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Özgür S, Koçaslan Toran M, Toygar İ, Yalçın GY, Eraksoy M. A machine learning approach to determine the risk factors for fall in multiple sclerosis. BMC Med Inform Decis Mak 2024; 24:215. [PMID: 39080657 PMCID: PMC11289943 DOI: 10.1186/s12911-024-02621-0] [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: 04/03/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Falls in multiple sclerosis can result in numerous problems, including injuries and functional loss. Therefore, determining the factors contributing to falls in people with Multiple Sclerosis (PwMS) is crucial. This study aims to investigate the contributing factors to falls in multiple sclerosis using a machine learning approach. METHODS This cross-sectional study was conducted with 253 PwMS admitted to the outpatient clinic of a university hospital between February and August 2023. A sociodemographic data collection form, Fall Efficacy Scale (FES-I), Berg Balance Scale (BBS), Fatigue Severity Scale (FSS), Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale (MSIS-29), and Timed 25 Foot Walk Test (T25-FW) were used for data collection. Gradient-boosting algorithms were employed to predict the important variables for falls in PwMS. The XGBoost algorithm emerged as the best performed model in this study. RESULTS Most of the participants (70.0%) were female, with a mean age of 40.44 ± 10.88 years. Among the participants, 40.7% reported a fall history in the last year. The area under the curve value of the model was 0.713. Risk factors of falls in PwMS included MSIS-29 (0.424), EDSS (0.406), marital status (0.297), education level (0.240), disease duration (0.185), age (0.130), family type (0.119), smoking (0.031), income level (0.031), and regular exercise habit (0.026). CONCLUSIONS In this study, smoking and regular exercise were the modifiable factors contributing to falls in PwMS. We recommend that clinicians facilitate the modification of these factors in PwMS. Age and disease duration were non-modifiable factors. These should be considered as risk increasing factors and used to identify PwMS at risk. Interventions aimed at reducing MSIS-29 and EDSS scores will help to prevent falls in PwMS. Education of individuals to increase knowledge and awareness is recommended. Financial support policies for those with low income will help to reduce the risk of falls.
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Affiliation(s)
- Su Özgür
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Türkiye
- Ege University Faculty of Medicine, EgeSAM-Translational Pulmonary Research Center, Bornova, İzmir, Türkiye
| | - Meryem Koçaslan Toran
- Bahçeşehir University, Institution of Postgraduate Education, Istanbul, Türkiye
- Üsküdar University Faculty of Health Sciences, Istanbul, Türkiye
| | - İsmail Toygar
- Muğla Sıtkı Koçman University, Fethiye Faculty of Health Sciences , Fethiye, Muğla, Türkiye.
| | - Gizem Yağmur Yalçın
- Istanbul University-Cerrahpasa, Institute of Graduate Studies, Istanbul, Türkiye
| | - Mefkure Eraksoy
- Department of Neurology, Istanbul University Faculty of Medicine, Istanbul, Türkiye
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Monaghan PG, Monaghan AS, Hooyman A, Fling BW, Huisinga JM, Peterson DS. Using the Instrumented Sway System (ISway) to Identify and Compare Balance Domain Deficits in People With Multiple Sclerosis. Arch Phys Med Rehabil 2023; 104:1456-1464. [PMID: 37037293 PMCID: PMC10524722 DOI: 10.1016/j.apmr.2023.02.018] [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: 06/28/2022] [Revised: 01/27/2023] [Accepted: 02/24/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To develop a multiple sclerosis (MS)-specific model of balance and examine differences between (1) MS and neurotypical controls and (2) people with MS (PwMS) with (MS-F) and without a fall history (MS-NF). DESIGN AND SETTING A cross-sectional study was conducted at the Gait and Balance Laboratory at the University of Kansas Medical Center. Balance was measured from the instrumented sway system (ISway) assessment. PARTICIPANTS In total, 118 people with relapsing-remitting MS (MS-F=39; MS-NF=79) and 46 age-matched neurotypical controls. INTERVENTION Not applicable. OUTCOME MEASURES A total of 22 sway measures obtained from the ISway were entered into an exploratory factor analysis to identify underlying balance domains. The model-derived balance domains were compared between (1) PwMS and age-matched, neurotypical controls and (2) MS-F and MS-NF. RESULTS Three distinct balance domains were identified: (1) sway amplitude and velocity, (2) sway frequency and jerk mediolateral, and (3) sway frequency and jerk anteroposterior, explaining 81.66% of balance variance. PwMS exhibited worse performance (ie, greater amplitude and velocity of sway) in the sway velocity and amplitude domain compared to age-matched neurotypical controls (P=.003). MS-F also exhibited worse performance in the sway velocity and amplitude domain compared to MS-NF (P=.046). The anteroposterior and mediolateral sway frequency and jerk domains were not different between PwMS and neurotypical controls nor between MS-F and MS-NF. CONCLUSIONS This study identified a 3-factor, MS-specific balance model, demonstrating that PwMS, particularly those with a fall history, exhibit disproportionate impairments in sway amplitude and velocity. Identifying postural stability outcomes and domains that are altered in PwMS and clinically relevant (eg, related to falls) would help isolate potential treatment targets.
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Affiliation(s)
| | | | - Andrew Hooyman
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ
| | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO
| | - Jessie M Huisinga
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, KS
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, Phoenix, AZ; Phoenix VA Health Care Center, Phoenix, AZ.
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Sandroff BM, Rafizadeh CM, Motl RW. Neuroimaging Technology in Exercise Neurorehabilitation Research in Persons with MS: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094530. [PMID: 37177732 PMCID: PMC10181711 DOI: 10.3390/s23094530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
There is increasing interest in the application of neuroimaging technology in exercise neurorehabilitation research among persons with multiple sclerosis (MS). The inclusion and focus on neuroimaging outcomes in MS exercise training research is critical for establishing a biological basis for improvements in functioning and elevating exercise within the neurologist's clinical armamentarium alongside disease modifying therapies as an approach for treating the disease and its consequences. Indeed, the inclusion of selective neuroimaging approaches and sensor-based technology among physical activity, mobility, and balance outcomes in such MS research might further allow for detecting specific links between the brain and real-world behavior. This paper provided a scoping review on the application of neuroimaging in exercise training research among persons with MS based on searches conducted in PubMed, Web of Science, and Scopus. We identified 60 studies on neuroimaging-technology-based (primarily MRI, which involved a variety of sequences and approaches) correlates of functions, based on multiple sensor-based measures, which are typically targets for exercise training trials in MS. We further identified 12 randomized controlled trials of exercise training effects on neuroimaging outcomes in MS. Overall, there was a large degree of heterogeneity whereby we could not identify definitive conclusions regarding a consistent neuroimaging biomarker of MS-related dysfunction or singular sensor-based measure, or consistent neural adaptation for exercise training in MS. Nevertheless, the present review provides a first step for better linking correlational and randomized controlled trial research for the development of high-quality exercise training studies on the brain in persons with MS, and this is timely given the substantial interest in exercise as a potential disease-modifying and/or neuroplasticity-inducing behavior in this population.
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Affiliation(s)
- Brian M Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Caroline M Rafizadeh
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL 60607, USA
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Zhang S, Liu D, Tian E, Wang J, Guo Z, Kong W. Central vestibular dysfunction: don't forget vestibular rehabilitation. Expert Rev Neurother 2022; 22:669-680. [PMID: 35912850 DOI: 10.1080/14737175.2022.2106129] [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: 11/04/2022]
Abstract
INTRODUCTION Vestibular rehabilitation (VR) is now a subject of active studies and has been shown to be effective for multiple vestibular disorders, peripheral or central. VR is a physical therapy that helps train the central nervous system to compensate for vestibular dysfunction. There is moderate to strong evidence that VR is safe and effective for the management of peripheral vestibular dysfunction. Nonetheless, the studies on how VR works on central vestibular dysfunction remains scanty. AREAS COVERED This article addressed the rehabilitation strategies and possible mechanisms, including how central vestibular function might improve upon rehabilitation. In addition, it provides some examples concerning the effect of VR on central vestibular dysfunction. EXPERT OPINION VR works on the vestibular system through repetition of specific physical exercises that activate central neuroplastic mechanisms to achieve adaptive compensation of the impaired functions. VR has become a mainstay in the management of patients with dizziness and balance dysfunction. Individualized VR programs are a safe and effective treatment option for a large percentage of patients with central vestibular disease reporting imbalance and dizziness. Exploration of various treatment strategies and possible mechanisms will help develop the best and personalized VR treatment for patients with central vestibular dysfunction.
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Affiliation(s)
- Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Zhaoqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Key Laboratory of Neurological Disorders of Education Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
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Yang Y, Wang M, Xu L, Zhong M, Wang Y, Luan M, Li X, Zheng X. Cerebellar and/or Brainstem Lesions Indicate Poor Prognosis in Multiple Sclerosis: A Systematic Review. Front Neurol 2022; 13:874388. [PMID: 35572921 PMCID: PMC9099189 DOI: 10.3389/fneur.2022.874388] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis is a serious neurological disease that affects millions of people worldwide. Cerebellar and brainstem symptoms are common in the course of multiple sclerosis, but their prognostic value is unclear. This systematic review aimed to determine the relationship between the location of lesions in the cerebellum and/or brainstem and the prognosis in multiple sclerosis. In this systematic review, we searched and comprehensively read articles related to this research topic in Chinese and English electronic databases (PubMed, Embase, Cochrane Library, CNKI, and CBM) using search terms “multiple sclerosis,” “cerebellum,” “brainstem,” “prognosis,” and others. Cerebellar and brainstem clinically isolated syndromes and clinically definite multiple sclerosis were important predictors of transformation (hazard ratio, 2.58; 95% confidence interval, 1.58–4.22). Cerebellar and/or brainstem lesions indicate a poor overall prognosis in multiple sclerosis, but because of inconsistency, more clinical data are needed.
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Affiliation(s)
- Yuyuan Yang
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Meng Wang
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lulu Xu
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Meixiang Zhong
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yajuan Wang
- Department of Geriatric Medicine, The Qingdao Eighth People's Hospital, Qingdao, China
| | - Moxin Luan
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xingao Li
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xueping Zheng
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Xueping Zheng
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Andreu-Caravaca L, Ramos-Campo DJ, Manonelles P, Chung LH, Ramallo S, Rubio-Arias JÁ. The Impact of Resistance Training Program on Static Balance in Multiple Sclerosis Population: A Randomized Controlled Trial Study. J Clin Med 2022; 11:jcm11092405. [PMID: 35566530 PMCID: PMC9106059 DOI: 10.3390/jcm11092405] [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: 03/24/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Multiple sclerosis (MS) is a neurological disease that affects balance. Among the non-pharmacological strategies to improve this variable, physical exercise is one of the most widely used. However, the benefits of some types of training, such as resistance training, on static balance in this population are still unclear. This study aims to analyze the effects of a resistance training (RT) intervention on balance in people with MS. Methods: Thirty people with MS were randomized to either an experimental (n = 18) or a control (n = 12) group. The RT group performed 10 weeks of lower limb resistance training with a concentric phase at maximum velocity. Static balance was measured before and after intervention. Results: No significant group × time interaction effects were found (ANOVA test) in any of the variables at the end of the intervention. No intragroup differences were found before or after the intervention in the balance variables. Conclusions: Resistance training with a concentric phase at maximum velocity showed no impact on balance in our sample. Future studies should examine programs of longer duration or combined with other types of training, such as balance training, with the aim of obtaining improvements in this variable in people with MS.
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Affiliation(s)
- Luis Andreu-Caravaca
- Faculty of Sport, Catholic University of Murcia, 30107 Murcia, Spain
- International Chair of Sports Medicine, Catholic University of Murcia, 30107 Murcia, Spain;
- Correspondence: ; Tel.: +34-968278800
| | - Domingo J. Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, 28001 Madrid, Spain;
| | - Pedro Manonelles
- International Chair of Sports Medicine, Catholic University of Murcia, 30107 Murcia, Spain;
| | - Linda H. Chung
- UCAM Research Center for High Performance, Catholic University of Murcia, 30107 Murcia, Spain;
| | - Salvador Ramallo
- Department of Quantitative Methods for Business and Economics, University of Murcia, 30100 Murcia, Spain;
| | - Jacobo Á. Rubio-Arias
- Health Research Centre, Department of Education, Faculty of Educational Sciences, University of Almería, 04120 Almeria, Spain;
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Bao J, Tu H, Li Y, Sun J, Hu Z, Zhang F, Li J. Diffusion Tensor Imaging Revealed Microstructural Changes in Normal-Appearing White Matter Regions in Relapsing–Remitting Multiple Sclerosis. Front Neurosci 2022; 16:837452. [PMID: 35310094 PMCID: PMC8924457 DOI: 10.3389/fnins.2022.837452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAxons and myelin sheaths are the physical foundation for white matter (WM) to perform normal functions. Our previous study found the metabolite abnormalities in frontal, parietal, and occipital normal-appearing white matter (NAWM) regions in relapsing–remitting multiple sclerosis (RRMS) patients by applying a 2D 1H magnetic resonance spectroscopic imaging method. Since the metabolite changes may associate with the microstructure changes, we used the diffusion tensor imaging (DTI) method to assess the integrity of NAWM in this study.MethodDiffusion tensor imaging scan was performed on 17 clinically definite RRMS patients and 21 age-matched healthy controls on a 3.0-T scanner. DTI metrics including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were extracted from 19 predefined regions of interest (ROIs), which were generated by removing a mask of manually drawn probabilistic lesion map from the Johns Hopkins University white-matter atlas. The mean values of FA, MD, AD, and RD were compared between different groups in the same ROIs.ResultsA probabilistic lesion map was successfully generated, and the lesion regions were eliminated from the WM atlas. We found that the RRMS patients had significantly lower FA in the entire corpus callosum (CC), bilateral of anterior corona radiata, and right posterior thalamic radiation (PTR). At the same time, RRMS patients showed significantly higher MD in the bilateral anterior corona radiata and superior corona radiata. Moreover, all AD values increased, and the bilateral external capsule, PTR, and left tapetum NAWM show statistical significance. What is more, all NAWM tracts showed increasing RD values in RRMS patients, and the bilateral superior corona radiata, the anterior corona radiata, right PTR, and the genu CC reach statistical significance.ConclusionOur study revealed widespread microstructure changes in NAWM in RRMS patients through a ready-made WM atlas and probabilistic lesion map. These findings support the hypothesis of demyelination, accumulation of inflammatory cells, and axonal injury in NAWM for RRMS. The DTI-based metrics could be considered as potential non-invasive biomarkers of disease severity.
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Affiliation(s)
- Jianfeng Bao
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Hui Tu
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
| | - Yijia Li
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
| | - Jubao Sun
- MRI Center, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Zhigang Hu
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
| | - Fengshou Zhang
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
- *Correspondence: Fengshou Zhang,
| | - Jinghua Li
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
- Jinghua Li,
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Cerebellar Contributions to Motor Impairments in People with Multiple Sclerosis. THE CEREBELLUM 2021; 21:1052-1060. [PMID: 34657272 DOI: 10.1007/s12311-021-01336-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 12/25/2022]
Abstract
Although Charcot characterized classic cerebellar symptoms in people with multiple sclerosis (PwMS) in 1877, the impact of cerebellar dysfunction on MS symptoms has predominately been evaluated in the last two decades. Recent studies have clearly demonstrated the association between cerebellar pathology, including atrophy and reduced fractional anisotropy in the peduncles, and motor impairments, such as reduced gait velocity and time to complete walking tasks. However, future studies using novel imaging techniques are needed to elucidate all potential pathophysiology that is associated with disability in PwMS. Additionally, future studies are required to determine the most effective treatments for motor impairments in PwMS, including the specific type and duration of exercise interventions, and potential means to amplify their effects, such as transcranial direct current stimulation (tDCS). This mini-review critically discusses the distinct role of cerebellar dysfunction in motor impairments in PwMS, potential treatments, and directions for future studies.
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Eskut N, Koc AM, Köskderelioglu A, Unsal Bilgin YO, Tekindal MA. Is there a relationship between fall status, cognition and cerebellar lobule volume in patients with multiple sclerosis? APPLIED NEUROPSYCHOLOGY-ADULT 2021:1-11. [PMID: 34410894 DOI: 10.1080/23279095.2021.1962881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this prospective case control study, relationship of detailed cerebellar volumetric data and cognition in patients with multiple sclerosis considering falling status using 3 D MRI and network analysis were evaluated. Participants consist of 106 adults with relapsing-remitting multiple sclerosis. Scores of Montreal cognitive assessment test, symbol digit modality Test, nine-hole peg test, berg balance scale test, timed up and go test, timed 25-foot walk test were worse in faller group than non faller group (p < 0.05 for all tests). There was no significant difference in terms of cerebellar lobule volumes between groups. But using artificial intelligence (AI) based network analysis, we brought a new perspective to interpreting the relationship between the cerebellum, cognition, gait, and balance. Overall, data from the study suggest a possible relationship between cerebellar volume changes and cognitive dysfunction through connectivity analysis in patients with multiple sclerosis. Further studies are needed to examine this issue by using connectivity analysis.
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Affiliation(s)
- Neslihan Eskut
- Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Ali Murat Koc
- Radiology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Asli Köskderelioglu
- Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Yaprak Ozum Unsal Bilgin
- Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
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Morelli N, Morelli H. Dual task training effects on gait and balance outcomes in multiple sclerosis: A systematic review. Mult Scler Relat Disord 2021; 49:102794. [PMID: 33540278 DOI: 10.1016/j.msard.2021.102794] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/30/2020] [Accepted: 01/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND People with Multiple Sclerosis (PwMS) exhibit deteriorated balance and gait performance during dual task (DT) conditions. Impaired dual tasking is related to increased fall risk and lower quality of life in PwMS. While dual task interventions have proven effective in various patient populations, evidence is lacking to support the use of DT interventions to improve clinical measures of balance and gait in PwMS. Therefore, the purpose of this systematic review was to synthesize the effectiveness of DT intervention at improving balance and gait in PwMS. METHODS A systematic search was completed using CINHAL, PubMed and MEDLINE. Methodological quality, level of evidence and recommendations for included studies was assessed by two reviewers. Effect sizes with 95% confidence intervals comparing single and DT outcomes were calculated for all balance and gait variables. RESULTS Five randomized control trials (RCTs) were included for review. Of the 23 effect sizes calculated, three had 95% confidence intervals which did not pass zero and were therefore interpreted as strong. Due to inconsistent level one evidence of DT interventions being superior to single task balance and gait interventions a grade B recommendation was given. CONCLUSION There is inconsistent evidence supporting the use of DT interventions to improve clinical balance measures in PwMS. There is supportive evidence for the use of DT interventions to improve both single and DT gait speed. However, there was heterogeneity between interventions and dosage among RCTs. Despite multiple promising findings, DT interventions appear to have minimal impact on clinical balance and gait measures in PwMS.
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Affiliation(s)
- Nathan Morelli
- Rehabilitation Sciences, College of Health Sciences, University of Kentucky, 900 S Limestone, Lexington, KY 40536, USA.
| | - Haley Morelli
- Rehabilitation Department, Chandler Medical Center at University of Kentucky, Lexington, KY, USA
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Almutairi AD, Hassan HA, Suppiah S, Alomair OI, Alshoaibi A, Almutairi H, Mahmud R. Lesion load assessment among multiple sclerosis patient using DIR, FLAIR, and T2WI sequences. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00312-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Magnetic resonance imaging (MRI) is one of the diagnostic imaging modalities employing in lesion detection in neurological disorders such as multiple sclerosis (MS). Advances in MRI techniques such as double inversion recovery (DIR) made it more sensitive to distinguish lesions in the brain. To investigate the lesion load on different anatomical regions of the brain with MS using DIR, fluid attenuated inversion recovery (FLAIR) and T2-weighted imaging (T2WI) sequences. A total of 97 MS patients were included in our retrospective study, confirmed by neurologist. The patients were randomly selected from the major hospital in Saudi Arabia. All images were obtained using 3T Scanner (Siemens Skyra). The images from the DIR, FLAIR, and T2WI sequence were compared on axial planes with identical anatomic position and the number of lesions was assigned to their anatomical region.
Results
Comparing the lesion load measurement at various brain anatomical regions showed a significant difference among those three methods (p < 0.05).
Conclusion
DIR is a valuable MRI sequence for better delineation, greater contrast measurements and the increasing total number of MS lesions in MRI, compared with FLAIR, and T2WI and DIR revealed more intracortical lesions as well; therefore, in MS patients, it is recommended to add DIR sequence in daily routine imaging sequences.
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Ulozienė I, Totilienė M, Balnytė R, Kuzminienė A, Kregždytė R, Paulauskas A, Blažauskas T, Marozas V, Uloza V, Kaski D. Subjective visual vertical and visual dependency in patients with multiple sclerosis. Mult Scler Relat Disord 2020; 44:102255. [DOI: 10.1016/j.msard.2020.102255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/05/2020] [Accepted: 05/31/2020] [Indexed: 01/19/2023]
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Diagnosis and management of multiple sclerosis: MRI in clinical practice. J Neurol 2020; 267:2917-2925. [PMID: 32472179 PMCID: PMC7501096 DOI: 10.1007/s00415-020-09930-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 12/22/2022]
Abstract
Background Recent changes in the understanding and management of multiple sclerosis (MS) have increased the role of MRI in supporting diagnosis and disease monitoring. However, published guidelines on the use of MRI in MS do not translate easily into different clinical settings and considerable variation in practice remains. Here, informed by published guidelines for the use of MRI in MS, we identified a clinically informative MRI protocol applicable in a variety of clinical settings, from district general hospitals to tertiary centres. Methods MS specialists geographically representing the UK National Health Service and with expertise in MRI examined existing guidelines on the use of MRI in MS and identification of challenges in their applications in various clinical settings informed the formulation of a feasible MRI protocol. Results We identified a minimum set of MRI information, based on clinical relevance, as well as on applicability to various clinical settings. This informed the selection of MRI acquisitions for scanning protocols, differentiated on the basis of their purpose and stage of the disease, and indication of timing for scans. Advice on standardisation of MRI requests and reporting, and proposed timing and frequency of MRI scans were generated. Conclusions The proposed MRI protocol can adapt to a range of clinical settings, aiding the impetus towards standardisation of practice and offering an example of research-informed service improvement to support optimisation of resources. Other neurological conditions, where a gap still exists between published guidelines and their clinical implementation, may benefit from this same approach.
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Pasqua G, Tommasin S, Bharti K, Ruggieri S, Petsas N, Piervincenzi C, Pozzilli C, Pantano P. Resting-state functional connectivity of anterior and posterior cerebellar lobes is altered in multiple sclerosis. Mult Scler 2020; 27:539-548. [PMID: 32463319 DOI: 10.1177/1352458520922770] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Damage to the cerebellar sensorimotor and cognitive domains may underlie physical and cognitive disability. OBJECTIVE To investigate resting-state functional connectivity (FC) of sensorimotor and cognitive cerebellum, and clinical correlates in multiple sclerosis (MS). METHODS A total of 119 patients with MS and 42 healthy subjects underwent multimodal 3T-magnetic resonance imaging (MRI). Patients were evaluated using the Expanded Disability Status Scale and Multiple Sclerosis Functional Composite Scale. After parcellation of sensorimotor (lobules I-V + VIII) and cognitive cerebellum (lobules VI, VII, IX, X), we calculated cerebellar resting-state FC using a seed-based approach. RESULTS In patients with MS, the sensorimotor cerebellum showed increased FC mainly with cerebellar, thalamic, and cortical (frontal, parietal, temporal) areas and decreased FC with insular areas; the cognitive cerebellum showed increased FC mainly with thalamic and cortical (temporal-occipital) areas, and decreased FC with frontal-insular areas. Both sensorimotor and cognitive cerebellar FC negatively correlated with disability, and positively with cognitive scores. Cerebellar structural damage only partially influenced results. CONCLUSION The two neocerebellar circuits showed altered FC with subcortical and cortical areas. The association between increased sensorimotor and cognitive cerebellar FC and low levels of physical and cognitive disability suggests that altered FC might modulate the effects of cerebellar structural damage on clinical condition.
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Affiliation(s)
- Gabriele Pasqua
- Medicine and Health Science Department, University of Molise, Campobasso, Italy/Human Neuroscience Department, Sapienza University of Rome, Rome, Italy
| | - Silvia Tommasin
- Human Neuroscience Department, Sapienza University of Rome, Rome, Italy
| | - Komal Bharti
- Human Neuroscience Department, Sapienza University of Rome, Rome, Italy
| | - Serena Ruggieri
- Human Neuroscience Department, Sapienza University of Rome, Rome, Italy
| | | | | | - Carlo Pozzilli
- Human Neuroscience Department, Sapienza University of Rome, Rome, Italy/Multiple Sclerosis Centre, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Patrizia Pantano
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy/IRCCS Neuromed, Pozzilli, Italy
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Inojosa H, Schriefer D, Trentzsch K, Klöditz A, Ziemssen T. Visual Feedback and Postural Control in Multiple Sclerosis. J Clin Med 2020; 9:jcm9051291. [PMID: 32365769 PMCID: PMC7288335 DOI: 10.3390/jcm9051291] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 01/07/2023] Open
Abstract
As people with multiple sclerosis (pwMS) manifest heterogeneous demyelinating lesions that could affect somatosensory or vestibular ways, visual stimulus as feedback could be especially relevant to achieve postural control. This has clinical importance for the development of preventive measures and rehabilitation therapies in order to avoid falls and accidents in this group. In our study, we objectively evaluated the influence of visual feedback on the stabilization of balance in pwMS versus healthy controls (HC) and its potential utility in clinical evaluation. Static posturography tests were performed in 99 pwMS and 30 HC. Subjects stood on a force platform with open and closed eyes. During this procedure, three balance parameters were obtained for both vision conditions: average sway, average speed, and average speed of sway. Neurostatus-Expanded Disease Disability Score (EDSS) and Multiple Sclerosis Functional Composite (MSFC) were performed in parallel as well. A two-way mixed repeated measures ANCOVA, controlling for sex and age, was performed to evaluate the effect of vision, MS diagnosis, and the interaction of both in static posturography parameters. The difference between both closed and open eyes conditions was calculated for each parameter and further analyzed according to MS-relevant clinical variables. The magnitude of the vision effect differed between pwMS and HC as a significant interaction between the vision and the MS diagnosis in the delineated area (p < 0.001) and average speed of sway (p = 0.001) was seen. These parameters had a greater increase in pwMS than in HC after closing eyes. For the average sway, a significant main effect of vision was present (p = 0.047). Additionally, the differences obtained between open and closed eyes conditions assessed with the delineated area and average speed of sway were moderately correlated to the assessed clinical tests EDSS (r = 0.405 and r = 0.329, respectively) and the MSFC (r = −0.385 and r = −0.259, respectively). In our study, pwMS were more dependent of visual feedback than HC to maintain postural control. This easy and short evaluation by static posturography could support the development of targeted preventive measures and interventions in pwMS.
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GÜRPINAR B, SOYSAL TOMRUK M, KARA B, İDİMAN E. Multipl sklerozlu hastalarda kombine Pilates ve akuapliyometrik egzersizlerin postural kontrol ve fiziksel fonksiyonlara etkisi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.631595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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17
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Brandstadter R, Ayeni O, Krieger SC, Harel NY, Escalon MX, Katz Sand I, Leavitt VM, Fabian MT, Buyukturkoglu K, Klineova S, Riley CS, Lublin FD, Miller AE, Sumowski JF. Detection of subtle gait disturbance and future fall risk in early multiple sclerosis. Neurology 2020; 94:e1395-e1406. [PMID: 32102980 DOI: 10.1212/wnl.0000000000008938] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/05/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To test the hypothesis that higher-challenge gait and balance tasks are more sensitive than traditional metrics to subtle patient-reported gait dysfunction and future fall risk in early multiple sclerosis (MS). METHODS Persons with early MS (n = 185; ≤5 years diagnosed) reported gait function (MS Walking Scale) and underwent traditional disability metrics (Expanded Disability Status Scale [EDSS], Timed 25 Foot Walk). Patients and healthy controls (n = 50) completed clinically feasible challenge tasks of gait endurance (2-Minute Walk Test), standing balance (NIH Toolbox), and dynamic balance (balance boards; tandem walk on 2 ten-foot boards of different widths, 4.5 and 1.5 in). MRI assessed global and regional brain volumes, total T2 lesion volume (T2LV), infratentorial T2LVs and counts, and cervical cord lesion counts. Falls, near falls, and fall-related injuries were assessed after 1 year. We examined links between all tasks and patient-reported gait, MRI markers, and fall data. RESULTS Patients performed worse on higher challenge balance, but not gait, tasks compared with healthy controls. Worse patient-reported gait disturbance was associated with worse performance on all tasks, but only dynamic balance was sensitive to mild patient-reported gait difficulty. Balance tasks were more correlated with MRI metrics than were walking tasks or EDSS score. Thirty percent of patients reported either a fall or near fall after 1 year, with poor dynamic balance as the only task independently predicting falls. CONCLUSIONS Balance plays a leading role in gait dysfunction early in MS. Clinically feasible higher-challenge balance tasks were most sensitive to patient-reported gait, MRI disease markers, and risk of future falls, highlighting potential to advance functional outcomes in clinical practice and trials.
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Affiliation(s)
- Rachel Brandstadter
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Oluwasheyi Ayeni
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Stephen C Krieger
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Noam Y Harel
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Miguel X Escalon
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Ilana Katz Sand
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Victoria M Leavitt
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Michelle T Fabian
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Korhan Buyukturkoglu
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Sylvia Klineova
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Claire S Riley
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Fred D Lublin
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Aaron E Miller
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - James F Sumowski
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY.
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Whittier TT, Richmond SB, Monaghan AS, Fling BW. Virtual time-to-contact identifies balance deficits better than traditional metrics in people with multiple sclerosis. Exp Brain Res 2019; 238:93-99. [DOI: 10.1007/s00221-019-05698-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
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19
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Capone F, Capone G, Motolese F, Voci A, Caminiti ML, Musumeci G, Di Lazzaro V. Spinal cord dysfunction contributes to balance impairment in multiple sclerosis patients. Clin Neurol Neurosurg 2019; 184:105451. [DOI: 10.1016/j.clineuro.2019.105451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/01/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
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Kim HY, Shin JH, Yang SP, Shin MA, Lee SH. Robot-assisted gait training for balance and lower extremity function in patients with infratentorial stroke: a single-blinded randomized controlled trial. J Neuroeng Rehabil 2019; 16:99. [PMID: 31358017 PMCID: PMC6664752 DOI: 10.1186/s12984-019-0553-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 06/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Balance impairments are common in patients with infratentorial stroke. Although robot-assisted gait training (RAGT) exerts positive effects on balance among patients with stroke, it remains unclear whether such training is superior to conventional physical therapy (CPT). Therefore, we aimed to investigate the effects of RAGT combined with CPT and compared them with the effects of CPT only on balance and lower extremity function among survivors of infratentorial stroke. Methods This study was a single-blinded, randomized controlled trial with a crossover design conducted at a single rehabilitation hospital. Patients (n = 19; 16 men, three women; mean age: 47.4 ± 11.6 years) with infratentorial stroke were randomly allocated to either group A (4 weeks of RAGT+CPT, followed by 4 weeks of CPT+CPT) or group B (4 weeks of CPT+CPT followed by 4 weeks of RAGT+CPT). Changes in dynamic and static balance as indicated by Berg Balance Scale scores were regarded as the primary outcome measure. Outcome measures were evaluated for each participant at baseline and after each 4-week intervention period. Results No significant differences in outcome-related variables were observed between group A and B at baseline. In addition, no significant time-by-group interactions were observed for any variables, indicating that intervention order had no effect on lower extremity function or balance. Significantly greater improvements in secondary functional outcomes such as lower extremity Fugl-Meyer assessment (FMA-LE) and scale for the assessment and rating of ataxia (SARA) were observed following the RAGT+CPT intervention than following the CPT+CPT intervention. Conclusion RAGT produces clinically significant improvements in balance and lower extremity function in individuals with infratentorial stroke. Thus, RAGT may be useful for patients with balance impairments secondary to other pathologies. Trial registration ClinicalTrials.gov Identifier NCT02680691. Registered 09 February 2016; retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12984-019-0553-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ha Yeon Kim
- Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Seoul, South Korea
| | - Joon-Ho Shin
- Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Seoul, South Korea. .,Department of Rehabilitation Medicine, National Rehabilitation Center, 58, Samgaksan-ro, Gangbuk-gu, Seoul, 01022, Republic of Korea.
| | - Sung Phil Yang
- Department of Rehabilitation Medicine, National Rehabilitation Center, 58, Samgaksan-ro, Gangbuk-gu, Seoul, 01022, Republic of Korea
| | - Min A Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, 58, Samgaksan-ro, Gangbuk-gu, Seoul, 01022, Republic of Korea
| | - Stephanie Hyeyoung Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, 58, Samgaksan-ro, Gangbuk-gu, Seoul, 01022, Republic of Korea
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How much does balance and muscle strength impact walking in persons with multiple sclerosis? - A cross-sectional study. Mult Scler Relat Disord 2019; 29:137-144. [DOI: 10.1016/j.msard.2019.01.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 11/20/2022]
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Cimino V, Chisari CG, Raciti G, Pappalardo A, Zappia M, Patti F. Static postural control disturbances among the different multiple sclerosis phenotypes: A Neurocom Balance Manager ® evaluation study. Mult Scler Relat Disord 2018; 26:46-51. [PMID: 30223228 DOI: 10.1016/j.msard.2018.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 08/03/2018] [Accepted: 08/23/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The computerized stabilometric platform can be used and privileged over clinical scales, as self-administered questionnaires to asses postural control and balance evaluation in Multiple sclerosis (MS). Aim of our study was to evaluate static postural control assessed by Neurocom Balance Manager® through the modified Clinical Test of Sensory Interaction on Balance (mCTSIB) in relapsing-remitting MS (RRMS), progressive MS (PMS) and CIS, compared to healthy controls (HC). METHODS We screened MS patients consecutively referring to our MS Center at University of Catania, during July 2013-June 2014 diagnosed as CIS, RRMS and PMS. All MS patients underwent clinical and neurological evaluations and a complete postural exam by Neurocom Balance Manager® in order to evaluate Center of Pressure (COP), through mCTSIB. We evaluated the following parameters: Total Path Length-open eyes (TPL-OE), Total Path Length-closed eyes (TPL-CE), Sway Area-open eyes (SA-OE), Sway Area-closed eyes (SA-CE), Mean sway velocity-open eyes (MSV-OE), Mean sway velocity-closed eyes (MSV-CE). Additionally, patients were tested by Berg balance scale (BBS) for balance and Barthel Index (BI) for disability outcomes. RESULTS Out of 170 MS patients assessed for eligibility, 163 met the inclusion/exclusion criteria and were finally enrolled. All balance parameters were found more impaired in MS group compared to controls and CIS. Moreover, no differences in terms of balance assessment were found between HC and CIS. The correlation analysis showed that BBS was strongly associated to SA-OE, SA-CE, TPL-OE and MSV-OE. We also found a correlation between BI and SA-CE. CONCLUSION Our study revealed significant differences among HCs, CIS and MS. MS, especially PMS, exhibit the worst balance performances especially in EC trials. The higher correlation between balance parameters, especially sway area, and BBS score confirmed the reliability and sensibility of mCTSIB assessment in evaluating static postural control in MS patients.
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Affiliation(s)
- V Cimino
- Centro Neurolesi "Bonino Pulejo", IRCSS, Messina, Italy
| | - C G Chisari
- Department G.F. Ingrassia, section of Neuroscience, University of Catania, Via S. Sofia n°78, Catania 95123, Italy
| | - G Raciti
- Centro Neurolesi "Bonino Pulejo", IRCSS, Messina, Italy
| | - A Pappalardo
- Department of Rehabilitation, S.Marta & S.Venera Hospital, Acireale, Catania, Italy
| | - M Zappia
- Department G.F. Ingrassia, section of Neuroscience, University of Catania, Via S. Sofia n°78, Catania 95123, Italy
| | - F Patti
- Department G.F. Ingrassia, section of Neuroscience, University of Catania, Via S. Sofia n°78, Catania 95123, Italy.
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Garg H, Dibble LE, Schubert MC, Sibthorp J, Foreman KB, Gappmaier E. Gaze Stability, Dynamic Balance and Participation Deficits in People with Multiple Sclerosis at Fall-Risk. Anat Rec (Hoboken) 2018; 301:1852-1860. [PMID: 29729209 DOI: 10.1002/ar.23852] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 08/31/2017] [Accepted: 10/24/2017] [Indexed: 11/09/2022]
Abstract
Despite the common complaints of dizziness and demyelination of afferent or efferent pathways to and from the vestibular nuclei which may adversely affect the angular vestibulo-ocular reflex (aVOR) and vestibulo-spinal function in persons with multiple sclerosis (PwMS), few studies have examined gaze and dynamic balance function in PwMS. (1) Determine the differences in gaze stability, dynamic balance and participation measures between PwMS and controls, (2) Examine the relationships between gaze stability, dynamic balance and participation. Nineteen ambulatory PwMS at fall-risk and 14 age-matched controls were recruited. Outcomes included (1) gaze stability (angular aVOR gain [ratio of eye to head velocity]; number of compensatory saccades [CS] per head rotation; CS latency; gaze position error; coefficient of variation [CV] of aVOR gain), (2) dynamic balance (functional gait assessment, FGA; four square step test), and (c) participation (dizziness handicap inventory; activities-specific balance confidence scale). Separate independent t-tests and Pearson's correlations were calculated. PwMS were age = 53 ± 11.7 years and had 4.2 ± 3.3 falls/year. PwMS demonstrated significant (P < 0.05) impairments in gaze stability, dynamic balance and participation measures compared to controls. CV of aVOR gain and CS latency were significantly correlated with FGA. Deficits and correlations across a spectrum of disability measures highlight the relevance of gaze and dynamic balance assessment in PwMS. Anat Rec, 301:1852-1860, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Hina Garg
- Entry-level DPT, Rocky Mountain University of Health Professions, 122 East 1700 South, Provo, Utah
| | - Leland E Dibble
- Department of Physical Therapy, The University of Utah, 520 Wakara Way, Salt Lake City, Utah
| | - Michael C Schubert
- Department of Otolaryngology - Head & Neck Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, Maryland
| | - Jim Sibthorp
- Department of Health, Kinesiology, and Recreation, The University of Utah, 250 S. 1850 E. Rm 200, Salt Lake City, Utah
| | - K Bo Foreman
- Department of Physical Therapy, The University of Utah, 520 Wakara Way, Salt Lake City, Utah
| | - Eduard Gappmaier
- Department of Health, Kinesiology, and Recreation, The University of Utah, 250 S. 1850 E. Rm 200, Salt Lake City, Utah
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Doty RL, MacGillivray MR, Talab H, Tourbier I, Reish M, Davis S, Cuzzocreo JL, Shepard NT, Pham DL. Balance in multiple sclerosis: relationship to central brain regions. Exp Brain Res 2018; 236:2739-2750. [PMID: 30019234 DOI: 10.1007/s00221-018-5332-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022]
Abstract
Dizziness, postural instability, and ataxia are among the most debilitating symptoms of multiple sclerosis (MS), reflecting, in large part, dysfunctional integration of visual, somatosensory, and vestibular sensory cues. However, the role of MS-related supratentorial lesions in producing such symptoms is poorly understood. In this study, motor control test (MCT) and dynamic sensory organization test (SOT) scores of 58 MS patients were compared to those of 72 healthy controls; correlations were determined between the MS scores of 49 patients and lesion volumes within 26 brain regions. Depending upon platform excursion direction and magnitude, MCT latencies, which were longer in MS patients than controls (p < 0.0001), were correlated with lesion volumes in the cortex, medial frontal lobes, temporal lobes, and parietal opercula (r's ranging from 0.20 to 0.39). SOT test scores were also impacted by MS and correlated with lesions in these same brain regions as well as within the superior frontal lobe (r's ranging from - 0.28 to - 0.40). The strongest and most consistent correlations occurred for the most challenging tasks in which incongruent visual and proprioceptive feedback were given. This study demonstrates that supratentorial lesion volumes are associated with quantitative balance measures in MS, in accord with the concept that balance relies upon highly convergent and multimodal neural pathways involving the skin, muscles, joints, eyes, and vestibular system.
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Affiliation(s)
- Richard L Doty
- Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4823, USA.
| | - Michael R MacGillivray
- Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4823, USA
| | - Hussam Talab
- Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4823, USA
| | - Isabelle Tourbier
- Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4823, USA
| | - Megan Reish
- Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4823, USA
| | - Sherrie Davis
- Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4823, USA
| | | | - Neil T Shepard
- Division of Audiology, Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Dzung L Pham
- Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Bethesda, MD, USA
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Kalron A, Allali G, Achiron A. Neural correlates of gait variability in people with multiple sclerosis with fall history. Eur J Neurol 2018; 25:1243-1249. [PMID: 29806963 DOI: 10.1111/ene.13689] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/24/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to investigate the association between step time variability and related brain structures in accordance with fall status in people with multiple sclerosis (PwMS). METHODS The study included 225 PwMS. Whole-brain magnetic resonance imaging was performed with a high-resolution 3.0 T magnetic resonance scanner in addition to volumetric analysis based on 3D T1-weighted images using the FreeSurfer image analysis suite. Step time variability was measured with an electronic walkway. Participants were defined as 'fallers' (at least two falls during the previous year) and 'non-fallers'. RESULTS In all, 105 PwMS were defined as fallers and had a greater step time variability compared to non-fallers [5.6% (SD = 3.4) vs. 3.4% (SD = 1.5); P = 0.001]. MS fallers exhibited a reduced volume in the left caudate and both cerebellum hemispheres compared to non-fallers. On using a linear regression analysis no association was found between gait variability and related brain structures in the total cohort and the non-fallers group. However, the analysis found an association between the left hippocampus and left putamen volumes with step time variability in the faller group: P = 0.031, 0.048, respectively, controlling for total cranial volume, walking speed, disability, age and gender. Nevertheless, according to the hierarchical regression model, the contribution of these brain measures to predict gait variability was relatively small compared to walking speed. CONCLUSIONS An association between low left hippocampal, putamen volumes and step time variability was found in PwMS with a history of falls, suggesting that brain structural characteristics may be related to falls and increased gait variability in PwMS.
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Affiliation(s)
- A Kalron
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neurosciences, Tel-Aviv University, Tel-Aviv, Israel
| | - G Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals, Geneva, Switzerland.,Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - A Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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The role of the cerebellum in multiple sclerosis—150 years after Charcot. Neurosci Biobehav Rev 2018; 89:85-98. [DOI: 10.1016/j.neubiorev.2018.02.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/02/2018] [Accepted: 02/18/2018] [Indexed: 12/22/2022]
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Prosperini L, Castelli L. Spotlight on postural control in patients with multiple sclerosis. Degener Neurol Neuromuscul Dis 2018; 8:25-34. [PMID: 30050386 PMCID: PMC6053902 DOI: 10.2147/dnnd.s135755] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Multiple sclerosis (MS) is a disease that heavily affects postural control, predisposing patients to accidental falls and fall-related injuries, with a relevant burden on their families, health care systems and themselves. Clinical scales aimed to assess balance are easy to administer in daily clinical setting, but suffer from several limitations including their variable execution, subjective judgment in the scoring system, poor performance in identifying patients at higher risk of falls, and statistical concerns mainly related to distribution of their scores. Today we are able to objectively and reliably assess postural control not only with laboratory-grade standard force platform, but also with low-cost systems based on commercial devices that provide acceptable comparability to gold-standard equipment. The sensitivity of measurements derived from force platforms is such that we can detect balance abnormalities even in minimally impaired patients and predict the risk of future accidental falls accurately. By manipulating sensory inputs (dynamic posturography) or by adding a concurrent cognitive task (dual-task paradigm) to the standard postural assessment, we can unmask postural control deficit even in patients at first demyelinating event or in those with a radiologic isolated syndrome. Studies on neuroanatomical correlates support the multifactorial etiology of postural control deficit in MS, with the association with balance impairment being correlated with cerebellum, spinal cord, and highly ordered processing network according to different studies. Postural control deficit can be managed by means of rehabilitation, which is the most important way to improve balance in patients with MS, but there are also suggestions of a beneficial effect of some pharmacologic interventions. On the other hand, it would be useful to pay attention to some drugs that are currently used to manage other symptoms in daily clinical setting because they can further impair postural controls of patients with MS.
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Affiliation(s)
- Luca Prosperini
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy,
| | - Letizia Castelli
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
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Tona F, De Giglio L, Petsas N, Sbardella E, Prosperini L, Upadhyay N, Giannì C, Pozzilli C, Pantano P. Role of Cerebellar Dentate Functional Connectivity in Balance Deficits in Patients with Multiple Sclerosis. Radiology 2018; 287:267-275. [DOI: 10.1148/radiol.2017170311] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Francesca Tona
- From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy (F.T., L.D.G., N.P., E.S., L.P., N.U., C.G., C.P.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (P.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.)
| | - Laura De Giglio
- From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy (F.T., L.D.G., N.P., E.S., L.P., N.U., C.G., C.P.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (P.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.)
| | - Nikolaos Petsas
- From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy (F.T., L.D.G., N.P., E.S., L.P., N.U., C.G., C.P.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (P.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.)
| | - Emilia Sbardella
- From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy (F.T., L.D.G., N.P., E.S., L.P., N.U., C.G., C.P.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (P.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.)
| | - Luca Prosperini
- From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy (F.T., L.D.G., N.P., E.S., L.P., N.U., C.G., C.P.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (P.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.)
| | - Neeraj Upadhyay
- From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy (F.T., L.D.G., N.P., E.S., L.P., N.U., C.G., C.P.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (P.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.)
| | - Costanza Giannì
- From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy (F.T., L.D.G., N.P., E.S., L.P., N.U., C.G., C.P.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (P.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.)
| | - Carlo Pozzilli
- From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy (F.T., L.D.G., N.P., E.S., L.P., N.U., C.G., C.P.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (P.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.)
| | - Patrizia Pantano
- From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy (F.T., L.D.G., N.P., E.S., L.P., N.U., C.G., C.P.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (P.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.)
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Kalron A, Allali G, Achiron A. Cerebellum and cognition in multiple sclerosis: the fall status matters. J Neurol 2018; 265:809-816. [PMID: 29396679 DOI: 10.1007/s00415-018-8774-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 11/29/2022]
Abstract
Cerebellar volume has been linked with cognitive performances in MS; however, the association in terms of fall status has never been compared. Therefore, the objective of the current study was to compare cognitive performance with cerebellar volume between MS fallers and non-fallers. The cross-sectional study included 140 PwMS (96 women). MRI volumetric analysis was based on the FreeSurfer image analysis suite. Volumes of the cerebellar gray and white matter were identified as the region of interest. Cognitive function included scores obtained from a computerized cognitive battery of tests. The sample was divided into fallers and non-fallers. MS fallers demonstrated a lower global cognitive performance and reduced gray and white matter cerebellar volumes compared to non-fallers. A significant association was found between total gray and white matter cerebellar volume and visual spatial subdomain (P value = 0.044 and 0.032, respectively) in the non-fallers group. The association remained significant after controlling for the total cranial volume and neurological disability (P value = 0.026 and 0.047, respectively). A relationship was found between the visual spatial score and the left gray matter cerebellum volume; R2 = 0.44, P value = 0.021. We believe that a unique relationship exists between the cerebellum structure and cognitive processing according to fall history in PwMS and should be considered when investigating the association between brain functioning and cognitive performances in MS.
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Affiliation(s)
- Alon Kalron
- Department of Physical Therapy, Sackler Faculty of Medicine, School of Health Professions, Tel-Aviv University, Tel Aviv, Israel. .,Sagol School of Neurosciences, Tel-Aviv University, Tel Aviv, Israel.
| | - Gilles Allali
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.,Division of Cognitive and Motor Aging, Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Hebert JR, Corboy JR, Vollmer T, Forster JE, Schenkman M. Efficacy of Balance and Eye-Movement Exercises for Persons With Multiple Sclerosis (BEEMS). Neurology 2018; 90:e797-e807. [DOI: 10.1212/wnl.0000000000005013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 11/08/2017] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo determine whether a multifaceted vestibular-related rehabilitation program (Balance and Eye-Movement Exercises for Persons with Multiple Sclerosis; BEEMS) improves balance in persons with MS and whether there are differences in outcomes based on brainstem/cerebellar lesion involvement.MethodsA 2-arm, examiner-blinded, stratified (involvement vs no involvement of brainstem/cerebellar structures), randomized controlled trial was implemented. Eighty-eight participants were allocated to BEEMS or no treatment control. Computerized Dynamic Posturography-Sensory Organization Test (CDP-SOT) measured balance control. The Dizziness Handicap Inventory (DHI), Modified Fatigue Impact Scale (MFIS), and Short Form-36 Health Status Questionnaire (SF-36) were also administered. Linear mixed models were used to investigate the primary and secondary aims.ResultsFrom baseline to 6 weeks, BEEMS participants experienced greater improvements compared to control participants in CDP-SOT composite (model-estimated difference in change 4.9, 95% confidence interval 1.39–8.38, p = 0.006), DHI total (−13.5, −17.7 to −7.25, p < 0.0001), MFIS total (−11.4, −15.7 to −7.0, p < 0.0001), SF-36 Mental (5.6, 2.43–8.71, p = 0.0006), and SF-36 Physical (3.5, 1.12–5.81, p = 0.004) scores and from baseline to 14 weeks in CDP-SOT composite (8.3, 4.73–11.9, p < 0.0001), DHI total (−13.9, −19.3 to −8.62, p < 0.0001), MFIS total (−12.3, −16.7 to −7.79, p < 0.0001), SF-36 Mental (3.9, 0.70–7.16, p = 0.02), and SF-36 Physical (3.2, 0.79–5.62, p = 0.01) scores. From baseline to 6 weeks, BEEMS participants with brainstem/cerebellar lesion involvement experienced greater improvements compared to those without in CDP-SOT composite (5.26, 0.34–10.2, p = 0.04) and MFIS total (−7.6, −14.0 to −1.33, p = 0.02) scores.ConclusionBEEMS improved multiple outcomes regardless of whether brainstem/cerebellar lesions were present, supporting the generalizability of BEEMS for ambulatory people with MS who have at least minimally impaired balance and fatigue.Clinical trials.gov identifierNCT01698086.Classification of evidenceThis study provides Class I evidence that BEEMS training improves dynamic posturography-based balance, dizziness, fatigue, and quality of life in persons with MS.
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The relationship between gait variability and cognitive functions differs between fallers and non-fallers in MS. J Neural Transm (Vienna) 2018; 125:945-952. [PMID: 29350300 DOI: 10.1007/s00702-018-1843-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
The objective of the study was to determine if cognitive function is associated with step time variability in people with multiple sclerosis (PwMS). The study included 355 PwMS (218 women), average age 41.1 (SD = 13.5), disease duration 5.9 (SD = 7.3) years, and a median expanded disability status scale score of 2.5. We separately analyzed the sample group of fallers and non-fallers based on their fall history. Gait variability was measured by an electronic walkway and all participants completed a computerized cognitive test battery designed to evaluate multiple cognitive domains. Fallers (43.7%) demonstrated elevated step time variability (%CV), 5.0 (SD = 3.4) vs. 3.5 (SD = 1.6), P < 0.001 compared to the non-faller subjects. According to the regression analysis in the non-fallers' group, step time variability was found significantly associated with the global cognitive score (P = 0.001), executive function subcategory (P = 0.038), and motor skills subcategory (P < 0.001). No relationship between step time variability and any cognitive domain was demonstrated in the faller group. This study illustrated that the association between gait variability and cognition occurs only in PwMS without a fall history. From a clinical standpoint, these findings might help medical professionals to create improved assessment tests and rehabilitation strategies in the MS population.
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Dynamic Balance Is Related to Physiological Impairments in Persons With Multiple Sclerosis. Arch Phys Med Rehabil 2017; 99:2030-2037. [PMID: 29274726 DOI: 10.1016/j.apmr.2017.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare physiological impairments between persons with multiple sclerosis (MS) with a history of falls and persons with MS without a history of falls, and to investigate the association between physiological impairments and dynamic balance. DESIGN Cross-sectional study. SETTING University motion analysis laboratory. PARTICIPANTS Persons with MS (N=55; 27 recurrent fallers and 28 nonfallers). Participants were classified as fallers if they self-reported ≥2 falls in the previous 6 months. INTERVENTIONS None. MAIN OUTCOME MEASURES Physiological impairment was assessed with sensorimotor delays, spasticity, plantar cutaneous sensation, and the sensory, cerebellar, and pyramidal subscales of the Expanded Disability Status Scale (EDSS). Dynamic balance was assessed using the average and variability of margin of stability and variability of trunk accelerations. RESULTS Compared with nonfallers, fallers had lower plantar sensation, longer sensorimotor delays, more spasticity, and more impairment in the pyramidal and cerebellar subscales of the EDSS. Additionally, these impairments were all moderately to strongly correlated with worse dynamic balance. CONCLUSIONS This study highlights the multifactorial nature of instability in persons with MS. A better understanding of the physiological mechanisms of dynamic instability in persons with MS can be used to improve methods of monitoring disease progression, identifying which impairments to target through interventions, and appropriately evaluating intervention efficacy.
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Farshidfar Z, Faeghi F, Haghighatkhah H, Abdolmohammadi J. The Optimization of Magnetic Resonance Imaging Pulse Sequences in Order to Better Detection of Multiple Sclerosis Plaques. J Biomed Phys Eng 2017; 7:265-270. [PMID: 29082217 PMCID: PMC5654132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 07/12/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVE Magnetic resonance imaging (MRI) is the most sensitive technique to detect multiple sclerosis (MS) plaques in central nervous system. In some cases, the patients who were suspected to MS, Whereas MRI images are normal, but whether patients don't have MS plaques or MRI images are not enough optimized enough in order to show MS plaques? The aim of the current study is evaluating the efficiency of different MRI sequences in order to better detection of MS plaques. MATERIALS AND METHODS In this cross-sectional study which was performed at Shohada-E Tajrish in Tehran - Iran hospital between October, 2011 to April, 2012, included 20 patients who suspected to MS disease were selected by the method of random sampling and underwent routine brain Pulse sequences (Axial T2w, Axial T1w, Coronal T2w, Sagittal T1w, Axial FLAIR) by Siemens, Avanto, 1.5 Tesla system. If any lesion which is suspected to the MS disease was observed, additional sequences such as: Sagittal FLAIR Fat Sat, Sagittal PDw-fat Sat, Sagittal PDw-water sat was also performed. RESULTS This study was performed in about 52 lesions and the results in more than 19 lesions showed that, for the Subcortical and Infratentorial areas, PDWw sequence with fat suppression is the best choice, And in nearly 33 plaques located in Periventricular area, FLAIR Fat Sat was the most effective sequence than both PDw fat and water suppression pulse sequences. CONCLUSION Although large plaques may visible in all images, but important problem in patients with suspected MS is screening the tiny MS plaques. This study showed that for revealing the MS plaques located in the Subcortical and Infratentorial areas, PDw-fat sat is the most effective sequence, and for MS plaques in the periventricular area, FLAIR fat Sat is the best choice.
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Affiliation(s)
- Z. Farshidfar
- MSc of Medical Imaging Technology (MRI), Radiology Department of Paramedical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - F. Faeghi
- Ph.D. in Medical Physics, Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H.R. Haghighatkhah
- MD, Department of Radiology, Shohada Tajrish Hospital, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - J. Abdolmohammadi
- MSc. of Medical Imaging Technology (MRI), Department of Radiology, Faculty of Paramedical Sciences, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Melillo F, Di Sapio A, Martire S, Malentacchi M, Matta M, Bertolotto A. Computerized posturography is more sensitive than clinical Romberg Test in detecting postural control impairment in minimally impaired Multiple Sclerosis patients. Mult Scler Relat Disord 2017; 14:51-55. [DOI: 10.1016/j.msard.2017.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/07/2017] [Accepted: 03/15/2017] [Indexed: 11/27/2022]
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35
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Grassi L, Rossi S, Studer V, Vasco G, Motta C, Patanè F, Castelli E, Rossi S, Cappa P. Quantification of postural stability in minimally disabled multiple sclerosis patients by means of dynamic posturography: an observational study. J Neuroeng Rehabil 2017; 14:4. [PMID: 28069073 PMCID: PMC5223530 DOI: 10.1186/s12984-016-0216-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 12/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is a widespread progressive neurologic disease with consequent impairments in daily activities. Disorders of balance are frequent and equilibrium tests are potentially useful to quantify disability and to verify treatment effectiveness. The fair sensitivity of the widely used not-perturbed tests to detect balance disturbances in MS patients have prompted the development of mechatronic systems capable to impose known equilibrium perturbations, in order to challenge the balance control and, consequently, to better assess the level of impairment. We sought to clarify whether the proposed perturbed-test is capable to discriminate healthy subjects from patients with MS, even in mild or in the absence of clinically evident balance disturbances. METHODS We assessed balance performances of 17 adults with MS and 13 age-matched healthy controls (HC) using both perturbed (PT) and not-perturbed (NPT) postural tests by means of a 3 Degree Of Freedom (DOF) rotational mechatronic platform. Participants stood barefoot on the platform in standing position and their center of pressure (CoP) was gathered by using a pressure matrix. Each trial lasted 30 s and was carried out with and without visual stimuli. Several postural indices were computed for each trial. Correlations between postural indices and clinical scales were analyzed. RESULTS No significant differences were found between groups for all indices when subjects performed NPTs. Conversely, significant differences in postural indices between MS and HC emerged during PTs. Additionally, PTs revealed significant differences between patients without any cerebellar impairment (cerebellar EDSS subscore equal to 0) and HC. The discrimination capability of PTs was confirmed by the ROC analysis. No significant change of the selected metrics occurred in HC when NPTs were performed with eyes closed, while indices presented a significant worsening in MS subjects. CONCLUSIONS Not-perturbed tests showed lower sensitivity than perturbed ones in the identification of equilibrium impairments in minimally disabled MS patients. However, not-perturbed tests allow to better evaluate the influence of visual flow disturbances on balance control in MS. In conclusion, our findings proved that the use of the novel tests based on a 3DOF mechatronic device represents an effective tool to investigate early balance disturbances in MS.
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Affiliation(s)
- Lucia Grassi
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
| | - Stefano Rossi
- Department of Economics and Management, Industrial Engineering, University of Tuscia, Viterbo, Italy.
| | - Valeria Studer
- Dipartimento di Medicina dei Sistemi, Tor Vergata University, Rome, Italy
| | - Gessica Vasco
- Department of Neurosciences, Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Caterina Motta
- Dipartimento di Medicina dei Sistemi, Tor Vergata University, Rome, Italy
| | - Fabrizio Patanè
- School of Mechanical Engineering, "Niccolò Cusano" University, Rome, Italy
| | - Enrico Castelli
- Department of Neurosciences, Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Silvia Rossi
- Neuroimmunology and Neuromuscular Diseases Unit, Foundation Neurological Institute Carlo Besta, Milan, Italy
| | - Paolo Cappa
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
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da Fonseca BAV, Pereira CB, Jorge F, Simm R, Apostolos-Pereira S, Callegaro D. A disturbed processing of graviceptive pathways may be involved in the pathophysiology of balance disorders in patients with multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:106-11. [PMID: 26982986 DOI: 10.1590/0004-282x20160004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/09/2015] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to determine the relationship between perception of verticality and balance disorders in multiple sclerosis patients. We evaluated patients and healthy controls. Patients were divided into two groups according to their risk of fall, with or without risk of fall, measured by a Dynamic Gait Index scale. Graviceptive perception was assessed using the subjective visual vertical test. Patients with risk of fall showed worse perception than those without risk of fall, p < 0.001. Misperception of verticality was correlated with the dynamic gait index scores (p < 0.001), suggesting that the larger the error for verticality judgment, the greater risk for falling. Considering that the perception of verticality is essential for postural control, our results suggested that the disturbed processing of graviceptive pathways may be involved in the pathophysiology of balance disorders in these patients.
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Affiliation(s)
| | | | - Frederico Jorge
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Renata Simm
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | | | - Dagoberto Callegaro
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
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Hoang PD, Baysan M, Gunn H, Cameron M, Freeman J, Nitz J, Low Choy NL, Lord SR. Fall risk in people with MS: A Physiological Profile Assessment study. Mult Scler J Exp Transl Clin 2016; 2:2055217316641130. [PMID: 28607722 PMCID: PMC5433510 DOI: 10.1177/2055217316641130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/02/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The Physiological Profile Assessment (PPA) is used in research and clinical practice for assessing fall risk. We compared PPA test performance between people with multiple sclerosis (MS) and healthy controls, determined the fall-risk profile for people with MS and developed a reference database for people with MS. METHODS For this study, 416 ambulant people with MS (51.5 ± 12.0 years) and 352 controls (52.8 ± 12.2 years) underwent the PPA (tests of contrast sensitivity, proprioception, quadriceps strength, reaction time and sway) with composite fall-risk scores computed from these measures. MS participants were followed prospectively for falls for 3 months. RESULTS The MS participants performed significantly worse than controls in each PPA test. The average composite fall-risk score was also significantly elevated, indicating a "marked" fall risk when compared with controls. In total, 155 MS participants (37.3%) reported 2 + falls in the follow-up period. Frequent fallers performed significantly worse than non-frequent fallers in the contrast sensitivity, reaction time and sway tests and had higher PPA composite scores. CONCLUSIONS In line with poor PPA test performances, falls incidence in people with MS was high. This study provides comprehensive reference data for the PPA measures for people with MS that could be used to inform future research and clinical practice.
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Affiliation(s)
- Phu D Hoang
- Neuroscience Research Australia and University of New South Wales, Sydney Australia
| | - Meryem Baysan
- Nijmegen Medical Centre, Radboud University, Nijmegen, The Netherlands
| | - Hilary Gunn
- School of Health Professions, Plymouth University, United Kingdom
| | - Michelle Cameron
- Oregon Health & Science University and VA Portland Health Care Service, Portland, Oregon, USA
| | - Jenny Freeman
- School of Health Professions, Plymouth University, United Kingdom
| | - Jennifer Nitz
- School of Health Sciences, The University of Queensland, Brisbane, Australia
| | - Nancy L Low Choy
- School of Health Sciences, The University of Queensland, Brisbane, Australia
| | - Stephen R Lord
- Neuroscience Research Australia and University of New South Wales, Sydney Australia
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Galli M, Coghe G, Sanna P, Cocco E, Marrosu MG, Pau M. Relationship between gait initiation and disability in individuals affected by multiple sclerosis. Mult Scler Relat Disord 2015; 4:594-7. [PMID: 26590668 DOI: 10.1016/j.msard.2015.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 09/12/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
This study analyzes how multiple sclerosis (MS) does affect one of the most common voluntary activities in life: the gait initiation (GI). The main aim of the work is to characterize the execution of this task by measuring and comparing relevant parameters based on center of pressure (COP) patterns and to study the relationship between these and the level of expanded disability status scale (EDSS). To this aim, 95 MS subjects with an average EDSS score of 2.4 and 35 healthy subjects were tested using a force platform during the transition from standing posture to gait. COP time-series were acquired and processed to extract a number of parameters related to the trajectory followed by the COP. The statistical analysis revealed that only a few measurements were statistically different between the two groups and only these were subsequently correlated with EDSS score. The correlation analysis underlined that a progressive alteration of the task execution can be directly related with the increase of EDSS score. These finding suggest that most of the impairment found in people with MS comes from the first part of the COP pattern, the anticipatory postural adjustments (APAs). The central nervous system performs APAs before every voluntary movement to minimize balance perturbation due to the movement itself. Gait Initiation's APAs consist in some ankle muscles contractions that induce a backward COP shift to the swing limb. The analysis here performed highlighted that MS affected patients have a reduced posterior COP shift that reveals that the anticipatory mechanism is impaired.
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Affiliation(s)
- Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy; Gait Analysis Lab, IRCCS San Raffaele Pisana, Rome, Italy
| | - Giancarlo Coghe
- Multiple Sclerosis Center, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Paola Sanna
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Maria Giovanna Marrosu
- Multiple Sclerosis Center, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering,University of Cagliari, Piazza d'Armi, 09123 Cagliari, Italy.
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Prins M, Schul E, Geurts J, van der Valk P, Drukarch B, van Dam AM. Pathological differences between white and grey matter multiple sclerosis lesions. Ann N Y Acad Sci 2015. [PMID: 26200258 DOI: 10.1111/nyas.12841] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Multiple sclerosis (MS) is a debilitating disease characterized by demyelination of the central nervous system (CNS), resulting in widespread formation of white matter lesions (WMLs) and grey matter lesions (GMLs). WMLs are pathologically characterized by the presence of immune cells that infiltrate the CNS, whereas these immune cells are barely present in GMLs. This striking pathological difference between WMLs and GMLs raises questions about the underlying mechanism. It is known that infiltrating leukocytes contribute to the generation of WMLs; however, since GMLs show a paucity of infiltrating immune cells, their importance in GML formation remains to be determined. Here, we review pathological characteristics of WMLs and GMLs, and suggest some possible explanations for the observed pathological differences. In our view, cellular and molecular characteristics of WM and GM, and local differences within WMLs and GMLs (in particular, in glial cell populations and the molecules they express), determine the pathway to demyelination. Further understanding of GML pathogenesis, considered to contribute to chronic MS, may have a direct impact on the development of novel therapeutic targets to counteract this progressive neurological disorder.
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Affiliation(s)
| | | | | | - Paul van der Valk
- Department of Pathology, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
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McLoughlin J, Barr C, Crotty M, Lord SR, Sturnieks DL. Association of Postural Sway with Disability Status and Cerebellar Dysfunction in People with Multiple Sclerosis: A Preliminary Study. Int J MS Care 2015; 17:146-51. [PMID: 26052260 DOI: 10.7224/1537-2073.2014-003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aims of this study were 1) to examine postural sway in the eyes open (EO) and eyes closed (EC) conditions in people with multiple sclerosis (MS) with moderate levels of disability compared with controls and 2) to examine relationships between postural sway and total Expanded Disability Status Scale (EDSS) scores, functional system subscores, and clinical measures of strength and spasticity in the MS group. METHODS Thirty-four people with moderate MS and ten matched controls completed measures of postural sway with EO and EC, knee extension and ankle dorsiflexion isometric strength, EDSS total score and subscores, and spasticity levels. RESULTS Participants with MS swayed significantly more with EO and EC and had reduced knee extension and ankle dorsiflexion strength compared with controls (P < .001). In the MS group, increased sway was associated with higher total EDSS scores and cerebellar function subscores, whereas increased sway ratio (EC/EO) was associated with reduced sensory function subscores. Postural sway was not significantly associated with strength or spasticity. CONCLUSIONS Participants with MS swayed more and were significantly weaker than controls. Cerebellar dysfunction was identified as the EDSS domain most strongly associated with increased sway, and sensory loss was associated with a relatively greater dependence on vision for balance control. These findings suggest that exercise interventions targeting sensory integration and cerebellar ataxia may be beneficial for enhancing balance control in people with MS.
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Affiliation(s)
- James McLoughlin
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia (JM, CB, MC); and Neuroscience Research Australia (SRL, DLS) and School of Public Health and Community Medicine (JM, SRL, DLS), University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Barr
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia (JM, CB, MC); and Neuroscience Research Australia (SRL, DLS) and School of Public Health and Community Medicine (JM, SRL, DLS), University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia (JM, CB, MC); and Neuroscience Research Australia (SRL, DLS) and School of Public Health and Community Medicine (JM, SRL, DLS), University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia (JM, CB, MC); and Neuroscience Research Australia (SRL, DLS) and School of Public Health and Community Medicine (JM, SRL, DLS), University of New South Wales, Sydney, New South Wales, Australia
| | - Daina L Sturnieks
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia (JM, CB, MC); and Neuroscience Research Australia (SRL, DLS) and School of Public Health and Community Medicine (JM, SRL, DLS), University of New South Wales, Sydney, New South Wales, Australia
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Fling BW, Gera Dutta G, Horak FB. Functional connectivity underlying postural motor adaptation in people with multiple sclerosis. NEUROIMAGE-CLINICAL 2015; 8:281-9. [PMID: 26106552 PMCID: PMC4474363 DOI: 10.1016/j.nicl.2015.04.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/14/2015] [Accepted: 04/30/2015] [Indexed: 01/04/2023]
Abstract
A well-characterized neural network is associated with motor learning, involving several brain regions known to have functional and structural deficits in persons with multiple sclerosis (PwMS). However, it is not known how MS affects postural motor learning or the neural networks involved. The aim of this study was to gain a better understanding of the neural networks underlying adaptation of postural responses within PwMS. Participants stood on a hydraulically driven, servo-controlled platform that translated horizontally forward and backward in a continuous sinusoidal pattern across multiple trials over two consecutive days. Our results show similar postural adaptation between PwMS and age-matched control participants despite overall deficits in postural motor control in PwMS. Moreover, PwMS demonstrated better retention the following day. PwMS had significantly reduced functional connectivity within both the cortico-cerebellar and cortico-striatal motor loops; neural networks that subserve implicit motor learning. In PwMS, greater connectivity strength within the cortico-cerebellar circuit was strongly related to better baseline postural control, but not to postural adaptation as it was in control participants. Further, anti-correlated cortico-striatal connectivity within the right hemisphere was related to improved postural adaptation in both groups. Taken together with previous studies showing a reduced reliance on cerebellar- and proprioceptive-related feedback control in PwMS, we suggest that PwMS may rely on cortico-striatal circuitry to a greater extent than cortico-cerebellar circuitry for the acquisition and retention of motor skills.
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Affiliation(s)
- Brett W Fling
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239-3098, USA ; Portland VA Medical Center, 3710 SW US Veterans Hospital Rd., Portland, OR 97239-9264, USA
| | - Geetanjali Gera Dutta
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239-3098, USA
| | - Fay B Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239-3098, USA ; Portland VA Medical Center, 3710 SW US Veterans Hospital Rd., Portland, OR 97239-9264, USA
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Nilsagård Y, Westerdahl E, Wittrin A, Gunnarsson M. Walking Distance as a Predictor of Falls in People With Multiple Sclerosis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2015; 21:102-8. [PMID: 25782023 PMCID: PMC6680182 DOI: 10.1002/pri.1625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 09/25/2014] [Accepted: 12/13/2014] [Indexed: 11/09/2022]
Abstract
Background and Purpose People with multiple sclerosis (PwMS) experience falls, usually when walking and transferring. The aim was to investigate if walking distance and patient overestimate of walking distance are predictors of falls in PwMS. Methods A prospective study was conducted, with a single test occasion followed by prospective registration of falls for 3 months. All PwMS in Region Örebro County with a previously registered Expanded Disability Status Scale score between 3.0 and 7.0 in the Swedish MS Registry were invited to participate (n = 149). Altogether, data from 49 PwMS being relapse free for at least 3 months and with a confirmed Expanded Disability Status Scale between 1.5 and 7.0 upon study entry were analysed. Results Twenty‐two PwMS (45%) fell during the study period, providing information of 66 falls. Walking distance or overestimate of one's walking distance, as compared with test results, did not predict falls in this MS sample. Discussion Walking and standing activities are associated with numerous falls in PwMS. Our data do not clearly support routine measurements of walking distance in assessing individual fall risk. © 2015 The Authors. Physiotherapy Research International published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Ylva Nilsagård
- Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden
| | | | - Anna Wittrin
- Department of Neurology, Örebro University Hospital, Örebro, Sweden
| | - Martin Gunnarsson
- Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.,Department of Neurology, Örebro University Hospital, Örebro, Sweden
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Effect of Tai Chi Chuan on balance in women with multiple sclerosis. Complement Ther Clin Pract 2015; 21:57-60. [DOI: 10.1016/j.ctcp.2014.09.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 08/21/2014] [Accepted: 09/12/2014] [Indexed: 11/21/2022]
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Chua MC, Hyngstrom AS, Ng AV, Schmit BD. Movement strategies for maintaining standing balance during arm tracking in people with multiple sclerosis. J Neurophysiol 2014; 112:1656-66. [PMID: 24966303 DOI: 10.1152/jn.00598.2013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to quantify hip and ankle movement strategies during a standing arm tracking task in people with multiple sclerosis (MS). Full-body kinematics and kinetics were assessed with motion analysis cameras and force plates in nine MS and nine age-matched control subjects. While standing, participants used their dominant hand to track a target moving around a large horizontal or vertical figure eight on a screen in front of them. The target moved at constant speed, or linearly increasing speeds, with a frequency between 0.05 Hz and 0.35 Hz. Hip and ankle moments and angles during tracking were calculated from kinematic and kinetic measurements. Ratios of peak-to-peak (PP) hip/ankle moments (kinetics) and angles (kinematics) were calculated to determine the strategies of the hips and ankles used to maintain balance during arm movements. Center of mass (CoM) root mean square (RMS) acceleration was calculated as a measure of overall balance performance. The MS group produced larger PP hip/ankle moments at all speeds compared with the control group (P < 0.05). The CoM RMS acceleration increased with tracking speed for both groups but was not significantly different between groups. Additionally, the ratios of hip to ankle moments were highly correlated with the Berg Balance Scale during horizontal steady-speed tracking in MS. These results suggest that people with MS increase the use of the hip during standing arm tracking compared with age-matched control subjects. This adapted strategy might allow people with MS to achieve balance performance similar to control subjects, possibly increasing the importance of the hip in maintaining balance during voluntary movements.
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Affiliation(s)
- Matthew C Chua
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | - Allison S Hyngstrom
- Program in Physical Therapy, Marquette University, Milwaukee, Wisconsin; and
| | - Alexander V Ng
- Program in Exercise Science, Marquette University, Milwaukee, Wisconsin
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin;
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Nilsagård Y, Gunn H, Freeman J, Hoang P, Lord S, Mazumder R, Cameron M. Falls in people with MS--an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States. Mult Scler 2014; 21:92-100. [PMID: 24948687 PMCID: PMC4361466 DOI: 10.1177/1352458514538884] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Falls are common in people with multiple sclerosis (PwMS). Previous studies have generally included small samples and had varied methods. Objectives: The objectives of this paper are to compile fall rates across a broad range of ages and disease severity and to definitively assess the extent to which MS-associated and demographic factors influence fall rates. Methods: Individual data from studies in four countries that prospectively measured falls for three months were analyzed. We determined fall rates, prevalence of fallers (≥1 falls) and frequent fallers (≥2 falls), location and timing of falls, and fall-related demographic factors. Results: A total of 537 participants reported 1721 falls: 56% were fallers and 37% frequent fallers. Most falls occurred indoors (65%) between 6 a.m. and 6 p.m. (75%). Primary progressive MS was associated with significantly increased odds of being a faller (odds ratio (OR) 2.02; CI 1.08–3.78). Fall risk peaked at EDSS levels of 4.0 and 6.0 with significant ORs between 5.30 (2.23–12.64) and 5.10 (2.08–12.47). The fall rate was lower in women than men (relative risk (RR) 0.80; CI 0.67–0.94) and decreased with increasing age (RR 0.97 for each year, CI 0.95–0.98). Conclusion: PwMS are at high risk of falls and there are important associations between falls and MS-associated disability, gender and age.
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Affiliation(s)
- Y Nilsagård
- Centre of Health Care Sciences, Örebro County Council, Sweden/School of Health and Medical Sciences, Örebro University, Sweden
| | - H Gunn
- School of Health Professions, Plymouth University, UK
| | - J Freeman
- School of Health Professions, Plymouth University, UK
| | - P Hoang
- Neuroscience Research Australia (NeuRA), University of NSW, Australia
| | - S Lord
- Neuroscience Research Australia (NeuRA), University of NSW, Australia
| | | | - Michelle Cameron
- Oregon Health and Science University, USA/Portland VA Medical Center, Oregon Health and Science University, USA
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Coote S, Finlayson M, Sosnoff JJ. Level of mobility limitations and falls status in persons with multiple sclerosis. Arch Phys Med Rehabil 2014; 95:862-6. [PMID: 24215991 DOI: 10.1016/j.apmr.2013.10.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/21/2013] [Accepted: 10/25/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate whether fall rates are constant across levels of mobility limitations. DESIGN Secondary analysis of baseline assessments from a stratified randomized controlled trial. SETTING Community. PARTICIPANTS Persons with multiple sclerosis (N=365) were divided into 5 groups based on the mobility section of the Guy's Neurological Disability Scale (GNDS): no walking impairment (n=82); impaired walking, no aid (n=87); unilateral support (n=76); bilateral support to walk (n=78); or occasional wheelchair user (n=42). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-reported fall history (ie, retrospective) in the preceding 3 months. RESULTS One hundred twenty-four persons in the overall sample reported falling in the last 3 months (fall prevalence, 33.97%). Of the total sample, 17.8% reported 2 or more falls in the last 3 months. Chi-square analysis revealed a significant difference in the proportion of fallers across GNDS categories (χ(2)=42.64, P<.001). Post hoc analysis revealed that the group who walked with bilateral support had the greatest proportion of fallers (52.6%), while the group without walking impairment had the lowest proportion (15.9%). An examination of recurrent fallers as a function of group found that there were more recurrent fallers (70%) in the group that had a walking impairment but used no aid, relative to the other groups. CONCLUSIONS The current findings highlight that fall rates including recurrent fall prevalence are not uniform across mobility aid categories in persons with MS. Those using bilateral assistance for gait have the highest prevalence of fallers, and those with walking limitations and not yet using an aid had the greatest prevalence of multiple falls.
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Affiliation(s)
- Susan Coote
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Jacob J Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL
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Fritz NE, Marasigan RER, Calabresi PA, Newsome SD, Zackowski KM. The impact of dynamic balance measures on walking performance in multiple sclerosis. Neurorehabil Neural Repair 2014; 29:62-9. [PMID: 24795162 DOI: 10.1177/1545968314532835] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Static posture imbalance and gait dysfunction are common in individuals with multiple sclerosis (MS). Although the impact of strength and static balance on walking has been examined, the impact of dynamic standing balance on walking in MS remains unclear. OBJECTIVE To determine the impact of dynamic balance, static balance, sensation, and strength measures on walking in individuals with MS. METHODS Fifty-two individuals with MS (27 women; 26 relapsing-remitting; mean age = 45.6 ± 10.3 years; median Expanded Disability Status Scale score = 3.5) participated in posturography testing (Kistler-9281 force plate), hip flexion, hip extension, ankle dorsiflexion strength (Microfet2 hand-held dynamometer), sensation (Vibratron II), and walk velocity (Optotrak Motion Analysis System). Analyses included, Mann-Whitney, Spearman correlation coefficients, and multiple regression. RESULTS All measures were abnormal in individuals with MS when compared with norms (P < .05). Static balance (eyes open, feet together [EOFT]), anterior-posterior (AP) dynamic sway, and hip extension strength were strongly correlated with walking velocity (AP sway r = 0.68; hip extension strength r = 0.73; EOFT r = -0.40). Together, AP dynamic sway (ρr = 0.71; P < .001), hip extension strength (ρr = 0.54; P < .001), and EOFT static balance (ρr = -0.41; P = .01) explained more than 70% of the variance in walking velocity (P < .001). CONCLUSIONS AP dynamic sway affects walking performance in MS. A combined evaluation of dynamic balance, static balance, and strength may lead to a better understanding of walking mechanisms and the development of strategies to improve walking.
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Affiliation(s)
- Nora E Fritz
- Kennedy Krieger Institute, Baltimore, MD, USA Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Kathleen M Zackowski
- Kennedy Krieger Institute, Baltimore, MD, USA Johns Hopkins University, Baltimore, MD, USA
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Utility of disease-specific measures and clinical balance tests in prediction of falls in persons with multiple sclerosis. J Neurol Phys Ther 2014; 37:99-104. [PMID: 23872680 DOI: 10.1097/npt.0b013e3182a18460] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The sensory and motor deficits associated with multiple sclerosis (MS) contribute to falls with the majority of persons with MS falling at least once annually. To appropriately direct treatment, accurate fall prediction measures are needed. In this study of community-dwelling individuals with MS followed for 12 months, we sought to determine frequency of falls, utility of clinical balance tests to predict falls, and accuracy of participants' retrospective recall of fall events. METHODS Independently ambulatory persons with MS underwent 5 clinical balance tests including Activities-specific Balance Confidence, Berg Balance Scale, Functional Reach, Timed Up and Go, and Dynamic Gait Index, and one disease-specific measure of disability (Expanded Disability Status Scale) and then were followed for 1 year. Participants were queried monthly by phone to determine the number of fall events that had occurred. Accuracy of fall prediction was determined by receiver operating characteristic curve analysis and comparison of balance test performance between fallers and nonfallers. RESULTS Sixty-one percent of the 38 participants were classified as fallers at 12-month follow-up. Only the Berg Balance Scale, Dynamic Gait Index, and the Activities-specific Balance Confidence demonstrated clinically useful levels of accuracy. In addition, participants were generally poor in their accurate recall of fall events relative to their monthly fall reports. DISCUSSION AND CONCLUSIONS The majority of participants fell during a 1-year prospective follow-up. Only 2 balance performance measures and 1 balance confidence measure accurately distinguished between fallers and nonfallers as well as possessed clinically useful levels of sensitivity and specificity. These results also emphasized the inaccuracy of retrospective fall history in an MS sample.
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Argento O, Incerti CC, Pisani V, Magistrale G, Di Battista G, Romano S, Ferraro E, Caltagirone C, Nocentini U. Domestic accidents and multiple sclerosis: an exploratory study of occurrence and possible causes. Disabil Rehabil 2014; 36:2205-9. [PMID: 24588071 DOI: 10.3109/09638288.2014.895429] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Domestic accidents are widespread, but no data are available on their occurrence in pathological populations such as patients with multiple sclerosis (MS). Aim was to investigate domestic habits and occurrence of different types of domestic accidents and near falls in a sample of MS patients compared with healthy controls and to determine whether patients' domestic accidents are linked to any disease characteristics. METHOD Descriptive survey of 50 patients and 50 healthy controls. Participants were administered an ad-hoc questionnaire to collect data on domestic habits and accidents they had in the past 2 months. Their physical and neuropsychological functioning, mood and fatigue were also assessed. RESULTS Results showed that patients spend most of their time at home with caregivers. No differences emerged for total number of domestic accident types, but there were differences in bumps and near falls. The latter seem to be linked to patients' walking ability and to bowel/bladder functioning and the former to reasoning ability and fatigue. CONCLUSIONS This study provides the first data on the occurrence of domestic accidents and possible causes in MS patients. It encourages further studies on the topic, with the final goal of designing preventive and rehabilitation strategies.
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Affiliation(s)
- Ornella Argento
- Neurology and Neurorehabilitation Unit, I.R.C.C.S. "Santa Lucia" Foundation , Rome , Italy
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Giannì C, Prosperini L, Jonsdottir J, Cattaneo D. A systematic review of factors associated with accidental falls in people with multiple sclerosis: a meta-analytic approach. Clin Rehabil 2014; 28:704-16. [DOI: 10.1177/0269215513517575] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 11/30/2013] [Indexed: 11/15/2022]
Abstract
Objective: To determine whether there are demographic, clinical, and instrumental variables useful to detect fall status of patients with multiple sclerosis. Data sources: PubMed and the Cochrane Library. Review methods: Eligible studies were identified by two independent investigators. Only studies having a clear distinction between fallers and non-fallers were included and meta-analysed. Odds ratios (ORs) and standard mean differences (SMDs) were calculated and pooled using fixed effect models. Results: Among 115 screened articles, 15 fulfilled criteria for meta-analyses, with a total of 2425 patients included. Proportion of fallers may vary from 30% to 63% in a time frame from 1 to 12 months. No significant publication bias was found, even though 12/15 studies relied on retrospective reports of falls, thus introducing recall biases. Risk factors for falls varied across studies, owing to heterogeneity of populations included and clinical instruments used. The meta-analytic approach found that, compared with non-fallers, fallers had longer disease duration (SMD = 0.14, p = 0.02), progressive course of disease (OR = 2.02, p < 0.0001), assistive device for walking (OR = 3.16, p < 0.0001), greater overall disability level (SMD = 0.74, p < 0.0001), slower walking speed (SMD = 0.45, p = 0.0005), and worse performances in balance tests (Berg Balance Scale: SMD = −0.48, p = 0.002; Timed up-and-go test, SMD = 0.31, p = 0.04), and force-platform measures (postural sway) with eyes opened (SMD = 0.71, p = 0.006) and closed (SMD = 0.83, p = 0.01), respectively. Conclusion: Elucidations regarding risk factors for accidental falls in patients with multiple sclerosis (PwMs) are provided here, with worse disability score, progressive course, use of walking aid, and poorer performances in static and dynamic balance tests strongly associated with fall status.
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Affiliation(s)
- Costanza Giannì
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Luca Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Johanna Jonsdottir
- LaRiCE: Gait and Balance Disorders Laboratory, Don Gnocchi Foundation I.R.C.C.S, Italy
| | - Davide Cattaneo
- LaRiCE: Gait and Balance Disorders Laboratory, Don Gnocchi Foundation I.R.C.C.S, Italy
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