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Karanfil E, Salci Y, Fil Balkan A, Tuncer A, Karabudak R. The acute effect of cervical mobilization on balance in patients with multiple sclerosis: a single-blind, randomized, controlled trial. Neurol Res 2024; 46:65-71. [PMID: 37724548 DOI: 10.1080/01616412.2023.2257455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/10/2023] [Indexed: 09/21/2023]
Abstract
The cervical region plays an important role in providing proprioceptive and vestibular input to the postural control system. OBJECTIVE To investigate the effect of cervical mobilization on balance in multiple sclerosis (MS) patients. METHODS The study was undertaken at the neurological rehabilitation unit with 36 MS participants who were assigned randomly to the study (n = 18) and control group (n = 18). While the study group received a single session of 15 minutes of cervical and soft tissue mobilization, no intervention was applied to the control group to investigate the learning effect of the assessment. Patients were evaluated using Computerized Dynamic Posturography (CDP) (Sensory Organization Test (SOT), Limits of Stability (LoS), and Adaptation Test (ADT)), which reflects postural stability. RESULTS In the study group, a treatment effect was found on the vestibular ratio (VEST) score (p < 0.001) and the composite score of SOT (p = 0.002). Improvements were achieved in all parameters of the LoS and ADT in the study group. There was no statistically significant difference in terms of CDP results in the control group. CONCLUSION Cervical mobilization has beneficial effects on balance in MS patients. Our findings support that cervical mobilization can be included in MS balance rehabilitation programs.
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Affiliation(s)
- Ecem Karanfil
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yeliz Salci
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ayla Fil Balkan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Aslı Tuncer
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Rana Karabudak
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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2
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Mestanza Mattos FG, Luciano F, Lencioni T, Gervasoni E, Jonsdottir J, Anastasi D, Pavei G, Clerici M, Cattaneo D. Complementary use of statistical parametric mapping and gait profile score to describe walking alterations in multiple sclerosis: a cross-sectional study. Sci Rep 2023; 13:10465. [PMID: 37380732 DOI: 10.1038/s41598-023-36916-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
Gait analysis is often used to study locomotor alterations in people with multiple sclerosis (PwMS), but the large number of extracted variables challenges the interpretability. In this paper, we analysed gait alterations by combining the Gait Profile Score (GPS), which summarizes kinematic locomotor deviations, and Statistical Parametric Mapping (SPM), which compares kinematics and kinetics over the whole gait cycle. Eleven PwMS and 11 speed-matched Healthy Controls (HC) underwent overground gait analysis. GPS were compared through independent-samples t-tests; sagittal-plane kinematics and power at hip, knee, and ankle were compared through SPM Hotelling's-T2 and SPM t-tests. Spearman's correlation coefficients (r) between GPS and clinical outcomes were also calculated. PwMS had higher GPS than HC (PwMS = 8.74 ± 2.13°; HC = 5.01 ± 1.41°;p < 0.001). Multivariate SPM found statistically significant differences at 0-49%, 70-80%, and 93-99% of stride (p < 0.05) and univariate analysis showed reduced ankle dorsiflexion, and lower knee flexion during pre-swing and swing. GPS correlated with Expanded Disability Status Scale (r = 0.65; 95%C.I.[0.04,0.91]; p = 0.04) and 2-Minute Walking Test (r = -0.65; 95%C.I.[-0.91,-0.04]; p = 0.04). GPS in conjunction with SPM revealed multi-joint kinematic alterations on sagittal plane involving distal joint angles, ankle and knee, during the stance phase with no changes at the proximal level. Gait deviations were more pronounced in PwMS with higher disability and walking limitations.
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Affiliation(s)
| | - Francesco Luciano
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20100, Milan, Italy
| | - Tiziana Lencioni
- IRCCS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148, Milan, Italy
| | - Elisa Gervasoni
- IRCCS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148, Milan, Italy.
| | - Johanna Jonsdottir
- IRCCS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148, Milan, Italy
| | - Denise Anastasi
- IRCCS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148, Milan, Italy
| | - Gaspare Pavei
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20100, Milan, Italy
| | - Mario Clerici
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20100, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148, Milan, Italy
| | - Davide Cattaneo
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20100, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148, Milan, Italy
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3
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DelMastro HM, Simaitis LB, Gromisch ES, Gomes K, Ruiz JA. Establishment of regression-based normative isometric strength values for major lower limb muscle groups in persons with multiple sclerosis. Mult Scler Relat Disord 2023; 75:104772. [PMID: 37247487 DOI: 10.1016/j.msard.2023.104772] [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: 02/07/2023] [Revised: 04/20/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Limb weakness is a major impairment that affects mobility in persons with multiple sclerosis (PwMS). Specifically, lower limb (LL) weakness can greatly affect gait and balance, while increasing fall risk and decreasing quality of life. Numerous studies have compared LL strength of PwMS to healthy controls, however none have objectively measured strength in all major LL joints (hip, knee, and ankle) in a large number of PwMS. Additionally, while discrete normative values exist for knee extensors in PwMS, there has yet to be regression-based normative isometric strength values for all major LL muscle groups. Therefore, this study aimed to develop gender-specific regression-based normative prediction equations, with 95% confidence intervals, for maximal isometric peak torque of major LL muscles in PwMS. A secondary aim was to characterize the prevalence of LL weakness in PwMS, defined as ≥ 2 SD below values reported for healthy individuals. METHODS A convenience sample of 175 (women: n = 135) PwMS participated in a prospective, cross-sectional study where isometric peak torque of hip flexors, extensors, and abductors, knee flexors and extensors, and ankle plantarflexors and dorsiflexors were measured using the Biodex System 4 Pro-Dynamometer®. Demographics (age, height, and weight) and disease characteristics (disease duration and disability) were collected. Performances were separated for each muscle group into strongest limb and weakest limb. For each gender, regression-based equations were generated for the LL muscle groups by limb with age, height, weight, disability, and disease duration as the covariates. Descriptive statistics were used to examine the frequency of LL weakness by gender and disability level. For comparison purposes, age-stratified (<30, 30-39, 40-49, 50-59, 60-69, >70 years) and disability-stratified (mild, moderate, and severe ambulant) discrete peak torque values were also generated for each gender. RESULTS Regression-based normative data are presented for men and women, accounting for age, height, weight, disability, and disease duration. Men were significantly stronger (P < 0.001) than women for all LL, with the men's models accounting for a greater percent of muscle strength variation than women's models for all muscle groups, except for hip extension. Disability was inversely related to strength in all of the models. LL weakness was prevalent in hip flexion (m: 47.5%; w: 63.0%) and extension (m: 92.5%; w: 88.1%), knee extension (m: 30.0%; w: 33.3%) and flexion (m: 25.0%; w: 34.8%), and ankle plantarflexion (m: 15.0%; w: 10.4%) and dorsiflexion (m: 100.0%; w: 96.3%). PwMS with mild disability had a high prevalence of ankle dorsiflexion (94.9-100.0%) and hip extension (81.4-90.0%) weakness. CONCLUSIONS This study is the first to provide regression-based normative data of bilateral strength in all major LL muscle groups and clinically useful prevalence data on the occurrence of weakness in these muscles. Of note, PwMS had a high prevalence of ankle dorsiflexion and hip extension weakness even when they were only mildly disabled. These findings can help guide the direction of future interventions and treatments to improve muscle function in PwMS.
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Affiliation(s)
- Heather M DelMastro
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States.
| | - Laura B Simaitis
- Department of Physical Therapy, School of Health Sciences at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States
| | - Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States; Department of Neurology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, United States
| | - Kayla Gomes
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Rehabilitation Medicine, Department of Veterans Affairs, 555 Willard Avenue, Newington, CT, 06111 United States
| | - Jennifer A Ruiz
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States
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4
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Mañago MM, Kline PW, Harris-Love MO, Christiansen CL. The Validity of the Single-Leg Heel Raise Test in People With Multiple Sclerosis: A Cross-Sectional Study. Front Neurol 2021; 12:650297. [PMID: 34354656 PMCID: PMC8333614 DOI: 10.3389/fneur.2021.650297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The single-leg heel raise test is a common clinical assessment; however, little is known about its validity in people with multiple sclerosis (MS). This study investigated the validity of the single-leg heel raise test in a group of people with MS and a healthy control group (CTL). Materials and Methods: Twenty-one people with MS (49 ± 12 years, Expanded Disability Status Scale 1.5–5.5) and 10 healthy controls (48 ± 12 years) performed the single-leg heel raise test, ankle plantarflexion isometric strength assessment using electromechanical dynamometry, and mobility measures (Timed 25-Foot Walk, 2-Min Walk Test, Functional Stair Test). Results: Convergent validity between the heel raise test and strength was moderate for participants with MS completing <20 heel raises (r = 0.63, p = 0.001) but weak for the entire sample (r = 0.30, p = 0.020). Compared to the average CTL group values, the heel raise test differentiated between groups on the MS groups' weaker (p < 0.001) and stronger (p = 0.003) limbs, while strength only differentiated between groups on the weaker limb (p = 0.010). Considering the weaker and strong limbs from the MS group and the CTL group average values, the mobility measures had moderate-to-strong correlations with the heel raise test on the weaker MS limb + CTL (r = 0.71–0.78) and stronger MS limb + CTL (r = 0.62–0.70), and weak-to-moderate correlations with strength on the weaker MS limb + CTL (r = 0.49–0.58, p = 0.001–0.007). Discussion: In people with MS, the single-leg heel raise test may be clinically useful as it identified impaired muscle performance and differentiated muscle performance from a healthy control group and, together with the control group, correlated with functional mobility.
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Affiliation(s)
- Mark M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical, Aurora, CO, United States.,Department of Neurology, School of Medicine, University of Colorado Anschutz Medical, Aurora, CO, United States.,Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
| | - Paul W Kline
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical, Aurora, CO, United States.,Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States.,Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, United States
| | - Michael O Harris-Love
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical, Aurora, CO, United States.,Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical, Aurora, CO, United States.,Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
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5
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Jonsdottir J, Lencioni T, Gervasoni E, Crippa A, Anastasi D, Carpinella I, Rovaris M, Cattaneo D, Ferrarin M. Improved Gait of Persons With Multiple Sclerosis After Rehabilitation: Effects on Lower Limb Muscle Synergies, Push-Off, and Toe-Clearance. Front Neurol 2020; 11:668. [PMID: 32793100 PMCID: PMC7393214 DOI: 10.3389/fneur.2020.00668] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 06/03/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction: Persons with MS (PwMS) have markedly reduced push-off and toe-clearance during gait compared to healthy subjects (HS). These deficits may result from alterations in neuromotor control at the ankle. To optimize rehabilitation interventions for PwMS, a crucial step is to evaluate if and how altered neuromotor control, as represented by muscle synergies, improves with rehabilitation. In this study we investigated changes in ankle motor control and associated biomechanical parameters during gait in PwMS, occurring with increase in speed after gait rehabilitation. Methods: 3D motion and EMG data were collected while 11 PwMS (age 50.3 + 11.1; EDSS 5.2 + 1.2) walked overground at self-selected speed before (T0) and after 20 sessions (T1) of intensive treadmill training. Muscle synergies were extracted using non-negative matrix factorization. Gait parameters were computed according to the LAMB protocol. Pearson's correlation coefficient was used to evaluate the similarity of motor modules between PwMS and HS. To assess differences in distal module activations representing neuromotor control at the ankle [Forward Propulsion (FPM) and Ground Clearance modules (GCM)], each module's activation timing was integrated over 100% of the gait cycle and the activation percentage index (API) was computed in six phases. Ten age matched HS provided two separate speed-matched normative datasets for T0 and T1. For speed independent comparison for the PwMs Z scores were calculated for all their gait variables. Results: In PwMS velocity increased significantly from T0 to T1 (0.74-0.90 m/s, p < 0.05). The activation profiles (API) of FPM and GCM of PwMS improved in pre-swing (p < 0.05): FPM (Mean [95% CI] [%]: T0: 12.5 [5.7-19.3] vs. T1: 9.0 [2.7-15.3]); GCM (T0: 26.7 [18.2-35.3] vs. T1: 24.5 [18.2-30.7]). This was associated with an increase in toe clearance (80.3 to 103.6 mm, p < 0.05) and a higher ankle power peak in pre-swing (1.53-1.93 W/kg, p < 0.05). Conclusion: Increased gait speed of PwMS after intensive gait training was consistent with improvements in spatio-temporal gait parameters. The most important finding of this study was the re-organization of distal leg modules related to neurophysiological changes induced by rehabilitation. This was associated with an improved ankle performance.
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6
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Massot C, Guyot MA, Donze C, Simoneau E, Gillet C, Leteneur S. Ankle dysfunction in multiple sclerosis and the effects on walking. Disabil Rehabil 2019; 43:2454-2463. [PMID: 31854195 DOI: 10.1080/09638288.2019.1702726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Even in the early stage of the disease, for patients suffering from multiple sclerosis (MS), the most common and reported biomechanical alterations in the lower limb are located at the ankle joint. However, the effects of these impairments on gait deterioration should be discussed. MATERIALS AND METHODS This review was written according to the PRISMA guidelines. The search focussed on biomechanical changes (kinetic, kinematic, and electromyographic data) at the ankle during gait in MS patients. The search was performed in the databases: Pubmed, Web of Science, and Cochrane Library. RESULTS Eleven studies were included. The reduction in the ankle range of motion (RoM) induced by increased cocontractions of the tibialis anterior and triceps surae muscles could be a compensatory strategy to improve body-weight support and balance during the stance phase. CONCLUSIONS Future rehabilitation programmes should consider the control of weight support at the ankle during gait training.Implications for rehabilitationThe ankle supports and stabilises the body during the stance phase of gait.The reduced ankle range of motion in multiple sclerosis (MS), even at an early stage of the disease, is due to cocontractions of tibialis anterior and triceps surae and could be a compensatory strategy to be more stable.Rehabilitation programmes for MS patients should focus on the control of body segments motion during the weight transfer above the ankle.
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Affiliation(s)
- Caroline Massot
- Service de Médecine Physique et de Réadaptation, Hôpital Saint Philibert, Lomme, France
| | - Marc-Alexandre Guyot
- Service de Médecine Physique et de Réadaptation, Hôpital Saint Philibert, Lomme, France
| | - Cécile Donze
- Service de Médecine Physique et de Réadaptation, Hôpital Saint Philibert, Lomme, France
| | - Emilie Simoneau
- Université Lille Nord de France, Lille, France.,UPHF, LAMIH, Valenciennes, France.,CNRS, UMR, Valenciennes, France
| | - Christophe Gillet
- Université Lille Nord de France, Lille, France.,UPHF, LAMIH, Valenciennes, France.,CNRS, UMR, Valenciennes, France
| | - Sébastien Leteneur
- Université Lille Nord de France, Lille, France.,UPHF, LAMIH, Valenciennes, France.,CNRS, UMR, Valenciennes, France
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7
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Torres-Pareja M, Sánchez-Lastra MA, Iglesias L, Suárez-Iglesias D, Mendoza N, Ayán C. Exercise Interventions for Improving Flexibility in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2019; 55:medicina55110726. [PMID: 31684026 PMCID: PMC6915647 DOI: 10.3390/medicina55110726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/27/2019] [Accepted: 10/30/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: People with multiple sclerosis (MS) often experience limitations in joint range of motion, which is linked to spasticity and continued inactivity. Low flexibility levels in this population have been linked to postural problems and muscular pain. Therefore, the purpose of this study was to conduct a systematic review and a meta-analysis aimed at identifying the characteristics and methodological quality of investigations studying the effects of exercise interventions on the flexibility levels of people with MS. Materials and Methods: Three electronic databases (MEDLINE/PubMed, SPORTDiscus and Scopus) were systematically searched up to May 2019 for intervention studies focused on the effects of exercise on the flexibility levels of people with MS. A meta-analysis, including randomized controlled trials (RCT), which reported information regarding the effects of exercise on flexibility, was also conducted. The methodological quality of included studies was assessed using the Physiotherapy Evidence Database, and the Quality Assessment Tool for Before–After Studies, with no control group. The quality of the information reported, regarding the programs conducted, was assessed by means of the Consensus on Exercise Reporting Template (CERT) scale. Results: Seven studies, four RCTs and three uncontrolled investigations were finally selected. The methodological quality of the RCTs was considered “poor” in one study, and “good” and “excellent” in two studies and one investigation, respectively. The three uncontrolled studies showed a methodological quality between “fair” and “poor”. Following the CERT scale, four studies were graded as “high” and three as “low”. Findings from the meta-analysis indicated no significant effects on hamstring flexibility, or the range of motion in the hips, knees or ankles. Conclusions: There is preliminary evidence from individual studies which indicates that people with MS can improve their lower limb flexibility following participation in physical exercise programs, but the meta-analysis did not confirm these findings.
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Affiliation(s)
- Marta Torres-Pareja
- Research Group DEPORSALUD (Physical Activity and Health, Studies in Sports Performance, Disability and Gender), Faculty of Sports Sciences, University of Castilla La-Mancha, A Carlos III s/n, E-45071 Toledo, Spain.
| | - Miguel A Sánchez-Lastra
- HealthyFit Research Group, Department of Special Didactics, Faculty of Educational Sciences and Sports, University of Vigo, Campus A Xunqueira s/n, E-36005 Pontevedra, Spain.
| | - Laura Iglesias
- Faculty of Education and Sport Science, University of Vigo, E-36005 Pontevedra, Spain.
| | - David Suárez-Iglesias
- VALFIS Research Group, Institute of Biomedicine (IBIOMED), Faculty of Physical Activity and Sports Sciences, University of León, 24071 León, Spain.
| | - Nuria Mendoza
- University of Francisco de Vitoria (UFV), Faculty of Healthy Sciences, Ctra Pozuelo a Majadahonda 11-515 KM 1.800, 28223 Pozuelo de Alarcón, Madrid, Spain.
| | - Carlos Ayán
- Well-Move Research Group, Department of Special Didactics, Faculty of Educational Sciences and Sports, University of Vigo, Campus A Xunqueira s/n, E-36005 Pontevedra, Spain.
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Capone F, Capone G, Motolese F, Voci A, Caminiti ML, Musumeci G, Di Lazzaro V. Spinal cord dysfunction contributes to balance impairment in multiple sclerosis patients. Clin Neurol Neurosurg 2019; 184:105451. [DOI: 10.1016/j.clineuro.2019.105451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/01/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
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9
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Mañago MM, Hebert JR, Kittelson J, Schenkman M. Contributions of Ankle, Knee, Hip, and Trunk Muscle Function to Gait Performance in People With Multiple Sclerosis: A Cross-Sectional Analysis. Phys Ther 2018; 98:595-604. [PMID: 29660080 DOI: 10.1093/ptj/pzy048] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 04/05/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND The relative importance of lower extremity and trunk muscle function to gait in people with multiple sclerosis (MS) is unknown. OBJECTIVE This study aimed to investigate the association of lower extremity and trunk muscle function with gait performance in people who have MS and mild-to-moderate disability. DESIGN This was a cross-sectional, observational study. METHODS Participants were people who had an Expanded Disability Status Scale score of ≤ 5.5. Eleven lower extremity and trunk muscles were assessed using handheld dynamometry or endurance tests. Gait performance was assessed with the Timed 25-Foot (7.62 m) Walk (T25FW) and 6-Minute Walk Test (6MWT). Regression analysis was used to quantify the association between gait outcomes and muscle variables. RESULTS Seventy-two participants with MS and a mean Expanded Disability Status Scale score of 3.5 (SD = 1.14) were enrolled. Adjusted for age and sex, the multivariate model including hip abduction, ankle plantar flexion, trunk flexion, and knee flexion explained 57% of the adjusted variance in the T25FW; hip abduction, ankle plantar flexion, and trunk flexion explained 61% of the adjusted variance in the 6MWT. The strongest predictors were ankle plantar flexion endurance for the T25FW and hip abduction strength for the 6MWT: a 1-SD increase in ankle plantar flexion (15.2 heel-raise repetitions) was associated with a 0.33-second reduction in the T25WT (95% CI = - 0.71 to - 0.14 seconds); a 1-SD increase in normalized hip abduction strength (0.14 kg/body mass index) was associated with a 54.4-m increase in the 6MWT (28.99 to 79.81 m). LIMITATIONS Different measurement scales for independent variables were included because the muscle function assessment used either force or endurance. CONCLUSIONS For the major muscles in the lower extremity and trunk, hip abduction, ankle plantar flexion, trunk flexion, and knee flexion were the strongest predictors of gait performance.
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Affiliation(s)
- Mark M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora, Colorado, and Department of Rehabilitation, University of Colorado Hospital, 1635 Aurora Ct, Aurora, CO 80045
| | - Jeffrey R Hebert
- Department of Physical Medicine and Rehabilitation and Department of Neurology, School of Medicine, University of Colorado Denver, Aurora. Dr. Hebert is a multiple sclerosis certified specialist through the Consortium of MS Centers
| | - John Kittelson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora
| | - Margaret Schenkman
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora. Dr Schenkman is a Catherine Worthingham Fellow of the American Physical Therapy Association
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10
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Arpin DJ, Gehringer JE, Wilson TW, Kurz MJ. Movement-Related Somatosensory Activity Is Altered in Patients with Multiple Sclerosis. Brain Topogr 2018; 31:700-707. [PMID: 29427250 DOI: 10.1007/s10548-018-0632-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 02/06/2018] [Indexed: 01/25/2023]
Abstract
During active movement the somatosensory cortical responses are often attenuated. This attenuation is referred to as movement-related sensory gating. It is well known that patients with multiple sclerosis (MS) have sensory processing deficits, and recent work has also suggested that these patients display impaired motor control of the ankle musculature. The primary goal of the current study was to: (1) examine the movement-related somatosensory gating in patients with MS and demographically-matched controls, and (2) identify the relationship between the sensory gating and motor control of the ankle musculature. To this end, we used magnetoencephalography brain imaging to assess the neural responses to a tibial nerve electrical stimulation that was applied at rest (passive) and during an ankle plantarflexion motor task (active condition). All participants also completed an ankle isometric motor control task that was performed outside the scanner. Our results indicated that the controls, but not patients with MS, exhibited significantly reduced somatosensory responses during the active relative to passive conditions, and that patients with MS had stronger responses compared with controls during the active condition. Additionally, control of the ankle musculature was related to the extent of movement-related sensory attenuation, with poor motor control being associated with reduced gating. Overall, these results show that patients with MS do not attenuate the somatosensory cortical activity during motor actions, and that the inability to modulate somatosensory cortical activity is partially related to the poor ankle motor control seen in these patients.
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Affiliation(s)
- David J Arpin
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics, and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198-5450, USA.,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - James E Gehringer
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics, and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198-5450, USA.,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tony W Wilson
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Max J Kurz
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics, and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198-5450, USA. .,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA.
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11
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Control of Stroke-Related Genu Recurvatum With Prolonged Timing of Dorsiflexor Functional Electrical Stimulation: A Case Study. J Neurol Phys Ther 2017; 40:209-15. [PMID: 27164309 DOI: 10.1097/npt.0000000000000137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Abnormal knee hyperextension during the stance phase (genu recurvatum) is a common gait abnormality in persons with hemiparesis due to stroke. While ankle-foot orthoses (AFOs) are often used to prevent genu recurvatum by maintaining ankle dorsiflexion during the stance phase, AFOs reduce ankle joint mobility. Functional electrical stimulation (FES) is an alternative to the use of AFO for producing appropriately timed ankle dorsiflexion and with prolonged timing may also have value for reducing genu recurvatum. CASE DESCRIPTION A 51-year-old man with chronic stroke was the subject of this case study. The patient had excessive plantarflexion during stance phase (ie, dynamic equinus foot), with associated genu recurvatum. INTERVENTION Evaluation included clinical examination, instrumented gait analysis, 10-meter walk test, and 6-minute walk test. The patient underwent a trial of botulinum toxin to the plantarflexor muscles that was not effective for controlling the genu recurvatum. A subsequent trial with surface FES to elicit dorsiflexion during gait was effective, and he subsequently received an implanted FES system. OUTCOMES Stimulation-induced contraction of the dorsiflexors during terminal swing phase resulted in improved ankle dorsiflexion at initial contact. Moreover, extension of stimulation into the loading phase ensured tibial advancement, which limited knee hyperextension. The patient was reevaluated 12 months following implantation with continued positive outcomes. DISCUSSION This case study illustrates the potential value of prolonged timing of dorsiflexor FES to manage genu recurvatum attributed to a dynamic equinus foot in a stroke survivor.
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12
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Arpin DJ, Heinrichs-Graham E, Gehringer JE, Zabad R, Wilson TW, Kurz MJ. Altered sensorimotor cortical oscillations in individuals with multiple sclerosis suggests a faulty internal model. Hum Brain Mapp 2017; 38:4009-4018. [PMID: 28485884 DOI: 10.1002/hbm.23644] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/19/2017] [Accepted: 04/27/2017] [Indexed: 11/09/2022] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disease that results in a broad array of symptoms, including impaired motor performance. How such demyelination of fibers affects the inherent neurophysiological activity in motor circuits, however, remains largely unknown. Potentially, the movement errors associated with MS may be due to imperfections in the internal model used to make predictions of the motor output that will meet the task demands. Prior magnetoencephalographic (MEG) and electroencephalographic brain imaging experiments have established that the beta (15-30 Hz) oscillatory activity in the sensorimotor cortices is related to the control of movement. Specifically, it has been suggested that the strength of the post-movement beta rebound may indicate the certainty of the internal model. In this study, we used MEG to evaluate the neural oscillatory activity in the sensorimotor cortices of individuals with MS and healthy individuals during a goal-directed isometric knee force task. Our results showed no difference between the individuals with MS and healthy individuals in the beta activity during the planning and execution stages of movement. However, we did find that individuals with MS exhibited a weaker post-movement beta rebound in the pre/postcentral gyri relative to healthy controls. Additionally, we found that the behavioral performance of individuals with MS was aberrant, and related to the strength of the post-movement beta rebound. These results suggest that the internal model may be faulty in individuals with MS. Hum Brain Mapp 38:4009-4018, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- David J Arpin
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska.,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth Heinrichs-Graham
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, Nebraska.,Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - James E Gehringer
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska.,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, Nebraska
| | - Rana Zabad
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Tony W Wilson
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, Nebraska.,Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Max J Kurz
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska.,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, Nebraska
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13
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Muscle strength and power in persons with multiple sclerosis – A systematic review and meta-analysis. J Neurol Sci 2017; 376:225-241. [DOI: 10.1016/j.jns.2017.03.022] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/14/2017] [Accepted: 03/15/2017] [Indexed: 12/16/2022]
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14
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Quartu M, Poddighe L, Melis T, Serra MP, Boi M, Lisai S, Carta G, Murru E, Muredda L, Collu M, Banni S. Involvement of the endocannabinoid system in the physiological response to transient common carotid artery occlusion and reperfusion. Lipids Health Dis 2017; 16:14. [PMID: 28103941 PMCID: PMC5248520 DOI: 10.1186/s12944-016-0389-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/13/2016] [Indexed: 12/29/2022] Open
Abstract
Background The transient global cerebral hypoperfusion/reperfusion achieved by induction of Bilateral Common Carotid Artery Occlusion followed by Reperfusion (BCCAO/R) may trigger a physiological response in an attempt to preserve tissue and function integrity. There are several candidate molecules among which the endocannabinoid system (ECS) and/or peroxisome-proliferator activated receptor-alpha (PPAR-alpha) may play a role in modulating oxidative stress and inflammation. The aims of the present study are to evaluate whether the ECS, the enzyme cyclooxygenase-2 (COX-2) and PPAR-alpha are involved during BCCAO/R in rat brain, and to identify possible markers of the ongoing BCCAO/R-induced challenge in plasma. Methods Adult Wistar rats underwent BCCAO/R with 30 min hypoperfusion followed by 60 min reperfusion. The frontal and temporal-occipital cortices and plasma were analyzed by high performance liquid chromatography-mass spectrometry (HPLC-MS) to determine concentrations of endocannabinoids (eCBs) and related molecules behaving as ligands of PPAR-alpha, and of oxidative-stress markers such as lipoperoxides, while Western Blot and immunohistochemistry were used to study protein expression of cannabinoid receptors, COX-2 and PPAR-alpha. Unpaired Student’s t-test was used to evaluate statistical differences between groups. Results The acute BCCAO/R procedure is followed by increased brain tissue levels of the eCBs 2-arachidonoylglycerol and anandamide, palmitoylethanolamide, an avid ligand of PPAR-alpha, lipoperoxides, type 1 (CB1) and type 2 (CB2) cannabinoid receptors, and COX-2, and decreased brain tissue concentrations of docosahexaenoic acid (DHA), one of the major targets of lipid peroxidation. In plasma, increased levels of anandamide and lipoperoxides were observed. Conclusions The BCCAO/R stimulated early molecular changes that can be easily traced in brain tissue and plasma, and that are indicative of the tissue physiological response to the reperfusion-induced oxidative stress and inflammation. The observed variations suggest that the positive modulation of the ECS and the increase of proinflammatory substances are directly correlated events. Increase of plasmatic levels of anandamide and lipoperoxides further suggests that dysregulation of these molecules may be taken as an indicator of an ongoing hypoperfusion/reperfusion challenge.
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Affiliation(s)
- Marina Quartu
- Department of Biomedical Sciences, Cittadella Universitaria di Monserrato, 09042, Monserrato, CA, Italy.
| | - Laura Poddighe
- Department of Biomedical Sciences, Cittadella Universitaria di Monserrato, 09042, Monserrato, CA, Italy
| | - Tiziana Melis
- Department of Biomedical Sciences, Cittadella Universitaria di Monserrato, 09042, Monserrato, CA, Italy
| | - Maria Pina Serra
- Department of Biomedical Sciences, Cittadella Universitaria di Monserrato, 09042, Monserrato, CA, Italy
| | - Marianna Boi
- Department of Biomedical Sciences, Cittadella Universitaria di Monserrato, 09042, Monserrato, CA, Italy
| | - Sara Lisai
- Department of Biomedical Sciences, Cittadella Universitaria di Monserrato, 09042, Monserrato, CA, Italy
| | - Gianfranca Carta
- Department of Biomedical Sciences, Cittadella Universitaria di Monserrato, 09042, Monserrato, CA, Italy
| | - Elisabetta Murru
- Department of Biomedical Sciences, Cittadella Universitaria di Monserrato, 09042, Monserrato, CA, Italy
| | - Laura Muredda
- Department of Biomedical Sciences, Cittadella Universitaria di Monserrato, 09042, Monserrato, CA, Italy
| | - Maria Collu
- Department of Biomedical Sciences, Cittadella Universitaria di Monserrato, 09042, Monserrato, CA, Italy
| | - Sebastiano Banni
- Department of Biomedical Sciences, Cittadella Universitaria di Monserrato, 09042, Monserrato, CA, Italy
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15
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Camerota F, Celletti C, Di Sipio E, De Fino C, Simbolotti C, Germanotta M, Mirabella M, Padua L, Nociti V. Focal muscle vibration, an effective rehabilitative approach in severe gait impairment due to multiple sclerosis. J Neurol Sci 2017; 372:33-39. [DOI: 10.1016/j.jns.2016.11.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 10/20/2016] [Accepted: 11/13/2016] [Indexed: 10/20/2022]
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16
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Errors in the ankle plantarflexor force production are related to the gait deficits of individuals with multiple sclerosis. Hum Mov Sci 2016; 51:91-98. [PMID: 27923175 DOI: 10.1016/j.humov.2016.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 11/09/2016] [Accepted: 11/11/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Individuals with multiple sclerosis (MS) often have limited mobility that is thought to be due to the neuromuscular impairments of the ankle. Greater isometric motor control of the ankle has been associated with better standing postural balance but its relationship to mobility is less understood. The objectives of this investigation were to quantify the motor control of the ankle plantarflexors of individuals with MS during a dynamic isometric motor task, and explore the relationship between the ankle force control and gait alterations. METHODS Fifteen individuals with MS and 15 healthy adults participated in both a dynamic isometric ankle plantarflexion force matching task and a biomechanical gait analysis. FINDINGS Our results displayed that the subjects with MS had a greater amount of error in their dynamic isometric force production, were weaker, walked with altered spatiotemporal kinematics, and had reduced maximal ankle moment at toe-off than the control group. The greater amount of error in the dynamic force production was related to the decreases in strength, step length, walking velocity, and maximal ankle moment during walking. INTERPRETATION Altogether these results imply that errors in the ankle plantarflexion force production may be a limiting factor in the mobility of individuals with MS.
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17
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Davies BL, Arpin DJ, Liu M, Reelfs H, Volkman KG, Healey K, Zabad R, Kurz MJ. Two Different Types of High-Frequency Physical Therapy Promote Improvements in the Balance and Mobility of Persons With Multiple Sclerosis. Arch Phys Med Rehabil 2016; 97:2095-2101.e3. [DOI: 10.1016/j.apmr.2016.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/22/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
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