sunnybrook Centre for Independent Living, Toronto, Ontario; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
| | - Bing Ye
- Faculty of Medicine, University of Toronto, Rehabilitation Sciences Institute, Toronto, Ontario; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Sarah Gregor
- Faculty of Medicine, University of Toronto, Rehabilitation Sciences Institute, Toronto, Ontario; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - David Berbrayer
- Faculty of Medicine, University of Toronto, Rehabilitation Sciences Institute, Toronto, Ontario; Sunnybrook Health Sciences Centre, Hurvitz Brain Sciences Program, Sunnybrook Centre for Independent Living, Toronto, Ontario
| | - Alex Mihailidis
- Faculty of Medicine, University of Toronto, Rehabilitation Sciences Institute, Toronto, Ontario; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Department of Occupational Science & Occupational Therapy, Toronto, Ontario
| | - Kara K Patterson
- Faculty of Medicine, University of Toronto, Rehabilitation Sciences Institute, Toronto, Ontario; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Department of Physical Therapy, Toronto, Ontario
| |
Collapse
|
6
|
Salehi R, Mofateh R, Mehravar M, Negahban H, Tajali S, Monjezi S. Comparison of the lower limb inter-segmental coordination during walking between healthy controls and people with multiple sclerosis with and without fall history. Mult Scler Relat Disord 2020; 41:102053. [DOI: 10.1016/j.msard.2020.102053] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/03/2020] [Accepted: 03/12/2020] [Indexed: 11/28/2022]
|
7
|
Kalron A, Achiron A, Menascu S. Gait Variability, Not Walking Speed, Is Related to Cognition in Adolescents With Multiple Sclerosis. J Child Neurol 2019; 34:27-32. [PMID: 30354845 DOI: 10.1177/0883073818808034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gait variability is associated with cognitive performance in people with central neurologic damage illnesses, which includes multiple sclerosis. However, presently, there have been no data available as to whether this association exists in adolescents with multiple sclerosis. Therefore, our objective was to investigate the association between gait variability and cognition in adolescents with multiple sclerosis encompassing 48 recently diagnosed adolescents with multiple sclerosis (26 girls; 22 boys), average age of 16.0 years (SD = 2.2), and an Expanded Disability Status Scale (EDSS) score of 1.6 (SD = 1.3). Walking speed and gait variability expressed by the coefficient of variation of the mean step time was studied using an electronic walkway. A computerized cognitive battery of tests evaluated cognition. Cognitive outcome measurements included verbal and nonverbal memory, executive function, visual spatial processing, verbal function, attention, information processing speed, and motor skills. Mean walking speed was 76.9 cm/s (SD = 57.6); mean step time variability was 3.5 (SD = 1.3) and the global cognitive score was 93.9 (SD = 12.5). According to linear regression analysis, a significant association was found between step time variability, cognitive subdomains of attention, and information processing speed. After incorporating walking speed into the model, the association remained significant. Increased gait variability, not walking speed, is suggested as a clinical marker of cognitive performance in minimally disabled adolescents with multiple sclerosis.
Collapse
Affiliation(s)
- Alon Kalron
- 1 Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,2 Sagol School of Neurosciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Achiron
- 2 Sagol School of Neurosciences, Tel-Aviv University, Tel-Aviv, Israel.,3 Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.,4 Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shay Menascu
- 3 Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.,4 Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
8
|
McIsaac TL, Fritz NE, Quinn L, Muratori LM. Cognitive-Motor Interference in Neurodegenerative Disease: A Narrative Review and Implications for Clinical Management. Front Psychol 2018; 9:2061. [PMID: 30425673 PMCID: PMC6218850 DOI: 10.3389/fpsyg.2018.02061] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 10/05/2018] [Indexed: 11/13/2022] Open
Abstract
This paper provides a narrative review of cognitive motor interference in neurodegeneration, including brain imaging findings specific to interference effects in neurodegenerative disease, and dual task assessment and intervention in Parkinson’s disease (PD), multiple sclerosis (MS), and Huntington’s disease (HD). In a healthy central nervous system the ability to process information is limited. Limitations in capacity to select and attend to inputs influence the ability to prepare and perform multiple tasks. As a result, the system balances demands, switching attention to the most task-relevant information as it becomes available. Limitations may become more apparent in persons with neurodegenerative diseases (ND) with system-specific impairments in PD, MS, and HD. These ND affect both cognitive and motor function and are thus particularly susceptible to dual task interference. Issues related to performer and task characteristics and implications of these findings for both the standard assessment of dual task abilities as well as development and evaluation of interventions aimed at improving dual task ability are discussed. In addition, we address the need for optimizing individualized assessment, intervention and evaluation of dual task function by choosing cognitive and motor tasks and measures that are sensitive to and appropriate for the individual’s level of function. Finally, we use current evidence to outline a 5-step process of clinical decision making that uses the dual task taxonomy as a framework for assessment and intervention.
Collapse
Affiliation(s)
- Tara L McIsaac
- Department of Physical Therapy, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, United States
| | - Nora E Fritz
- Program in Physical Therapy and Department of Neurology, Wayne State University, Detroit, MI, United States
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Lisa M Muratori
- Department of Physical Therapy, SHTM, Stony Brook University, Stony Brook, NY, United States
| |
Collapse
|
9
|
Kalron A, Allali G, Achiron A. Cerebellum and cognition in multiple sclerosis: the fall status matters. J Neurol 2018; 265:809-816. [PMID: 29396679 DOI: 10.1007/s00415-018-8774-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 11/29/2022]
Abstract
Cerebellar volume has been linked with cognitive performances in MS; however, the association in terms of fall status has never been compared. Therefore, the objective of the current study was to compare cognitive performance with cerebellar volume between MS fallers and non-fallers. The cross-sectional study included 140 PwMS (96 women). MRI volumetric analysis was based on the FreeSurfer image analysis suite. Volumes of the cerebellar gray and white matter were identified as the region of interest. Cognitive function included scores obtained from a computerized cognitive battery of tests. The sample was divided into fallers and non-fallers. MS fallers demonstrated a lower global cognitive performance and reduced gray and white matter cerebellar volumes compared to non-fallers. A significant association was found between total gray and white matter cerebellar volume and visual spatial subdomain (P value = 0.044 and 0.032, respectively) in the non-fallers group. The association remained significant after controlling for the total cranial volume and neurological disability (P value = 0.026 and 0.047, respectively). A relationship was found between the visual spatial score and the left gray matter cerebellum volume; R2 = 0.44, P value = 0.021. We believe that a unique relationship exists between the cerebellum structure and cognitive processing according to fall history in PwMS and should be considered when investigating the association between brain functioning and cognitive performances in MS.
Collapse
Affiliation(s)
- Alon Kalron
- Department of Physical Therapy, Sackler Faculty of Medicine, School of Health Professions, Tel-Aviv University, Tel Aviv, Israel. .,Sagol School of Neurosciences, Tel-Aviv University, Tel Aviv, Israel.
| | - Gilles Allali
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.,Division of Cognitive and Motor Aging, Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|