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Miyazaki Y, Hara T, Hagiwara K, Nakamura T, Kamimura A, Takeshita E, Komaki H, Mizuno K, Tsuji T, Abo M. Validity of the Functional Classification of the Upper Extremities for Duchenne Muscular Dystrophy. Prog Rehabil Med 2024; 9:20240016. [PMID: 38665904 PMCID: PMC11040242 DOI: 10.2490/prm.20240016] [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: 12/11/2023] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Objectives Some upper-limb function assessments can evaluate treatments in the non-ambulatory stage of Duchenne muscular dystrophy (DMD). The Functional Classification of the Upper Extremities (FCUE) was developed for DMD in Japan. The FCUE is easier to use than the Performance of Upper Limb (PUL) and is more detailed than the Brooke Upper Extremity Scale. This study aimed to determine the concurrent validity of FCUE with other methods of assessment for DMD. Methods This retrospective study reviewed the medical records of 39 boys with DMD from the National Center of Neurology and Psychiatry to evaluate the concurrent validity of the FCUE and PUL using non-parametric Spearman rank correlation (ρ). We also determined the concurrent validity of the Brooke Upper Extremity Scale and PUL for comparison. Results The ρ value between the FCUE and PUL was -0.914 (P<0.001). The FCUE showed robust concurrent validity with the PUL. That correlation between the FCUE and Brooke Upper Extremity Scale gave a ρ value of -0.854 (P<0.001). Conclusions The FCUE had a higher concurrent validity with the PUL than with the Brooke Upper Extremity Scale. The FCUE is considered a valid assessment tool of upper-limb function in boys with DMD. Selecting the best assessment method depends on the severity of the patient's condition and a balance between assessment accuracy and evaluation time.
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Affiliation(s)
- Yuta Miyazaki
- Department of Rehabilitation Medicine, National Center
Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation Medicine, Keio University
School of Medicine, Tokyo, Japan
| | - Takatoshi Hara
- Department of Rehabilitation Medicine, National Center
Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation Medicine, The Jikei University
School of Medicine, Tokyo, Japan
| | - Kazuki Hagiwara
- Department of Rehabilitation Medicine, National Center
Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation Medicine, Keio University
School of Medicine, Tokyo, Japan
| | - Takuya Nakamura
- Department of Rehabilitation Medicine, National Center
Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation Medicine, Keio University
School of Medicine, Tokyo, Japan
| | - Akiko Kamimura
- Department of Rehabilitation Medicine, National Center
Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Eri Takeshita
- Department of Child Neurology, National Center Hospital,
National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hirofumi Komaki
- Department of Child Neurology, National Center Hospital,
National Center of Neurology and Psychiatry, Tokyo, Japan
- Translational Medical Center, National Center of Neurology
and Psychiatry, Tokyo, Japan
| | - Katsuhiro Mizuno
- Department of Rehabilitation Medicine, Tokai University
School of Medicine, Hiratsuka, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University
School of Medicine, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University
School of Medicine, Tokyo, Japan
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Decostre V, De Antonio M, Servais L, Hogrel JY. Relationship Between Hand Strength and Function in Duchenne Muscular Dystrophy and Spinal Muscular Atrophy: Implications for Clinical Trials. J Neuromuscul Dis 2024; 11:777-790. [PMID: 38788084 PMCID: PMC11307056 DOI: 10.3233/jnd-230182] [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] [Accepted: 04/16/2024] [Indexed: 05/26/2024]
Abstract
Background Measurement of muscle strength and motor function is recommended in clinical trials of neuromuscular diseases, but the loss of hand strength at which motor function is impacted is not documented. Objectives To establish the relationship between hand strength and function, and to determine the strength threshold that differentiates normal and abnormal hand function in individuals with Duchenne Muscular Dystrophy (DMD) or Spinal Muscular Atrophy (SMA). Methods Maximal handgrip and key pinch strength were measured with the MyoGrip and MyoPinch dynamometers, respectively. Hand function was assessed using the MoviPlate, the Motor Function Measure items for distal upper limb (MFM-D3-UL) and the Cochin Hand Function Scale (CHFS). Results Data from 168 participants (91 DMD and 77 SMA, age 6-31 years) were analyzed. Relationships between strength and function were significant (P < 0.001). Hand function was generally preserved when strength was above the strength threshold determined by Receiver-Operating Characteristic (ROC) analysis: For MFM-D3-UL, the calculated handgrip strength thresholds were 41 and 13% of the predicted strength for a healthy subject (% pred) and the key pinch strength thresholds were 42 and 26% pred for DMD and SMA, respectively. For the MoviPlate, handgrip strength thresholds were 11 and 8% pred and key pinch strength thresholds were 21 and 11% pred for DMD and SMA, respectively. For participants with sub-threshold strength, hand function scores decreased with decreasing strength. At equal % pred strength, individuals with SMA had better functional scores than those with DMD. Conclusions Hand function is strength-dependent for most motor tasks. It declines only when strength falls below a disease-specific threshold. Therefore, therapies capable of maintaining strength above this threshold should preserve hand function.
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Affiliation(s)
| | - Marie De Antonio
- Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
- Present address: Direction de la Recherche Clinique et de l’Innovation, Centre hospitalier universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurent Servais
- Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
- Present address: Department of Paediatrics, MDUK Oxford Neuromuscular Centre & NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Present address: Department of Pediatrics, Division of Child Neurology, Centre de Référence des Maladies Neuromusculaires, University Hospital Liège and University of Liège, Liège, Belgium
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Hakim Zada F, Ahmad Azahari AHS, Wong SW, Ali A, Ismail NAS. Understanding Challenges of Genetic Testing on Neuromuscular Disorders from the Parental Lens. J Pers Med 2023; 13:1652. [PMID: 38138879 PMCID: PMC10744978 DOI: 10.3390/jpm13121652] [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: 10/20/2023] [Revised: 11/14/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023] Open
Abstract
Neuromuscular disorders, characterized by progressive muscle degeneration and weakness, present substantial challenges to both affected individuals and their families. Genetic testing assumes a pivotal role in facilitating early diagnosis, intervention, treatment, and informed family planning for these conditions. The objective of this qualitative study is to delve into the knowledge, awareness, and perceptions surrounding genetic testing within the cohort of parents caring for individuals with neuromuscular disorders in Malaysia. A semi-structured interview approach was employed to elicit data from parents of individuals diagnosed with neuromuscular disorders, encompassing those with clinical diagnoses and those diagnosed through genetic testing. Examination of the interview responses yielded nine overarching themes, which furnish invaluable insights into the perspectives of Malaysian parents concerning genetic testing. The study discerned several challenges associated with genetic testing, notably encompassing the limited awareness among parents, the financial constraints associated with genetic testing, and the perceived significance of genetic testing in the context of neuromuscular disorders. The findings suggest that the level of knowledge and awareness pertaining to genetic testing for neuromuscular disorders among parents in Malaysia varies, with initial levels of awareness ranging from relatively low to reasonably sufficient prior to and following the birth of an affected child. However, the investigation revealed that parents tended to cultivate more favorable perceptions regarding genetic testing subsequent to their experience with genetic counseling. This underscores the potential for heightened awareness and comprehension as a consequence of the personal experience of parenting an affected child confirmed through genetic testing and genetic counseling, ultimately influencing parental awareness.
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Affiliation(s)
- Farheen Hakim Zada
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia; (F.H.Z.); (A.H.S.A.A.); (S.W.W.); (A.A.)
| | - Ahmad Hazim Syakir Ahmad Azahari
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia; (F.H.Z.); (A.H.S.A.A.); (S.W.W.); (A.A.)
| | - Sau Wei Wong
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia; (F.H.Z.); (A.H.S.A.A.); (S.W.W.); (A.A.)
| | - Adli Ali
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia; (F.H.Z.); (A.H.S.A.A.); (S.W.W.); (A.A.)
- Research Centre, Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, UKM Specialist Children’s Hospital, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia
| | - Noor Akmal Shareela Ismail
- Research Centre, Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, UKM Specialist Children’s Hospital, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia
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Cicala G, Pane M, Coratti G, Brogna C, Fanelli L, Norcia G, Forcina N, Mazzone E, Stanca G, Ferrante R, Vento A, Ferraroli E, Ricci M, Capasso A, Leone D, Palermo C, Berti B, Cutrona C, Mahyew A, Duong T, Goemans N, Vroom E, Mercuri E. Patient reported outcome measure for upper limb in Duchenne muscular dystrophy: correlation with PUL2.0. Neuromuscul Disord 2023; 33:69-73. [PMID: 37612177 DOI: 10.1016/j.nmd.2023.07.003] [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: 04/18/2023] [Revised: 06/19/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023]
Abstract
The increasing pressure to include non ambulant Duchenne muscular dystrophy (DMD) boys in clinical trials has highlighted the need for outcome measures that could address the impact of upper limb function on activities of daily living. The aim of the present study was to establish the correlation between the recently developed Patient Reported Outcome Measure for the upper limb (PROM UL) and the observer rated functional scale Performance of Upper Limb (PUL 2.0) in a large cohort of DMD boys and young adults. As part of a larger natural history study, non ambulant DMD patients were assessed using PUL2.0 and PROM UL. One hundred and twenty-five concurrent PUL 2.0 and PROM UL evaluations from 60 non ambulant DMD boys were taken into consideration. The total PROM UL scores showed a strong correlation with both PUL 2.0 total scores and with PUL 2.0 entry item score. The strong correlation between the two tools confirms the clinical meaningfulness of the PUL2.0 and that the PROM UL can help to detect the gradient of progression of upper limb involvement.
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Affiliation(s)
- Gianpaolo Cicala
- Paediatric Neurology, Catholic University, Rome, Italy; Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Marika Pane
- Paediatric Neurology, Catholic University, Rome, Italy; Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Giorgia Coratti
- Paediatric Neurology, Catholic University, Rome, Italy; Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Claudia Brogna
- Neuropsichiatria Infantile, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Lavinia Fanelli
- Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Giulia Norcia
- Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Nicola Forcina
- Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Elena Mazzone
- Paediatric Neurology, Catholic University, Rome, Italy
| | - Giulia Stanca
- Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Roberta Ferrante
- Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Alessandra Vento
- Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | | | - Martina Ricci
- Paediatric Neurology, Catholic University, Rome, Italy; Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Anna Capasso
- Paediatric Neurology, Catholic University, Rome, Italy; Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Daniela Leone
- Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Concetta Palermo
- Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Beatrice Berti
- Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | | | - Anna Mahyew
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle upon Tyne, UK
| | - Tina Duong
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Natalie Goemans
- Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium
| | | | - Eugenio Mercuri
- Paediatric Neurology, Catholic University, Rome, Italy; Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy; Neuropsichiatria Infantile, Fondazione Policlinico Gemelli IRCCS, Rome, Italy.
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Safran E, Ozer AY, Gurses HN. Do handgrip strength and dexterity predict respiratory function in neuromuscular disease? ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:1141-1148. [PMID: 36577413 PMCID: PMC9797284 DOI: 10.1055/s-0042-1758757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Neuromuscular diseases are acquired or inherited diseases that affect the function of the muscles in our body, including respiratory muscles. OBJECTIVE We aimed to discover more cost-effective and practical tools to predict respiratory function status, which causes serious problems with patients with neuromuscular disease. METHODS The Vignos and Brooke Upper Extremity Functional Scales were used to evaluate functional status for patient recruitment. The handgrip strength and dexterity of patients were measured using a dynamometer and nine-hole peg test. Respiratory function parameters: forced vital capacity, forced expiratory volume in one second, and peak expiratory flow were evaluated using spirometry. RESULTS The mean age of the 30 patients was 11.5 ± 3.79 years old. Significant relationships were found between nine-hole-peg-test scores and respiratory function parameters on both sides. Significant correlations were found between both handgrip strength and respiratory function parameters (p < 0.05). In the linear regression analysis, it was seen that the forced expiratory volume in 1 second, and peak expiratory flow values could be explained in different percentages (p < 0.05). CONCLUSIONS Handgrip strength and dexterity measurements can be used as indicators for estimating respiratory function parameters in terms of cost and accessibility, although it is known that they will not replace respiratory function tests.
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Affiliation(s)
- Ertugrul Safran
- Bezmialem Vakif University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Aysel Yildiz Ozer
- Marmara University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Department of Cardiopulmonary Physiotherapy Rehabilitation, Istanbul, Turkey.,Address for correspondence Aysel Yildiz Ozer
| | - Hulya Nilgun Gurses
- Bezmialem Vakif University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Department of Cardiopulmonary Physiotherapy and Rehabilitation, Istanbul, Turkey.
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