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Sarasso E, Filippi M, Agosta F. Clinical and MRI features of gait and balance disorders in neurodegenerative diseases. J Neurol 2023; 270:1798-1807. [PMID: 36577818 DOI: 10.1007/s00415-022-11544-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
Gait and balance disorders are common signs in several neurodegenerative diseases such as Parkinson's disease, atypical parkinsonism, idiopathic normal pressure hydrocephalus, cerebrovascular disease, dementing disorders and multiple sclerosis. According to each condition, patients present with different gait and balance alterations depending on the structural and functional brain changes through the disease course. In this review, we will summarize the main clinical characteristics of gait and balance disorders in the major neurodegenerative conditions, providing an overview of the significant structural and functional MRI brain alterations underlying these deficits. We also will discuss the role of neurorehabilitation strategies in promoting brain plasticity and gait/balance improvements in these patients.
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Affiliation(s)
- Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Ragothaman A, Mancini M, Nutt JG, Fair DA, Miranda-Dominguez O, Horak FB. Resting state functional networks predict different aspects of postural control in Parkinson's disease. Gait Posture 2022; 97:122-129. [PMID: 35931013 DOI: 10.1016/j.gaitpost.2022.07.003] [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: 01/13/2022] [Revised: 06/17/2022] [Accepted: 07/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disorder causing postural control impairments. Postural control involves multiple domains, such as control of postural sway in stance, automatic postural responses (APRs) and anticipatory postural adjustments (APAs). We hypothesize that impairments in each postural domain is associated with resting-state functional connectivity (rsFC), accounted by predictive modeling and that cortical and cerebellar networks would predict postural control in people with PD (PwPD). OBJECTIVE To determine whether rsFC can predict three domains of postural control independently in PwPD and older adults (OA) based on predictive accuracy of models. METHODS The cohort consisted of 65 PwPD (67.7 +8.1 age) tested in their OFF-state and 42 OA (69.7 +8.2 age). Six body-worn, inertial sensors measured postural sway area while standing on foam, step length of APRs to a backward push-and-release perturbation, and magnitude of lateral APAs prior to voluntary gait initiation. Resting state-fMRI data was reported on 384 regions of interest that were grouped into 13 functional brain networks. Associations between rsFC and postural metrics were characterized using predictive modeling, with an independent training (n = 67) and validation (n = 40) dataset. Models were trained in the training sample and performance of the best model was validated in the independent test dataset. RESULTS rsFC of different brain networks predicted each domain of postural control in PD: Frontoparietal and Ventral Attention rsFC for APAs; Cerebellar-Subcortical and Visual rsFC and Auditory and Cerebellar-Subcortical rsFC for APRs; Ventral Attention and Ventral Multimodal rsFC for postural sway. In OA, CinguloOpercular and Somatomotor rsFC predicted APAs. CONCLUSIONS Our findings suggest that cortical networks predict postural control in PD and there is little overlap in brain network connectivities that predict different domains of postural control, given the rsFC methodology used. PwPD use different cortical networks for APAs compared to OA.
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Affiliation(s)
| | - Martina Mancini
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR 97239, USA; Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
| | - John G Nutt
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
| | - Damien A Fair
- Masonic Institute for the Developing Brain (MIDB), University of Minnesota, Minneapolis, MN 55455, USA; Institute of Child Development, College of Education and Human Development, University of Minnesota, Minneapolis, MN 55455, USA; Department of Pediatrics, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN 55455, USA; Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR 97239, USA
| | - Oscar Miranda-Dominguez
- Masonic Institute for the Developing Brain (MIDB), University of Minnesota, Minneapolis, MN 55455, USA; Department of Pediatrics, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN 55455, USA
| | - Fay B Horak
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR 97239, USA; Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA.
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Riem L, Beardsley SA, Obeidat AZ, Schmit BD. Visual oscillation effects on dynamic balance control in people with multiple sclerosis. J Neuroeng Rehabil 2022; 19:90. [PMID: 35978431 PMCID: PMC9382748 DOI: 10.1186/s12984-022-01060-0] [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: 03/16/2022] [Accepted: 06/15/2022] [Indexed: 12/03/2022] Open
Abstract
Background People with multiple sclerosis (PwMS) have balance deficits while ambulating through environments that contain moving objects or visual manipulations to perceived self-motion. However, their ability to parse object from self-movement has not been explored. The purpose of this research was to examine the effect of medial–lateral oscillations of the visual field and of objects within the scene on gait in PwMS and healthy age-matched controls using virtual reality (VR). Methods Fourteen PwMS (mean age 49 ± 11 years, functional gait assessment score of 27.8 ± 1.8, and Berg Balance scale score 54.7 ± 1.5) and eleven healthy controls (mean age: 53 ± 12 years) participated in this study. Dynamic balance control was assessed while participants walked on a treadmill at a self-selected speed while wearing a VR headset that projected an immersive forest scene. Visual conditions consisted of (1) no visual manipulations (speed-matched anterior/posterior optical flow), (2) 0.175 m mediolateral translational oscillations of the scene that consisted of low pairing (0.1 and 0.31 Hz) or (3) high pairing (0.15 and 0.465 Hz) frequencies, (4) 5 degree medial–lateral rotational oscillations of virtual trees at a low frequency pairing (0.1 and 0.31 Hz), and (5) a combination of the tree and scene movements in (3) and (4). Results We found that both PwMS and controls exhibited greater instability and visuomotor entrainment to simulated mediolateral translation of the visual field (scene) during treadmill walking. This was demonstrated by significant (p < 0.05) increases in mean step width and variability and center of mass sway. Visuomotor entrainment was demonstrated by high coherence between center of mass sway and visual motion (magnitude square coherence = ~ 0.5 to 0.8). Only PwMS exhibited significantly greater instability (higher step width variability and center of mass sway) when objects moved within the scene (i.e., swaying trees). Conclusion Results suggest the presence of visual motion processing errors in PwMS that reduced dynamic stability. Specifically, object motion (via tree sway) was not effectively parsed from the observer’s self-motion. Identifying this distinction between visual object motion and self-motion detection in MS provides insight regarding stability control in environments with excessive external movement, such as those encountered in daily life.
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Affiliation(s)
- Lara Riem
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Scott A Beardsley
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Ahmed Z Obeidat
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA.
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Impact of pathological conditions on postural reflex latency and adaptability following unpredictable perturbations: A systematic review and meta-analysis. Gait Posture 2022; 95:149-159. [PMID: 35500364 DOI: 10.1016/j.gaitpost.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/01/2022] [Accepted: 04/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pathological conditions can impair responses to postural perturbations and increase risk of falls. RESEARCH QUESTION To what extent are postural reflexes impaired in people with pathological conditions and can exercise interventions shorten postural reflexes? METHODS MEDLINE, EMBASE, Scopus, SportDiscus and Web of Science were systematically searched for articles comparing muscle activation onset latency in people with pathological conditions to healthy controls following unpredictable perturbations including the effect of exercise interventions (registration: CRD42020170861). RESULTS Fifty-three articles were included for systematic review. Significant delays in muscle activity onset following perturbations were evident in people with multiple sclerosis (n = 7, mean difference [MD]: 22 ms, 95% confidence interval [CI]: 11, 33), stroke (n = 10, MD: 34 ms, 95% CI: 19, 49), diabetes (n = 2, MD: 19 ms, 95% CI: 10, 27), HIV (n = 3, MD: 9 ms, 95% CI: 4, 14), incomplete spinal cord injury (n = 2, MD: 57 ms, 95% CI: 33, 80) and back and knee pain (n = 7, MD: 12 ms, 95% CI: 6, 18), but not in people with Parkinson's disease (n = 10) or cerebellar dysfunction (n = 4). Following exercise interventions, the paretic limb of stroke survivors (n = 3) displayed significantly faster muscle activation onset latency compared to pre-exercise (MD: -13 ms, 95% CI: -24, -4), with no significant changes in Parkinson's disease (n = 3). CONCLUSIONS This systematic review demonstrated that postural reflexes are significantly delayed in people with multiple sclerosis (+22 ms), stroke (+34 ms), diabetes (+19 ms), HIV (+9 ms), incomplete spinal cord injury (+57 ms), back and knee pain (+12 ms); pathological conditions characterized by impaired sensation or neural function. In contrast, timing of postural reflexes was not impaired in people with Parkinson's disease and cerebellar dysfunction, confirming the limited involvement of supraspinal structures. The meta-analysis showed exercise interventions can significantly shorten postural reflex latencies in stroke survivors (-14 ms), but more research is needed to confirm this finding and in people with other pathological conditions.
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Mohamed Suhaimy MSB, Lord SR, Hoang PD, Nieto A, Sturnieks DL, Okubo Y. Reactive balance responses to a trip and slip during gait in people with multiple sclerosis. Clin Biomech (Bristol, Avon) 2021; 90:105511. [PMID: 34710843 DOI: 10.1016/j.clinbiomech.2021.105511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/20/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To examine reactive balance responses to a trip and slip during gait in people with multiple sclerosis (MS). METHODS This cross-sectional laboratory study involved 29 participants with MS (50.6 ± 13.4 years) and 29 gender-and-aged-matched healthy controls (50.9 ± 19.2 years). Falls following an induced trip and slip along a 10 m walkway, approach (e.g. gait speed, step length, foot contact angle) and recovery strategies (e.g. response time, extrapolated centre of mass position, margin of stability) were compared between the two groups. FINDINGS The rate of falls was significantly higher in the participants with MS relative to healthy controls (rate ratio=2.82, 95% confidence interval [CI]=1.42, 5.61). Participants with MS also experienced more trip falls (odds ratio [OR]=3.90, 95% CI=1.16, 13.08) and more slip falls (OR=6.27, 95% CI=1.95, 20.22) than the heathy controls. Participants with MS had significantly slower gait speed, step length, cadence, and foot contact angle during approach (P < 0.05). Following slips, participants with MS had significantly greater stance limb knee flexion (P < 0.05), suggesting inadequate lower limb support to recover balance post-slip. Following trips, participants with MS had significantly delayed response initiation, lower toe clearance, shorter step length, and greater trunk sway (P < 0.05). Fewer participants with MS showed a hopping response to clear the obstacle (P < 0.05). INTERPRETATION Multiple sclerosis impairs reactive balance responses to a trip and slip associated with reduced lower limb function and delayed postural responses. Neurorehabilitation targeting reactive balance may facilitate fall prevention in people with multiple sclerosis.
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Affiliation(s)
| | - Stephen R Lord
- Faculty of Medicine and Health, University of New South Wales, UNSW Sydney, Sydney, NSW 2052, Australia; Falls, Balance, and Injury Research Centre, Neuroscience Research, 139 Barker Street, Randwick, NSW 2031, Australia
| | - Phu D Hoang
- Faculty of Medicine and Health, University of New South Wales, UNSW Sydney, Sydney, NSW 2052, Australia; Falls, Balance, and Injury Research Centre, Neuroscience Research, 139 Barker Street, Randwick, NSW 2031, Australia
| | - Alex Nieto
- Worcester Polytechnic Institute, 100 Institute Rd, Worcester, MA 01609, United States
| | - Daina L Sturnieks
- Faculty of Medicine and Health, University of New South Wales, UNSW Sydney, Sydney, NSW 2052, Australia; Falls, Balance, and Injury Research Centre, Neuroscience Research, 139 Barker Street, Randwick, NSW 2031, Australia
| | - Yoshiro Okubo
- Faculty of Medicine and Health, University of New South Wales, UNSW Sydney, Sydney, NSW 2052, Australia; Falls, Balance, and Injury Research Centre, Neuroscience Research, 139 Barker Street, Randwick, NSW 2031, Australia.
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Monaghan AS, Peterson DS. Torque responses to in-place-perturbations in people with multiple sclerosis. Gait Posture 2021; 84:346-351. [PMID: 33454502 DOI: 10.1016/j.gaitpost.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/26/2020] [Accepted: 01/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Automatic postural responses are critical to prevent falls after a loss of balance. Although responses have been shown to be delayed in people with multiple sclerosis (PwMS), the degree to which other aspects of these movements are impacted by MS remains unknown. RESEARCH QUESTION Do responses to in-place support-surface perturbations differ in PwMS compared to neurotypical adults? Are these responses related to a functional measure of postural response performance- center of mass (COM) displacement?. METHOD 52 PwMS and 20 neurotypical, age-matched adults (NA) experienced backward support surface perturbations resulting in forward loss of balance and requiring an in-place response. Center of pressure (COP) and torque were calculated from force plates while center of mass (COM) approximations were collected via motion capture. Primary outcomes were maximal torque production at the foot and its timing, rate, and onset. RESULTS PwMS and NA demonstrated no differences in maximal torque production (p = 0.79), timing of maximal torque (p = 0.29), rate of torque development (p = 0.76), or the onset of AP COP movement (p = 0.44). There was a significant negative association between the rate of torque development and forward COM displacement in both groups (Control: r=-0.64, p = 0.002; MS: r=-0.35, p = 0.01). Larger maximal torque production was also associated with smaller COM displacement in PwMS (r=-0.33, p = 0.02). CONCLUSION Torque profiles in response to backward support surface translations resulting in feet in-place responses were similar in people with mild MS and neurotypical adults. The rate of development and maximal torque were however correlated to functional postural response outcomes. These findings suggest that while not worse in PwMS during in-place perturbations, force-responses seem to be important predictors of the effectiveness of reactive postural control responses.
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Affiliation(s)
- Andrew S Monaghan
- Arizona State University, College of Health Solutions, United States
| | - Daniel S Peterson
- Arizona State University, College of Health Solutions, United States; Phoenix VA Medical Center, Department of Veterans Affairs, United States.
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Mohamed Suhaimy MSB, Okubo Y, Hoang PD, Lord SR. Reactive Balance Adaptability and Retention in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2020; 34:675-685. [PMID: 32507036 DOI: 10.1177/1545968320929681] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim. To compare reactive balance in people with multiple sclerosis (MS) with healthy controls and to examine the ability of people with MS to adapt their reactive balance and retain training effects. Data Sources. Electronic databases (PubMed, EMBASE, PsychINFO) and reference lists of included articles from inception to February 25, 2019. Study Selection. Case-control and intervention studies that assessed reactive balance using mechanical perturbations in people with a confirmed diagnosis of MS. Results. Meta-analyses of 9 studies (n = 342) showed that people with MS have significantly worse reactive balance than healthy controls (standardized mean difference [SMD] 0.78, 95% CI 0.44-1.11, P < .0001, I2 = 47%). Specifically, people with MS have greater center of mass displacements (SMD 0.41, 95% CI 0.05-0.77, P = .02, I2 = 9%) and longer response times (MD (ms) 31.45, 95% CI 19.91-42.98, P < .0001, I2 = 75%) in response to standing perturbations than healthy controls. Subsequent meta-analyses revealed training comprising repeated exposure to perturbations improved response times (P < .001) and training effects on response times could be retained for 24 hours (P < .001) in people with MS. Conclusions. Reactive balance assessments can highlight functional impairments related to falls in people with MS, and perturbation training can acutely improve reactive balance control and such improvements can be retained for 24 hours in this population. Systematic review registration number: CRD42019126130.
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Affiliation(s)
| | - Yoshiro Okubo
- University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Phu D Hoang
- University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Stephen R Lord
- University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
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Bonnechère B, Van Hove O, Jansen B, Van Sint Jan S. Validation of the Wii Balance Board to assess static balance during dual-task activity in healthy subjects. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2019. [DOI: 10.1016/j.medntd.2019.100003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Findling O, Rust H, Yaldizli Ö, Timmermans DPH, Scheltinga A, Allum JHJ. Balance Changes in Patients With Relapsing-Remitting Multiple Sclerosis: A Pilot Study Comparing the Dynamics of the Relapse and Remitting Phases. Front Neurol 2018; 9:686. [PMID: 30186223 PMCID: PMC6110896 DOI: 10.3389/fneur.2018.00686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/30/2018] [Indexed: 11/15/2022] Open
Abstract
Aims: To compare balance changes over time during the relapse phase of relapsing-remitting multiple sclerosis (RRMS) with balance control during the remitting phase. Methods: Balance control during stance and gait tasks of 24 remitting-phase patients (mean age 43.7 ± 10.5, 15 women, mean EDSS at baseline 2.45 ± 1.01) was examined every 3 months over 9 months and compared to that of nine relapsing patients (age 42.0 ± 12.7, all women, mean EDSS at relapse onset 3.11 ± 0.96) examined at relapse onset and 3 months later. Balance was also compared to that of 40 healthy controls (HCs) (age 39.7 ± 12.6, 25 women). Balance control was measured as lower-trunk sway angles with body-worn gyroscopes. Expanded Disability Status Scale scores (EDSS) were used to monitor, clinically, disease progression. Results: Remitting-phase patients showed more unstable stance balance control than HCs (p < 0.04) with no worsening over the observation period of 9 months. Gait balance control was normal (p > 0.06). Relapsing patients had stance balance control significantly worse at onset compared to remitting-phase patients and HCs (p < 0.04). Gait tasks showed a significant decrease of gait speed and trunk sway in relapsing patients (p = 0.018) compatible with having increased gait instability at normal speeds. Improvement to levels of remitting patients generally took longer than 3 months. Balance and EDSS scores were correlated for remitting but not for relapse patients. Conclusions: Balance in remitting RRMS patients does not change significantly over 9 months and correlated well with EDSS scores. Our results indicate that balance control is a useful measure to assess recovery after a relapse, particularly in patients with unchanged EDSS scores. Based on our results, balance could be considered as additional measurement to assess recovery after a relapse, particularly in patients with unchanged EDSS.
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Affiliation(s)
- Oliver Findling
- Department of Neurology, University of Basel Hospital, Basel, Switzerland
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Heiko Rust
- Department of Neurology, University of Basel Hospital, Basel, Switzerland
- Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Özgür Yaldizli
- Department of Neurology, University of Basel Hospital, Basel, Switzerland
| | - Dionne P. H. Timmermans
- Radboud University Nijmegen, Nijmegen, Netherlands
- Division of Audiology and Neurootology, Department of ORL, University of Basel Hospital, Basel, Switzerland
| | - Alja Scheltinga
- Radboud University Nijmegen, Nijmegen, Netherlands
- Division of Audiology and Neurootology, Department of ORL, University of Basel Hospital, Basel, Switzerland
| | - John H. J. Allum
- Department of Neurology, University of Basel Hospital, Basel, Switzerland
- Division of Audiology and Neurootology, Department of ORL, University of Basel Hospital, Basel, Switzerland
- *Correspondence: John H. J. Allum
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Improvement of postural control in individuals with multiple sclerosis after a single-session of ball throwing exercise. Mult Scler Relat Disord 2017; 17:224-229. [DOI: 10.1016/j.msard.2017.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 12/11/2022]
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Peterson DS, Fling BW. How changes in brain activity and connectivity are associated with motor performance in people with MS. Neuroimage Clin 2017; 17:153-162. [PMID: 29071209 PMCID: PMC5651557 DOI: 10.1016/j.nicl.2017.09.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 01/18/2023]
Abstract
People with multiple sclerosis (MS) exhibit pronounced changes in brain structure, activity, and connectivity. While considerable work has begun to elucidate how these neural changes contribute to behavior, the heterogeneity of symptoms and diagnoses makes interpretation of findings and application to clinical practice challenging. In particular, whether MS related changes in brain activity or brain connectivity protect against or contribute to worsening motor symptoms is unclear. With the recent emergence of neuromodulatory techniques that can alter neural activity in specific brain regions, it is critical to establish whether localized brain activation patterns are contributing to (i.e. maladaptive) or protecting against (i.e. adaptive) progression of motor symptoms. In this manuscript, we consolidate recent findings regarding changes in supraspinal structure and activity in people with MS and how these changes may contribute to motor performance. Furthermore, we discuss a hypothesis suggesting that increased neural activity during movement may be either adaptive or maladaptive depending on where in the brain this increase is observed. Specifically, we outline preliminary evidence suggesting sensorimotor cortex activity in the ipsilateral cortices may be maladaptive in people with MS. We also discuss future work that could supply data to support or refute this hypothesis, thus improving our understanding of this important topic.
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Affiliation(s)
- Daniel S Peterson
- Arizona State University, Tempe, AZ, USA; Veterans Affairs Phoenix Medical Center Phoenix, AZ, USA.
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