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Phillips CD, Hodge AT, Myers CC, Leventhal DK, Burgess CR. Striatal Dopamine Contributions to Skilled Motor Learning. J Neurosci 2024; 44:e0240242024. [PMID: 38806248 PMCID: PMC11211718 DOI: 10.1523/jneurosci.0240-24.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
Coordinated multijoint limb and digit movements-"manual dexterity"-underlie both specialized skills (e.g., playing the piano) and more mundane tasks (e.g., tying shoelaces). Impairments in dexterous skill cause significant disability, as occurs with motor cortical injury, Parkinson's disease, and a range of other pathologies. Clinical observations, as well as basic investigations, suggest that corticostriatal circuits play a critical role in learning and performing dexterous skills. Furthermore, dopaminergic signaling in these regions is implicated in synaptic plasticity and motor learning. Nonetheless, the role of striatal dopamine signaling in skilled motor learning remains poorly understood. Here, we use fiber photometry paired with a genetically encoded dopamine sensor to investigate striatal dopamine release in both male and female mice as they learn and perform a skilled reaching task. Dopamine rapidly increases during a skilled reach and peaks near pellet consumption. In the dorsolateral striatum, dopamine dynamics are faster than in the dorsomedial and ventral striatum. Across training, as reaching performance improves, dopamine signaling shifts from pellet consumption to cues that predict pellet availability, particularly in medial and ventral areas of the striatum. Furthermore, performance prediction errors are present across the striatum, with reduced dopamine release after an unsuccessful reach. These findings show that dopamine dynamics during skilled motor behaviors change with learning and are differentially regulated across striatal subregions.
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Affiliation(s)
- Chris D Phillips
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan 48109
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan 48109
- Department of Neuroscience, University of Texas at Dallas, Richardson, Texas 75080
| | - Alexander T Hodge
- Department of Neurology, University of Michigan, Ann Arbor, Michigan 48109
| | - Courtney C Myers
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan 48109
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, Michigan 48109
| | - Daniel K Leventhal
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan 48109
- Department of Neurology, University of Michigan, Ann Arbor, Michigan 48109
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, Michigan 48109
- Parkinson's Disease Foundation Research Center of Excellence, University of Michigan, Ann Arbor, Michigan 48109
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109
- Department of Neurology, VA Ann Arbor Health System, Ann Arbor, Michigan 48109
| | - Christian R Burgess
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan 48109
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan 48109
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, Michigan 48109
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Phillips CD, Myers CC, Leventhal DK, Burgess CR. Striatal dopamine contributions to skilled motor learning. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.06.579240. [PMID: 38370850 PMCID: PMC10871330 DOI: 10.1101/2024.02.06.579240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Coordinated multi-joint limb and digit movements - "manual dexterity" - underlie both specialized skills (e.g., playing the piano) and more mundane tasks (e.g., tying shoelaces). Impairments in dexterous skill cause significant disability, as occurs with motor cortical injury, Parkinson's Disease, and a range of other pathologies. Clinical observations, as well as basic investigations, suggest that cortico-striatal circuits play a critical role in learning and performing dexterous skills. Furthermore, dopaminergic signaling in these regions is implicated in synaptic plasticity and motor learning. Nonetheless, the role of striatal dopamine signaling in skilled motor learning remains poorly understood. Here, we use fiber photometry paired with a genetically encoded dopamine sensor to investigate striatal dopamine release as mice learn and perform a skilled reaching task. Dopamine rapidly increases during a skilled reach and peaks near pellet consumption. In dorsolateral striatum, dopamine dynamics are faster than in dorsomedial and ventral striatum. Across training, as reaching performance improves, dopamine signaling shifts from pellet consumption to cues that predict pellet availability, particularly in medial and ventral areas of striatum. Furthermore, performance prediction errors are present across the striatum, with reduced dopamine release after an unsuccessful reach. These findings show that dopamine dynamics during skilled motor behaviors change with learning and are differentially regulated across striatal subregions.
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Affiliation(s)
- Chris D. Phillips
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA, 48109
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA, 48109
- Department of Neuroscience, University of Texas at Dallas, Richardson, TX, USA, 75080
| | - Courtney C. Myers
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA, 48109
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA, 48109
| | - Daniel K. Leventhal
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA, 48109
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA, 48109
- Parkinson Disease Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, USA, 48109
- Department of Neurology, VA Ann Arbor Health System, Ann Arbor, MI, USA, 48109
| | - Christian R. Burgess
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA, 48109
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA, 48109
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA, 48109
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Boyko AN, Belova AN, Rahmanova EM, Siverzeva SA. [Questionnaires for arm function assessment in patients with multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:36-42. [PMID: 39072564 DOI: 10.17116/jnevro202412406136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Arm dysfunction is one of the disabling manifestations of multiple sclerosis (MS), especially in later stages of the disease. Assessment of the functioning of the upper limbs is necessary to objectify the course of MS, determine the effectiveness of therapy, and individualize rehabilitation measures. The tools that assess the upper extremity dysfunction include tests and questionnaires. Questionnaires (patient-reported outcome measures) represent the special importance, since the opinions and preferences of patients themselves help to implement a patient-centered approach to treatment. The article presents a brief description of three multidimensional MS-specific and four unidimensional MS-nonspecific questionnaires that used in assessment of upper limb function in MS patients. The disease-specific unidimensional Arm Function in Multiple Sclerosis Questionnaire (AMSQ), specifically designed to assess the arm use in patients with MS, is discussed in more detail. The use of AMSQ in the Russian population is possible only after the procedure of cultural adaptation and validation of the Russian version.
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Affiliation(s)
- A N Boyko
- Pirogov National Medical Research University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - A N Belova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - E M Rahmanova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - S A Siverzeva
- Tyumen Regional Center for Multiple Sclerosis - AO MSCH "Neftyanik", Tyumen, Russia
- Ural State Medical University, Yekaterinburg, Russia
- Kirov State Medical University, Kirov, Russia
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Ilardi CR, La Marra M, Amato R, Di Cecca A, Di Maio G, Ciccarelli G, Migliaccio M, Cavaliere C, Federico G. The "Little Circles Test" (LCT): a dusted-off tool for assessing fine visuomotor function. Aging Clin Exp Res 2023; 35:2807-2820. [PMID: 37910290 DOI: 10.1007/s40520-023-02571-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND The fine visuomotor function is commonly impaired in several neurological conditions. However, there is a scarcity of reliable neuropsychological tools to assess such a critical domain. AIMS The aim of this study is to explore the psychometric properties and provide normative data for the Visual-Motor Speed and Precision Test (VMSPT). RESULTS Our normative sample included 220 participants (130 females) aged 18-86 years (mean education = 15.24 years, SD = 3.98). Results showed that raw VMSPT scores were affected by higher age and lower education. No effect of sex or handedness was shown. Age- and education-based norms were provided. VMSPT exhibited weak-to-strong correlations with well-known neuropsychological tests, encompassing a wide range of cognitive domains of clinical relevance. By gradually intensifying the cognitive demands, the test becomes an indirect, performance-oriented measure of executive functioning. Finally, VMSPT seems proficient in capturing the speed-accuracy trade-off typically observed in the aging population. CONCLUSIONS This study proposes the initial standardization of a versatile, time-efficient, and cost-effective neuropsychological tool for assessing fine visuomotor coordination. We propose renaming the VMSPT as the more approachable "Little Circles Test" (LCT).
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Affiliation(s)
| | - Marco La Marra
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Raffaella Amato
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Angelica Di Cecca
- IRCCS SYNLAB SDN S.P.A., Via Emanuele Gianturco 113, 80143, Naples, Italy
| | - Girolamo Di Maio
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Miriana Migliaccio
- IRCCS SYNLAB SDN S.P.A., Via Emanuele Gianturco 113, 80143, Naples, Italy
| | - Carlo Cavaliere
- IRCCS SYNLAB SDN S.P.A., Via Emanuele Gianturco 113, 80143, Naples, Italy
| | - Giovanni Federico
- IRCCS SYNLAB SDN S.P.A., Via Emanuele Gianturco 113, 80143, Naples, Italy
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Maggio MG, Stagnitti MC, Rizzo E, Andaloro A, Manuli A, Bruschetta A, Naro A, Calabrò RS. Limb apraxia in individuals with multiple sclerosis: Is there a role of semi-immersive virtual reality in treating the Cinderella of neuropsychology? Mult Scler Relat Disord 2023; 69:104405. [PMID: 36417812 DOI: 10.1016/j.msard.2022.104405] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Limb apraxia is an acquired cognitive-motor disorder characterized by spatial and temporal disorganization of limb movements, negatively affecting the quality of life of patients, including those with multiple sclerosis (MS). Although recent studies have shown the potential role of VR in increasing cognitive and motor functions, only a few studies have been carried out on the rehabilitation of upper limb apraxia. Hence, our study aims to evaluate the potential efficacy of VR training to improve upper limb ideomotor apraxia in patients with MS. METHODS One hundred and six patients, affected by secondary progressive MS, who attended our Robotic and Behavioral Neurorehabilitation Service from March 2019 to February 2020, were enrolled in this study and randomly divided into two groups: the control group (CG: 53 patients) performed traditional therapy whereas the experimental group (EG:53 patients) received training using semi-immersive VR. All patients underwent the same amount of cognitive training, 3 times a week for 8 weeks. They were submitted to a specific neuropsychological assessment before (T0) and after the rehabilitation treatment (T1). RESULTS The VR training led to a significant improvement in global cognitive functions, with regard to constructive and ideomotor apraxia. On the contrary, the CG achieved significant improvements only in ideomotor apraxia. Moreover, only in the EG, we observed an improvement in the mood at the end of training. CONCLUSION The present study demonstrates that VR rehabilitation can be an effective tool for the treatment of apraxia, which is a neuropsychological problem often underestimated in MS patients. Further studies with long-term follow-up periods are needed to confirm the effect of this promising approach.
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Affiliation(s)
- Maria Grazia Maggio
- University of Catania, Department of Biomedical and Biotechnological Science, Via S. Sofia, 64, 95125 Catania (CT), Italy
| | - Maria Chiara Stagnitti
- Studio di Psicoterapia Relazionale e Riabilitazione Cognitiva, viale Europa, 107, 98121, Messina (ME), Italy
| | - Erika Rizzo
- I.O.M.I. "Franco Scalabrino", Via Consolare Pompea, 360, 98165 Ganzirri, Messina (ME), Italy
| | - Adriana Andaloro
- Studio di Riabilitazione Nutrizionale e Cognitiva, Via Sant'Agostino, 14, 98122, Messina (ME), Italy
| | - Alfredo Manuli
- Azienda Ospedaliera Universitaria di Messina "G. Martino", Via Consolare Valeria, 98125, Messina (ME), Italy
| | - Antongiulio Bruschetta
- Azienda Ospedaliera Universitaria di Messina "G. Martino", Via Consolare Valeria, 98125, Messina (ME), Italy
| | - Antonino Naro
- Azienda Ospedaliera Universitaria di Messina "G. Martino", Via Consolare Valeria, 98125, Messina (ME), Italy
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Yıldız Z, Doymaz F, Özden F. The reliability and validity of the Turkish version of the apraxia screen of TULIA in multiple sclerosis patients. Disabil Rehabil 2022; 44:8042-8047. [PMID: 34898347 DOI: 10.1080/09638288.2021.2003447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The study was aimed to analyze the psychometric properties of the Turkish version of the Apraxia Screen of TULIA (T-AST). METHODS A total of 112 patients with multiple sclerosis (MS) were included in the study. T-AST tasks were performed once while recording with a video camera. Two physiotherapists scored T-AST, independently. Rater(1) performed a second assessment of apraxia with AST one week later. The disability was evaluated by Expanded Disability Status Scale (EDSS). Cognitive assessment was carried out with Mini-Mental State Examination (MMSE). Depression was evaluated with Hamilton Depression Rating Scale (HAM-D). Multiple Sclerosis International Quality of Life (MusiQoL) was used to assess the quality of life. In addition, fatigue was evaluated with Fatigue Severity Scale (FSS). RESULTS The mean age of the patients was 42.3 ± 11.0 years. The Cronbach's alpha coefficient of the rater(1)'s and rater(2)'s evaluation was 0.820 and 0.800, respectively. ICC score of the intra-rater reliability was 0.960. ICC score of the inter-rater reliability was 0.971. The Spearman correlation coefficients between T-AST and MMSE, EDSS, MusiQoL, HAM-D, FSS were low to excellent, respectively (r = 0.863; p < 0.001, r = -0.768; p < 0.001, r = -0.560; p < 0.001, r = -0.393, p < 0.001, r = -0.324, p < 0.001). CONCLUSION The Turkish version of the AST is a reliable and valid tool for assessing upper limb apraxia in patients with MS.Implications for RehabilitationThe Turkish version of the Apraxia Screen of TULIA (T-AST) is a reliable and valid test for assessing apraxia in patients with multiple sclerosis.Considering the short structure, high reliability, and validity, T-AST could be used in clinical practice and clinical trials.
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Affiliation(s)
- Zeynep Yıldız
- Department of Occupational Therapy, Artvin Çoruh University, Vocational School of Health Services, Artvin, Turkey
| | - Fadime Doymaz
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kıbrıs İlim University, Kyrenia, North Cyprus
| | - Fatih Özden
- Elderly Care Department, Muğla Sıtkı Koçman University, Köyceğiz Vocational School of Health Services, Muğla, Turkey
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Nintendo Switch Joy-Cons' Infrared Motion Camera Sensor for Training Manual Dexterity in People with Multiple Sclerosis: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11123261. [PMID: 35743333 PMCID: PMC9224824 DOI: 10.3390/jcm11123261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The Nintendo Switch® (NS) is the ninth video game console developed by Nintendo®. Joy-Cons® are the primary game controllers for the NS® video game console, and they have an infrared motion camera sensor that allows capturing the patient's hands without the need to place sensors or devices on the body. The primary aim of the present study was to evaluate the effects of the NS®, combined with a conventional intervention, for improving upper limb (UL) grip muscle strength, coordination, speed of movements, fine and gross dexterity, functionality, quality of life, and executive function in multiple sclerosis (MS) patients. Furthermore, we sought to assess satisfaction and compliance levels. METHODS A single-blinded, randomized clinical trial was conducted. The sample was randomized into two groups: an experimental group who received treatment based on Dr Kawashima's Brain Training® for the NS® (20 min) plus conventional rehabilitation (40 min), and a control group who received the same conventional rehabilitation (60 min) for the ULs. Both groups received two 60 min sessions per week over an eight-week period. Grip strength, the Box and Blocks Test (BBT), the Nine Hole Peg Test (NHPT), the QuickDASH, the Multiple Sclerosis Impact Scale (MSIS-29), the Trail Making Test (TMT), and the Stroop Color and Word Test (SCWT) were used pre- and post-treatment. Side effects and attendance rates were also recorded. RESULTS Intragroup analysis showed significant improvements for the experimental group in the post-treatment assessments for grip strength in the more affected side (p = 0.033), the BBT for the more (p = 0.030) and the less affected side (p = 0.022), the TMT (A section) (p = 0.012), and the QuickDASH (p = 0.017). No differences were observed for the control group in intragroup analysis, but they were observed in the NHPT for the more affected side (p = 0.012). The intergroup analysis did not show differences between both groups. CONCLUSIONS Our results show that an eight-week experimental protocol, after using Dr Kawashima's Brain Training® and the right-side Joy-Con controller for the NS®, combined with a conventional intervention, showed improvements in grip strength, coordination, fine and gross motor function, executive functions, and upper limb functionality in the experimental group. However, no differences were observed when both groups were compared in the intergroup analysis. The addition of Brain Training® for the NS® for the upper limb rehabilitation did not show side effects and was rated with a high satisfaction and excellent compliance in people with MS. TRIAL REGISTRATION This randomized controlled trial has been registered at ClinicalTrials Identifier: NCT04171908, November 2019.
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Effects of EMG-Controlled Video Games on the Upper Limb Functionality in Patients with Multiple Sclerosis: A Feasibility Study and Development Description. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:3735979. [PMID: 35449748 PMCID: PMC9017529 DOI: 10.1155/2022/3735979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/27/2022] [Accepted: 02/09/2022] [Indexed: 11/17/2022]
Abstract
Multiple sclerosis (MS) is the most common inflammatory neurological disease in young adults, with a high prevalence worldwide (2.8 million people). To aid in the MS treatment, using VR tools in cognitive and motor rehabilitation of such disease has been growing progressively in the last years. However, the role of VR as a rehabilitative tool in MS treatment is still under debate. This paper explores the effects of VR training using EMG activation in upper limb functionality. An experimental training protocol using video games controlled using an MYO armband sensor was conducted in a sample of patients with MS. Results support the use of EMG-commanded video games as a rehabilitative tool in patients with MS, obtaining favorable outcomes related to upper limb functionality and satisfaction.
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Kalron A, Frid L, Fonkatz I, Menascu S, Dolev M, Magalashvili D, Achiron A. Design, development, and testing of a virtual reality device for upper limb training in people with multiple sclerosis: a feasibility study (Preprint). JMIR Serious Games 2022; 10:e36288. [PMID: 36094809 PMCID: PMC9513692 DOI: 10.2196/36288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 06/21/2022] [Accepted: 08/11/2022] [Indexed: 01/16/2023] Open
Abstract
Background Multiple sclerosis (MS) is a common nontraumatic, neurological, disabling disease that often presents with upper limb dysfunction. Exercise training has resulted in improvement for patients; however, there can be a lack of compliance due to access because of location and lack of MS experts. Virtual reality (VR) is a promising technology that can offer exercise therapy/rehabilitation at a distance. This type of remote training can be motivational and effective for patients with MS and can improve range of motion and muscle strength for those with upper limb dysfunction. Objective The aim of this study is to evaluate the safety and feasibility of the XRHealth software and the Oculus Rift Station for patients with MS with upper limb motor dysfunction. Methods A single-center, prospective, feasibility study was conducted with patients with MS who had upper limb motor dysfunction. Patients participated in a single 45-minute digital environment session with VR and completed a questionnaire about the quality of the training and fatigability. The clinician also completed a questionnaire to evaluate the suitability and safety of the training. Results Overall, 30 patients were enrolled between the ages of 20 and 81 years. Patients reported that the training sessions within the digital environment were helpful, challenging, fun, and simple to understand, and that they would be willing to repeat the sessions again. The physical therapist that oversaw the patients reported that the training was suitable for 87% (n=26) of the patients. Anticipated adverse events were fatigue, temporary dizziness, and temporary nausea. The operator complications included that the cable of the head-mounted display interrupted the training (n=2, 7%) and fatigue that caused cessation of the VR training session (n=2, 7%). No serious adverse events were reported. Conclusions These preliminary results demonstrated that the use of the XRHealth software and Oculus Rift Station platform is feasible, safe, and engaging for patients, and has the potential to improve the functionality of the upper limbs in patients with MS. This study provides support for future studies of implementing a series of training sessions with virtual reality in a home-based environment.
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Affiliation(s)
- Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Lior Frid
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Iliya Fonkatz
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Stoll SEM, Finkel L, Buchmann I, Hassa T, Spiteri S, Liepert J, Randerath J. 100 years after Liepmann-Lesion correlates of diminished selection and application of familiar versus novel tools. Cortex 2021; 146:1-23. [PMID: 34801831 DOI: 10.1016/j.cortex.2021.10.002] [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] [Received: 09/29/2020] [Revised: 07/30/2021] [Accepted: 10/06/2021] [Indexed: 01/02/2023]
Abstract
100 years ago, Liepmann highlighted the role of left ventro-dorsal lesions for impairments in conceptual (rather ventral) and motor (more dorsal) related aspects of apraxia. Many studies thereafter attributed to an extended left fronto-temporo-parietal network. Yet, to date there are only few studies that looked at apraxic performance in the selection and application of familiar versus novel tools. In the current study we applied modern voxel-based lesion-symptom mapping (VLSM) to analyze neural correlates of impaired selection and application of familiar versus novel tools. 58 left (LBD) and 51 right brain damaged (RBD) stroke patients participated in the Novel Tools Test (NTT) and the Familiar Tools Test (FTT) of the Diagnostic Instrument for Limb Apraxia (DILA-S). We further assessed performance in control tasks, namely semantic knowledge (BOSU), visuo-spatial working memory (Corsi Block Tapping) and meaningless imitation of gestures (IML). Impaired tool use was most pronounced after LBD. Our VLSM results in the LBD group suggested that selection- versus application-related aspects of praxis and semantics of familiar versus novel tool use can be behaviorally and neuro-anatomically differentiated. For impairments in familiar tool tasks, the major focus of lesion maps was rather ventral while deficiencies in novel tool tasks went along with rather dorsal lesions. Affected selection processes were linked to rather anterior lesions, while impacted application processes went along with rather posterior lesion maps. In our study, particular tool selection processes were rather specific for familiar versus novel tools. Foci for lesion overlaps of experimental and control tasks were noticed ventrally for semantic knowledge and FTT, in fronto-parietal regions for working memory and NTT, and ventro-dorsally for imitation of meaningless gestures and the application of NTT and FTT. We visualized our current interpretation within a neuroanatomical model for apraxia of tool use.
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Affiliation(s)
- Sarah E M Stoll
- University of Konstanz, Konstanz, Germany; Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | - Lisa Finkel
- University of Konstanz, Konstanz, Germany; Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | - Ilka Buchmann
- University of Konstanz, Konstanz, Germany; Rehaklinik Zihlschlacht, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Thomas Hassa
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany; Kliniken Schmieder, Allensbach, Germany
| | - Stefan Spiteri
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany; Kliniken Schmieder, Allensbach, Germany
| | - Joachim Liepert
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany; Kliniken Schmieder, Allensbach, Germany
| | - Jennifer Randerath
- University of Konstanz, Konstanz, Germany; Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany.
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The Influence of Self-Perception on Manipulative Dexterity in Adults with Multiple Sclerosis. Occup Ther Int 2021; 2021:5583063. [PMID: 34483781 PMCID: PMC8384504 DOI: 10.1155/2021/5583063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background Multiple sclerosis is a disorder which causes a loss of functionality, affecting the person's ability to perform activities of daily living, such as interpersonal interactions and relationship, dressing, self-care, or bathing, as well as having a negative impact on work and leisure activities. Aims This study examined the relationship (correlational or associations/predictive) between self-perceived quality of life and performance of manipulative dexterity. Also, this study sought to measure predictors of dexterity. Study Design. A cross-sectional study from two associations of MS within the Community of Madrid, Spain. Methods and Procedures. A final sample of 30 people with multiple sclerosis. The outcome measures used were the ABILHAND questionnaire, the Purdue Pegboard Test, the Nine Hole Peg Test, and the Box and Block Test. Results No significant correlations were found between dexterity and self-perception tests; however, correlations were found between perceived dexterity and quality of life (p < 0.001). Scores for the ABILHAND questionnaire, which measures the perception of skills in daily living, predicted up to 60% of the variance in the dexterity tests. Conclusions The results of this study suggest that interventions for improving the manipulative dexterity of people with multiple sclerosis should address the person's perception of improving their manipulative dexterity and the perceived of quality of life, as both factors may influence manipulative dexterity.
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Zhang E, Tian X, Li R, Chen C, Li M, Ma L, Wei R, Zhou Y, Cui Y. Dalfampridine in the treatment of multiple sclerosis: a meta-analysis of randomised controlled trials. Orphanet J Rare Dis 2021; 16:87. [PMID: 33588903 PMCID: PMC7885571 DOI: 10.1186/s13023-021-01694-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Multiple sclerosis (MS) is a chronic illness involving the central nervous system (CNS) that is characterised by inflammation, demyelination, and degenerative changes. Dalfampridine is one of the available treatments for MS symptoms and comorbidities. This meta-analysis aimed to assess the safety and benefits of dalfampridine versus placebo in MS by summarising data deriving from previously published clinical randomised controlled studies (RCTs). Results A total of 9 RCTs were included in this meta-analysis, involving 1691 participants. There were significant differences between dalfampridine and placebo in terms of decreased 12-item Multiple Sclerosis Walking Scale score (weighted mean difference [WMD] = − 3.68, 95% confidence interval [CI] [− 5.55, − 1.80], p = 0.0001), improved response to the timed 25-foot walk test (relative risk [RR] = 2.57, 95% CI [1.04, 6.33], p = 0.04), increased 6-min walk test (WMD = 18.40, 95% CI [1.30, 35.51], p = 0.03), increased 9-Hole Peg Test score (WMD = 1.33, 95% CI [0.60, 2.05], p = 0.0004), and increased Symbol Digit Modalities Test score (WMD = 4.47, 95% CI [3.91, 5.02], p < 0.00001). Significant differences in the incidence of side effects were also observed (RR = 1.12, 95% CI [1.04, 1.21], p = 0.002). Conclusion Dalfampridine exerts positive effects on walking ability, finger dexterity, and cognitive function. Treatment should be administered under the guidance of a physician or pharmacist given the higher incidence of adverse events.
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Affiliation(s)
- Enyao Zhang
- Department of Pharmacy, Peking University First Hospital, 6 Dahongluochang Street, Xicheng District, Beijing, 100034, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Xin Tian
- Department of Pharmacy, Peking University First Hospital, 6 Dahongluochang Street, Xicheng District, Beijing, 100034, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Ruoming Li
- Department of Pharmacy, Peking University First Hospital, 6 Dahongluochang Street, Xicheng District, Beijing, 100034, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Chaoyang Chen
- Department of Pharmacy, Peking University First Hospital, 6 Dahongluochang Street, Xicheng District, Beijing, 100034, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Min Li
- Department of Pharmacy, Peking University First Hospital, 6 Dahongluochang Street, Xicheng District, Beijing, 100034, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Lingyun Ma
- Department of Pharmacy, Peking University First Hospital, 6 Dahongluochang Street, Xicheng District, Beijing, 100034, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Ran Wei
- Department of Pharmacy, Peking University First Hospital, 6 Dahongluochang Street, Xicheng District, Beijing, 100034, China
| | - Ying Zhou
- Department of Pharmacy, Peking University First Hospital, 6 Dahongluochang Street, Xicheng District, Beijing, 100034, China.
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, 6 Dahongluochang Street, Xicheng District, Beijing, 100034, China.
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13
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Gesture deficits and apraxia in schizophrenia. Cortex 2020; 133:65-75. [PMID: 33099076 DOI: 10.1016/j.cortex.2020.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
Abstract
Aberrant performance of skilled action has long been noted in schizophrenia and relatedly, recent reports have demonstrated impaired use, performance, and perception of hand gestures in this group. Still, this deficit is not acknowledged as apraxia, which to the broader medical field, characterizes impairments in skilled actions. Understanding the relationship between apraxia and schizophrenia may shed an invaluable new perspective on disease mechanism, and highlight novel treatment opportunities as well. To examine this potential link, we reviewed the evidence for the types of praxis errors, associated psychopathology, and cerebral correlates of the praxis deficit in schizophrenia. Notably, the review indicated that gesture deficits are severe enough to be considered genuine apraxia in a substantial proportion of patients (about 25%). Further, other potential contributors (e.g., hypokinetic motor abnormalities, cognitive impairment) are indeed associated with gesture deficits in schizophrenia, but do not sufficiently explain the abnormality. Finally, patients with praxis deficits have altered brain structure and function including the left parieto-premotor praxis network and these neural correlates are specific to the praxis deficit. Therefore, we argue that the gestural disorder frequently observed in schizophrenia shares both the clinical and neurophysiological features of true apraxia, as in other neuropsychiatric disorders with impaired higher order motor control, such as Parkinson's disease.
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14
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Cuesta-Gómez A, Sánchez-Herrera-Baeza P, Oña-Simbaña ED, Martínez-Medina A, Ortiz-Comino C, Balaguer-Bernaldo-de-Quirós C, Jardón-Huete A, Cano-de-la-Cuerda R. Effects of virtual reality associated with serious games for upper limb rehabilitation inpatients with multiple sclerosis: randomized controlled trial. J Neuroeng Rehabil 2020; 17:90. [PMID: 32660604 PMCID: PMC7359450 DOI: 10.1186/s12984-020-00718-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/03/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Dexterity and activities of daily living limitations on the upper limb (UL) represent one of the most common problems in patients with multiple sclerosis (MS). The aim of this study was to evaluate the effectiveness of the specially developed Serious Games that make use of the Leap Motion Controller (LMC) as main user interface for improving UL grip muscle strength, dexterity, fatigue, quality of life, satisfaction and compliance. METHODS A single-blinded randomized controlled trial was conducted. The sample was randomized into two groups: an experimental group who received treatment based on serious games designed by the research team using the developed LMC based Serious Games for the UL plus conventional rehabilitation, and a control group who received the same conventional rehabilitation for the UL. Both groups received two 60 min sessions per week over a ten-week period. Grip muscle strength, coordination, speed of movements, fine and gross UL dexterity, fatigue, quality of life, satisfaction and compliance were assessed in both groups pre-treatment, post-treatment and in a follow-up period of 1 month without receiving any treatment. RESULTS In the experimental group compared to the control group, significant improvements were observed in the post-treatment assessment for coordination, speed of movements, fine and gross UL dexterity. Also, significant results were found in the follow-up in coordination, speed of movements, fine and gross for the more affected side. CONCLUSIONS An experimental protocol using an LMC based Serious Games designed for UL rehabilitation showed improvements for unilateral gross manual dexterity, fine manual dexterity, and coordination in MS patients with high satisfaction and excellent compliance. TRIAL REGISTRATION This randomized controlled trial has been registered at ClinicalTrials.gov Identifier: NCT04171908 , Nov 2019.
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Affiliation(s)
- Alicia Cuesta-Gómez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, Avenida de Atenas s/n 28922 Alcorcón, Madrid, Spain
| | - Patricia Sánchez-Herrera-Baeza
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, Avenida de Atenas s/n 28922 Alcorcón, Madrid, Spain.
| | | | | | | | | | | | - Roberto Cano-de-la-Cuerda
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, Avenida de Atenas s/n 28922 Alcorcón, Madrid, Spain
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15
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Tacchino A, Ponzio M, Pedullà L, Podda J, Bragadin MM, Pedrazzoli E, Konrad G, Battaglia MA, Mokkink L, Brichetto G. Italian validation of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ). Neurol Sci 2020; 41:3273-3281. [DOI: 10.1007/s10072-020-04363-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 03/20/2020] [Indexed: 12/20/2022]
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16
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A Descriptive Cross-Sectional Study of Manipulative Dexterity on Different Subtypes of Multiple Sclerosis. Occup Ther Int 2020; 2020:6193938. [PMID: 32425718 PMCID: PMC7211248 DOI: 10.1155/2020/6193938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Manipulative dexterity impairments affect 76% of individuals with multiple sclerosis (MS). Patients with MS can experience reduced skill when performing both basic activities of daily living and instrumental activities of daily living. Many studies consider that physical rehabilitation leads to a decrease in the level of disability, especially at the mild and moderate stages of the disease. However, most studies fail to distinguish between the different MS subtypes. Purpose Our aims were (1) to describe the manipulative skills of people according to the different subtypes of MS, (2) to analyze the correlation between dexterity and self-perception variables, and (3) to identify possible predictors of functionality. Study Design. A descriptive cross-sectional study. Methods 30 individuals with MS. The measurement tools used were the ABILHAND, the Purdue Pegboard Test (PPT), the Nine-Hole Peg Test, and the Box and Block Test. Results All subtypes of MS obtained lower scores for manipulative dexterity compared to normal skill levels, with individuals with primary progressive MS displaying the lowest values. However, the analysis of differences between the different subtypes did not reveal statistically significant intragroup differences. In addition, differences were found regarding the effect size of practically all the variables analyzed for both manipulative dexterity (PPT, NHPT, and BBT) and the self-perception of ADLs (ABILHAND), for which high values (d r = 0.72) and very high values (d r = 1.46) were obtained. Conclusions Although no significant differences were found between the different types of MS, the assessment of manual dexterity and perceived efficacy of daily activities must be considered as prognostic factors in the progression of the disease. These findings may help support further research on targeted interventions to improve dexterity deficiencies, as well as promote an improved quality of therapeutic interventions.
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17
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Tramontano M, Morone G, De Angelis S, Casagrande Conti L, Galeoto G, Grasso MG. Sensor-based technology for upper limb rehabilitation in patients with multiple sclerosis: A randomized controlled trial. Restor Neurol Neurosci 2020; 38:333-341. [PMID: 32925119 DOI: 10.3233/rnn-201033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sensor-based technological therapy devices may be good candidates for neuromotor rehabilitation of people with Multiple Sclerosis (MS), especially for treating upper extremities function limitations. The sensor-based device rehabilitation is characterized by interactive therapy games with audio-visual feedback that allows training the movement of shoulders, elbows, and wrist, measuring the strength and the active range of motion of upper limb, registering data in an electronic database to quantitatively monitoring measures and therapy progress. OBJECTIVE This study aimed to investigate the effects of sensor-based motor rehabilitation in add-on to the conventional neurorehabilitation, on increasing the upper limb functions of patients with MS. METHODS Thirty patients were enrolled in the study and randomly assigned to the experimental group and the control group. The training consisting of twelve sessions of upper limb training was compared with twelve sessions of upper limb sensory-motor training, without robotic support. Both rehabilitation programs were performed for 40 minutes three times a week, for 4 weeks, in addition to conventional therapy. All patients were evaluated at the baseline (T0) and after 4 weeks of training (T1). RESULTS The within-subject analysis showed a statistically significant improvement in both groups, in the Modified Barthel Index and in the Rivermead Mobility Index scores and a significant improvement in Multiple Sclerosis Quality of Life-54 in the experimental. The analysis of effectiveness revealed that, compared with baseline (T0), the improvement percentage in all clinical scale scores was greater in the experimental group than the control group. CONCLUSIONS Proposed training provides an intensive and functional-oriented rehabilitation that objectively evaluates achieved progress through exercises. Therefore, it can represent a good complementary strategy for hand rehabilitation in MS patients.
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Affiliation(s)
- Marco Tramontano
- Santa Lucia Foundation, IRCCS, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Rome, Italy
| | | | | | | | - Giovanni Galeoto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
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18
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Kalkers NF, Galan I, Kerbrat A, Tacchino A, Kamm CP, O'Connell K, McGuigan C, Edan G, Montalban X, Uitdehaag BM, Mokkink LB. Differential item functioning of the Arm function in Multiple Sclerosis Questionnaire (AMSQ) by language, a study in six countries. Mult Scler 2019; 27:90-96. [PMID: 31845614 DOI: 10.1177/1352458519895450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Arm function in Multiple Sclerosis Questionnaire (AMSQ) has been developed as a self-reported measure of arm and hand functioning for patients with multiple sclerosis (MS). The AMSQ was originally developed in Dutch and to date translated into five languages (i.e. English, German, Spanish, French, and Italian). OBJECTIVE The aim of this study was to evaluate differential item functioning (DIF) of the AMSQ in these languages. METHODS We performed DIF analyses, using "language" as the polytomous group variable. To detect DIF, logistic regression and item response theory principles were applied. Multiple logistic regression models were evaluated. We used a pseudo R2 value of 0.02 or more as the DIF threshold. RESULTS A total of 1733 male and female patients with all subtypes of MS were included. The DIF analysis for the whole dataset showed no uniform or non-uniform DIF on any of the 31 items. All R2 values were below 0.02. CONCLUSION The AMSQ is validated in six languages. All items have the same meaning to MS patients in Dutch, English, German, Spanish, French, and Italian. This validation study enables use of the AMSQ in international studies, for monitoring treatment response and disease progression.
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Affiliation(s)
- Nynke F Kalkers
- Department of Neurology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands/Department of Neurology, OLVG, Amsterdam, The Netherlands
| | - Ingrid Galan
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Anne Kerbrat
- Department of Neurology, Rennes University Hospital, Rennes, France
| | - Andrea Tacchino
- Scientific Research Area, Italian MS Foundation (FISM), Genoa, Italy
| | - Christian P Kamm
- Neurology and Neurorehabilitation Center, Lucerne Cantonal Hospital, Lucerne, Switzerland/Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Karen O'Connell
- Department of Neurology, St. Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Chris McGuigan
- Department of Neurology, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Gilles Edan
- Department of Neurology, Rennes University Hospital, Rennes, France
| | - Xavier Montalban
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Barcelona, Spain/Department of Neurology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Lidwine B Mokkink
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Location VUmc and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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19
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Responder rates to fampridine differ between clinical subgroups of MS patients and patient reported outcome influences treatment decision making. Mult Scler Relat Disord 2019; 38:101489. [PMID: 31731213 DOI: 10.1016/j.msard.2019.101489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 10/06/2019] [Accepted: 10/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fampridine is an effective treatment to improve ambulation for some multiple sclerosis (MS) patients. Remarkable discrepancies exist between responder rates in clinical trials and the proportion of patients continuing treatment in clinical practice. This may be related to clinical phenotypes of MS patients, and the influence of patient reported outcome (PRO) on treatment decision making. OBJECTIVE To analyse responder rates to fampridine on ambulation and upper extremity function (UEF) and the influence on treatment decision making in different clinical subgroups in a real-world setting. METHODS MS patients with ambulatory impairment treated with fampridine were included. Patients were subdivided based on disease duration, clinical phenotype, Expanded Disability Status Scale (EDSS), baseline walking speed, and presence of UEF impairment. Ambulatory response was assessed with the Timed 25-Foot Walk (T25FW, responder defined as ≥20% improvement) and with the MS Walking Scale (MSWS, responder defined as ≥8 points improvement) as a PRO. For patients also reporting impaired UEF, the Arm Function in MS Questionnaire (AMSQ, responder defined as ≥15 improvement) was the PRO of choice. Decision on treatment continuation was based on improvement of T25FW, MSWS and the clinicians' overall impression for improvement. RESULTS In total 344 patients were included of which 75.3% continued treatment. More patients with a relapsing clinical phenotype continued treatment vs patients with a progressive phenotype (83.6 vs 68.6%, p < 0.01). A positive linear trend was found between severity of walking disability, as determined by baseline walking speed, and T25FW response (p < 0.01), while there was an inverse linear association between walking disability and MSWS response (p = 0.03). However, the proportion of patients continuing treatment was similar between subgroups of baseline walking speed. Impaired UEF was reported by 183 (66.5%) patients, of which 64 (39.3%) were AMSQ responders. Patients responding on AMSQ compared to non-responders, were also more frequently MSWS responders (82.8 vs 65.3%, p = 0.02), while response on T25FW was similar, and continued treatment more often (85.9 vs 70.7%, p = 0.04). This suggests an influence of PRO on treatment decision making. CONCLUSION Responder rates and treatment continuation of fampridine differed between clinical subgroups of MS. PROs influenced treatment decision making of fampridine in clinical practice, particularly in patients with mild ambulatory impairment or those reporting UEF impairment. To some extent, these findings explain discrepancies found between clinical trials and clinical practice, and support the importance of subgroup analyses and incorporation of PROs in clinical trials. For clinical practice, using PROs to assess patients experience in conjunction with performance measures helps in treatment decision making.
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20
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Weygandt M, Behrens J, Brasanac J, Söder E, Meyer-Arndt L, Wakonig K, Ritter K, Brandt AU, Bellmann-Strobl J, Gold SM, Haynes JD, Paul F. Neural mechanisms of perceptual decision-making and their link to neuropsychiatric symptoms in multiple sclerosis. Mult Scler Relat Disord 2019; 33:139-145. [PMID: 31195338 DOI: 10.1016/j.msard.2019.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 05/17/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Decision-making (DM) capabilities are impaired in multiple sclerosis (MS). A variety of researchers hypothesized that this impairment is associated with reduced quality of life (QoL) and neuropsychiatric symptoms. Studies explicitly testing this hypothesis, however, are rare, provided inconclusive results, or evaluated only a limited selection of DM domains. Consequently, we conducted the first MS study on perceptual DM (e.g. deciding whether a car will fit into a parking lot based on a visual percept) to test this assumption. METHODS Specifically, we used an fMRI task that measured brain activity in 30 MS patients and 19 healthy controls (HCs) while the participants repeatedly decided whether objects referenced indirectly via their written object names would fit into a shoebox to investigate neural mechanisms of perceptual DM. The objects varied in size and thus decision difficulty. From these data, we determined voxel-wise brain activity parameters reflecting (i) decision difficulty and (ii) decision speed and related them to behavioral DM performance, QoL, mild to moderate depressive symptoms, and fatigue. RESULTS Patients showed reduced DM performance. Activity reflecting decision difficulty in the middle temporal gyrus was negatively related to DM performance across MS patients and HCs; activity reflecting decision speed in MS patients was associated with depressive symptoms and fatigue in areas of the dorsal visual stream. CONCLUSION The study shows that the perceptual DM capacity is reduced in MS. Moreover, the link between neural mechanisms of perceptual DM and neuropsychiatric symptoms suggests that an impairment in this domain is clinically relevant.
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Affiliation(s)
- Martin Weygandt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin Center for Advanced Neuroimaging, Department of Neurology, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Bernstein Center for Computational Neuroscience, Berlin 10117, Germany.
| | - Janina Behrens
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Berlin 10117, Germany
| | - Jelena Brasanac
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin 12203, Germany
| | - Eveline Söder
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, Germany
| | - Lil Meyer-Arndt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany
| | - Katharina Wakonig
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany
| | - Kerstin Ritter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin Center for Advanced Neuroimaging, Department of Neurology, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Bernstein Center for Computational Neuroscience, Berlin 10117, Germany
| | - Alexander U Brandt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany
| | - Judith Bellmann-Strobl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin 13125, Germany
| | - Stefan M Gold
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin 12203, Germany; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center, Hamburg 20251, Germany
| | - John-Dylan Haynes
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin Center for Advanced Neuroimaging, Department of Neurology, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Bernstein Center for Computational Neuroscience, Berlin 10117, Germany
| | - Friedemann Paul
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Berlin 10117, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin 13125, Germany
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21
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Buchmann I, Dangel M, Finkel L, Jung R, Makhkamova I, Binder A, Dettmers C, Herrmann L, Liepert J, Möller JC, Richter G, Vogler T, Wolf C, Randerath J. Limb apraxia profiles in different clinical samples. Clin Neuropsychol 2019; 34:217-242. [DOI: 10.1080/13854046.2019.1585575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ilka Buchmann
- University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | | | - Lisa Finkel
- University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | | | - Inara Makhkamova
- University of Konstanz, Konstanz, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andreas Binder
- Center for Neurological Rehabilitation, Rehaklinik Zihlschlacht, Zihlschlacht, Switzerland
| | - Christian Dettmers
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
- Kliniken Schmieder, Konstanz, Germany
| | - Laura Herrmann
- Klinik für Alterspsychiatrie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
| | - Joachim Liepert
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
- Kliniken Schmieder, Allensbach, Germany
| | - Jens Carsten Möller
- Center for Neurological Rehabilitation, Rehaklinik Zihlschlacht, Zihlschlacht, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
| | - Gabriel Richter
- Klinik für Alterspsychiatrie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
| | - Tobias Vogler
- Klinik für Alterspsychiatrie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
| | - Caroline Wolf
- Klinik für Alterspsychiatrie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
| | - Jennifer Randerath
- University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
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22
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van Beek JJW, van Wegen EEH, Bol CD, Rietberg MB, Kamm CP, Vanbellingen T. Tablet App Based Dexterity Training in Multiple Sclerosis (TAD-MS): Research Protocol of a Randomized Controlled Trial. Front Neurol 2019; 10:61. [PMID: 30804879 PMCID: PMC6378288 DOI: 10.3389/fneur.2019.00061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/17/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Patients with Multiple Sclerosis exhibit disturbed dexterity, leading to difficulties in fine motor skills such as buttoning a T-shirt or hand-writing. Consequently, activities of daily living and quality of life are affected. The aim of the present study is to investigate the effectiveness of a tablet app-based home-based training intervention to improve dexterity in patients with Multiple Sclerosis. Methods: An observer-blinded randomized controlled trial will be performed. Seventy patients with Multiple Sclerosis with self-reported difficulties in dexterity while executing activities of daily living will be recruited. After baseline assessment, participants are randomized to either an intervention group (n = 35) or control group (n = 35) by a computerized procedure. Blinded assessments will be done at baseline, post-intervention (after 4 weeks) and 12 weeks follow-up. The home-based intervention consists of a 4-week tablet app-based dexterity program. The app contains six dexterity games in which finger coordination, tapping, pinch grip is required. The control group will receive a Thera-band training program focused on strengthening the upper limb. The primary outcome is the Arm function of Multiple Sclerosis Questionnaire, a measure of patient-reported activities of daily living related dexterity. Secondary outcomes are dexterous function, hand strength, and quality of life. Discussion: This study will evaluate the effects of tablet app-based training for dexterity in patients with Multiple Sclerosis. We hypothesize that a challenging app-based dexterity program will improve dexterity both in the short term and the long-term. The improved finger and hand functions are expected to generalize to improved activities of daily living and quality of life.
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Affiliation(s)
- Judith J. W. van Beek
- Neurocenter, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Erwin E. H. van Wegen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, Amsterdam University Medical Center VUmc, Amsterdam, Netherlands
| | - Cleo D. Bol
- Neurocenter, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Marc B. Rietberg
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, Amsterdam University Medical Center VUmc, Amsterdam, Netherlands
| | - Christian P. Kamm
- Neurocenter, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Neurology, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
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Oagaz H, Schoun B, Pooji M, Choi MH. Neurocognitive Assessment in Virtual Reality Through Behavioral Response Analysis. IEEE J Biomed Health Inform 2018; 23:1899-1910. [PMID: 30442624 DOI: 10.1109/jbhi.2018.2881455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The ability to detect and diagnose neurocognitive disorders at the earliest possible moment is key to a better prognosis for the patient. Two of the earliest indicators of potential neurocognitive problems are motor and visual dysfunction. Motor disorders and problems in visual cognition can be seen in many neurocognitive disorders, resulting in abnormal physical reactions to visual stimuli. Analyzing physical behaviors when presented with such stimuli can provide insights into the visual perception and motor abilities of an individual, yet there is currently no unbiased, objective, general-purpose tool that analyzes attention and motor behavior to assess neurocognitive function. We propose a novel method of neurocognitive function assessment that tests the patient's cognition using virtual reality with eye tracking and motion analysis. By placing the patient in a controlled virtual environment and analyzing their movements, we can evoke certain physical responses from subjects for neurocognitive assessment. We have developed a prototype system that places the subject in a virtual baseball field and captures their full body motion as they try to catch baseballs. This scenario tests the subject's ability to determine the landing time and position of the ball, as well as the test subject's balance, motor skills, attention, and memory. Preliminary tests with 20 healthy normal individuals demonstrate the ability of this tool to assess the test subject's balance, memory, attention, and reaction to visual stimuli. This platform has a twofold contribution: it is used to assess several neurocognitive constructs that affect visual and motor capability neutrally and objectively based on controlled stimuli, and it enables objective comparison between different neurocognitive disorders research in this field.
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Ortiz-Rubio A, Cabrera-Martos I, Rodríguez-Torres J, Fajardo-Contreras W, Díaz-Pelegrina A, Valenza MC. Effects of a Home-Based Upper Limb Training Program in Patients With Multiple Sclerosis: A Randomized Controlled Trial. Arch Phys Med Rehabil 2016; 97:2027-2033. [DOI: 10.1016/j.apmr.2016.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/05/2016] [Accepted: 05/17/2016] [Indexed: 11/30/2022]
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van Leeuwen LM, Mokkink LB, Kamm CP, de Groot V, van den Berg P, Ostelo RWJG, Uitdehaag BMJ. Measurement properties of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ): a study based on Classical Test Theory. Disabil Rehabil 2016; 39:2097-2104. [PMID: 27665841 DOI: 10.1080/09638288.2016.1213898] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The construct validity, test-retest reliability, and measurement error of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) were examined. Additionally, the influence of administration-method on reliability and measurement error was investigated. METHOD 112 Dutch adult MS-patients from an academic- and a residential care-facility participated. Questionnaires were administered on paper, online or as interview, and patients performed several performance tests. Construct validity was assessed by testing pre-defined hypotheses. Reliability was assessed using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurements (SEMs) and Smallest Detectable Changes (SDCs). RESULTS For construct validity (N = 105) 9 of 13 hypotheses were confirmed (69%). As expected, the AMSQ showed moderate to strong relationships with the instruments measuring similar constructs. The test-retest reliability coefficient was 0.96 (95% Confidence Interval 0.94-0.97); SEM was 6.3 (6.3% of scale range); SDC was 17.5 (on a sale from 0 to 100). Different administration-methods showed good reliability (ICC 0.88-0.94) and small standard errors (SEM 5.6-7.2). CONCLUSION The AMSQ shows satisfying results for validity and excellent reliability; allowing for proper use in research. Due to a large SDC value, caution is needed when using the AMSQ in individual patient care. Further research should determine whether the SDC is smaller than the minimal important change. Implications for Rehabilitation The Arm Function in Multiple Sclerosis Questionnaire (AMSQ) measures activity limitations due to hand and arm functioning in patients with Multiple Sclerosis (MS). Results of this study confirm adequate validity and reliability of the AMSQ in patient with MS. The equivalence of scores from online, paper or interview administration is supported. A change score of ≥18 points on the scale of the AMSQ (on a scale 0-100) needs to occur to be certain a change beyond measurement error has occurred in an individual patient.
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Affiliation(s)
- Lisette M van Leeuwen
- a Department of Otolaryngology - Head and Neck Surgery, Section Ear & Hearing , EMGO Institute for Health and Care Research, VU University Medical Center , Amsterdam , The Netherlands
| | - Lidwine B Mokkink
- b Department of Epidemiology and Biostatistics, EMGO institute for Health and Care Research , VU University Medical Center , Amsterdam , The Netherlands
| | - Christian P Kamm
- c Department of Neurology, Inselspital , Bern University Hospital, University of Bern , Bern , Switzerland.,d Department of Neurology , VU University Medical Center , Amsterdam , The Netherlands
| | - Vincent de Groot
- e Department of Rehabilitation Medicine , VU University Medical Center , Amsterdam , The Netherlands
| | | | - Raymond W J G Ostelo
- b Department of Epidemiology and Biostatistics, EMGO institute for Health and Care Research , VU University Medical Center , Amsterdam , The Netherlands.,g Department of Health Sciences, Faculty of Earth and Life Science , EMGO Institute for Health and Care Research, VU University Medical Center , Amsterdam , The Netherlands
| | - Bernard M J Uitdehaag
- d Department of Neurology , VU University Medical Center , Amsterdam , The Netherlands
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Kamm CP, Mattle HP, Müri RM, Heldner MR, Blatter V, Bartlome S, Lüthy J, Imboden D, Pedrazzini G, Bohlhalter S, Hilfiker R, Vanbellingen T. Home-based training to improve manual dexterity in patients with multiple sclerosis: A randomized controlled trial. Mult Scler 2015; 21:1546-56. [DOI: 10.1177/1352458514565959] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/04/2014] [Indexed: 11/15/2022]
Abstract
Background: Impaired manual dexterity is frequent and disabling in patients with multiple sclerosis (MS), affecting activities of daily living (ADL) and quality of life. Objective: We aimed to evaluate the effectiveness of a standardized, home-based training program to improve manual dexterity and dexterity-related ADL in MS patients. Methods: This was a randomized, rater-blinded controlled trial. Thirty-nine MS patients acknowledging impaired manual dexterity and having a pathological Coin Rotation Task (CRT), Nine Hole Peg Test (9HPT) or both were randomized 1:1 into two standardized training programs, the dexterity training program and the theraband training program. Patients trained five days per week in both programs over a period of 4 weeks. Primary outcome measures performed at baseline and after 4 weeks were the CRT, 9HPT and a dexterous-related ADL questionnaire. Secondary outcome measures were the Chedoke Arm and Hand Activity Inventory (CAHAI-8) and the JAMAR test. Results: The dexterity training program resulted in significant improvements in almost all outcome measures at study end compared with baseline. The theraband training program resulted in mostly non-significant improvements. Conclusion: The home-based dexterity training program significantly improved manual dexterity and dexterity-related ADL in moderately disabled MS patients. Trial Registration NCT01507636.
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Affiliation(s)
- Christian P Kamm
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - René M Müri
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Verena Blatter
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Sandrine Bartlome
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Judith Lüthy
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Debora Imboden
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Giovanna Pedrazzini
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland
| | - Roger Hilfiker
- HES-SO Valais-Wallis, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland Valais, Sion, Switzerland
| | - Tim Vanbellingen
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland/Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland
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Abstract
BACKGROUND Impaired manual dexterity is frequent and disabling in people with multiple sclerosis (MS). Therefore, convenient, quick, and validated tests for manual dexterity in people with MS are needed. OBJECTIVE The aim of this study was to validate the Coin Rotation Task (CRT) for examining manual dexterity in people with MS. DESIGN This was a cross-sectional study. METHODS A total of 101 outpatients with MS were assessed with the CRT, the Expanded Disability Status Scale (EDSS), the Scale for the Assessment and Rating of Ataxia (SARA), and the Modified Ashworth Scale (MAS); muscle strength and sensory deficits of the hands were noted. The concurrent validity and diagnostic accuracy of the CRT were determined by comparison with the 9-Hole Peg Test (9HPT). Construct validity was determined by comparison with a valid dexterity questionnaire. Multiple regression analyses were done to explore correlations of the CRT with the EDSS, SARA, MAS, muscle strength, and sensory deficits. RESULTS The CRT correlated significantly with the 9HPT (r=.73, P<.0001), indicating good concurrent validity. The cutoff values for the CRT relative to the 9HPT were 18.75 seconds for the dominant hand (sensitivity=81.5%, specificity=80.0%) and 19.25 seconds for the nondominant hand (sensitivity=90.3%, specificity=81.8%); these values indicated good diagnostic accuracy. Furthermore, the CRT correlated significantly with the dexterity questionnaire (r=-.49, P<.0001), indicating moderate construct validity. Multiple regression analyses revealed that the EDSS was the strongest predictor for impaired dexterity. LIMITATIONS Most of the people examined had relapsing-remitting MS and EDSS scores of up to 7. CONCLUSIONS This study validated the CRT as a test that can be used easily and quickly to evaluate manual dexterity in people with MS.
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Lamers I, Kelchtermans S, Baert I, Feys P. Upper limb assessment in multiple sclerosis: a systematic review of outcome measures and their psychometric properties. Arch Phys Med Rehabil 2014; 95:1184-200. [PMID: 24631802 DOI: 10.1016/j.apmr.2014.02.023] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/30/2014] [Accepted: 02/25/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide an overview of applied upper limb outcome measures in multiple sclerosis (MS) according to the International Classification of Functioning, Disability and Health (ICF) levels and to review their psychometric properties in MS. DATA SOURCES PubMed and Web of Knowledge. STUDY SELECTION Articles published until June 2013 were selected when written in English, published in the last 25 years, peer reviewed, including >5 persons with MS, and including standardized clinical upper limb outcome measures. Included articles were screened based on title/abstract and full text by 2 independent reviewers. In case of doubt, feedback from a third independent reviewer was obtained. Additionally, references lists were checked for relevant articles. Of the articles, 109 met the selection criteria and were included for data extraction. DATA EXTRACTION All reported clinical upper limb outcome measures were extracted from the included studies and classified according to the ICF levels by 2 independent reviewers. In addition, available psychometric properties (reliability, validity, responsiveness) in MS were summarized and discussed. DATA SYNTHESIS A diversity of outcome measures assessing impairments on the body functions and structures level (n=33), upper limb capacity (n=11), and performance (n=8) on the activity level were extracted from 109 articles. Hand grip strength and the nine-hole peg test (NHPT) were the most frequently used outcome measures. However, multiple outcome measures are necessary to encapsulate the multidimensional character of the upper limb function. The psychometric properties were insufficiently documented for most of the outcome measures, except for the NHPT. CONCLUSIONS The results of this review may help with the selection of appropriate outcome measures and may guide future research regarding the psychometric properties in MS.
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Affiliation(s)
- Ilse Lamers
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
| | - Silke Kelchtermans
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Ilse Baert
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Peter Feys
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Norman KE, Héroux ME. Measures of fine motor skills in people with tremor disorders: appraisal and interpretation. Front Neurol 2013; 4:50. [PMID: 23717299 PMCID: PMC3650669 DOI: 10.3389/fneur.2013.00050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/24/2013] [Indexed: 12/04/2022] Open
Abstract
People with Parkinson's disease, essential tremor, or other movement disorders involving tremor have changes in fine motor skills that are among the hallmarks of these diseases. Numerous measurement tools have been created and other methods devised to measure such changes in fine motor skills. Measurement tools may focus on specific features - e.g., motor skills or dexterity, slowness in movement execution associated with parkinsonian bradykinesia, or magnitude of tremor. Less obviously, some tools may be better suited than others for specific goals such as detecting subtle dysfunction early in disease, revealing aspects of brain function affected by disease, or tracking changes expected from treatment or disease progression. The purpose of this review is to describe and appraise selected measurement tools of fine motor skills appropriate for people with tremor disorders. In this context, we consider the tools' content - i.e., what movement features they focus on. In addition, we consider how measurement tools of fine motor skills relate to measures of a person's disease state or a person's function. These considerations affect how one should select and interpret the results of these tools in laboratory and clinical contexts.
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Affiliation(s)
- Kathleen E. Norman
- School of Rehabilitation Therapy, Queen’s UniversityKingston, ON, Canada
- Centre for Neuroscience Studies, Queen’s UniversityKingston, ON, Canada
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Ozkan S, Adapinar DO, Elmaci NT, Arslantas D. Apraxia for differentiating Alzheimer's disease from subcortical vascular dementia and mild cognitive impairment. Neuropsychiatr Dis Treat 2013; 9:947-51. [PMID: 23882142 PMCID: PMC3709829 DOI: 10.2147/ndt.s47879] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although ideomotor limb apraxia is considered to be a typical sign of cortical pathologies such as Alzheimer's disease (AD), it has been also reported in subcortical neurodegenerative diseases and vascular lesions. We aimed to investigate the difference between AD, subcortical vascular dementia (SVaD) and mild cognitive impairment (MCI) patients by means of ideomotor limb apraxia frequency and severity. Ninety-six AD, 72 SVaD, and 84 MCI patients were assessed with the mini-mental status examination (MMSe), clinical dementia rating (CDR) and the apraxia screening test of TULIA (AST). Apraxia was significantly more frequent in the AD patients (32.3%) than in both of the SVaD (16.7%) and MCI (4.8%) patients. The frequency of apraxia was also significantly higher in SVaD patients than in MCI patients. AD patients had significantly lower apraxia scores than both SVaD and MCI patients. In addition, a significant difference was found between SVaD and MCI patients in terms of apraxia scores. These results suggest that the widespread belief of the association between apraxia and cortical dementias is not exactly correct. The significant difference between both of the dementia groups and the MCI patients suggests that the absence of apraxia can be an indicator for MCI diagnosis.
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Affiliation(s)
- Serhat Ozkan
- Department of Neurology, Eskişehir Osmangazi University Medical Faculty, Eskisehir, Turkey
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