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Alberts L, Voet N, Janssen M. Evaluation of fatigue and fatigability in people with Duchenne muscular dystrophy using a dynamic arm support - a pilot study. Disabil Rehabil Assist Technol 2024:1-10. [PMID: 39264126 DOI: 10.1080/17483107.2024.2388284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 11/25/2024] [Accepted: 07/02/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Due to progressive muscle wasting and weakness in patients with Duchenne Muscular Dystrophy (DMD), physical fatigability increases, upper extremity function reduces, which negatively impacts quality of life. Assistive technology such as dynamic arm supports (DAS) may help reduce this fatigability. This study aims to assess whether the novel Yumen 'EXone' DAS can reduce upper extremity fatigue and fatigability in DMD patients and healthy controls (HC), both with and without the DAS. Additionally, longitudinal changes in DMD patients were evaluated. METHODS Five DMD patients from the Yumen Bionics pioneer program and five HCs participated. Two submaximal tests simulating drinking and reaching were performed for two minutes, each with and without DAS. DMD participants completed these tests twice, at baseline (T0) and after 6-9 months (T1), while HCs completed them once. Physical fatigability was measured by the number of repetitions and changes in surface electromyography (sEMG) amplitude. Subjective fatigue was assessed using the Borg Scale (6-20) Rate of Perceived Exertion (RPE). RESULTS DMD participants generally performed more repetitions with the DAS than without. HCs showed similar or increased repetitions with the DAS. Assessing fatigability with sEMG was difficult due to the compensatory mechanisms used for the tests. Subjective fatigue scores on the Borg Scale were lower with the DAS for both DMD patients and HCs. CONCLUSION The Yumen 'EXone' DAS effectively reduces both fatigue and fatigability in DMD patients and healthy controls. Despite the methodological shortcomings, this research is one of the first studies investigating the impact of DAS on fatigue and fatigability.
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Affiliation(s)
- Lonneke Alberts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole Voet
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Klimmendaal, Rehabilitation Center, Arnhem, The Netherlands
- The Netherlands Neuromuscular Center (NL-NMD) and the European Reference Network for Rare Neuromuscular Diseases EURO-NMD
| | - Mariska Janssen
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Klimmendaal, Rehabilitation Center, Arnhem, The Netherlands
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Paksoy Y, Kpobi D, Henschke J, Risch L, Engel T. A comparison of individual force decline profiles during a fatiguing eccentric trunk flexion and extension protocol: a pilot study. Front Sports Act Living 2024; 6:1431607. [PMID: 39234529 PMCID: PMC11371616 DOI: 10.3389/fspor.2024.1431607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 08/05/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction Muscle fatigue, characterized by diminished force production and contraction sustainability, can impair muscle coordination and increase joint instability. Differing force profiles used in fatiguing tasks, such as prolonged eccentric trunk protocols, might provide insights into individualized strategies and resulting spinal stability. Thus, this study assessed individual differences in fatigue characteristics during an eccentric trunk flexion-extension protocol in a population of asymptomatic individuals. Methods Twelve participants (2 f/10 m, 29 ± 4 years, 78.4 ± 16.9 kg, 1.76 ± 0.10 m) performed an eccentric trunk flexion and extension protocol on an isokinetic dynamometer (45° flexion to 10° extension; 60°/s), with final analysis on 8 participants for trunk flexion and 11 for trunk extension due to data exclusions. Participants engaged in a maximal all-out (AO) task for 2 min. Each participant's torque output (Nm) was assessed on a repetition-by-repetition basis, and smoothened by a moving average of 5 repetitions. Individual time profiles for reaching fatigue thresholds (10%, 15%, 20% and 30% reduction of initial torque output), and inter subject variability (by coefficient of variation, CV in %) were assessed throughout the AO task. Further, percentage torque reduction and variability were assessed at mid (1-minute) and end (2-minute) of task. Results On average, for flexor and extensor muscles combined, participants reached a force reduction of 10% within 23.2 ± 19.1 s, of 15% within 44.9 ± 19.6 s, of 20% in 62.4 ± 26.3 s, and of 30% within 79.2 ± 21.8 s. The variability between individuals for the timepoint of reaching the defined torque thresholds was assessed by CV ranged between 23.4% and 103.8% for trunk flexor muscles, and between 28.4% and 56.5% for trunk extensor muscles. Discussion A reduction of up to 20% was seen on average for all participants within 1-minute of eccentric trunk flexion and extension. Different inter-individual force output profiles were seen throughout the AO protocol, potentially related to physiological, skill-based, technical, adaptational, and/or motivational factors. The increase in fatigue resulted in a reduction in variability among individuals. A 2-minute protocol effectively induced pronounced fatigue, offering insights into individual force profiles and strategies.
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Affiliation(s)
- Yasemin Paksoy
- University Outpatient Clinic, Sports Medicine and Sports Orthopedics, University of Potsdam, Potsdam, Germany
| | - David Kpobi
- University Outpatient Clinic, Sports Medicine and Sports Orthopedics, University of Potsdam, Potsdam, Germany
| | - Jakob Henschke
- University Outpatient Clinic, Sports Medicine and Sports Orthopedics, University of Potsdam, Potsdam, Germany
| | - Lucie Risch
- University Outpatient Clinic, Sports Medicine and Sports Orthopedics, University of Potsdam, Potsdam, Germany
| | - Tilman Engel
- University Outpatient Clinic, Sports Medicine and Sports Orthopedics, University of Potsdam, Potsdam, Germany
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Jagadish A, Shankaranarayana AM, Natarajan M, Solomon JM. Transcranial direct current stimulation for fatigue in neurological conditions: A systematic scoping review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2054. [PMID: 37838979 DOI: 10.1002/pri.2054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND AND PURPOSE Fatigue following neurological conditions negatively impacts daily activities, reducing overall quality of life. Transcranial direct current stimulation (tDCS) for fatigue management is still underexplored. This scoping review explores its use in managing fatigue among various neurological conditions. METHODS A thorough literature search was carried out using PubMed, Scopus, CINAHL, Web of Science, Embase, ProQuest, and the Cochrane Library. Google Scholar and clinicaltrials.gov were manually searched for gray literature and ongoing trials, respectively. Regardless of the study design, all studies utilizing tDCS for the management of fatigue in various neurological conditions were considered. Two reviewers independently screened all the studies, following which the data were retrieved. RESULTS Studies employing tDCS for fatigue management across neurological conditions is as follows: Multiple sclerosis (MS) (n = 28, 66%), stroke (n = 5, 12%), Parkinson's disease (PD) (n = 4, 10%), post-polio syndrome (PPS) (n = 2, 5%), traumatic brain injury (TBI) (n = 2, 5%), and amyotrophic lateral sclerosis (n = 1, 2%). All the studies used anodal stimulation, with the common stimulation site being the left dorsolateral prefrontal cortex for MS, stroke, and PD. A stimulation intensity of 1.0-4.0 mA with a duration ranging from 15 to 30 min in 1 to 24 sessions were commonly reported. The Fatigue Severity Scale (n = 21) and Modified Fatigue Impact Scale (n = 17) were frequently implemented outcome measures. Regardless of the study design, 36/42 (85.7%) studies reported an improvement in fatigue scores in the tDCS group. The common adverse events noted were tingling (n = 8, 35%), headache (n = 6, 26%), and itching (n = 6, 26%). DISCUSSION Application of tDCS for fatigue was explored in individuals with stroke, PD, PPS, and TBI after MS. Even though a wide range of treatment parameters and outcome measures were adopted to assess and target fatigue, tDCS proves to have a promising role in alleviating this symptom.
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Affiliation(s)
- Akhila Jagadish
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Apoorva M Shankaranarayana
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Klawitter LA, Hackney KJ, Christensen BK, Hamm JM, Hanson M, McGrath R. Using Electronic Handgrip Dynamometry and Accelerometry to Examine Multiple Aspects of Handgrip Function in Master Endurance Athletes: A Pilot Study. J Strength Cond Res 2023; 37:1777-1782. [PMID: 37616535 DOI: 10.1519/jsc.0000000000004459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/19/2022] [Indexed: 08/26/2023]
Abstract
ABSTRACT Klawitter, LA, Hackney, KJ, Christensen, BK, Hamm, JM, Hanson, M, and McGrath, R. Using electronic handgrip dynamometry and accelerometry to examine multiple aspects of handgrip function in master endurance athletes: A Pilot Study. J Strength Cond Res 37(9): 1777-1782, 2023-Electronic handgrip dynamometry and accelerometry may provide novel opportunities to comprehensively measure muscle function for human performance, especially for master athletes. This investigation sought to determine the multivariate relationships between maximal strength, asymmetry, rate of force development, fatigability, submaximal force control, bimanual coordination, and neuromuscular steadiness to derive one or more handgrip principal components in master-aged endurance athletes. We included n = 31 cyclists and triathletes aged 35-70 years. Maximal strength, asymmetry, rate of force development, fatigability, submaximal force control, bimanual coordination, and neuromuscular steadiness were measured twice on each hand using electronic handgrip dynamometry and accelerometry. The highest performing measures were included in the analyses. A principal component analysis was conducted to derive a new collection of uncorrelated variables from the collected handgrip measurements. Principal components with eigenvalues >1.0 were kept, and individual measures with a factor loading of |>0.40| were retained in each principal component. There were 3 principal components retained with eigenvalues of 2.46, 1.31, and 1.17. The first principal component, "robust strength," contained maximal strength, rate of force development, submaximal force control, and neuromuscular steadiness. The second principal component, "bilateral synergy," contained asymmetry and bimanual coordination, whereas the third principal component, "muscle conditioning," contained fatigability. Principal components 1, 2, and 3 explained 44.0, 31.6, and 24.4% of the variance, respectively. Different dimensions of muscle function emerged from our findings, suggesting the potential of a muscle function battery. Further research examining how these measures are associated with appropriate human performance metrics and lower extremity correlates is warranted.
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Affiliation(s)
- Lukus A Klawitter
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, North Dakota
- School of Health and Human Performance, Northern Michigan University, Marquette, Michigan
| | - Kyle J Hackney
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, North Dakota
| | - Bryan K Christensen
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, North Dakota
| | - Jeremy M Hamm
- Department of Psychology, North Dakota State University, Fargo, North Dakota
| | - Matt Hanson
- Matt Hanson Racing, Castle Rock, Colorado; and
| | - Ryan McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, North Dakota
- Fargo VA Healthcare System, Fargo, North Dakota
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Campos MC, Nery T, Starke AC, de Bem Alves AC, Speck AE, S Aguiar A. Post-viral fatigue in COVID-19: A review of symptom assessment methods, mental, cognitive, and physical impairment. Neurosci Biobehav Rev 2022; 142:104902. [PMID: 36202253 PMCID: PMC9528075 DOI: 10.1016/j.neubiorev.2022.104902] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/26/2022] [Accepted: 10/01/2022] [Indexed: 12/14/2022]
Abstract
Coronavirus 2 is responsible for Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), and the main sequela is persistent fatigue. Post-viral fatigue is common and affects patients with mild, asymptomatic coronavirus disease-2019 (COVID-19). However, the exact mechanisms involved in developing post-COVID-19 fatigue remain unclear. Furthermore, physical and cognitive impairments in these individuals have been widely described. Therefore, this review aims to summarize and propose tools from a multifaceted perspective to assess COVID-19 infection. Herein, we point out the instruments that can be used to assess fatigue in long-term COVID-19: fatigue in a subjective manner or fatigability in an objective manner. For physical and mental fatigue, structured questionnaires were used to assess perceived symptoms, and physical and cognitive performance assessment tests were used to measure fatigability using reduced performance.
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Affiliation(s)
| | | | | | | | | | - Aderbal S Aguiar
- Correspondence to: Labioex, Federal University of Santa Catarina, Pedro João Pereira, nº 150, Mato Alto, Araranguá, Santa Catarina, Brazil
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Shi Y, Hu X, Cui J, Li J, Bi Z, Li J, Fu H, Wang Y, Cui L, Xu J. Correlation Analysis of Data of Tongue and Pulse in Patients With Disease Fatigue and Sub-health Fatigue. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580211060781. [PMID: 35112891 PMCID: PMC8819780 DOI: 10.1177/00469580211060781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Fatigue is one of the most common subjective symptoms of abnormal health state,
there is still no reliable and stable evaluation method to distinguish disease
fatigue and non-disease fatigue. Studies have shown that tongue diagnosis and
pulse diagnosis are the reflection of overall state of the body. This study aims
to explore the distribution rules and correlation of data of tongue and pulse in
population with disease fatigue and sub-health fatigue and provide a new method
of clinical diagnosis of fatigue from the perspective of tongue diagnosis and
pulse diagnosis. In this study, a total of 736 people were selected and divided
into healthy controls (n = 250), sub-health fatigue group (n = 242), and disease
fatigue group (n = 244). TFDA-1 tongue diagnosis instrument and PDA-1 pulse
diagnosis instrument were used to collect tongue image and sphygmogram, simple
correlation analysis and canonical correlation analysis were used to analyze the
correlation of tongue and pulse data about the two groups of fatigue people. The
study had shown that tongue and pulse data could provide a certain reference for
the diagnosis of different types of fatigue, tongue and pulse data in disease
fatigue and sub-health fatigue population had different distribution rules, and
there was a simple correlation and canonical correlation in the disease fatigue
population, the coefficient of canonical correlation was .649 (P <.05).
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Affiliation(s)
- Yulin Shi
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaojuan Hu
- Shanghai Collaborative Innovation Center of Health Service in Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ji Cui
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Li
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zijuan Bi
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiacai Li
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongyuan Fu
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Wang
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Longtao Cui
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiatuo Xu
- Department of Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Assessing Additional Characteristics of Muscle Function With Digital Handgrip Dynamometry and Accelerometry: Framework for a Novel Handgrip Strength Protocol. J Am Med Dir Assoc 2021; 22:2313-2318. [PMID: 34166628 DOI: 10.1016/j.jamda.2021.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/06/2021] [Accepted: 05/22/2021] [Indexed: 12/18/2022]
Abstract
Maximal handgrip strength (HGS) is a convenient and reliable, but incomplete, assessment of muscle function. Although low HGS is a powerful predictor of poor health, several limitations to maximal HGS exist. The predictive value of HGS is restricted because low HGS is associated with a wide range of unspecified health conditions, and other characteristics of muscle function aside from strength capacity are not evaluated. Current HGS protocol guidelines emphasize the ascertainment of maximal force, which is only a single muscle function characteristic. Muscle function is intrinsically multivariable, and assessing other attributes in addition to strength capacity will improve screenings for age-related disabilities and diseases. Digital handgrip dynamometers and accelerometers provide unique opportunities to examine several aspects of muscle function beyond strength capacity, while also maintaining procedural ease. Specifically, digital handgrip dynamometry and accelerometry can assess the rate of force development, submaximal force steadiness, fatigability, and task-specific tremoring. Moreover, HGS protocols can be easily refined to include an examination of strength asymmetry and bilateral strength. Therefore, evaluating muscle function with new HGS technologies and protocols may provide a more comprehensive assessment of muscle function beyond maximal strength, without sacrificing feasibility. This Special Article introduces a novel framework for assessing multiple attributes of muscle function with digital handgrip dynamometry, accelerometry, and refinements to current HGS protocols. Such framework may aid in the discovery of measures that better predict and explain age-related disability, biological aging, and the effects of comorbid diseases that are amenable to interventions. These additional HGS measures may also contribute to our understanding of concepts such as resilience. Using sophisticated HGS technologies that are currently available and modernizing protocols for developing a new muscle function assessment may help transform clinical practice by enhancing screenings that will better identify the onset and progression of the disabling process.
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8
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Effects of prolonged interruption of rehabilitation routines in amyotrophic lateral sclerosis patients. Palliat Support Care 2021; 20:369-374. [PMID: 33942709 DOI: 10.1017/s1478951521000584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with amyotrophic lateral sclerosis (ALS) experienced prolonged interruption of their rehabilitation palliative care routines due to restrictive COVID-19 pandemic public health measures. This study assesses the effects of before and after the lockdown on functionality rates and quality of life (QoL) in patients with ALS. METHODS A longitudinal observational study was conducted. Participants were assessed three times - early January (T0), before mandatory lockdown (T1), and during lockdown (T2) - using the ALS Functional Rating Scale-revised (ALSFRS-R), Fatigue Severity Scale (FSS), and the ALS-Specific Quality of Life-Short Form (ALSSQOL-SF). The paired-sample t-test and Wilcoxon signed-rank test were used. RESULTS Thirty-two patients were included with a mean age of 56.9 (SD 14.2) years and mean symptoms onset of 27.1 (SD 14.3) months. ALSFRS-R mean scores decayed significantly over time when comparing T0-T1 (0.26 ± 0.38) and T1-T2 (1.36 ± 1.43) slopes (p < 0.001). Significant differences were observed between T1 and T2 for ALSSQOL-SF scores (115.31 ± 17.06 vs. 104.31 ± 20.65), especially in four specific domains, and FSS scores (34.06 ± 16.84 vs. 40.09 ± 17.63). Negative correlations between negative emotions and physical symptoms assessed by ALSSQOL-SF and FSS were found. SIGNIFICANCE OF THE RESULTS Rehabilitation treatment routines in palliative care, such as physiotherapy and speech therapy, appear to mitigate the ALSFRS-R slope. Prolonged interruption of rehabilitation during the lockdown may have accelerated the functional decline in ALS patients' motor skills with as measured after 2 months by the ALSFRS-R in the limb and bulbar subscores, but not respiratory subscore. Other short-term effects, increased fatigue and negative impact on QoL, were also verified.
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Abstract
Neuromuscular fatigue (NMF) is usually assessed non-invasively in healthy, athletic or clinical populations with the combination of voluntary and evoked contractions. Although it might appear relatively straightforward to magnetically or electrically stimulate at different levels (cortical/spinal/muscle) and to measure mechanical and electromyographic responses to quantify neuromuscular adjustments due to sustained/repeated muscle contractions, there are drawbacks that researchers and clinicians need to bear in mind. The aim of this opinion paper is to highlight the pitfalls inevitably faced when NMF is quantified. The first problem might arise from the definition of fatigue itself and the parameter(s) used to measure it; for instance, measuring power vs. isometric torque may lead to different conclusions. Another potential limitation is the delay between exercise termination and the evaluation of neuromuscular function; the possible underestimation of exercise-induced neural and contractile impairment and misinterpretation of fatigue etiology will be discussed, as well as solutions recently proposed to overcome this problem. Quantification of NMF can also be biased (or not feasible) because of the techniques themselves (e.g. results may depend on stimulation intensity for transcranial magnetic stimulation) or the way data are analyzed (e.g. M wave peak-to-peak vs first phase amplitude). When available, alternatives recently suggested in the literature to overcome these pitfalls are considered and recommendations about the best practices to assess NMF (e.g. paying attention to the delay between exercise and testing, adapting the method to the characteristics of the population to be tested and considering the limitations associated with the techniques) are proposed.
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Affiliation(s)
- Nicolas Place
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Guillaume Y Millet
- Univ Lyon, UJM-Saint-Etienne, Inter-University Laboratory of Human Movement Biology, EA 7424, 42023, Saint-Étienne, France. .,Faculty of Kinesiology, University of Calgary, Calgary, Canada.
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Klawitter L, Mahoney SJ, Dahl L, Hackney KJ, Herrmann SD, Edwards B, McGrath R. Evaluating Additional Aspects of Muscle Function with a Digital Handgrip Dynamometer and Accelerometer for Cognitive Functioning in Older Adults: A Pilot Study. J Alzheimers Dis Rep 2020; 4:495-499. [PMID: 33532697 PMCID: PMC7836018 DOI: 10.3233/adr-200225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Handgrip dynamometers are used to assess handgrip strength (HGS), and low HGS is linked to poor cognitive function. Although HGS is a reliable measure of muscle function, it is only measuring maximal grip force. Other aspects of muscle function such as force control, fatigability, and steadiness are unaccounted for in current HGS protocols. This pilot study sought to determine the role of maximal HGS, submaximal HGS force control, HGS fatigability, and HGS neuromuscular steadiness on cognitive function in older adults. Our findings indicate that these additional HGS measurements could factor into detecting poorer cognitive functioning, while also evolving HGS protocols.
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Affiliation(s)
- Lukus Klawitter
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | - Sean J Mahoney
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | - Lindsey Dahl
- Sanford Health, Fargo, ND, USA.,Department of Geriatrics, University of North Dakota, Grand Forks, ND, USA
| | - Kyle J Hackney
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | | | | | - Ryan McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
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Mahoney S, Klawitter L, Hackney KJ, Dahl L, Herrmann SD, Edwards B, McGrath R. Examining Additional Aspects of Muscle Function with a Digital Handgrip Dynamometer and Accelerometer in Older Adults: A Pilot Study. Geriatrics (Basel) 2020; 5:geriatrics5040086. [PMID: 33142897 PMCID: PMC7709634 DOI: 10.3390/geriatrics5040086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Maximal handgrip strength (HGS) could be an incomplete and unidimensional measure of muscle function. This pilot study sought to examine the relationships between maximal HGS, radial and ulnar digit grip strength, submaximal HGS force control, HGS fatigability, neuromuscular HGS steadiness, and HGS asymmetry in older adults. Methods: A digital handgrip dynamometer and accelerometer was used to collect several HGS measurements from 13 adults aged 70.9 ± 4.0 years: maximal strength, radial and ulnar digit grip strength, submaximal force control, fatigability, neuromuscular steadiness, and asymmetry. Pearson correlations determined the relationships between individual HGS measurements. A principal component analysis was used to derive a collection of new uncorrelated variables from the HGS measures we examined. Results: The individual HGS measurements were differentially correlated. Maximal strength (maximal HGS, radial digit strength, ulnar digits strength), contractile steadiness (maximal HGS steadiness, ulnar digit grip strength steadiness), and functional strength (submaximal HGS force control, HGS fatigability, HGS asymmetry, HGS fatigability steadiness) emerged as dimensions from the HGS measurements that we evaluated. Conclusion: Our findings suggest that these additional measures of muscle function may differ from maximal HGS alone. Continued research is warranted for improving how we assess muscle function with more modern technologies, including handgrip dynamometry and accelerometry.
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Affiliation(s)
- Sean Mahoney
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA; (S.M.); (L.K.); (K.J.H.)
| | - Lukus Klawitter
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA; (S.M.); (L.K.); (K.J.H.)
| | - Kyle J. Hackney
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA; (S.M.); (L.K.); (K.J.H.)
| | - Lindsey Dahl
- Sanford Health, Fargo, ND 58103, USA;
- Department of Geriatrics, Grand Forks, ND 58202, USA
| | | | | | - Ryan McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA; (S.M.); (L.K.); (K.J.H.)
- Correspondence: ; Tel.: +701-231-7474
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Vogt S, Schreiber S, Pfau G, Kollewe K, Heinze HJ, Dengler R, Petri S, Vielhaber S, Brinkers M. Dyspnea as a Fatigue-Promoting Factor in ALS and the Role of Objective Indicators of Respiratory Impairment. J Pain Symptom Manage 2020; 60:430-438.e1. [PMID: 32145336 DOI: 10.1016/j.jpainsymman.2020.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT There is no evidence-based treatment for fatigue in amyotrophic lateral sclerosis (ALS), and identification of treatable causes determines management strategies. Although dyspnea is a key symptom of ALS and effectively treatable, it has not been sufficiently investigated whether dyspnea may be a fatigue-promoting factor. OBJECTIVES To determine the level of fatigue in dyspneic ALS patients and whether fatigue is promoted by dyspnea. We further evaluated the correlation of fatigue with respiratory function tests. METHODS About 101 dyspneic patients and 20 matched controls completed the ALS Functional Rating Scale-Extension and the Fatigue Severity Scale. Dyspneic patients additionally completed the Dyspnea-ALS Scale and the ALS Assessment Questionnaire and underwent respiratory function tests (forced vital capacity, sniff nasal inspiratory pressure, mean inspiratory and expiratory pressure with respective relaxation rates, and blood gases). Multiple regression and correlation analyses were conducted. RESULTS Dyspneic patients had significantly higher fatigue scores than nondyspneic patients, and their fatigue significantly affected quality of life. Dyspnea alone explained up to 24% of the variance in fatigue. No associations were observed between fatigue and respiratory function tests. Patients with noninvasive ventilation reported significantly more dyspnea and fatigue. CONCLUSION Fatigue is a frequent and bothersome symptom in dyspneic ALS patients. Dyspnea-related distress is, in contrast to objective indicators of respiratory impairment, a determining factor of experienced fatigue. There is an urgent need for further symptom relief beyond noninvasive ventilation. Adequate treatment of dyspnea has the potential for synergies in symptom management arising from the association between fatigue and dyspnea.
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Affiliation(s)
- Susanne Vogt
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Giselher Pfau
- Department of Anesthesiology and Intensive Care, Otto-von-Guericke University, Magdeburg, Germany
| | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases, Magdeburg, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | - Michael Brinkers
- Department of Anesthesiology and Intensive Care, Otto-von-Guericke University, Magdeburg, Germany
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El-Aloul B, Speechley KN, Wei Y, Wilk P, Campbell C. Fatigue in young people with Duchenne muscular dystrophy. Dev Med Child Neurol 2020; 62:245-251. [PMID: 30980541 DOI: 10.1111/dmcn.14248] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Abstract
AIM To describe fatigue in Duchenne muscular dystrophy (DMD) from patients' and parents' perspectives and to explore risk factors for fatigue in children and adolescents with DMD. METHOD A multicentre, cross-sectional study design was used. Seventy-one patients (all males; median age 12y, age range 5-17y) identified via the Canadian Neuromuscular Disease Registry, and their parents completed questionnaires. Subjective fatigue was assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale by child self-report and parent proxy-report. RESULTS Patients with DMD across ages and disease stages experienced greater fatigue compared to typically developing controls from published data. Sleep disturbance symptoms were associated with greater fatigue by child self-report (ρ=-0.42; p=0.003) and parent proxy-report (ρ=-0.51; p<0.001). Depressive symptoms were associated with greater fatigue by child self-report (ρ=-0.46; p<0.001) and parent proxy-report (ρ=-0.45; p<0.001). Lower functional ability was associated with greater fatigue by parent proxy-report (ρ=0.26; p=0.03). Physical activity level, and musculoskeletal, respiratory, and cardiac function were not associated with fatigue. INTERPRETATION In paediatric DMD, sleep disturbance symptoms and depressive symptoms are potentially modifiable factors associated with fatigue, warranting additional investigation to facilitate the development of therapeutic strategies to reduce fatigue. WHAT THIS PAPER ADDS Fatigue is a major issue in paediatric Duchenne muscular dystrophy (DMD) across ages and disease stages. Sleep disturbance and depressive symptoms are significantly associated with fatigue in paediatric DMD.
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Affiliation(s)
- Basmah El-Aloul
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada
| | - Kathy N Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.,Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Yi Wei
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.,Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Piotr Wilk
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.,Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Craig Campbell
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.,Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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14
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Bartels B, Habets LE, Stam M, Wadman RI, Wijngaarde CA, Schoenmakers MAGC, Takken T, Hulzebos EH, van der Pol WL, de Groot JF. Assessment of fatigability in patients with spinal muscular atrophy: development and content validity of a set of endurance tests. BMC Neurol 2019; 19:21. [PMID: 30738436 PMCID: PMC6368708 DOI: 10.1186/s12883-019-1244-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/29/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Fatigability has emerged as an important dimension of physical impairment in patients with Spinal Muscular Atrophy (SMA). At present reliable and valid outcome measures for both mildly and severely affected patients are lacking. Therefore the primary aim of this study is the development of clinical outcome measures for fatigability in patients with SMA across the range of severity. METHODS We developed a set of endurance tests using five methodological steps as recommended by the 'COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). In this iterative process, data from multiple sources were triangulated including a scoping review of scientific literature, input from a scientific and clinical multidisciplinary expert panel and three pilot studies including healthy persons (N = 9), paediatric patients with chronic disorders (N = 10) and patients with SMA (N = 15). RESULTS Fatigability in SMA was operationalised as the decline in physical performance. The following test criteria were established; one method of testing for patients with SMA type 2-4, a set of outcome measures that mimic daily life activities, a submaximal test protocol of repetitive activities over a longer period; external regulation of pace. The scoping review did not generate suitable outcome measures. We therefore adapted the Endurance Shuttle Walk Test for ambulatory patients and developed the Endurance Shuttle Box and Block Test and the - Nine Hole Peg Test for fatigability testing of proximal and distal arm function. Content validity was established through input from experts and patients. Pilot testing showed that the set of endurance tests are comprehensible, feasible and meet all predefined test criteria. CONCLUSIONS The development of this comprehensive set of endurance tests is a pivotal step to address fatigability in patients with SMA.
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Affiliation(s)
- Bart Bartels
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, KB 02.056.0, 3508 AB Utrecht, The Netherlands
| | - Laura E. Habets
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, KB 02.056.0, 3508 AB Utrecht, The Netherlands
| | - Marloes Stam
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Renske I. Wadman
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Camiel A. Wijngaarde
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marja A. G. C. Schoenmakers
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, KB 02.056.0, 3508 AB Utrecht, The Netherlands
| | - Tim Takken
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, KB 02.056.0, 3508 AB Utrecht, The Netherlands
| | - Erik H.J. Hulzebos
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, KB 02.056.0, 3508 AB Utrecht, The Netherlands
| | - W. Ludo van der Pol
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Janke F. de Groot
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, KB 02.056.0, 3508 AB Utrecht, The Netherlands
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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15
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Pitt K, Brumberg J. A screening protocol incorporating brain-computer interface feature matching considerations for augmentative and alternative communication. Assist Technol 2018; 32:161-172. [DOI: 10.1080/10400435.2018.1512175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Kevin Pitt
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence, Kansas, USA
| | - Jonathan Brumberg
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence, Kansas, USA
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16
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Gibbons C, Pagnini F, Friede T, Young CA. Treatment of fatigue in amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database Syst Rev 2018; 1:CD011005. [PMID: 29293261 PMCID: PMC6494184 DOI: 10.1002/14651858.cd011005.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), is terminal, progressive neurological condition for which there are no curative treatments. Among people with ALS/MND, fatigue is a common and debilitating symptom, which is characterised by reversible motor weakness and whole-body tiredness that is only partially relieved by rest. The effectiveness of pharmacological or non-pharmacological treatments for fatigue in ALS/MND is not yet established. OBJECTIVES To assess the effects of pharmacological and non-pharmacological interventions for fatigue in ALS/MND. SEARCH METHODS We searched the following databases on 5 September 2017: Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL Plus, and ERIC. We also searched two clinical trials registries. SELECTION CRITERIA We selected randomised and quasi-randomised controlled trials of any intervention which sought to reduce fatigue for people with ALS/MND. We included studies if reduction in fatigue was a primary or secondary outcome of the trial. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included one pharmacological (modafinil) study and three non-pharmacological studies (resistance exercise, respiratory exercise, and repetitive transcranial magnetic stimulation (rTMS)), involving a total of 86 participants with ALS/MND. None of the included studies were free from risk of bias. Since there was only one trial for each intervention, no meta-analysis was possible. All studies assessed fatigue using the Fatigue Severity Scale (FSS; scale from 9 to 63, higher scores indicate more fatigue). Information for assessing bias was often lacking in study reports, making the risk of bias unclear across several domains in all trials. Blinding of participants was not possible in exercise trials, but the outcome assessment was blinded.We found very low-quality evidence suggesting possible improvements in fatigue for modafinil treatment versus placebo (MD -11.00, 95% CI -23.08 to 1.08), respiratory exercise versus a sham intervention (MD -9.65, 95% CI -22.04 to 2.73), and rTMS versus sham rTMS (data not provided), which warrant further investigation to clarify the efficacy of these treatments for fatigue in ALS/MND. We found no clear improvements in fatigue for resistance exercise versus usual care (MD 0.20, 95% CI -10.98 to 11.38; very low-quality evidence).Three participants in the modafinil group dropped out of the modafinil study, two citing issues with headache and one with chest tightness; other adverse effects were anxiety, nausea, dizziness, and sialorrhoea (probably ALS-related). The trials reported no adverse effects of exercise or rTMS.We cannot be certain about the effects of any of the interventions studied because of imprecision (small numbers of participants, wide CI), and possible study limitations. AUTHORS' CONCLUSIONS It is impossible to draw firm conclusions about the effectiveness of interventions to improve fatigue for people with ALS/MND as there are few randomised studies, and the quality of available evidence is very low.
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Affiliation(s)
- Chris Gibbons
- University of CambridgeThe Primary Care UnitForvie SiteRobinson WayCambridgeCambridgeshireUKCB2 0SR
| | - Francesco Pagnini
- Università Cattolica del Sacro CuoreDepartment of PsychologyVia Nirone 15,MilanoItaly20123
- Harvard UniversityDepartment of PsychologyCambridgeMassachusettsUSA
| | - Tim Friede
- University Medical Center GoettingenDepartment of Medical StatisticsGoettingenGermany
| | - Carolyn A Young
- The Walton Centre NHS Foundation TrustLower LaneFazakerleyLiverpoolUKL9 7LJ
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17
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Kluger BM. Fatigue in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:743-768. [DOI: 10.1016/bs.irn.2017.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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18
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Kluger BM, Herlofson K, Chou KL, Lou JS, Goetz CG, Lang AE, Weintraub D, Friedman J. Parkinson's disease-related fatigue: A case definition and recommendations for clinical research. Mov Disord 2016; 31:625-31. [PMID: 26879133 DOI: 10.1002/mds.26511] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/04/2015] [Accepted: 11/18/2015] [Indexed: 12/28/2022] Open
Abstract
Fatigue is one of the most common and disabling symptoms in Parkinson's disease (PD). Since fatigue was first described as a common feature of PD 20 years ago, little progress has been made in understanding its causes or treatment. Importantly, PD patients attending the 2013 World Parkinson Congress voted fatigue as the leading symptom in need of further research. In response, the Parkinson Disease Foundation and ProjectSpark assembled an international team of experts to create recommendations for clinical research to advance this field. The working group identified several areas in which shared standards would improve research quality and foster progress including terminology, diagnostic criteria, and measurement. Terminology needs to (1) clearly distinguish fatigue from related phenomena (eg, sleepiness, apathy, depression); (2) differentiate subjective fatigue complaints from objective performance fatigability; and (3) specify domains affected by fatigue and causal factors. We propose diagnostic criteria for PD-related fatigue to guide participant selection for clinical trials and add rigor to mechanistic studies. Recommendations are made for measurement of subjective fatigue complaints, performance fatigability, and neurophysiologic changes. We also suggest areas in which future research is needed to address methodological issues and validate or optimize current practices. Many limitations in current PD-related fatigue research may be addressed by improving methodological standards, many of which are already being successfully applied in clinical fatigue research in other medical conditions (eg, cancer, multiple sclerosis). © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Kelvin L Chou
- Departments of Neurology and Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jau-Shin Lou
- Department of Neurology, University of North Dakota School of Medicine and Health Science, Department of Neurology, Sanford Health, Fargo, North Dakota, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Parkinson's Disease and Mental Illness Research, Education and Clinical Centers (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Joseph Friedman
- Department of Neurology, Butler Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Cai B, Allexandre D, Rajagopalan V, Jiang Z, Siemionow V, Ranganathan VK, Davis MP, Walsh D, Dai K, Yue GH. Evidence of significant central fatigue in patients with cancer-related fatigue during repetitive elbow flexions till perceived exhaustion. PLoS One 2014; 9:e115370. [PMID: 25532032 PMCID: PMC4274034 DOI: 10.1371/journal.pone.0115370] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 11/21/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To investigate whether fatigue induced by an intermittent motor task in patients with cancer-related fatigue (CRF) is more central or peripheral. METHODS Ten patients with CRF who were off chemo and radiation therapies and 14 age-matched healthy controls were enrolled. Participants completed a Brief Fatigue Inventory (BFI) and performed a fatigue task consisting of intermittent elbow-flexion contractions at submaximal (40% maximal voluntary contraction) intensity till self-perceived exhaustion. Twitch force was elicited by an electrical stimulation applied to the biceps brachii muscle. The relative degree of peripheral (muscle) vs. central contribution to fatigue induced by the intermittent motor task (IMT) was assessed using twitch force ratio (TF ratio) defined as post IMT twitch force to pre IMT twitch force. The total number of trials (intermittent contractions) and total duration of all trials performed by each subject were also quantified. RESULTS BFI scores were higher (p < 0.001) in CRF than controls, indicating greater feeling of fatigue in CRF patients than controls. A significantly smaller number of trials and shorter total duration of the trials (p < 0.05) were observed in CRF than control participants. The TF ratio (0.81 ± 0.05) in CRF was higher (p < 0.05) compared with that of controls (0.62 ± 0.05), suggesting CRF patients experienced a significantly lower degree of muscle (peripheral) fatigue at the time of perceived exhaustion. CONCLUSION Consistent with prior findings for fatigue under submaximal sustained contraction, our results indicate that motor fatigue in CRF is more of central than peripheral origin during IMT. Significant central fatigue in CRF patients limits their ability to prolong motor performance.
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Affiliation(s)
- Bin Cai
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
- Institute of Rehabilitation Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China
| | - Didier Allexandre
- Human Performance & Engineering Laboratory, Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, New Jersey 07052, United States of America
| | - Venkateswaran Rajagopalan
- Human Performance & Engineering Laboratory, Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, New Jersey 07052, United States of America
| | - Zhiguo Jiang
- Human Performance & Engineering Laboratory, Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, New Jersey 07052, United States of America
| | - Vlodek Siemionow
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio 44195, United States of America
| | - Vinoth K. Ranganathan
- Department of Physical Medicine & Rehabilitation, Cleveland Clinic, Cleveland, Ohio 44195, United States of America
| | - Mellar P. Davis
- The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio 44195, United States of America
| | - Declan Walsh
- The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio 44195, United States of America
| | - Kerong Dai
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, PRC, 1954 Huashan Road, Shanghai 200030, China
| | - Guang H. Yue
- Human Performance & Engineering Laboratory, Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, New Jersey 07052, United States of America
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio 44195, United States of America
- Department of Physical Medicine & Rehabilitation, Cleveland Clinic, Cleveland, Ohio 44195, United States of America
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Rakocevic-Stojanovic V, Peric S, Madzarevic R, Dobricic V, Ralic V, Ilic V, Basta I, Nikolic A, Stefanova E. Significant impact of behavioral and cognitive impairment on quality of life in patients with myotonic dystrophy type 1. Clin Neurol Neurosurg 2014; 126:76-81. [PMID: 25215445 DOI: 10.1016/j.clineuro.2014.08.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 08/15/2014] [Accepted: 08/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess an impact of cognitive and behavioral impairment on QoL in a larger cohort of patients with DM1. METHODS Sixty six genetically confirmed DM1 patients (22 with juvenile (jDM1) and 44 with adult form (aDM1) of the disease) were recruited. Following behavioral tests were used: Hamilton scales for depression and anxiety (HamD and HamA), Daytime Sleepiness Scale (DSS), and Krupp's Fatigue Severity Scale (FSS). Patients also underwent detailed classic neuropsychological investigation and Cambridge Neuropsychological Test Automated Battery (CANTAB). Individualized Neuromuscular Quality of Life questionnaire (INQoL) was used as a measure of QoL. RESULTS Patients with jDM1 scored lower than aDM1 patients regarding total INQoL score and all INQoL subdomains, except for myotonia. Significant predictors of total INQoL score in patients with jDM1 were severity of fatigue (β=+0.60, p<0.01) and percentage of correct responses on Spatial Recognition Memory test from CANTAB that measures visuospatial abilities (β=-0.38, p<0.05). The most important predictors of total INQoL score in patients with aDM1 were severity of fatigue (β=+0.36, p<0.05) and level of education (β=-0.29, p<0.05). CONCLUSION Our results showed clear influence of different central manifestations on QoL in patients with both aDM1 and jDM1.
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Affiliation(s)
- V Rakocevic-Stojanovic
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - S Peric
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia.
| | - R Madzarevic
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - V Dobricic
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - V Ralic
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - V Ilic
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - I Basta
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - A Nikolic
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - E Stefanova
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
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Lin Y, Liu HL, Fang J, Yu CH, Xiong YK, Yuan K. Anti-fatigue and vasoprotective effects of quercetin-3-O-gentiobiose on oxidative stress and vascular endothelial dysfunction induced by endurance swimming in rats. Food Chem Toxicol 2014; 68:290-6. [DOI: 10.1016/j.fct.2014.03.026] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 03/18/2014] [Accepted: 03/21/2014] [Indexed: 01/04/2023]
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Breiner A, Barnett C, Bril V. INCAT disability score: a critical analysis of its measurement properties. Muscle Nerve 2014; 50:164-9. [PMID: 24723454 DOI: 10.1002/mus.24207] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND The INCAT (Inflammatory Neuropathy Cause and Treatment) disability score is a measure of activity limitation. It is used frequently as a primary endpoint in inflammatory polyneuropathy clinical trials. A comprehensive critical analysis of its measurement properties has not been performed. METHODS Critical analysis of measurement properties. RESULTS The INCAT disability score was derived based on items from Guy's Neurological Disability Scale (GNDS), a disability measure intended for application in multiple sclerosis. Strengths of the INCAT score include evaluation of upper and lower limb dysfunction, ease of administration (feasibility), high face validity, and high reliability. Weaknesses of the scale include concerns about methodological quality of validation studies; failure to properly capture activity limitations due to proximal arm weakness, or fatigue; heavy individual item weighting; and poor sensitivity for detection of clinically important change. CONCLUSIONS Although the INCAT scale has been an effective tool in inflammatory polyneuropathy studies, its limitations may warrant development of new scales.
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Affiliation(s)
- Ari Breiner
- Division of Neurology, Department of Medicine, University of Toronto, 200 Elizabeth Street, Room 5EC-309, Toronto, Ontario, Canada, M5G 2C4
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Young CA, Gibbons C, Pagnini F, Friede T. Treatment for fatigue in amyotrophic lateral sclerosis/motor neuron disease (ALS/MND). Hippokratia 2014. [DOI: 10.1002/14651858.cd011005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Carolyn A Young
- The Walton Centre for Neurology and Neurosurgery; Lower Lane Fazakerley Liverpool UK L9 7LJ
| | - Chris Gibbons
- University of Manchester; Collaboration for Leadership in Applied Health Research and Care (CLAHRC); School of Community Based Medicine, Williamson Building, Oxford Road, Manchester UK M13 9PL
| | - Francesco Pagnini
- Catholic University of Milan; Department of Psychology; Via Nirone 15, Milano Italy 20123
| | - Tim Friede
- Universitätsmedizin Göttingen; Institut für Medizinische Statistik; Humboldtallee 32 Göttingen Germany 37073
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Interventions in pediatric chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review. J Adolesc Health 2013; 53:154-65. [PMID: 23643337 DOI: 10.1016/j.jadohealth.2013.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE A range of interventions have been used for the management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) in children and adolescents. Currently, debate exists as to the effectiveness of these different management strategies. The objective of this review was to synthesize and critically appraise the literature on interventions for pediatric CFS/ME. METHOD CINAHL, PsycINFO and Medline databases were searched to retrieve relevant studies of intervention outcomes in children and/or adolescents diagnosed with CFS/ME. Two reviewers independently selected articles and appraised the quality on the basis of predefined criteria. RESULTS A total of 24 articles based on 21 studies met the inclusion criteria. Methodological design and quality were variable. The majority assessed behavioral interventions (10 multidisciplinary rehabilitation; 9 psychological interventions; 1 exercise intervention; 1 immunological intervention). There was marked heterogeneity in participant and intervention characteristics, and outcome measures used across studies. The strongest evidence was for Cognitive Behavioral Therapy (CBT)-based interventions, with weaker evidence for multidisciplinary rehabilitation. Limited information exists on the maintenance of intervention effects. CONCLUSIONS Evidence for the effectiveness of interventions for children and adolescents with CFS/ME is still emerging. Methodological inadequacies and inconsistent approaches limit interpretation of findings. There is some evidence that children and adolescents with CFS/ME benefit from particular interventions; however, there remain gaps in the current evidence base.
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Abstract
OBJECTIVES Although fatigue is experienced by everyone, its definition and classification remains under debate. METHODS A review of the previously published data on fatigue. RESULTS Fatigue is influenced by age, gender, physical condition, type of food, latency to last meal, mental status, psychological conditions, personality type, life experience, and the health status of an individual. Fatigue may not only be a symptom but also a measurable and quantifiable dimension, also known as fatigability. Additionally, it may be classified as a condition occurring at rest or under exercise or stress, as physiologic reaction or pathologic condition, as spontaneous phenomenon or triggerable state, as resistant or irresistant to preconditioning, training, or attitude, as prominent or collateral experience, and as accessible or inaccessible to any type of treatment or intervention. Fatigue may be the sole symptom of a disease or one among others. It may be also classified as acute or chronic. Quantification of fatigability is achievable by fatigue scores, force measurement, electromyography, or other means. Fatigue and fatigability need to be delineated from conditions such as sleepiness, apathy, exhaustion, exercise intolerance, lack of vigor, weakness, inertia, or tiredness. Among neurological disorders, the prevalence of fatigue is particularly increased in multiple sclerosis, amyotrophic lateral sclerosis, Parkinson disease, traumatic brain injury, stroke, and bleeding and also in neuromuscular disorders. Fatigue may be influenced by training, mental preconditioning, or drugs. CONCLUSIONS Fatigue needs to be recognized as an important condition that is not only a symptom but may also be quantified and can be modified by various measures depending on the underlying cause.
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Affiliation(s)
| | - Sinda Zarrouk Mahjoub
- Laboratory of Biochemistry, UR "Human Nutrition and Metabolic Disorders" Faculty of Medicine Monastir, Monastir, Tunisie
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Gibbons CJ, Young CA. Assessing and managing depression and fatigue in motor neuron disease. Neurodegener Dis Manag 2012. [DOI: 10.2217/nmt.12.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
SUMMARY This review evaluates strategies for assessing and treating depression and fatigue for patients diagnosed with motor neuron disease. A summary is given of questionnaire, interview and laboratory methods of assessment, including disease-specific techniques. The unique physical demands of the disease may preclude accurate measurement using generic questionnaire measures and disease-validated measures should be used, where available. There is an urgent need to develop psychological therapies for depression that can cater for the needs of motor neuron disease patients and their carers. Currently, no evidence-based treatment exists for fatigue and further work is warranted to systematically evaluate current evidence and develop novel treatments for this burdensome symptom.
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Affiliation(s)
- Chris J Gibbons
- The Walton Centre for Neurology & Neurosurgery, Liverpool, L9 7LJ, UK
- NIHR Collaboration for Leadership in Applied Health Research & Care, University of Manchester, Manchester, UK
| | - Carolyn A Young
- The Walton Centre for Neurology & Neurosurgery, Liverpool, L9 7LJ, UK
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