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Wang X, Wang X, Yan Z, Yin F, Li Y, Liu X, Liu Y. Enhanced choroid plexus segmentation with 3D UX-Net and its association with disease progression in multiple sclerosis. Mult Scler Relat Disord 2024; 88:105750. [PMID: 38986172 DOI: 10.1016/j.msard.2024.105750] [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: 03/25/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The choroid plexus (CP) is suggested to be closely associated with the neuroinflammation of multiple sclerosis (MS). Segmentation based on deep learning (DL) could facilitate rapid and reproducible volume assessment of the CP, which is crucial for elucidating its role in MS. PURPOSE To develop a reliable DL model for the automatic segmentation of CP, and further validate its clinical significance in MS. METHODS The 3D UX-Net model (3D U-Net used for comparison) was trained and validated on T1-weighted MRI from a cohort of 216 relapsing-remitting MS (RRMS) patients and 75 healthy subjects. Among these, 53 RRMS with baseline and 2-year follow-up scans formed an internal test set (dataset1b). Another 58 RRMS from multi-center data served as an external test set (dataset2). Dice coefficient was computed to assess segmentation performance. Compare the correlation of CP volume obtained through automatic and manual segmentation with clinical outcomes in MS. Disability and cognitive function of patients were assessed using the Expanded Disability Status Scale (EDSS) and Symbol Digit Modalities Test (SDMT). RESULTS The 3D UX-Net model achieved Dice coefficients of 0.875 ± 0.030 and 0.870 ± 0.044 for CP segmentation on dataset1b and dataset2, respectively, outperforming 3D U-Net's scores of 0.809 ± 0.098 and 0.601 ± 0.226. Furthermore, CP volumes segmented by the 3D UX-Net model aligned consistently with clinical outcomes compared to manual segmentation. In dataset1b, both manual and automatic segmentation revealed a significant positive correlation between normalized CP volume (nCPV) and EDSS scores at baseline (manual: r = 0.285, p = 0.045; automatic: r = 0.287, p = 0.044) and a negative correlation with SDMT scores (manual: r = -0.331, p = 0.020; automatic: r = -0.329, p = 0.021). In dataset2, similar correlations were found with EDSS scores (manual: r = 0.337, p = 0.021; automatic: r = 0.346, p = 0.017). Meanwhile, in dataset1b, both manual and automatic segmentation revealed a significant increase in nCPV from baseline to follow-up (p < 0.05). The increase of nCPV was more pronounced in patients with disability worsened than stable patients (manual: p = 0.023; automatic: p = 0.018). Patients receiving disease-modifying therapy (DMT) exhibited a significantly lower nCPV increase than untreated patients (manual: p = 0.004; automatic: p = 0.004). CONCLUSION The 3D UX-Net model demonstrated strong segmentation performance for the CP, and the automatic segmented CP can be directly used in MS clinical practice. CP volume can serve as a surrogate imaging biomarker for monitoring disease progression and DMT response in MS patients.
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Affiliation(s)
- Xiaohua Wang
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, China; Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiaolong Wang
- College of Computer and Information Science, Southwest University, Chongqing, 400054, China
| | - Zichun Yan
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Feiyue Yin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Xiaojuan Liu
- College of Computer and Information Science, Southwest University, Chongqing, 400054, China.
| | - Yanbing Liu
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, China.
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Takagi-Stewart J, Prater LC, Marts E, Ayachit P, Jesus TS. Circumstantial variables preceding firearm suicide among females with and without mobility disability in the USA: comparative analysis using data from the National Violent Death Reporting System. Inj Prev 2024:ip-2023-045195. [PMID: 39025667 DOI: 10.1136/ip-2023-045195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 07/07/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Mobility disability impacts approximately 12% of the US population; females are overrepresented among persons with mobility disability. Those with mobility disability are at increased risk of suicide compared with their non-disabled counterparts. Suicide using a firearm has increased among females in the last two decades. This study aims to describe and explore significant circumstantial variables (eg, socio-demographic, health indicators) preceding firearm suicide among females with mobility disability as compared with females without mobility disability. METHODS This is a secondary comparative, retrospective analysis of the narrative data from the National Violent Death Reporting System Restricted Access Database. Persons with mobility disability were identified through text mining and manual review and subsequently analysed with a summative form of content analysis. Pearson/Fisher's X2 or t-tests were used to assess differences in the circumstantial variables between those with and without mobility disabilities. RESULTS Among female firearm suicide decedents, persons with mobility disability were more commonly older (p<0.001), identified as a homemaker (p<0.001), were perceived to be in a depressed mood before death (p<0.05), had a history of suicidal thoughts (p<0.05) and were perceived to have physical pain (p<0.001); they less commonly had relationship problems (p<0.05). CONCLUSIONS Females with mobility disability who die by firearm suicide may be differentiated from suicide decedents without mobility disability by age, employment status, depressive mood, relationship problems and physical pain. The significance of these variables as independent risk factors for firearm suicide may be tested with prospective study designs, which in turn may inform the development of targeted or disability-inclusive prevention strategies.
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Affiliation(s)
- Julian Takagi-Stewart
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- Firearm Injury and Policy Research Program, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Laura C Prater
- Firearm Injury and Policy Research Program, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Erika Marts
- Firearm Injury and Policy Research Program, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Pooja Ayachit
- Firearm Injury and Policy Research Program, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Tiago S Jesus
- Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
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Mañago MM, Will R, Strahler T, Van Valkenburgh L, Harris-Love MO, Forster JE, Cameron M, Christiansen CL. Blood Flow Restriction and Veterans With Multiple Sclerosis and Advanced Disability: Protocol for a Randomized Controlled Trial. Phys Ther 2024; 104:pzae037. [PMID: 38452199 DOI: 10.1093/ptj/pzae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/06/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE The purpose of this study will be to determine the efficacy of low intensity lower extremity resistance training with and without blood flow restriction (BFR) on quadriceps muscle strength and thickness in veterans with advanced multiple sclerosis (MS). METHODS This will be an assessor-blinded, 2-group (1 to 1 allocation) randomized controlled trial targeting an enrollment of 58 participants with advanced MS as defined by Patient-Determined Disease Steps scale levels 4 to 7. Both groups will complete 10 weeks of twice weekly low-load resistance training (20%-30% of 1-repetition max) targeting knee and hip extension, knee flexion, and ankle plantarflexion. The intervention group will perform all training using BFR, with limb occlusion pressures between 60% and 80% of maximal limb occlusion pressure. Primary outcomes will be quadriceps muscle strength and thickness. Secondary outcomes will include knee flexion and ankle plantarflexion strength, functional mobility, physical activity, and patient-reported measures. All outcomes will be assessed at baseline before the intervention, immediately after the intervention, and at a 2-month follow-up assessment. The change between groups postintervention and after the 2-month follow-up will be reported for all outcomes. All analyses will assume a 2-sided test of hypothesis (α = .05). IMPACT There is very little evidence for the efficacy of exercise interventions in people with MS who have advanced mobility disability. Resistance training with BFR may be an important approach for people with advanced MS who may not tolerate more conventional, moderate-to-high intensity resistance training. The results of this study will inform clinicians regarding exercise decisions for people with advanced MS and future investigations on the role of BFR in people with MS.
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Affiliation(s)
- Mark M Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Robert Will
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Talia Strahler
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Lauren Van Valkenburgh
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Michael O Harris-Love
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Data and Statistical Core, Aurora, Colorado, USA
| | - Michelle Cameron
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
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Willingham TB, Stowell J, Collier G, Backus D. Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:79. [PMID: 38248542 PMCID: PMC10815484 DOI: 10.3390/ijerph21010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024]
Abstract
Physical rehabilitation and exercise training have emerged as promising solutions for improving health, restoring function, and preserving quality of life in populations that face disparate health challenges related to disability. Despite the immense potential for rehabilitation and exercise to help people with disabilities live longer, healthier, and more independent lives, people with disabilities can experience physical, psychosocial, environmental, and economic barriers that limit their ability to participate in rehabilitation, exercise, and other physical activities. Together, these barriers contribute to health inequities in people with disabilities, by disproportionately limiting their ability to participate in health-promoting physical activities, relative to people without disabilities. Therefore, there is great need for research and innovation focusing on the development of strategies to expand accessibility and promote participation in rehabilitation and exercise programs for people with disabilities. Here, we discuss how cutting-edge technologies related to telecommunications, wearables, virtual and augmented reality, artificial intelligence, and cloud computing are providing new opportunities to improve accessibility in rehabilitation and exercise for people with disabilities. In addition, we highlight new frontiers in digital health technology and emerging lines of scientific research that will shape the future of precision care strategies for people with disabilities.
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Affiliation(s)
- T. Bradley Willingham
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
- Department of Physical Therapy, Georgia State University, Atlanta, GA 30302, USA
| | - Julie Stowell
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
- Department of Physical Therapy, Georgia State University, Atlanta, GA 30302, USA
| | - George Collier
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
| | - Deborah Backus
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
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Baynard T, Griffith GJ, Wee SO, McMillan NJ, Bollaert RE, Motl RW, Fernhall B. Home-based exercise improves subclinical atherosclerosis marker in multiple sclerosis. Mult Scler Relat Disord 2023; 79:105002. [PMID: 37716212 DOI: 10.1016/j.msard.2023.105002] [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: 03/09/2023] [Revised: 07/12/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Using a 12-week, randomized controlled trial coupled with social cognitive theory behavioral coaching, we aimed to assess the effect of a home-based aerobic training intervention versus an attention-control on aerobic fitness, subclinical atherosclerosis, and mobility in persons with MS. METHODS Persons with MS with an expanded disability status scale score between 0 and 4 were randomized to a 12-week aerobic exercise (EX) (n = 26; 19 females; 49 yrs; 28.8 kg/m2) or attention-control (CON) condition (stretching; n = 22; 16 females; 44 yrs; 29.2 kg/m2). Aerobic capacity was assessed via a graded cycle ergometry test with indirect calorimetry. The co-primary measures of subclinical atherosclerosis assessed included carotid intima media thickness, a test of vasodilatory reactivity, and arterial stiffness. Mobility was assessed via a timed 25-foot walk test (T25FW) and a 6 min walk test. The EX group engaged in cycle ergometry 3d/wk with gradual increases in the intensity and duration of the exercise sessions. CON participated in standardized stretching designed to provide the same contact time as EX 3d/wk. Behavioral coaching took place via weekly phone/video chats to track adherence. RESULTS Aerobic capacity, vasodilatory reactivity, and T25FW speed increased only in the EX group, 7%, 16%, and 13% (p<0.05), respectively; whereas the CON group did not change. CONCLUSION The EX group had modest, yet significant, increases in aerobic capacity over the 12-week period, coupled with improvements in T25FW speed and vasodilatory reactivity. A home-based exercise intervention can improve outcomes of a subclinical marker of atherosclerosis, which provides a basis for examining these outcomes in persons prescreened for CVD-related comorbidities and/or mobility issues.
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Affiliation(s)
- Tracy Baynard
- Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL 60612; Currently affiliated with the Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125.
| | - Garett J Griffith
- Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL 60612; Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, 60611
| | - Sang Ouk Wee
- Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL 60612; Department of Kinesiology, California State University, San Bernardino, CA 92407
| | - Neil J McMillan
- Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL 60612; Department of Nutrition & Exercise Physiology, University of Missouri, Columbia, MO 65211
| | - Rachel E Bollaert
- Department of Physical Therapy, Marquette University, Milwaukee, WI 53201
| | - Robert W Motl
- Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL 60612
| | - Bo Fernhall
- Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL 60612
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Nieste I, Franssen WMA, Duvivier BMFM, Spaas J, Savelberg HHCM, Eijnde BO. Replacing sitting with light-intensity physical activity throughout the day versus 1 bout of vigorous-intensity exercise: similar cardiometabolic health effects in multiple sclerosis. A randomised cross-over study. Disabil Rehabil 2023; 45:3293-3302. [PMID: 36190113 DOI: 10.1080/09638288.2022.2122601] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Persons with Multiple Sclerosis (PwMS) are physically inactive and spend more time in sedentary behaviours than healthy persons, which increases the risk of developing cardiometabolic diseases. In this randomised crossover study, the cardiometabolic health effects of replacing sitting with light-intensity physical activity (LIPA) and exercise (EX) were investigated. MATERIALS AND METHODS Twenty-eight mildly disabled PwMS performed four 4-day activity regimens in free-living conditions; CONTROL (habitual activity), SIT, LIPA, and EX. Plasma glucose and insulin (oral glucose tolerance test), plasma lipids, inflammation, resting heart rate, blood pressure, body weight, and perceived exertion were measured (clinical-trials.gov: NCT03919058). RESULTS CONTROL: 9.7 h sitting/day, SIT: 13.3 h sitting/day, LIPA: 8.3 h sitting, 4.7 h standing, and 2.7 h light-intensity walking/day, and EX: 11.6 h sitting/day with 1.3 h vigorous-intensity cycling. Compared to SIT, improvements (p < 0.001) after LIPA and EX were found for insulin total area under the curve (-17 019 ± 5708 and -23 303 ± 7953 pmol/L*min), insulin sensitivity (Matsuda index +1.8 ± 0.3 and +1.9 ± 0.4) and blood lipids (triglycerides: -0.4 ± 0.1 and -0.5 ± 0.1 mmol/L; non-high-density lipoprotein cholesterol: -0.3 ± 0.1 and -0.5 ± 0.1 mmol/L), with no difference between LIPA and EX. Perceived exertion was higher after EX compared to LIPA (Borg score [6-20]: +2.6 ± 3.3, p = 0.002). CONCLUSION Replacing sitting with LIPA throughout the day exerts similar cardiometabolic health effects as a vigorous-intensity exercise in PwMS.IMPLICATIONS FOR REHABILITATIONIncreasing light-intensity physical activity (LIPA) throughout the day improves cardiometabolic health to the same extent as one vigorous-intensity exercise sessionIncreasing LIPA induces less exertion than performing a vigorous-intensity exercise.
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Affiliation(s)
- Ine Nieste
- Faculty of Medicine and Life Sciences, Sports Medicine Research Center, SMRC, BIOMED, Biomedical Research Institute, Hasselt University, Hasselt, Belgium
- Department of Nutrition and Movement Sciences, Faculty of Health, Medicine and Life Sciences, NUTRIM, School for Nutrition and Translation Research Maastricht, Maastricht University, Maastricht, Netherlands
- University MS Center (UMSC) Hasselt-Pelt, Hasselt, Belgium
| | - Wouter M A Franssen
- Faculty of Medicine and Life Sciences, Sports Medicine Research Center, SMRC, BIOMED, Biomedical Research Institute, Hasselt University, Hasselt, Belgium
- Department of Nutrition and Movement Sciences, Faculty of Health, Medicine and Life Sciences, NUTRIM, School for Nutrition and Translation Research Maastricht, Maastricht University, Maastricht, Netherlands
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
| | | | - Jan Spaas
- Faculty of Medicine and Life Sciences, Sports Medicine Research Center, SMRC, BIOMED, Biomedical Research Institute, Hasselt University, Hasselt, Belgium
- University MS Center (UMSC) Hasselt-Pelt, Hasselt, Belgium
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Sciences, Faculty of Health, Medicine and Life Sciences, NUTRIM, School for Nutrition and Translation Research Maastricht, Maastricht University, Maastricht, Netherlands
| | - Bert O Eijnde
- Faculty of Medicine and Life Sciences, Sports Medicine Research Center, SMRC, BIOMED, Biomedical Research Institute, Hasselt University, Hasselt, Belgium
- University MS Center (UMSC) Hasselt-Pelt, Hasselt, Belgium
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Marcu FM, Brihan I, Ciubara A, Lupu VV, Negrut N, Jurcau A, Lupu A, Burlea SL, Dragan F, Butnariu LI, Ignat AE, Ciubara AB. The Early Initiation Advantages of Physical Therapy in Multiple Sclerosis-A Pilot Study. Life (Basel) 2023; 13:1501. [PMID: 37511877 PMCID: PMC10381402 DOI: 10.3390/life13071501] [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: 05/07/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Multiple sclerosis (MS), a chronic progressive neurological disorder which affects the central nervous system (CNS), can result in disorders of all the functions controlled by the CNS: motor, sensory, cognitive and emotional. Physical therapy (PT), conducted through proprioceptive neuromuscular facilitation (PNF) techniques, can be customized to the individual patient's needs and has the potential to improve the patient's evolution. This study aims to establish if PT based on PNF techniques has a beneficial role in MS treatment. (2) Methods: We performed a prospective study on 40 patients who were diagnosed with MS and previously treated only with MS drug treatment (DT). These patients have participated in a PT program throughout one year. At the beginning and at the end of our study, after one year, we have assessed the following parameters: timed walk for 25 feet (Timed 25-Foot Walk test- T25FW test), dexterity of the upper limbs (9-Hole Peg Test-9HPT), disability level (Expanded Disability Status Scale-EDSS) and cognitive function (Paced Auditory Serial Addition Test-PASAT. (3) Results: In subjects in the early stages of MS, lower limb mobility improved significantly, T25FW decreasing from 6.46 to 5.80 (p < 0.001) and upper limb ability increased significantly in the dominant hand, 9HPT decreasing from 17.73 to 16.97 (p = 0.006) and not significantly in the non-dominant hand, 9HPT decreasing from 17.73 to 17.50 (p = 0.255). Furthermore, among these subjects, cognitive performance improved; their PASAT increased from 52.14 to 54.14 (p = 0.036), while the level of disability of these subjects improved only slightly, the EDSS scale evolving from 3.08 to 2.91 (p = 0.650). (4) Conclusions: In patients with early forms of MS, combining DT with a PT program based on PNF techniques results in: regaining muscle strength in the lower limbs, improving coordination while walking, correcting dexterity in the upper limbs and increasing the ability to concentrate.
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Affiliation(s)
- Florin Mihai Marcu
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Ilarie Brihan
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Anamaria Ciubara
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800008 Galati, Romania
| | - Vasile Valeriu Lupu
- Faculty of General Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Nicoleta Negrut
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Anamaria Jurcau
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Ancuta Lupu
- Faculty of General Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Stefan Lucian Burlea
- Public Health and Management Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Felicia Dragan
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
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Mañago MM, Seamon BA, Boncella KL, Wallin MT, Maloni H, Hoover B, Blackman MR, Harris-Love MO. Ultrasound measures of muscle morphology in people with multiple sclerosis are associated with muscle performance and functional mobility. Mult Scler Relat Disord 2023; 75:104759. [PMID: 37192587 PMCID: PMC10330594 DOI: 10.1016/j.msard.2023.104759] [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: 03/08/2023] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Neurologically-based muscle weakness is a common symptom in people with multiple sclerosis MS (MS), who may also exhibit muscle morphology changes and intrinsic muscle dysfunction. Diagnostic ultrasound (sonography) is a non-invasive, inexpensive, and clinically feasible method to measure muscle morphology. The purpose of this study was to investigate possible asymmetries in lower limb muscle morphology and performance in people with MS, and to assess the relationships of muscle morphology measures with individual patient characteristics, muscle performance, and functional mobility. METHODS This cross-sectional study was conducted at the Washington, DC Veterans Affairs Medical Center. The study participants were 29 Veterans with MS (52% female, 79% African-American, 48.6 ± 11.2 years old, Mean Expanded Disability Status Scale: 3.6 ± 1.4) who completed seated knee extension isokinetic strength and power tests, functional assessments (Timed 25-Foot Walk - T25FW, 5-Times Sit-to-Stand - 5STS), and quantitative B-mode ultrasound image acquisition of the rectus femoris muscle to derive morphology measures (thickness and echogenicity). The limb with weaker knee extension strength was identified as the more-involved limb. Differences between the more and less-involved limb were quantified using a t-test for all muscle morphology and muscle performance measures. Relationships between muscle morphology and patient characteristics, muscle performance, and functional mobility were evaluated using bivariate and multivariate analyses. RESULTS The rectus femoris thickness from the more-involved limb was lower (p<0.001) than that of the less-involved limb, whereas echogenicity was not different between the two limbs (p=0.147). Rectus femoris thickness of the more-involved limb was directly related to age (r=-0.63, p<0.001), muscle strength (r=0.53, p=0.003) and power (r=0.53, p=0.003), and gait speed (r=0.42, p=0.024); whereas its echogenicity was positively associated only with muscle strength (r=-0.46, p=0.013) and power (r=-0.50, p=0.006). Together rectus femoris thickness and echogenicity of the more involved limb explained 44% and 48% of the variance in muscle strength and power, respectively (p<0.001). CONCLUSION This study supports the ability of sonography to measure muscle morphology in people with MS, identify asymmetries, and quantify associations with important clinical correlates. Compared with more invasive and costly alternatives, sonography is a clinically feasible, relatively low-cost tool that can be used to assess muscle morphology in people with MS. Further research is warranted to determine the potential clinical utility of sonographic measures of muscle morphology in evaluating changes due to disease progression or therapeutic interventions in this population.
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Affiliation(s)
- Mark M Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; VA Research Service, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.
| | - Bryant A Seamon
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA; Muscle Morphology, Mechanics and Performance Lab, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Research Service, Washington DC VA Medical Center, Washington, DC, USA
| | - Katie L Boncella
- Muscle Morphology, Mechanics and Performance Lab, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mitchell T Wallin
- VA Multiple Sclerosis Center of Excellence and Neurology Service, Washington DC VA Medical Center, Washington, DC, USA
| | - Heidi Maloni
- VA Multiple Sclerosis Center of Excellence and Neurology Service, Washington DC VA Medical Center, Washington, DC, USA
| | - Brian Hoover
- Muscle Morphology, Mechanics and Performance Lab, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Research Service, Washington DC VA Medical Center, Washington, DC, USA
| | - Marc R Blackman
- Research Service, Washington DC VA Medical Center, Washington, DC, USA; Departments of Medicine and Rehabilitation Medicine, Georgetown University, Washington, DC, USA; Department of Medicine, George Washington University, Washington, DC, USA
| | - Michael O Harris-Love
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; VA Research Service, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA; Muscle Morphology, Mechanics and Performance Lab, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Research Service, Washington DC VA Medical Center, Washington, DC, USA; Geriatric Service, Washington DC VA Medical Center, Washington, DC, USA
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9
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Kline PW, Christiansen CL, Judd DL, Mañago MM. Clinical utility of the Trendelenburg Test in people with multiple sclerosis. Physiother Theory Pract 2023; 39:1016-1023. [PMID: 35073816 PMCID: PMC9536282 DOI: 10.1080/09593985.2022.2030446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 10/14/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The clinical utility of the Trendelenburg Test remains unknown in people with multiple sclerosis (MS). OBJECTIVE To measure (1) intra-rater reliability, (2) agreement of goniometer-assessed Trendelenburg pelvis-on-femur angle (POF) with motion capture, and (3) concurrent validity of Trendelenburg POF and hip abduction strength with POF during walking and step negotiation. METHODS Trendelenburg POF was measured in 20 people with MS using goniometry and motion analysis. In addition, peak POF was measured using motion analysis during walking, step ascent, and step descent. Intra-rater reliability of goniometer-assessed Trendelenburg POF and agreement with motion analysis-assessed POF were analyzed. Pearson's r was used to determine the relationships between Trendelenburg POF and hip abduction strength with peak POF during each functional activity. RESULTS Goniometer-assessed Trendelenburg POF demonstrated very strong reliability (ICC: 0.948), strong agreement with 3D motion analysis (ICC: 0.792), correlated moderately with peak POF during walking (r = 0.519) and step ascent (r = 0.572), and weakly with step descent (r = 0.463). Hip abductor strength correlated weakly with peak POF during step ascent (r = -0.307) and negligibly during walking (r = -0.270) and step descent (r = -0.249). CONCLUSIONS Goniometer-assessed Trendelenburg POF was reliable, agreed with motion analysis, and may provide insight into hip abduction muscle performance during functional activities in people with MS.
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Affiliation(s)
- Paul W. Kline
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC United States
| | - Cory L. Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
| | - Dana L. Judd
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States
| | - Mark M Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus Aurora, CO, United States
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10
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Courter RJ, Alvarez E, Enoka RM, Ahmed AA. Metabolic costs of walking and arm reaching in persons with mild multiple sclerosis. J Neurophysiol 2023; 129:819-832. [PMID: 36883754 PMCID: PMC10085565 DOI: 10.1152/jn.00373.2022] [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: 09/07/2022] [Revised: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
Movement slowness is a common and disruptive symptom of multiple sclerosis (MS). A potential cause is that individuals with MS slow down to conserve energy as a behavioral adjustment to heightened metabolic costs of movement. To investigate this prospect, we measured the metabolic costs of both walking and seated arm reaching at five speeds in persons with mild MS (pwMS; n = 13; 46.0 ± 7.7 yr) and sex- and age-matched controls (HCs; n = 13; 45.8 ± 7.8 yr). Notably, the cohort of pwMS was highly mobile and no individuals required a cane or aid when walking. We found that the net metabolic power of walking was approximately 20% higher for pwMS across all speeds (P = 0.0185). In contrast, we found no differences in the gross power of reaching between pwMS and HCs (P = 0.492). Collectively, our results suggest that abnormal slowness of movement in MS-particularly reaching-is not the consequence of heightened effort costs and that other sensorimotor mechanisms are playing a considerable role in slowing.NEW & NOTEWORTHY Individuals with multiple sclerosis (MS) often move more slowly than those without the disease. A possible cause is that movements in MS are more energetically expensive and slowing is an adaptation to conserve metabolic resources. Here, we find that while walking is more costly for persons with MS, arm-reaching movements are not. These results bring into question the driving force of movement slowness in MS and implicate other motor-related networks contributing to slowing.
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Affiliation(s)
- Robert J Courter
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, United States
- Department of Mechanical Engineering, University of Colorado, Colorado, Boulder, United States
| | - Enrique Alvarez
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Roger M Enoka
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, United States
| | - Alaa A Ahmed
- Department of Mechanical Engineering, University of Colorado, Colorado, Boulder, United States
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11
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Tyszka EE, Bozinov N, Briggs FBS. Characterizing Relationships Between Cognitive, Mental, and Physical Health and Physical Activity Levels in Persons With Multiple Sclerosis. Int J MS Care 2022; 24:242-249. [PMID: 36090238 DOI: 10.7224/1537-2073.2021-108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although persons with multiple sclerosis (MS) are encouraged to engage in physical activity, they are less active than the general population and experience poorer emotional/cognitive health, underscoring the need for increased understanding of the factors independently associated with exercise in MS. METHODS Six hundred forty people with MS completed a detailed demographic survey, the Godin Leisure-Time Exercise Questionnaire, and Quality of Life in Neurological Disorders short forms. The average number of weekly sessions of exercise was examined as a count, as a binary variable (a weekly minimum of 4 sessions of physical activity), and as an ordinal variable of being active using multivariable zero-inflated negative binomial, logistic, and ordered logistic regression models, respectively. Primary predictors of interest included depression, cognitive function, positive affect, and lower extremity functioning as measured by the Quality of Life in Neurological Disorders short forms. RESULTS The study sample was 91% White race, 83% female, 65% with a relapsing-remitting MS diagnosis. The mean participant age was 52 years. Across analyses, body mass index and disability were inversely associated with exercising. Greater lower extremity impairment was associated with decreased odds of exercising and being active. A greater burden of depression symptoms was correlated with lower odds of engaging in physical activity. People with MS with higher self-reported cognitive functioning were less likely to engage in any exercise, but it was not associated with frequency of activities. CONCLUSIONS These results demonstrate associations between exercise and cognitive and emotional health in people with MS, underscoring the need to consider these factors when designing MS-targeted physical activity recommendations.
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Affiliation(s)
- Emily E Tyszka
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA (EET, FBSB)
| | - Nina Bozinov
- Department of Neurology, Kootenai Clinic, Coeur d'Alene, ID, USA (NB)
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA (EET, FBSB)
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12
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Lifestyle factors in multiple sclerosis disability progression and silent brain damage: A cross-sectional study. Mult Scler Relat Disord 2022; 65:104016. [DOI: 10.1016/j.msard.2022.104016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/02/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022]
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13
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Gervasoni E, Anastasi D, Giovanni RD, Solaro C, Rovaris M, Brichetto G, Carpinella I, Confalonieri P, Tacchino A, Rabuffetti M, Cattaneo D. Physical activity in non-disabled People with early Multiple Sclerosis: a multicenter cross-sectional study. Mult Scler Relat Disord 2022; 64:103941. [DOI: 10.1016/j.msard.2022.103941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/16/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
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Duddy D, Doherty R, Connolly J, Loughrey J, Condell J, Hassan D, Faulkner M. The Cardiorespiratory Demands of Treadmill Walking with and without the Use of Ekso GT™ within Able-Bodied Participants: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6176. [PMID: 35627714 PMCID: PMC9141321 DOI: 10.3390/ijerph19106176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 12/07/2022]
Abstract
Individuals with neurological impairments tend to lead a predominantly sedentary lifestyle due to impaired gait function and mobility. This may be detrimental to health by negatively impacting cardiorespiratory fitness and muscular strength, and increasing the risk of developing secondary health problems. Powered exoskeletons are assistive devices that may aid neurologically impaired individuals in achieving the World Health Organisation's (WHO) physical activity (PA) guidelines for health. Increased PA should elicit a sufficient cardiorespiratory stimulus to provide health benefits to exoskeleton users. This study examined the cardiorespiratory demands of treadmill walking with and without the Ekso GT™ among able-bodied participants. The Ekso GT™ is a powered exoskeleton that enables individuals with neurological impairments to walk by supporting full body mass with motors attached at the hip and knee joints to generate steps. This feasibility study consisted of one group of healthy able-bodied individuals (n = 8). Participants completed two 12 min treadmill walking assessments, one with and one without the Ekso GT™ at the same fixed speed. Throughout each walking bout, various cardiorespiratory parameters, namely, volume of oxygen per kilogram (kg) of body mass (V˙O2·kg-1), volume of carbon dioxide per kg of body mass (V˙CO2·kg-1), respiratory exchange ratio (RER), ventilation (V˙E), heart rate (HR), and rate of perceived exertion (RPE), were recorded. Treadmill walking with Ekso GT™ elevated all recorded measurements to a significantly greater level (p ≤ 0.05) (except RER at 1 km·h-1; p = 0.230) than treadmill walking without the Ekso GT™ did at the same fixed speed. An increased cardiorespiratory response was recorded during treadmill walking with the exoskeleton. Exoskeleton walking may, therefore, be an effective method to increase PA levels and provide sufficient stimulus in accordance with the PA guidelines to promote cardiorespiratory fitness and subsequently enhance overall health.
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Affiliation(s)
- Damien Duddy
- Sports Lab North West, Atlantic Technological University Donegal, Letterkenny Campus, Port Road, F92 FC93 Letterkenny, Ireland; (R.D.); (M.F.)
| | - Rónán Doherty
- Sports Lab North West, Atlantic Technological University Donegal, Letterkenny Campus, Port Road, F92 FC93 Letterkenny, Ireland; (R.D.); (M.F.)
| | - James Connolly
- Department of Computing, Atlantic Technological University Donegal, Letterkenny Campus, Port Road, F92 FC93 Letterkenny, Ireland;
| | | | - Joan Condell
- School of Computing, Engineering and Intelligent Systems, Ulster University Magee, Londonderry BT48 7JL, UK;
| | - David Hassan
- Sport and Exercise Sciences Research Institute, Ulster University Jordanstown, Newtownabbey BT37 0QB, UK;
| | - Maria Faulkner
- Sports Lab North West, Atlantic Technological University Donegal, Letterkenny Campus, Port Road, F92 FC93 Letterkenny, Ireland; (R.D.); (M.F.)
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THE EFFECT OF VIRTUAL REALITY-BASED THERAPY ON FEAR OF FALLING IN MULTIPLE SCLEROSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Mult Scler Relat Disord 2022; 63:103791. [DOI: 10.1016/j.msard.2022.103791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/25/2022] [Accepted: 04/01/2022] [Indexed: 11/19/2022]
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16
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Richardson EV, Motl RW. "Kicking and Screaming" or "Gracefully Conceding": Creative Nonfiction Stories of Aging With Multiple Sclerosis. QUALITATIVE HEALTH RESEARCH 2021; 31:1861-1874. [PMID: 33926326 PMCID: PMC8446897 DOI: 10.1177/10497323211009864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Aging with multiple sclerosis (MS) is a complex phenomenon. Some individuals report physical and cognitive dysfunctions regarding these combined experiences, whereas others report perceived improvements in quality of life. Beyond this, little is known regarding how people make sense of, and come to embody, negative or positive experiences of MS. Thus, our objectives were to (a) explore how people made sense of aging with MS and (b) present this in an artful, engaging, transformative way. To achieve this, we conducted 40 semi-structured interviews with older adults who had MS, analyzed data using pluralistic narrative analyses, and presented results through two creative nonfictions. We detail our process of creating the nonfictions before presenting the different stories of aging with MS, namely "Kicking and Screaming" and "Gracefully Conceding." We then offer recommendations and implications for using these stories as knowledge translation devices, and further critique the limitations of these stories in practice.
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Affiliation(s)
| | - Robert W. Motl
- University of Alabama at
Birmingham, Birmingham, Alabama, USA
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17
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Schättin A, Häfliger S, Meyer A, Früh B, Böckler S, Hungerbühler Y, de Bruin ED, Frese S, Steinlin Egli R, Götz U, Bauer R, Martin-Niedecken AL. Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies. JMIR Serious Games 2021; 9:e22826. [PMID: 33960956 PMCID: PMC8140386 DOI: 10.2196/22826] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Patients with MS experience a wide range of physical and cognitive dysfunctions that affect their quality of life. A promising training approach that concurrently trains physical and cognitive functions is video game-based physical exercising (ie, exergaming). Previous studies have indicated that exergames have positive effects on balance and cognitive functions in patients with MS. However, there is still a need for specific, user-centered exergames that function as a motivating and effective therapy tool for patients with MS and studies investigating their usability and feasibility. OBJECTIVE The aim of this interdisciplinary research project is to develop usable and feasible user-centered exergames for the pressure-sensitive plate Dividat Senso by incorporating theoretical backgrounds from movement sciences, neuropsychology, and game research as well as participatory design processes. METHODS Focus groups (patients and therapists) were set up to define the user-centered design process. This was followed by the field testing of newly developed exergame concepts. Two sequential usability and feasibility studies were conducted on patients with MS. The first study included a single exergaming session followed by measurements. Between the first and second studies, prototypes were iterated based on the findings. The second study ran for 4 weeks (1-2 trainings per week), and measurements were taken before and after the intervention. For each study, participants answered the System Usability Scale (SUS; 10 items; 5-point Likert Scale; score range 0-100) and interview questions. In the second study, participants answered game experience-related questionnaires (Flow Short Scale [FSS]: 13 items; 7-point Likert Scale; score range 1-7; Game Flow questionnaire: 17 items; 6-point Likert Scale; score range 1-6). Mixed methods were used to analyze the quantitative and qualitative data. RESULTS In the first study (N=16), usability was acceptable, with a median SUS score of 71.3 (IQR 58.8-80.0). In the second study (N=25), the median SUS scores were 89.7 (IQR 78.8-95.0; before) and 82.5 (IQR 77.5-90.0; after), and thus, a significant decrease was observed after training (z=-2.077; P=.04; r=0.42). Moreover, high values were observed for the overall FSS (pre: median 5.9, IQR 4.6-6.4; post: median 5.8, IQR 5.4-6.2) and overall Game Flow Questionnaire (pre: median 5.0, IQR 4.7-5.3; post: median 5.1, IQR 4.9-5.3). A significant decrease was observed in the item perceived importance (FSS: z=-2.118; P=.03; r=0.42). Interviews revealed that user-centered exergames were usable, well accepted, and enjoyable. Points of reference were identified for future research and development. CONCLUSIONS The project revealed that the newly developed, user-centered exergames were usable and feasible for patients with MS. Furthermore, exergame elements should be considered in the development phase of user-centered exergames (for patients with MS). Future studies are needed to provide indications about the efficacy of user-centered exergames for patients with MS.
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Affiliation(s)
- Alexandra Schättin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Stephan Häfliger
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Alain Meyer
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Barbara Früh
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Sonja Böckler
- Department of Design, Subject Area in Game Design, Zurich University of the Arts, Zurich, Switzerland
| | - Yannic Hungerbühler
- Department of Design, Subject Area in Game Design, Zurich University of the Arts, Zurich, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Sebastian Frese
- Technology and Innovation Unit and Department of Research, ZURZACH Care, Bad Zurzach, Switzerland
| | | | - Ulrich Götz
- Department of Design, Subject Area in Game Design, Zurich University of the Arts, Zurich, Switzerland
| | - René Bauer
- Department of Design, Subject Area in Game Design, Zurich University of the Arts, Zurich, Switzerland
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Abstract
PURPOSE OF REVIEW To outline recent applications of e-health data and digital tools for improving the care and management of healthcare for people with multiple sclerosis. RECENT FINDINGS The digitization of most clinical data, along with developments in communication technologies, miniaturization of sensors and computational advances are enabling aggregation and clinically meaningful analyses of real-world data from patient registries, digital patient-reported outcomes and electronic health records (EHR). These data are allowing more confident descriptions of prognoses for multiple sclerosis patients and the long-term relative benefits and safety of disease-modifying treatments (DMT). Registries allow detailed, multiple sclerosis-specific data to be shared between clinicians more easily, provide data needed to improve the impact of DMT and, with EHR, characterize clinically relevant interactions between multiple sclerosis and other diseases. Wearable sensors provide continuous, long-term measures of performance dynamics in relevant ecological settings. In conjunction with telemedicine and online apps, they promise a major expansion of the scope for patients to manage aspects of their own care. Advances in disease understanding, decision support and self-management using these Big Data are being accelerated by machine learning and artificial intelligence. SUMMARY Both health professionals and patients can employ e-health approaches and tools for development of a more patient-centred learning health system.
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19
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Hubbard EA, Motl RW, Elmer DJ. Feasibility and initial efficacy of a high-intensity interval training program using adaptive equipment in persons with multiple sclerosis who have walking disability: study protocol for a single-group, feasibility trial. Trials 2020; 21:972. [PMID: 33239079 PMCID: PMC7687792 DOI: 10.1186/s13063-020-04887-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background There is considerable evidence for the efficacy of moderate-intensity continuous exercise benefitting clinically relevant outcomes in persons with multiple sclerosis (MS). However, persons with MS who have walking disability (pwMS-wd) are severely deconditioned and may achieve superior benefits by engaging in high-intensity interval training (HIIT), especially while utilizing adaptive equipment, such as recumbent arm/leg stepping (RSTEP). The proposed study will assess the feasibility of a 12-week, RSTEP HIIT program in pwMS-wd. The secondary aim will examine changes in aerobic fitness, physical activity, ambulation, upper arm function, cognition, fatigue, and depression as clinically relevant efficacy outcomes following the 12-week, RSTEP HIIT intervention. Methods The study will recruit 15 pwMS-wd. Feasibility will be measured via process, resource, management, and scientific outcomes throughout the entirety of the research study. The secondary, clinically relevant outcomes will consist of a neurological exam, aerobic capacity, physical activity, ambulation, cognition, upper arm function, fatigue, and depression. Outcomes will be assessed at baseline (T1), midpoint (T2, following 6 weeks), and post-intervention (T3, following 12 weeks). The intervention will involve 12 weeks of supervised, individualized HIIT sessions two to three times per week. The individual HIIT sessions will each involve 10 cycles of 60-s intervals at the wattage associated with 90% VO2peak followed by 60 s of active recovery intervals at 15 W, totaling 20 min in length plus 5-min warm-up and cool-down periods. Discussion The feasibility design of the proposed study will provide experience and preliminary data for advancing towards a proof-of-concept study comparing HIIT to moderate-intensity continuous RSTEP for improving clinically relevant outcomes in a randomized control trial design. The results will be disseminated via manuscripts for publication and a report for distribution among the National Multiple Sclerosis Society. Trial registration ClinicalTrials.gov NCT04416243. Retrospectively registered on June 4, 2020
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Affiliation(s)
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David J Elmer
- Department of Kinesiology, Berry College, Mount Berry, GA, USA
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Elwishy A, Ebraheim AM, Ashour AS, Mohamed AA, Sherbini AEHEE. Influences of Dual-Task Training on Walking and Cognitive Performance of People With Relapsing Remitting Multiple Sclerosis: Randomized Controlled Trial. J Chiropr Med 2020; 19:1-8. [PMID: 33192186 DOI: 10.1016/j.jcm.2019.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 07/29/2019] [Accepted: 08/05/2019] [Indexed: 10/23/2022] Open
Abstract
Objective We sought to investigate whether there is any additional effect of coupled cognitive and physical rehabilitation compared to exercise training alone on walking and cognitive performance in individuals with relapsing remitting multiple sclerosis (RRMS). Methods A randomized controlled trial was conducted from March to November 2015 with 30 individuals with RRMS (aged 20 to 50 years; 21 women, 9 men), who underwent detailed medical and neurologic examination. They were randomly allocated using sealed envelopes to either the study group, who received physical and cognitive rehabilitation (dual-task training), or the control group, who received physical rehabilitation alone. Participants (in both groups) were assessed twice (8 weeks apart), before and after rehabilitation. Assessment tools were the Mini-Mental State Examination (MMSE), the Expanded Disability Status Scale (EDSS), neuropsychological evaluation (using RehaCom), and walking tests. Results After training, the control group significantly improved regarding MMSE, attention/concentration test, and 10-meter walking test, whereas the scores of the study group significantly improved in all studied parameters (Expanded Disability Status Scale, MMSE, logical reasoning, and attention/concentration and walking tests). The differential (delta) scores from before to after rehabilitation were significantly higher in the study group for logical reasoning, attention/concentration, and 2-minute walking distance scores. Conclusions Coupled physical and cognitive (dual-task) training showed concurrent improvement in cognitive and walking abilities in individuals with RRMS which exceeded that achieved by physical training alone.
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Affiliation(s)
- Abeer Elwishy
- Department of Neuromuscular Disorders and Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Asmaa M Ebraheim
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amal S Ashour
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Abeer A Mohamed
- Department of Neuromuscular Disorders and Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Abd El Hamied E El Sherbini
- National Institute of Longevity Elderly Sciences, Department of Occupational Therapy, Beni Suef University, Beni Suef, Egypt
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Silva BA, Miglietta EA, Ferrari CC. Training the brain: could it improve multiple sclerosis treatment? Rev Neurosci 2020; 31:779-792. [PMID: 32712593 DOI: 10.1515/revneuro-2020-0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/17/2020] [Indexed: 12/22/2022]
Abstract
Multiple sclerosis (MS) is a neurological disease characterized by neuroinflammation, demyelination and axonal degeneration along with loss of function in the central nervous system. For many years, research in MS has focused on the efficacy of pharmacological treatments. However, during the last years, many publications have been dedicated to the study of the efficacy of non-pharmacological strategies, such as physical exercise and cognitive training. Beneficial effects of the combination of both strategies on cognitive function have been described in both ageing adults and patients with neurodegenerative diseases, such as MS. The analysis of combining both physical and cognitive stimulation can be summarized by the environmental enrichment (EE) experiments, which are more suitable for animal models. EE refers to housing conditions consisting of exercise and cognitive and social stimulation. In this review, we will summarize the available studies that describe the influence of EE in both MS patients and MS animal models.
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Affiliation(s)
- Berenice Anabel Silva
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB)-CONICET, Potosí 4240, Buenos Aires, C1181ACH, Argentina.,Leloir Institute Foundation, Institute for Biochemical Investigations, IIBBA-CONICET, Patricias Argentinas 435, C1405BWE, Buenos Aires, Argentina
| | - Esteban Alberto Miglietta
- Leloir Institute Foundation, Institute for Biochemical Investigations, IIBBA-CONICET, Patricias Argentinas 435, C1405BWE, Buenos Aires, Argentina
| | - Carina Cintia Ferrari
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB)-CONICET, Potosí 4240, Buenos Aires, C1181ACH, Argentina.,Leloir Institute Foundation, Institute for Biochemical Investigations, IIBBA-CONICET, Patricias Argentinas 435, C1405BWE, Buenos Aires, Argentina
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22
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Richardson EV, Motl RW. The experience and meaning of aging with multiple sclerosis: An existential phenomenological approach. J Aging Stud 2020; 54:100872. [PMID: 32972621 DOI: 10.1016/j.jaging.2020.100872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Over the past 3 decades there have been significant advances in the development of pharmaceutical and rehabilitative treatments for persons with multiple sclerosis (MS), such that life expectancy is continuing to increase. Whilst these advancements are exciting, there are also concerns and unknowns regarding what it is like to age with MS. The objectives of this research were to explore the lived experiences and meaning of aging in conjunction with having MS. METHODS Semi-structured interviews with 40 persons with MS over 60 years were conducted. Thereafter data were subject to an existential phenomenological analysis. RESULTS Four different ways were discussed with regards to embodied experiences of aging with MS: aging makes MS worse; MS makes aging worse; aging makes MS better; and MS makes aging better. DISCUSSION This research highlighted the complexity of aging with MS and the various of ways persons over 60 with MS experience and interpret this phenomenon.
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Affiliation(s)
- Emma V Richardson
- School of Sport and Exercise, College of Business, Psychology and Sport, University of Worcester, UK.
| | - Robert W Motl
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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Backus D, Moldavskiy M, Sweatman WM. Effects of Functional Electrical Stimulation Cycling on Fatigue and Quality of Life in People with Multiple Sclerosis Who Are Nonambulatory. Int J MS Care 2020; 22:193-200. [PMID: 32863788 PMCID: PMC7446631 DOI: 10.7224/1537-2073.2019-101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Functional electrical stimulation (FES) cycling provides an exercise opportunity for people with multiple sclerosis (MS) who are nonambulatory. This study evaluated the efficacy of FES cycling for reducing fatigue and improving quality of life in people with MS who are nonambulatory and compared outcomes with those in a control group that did not take part in FES cycling. METHODS Adults with MS with self-reported Expanded Disability Status Scale scores of 7.0 to 8.5 were randomized into a training group (n = 12) or a control group (n = 9). The training group performed FES cycling for 30 minutes, two to three times a week for 12 weeks. The primary outcome was safety, measured as the number and type of adverse events and any increase in symptoms. Other outcomes collected before and after the intervention were scores on the modified Ashworth Scale, manual muscle test, 5-item Modified Fatigue Impact Scale (MFIS-5), Fatigue Scale for Motor and Cognitive Functions (FSMC), Medical Outcomes Study Pain Effects Scale, Patient Health Questionnaire-9 (PHQ-9), Multiple Sclerosis Quality of Life-54 (MSQOL-54), and Exercise Self-Efficacy Scale. RESULTS Twelve participants completed the study and were analyzed. Six participants completed training with no adverse events. The MFIS-5 (Cohen's d = 0.60), FSMC (Cohen's d = 0.37), and PHQ-9 (Cohen's d = 0.67) scores and the physical health composite of the MSQOL-54 (Cohen's d = 1.48) improved for the training group compared with the control group (n = 6). CONCLUSIONS Functional electrical stimulation cycling is safe for people with MS who are nonambulatory and may reduce fatigue and improve measurements of quality of life.
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Shahidi SH, Kordi MR, Rajabi H, Malm C, Shah F, Quchan ASK. Exercise modulates the levels of growth inhibitor genes before and after multiple sclerosis. J Neuroimmunol 2020; 341:577172. [DOI: 10.1016/j.jneuroim.2020.577172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 01/09/2023]
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Williams J, Moldavskiy M, Bauer K, Reed G, Theuring A, Zedrow J, Sweatman WM, Backus D. Safety and Feasibility of Various Functional Electrical Stimulation Cycling Protocols in Individuals With Multiple Sclerosis Who Are Nonambulatory. Arch Rehabil Res Clin Transl 2020; 2:100045. [PMID: 33543074 PMCID: PMC7853402 DOI: 10.1016/j.arrct.2020.100045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To examine the safety, feasibility, and response to functional electrical stimulation (FES) cycling protocols requiring differing levels of effort in people with multiple sclerosis (MS) who are nonambulatory. Design Pilot study with pre-post intervention testing. Setting Outpatient clinic setting of a long-term acute care hospital. Participants Individuals (N=10) with MS (6 men; mean age 58.6±9.86y) who use a wheelchair for community mobility. Participants’ Expanded Disability Status Scale score ranged from 6.5 to 8.5 (median 7.5). Intervention Participants performed 3 or 4 FES cycling protocols requiring different levels of volitional effort during 6-8 testing sessions. Main Outcome Measures The primary outcome was safety, measured by adverse events and increase in MS symptoms, all assessed throughout, immediately post- and 1 day postsession. FES cycling performance for each protocol was also recorded. Exploratory outcome measures collected before and after all testing sessions included functional assessment of MS, MS Impact Scale, Exercise Self Efficacy Scale, Patient Health Questionnaire-9 item, and the Zarit Caregiver Burden Scale. Results All participants (4 women, 6 men) completed all testing sessions. There were no serious adverse events or differences in vitals or symptoms between protocols. Two participants had an isolated episode of mild hypotension. Changes in pain, spasticity, and fatigue were minimal. Five participants were able to cycle for 30 minutes and completed interval training protocols requiring increasing difficulty. The remainder cycled for <3 minutes and completed a rest interval protocol. There was modest improvement on the exploratory outcome measures. Conclusions People with MS who use a wheelchair for community mobility can safely perform FES cycling requiring more effort than previously reported research. Therefore, the individuals may experience greater benefits than previously reported. Further study is required to better understand the potential benefits for optimizing function and improving health in people with MS. People with multiple sclerosis who are nonambulatory can safely perform functional electrical stimulation (FES) cycling using parameters requiring more effort. FES cycling may offer an opportunity for increased exercise stimulus or neuromuscular training if individuals are adequately challenged using an appropriate cycling protocol.
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Key Words
- ADLs, activities of daily living
- EDSS, Expanded Disability Status Scale
- ESES, Exercise Self-Efficacy Scale
- Exercise
- FAMS, functional assessment of multiple sclerosis
- FES, functional electrical stimulation
- Health
- I-Resist, resistance interval
- I-Rest, rest interval
- I-Stim, stimulation interval
- MA, motor assist
- MS, multiple sclerosis
- MSIS-29, 29-Item Multiple Sclerosis Impact Scale
- Multiple sclerosis
- PHQ-9, 9-Item Patient Health Questionnaire
- QOL, quality of life
- Rehabilitation
- S, standard protocol
- VAS-P, visual analog scale of pain
- VAS-S, visual analog scale of spasticity
- rpm, revolutions per minute
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Affiliation(s)
- Joy Williams
- Multiple Sclerosis Rehabilitation and Wellness Program, Crawford Research Institute Shepherd Center, Atlanta, GA
| | - Marina Moldavskiy
- Multiple Sclerosis Rehabilitation and Wellness Program, Crawford Research Institute Shepherd Center, Atlanta, GA.,Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Katie Bauer
- Emory University, Division of Physical Therapy, Atlanta, GA
| | - Grace Reed
- Emory University, Division of Physical Therapy, Atlanta, GA
| | | | - Jayme Zedrow
- Emory University, Division of Physical Therapy, Atlanta, GA
| | | | - Deborah Backus
- Multiple Sclerosis Rehabilitation and Wellness Program, Crawford Research Institute Shepherd Center, Atlanta, GA.,Crawford Research Institute, Shepherd Center, Atlanta, GA
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Exercise as Medicine in Multiple Sclerosis—Time for a Paradigm Shift: Preventive, Symptomatic, and Disease-Modifying Aspects and Perspectives. Curr Neurol Neurosci Rep 2019; 19:88. [DOI: 10.1007/s11910-019-1002-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Baird JF, Cederberg KL, Sikes EM, Silveira SL, Jeng B, Sasaki JE, Sandroff BM, Motl RW. Physical activity and walking performance across the lifespan among adults with multiple sclerosis. Mult Scler Relat Disord 2019; 35:36-41. [DOI: 10.1016/j.msard.2019.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/12/2019] [Accepted: 07/04/2019] [Indexed: 11/28/2022]
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Smith M, Barker R, Williams G, Carr J, Gunnarsson R. The effect of exercise on high-level mobility in individuals with neurodegenerative disease: a systematic literature review. Physiotherapy 2019; 106:174-193. [PMID: 31477333 DOI: 10.1016/j.physio.2019.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/27/2019] [Accepted: 04/25/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the effect of exercise on high-level mobility (i.e. mobility more advanced than independent level walking) in individuals with neurodegenerative disease. DATA SOURCES A systematic literature search was conducted in Medline, CINAHL, Scopus, SportDiscus and PEDro. STUDY SELECTION Randomised controlled trials of exercise interventions for individuals with neurodegenerative disease, with an outcome measure that contained high-level mobility items were included. High-level mobility items included running, jumping, bounding, stair climbing and backward walking. Outcome measures with high-level mobility items include the High Level Mobility Assessment Tool (HiMAT); Dynamic Gait Index; Rivermead Mobility Index (RMI) or modified RMI; Functional Gait Assessment and the Functional Ambulation Category. STUDY APPRAISAL Quality was evaluated with the Cochrane Risk of Bias Tool. RESULTS Twenty-four studies with predominantly moderate to low risk of bias met the review criteria. High-level mobility items were included within primary outcome measures for only two studies and secondary outcome measures for 22 studies. Eight types of exercise interventions were investigated within which high-level mobility tasks were not commonly included. In the absence of outcome measures or interventions focused on high-level mobility, findings suggest some benefit from treadmill training for individuals with multiple sclerosis or Parkinson's disease. Progressive resistance training for individuals with multiple sclerosis may also be beneficial. With few studies on other neurodegenerative diseases, further inferences cannot be made. CONCLUSION Future studies need to specifically target high-level mobility in the early stages of neurodegenerative disease and determine the impact of high-level mobility interventions on community participation and maintenance of an active lifestyle. Systematic review registration number PROSPERO register for systematic reviews (registration number: CRD42016050362).
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Affiliation(s)
- Moira Smith
- College of Healthcare Sciences, Building 043-114, James Cook University, Townsville, Queensland 4811, Australia.
| | - Ruth Barker
- College of Healthcare Sciences, James Cook University, Cairns, Queensland 4878, Australia.
| | | | - Jennifer Carr
- College of Healthcare Sciences, James Cook University, Cairns, Queensland 4878, Australia.
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HUBBARD ELIZABETHA, MOTL ROBERTW, FERNHALL BO. Acute High-Intensity Interval Exercise in Multiple Sclerosis with Mobility Disability. Med Sci Sports Exerc 2019; 51:858-867. [DOI: 10.1249/mss.0000000000001866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Smith M, Neibling B, Williams G, Birks M, Barker R. A qualitative study of active participation in sport and exercise for individuals with multiple sclerosis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1776. [DOI: 10.1002/pri.1776] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/19/2019] [Accepted: 03/17/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Moira Smith
- College of Healthcare SciencesJames Cook University Townsville Queensland Australia
| | - Bridee Neibling
- College of Healthcare SciencesJames Cook University Townsville Queensland Australia
| | - Gavin Williams
- Faculty of Medicine, Dentistry and Health SciencesUniversity of Melbourne Melbourne Victoria Australia
| | - Melanie Birks
- College of Healthcare SciencesJames Cook University Townsville Queensland Australia
| | - Ruth Barker
- College of Healthcare SciencesJames Cook University Townsville Queensland Australia
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Jeng B, Sandroff BM, Motl RW. Energetic cost of walking and spasticity in persons with multiple sclerosis with moderate disability. NeuroRehabilitation 2019; 43:483-489. [PMID: 30400119 DOI: 10.3233/nre-182498] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The energetic cost of walking (Cw) is elevated in persons with multiple sclerosis (MS). This may be explained by spasticity and spatiotemporal parameters of gait. OBJECTIVE To examine the associations among Cw, spasticity of ankle plantarflexors, and spatiotemporal gait parameters in persons with MS who had moderate disability. METHODS The sample included 44 persons with MS who had moderate disability. Cw was measured over-ground during the 6-Minute Walk using indirect calorimetry and was calculated based on net oxygen consumption and walking speed (i.e., expressed ml·kg-1·m-1). Participants underwent the Modified Ashworth Scale as a measurement of spasticity and performed 4 trials of walking on a GAITRite electronic walkway for measurement of spatiotemporal gait parameters. RESULTS Spasticity was positively correlated with Cw (r = 0.52, p < 0.05) and inversely correlated with cadence (r = -.45, p < 0.05) and step length (r = -0.40, p < 0.05). Cadence (r = -0.59, p < 0.05) and step length (r = -0.56, p < 0.05) were inversely correlated with Cw. The regression analysis indicated that spasticity explained significant variance in Cw, and cadence and step length accounted for the association. CONCLUSIONS These results suggest that worse spasticity of the ankle plantarflexors and slower cadence and shorter step length, in turn, are responsible for elevated Cw among persons with MS with moderate disability. This supports the development of therapeutic, rehabilitation interventions delivered by clinicians for managing spasticity and the resulting Cw that may interfere with activities of daily living.
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Affiliation(s)
- Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Miller Renfrew L, Flowers P, Lord AC, Rafferty D, McFadyen AK, Bowers R, Mattison P, Paul L. An exploration of the experiences and utility of functional electrical stimulation for foot drop in people with multiple sclerosis. Disabil Rehabil 2018; 42:510-518. [PMID: 30299176 DOI: 10.1080/09638288.2018.1501100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: Functional electrical stimulation (FES) is effective in improving walking in people with multiple sclerosis (MS) with foot drop. There is limited research exploring people's experiences of using this device. This study aims to explore the utility, efficacy, acceptability, and impact on daily life of the device in people with MS.Methods: An interpretative phenomenological approach was employed. Ten participants who had used FES for 12 months were interviewed. Transcripts were analysed, and emergent themes identified.Results: Nine participants continued to use the device. Three relevant super-ordinate themes were identified; impact of functional electrical stimulation, sticking with functional electrical stimulation, and autonomy and control. Participants reported challenges using the device; however, all reported positive physical and psychological benefits. Intrinsic and external influences such as; access to professional help, the influence of others, an individual's ability to adapt, and experiences using the device, influenced their decisions to continue with the device. A thematic model of these factors was developed.Conclusions: This study has contributed to our understanding of people with MS experiences of using the device and will help inform prescribing decisions and support the continued, appropriate use of FES over the longer term.Implications for RehabilitationPeople with multiple sclerosis using functional electrical stimulation report benefits in many aspects of walking, improved psychological well-being and increased engagement in valued activities.A number of challenges impact on functional electrical stimulation use. Factors such as; a positive experience using the device, access to professional help, the influence of others, a strong sense of personal autonomy and an individual's ability to adapt, influence an individual's decision to continue using functional electrical stimulation.Clinicians prescribing functional electrical stimulation should be aware of these factors so that the right support and guidance can be provided to people with multiple sclerosis, thus improving outcomes and compliance over the long term.
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Affiliation(s)
- Linda Miller Renfrew
- MS Service, Douglas Grant Rehabilitation Centre, Irvine, UK.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Paul Flowers
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Anna C Lord
- MS Service, Douglas Grant Rehabilitation Centre, Irvine, UK
| | - Danny Rafferty
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Roy Bowers
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Paul Mattison
- MS Service, Douglas Grant Rehabilitation Centre, Irvine, UK
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Said M, El Ayoubi NK, Hannoun S, Haddad R, Saba L, Jalkh Y, Yamout BI, Khoury SJ. The Bayesian risk estimate at onset (BREMSO) correlates with cognitive and physical disability in patients with early multiple sclerosis. Mult Scler Relat Disord 2018; 26:96-102. [PMID: 30243236 DOI: 10.1016/j.msard.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/03/2018] [Accepted: 09/06/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prevention of long-term disability is the goal of therapeutic intervention in Relapsing Remitting MS (RRMS). The Bayesian Risk Estimate for MS at Onset (BREMSO) gives an individual risk score predicting disease evolution into Secondary Progressive MS (SPMS). We investigated whether BREMSO correlates with physical disability, cognitive dysfunction, and regional brain atrophy early in MS. METHODS One hundred RRMS patients with at least two years of follow-up were enrolled. BREMSO score as well as Symbol Digit Modalities Test (SDMT) and Multiple Sclerosis Severity Score (MSSS), Timed 25-Foot Walk Test (T25-FW) and 9-Hole Peg Test (9-HPT), were assessed. Intracranial volume (ICV), subcortical gray matter structures and corpus callosum (CC) were automatically segmented on MRI images and their volumes measured. RESULTS BREMSO score correlated negatively with SDMT at visit1 (β = -0.33, p = 0.019), visit2 (β = -0.34, p = 0.017) and visit3 (β = -0.34, p = 0.014), and positively with MSSS at visit1 (r = 0.38, p = 0.006), visit2 (r = 0.47, p < 0.0001) and visit3 (r = 0.42, p = 0.002), but not with T25-FW and 9-HPT. BREMSO negatively correlated with CC volume at baseline (p < 0.03). No correlations were found with ICV and subcortical gray matter. CONCLUSIONS BREMSO score at onset correlated with physical disability (MSSS), cognitive function (SDMT) and CC volume measurements in patients with early MS.
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Affiliation(s)
- Marianne Said
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Nabil K El Ayoubi
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Salem Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon; Abu-Haidar Neuroscience Institute, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Ribal Haddad
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Leslie Saba
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Youmna Jalkh
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Bassem I Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon; Abu-Haidar Neuroscience Institute, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
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Abstract
INTRODUCTION Mobility disability is one of the most widespread and impactful consequences of multiple sclerosis (MS). Disease modifying drugs (DMDs) may delay the progression of disability over time; however, there is minimal evidence supporting the efficacy of DMDs for reversing mobility disability or restoring ambulatory function in persons with MS. Areas covered: This review outlines symptomatic pharmacologic and non-pharmacologic therapeutic approaches that target mobility disability with the goal of restoring and improving walking function. First, the efficacy of dalfampridine, currently the only Food and Drug Administration approved symptomatic pharmacologic agent that improves walking in persons with MS is described. Next, a review of the efficacy of non-pharmacologic therapies for improving walking, including exercise training, physical therapy, and gait training is given. Last, guidance on future research on mobility in MS is provided by emphasizing the importance of combinatory treatment approaches that include multiple intervention modalities, as the best treatment plan likely involves a comprehensive, multidisciplinary approach. Expert commentary: There has been an increased effort to develop symptom-specific treatments in MS that directly target mobility disability; however, more research is needed to determine the efficacy of these rehabilitative strategies alone and together for improving walking in persons with MS.
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Affiliation(s)
- Jessica F. Baird
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian M. Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Hubbard EA, Motl RW, Fernhall B. Sedentary Behavior and Blood Pressure in Patients with Multiple Sclerosis. Int J MS Care 2018; 20:1-8. [PMID: 29507537 DOI: 10.7224/1537-2073.2016-021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Sedentary behavior is a pervasive public health concern in the general population. To date, little is known regarding the possible health risks associated with sedentary behavior in patients with multiple sclerosis (MS), although this population has increased risks of comorbidities such as hypertension. Methods This cross-sectional study examined the association between sedentary behavior and blood pressure (BP) in 31 patients with MS and 31 matched controls. Self-reported sitting time, one form of sedentary behavior, was measured using the International Physical Activity Questionnaire. Using an automated oscillometric monitor, systolic BP, diastolic BP, and mean arterial pressure were measured in the supine position after 10 minutes of rest lying down in a quiet room. Results There were significant correlations between International Physical Activity Questionnaire-measured sitting time and systolic BP (r = 0.365, P = .044, 95% CI, 0.013-0.636), diastolic BP (r = 0.382, P = .034, 95% CI, 0.032-0.648), and mean arterial pressure (r = 0.425, P = .017, 95% CI, 0.084-0.677) in patients with MS but not in controls (P > .05). The associations in patients with MS were unchanged even after adjusting for body mass index in linear regression analyses. Conclusions This study identified a significant association between sitting time and BP outcomes in patients with MS, supporting the need for additional examinations of sitting time and its possible health consequences in patients with MS.
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Riksfjord SM, Brændvik SM, Røksund OD, Aamot IL. Ventilatory efficiency and aerobic capacity in people with multiple sclerosis: A randomized study. SAGE Open Med 2017; 5:2050312117743672. [PMID: 29276588 PMCID: PMC5734440 DOI: 10.1177/2050312117743672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/29/2017] [Indexed: 01/10/2023] Open
Abstract
Objectives: To assess ventilatory efficiency and aerobic capacity in people with multiple sclerosis and whether treadmill walking or progressive strength training has an effect on these parameters in this population. Methods: In all, 24 adults with multiple sclerosis with an Expanded Disability Status Scale score of ≤6 completed a cardiopulmonary exercise test before and after 8 weeks of exercise. They were randomized to treadmill walking of low-to-moderate intensity (50%–70% of peak heart rate) or progressive strength training (six repetitions × two at 80% of one repetition maximum). Both groups exercised for 30 min three times per week. Primary outcome measure was ventilatory efficiency measured as the minute ventilation/carbon dioxide production (VE/VCO2) ratio and oxygen uptake efficiency slope. Secondary outcome was aerobic capacity, measured as peak oxygen uptake (VO2peak). Results: Despite low aerobic capacity, ventilatory efficiency was found to be within normal range. After 8 weeks of exercise, no significant between-group differences emerged in (1) VE/VCO2 ratio (26 ± 2.2 to 26 ± 2.0, 29 ± 2.0 to 28 ± 2.3, p = 0.66), (2) oxygen uptake efficiency slope (2697 ± 442 to 2701 ± 577, 2473 ± 800 to 2481 ± 896, p = 0.71), or (3) VO2peak in mL/kg/min (28 ± 4.4 to 30 ± 4.3, 29 ± 6.7 to 29 ± 6.4, p = 0.38) in treadmill walking and progressive strength training, respectively. There were no significant within-group differences either. No adverse events occurred during cardiopulmonary exercise test or exercise training. Conclusion: In people with mild-to-moderate multiple sclerosis, 8 weeks of treadmill walking of low-to-moderate intensity or progressive strength training did not have any effect on ventilatory efficiency or aerobic capacity. Although aerobic capacity was lower than reference values, ventilatory efficiency was not reduced.
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Affiliation(s)
- Stine Maren Riksfjord
- Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway.,Clinic of Clinical Services, St. Olav's University Hospital, Trondheim, Norway
| | - Siri Merete Brændvik
- Clinic of Clinical Services, St. Olav's University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ola D Røksund
- Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
| | - Inger-Lise Aamot
- Clinic of Clinical Services, St. Olav's University Hospital, Trondheim, Norway.,K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Sandroff BM, Bollaert RE, Pilutti LA, Peterson ML, Baynard T, Fernhall B, McAuley E, Motl RW. Multimodal exercise training in multiple sclerosis: A randomized controlled trial in persons with substantial mobility disability. Contemp Clin Trials 2017; 61:39-47. [DOI: 10.1016/j.cct.2017.07.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
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Edwards T, Pilutti LA. The effect of exercise training in adults with multiple sclerosis with severe mobility disability: A systematic review and future research directions. Mult Scler Relat Disord 2017; 16:31-39. [PMID: 28755682 DOI: 10.1016/j.msard.2017.06.003] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 05/10/2017] [Accepted: 06/09/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION There is evidence for the benefits of exercise training in persons with multiple sclerosis (MS). However, these benefits have primarily been established in individuals with mild-to-moderate disability (i.e., Expanded Disability Status Scale [EDSS] scores 1.0-5.5), rather than among those with significant mobility impairment. Further, the approaches to exercise training that have been effective in persons with mild-to-moderate MS disability may not be physically accessible for individuals with mobility limitations. Therefore, there is a demand for an evidence-base on the benefits of physically accessible exercise training approaches for managing disability in people with MS with mobility impairment. OBJECTIVE To conduct a systematic review of the current literature pertaining to exercise training in individuals with multiple sclerosis (MS) with severe mobility disability. METHODS Four electronic databases (PubMed, EMBASE, OvidMEDLINE, and PsychINFO) were searched for relevant articles published up until October 2016. The review focused on English-language studies that examined the effect of exercise training in people with MS with severe mobility disability, characterized as the need for assistance in ambulation or EDSS score ≥ 6.0. The inclusion criteria involved full-text articles that: (i) included participants with a diagnosis of MS; (ii) included primarily participants with a reported EDSS score ≥ 6.0 and/or definitively described disability consistent with this level of neurological impairment; and (iii) implemented a prospective, structured exercise intervention. Data were analyzed using a descriptive approach and summarized by exercise training modality (conventional or adapted exercise training), and by outcome (disability, physical fitness, physical function, and symptoms and participation). RESULTS Initially, 1164 articles were identified and after removal of duplicates, 530 articles remained. In total, 512 articles did not meet the inclusion criteria. 19 articles were included in the final review. Five studies examined conventional exercise training (aerobic and resistance training), and thirteen studies examined adapted exercise modalities including body-weight support treadmill training (BWSTT), total-body recumbent stepper training (TBRST), and electrical stimulation cycling (ESAC). Outcomes related to mobility, fatigue, and quality of life (QOL) were most frequently reported. Two of five studies examining conventional resistance exercise training reported significant improvements in physical fitness, physical function, and/or symptomatic and participatory outcomes. Nine of 13 studies examining adapted exercise training reported significant improvements in disability, physical fitness, physical function, and/or symptomatic and participatory outcomes. CONCLUSIONS There is limited, but promising evidence for the benefits of exercise training in persons with MS with severe mobility disability. Considering the lack of effective therapeutic strategies for managing long-term disability accumulation, exercise training could be considered as an alternative approach. Further research is necessary to optimize the prescription and efficacy of exercise training for adults with MS with severe mobility disability.
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Affiliation(s)
- Thomas Edwards
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario, Canada K1N 6N5.
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Merkt H, Sadeghi Bahmani D, Calabrese P, Naegelin Y, Gerber M, Pühse U, Holsboer-Trachsler E, Brand S. Multiple Sclerosis: Associations Between Physical Disability and Depression Are Not Mediated by Self-Reported Physical Activity. Percept Mot Skills 2017; 124:974-991. [DOI: 10.1177/0031512517711851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigated the interrelatedness of physical disability, physical activity, and depression among patients with multiple sclerosis (MS). We hypothesized that self-reported physical activity would mediate the effect of disability on depressive symptoms. Twenty-seven patients with MS (mean age: 49 years; 44.5% females) completed self-rating scales covering sociodemographic variables, intake of antidepressants, physical activity, and symptoms of depression; disability was measured by the Expanded Disability Status Scale. We found a higher level of disability to be significantly associated with more symptoms of depression. While higher reported physical activity was descriptively associated with lower depression scores and unrelated to Expanded Disability Status Scale, physical activity levels did not mediate the effect of disability on depressive symptoms.
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Affiliation(s)
- Helene Merkt
- Division of Molecular and Cognitive Neurosciences, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Dena Sadeghi Bahmani
- Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), University of Basel, Basel, Switzerland
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neurosciences, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Department of Neurology, University Hospital, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, Division of Sport and Psychosocial Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, Division of Sport and Psychosocial Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Edith Holsboer-Trachsler
- Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), University of Basel, Basel, Switzerland
| | - Serge Brand
- Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), University of Basel, Basel, Switzerland
- Department of Sport, Exercise and Health, Division of Sport and Psychosocial Health, Faculty of Medicine, University of Basel, Basel, Switzerland
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Lithopoulos A, Bassett-Gunter RL, Martin Ginis KA, Latimer-Cheung AE. The Effects of Gain- versus Loss-Framed Messages Following Health Risk Information on Physical Activity in Individuals With Multiple Sclerosis. JOURNAL OF HEALTH COMMUNICATION 2017; 22:523-531. [PMID: 28481157 DOI: 10.1080/10810730.2017.1318983] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Few people with multiple sclerosis engage in physical activity. Messaging interventions may motivate more physical activity among these individuals. The purpose of this online study was to evaluate an intervention presenting participants with multiple sclerosis (N = 237) with risk information (i.e., information demonstrating people with multiple sclerosis are more likely to experience certain health issues) or no risk information followed by gain- or loss-framed physical activity messages. Participants completed questionnaires on Days 1, 6, and 28 and received information material on Days 2-5. The dependent variables were as follows: physical activity intentions and behavior, response and task efficacy, perceived threat (i.e., perception of threat to health issues relevant to people with multiple sclerosis), and avoidance (i.e., avoiding thinking about/doing something about the health issues presented in the messages). Analyses indicated physical activity and response efficacy increased over time. Also, participants receiving risk information had higher levels of physical activity and perceived threat. However, manipulation checks showed no differences between participants regarding perceptions of risk information or gain/loss-framed messages. Despite the lack of impact of the framing intervention, this study suggests that a brief informational intervention can positively influence physical activity and certain correlates of physical activity among people with multiple sclerosis.
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Affiliation(s)
- Alexander Lithopoulos
- a School of Kinesiology and Health Studies , Queen's University , Kingston , Ontario , Canada
| | | | - Kathleen A Martin Ginis
- c School of Health and Exercise Science , University of British Columbia , Kelowna , British Columbia , Canada
| | - Amy E Latimer-Cheung
- a School of Kinesiology and Health Studies , Queen's University , Kingston , Ontario , Canada
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Backus D, Burdett B, Hawkins L, Manella C, McCully KK, Sweatman M. Outcomes After Functional Electrical Stimulation Cycle Training in Individuals with Multiple Sclerosis Who Are Nonambulatory. Int J MS Care 2017; 19:113-121. [PMID: 28603459 DOI: 10.7224/1537-2073.2015-036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exercise is safe and beneficial for people with multiple sclerosis (MS). Functional electrical stimulation (FES) cycling offers people with significant weakness and mobility challenges an option for exercise. We sought to evaluate the safety of FES cycling and its potential to improve fatigue, pain, spasticity, and quality of life in people with moderate-to-severe MS. METHODS Sixteen participants with MS who were nonambulatory cycled for 30 minutes two to three times a week for 1 month. Outcomes assessed included MS Quality of Life Inventory (MSQLI) subscales, Modified Ashworth Scale (MAS), and manual muscle test (MMT). RESULTS Fourteen participants (six women and eight men) with MS completed the training. All were able to maintain or increase their cycle time; half increased the resistance while cycling. Participants demonstrated a significant decrease in the Physical (P = .02) and Psychosocial (P < .01) subscales of the Modified Fatigue Impact Scale. There was no significant change in the other MSQLI subscale scores. There was no change in MAS and MMT scores. Type of MS and the use of antispasticity medications, disease-modifying therapies, or dalfampridine did not seem to influence response to training. There were no adverse events. CONCLUSIONS Functional electrical stimulation cycling may be a viable and effective exercise option for people with moderate-to-severe MS. Further study is required to examine the parameters of FES cycling that are most effective for people with different MS symptoms and to fully explore the potential benefits of optimizing function and improving health in people with MS.
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Bisson EJ, Fakolade A, Pétrin J, Lamarre J, Finlayson M. Exercise interventions in multiple sclerosis rehabilitation need better reporting on comorbidities: a systematic scoping review. Clin Rehabil 2017; 31:1305-1312. [PMID: 28933610 DOI: 10.1177/0269215517698734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To identify the extent to which exercise intervention studies in multiple sclerosis rehabilitation are addressing comorbidities and if researchers consider comorbidities as possible moderators or mediators of exercise outcomes. METHODS Five databases were searched from inception to January 8, 2016, for exercise-related terms in combination with multiple sclerosis. Studies were screened and limited to randomized control trials, full text, and English language. We assessed whether comorbidities were excluded or included, how they were reported and described, and if they were examined as possible moderators or mediators of exercise outcomes. RESULTS We reviewed 99 articles that included various exercise interventions, where the most common were general multi-faceted exercise training ( n=34), cardiovascular training ( n=18), progressive-resistance training ( n=12), and balance and gait training ( n=12). In total, 77 of 99 studies reported one or more comorbidities as an exclusion criterion. The most commonly excluded comorbidities were cardiovascular diseases, cognitive impairments or psychiatric disorders, and unspecified conditions or contraindications. Only nine studies reported details on excluded participants with comorbidities. Across studies that reported comorbidities of included participants ( n=8), none examined comorbidities as possible moderators or mediators of exercise outcomes. CONCLUSION Although a variety of exercise interventions have positive outcomes, there is limited evidence that these interventions are generalizable to people with multiple sclerosis who have comorbid conditions.
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Affiliation(s)
- Etienne J Bisson
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Afolasade Fakolade
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Julie Pétrin
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Julie Lamarre
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Leonard G. Noninvasive tongue stimulation combined with intensive cognitive and physical rehabilitation induces neuroplastic changes in patients with multiple sclerosis: A multimodal neuroimaging study. Mult Scler J Exp Transl Clin 2017; 3:2055217317690561. [PMID: 28607750 PMCID: PMC5466147 DOI: 10.1177/2055217317690561] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/23/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) patients have central nervous system (CNS) lesions that may impede cognitive and sensorimotor function. Few rehabilitative therapies are available. OBJECTIVES The objective of this paper is to study effects of noninvasive tongue stimulation using the Portable Neuromodulation Stimulator (PoNS™) combined with intensive cognitive and physical rehabilitation on working memory, gait, balance and concomitant changes in the brain. METHODS Fourteen MS patients, seven each in an active and a sham stimulation group, participated. Participants received intensive physical therapy and working memory training for 14 weeks. Functional magnetic resonance imaging (fMRI) using motor imagery and working-memory tasks were completed prior to and following therapy, as were sensory organization tests (SOT), motor performance measures, and neuropsychological assessment. RESULTS On the SOT, the active group showed significant improvement from baseline. fMRI revealed significant blood oxygen level-dependent signal changes in the left primary motor cortex for the Active Group, while the sham group had increased activity in bilateral premotor cortices. All individuals improved on working-memory tasks, but only the active group showed increased dorsolateral prefrontal cortex activity. CONCLUSIONS In this cohort of MS patients, the results suggest that PoNS stimulation can enhance motor performance and working memory while also driving neuroplasticity. Further studies are warranted to explore these findings.
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Affiliation(s)
- Gabriel Leonard
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Canada; Cognitive Neuroscience, Montreal Neurological Institute, Canada
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Motl RW, Sandroff BM, Pilutti LA, Klaren RE, Baynard T, Fernhall B. Physical activity, sedentary behavior, and aerobic capacity in persons with multiple sclerosis. J Neurol Sci 2017; 372:342-346. [DOI: 10.1016/j.jns.2016.11.070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/18/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
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Yang F, Estrada EF, Sanchez MC. Vibration training improves disability status in multiple sclerosis: A pretest-posttest pilot study. J Neurol Sci 2016; 369:96-101. [DOI: 10.1016/j.jns.2016.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 01/17/2023]
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Effects of a combined aerobic and resistance exercise program in people with multiple sclerosis: a pilot study. SPORT SCIENCES FOR HEALTH 2016. [DOI: 10.1007/s11332-016-0310-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pilutti LA, Motl RW, Edwards TA, Wilund KR. Rationale and design of a randomized controlled clinical trial of functional electrical stimulation cycling in persons with severe multiple sclerosis. Contemp Clin Trials Commun 2016; 3:147-152. [PMID: 29736463 PMCID: PMC5935873 DOI: 10.1016/j.conctc.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/27/2016] [Accepted: 05/11/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This randomized controlled trial (RCT) will examine the efficacy of supervised functional electrical stimulation (FES) cycling on walking performance and physiological function among persons with multiple sclerosis (MS) with severe mobility disability. METHODS/DESIGN This RCT will recruit 16 persons with MS that require unilateral or bilateral assistance for ambulation (i.e., Expanded Disability Status Scale (EDSS) score = 6.0-6.5). Participants will be randomized to one of two conditions: supervised FES cycling or passive cycling. The FES cycling condition will involve mild electrical stimulation that will generate an activation pattern that results in cycling the leg ergometer. The passive cycling condition will not provide any electrical stimulation, rather the movement of the pedals will be controlled by the electrical motor. Both conditions will be delivered 3 days/week for the same duration, over 6 months. Primary outcomes will include walking performance assessed as walking speed, endurance, and agility. Secondary outcomes will include physiological function assessed as cardiorespiratory fitness, muscular strength, and balance. Assessments will take place at baseline, mid-point (3-months), and immediately following the intervention (6-months). DISCUSSION This study will lay the foundation for the design of a future RCT by: (1) providing effect sizes that can be included in a power analysis for optimal sample size estimation; and (2) identifying cardiorespiratory fitness, muscular strength, and balance (i.e., physiological function) as mechanisms for the beneficial effects of FES cycling on walking performance. This trial will provide important information on a novel exercise rehabilitation therapy for managing walking impairment in persons with severe MS.
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Affiliation(s)
- Lara A Pilutti
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
| | - Thomas A Edwards
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
| | - Kenneth R Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
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Sandroff BM, Motl RW, Scudder MR, DeLuca J. Systematic, Evidence-Based Review of Exercise, Physical Activity, and Physical Fitness Effects on Cognition in Persons with Multiple Sclerosis. Neuropsychol Rev 2016; 26:271-294. [PMID: 27447980 DOI: 10.1007/s11065-016-9324-2] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
Cognitive dysfunction is highly prevalent, disabling, and poorly-managed in persons with multiple sclerosis (MS). Recent evidence suggests that exercise might have beneficial effects on cognition in this population. The current systematic, evidence-based review examined the existing literature on exercise, physical activity, and physical fitness effects on cognition in MS to accurately describe the current status of the field, offer recommendations for clinicians, and identify study-specific and participant-specific characteristics for providing future direction for ongoing MS research. We performed an open-dated search of Medline, PsychInfo, and CINAHL in December 2015. The search strategy involved using the terms 'exercise' OR 'physical activity' OR 'physical fitness' OR 'aerobic' OR 'resistance' OR 'balance' OR 'walking' OR 'yoga' OR 'training' OR 'rehabilitation' AND 'multiple sclerosis'. Articles were eliminated from the systematic review if it was a review article, theoretical paper, or textbook chapter; did not involve persons with MS; involved only persons with pediatric-onset MS; did not involve neuropsychological outcomes; did not include empirical data to evaluate outcomes; involved pharmacological interventions; or was not available in English. The selected articles were first classified as examining exercise, physical activity, or physical fitness, and were then randomly assigned to 2 independent reviewers who rated each article for level of evidence based on American Academy of Neurology criteria. Reviewers further completed a table to characterize important elements of each study (i.e., intervention characteristics), the cognitive domain(s) that were targeted, participant-specific characteristics, outcome measures, and study results. The present review resulted in 26 studies on the effects of exercise, physical activity, and physical fitness on cognition in persons with MS. This included 1 Class I study, 3 Class II studies, 8 Class III studies, and 14 Class IV studies. Of the 26 total studies, 6 were randomized controlled trials. Overall, there is conflicting evidence for the effects of exercise on cognition in MS, and overall positive, but not definitive evidence for the effects of physical activity and physical fitness, respectively, on cognition in this population. Collectively, there is insufficient well-designed research to definitively conclude that exercise, physical activity, and physical fitness are effective for improving cognition in MS. This is based, in part, on methodological issues of Class I and II studies, such as inclusion of cognition as a secondary outcome (35 % of reviewed studies), poorly-developed exercise interventions, and paucity of research that included cognitively-impaired MS samples. However, promising evidence from Class III and Class IV studies may be useful for informing the development of better intervention research.
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Affiliation(s)
- Brian M Sandroff
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Louise Freer Hall, 906 S. Goodwin Ave, Urbana, IL, 61801, USA
| | - Mark R Scudder
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Louise Freer Hall, 906 S. Goodwin Ave, Urbana, IL, 61801, USA
| | - John DeLuca
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA.
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Physical Exercise Attenuates Experimental Autoimmune Encephalomyelitis by Inhibiting Peripheral Immune Response and Blood-Brain Barrier Disruption. Mol Neurobiol 2016; 54:4723-4737. [DOI: 10.1007/s12035-016-0014-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/10/2016] [Indexed: 01/05/2023]
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Backus D. Increasing Physical Activity and Participation in People With Multiple Sclerosis: A Review. Arch Phys Med Rehabil 2016; 97:S210-7. [PMID: 27211007 DOI: 10.1016/j.apmr.2015.09.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/14/2015] [Accepted: 09/10/2015] [Indexed: 11/29/2022]
Abstract
Multiple sclerosis (MS) is a chronic progressive disease of the central nervous system (CNS) affecting >2.5 million people worldwide. Damage to neurons in the CNS causes various sensorimotor and cognitive symptoms, such as fatigue, pain, spasticity, memory deficits, and impairment of mobility. Until the late 1990s, it was believed that symptoms of MS would be worsened with physical exertion and people with MS were encouraged to limit physical activity and exertion. Not only has emerging evidence suggested that physical activity, including exercise, is safe for people with MS, there is also evidence that at least some of the disability that occurs after MS is due to secondary deconditioning from the sedentary lifestyle adopted because of the symptoms of MS, not just CNS damage alone. Therefore, not only is physical activity safe, it is also required for maintaining function and health in people with MS. The purpose of this article is to review the unique physical and social barriers to physical activity in people with MS, including those with moderate to severe disability who use a wheelchair or scooter for mobility. We will discuss how existing guidelines for physical activity may not meet the needs of people with MS and present evidence-based considerations for promoting physical activity in people with MS. Ultimately, the goal is to overcome the barriers to physical activity and improve health, participation, and quality of life in people with MS.
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Affiliation(s)
- Deborah Backus
- Crawford Research Institute, Shepherd Center, Atlanta, GA.
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