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Kaddoura R, Faraji H, Othman M, Abu Hijleh A, Loney T, Goswami N, Benamer HTS. Exploring Factors Associated with Falls in Multiple Sclerosis: Insights from a Scoping Review. Clin Interv Aging 2024; 19:923-938. [PMID: 38803468 PMCID: PMC11129740 DOI: 10.2147/cia.s460475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory condition that causes demyelination of the central nervous system accompanied by a wide range of symptoms. The high prevalence of falls among patients diagnosed with MS within the initial six months highlights the importance of this issue. The objective of this study is to identify factors associated with falls in MS patients in order to increase awareness and reduce the risk of falls. This scoping review used specific Mesh terms to formulate the literature search around falls and MS using Medline, Google Scholar, Scopus, and Embase search engines. English papers published between 2012 and 2022, studies with a clear definition of falls, McDonald's diagnostic criteria for MS, and those with Expanded Disability Status Scale (EDSS) or Patient Determined Disease Steps (PDDS) scores were included. Critical data from the selected articles were extracted and classified according to the different factors associated with falls in MS patients. Eighteen articles were included in this review. The most important factors associated with falls in MS patients identified were the severity and progression of the disease, mobility and balance problems, bladder dysfunction, fear of falling, fatigue, and cognitive dysfunction. In conclusion, this scoping review yielded the most common factors associated with falls in patients with MS. Study findings can be used to develop future interventions focusing on improving mobility, proprioception, and balance to decrease fall risk and injury amongst MS patients.
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Affiliation(s)
- Rachid Kaddoura
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Hanan Faraji
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Malek Othman
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Amin Abu Hijleh
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Tom Loney
- Department of Basic Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Nandu Goswami
- Division of Physiology and Pathophysiology, Medical University of Graz, Graz, Austria
- Center for Space and Aviation Health, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Hani T S Benamer
- Department of Clinical Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Abou L, Peters J, Freire B, Sosnoff JJ. Fear of falling and common symptoms of multiple sclerosis: Physical function, cognition, fatigue, depression, and sleep - A systematic review. Mult Scler Relat Disord 2024; 84:105506. [PMID: 38422635 DOI: 10.1016/j.msard.2024.105506] [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: 01/12/2024] [Revised: 02/03/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Fear of falling (FOF) is a common concern among persons with multiple sclerosis (MS) and affects the performance of their daily living activities. Falls may result in FOF, leading to worsening of symptoms of MS, physical deconditioning, and exposure to future falls. This may trigger a vicious cycle between FOF and falls. A better understanding of the relationship between FOF and symptoms of MS may be helpful to develop a conceptual model to guide fall prevention interventions. OBJECTIVE To synthesize the correlational and predictive relationships between FOF and common symptoms of MS. METHODS Databases including PubMed, Embase, Web of Science, Scopus, CINHAL, PsycINFO, and SPORTDiscuss were searched from inception to October 2023. Studies examining correlations and/or predictions between FOF and common MS symptoms that include measures of gait, postural control, fatigue, cognition, pain, sleep, depression, and anxiety were identified by two independent reviewers. Both reviewers also conducted the methodological quality assessment of the included studies. RESULTS Twenty-three studies with a total of 2819 participants were included in the review. Correlational findings indicated that increased FOF was significantly associated with greater walking deficits (lower gait speed, smaller steps), reduced mobility, and poorer balance. Increased FOF was also significantly correlated with higher cognitive impairments, more fatigue, sleep disturbances, and depression. Decreased gait parameters, reduced balance, lower physical functions, cognitive impairments, and sleep deficits were found as significant predictors of increased FOF. CONCLUSION Evidence indicates significant correlational and bidirectional predictive relationships exist between FOF and common MS symptoms. A comprehensive conceptual framework accounting for the interaction between FOF and MS symptoms is needed to develop effective falls prevention strategies.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Joseph Peters
- Kansas City University College of Osteopathic Medicine, Kansas City University of Medicine and Bioscience, Kansas City, MO, USA
| | - Bruno Freire
- Health and Sports Sciences Center, Santa Catarina State University, Florianópolis, SC, Brazil
| | - Jacob J Sosnoff
- Department of Physical Therapy, Rehabilitation Science, & Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
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Yao S, Chen XW. The association between depressive symptoms with fear of falling and cognitive decline in older adults in the Korean community: An analysis of the Korean Longitudinal Study of Aging (KLoSA), 2006-2020. Arch Gerontol Geriatr 2024; 117:105177. [PMID: 37690256 DOI: 10.1016/j.archger.2023.105177] [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: 07/03/2023] [Revised: 08/19/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES This study aimed to investigate the effects of fear of falling (FOF) on cognitive decline in older adults in the Korean community, depending on the presence of accompanying depressive symptoms. METHODS A total of 6263 individuals were included in the final analysis. Based on their baseline evaluation results for depressive symptoms and FOF, the subjects were divided into four groups: "normal control" (NC, n = 3783), "depression only" (Dep-only, n = 291), "fear of falling only" (FOF-only, n = 1755), and "depression with fear of falling" (Dep-FOF, n = 434). Cognitive decline was defined as a loss of more than three points in the K-MMSE score in participants with at least two years of follow-up. We examined the association between FOF accompanied by depressive symptoms and cognitive decline using a multivariate Cox proportional hazard model. RESULTS Cognitive decline occurred in 76.3%, 68.5%, 63.9%, and 56.4% of the Dep-FOF, FOF-only, Dep-only, and NC groups, respectively. Our findings suggest that individuals with FOF do not always have cognitive decline (HR = 1.03, 95% CI = 0.95-1.12, P = 0.43) compared to individuals without FOF. Furthermore, depressive symptoms with FOF are associated with a higher risk of cognitive decline (HR = 1.23, 95% CI = 1.08-1.41, P = 0.002) in community-dwelling older adults in Korea. CONCLUSION Healthcare providers should be attentive to community-dwelling older adults who experience both depressive symptoms and FOF because our findings suggest that this unique combination increases the risk of cognitive decline.
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Affiliation(s)
- Shaoli Yao
- Department of Neurology, Hospital of Chengdu Office of People's Government of Tibet Autonomous Region, Chengdu, Sichuan, China.
| | - Xi-Wen Chen
- Department of Neurology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, Sichuan, China
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Mañago MM, Cohen ET, Alvarez E, Hager ER, Owens JG, Bade M. Feasibility of Low-Load Resistance Training Using Blood Flow Restriction for People With Advanced Multiple Sclerosis: A Prospective Cohort Study. Phys Ther 2024; 104:pzad135. [PMID: 37815934 PMCID: PMC10822774 DOI: 10.1093/ptj/pzad135] [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: 01/10/2023] [Revised: 06/03/2023] [Accepted: 08/05/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE The objective of this study was to determine the feasibility of low-load resistance training with blood flow restriction (BFR) for people with advanced disability due to multiple sclerosis (MS). METHODS In this prospective cohort study, 14 participants with MS (Expanded Disability Status Scale [EDSS] score = 6.0 to 7.0; mean age = 55.4 [SD = 6.2] years; 71% women) were asked to perform 3 lower extremity resistance exercises (leg press, calf press, and hip abduction) bilaterally twice weekly for 8 weeks using BFR. Feasibility criteria were as follows: enrollment of 20 participants, ≥80% retention and adherence, ≥90% satisfaction, and no serious adverse events related to the intervention. Other outcomes included knee extensor, ankle plantar flexor, and hip abductor muscle strength, 30-Second Sit-to-Stand Test, Berg Balance Scale, Timed 25-Foot Walk Test, 12-Item MS Walking Scale, Modified Fatigue Impact Scale, Patient-Specific Functional Scale, and daily step count. RESULTS Sixteen participants consented, and 14 completed the intervention, with 93% adherence overall. All participants were satisfied with the intervention. A minor hip muscle strain was the only intervention-related adverse event. There were muscle strength improvements on the more-involved (16%-28%) and less-involved (12%-19%) sides. There were also changes in the 30-Second Sit-to-Stand Test (1.9 repetitions; 95% CI = 1.0 to 2.8), Berg Balance Scale (5.3 points; 95% CI = 3.2 to 7.4), Timed 25-Foot Walk Test (-3.3 seconds; 95% CI = -7.9 to 1.3), Modified Fatigue Impact Scale (-8.8 points; 95% CI = -16.5 to -1.1), 12-Item MS Walking Scale (-3.6 points; 95% CI = -11.5 to 4.4), Patient-Specific Functional Scale (2.9 points; 95% CI = 1.9 to 3.8), and daily step count (333 steps; 95% CI = -191 to 857). CONCLUSION Low-load resistance training using BFR in people with MS and EDSS scores of 6.0 to 7.0 appears feasible, and subsequent investigation into its efficacy is warranted. IMPACT Although efficacy data are needed, combining BFR with low-load resistance training may be a viable alternative for people who have MS and who do not tolerate conventional moderate- to high-intensity training because of more severe symptoms, such as fatigue and weakness. LAY SUMMARY Low-load strength training with BFR was feasible in people who have advanced disability due to MS. Using BFR may provide an alternative for people with MS who do not tolerate higher intensity training due to more severe symptoms, such as fatigue and weakness.
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Affiliation(s)
- Mark M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Evan T Cohen
- Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Enrique Alvarez
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Emily R Hager
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | | | - Michael Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
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Gopal A, Gelfand JM, Bove R, Block VJ. Fall Assessment and Monitoring in People With Multiple Sclerosis: A Practical Evidence-Based Review for Clinicians. Neurol Clin Pract 2023; 13:e200184. [PMID: 37720138 PMCID: PMC10503932 DOI: 10.1212/cpj.0000000000200184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/07/2023] [Indexed: 09/19/2023]
Abstract
Purpose of Review Falls occur in more than half of all people with multiple sclerosis (MS) but tend to be underdiagnosed and underreported in clinical encounters. This narrative review aims to summarize evidence-based approaches for evaluating fall risk and proven treatment strategies to reduce falling in people with MS to improve care for people with MS and to enhance interprofessional care coordination between treating neurologic and physical therapy (PT) teams. Recent Findings Screening not just for falls but for near-falls as well because fear of falling can improve fall assessment and identify patients who may benefit from fall prevention interventions. A number of barriers, including time constraints during visits and the fallacy that falling is inevitable in MS, can limit clinician awareness about patient falls and delay timely referral to PT. Consultation with physical therapists for individualized fall prevention treatment can reduce risk of falling. Interventional studies have also shown that PT-guided exercise programs improve balance confidence in people with MS. However, people with MS are often under-referred to PT by treating clinicians. Summary A clinical approach is provided to summarize practical, accessible, evidence-based, low-burden measurements and interventions likely to improve ascertainment of patients at risk of falling and optimize timely PT referral and treatment.
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Affiliation(s)
- Arpita Gopal
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
| | - Jeffrey M Gelfand
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
| | - Riley Bove
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
| | - Valerie J Block
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
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Takla TN, Chargo AN, Daugherty AM, Fritz NE. Cognitive Contributors of Backward Walking in Persons with Multiple Sclerosis. Mult Scler Int 2023; 2023:5582242. [PMID: 37600498 PMCID: PMC10438976 DOI: 10.1155/2023/5582242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose Individuals with multiple sclerosis (MS) are at an increased fall risk due to motor and cognitive dysfunction. Our past studies suggest that backward walking (BW) velocity predicts fall risk; however, specific cognitive domains associated with BW velocity remain understudied. The goal of this study was to determine the specific contributions of cognitive functioning to BW velocity in persons with MS. We hypothesized that better visuospatial memory, verbal immediate recall, and faster information processing speed would contribute to faster BW velocity, and deficits in these domains would partially account for disease severity-related impairment in BW velocity. Methods Participants completed demographic questionnaires, walking tests, and cognitive assessments. Applied structural equation modeling was used to test our hypothesized model of competing cognitive mediators. Within the model, disease severity was a predictor of BW via three intercorrelated cognitive mediators. Results Participants included 39 individuals with relapsing-remitting MS. Results indicated that 35.3% of the significant total effect of disease severity on BW was accounted for by specific cognitive deficits. Verbal immediate recall had the largest contribution, followed by visuospatial memory and information processing speed. Conclusions When examining the unique effects of cognitive domains on disease severity-related deficits in BW, a meaningful source of impairment related to visuospatial memory and verbal immediate recall was demonstrated. Considering the utility of BW velocity as a predictor of falls, these results highlight the importance of assessing cognition when evaluating fall risk in MS. Cognitive-based intervention studies investigating fall prevention may find BW as a more specific and sensitive predictor of fall risk than forward walking.
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Affiliation(s)
- Taylor N. Takla
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
| | - Alexis N. Chargo
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Ana M. Daugherty
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Nora E. Fritz
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
- Department of Health Care Sciences, Wayne State University, Detroit, MI, USA
- Department of Neurology, Wayne State University, Detroit, MI, USA
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Jawad A, Baattaiah BA, Alharbi MD, Chevidikunnan MF, Khan F. Factors contributing to falls in people with multiple sclerosis: The exploration of the moderation and mediation effects. Mult Scler Relat Disord 2023; 76:104838. [PMID: 37390785 DOI: 10.1016/j.msard.2023.104838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/12/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The prevalence of multiple sclerosis (MS) has significantly increased in recent decades. People with MS have a high risk of falling; these falls may lead to serious injuries, affecting their quality of life PURPOSE: The aim of this study is to assess the factors affecting falls in people with MS and map out the most significant ones. This study also aims to determine whether fatigue has a moderation effect and balance has a mediation effect on falls in people with MS METHODS: In total, 103 people with MS with a mean age of 32.09 ± 7.17 were enrolled. All subjects were assessed for multiple variables including balance using the Berg Balance Scale (BBS), speed of gait using the Timed Up and Go (TUG) test, fear of falling using the Falls Efficacy Scale-International (FES-I), level of fatigue using the Modified Fatigue Impact Scale (MFIS), and lower limb muscle strength using a handheld digital dynamometer RESULTS: Simple binary logistic regression analysis showed significant results for BBS (OR: 10.88; 95% CI: 4.24-27.96; p < 0.0001), TUG (OR: 1.18; 95% CI: 1.09-1.28; p < 0.0001), FES-I (OR: 1.06; 95% CI: 1.02-1.10; p = 0.001), and MFIS (OR: 1.04; 95% CI: 1.02-1.07; p < 0.0001) as factors affecting falls. According to multivariate analysis, balance (OR: 3.924; 95% CI: 1.307-11.780, p = 0.015), speed of gait (OR: 1.122; 95% CI: 1.023-1.231; p = 0.015), and fatigue (OR: 1.029; 95% CI: 1.002-1.058; p = 0.038) were the strongest predicting factors of falls. Hayes's PROCESS analysis showed that fatigue had a significant moderation effect on the relationship between gait speed and falls (MFIS; β; 0.10; p < 0.0001; 95% CI: 0.07-0.14) and balance had a mediation effect on the relationship between gait speed and falls (BBS; indirect effect; 0.08; 95% CI: 0.02-0.13) CONCLUSIONS: People with MS with impaired balance, slower gait speeds, higher levels of fatigue, and a fear of falling were at a high risk of falling. The relationship between gait speed and falls can be mediated by impaired balance and moderated by the level of fatigue. Our data suggest that targeting balance and fatigue while developing rehabilitation interventions could decrease the incidence of falls among people with MS.
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Affiliation(s)
- Adel Jawad
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia; Department of Physical Therapy, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Baian A Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Mutasim D Alharbi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Mohamed Faisal Chevidikunnan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia.
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Chang MC, Lee BJ, Yang D, Kim CR, Park D, Kim S. The association between cognition and gait disturbance in central nervous system demyelinating disorder with mild disability. BMC Neurol 2023; 23:177. [PMID: 37120584 PMCID: PMC10148385 DOI: 10.1186/s12883-023-03210-w] [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: 09/03/2022] [Accepted: 04/14/2023] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Gait disturbance in central nervous system (CNS) demyelinating disorders, including multiple sclerosis (MS) and neuromyelitis optica (NMO) is one of the most troublesome problems that has a direct impact on the quality of life. However, the associations between gait disturbance and other clinical variables of these two diseases have not been fully elucidated. OBJECTIVE This study aimed to evaluate gait disturbance using a computerized gait analysis system and its association with various clinical variables in patients with MS and NMO. METHODS A total of 33 patients (14 with MS and 19 with NMO) with minor disabilities, who were able to walk independently and had passed their acute phase, were enrolled in the study. Gait analysis were performed using a computer-based instrumented walkway system. (Walk-way MG-1000, Anima, Japan) Clinical variables, such as disease duration, medication, body mass index (BMI), hand grip power, and muscle mass were recorded. The Montreal Cognitive Assessment (MOCA), Beck Depression Inventory score-II (BDI), and fatigue scale were measured using the Functional Assessment of Chronic Illness Therapy-fatigue scale (FACIT-fatigue) scale. A trained neurologist scored the Expanded Disability Status Scale (EDSS). RESULTS Gait speed was the single parameter that showed a significant positive correlation with MOCA (p < 0.001). The stance phase time was the single parameter that showed a significant negative correlation with EDSS (p < 0.001). Hand grip strength showed a significant positive correlation with skeletal muscle mass as assessed by bioimpedance analysis (p < 0.05). The FACIT-fatigue scale score showed a significant negative correlation with the BDI (p < 0.001). CONCLUSION In our patients with MS/NMO with mild disability, cognitive impairment was significantly correlated with gait speed, and the degree of disability was significantly correlated with stance phase time. Our findings may imply that early detection of a decrease in gait speed and an increase in stance phase time can predict the progression of cognitive impairment in patients with MS/NMO with mild disability.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Byung Joo Lee
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Ayang-Ro 99 Gil, Dong-Gu, Daegu, 41199, Republic of Korea
| | - Dongseok Yang
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Chung Reen Kim
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Ayang-Ro 99 Gil, Dong-Gu, Daegu, 41199, Republic of Korea.
| | - Sunyoung Kim
- Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, 877 Bangeojin sunhwando-ro, Dong-gu, 44033, Ulsan, Korea.
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Alharthi HM, Almurdi MM. Association between cognitive impairment and motor dysfunction among patients with multiple sclerosis: a cross-sectional study. Eur J Med Res 2023; 28:110. [PMID: 36864515 PMCID: PMC9979523 DOI: 10.1186/s40001-023-01079-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Previous studies have shown that there is a relationship between cognitive impairment (CI) and motor dysfunction (MD) in neurological diseases, such as Alzheimer's and Parkinson's disease. However, there whether CI and MD are associated in patients with multiple sclerosis (MS) is unknown. Here we studied the association between CI and MD in patients with MS and examined if muscle weakness or incoordination, balance impairment, gait abnormalities, and/or increased fall risk are indicators of CI in patients with MS. METHODS Seventy patients with MS were included in this cross-sectional study. Cognitive impairment was assessed using the Montreal Cognitive Assessment Scale (MoCA), muscle strength using a hand-held dynamometer, and balance, gait, and fall risk assessment using the Tinetti scale. Motor coordination was assessed using the timed rapid alternating movement test for the upper extremity and the timed alternate heel-to-knee test for the lower extremity. RESULTS There was a significant association between CI and motor coordination, balance, gait, and risk of fall (p < 0.005) but not muscle strength. Stepwise multiple linear regression showed that 22.7% of the variance in the MoCA was predicted by the fall risk and incoordination of the upper extremities in the MS population. CONCLUSIONS CI is significantly associated with motor incoordination, balance impairment, gait abnormality, and increased fall risk. Furthermore, the risk of fall and upper extremity incoordination appeared to be best indicators of CI in patients with MS.
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Affiliation(s)
- Hanadi Matar Alharthi
- Rehabilitation of Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Muneera Mohammed Almurdi
- grid.56302.320000 0004 1773 5396Rehabilitation of Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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The moderating roles of self-efficacy and depression in dual-task walking in multiple sclerosis: A test of self-awareness theory. J Int Neuropsychol Soc 2023; 29:274-282. [PMID: 35465869 DOI: 10.1017/s1355617722000200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a debilitating neurological disease associated with a variety of psychological, cognitive, and motoric symptoms. Walking is among the most important functions compromised by MS. Dual-task walking (DTW), an everyday activity in which people walk and engage in a concurrent, discrete task, has been assessed in MS, but little is known about how it relates to other MS symptoms. Self-awareness theory suggests that DTW may be a function of the interactions among psychological, cognitive, and motor processes. METHOD Cognitive testing, self-report assessments for depression and falls self-efficacy (FSE), and walk evaluations [DTW and single-task walk (STW)] were assessed in seventy-three people with MS in a clinical care setting. Specifically, we assessed whether psychological factors (depression and FSE) that alter subjective evaluations regarding one's abilities would moderate the relationships between physical and cognitive abilities and DTW performance. RESULTS DTW speed is related to diverse physical and cognitive predictors. In support of self-awareness theory, FSE moderated the relationship between STW and DTW speeds such that lower FSE attenuated the strength of the relationship between them. DTW costs - the change in speed normalized by STW speed - did not relate to cognitive and motor predictors. DTW costs did relate to depressive symptoms, and depressive symptoms moderated the effect of information processing on DTW costs. CONCLUSIONS Findings indicate that an interplay of physical ability and psychological factors - like depression and FSE - may enhance understanding of walking performance under complex, real-world, DTW contexts.
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Edwards EM, Daugherty AM, Fritz NE. Examining the Influence of Cognition on the Relationship Between Backward Walking and Falls in Persons With Multiple Sclerosis. Int J MS Care 2023; 25:51-55. [PMID: 36923580 PMCID: PMC10010112 DOI: 10.7224/1537-2073.2021-130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) causes motor, cognitive, and sensory impairments that result in injurious falls. Current fall risk measures in MS (ie, forward walking [FW] speed and balance) are limited in their sensitivity. Backward walking (BW) velocity is a sensitive marker of fall risk and correlates with information processing speed (IPS) and visuospatial memory (VSM) in persons with MS. Backward walking is a complex motor task that requires increased cognitive demands, which are negatively affected by MS; however, whether cognitive function modifies the sensitivity of BW as a fall risk assessment in MS remains unknown. This study examines the influence of cognition on the relationship between BW and falls in persons with MS. METHODS Measures of BW, FW, IPS, VSM, and retrospective falls were collected. Hierarchical regression tested moderation and included an interaction term predicting number of falls. Covariates for all analyses included age and disease severity. RESULTS Thirty-eight persons with MS participated. Although BW, IPS, and covariates significantly predicted the number of falls (R 2 = 0.301; P = .016), there was no evidence of moderation. Backward walking, VSM, and covariates also significantly predicted number of falls (R 2 = 0.332, P = .008), but there was no evidence of moderation. The FW models generated comparable results. CONCLUSIONS The relationship between BW velocity and falls was not conditional on IPS or VSM in this sample. Larger-scale studies examining additional cognitive domains commonly affected by MS and prospective falls are needed to characterize neurobiological processes relevant to BW and its clinical application in the assessment of fall risk.
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Affiliation(s)
- Erin M. Edwards
- From the Translational Neuroscience Program (EME, AMD, NEF), Wayne State University, Detroit, MI, USA
- Department of Health Care Sciences (EME, NEF), Wayne State University, Detroit, MI, USA
| | - Ana M. Daugherty
- Department of Psychology (AMD), Wayne State University, Detroit, MI, USA
- Institute of Gerontology (AMD), Wayne State University, Detroit, MI, USA
| | - Nora E. Fritz
- From the Translational Neuroscience Program (EME, AMD, NEF), Wayne State University, Detroit, MI, USA
- Department of Health Care Sciences (EME, NEF), Wayne State University, Detroit, MI, USA
- Department of Neurology (NEF), Wayne State University, Detroit, MI, USA
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12
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Iodice R, Aceto G, Ruggiero L, Cassano E, Manganelli F, Dubbioso R. A review of current rehabilitation practices and their benefits in patients with multiple sclerosis. Mult Scler Relat Disord 2023; 69:104460. [PMID: 36535234 DOI: 10.1016/j.msard.2022.104460] [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: 09/14/2022] [Revised: 11/18/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
Multiple sclerosis (MS) is a chronic, debilitating disease characterised by demyelination of the nerves of the central nervous system that results in patients progressively losing the ability to perform daily tasks. As there is no cure for this disease, rehabilitation therapy is an important aspect of care; assisting patients to regain or retain function and improve their physical, mental and social wellbeing. At present there is no current consistent model of care for MS, likely due to the variable symptom presentation. Various forms of rehabilitation therapy are available, and these include physical rehabilitation methods, such as balance and gait therapy, speech and respiration rehabilitation, and occupational therapy. Contrary to previous understanding, exercise-based therapies have shown various benefits for patients with MS, and in addition to improving MS-related physical symptoms, have been shown to reduce the risk of developing cardiovascular disease and can improve cognitive function. Cognition rehabilitation therapy specifically focuses on behavioural tasks and is divided into two main forms: compensatory rehabilitation, which offers cognitive functioning benefits, and restorative rehabilitation, which offers memory benefits. Excitation therapies include cranial stimulation and other stimulation rehabilitation methods such as focal muscle vibration therapy and these non-invasive techniques may improve patient's physical ability. Additionally, more novel rehabilitation methods include robot-assisted gait therapy and telerehabilitation, both of which are expected to play progressively more prominent roles in the future of rehabilitation therapy. The structure of the care team has been found to impact patient outcomes, and both in- and out-patient care settings have been found to be beneficial, dependant on the patient's circumstances, with certain patients better suited to a particular setting. While a single point of care is recommended for patients, a multidisciplinary care team and regular reassessment is recommended to manage changing symptoms and ensure continuity of care. The importance of the critical components of rehabilitation have been identified, and these are of vital importance in achieving beneficial outcomes. These components include the patients' participation in the treatment, goal setting with a multidisciplinary care team, a guiding-light purpose for the patient, which focusses on recognizing their personal potential and obtaining improvements through a tailored plan. The final critical component of rehabilitation is the results measurement, which highlights the need for a quantifiable reduction in impairment and improvement in activity and participation. Overall, a lack of standardisation in outcome measurements makes comparison challenging. This is particularly important when comparing standard methods of care with more novel rehabilitation techniques. However, within the broad area of rehabilitation therapies, it is clear that patients with MS can benefit from rehabilitation practices; physically, mentally and socially.
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Affiliation(s)
- Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy.
| | - Gabriella Aceto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Lucia Ruggiero
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Emanuele Cassano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
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13
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Henning DA, Huisinga JM, Lynch S, Fritz NE. Cognition and proprioception in persons with multiple sclerosis and healthy controls: Nascent findings. Mult Scler Relat Disord 2022; 68:104372. [PMID: 36544319 DOI: 10.1016/j.msard.2022.104372] [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: 03/18/2022] [Revised: 09/24/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although proprioception and cognitive dysfunction are commonly associated with balance impairment and fall risk in persons with multiple sclerosis (MS), the relationship between cognitive functioning and a quantitative measure of proprioception has not been examined in MS. OBJECTIVE The primary goals of this study were to determine differences in vibratory sensation, a proxy measure of proprioception between persons with MS and healthy controls, examine relationships between cognition and vibration sensation, and determine the contribution of cognitive function and demographics to vibratory sensation between persons with MS and healthy controls. METHODS One hundred and twenty-two individuals with MS, aged 20-60, with Expanded Disability Status Scale (EDSS) scores ≤5.5 and 48 healthy controls completed reaction time testing, the Stroop test and lower extremity vibratory sensation. RESULTS Persons with MS performed significantly worse than controls on measures of vibratory sensation (p = 0.001), two-choice reaction time (p = 0.018), and Stroop Incongruent (p < 0.001) Relative Incongruent Score (RIS) (p = 0.047). In MS, average vibration was significantly related to age (p = 0.002), sex (p = 0.038), disease severity (EDSS; p < 0.001), years since diagnosis (p = 0.016), and Stroop Word (p = 0.041). A model with demographics; including age and disease severity, two-choice reaction time, and RIS explained 33.2% of the variance vibratory sensation in persons with MS. CONCLUSIONS These results provide early evidence for the relation between cognitive functioning and proprioception in persons with MS and add to prior work linking cognitive functioning, postural control and falls in persons with MS. This work provides a basis for future studies combining quantitative measures of proprioception and cognitive and postural control assessment to improve fall prediction.
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Affiliation(s)
- David A Henning
- Department of Health Care Sciences, Wayne State University, 259 Mack Avenue, #2324, Detroit, MI 48201, USA
| | - Jessie M Huisinga
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, KU Medical Center 3901 Rainbow Blvd / MS2002, Kansas City, KS 66160, USA
| | - Sharon Lynch
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Nora E Fritz
- Department of Health Care Sciences, Wayne State University, 259 Mack Avenue, #2324, Detroit, MI 48201, USA; Department of Neurology, Detroit Medical Center, University Health Center, Wayne State University, 8th floor 4201 St. Antoine, Detroit, MI 48201, USA.
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14
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Van Laethem D, Van de Steen F, Kos D, Naeyaert M, Van Schuerbeek P, D’Haeseleer M, D’Hooghe MB, Van Schependom J, Nagels G. Cognitive-motor telerehabilitation in multiple sclerosis (CoMoTeMS): study protocol for a randomised controlled trial. Trials 2022; 23:778. [PMID: 36104820 PMCID: PMC9473474 DOI: 10.1186/s13063-022-06697-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background The management of cognitive impairment is an important goal in the treatment of multiple sclerosis (MS). While cognitive rehabilitation has been proven to be effective in improving cognitive performance in MS, research in the elderly indicates a higher effectiveness of combined cognitive-motor rehabilitation. Here, we present the protocol of a randomised controlled clinical trial to assess whether a combined cognitive-motor telerehabilitation programme is more effective in improving working memory than only cognitive or motor training. Methods/design The CoMoTeMS-trial is a two-centre, randomised, controlled and blinded clinical trial. A total of 90 patients with MS will receive 12 weeks of either a combined cognitive-motor telerehabilitation programme or only cognitive or motor training. The primary outcome is a change in the digit span backwards. Secondary outcomes are other cognitive changes (Brief International Cognitive Assessment for Multiple Sclerosis and Backward Corsi), Expanded Disability Status Scale (EDSS), 6-Min Walk Test, 25-Foot Walk Test, 9-Hole Peg Test, anxiety and depression, fatigue, quality of life, cognitive and physical activity level, electroencephalography and magnetic resonance imaging of the brain. Discussion We hypothesise that the improvement in digit span backwards after 12 weeks of treatment will be significantly higher in the group treated with the combined cognitive-motor telerehabilitation programme, compared to the groups receiving only cognitive and only motor training. Trial registration ClinicalTrials.gov NCT05355389. Registered on 2 May 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06697-9.
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15
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Dreyer-Alster S, Menascu S, Aloni R, Givon U, Dolev M, Achiron A, Kalron A. Motoric cognitive risk syndrome in people with multiple sclerosis: prevalence and correlations with disease-related factors. Ther Adv Neurol Disord 2022; 15:17562864221109744. [PMID: 35813608 PMCID: PMC9260572 DOI: 10.1177/17562864221109744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background: The motoric cognitive risk (MCR) syndrome, defined as the coexistence of slow
gait and subjective cognitive complaints, has as yet not been researched in
people with multiple sclerosis (pwMS). Objective: To examine the prevalence of the MCR syndrome in pwMS and its association
with disability, disease duration, perceived fatigue, and fear of
falling. Methods: The study comprised 618 pwMS [43.7 (SD = 12.6) years, 61.7% females]. Gait
speed was measured by the GAITRite™ electronic walkway (CIR Systems, Inc.
Haverton, PA, USA). Cognitive status was defined according to the global
cognitive score computed by the NeuroTrax™ cognitive battery (NeuroTrax
Corporation, Medina, NY, USA). The sample was divided into four main groups:
‘normal’, ‘cognitively impaired’, ‘gait impaired’ or ‘MCR’. Perceived
fatigue was assessed by the Modified Fatigue Impact Scale; fear of falling
by the Falls Efficacy Scale International. Results: Sixty-three (10.2%) patients were diagnosed with MCR. The percentage of
subjects categorized as MCR was 26.0% in severely disabled pwMS compared
with 10.9%, 6.0%, and 4.6% in moderately, mildly and very mildly disabled
pwMS, respectively. Subjects in the MCR group presented with elevated
fatigue compared with patients classified as normal [49.7 (SD = 23.3) vs
26.5 (SD = 19.2), p < 0.001]. Fear of falling was
significantly higher in the MCR and gait impairment groups compared with the
cognitively impaired and normal groups. Conclusions: The current study corroborates the presence of MCR in pwMS. Nevertheless,
future longitudinal research is warranted to better understand its
application.
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Affiliation(s)
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Aloni
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Uri Givon
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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16
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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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17
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Kraut R, Holtzer R. Recurrent but not single report of fear of falling predicts cognitive decline in community-residing older adults. Aging Ment Health 2022; 26:100-106. [PMID: 33938782 DOI: 10.1080/13607863.2021.1916878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Literature regarding the association of fear of falling (FOF), a common concern in aging, and cognition is scarce. Moreover, whether frequency of FOF endorsement influences age-related cognitive decline has not been reported. Here we determined whether FOF status (no FOF, single-report FOF, recurrent FOF), predicted decline in global cognitive function (GCF), memory, and attention/executive functions. METHODS Participants were community-residing older adults (n = 421; mean age = 76.29 ± 6.48; %female = 56.06). FOF was assessed bimonthly through yes/no responses to "do you have a fear of falling?" during the first year of the study. Recurrent status required two or more FOF endorsements. GCF was assessed using Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); composite scores were used to assess memory as well as attention/executive functions. Cognitive measures were administered annually for up to six years. RESULTS Stratification of the cohort by FOF status showed that 81 participants reported recurrent FOF, 60 participants endorsed FOF once and 280 participants reported no FOF. Linear mixed effects models revealed that compared to no FOF, recurrent FOF was associated with worse declines in GCF (estimate=-0.03, p=.006), memory (estimate=-0.04, p=.012) and attention/executive functions (estimate=-0.04, p=.006). Comparisons between single-report FOF and no FOF, however, were not significant. CONCLUSIONS These findings demonstrate that recurrent but not single-report FOF is a risk factor for cognitive decline in community-residing older adults.
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Affiliation(s)
- Rebecca Kraut
- Ferkauf Graduate School of Psychology, Clinical Psychology Doctorate Program, Yeshiva University, New York, New York, USA
| | - Roee Holtzer
- Ferkauf Graduate School of Psychology, Clinical Psychology Doctorate Program, Yeshiva University, New York, New York, USA.,Neurology, Albert Einstein College of Medicine, New York, New York, USA
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18
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Eskut N, Koc AM, Köskderelioglu A, Unsal Bilgin YO, Tekindal MA. Is there a relationship between fall status, cognition and cerebellar lobule volume in patients with multiple sclerosis? APPLIED NEUROPSYCHOLOGY-ADULT 2021:1-11. [PMID: 34410894 DOI: 10.1080/23279095.2021.1962881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this prospective case control study, relationship of detailed cerebellar volumetric data and cognition in patients with multiple sclerosis considering falling status using 3 D MRI and network analysis were evaluated. Participants consist of 106 adults with relapsing-remitting multiple sclerosis. Scores of Montreal cognitive assessment test, symbol digit modality Test, nine-hole peg test, berg balance scale test, timed up and go test, timed 25-foot walk test were worse in faller group than non faller group (p < 0.05 for all tests). There was no significant difference in terms of cerebellar lobule volumes between groups. But using artificial intelligence (AI) based network analysis, we brought a new perspective to interpreting the relationship between the cerebellum, cognition, gait, and balance. Overall, data from the study suggest a possible relationship between cerebellar volume changes and cognitive dysfunction through connectivity analysis in patients with multiple sclerosis. Further studies are needed to examine this issue by using connectivity analysis.
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Affiliation(s)
- Neslihan Eskut
- Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Ali Murat Koc
- Radiology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Asli Köskderelioglu
- Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Yaprak Ozum Unsal Bilgin
- Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
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19
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Cohen JN, Seng E, Foley FW. Cognitive and motor slowing mediate the relationship between depression and falls in multiple sclerosis patients. Mult Scler Relat Disord 2021; 50:102808. [PMID: 33596493 DOI: 10.1016/j.msard.2021.102808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/08/2021] [Accepted: 01/31/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Given the limited research concerning the relationship between depression and falls in multiple sclerosis (MS), this study aimed to examine the direct and indirect association between fall history and depressive symptoms. METHODS One hundred and forty seven MS patients had completed at least one neuropsychological assessment that included detailed information regarding fall history, as well as measures of depression, motor function, and cognitive processing speed. RESULTS Fall history was associated with higher depressive symptoms and poorer overall motor function. Higher self-reported depressive symptoms were associated with higher odds of falls in the last year (OR = 1.64, 95% CI 1.16, 2.31) in an age adjusted model. Cognitive and motor slowing serially mediated the relationship between depressive symptoms and fall history (estimate = 0.060, 95% CI = 0.01, 0.15). CONCLUSIONS With the extensive research on the cognitive and motor correlates of falls in MS, our findings suggest that depressive symptoms are also associated with falls in people with MS. Moreover, this study provides preliminary support for a pathway by which depressive symptoms are related to falls in part through their relationships with cognitive and motor slowing.
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Affiliation(s)
- Jenna N Cohen
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10461, United States
| | - Elizabeth Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10461, United States; The Saul R Korey Department of Neurology, Albert Einstein College of Medicine, 1225 Morris Park Avenue, Van Etten Building, Bronx, NY 10461, United States
| | - Frederick W Foley
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10461, United States; Holy Name Medical Center Multiple Sclerosis Center, 718 Teaneck Road, Teaneck, NJ 07666, United States.
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20
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Hentzen C, Villaumé A, Turmel N, Chesnel C, Le Breton F, Haddad R, Amarenco G. Are falls in people with multiple sclerosis related to the severity of urinary disorders? Ann Phys Rehabil Med 2020; 64:101452. [PMID: 33186783 DOI: 10.1016/j.rehab.2020.10.006] [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: 04/08/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTSs), especially overactive bladder, are frequent in people with multiple sclerosis (PwMS). Urinary urgency and urge urinary incontinence could lead to precipitation and thus could increase the risk of falling in these individuals. OBJECTIVE We aimed to assess the association between severity of LUTSs and risk of falling in PwMS. METHODS PwMS with LUTSs were recruited in a neuro-urology department. Participants were asked about the number of falls in the past 3 months and their circumstances. Severity of LUTSs was assessed by the Urinary Symptoms Profile (USP) score, and individuals were classified as with or without urinary incontinence. RESULTS This cross-sectional study included 154 patients (69% women); the mean (SD) age was 50.1 (11.5) years and median EDSS was 5 (interquartile range 3-6). Overall, 20 (13%) patients reported one fall during the past 3 months, and 43 (28%) reported at least 2 falls. Only 9 (6%) patients reported a fall on the way to the toilet, 6 during a urinary urgency. No link was found between falls and urinary incontinence (P=0.71), type or severity of urinary symptoms (overactivity, voiding dysfunction or stress incontinence, P>0.05). Falls on the way to the bathroom was associated with high USP score related to overactive bladder (P=0.03) and severe nocturia (>2 nocturnal micturitions) (P<0.01). Falling at night was also associated with severe nocturia (P<0.001). CONCLUSIONS The severity of LUTSs and presence of urinary incontinence do not appear related to the risk of falling in PwMS and urinary disorders but rather to the specific risk of falling on the way to the bathroom. Severe nocturia increases the risk of falling at night. Further studies are needed to assess the impact of LUTS treatment on the risk of falling. ClinicalTrials.gov (NCT04338646).
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Affiliation(s)
- Claire Hentzen
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne Université, AP-HP, 75020 Paris, France.
| | - Anaïs Villaumé
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne Université, AP-HP, 75020 Paris, France
| | - Nicolas Turmel
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne Université, AP-HP, 75020 Paris, France
| | - Camille Chesnel
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne Université, AP-HP, 75020 Paris, France
| | - Frédérique Le Breton
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne Université, AP-HP, 75020 Paris, France
| | - Rebecca Haddad
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne Université, AP-HP, 75020 Paris, France
| | - Gérard Amarenco
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne Université, AP-HP, 75020 Paris, France
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Sá MJ, Soares Dos Reis R, Altintas A, Celius EG, Chien C, Comi G, Graus F, Hillert J, Hobart J, Khan G, Kissani N, Langdon D, Leite MI, Okuda DT, Palace J, Papais-Alvarenga RM, Mendes-Pinto I, Shi FD. State of the Art and Future Challenges in Multiple Sclerosis Research and Medical Management: An Insight into the 5th International Porto Congress of Multiple Sclerosis. Neurol Ther 2020; 9:281-300. [PMID: 32666470 PMCID: PMC7606370 DOI: 10.1007/s40120-020-00202-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Indexed: 02/07/2023] Open
Abstract
The 5th International Porto Congress of Multiple Sclerosis took place between the 14th and 16th of February 2019 in Porto, Portugal. Its intensive programme covered a wide-range of themes-including many of the hot topics, challenges, pitfalls and yet unmet needs in the field of multiple sclerosis (MS)-led by a number of well-acknowledged world experts. This meeting review summarizes the talks that took place during the congress, which focussed on issues in MS as diverse as the development and challenges of progressive MS, epidemiology, differential diagnosis, medical management, molecular research and imaging tools.
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Affiliation(s)
- María José Sá
- Department of Neurology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernáni Monteiro, Porto, Portugal.
- Faculty of Health Sciences, University Fernando Pessoa, Rua Carlos da Maia, Porto, Portugal.
| | - Ricardo Soares Dos Reis
- Department of Neurology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernáni Monteiro, Porto, Portugal.
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Ayse Altintas
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey
| | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claudia Chien
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Giancarlo Comi
- Department of Neurology, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesc Graus
- Department of Neurology, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Hospital Clínic, Barcelona, Spain
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jeremy Hobart
- Department of Neurology, University Hospitals Plymouth, Plymouth, UK
- Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Gulfaraz Khan
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Najib Kissani
- Neurology Department, Marrakech University Hospital Mohammed VI, Marrakech, Morocco
- Neuroscience Research Laboratory, Marrakesh Medical School, Cadi Ayyad University, Marrakech, Morocco
| | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Darin T Okuda
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | | | - Fu-Dong Shi
- Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
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Scholz M, Haase R, Trentzsch K, Weidemann ML, Ziemssen T. Fear of falling and falls in people with multiple sclerosis: A literature review. Mult Scler Relat Disord 2020; 47:102609. [PMID: 33189021 DOI: 10.1016/j.msard.2020.102609] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Fear of falling (FOF) is a widespread problem affecting about 60% of people with multiple sclerosis (pwMS). Inflammatory lesions in the brain that are caused by the disease result in gait deficits and increase the risk of fall. Falls induce fear of falling and trigger a vicious circle, which in turn increases the likelihood of falling. Objective of this review was to provide an overview of existing research on the effects of FOF and therapy options in multiple sclerosis. METHODS A systematic search at Web of Science and PubMed was conducted. The search included the terms (fear of falling) OR (concern about falling) OR (fall anxiety) AND (multiple sclerosis). RESULTS In included studies, FOF was measured by different instruments. The Falls Efficacy Scale-International (FES-I) was the most frequently used instrument for pwMS. Patients with a higher FOF score fell more frequently, had lower walking speed, shorter stride length, larger ellipse sway area and a more severe disability. At present, therapeutic offers exist mainly in the field of physiotherapy. For reducing FOF, assisted vibration (dz = 0.68), VR (dz =0.87) and bicycle training (dz = 1.23) were the most effective methods. CONCLUSION It is advisable to develop therapies that incorporate both physical and psychological aspects in neurorehabilitation, like in a cognitive behavioral therapy. Moreover, FOF monitoring should be integrated into the clinical routine.
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Affiliation(s)
- Maria Scholz
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Rocco Haase
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Katrin Trentzsch
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Marie Luise Weidemann
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Tjalf Ziemssen
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
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23
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Coote S, Comber L, Quinn G, Santoyo-Medina C, Kalron A, Gunn H. Falls in People with Multiple Sclerosis: Risk Identification, Intervention, and Future Directions. Int J MS Care 2020; 22:247-255. [PMID: 33424479 DOI: 10.7224/1537-2073.2020-014] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Falls are highly prevalent in people with multiple sclerosis (MS) and result in a range of negative consequences, such as injury, activity curtailment, reduced quality of life, and increased need for care and time off work. This narrative review aims to summarize key literature and to discuss future work needed in the area of fall prevention for people with MS. The incidence of falls in people with MS is estimated to be more than 50%, similar to that in adults older than 80 years. The consequences of falls are considerable because rate of injury is high, and fear of falling and low self-efficacy are significant problems that lead to activity curtailment. A wide range of physiological, personal, and environmental factors have been highlighted as potential risk factors and predictors of falls. Falls are individual and multifactorial, and, hence, approaches to interventions will likely need to adopt a multifactorial approach. However, the literature to date has largely focused on exercise-based interventions, with newer, more comprehensive interventions that use both education and exercise showing promising results. Several gaps in knowledge of falls in MS remain, in particular the lack of standardized definitions and outcome measures, to enable data pooling and comparison. Moving forward, the involvement of people with MS in the design and evaluation of programs is essential, as are approaches to intervention development that consider implementation from the outset.
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24
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Choobsaz H, ShahAli S, Salehi R, Noorizadeh Dehkordi S, Shanbehzadeh S. Discriminative ability of fall efficacy scale international in Iranian people with multiple sclerosis. Mult Scler Relat Disord 2020; 42:102083. [DOI: 10.1016/j.msard.2020.102083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/16/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
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Mañago MM, Callesen J, Dalgas U, Kittelson J, Schenkman M. Does disability level impact the relationship of muscle strength to walking performance in people with multiple sclerosis? a cross-sectional analysis. Mult Scler Relat Disord 2020; 42:102052. [PMID: 32240963 DOI: 10.1016/j.msard.2020.102052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Strength training can improve muscle weakness in people with multiple sclerosis (MS), but does not consistently improve walking. Disability level may impact the relationship of muscle weakness and walking performance in people with MS, but few studies have investigated the impact of disability on the relationship of strength and walking. The purpose of this study was to compare the relationships of strength in lower body and trunk muscles to walking performance between mild and moderate disability groups in people with MS. METHODS Data from 36 participants with MS who had mild disability (Expanded Disability Status Scale - EDSS 0 to 3.5) and 36 participants who had moderate disability (EDSS 4.0 to 5.5) were analyzed. Hand-held dynamometry measured strength in eight muscle groups from the ankle, knee, hip, and trunk. Timed 25-Foot Walk (T25FW) and 6-Minute Walk Test (6MWT) measured walking speed and endurance, respectively. Pearson correlations and beta coefficients (ß) were reported for each bivariate relationship of muscle strength to T25FW and 6MWT from both mild and moderate disability groups. Linear regression was then used to compare differences in beta coefficients (Δß) between disability groups for the relationship of each muscle variable to T25FW and 6MWT. A positive Δß indicated a stronger relationship of strength to walking performance in the mild disability group, while a negative Δß favored the moderate disability group. RESULTS Overall, there were stronger Pearson correlations between muscle strength variables to T25FW and 6MWT in the mild (r = 0.57 to 0.77) compared to moderate disability group (r = 0.10 to 0.54). The mild disability group had significantly greater beta coefficients for T25FW with ankle dorsiflexion (Δß = 0.67, 95%CI: 0.27-1.07), knee extension (Δß = 0.68, 95%CI: 0.28-1.08), and hip abduction (Δß = 0.77, 95%CI: 0.01-1.52); and for 6MWT with knee extension (Δß = 0.47, 95%CI: 0.06 to 0.88). DISCUSSION AND CONCLUSION For people with MS, muscle strength in the lower extremity and trunk may be a more important contributor to T25FW in mild versus moderate disability, but not for 6MWT. While more studies are needed, these results may help to inform rehabilitation intervention when prioritizing strength training to improve walking.
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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, CO.
| | - Jacob Callesen
- VIA University College, Faculty of Health Science, Department of Rehabilitation and Health Promotion Research; Aarhus University, Department of Public Health, Section of Sport Science
| | - Ulrik Dalgas
- Aarhus University, Department of Public Health, Section of Sport Science
| | - John Kittelson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Margaret Schenkman
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora, CO
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26
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Prosperini L, Castelli L, De Giglio L, Bonanno V, Gasperini C, Pozzilli C. Dalfampridine to Improve Balance in Multiple Sclerosis: Substudy from a Randomized Placebo-Controlled Trial. Neurotherapeutics 2020; 17:704-709. [PMID: 31820274 PMCID: PMC7283428 DOI: 10.1007/s13311-019-00813-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
This was a substudy of a randomized, double-blind, placebo-controlled trial originally designed to explore the effect of dalfampridine on information processing speed (2013-002558-64 EU Clinical Trials Register) in patients with multiple sclerosis (MS). A total of 120 patients were originally randomized in a 2:1 ratio to receive dalfampridine 10 mg or placebo twice daily for 12 weeks. Here, we sought to explore the effect of dalfampridine on static balance in single-task and dual-task conditions in a subgroup of 41 patients. They underwent static posturography in quiet standing (single-task) and while performing the Stroop test (dual-task) at randomization (baseline), after 12 weeks and after a 4-week wash-out period. Baseline characteristics of active group (n = 27) did not differ from those of placebo group (n = 14). Dalfampridine treatment was associated with better balance control than placebo in both single-task (F = 4.80, p = 0.034) and dual-task (F = 6.42, p = 0.015) conditions, with small-to-moderate effect sizes (Cohen's f2 = 0.122-0.162). The beneficial effect of dalfampridine was not retained 4 weeks after its discontinuation. The rate of accidental falls per month did not differ between the two groups (p = 0.12). Our preliminary findings suggest that dalfampridine can be considered a potential option to treat balance impairment due to MS. Larger sample sizes are needed to verify if the beneficial effect of dalfampridine on balance can be translated into a reduced risk of accidental falls.
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Affiliation(s)
- Luca Prosperini
- Dept. of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy.
| | - Letizia Castelli
- Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Fondazione Don Carlo Gnocchi, -, Piazzale Morandi 6, 20121, Milano, Italy
| | - Laura De Giglio
- Neurology Unit, S. Filippo Neri Hospital, Via G. Martinotti 20, 00135, Rome, Italy
- S. Andrea Hospital, Sapienza University, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Valeria Bonanno
- S. Andrea Hospital, Sapienza University, Via di Grottarossa 1035, 00189, Rome, Italy
- Dept. of Human Neuroscience, Sapienza University, Viale dell'Università 30, 00185, Rome, Italy
| | - Claudio Gasperini
- Dept. of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| | - Carlo Pozzilli
- S. Andrea Hospital, Sapienza University, Via di Grottarossa 1035, 00189, Rome, Italy
- Dept. of Human Neuroscience, Sapienza University, Viale dell'Università 30, 00185, Rome, Italy
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27
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Matsuda PN, Eagen T, Hreha KP, Finlayson ML, Molton IR. Relationship Between Fear of Falling and Physical Activity in People Aging With a Disability. PM R 2019; 12:454-461. [DOI: 10.1002/pmrj.12289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/04/2019] [Indexed: 12/28/2022]
Affiliation(s)
| | - Thomas Eagen
- Department of Rehabilitation MedicineUniversity of Washington Seattle WA
| | - Kimberly P. Hreha
- Division of Rehabilitation SciencesUniversity of Texas Medical Branch at Galveston Galveston TX
| | | | - Ivan R. Molton
- Department of Rehabilitation MedicineUniversity of Washington Seattle WA
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28
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Eagen TJ, Teshale SM, Herrera-Venson AP, Ordway A, Caldwell J. Participation in Two Evidence-Based Falls Prevention Programs by Adults Aging With a Long-Term Disability: Case-Control Study of Reach and Effectiveness. J Aging Health 2018; 31:39S-67S. [PMID: 30442042 DOI: 10.1177/0898264318808918] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Adults aging with a long-term disability (LTD) are at an increased risk for falls. The Older Americans Act Title III-D and Prevention and Public Health Fund (PPHF) support several organizations to deliver falls prevention evidence-based programs designed to reduce risk factors; however, little is understood about the reach and effectiveness of these fall prevention programs for those with LTD compared to those without LTD. This study compared the reach and effectiveness of two evidence-based falls prevention programs between older adults with and without LTD. Method: Using a matched case-control design, 105 LTD older adults enrolled in A Matter of Balance (AMOB) or Stepping On were matched to 315 non-LTD older adults on age, sex, race, and education. Results: On average, LTD older adults attended a higher number of class sessions and were significantly more likely to complete the program compared with the matched-sample of non-LTD older adults. LTD older adults were equally likely as non-LTD older adults to report significant reductions in self-reported fear of falling, falls-related activity restriction, and improvement in falls self-efficacy following completion of the programs. Discussion: These findings provide preliminary evidence for the effectiveness of these evidence-based falls prevention programs for LTD older adults; however, more research is needed to extend these findings.
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Affiliation(s)
- Thomas J Eagen
- University of Washington, Seattle, USA.,National Council on Aging, Arlington, VA, USA
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29
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Kalron A, Aloni R, Allali G. The relationship between depression, anxiety and cognition and its paradoxical impact on falls in multiple sclerosis patients. Mult Scler Relat Disord 2018; 25:167-172. [DOI: 10.1016/j.msard.2018.07.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/18/2018] [Accepted: 07/16/2018] [Indexed: 11/26/2022]
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30
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Barbarulo AM, Lus G, Signoriello E, Trojano L, Grossi D, Esposito M, Costabile T, Lanzillo R, Saccà F, Morra VB, Conchiglia G. Integrated Cognitive and Neuromotor Rehabilitation in Multiple Sclerosis: A Pragmatic Study. Front Behav Neurosci 2018; 12:196. [PMID: 30271331 PMCID: PMC6146227 DOI: 10.3389/fnbeh.2018.00196] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Few studies examined the effects of combined motor and cognitive rehabilitation in patients with multiple sclerosis (MS). The present prospective, multicenter, observational study aimed to determine the efficacy of an integrated cognitive and neuromotor rehabilitation program versus a traditional neuromotor training on walking, balance, cognition and emotional functioning in MS patients. Methods: Sixty three MS patients were selected and assigned either to the Integrated Treatment Group (ITG; n = 32), receiving neuropsychological treatment (performed by ERICA software and paper–pencil tasks) complemented by conventional neuromotor rehabilitation, or to the Motor Treatment Group (n = 31) receiving neuromotor rehabilitation only. The intervention included two 60-min sessions per week for 24 weeks. At baseline and at end of the training all patients underwent a wide-range neuropsychological, psychological/emotional, and motor assessment. Results: At baseline the two groups did not differ for demographic, neuropsychological, psychological/emotional, and motor features significantly. After rehabilitation, only ITG group significantly (p-corrected for False Discovery Rate) improved on test tapping spatial memory, attention and cognitive flexibility, as well as on scales assessing depression and motor performance (balance and gait). A regression analysis showed that neuropsychological and motor improvement was not related to improvements in fatigue and depression. Conclusion: The present study demonstrated positive effects in emotional, motor, and cognitive aspects in MS patients who received an integrated cognitive and neuromotor training. Overall, results are supportive of interventions combining motor and cognitive training for MS.
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Affiliation(s)
- Anna M Barbarulo
- Multiple Sclerosis Center, II Division of Neurology, Department of Surgical Medical Science, Neurological, Metabolic and Aging, University of Campania Luigi Vanvitelli, Naples, Italy.,Interuniversity Center for Research in Neurosciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, II Division of Neurology, Department of Surgical Medical Science, Neurological, Metabolic and Aging, University of Campania Luigi Vanvitelli, Naples, Italy.,Interuniversity Center for Research in Neurosciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Elisabetta Signoriello
- Multiple Sclerosis Center, II Division of Neurology, Department of Surgical Medical Science, Neurological, Metabolic and Aging, University of Campania Luigi Vanvitelli, Naples, Italy.,Interuniversity Center for Research in Neurosciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luigi Trojano
- Interuniversity Center for Research in Neurosciences, University of Campania Luigi Vanvitelli, Naples, Italy.,Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Dario Grossi
- Interuniversity Center for Research in Neurosciences, University of Campania Luigi Vanvitelli, Naples, Italy.,Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Mariateresa Esposito
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Teresa Costabile
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco Saccà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
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31
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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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32
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Mateen BA, Bussas M, Doogan C, Waller D, Saverino A, Király FJ, Playford ED. The Trail Making test: a study of its ability to predict falls in the acute neurological in-patient population. Clin Rehabil 2018; 32:1396-1405. [DOI: 10.1177/0269215518771127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To determine whether tests of cognitive function and patient-reported outcome measures of motor function can be used to create a machine learning-based predictive tool for falls. Design: Prospective cohort study. Setting: Tertiary neurological and neurosurgical center. Subjects: In all, 337 in-patients receiving neurosurgical, neurological, or neurorehabilitation-based care. Main Measures: Binary (Y/N) for falling during the in-patient episode, the Trail Making Test (a measure of attention and executive function) and the Walk-12 (a patient-reported measure of physical function). Results: The principal outcome was a fall during the in-patient stay ( n = 54). The Trail test was identified as the best predictor of falls. Moreover, addition of other variables, did not improve the prediction (Wilcoxon signed-rank P < 0.001). Classical linear statistical modeling methods were then compared with more recent machine learning based strategies, for example, random forests, neural networks, support vector machines. The random forest was the best modeling strategy when utilizing just the Trail Making Test data (Wilcoxon signed-rank P < 0.001) with 68% (± 7.7) sensitivity, and 90% (± 2.3) specificity. Conclusion: This study identifies a simple yet powerful machine learning (Random Forest) based predictive model for an in-patient neurological population, utilizing a single neuropsychological test of cognitive function, the Trail Making test.
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Affiliation(s)
- Bilal Akhter Mateen
- Medical School, University College London, London, UK
- Therapy and Rehabilitation Services, National Hospital for Neurology and Neurosurgery, London, UK
- The Alan Turing Institute, London, UK
| | - Matthias Bussas
- Department of Statistical Science, University College London, London, UK
| | - Catherine Doogan
- Therapy and Rehabilitation Services, National Hospital for Neurology and Neurosurgery, London, UK
| | - Denise Waller
- Neurorehabilitation Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Alessia Saverino
- Wolfson Neuro Rehabilitation Centre, St George’s Hospital, London, UK
| | - Franz J Király
- The Alan Turing Institute, London, UK
- Department of Statistical Science, University College London, London, UK
| | - E Diane Playford
- Therapy and Rehabilitation Services, National Hospital for Neurology and Neurosurgery, London, UK
- Institute of Neurology, University College London, London, UK
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33
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Kalron A, Allali G, Achiron A. Cerebellum and cognition in multiple sclerosis: the fall status matters. J Neurol 2018; 265:809-816. [PMID: 29396679 DOI: 10.1007/s00415-018-8774-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 11/29/2022]
Abstract
Cerebellar volume has been linked with cognitive performances in MS; however, the association in terms of fall status has never been compared. Therefore, the objective of the current study was to compare cognitive performance with cerebellar volume between MS fallers and non-fallers. The cross-sectional study included 140 PwMS (96 women). MRI volumetric analysis was based on the FreeSurfer image analysis suite. Volumes of the cerebellar gray and white matter were identified as the region of interest. Cognitive function included scores obtained from a computerized cognitive battery of tests. The sample was divided into fallers and non-fallers. MS fallers demonstrated a lower global cognitive performance and reduced gray and white matter cerebellar volumes compared to non-fallers. A significant association was found between total gray and white matter cerebellar volume and visual spatial subdomain (P value = 0.044 and 0.032, respectively) in the non-fallers group. The association remained significant after controlling for the total cranial volume and neurological disability (P value = 0.026 and 0.047, respectively). A relationship was found between the visual spatial score and the left gray matter cerebellum volume; R2 = 0.44, P value = 0.021. We believe that a unique relationship exists between the cerebellum structure and cognitive processing according to fall history in PwMS and should be considered when investigating the association between brain functioning and cognitive performances in MS.
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Affiliation(s)
- Alon Kalron
- Department of Physical Therapy, Sackler Faculty of Medicine, School of Health Professions, Tel-Aviv University, Tel Aviv, Israel. .,Sagol School of Neurosciences, Tel-Aviv University, Tel Aviv, Israel.
| | - Gilles Allali
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.,Division of Cognitive and Motor Aging, Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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The relationship between gait variability and cognitive functions differs between fallers and non-fallers in MS. J Neural Transm (Vienna) 2018; 125:945-952. [PMID: 29350300 DOI: 10.1007/s00702-018-1843-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
The objective of the study was to determine if cognitive function is associated with step time variability in people with multiple sclerosis (PwMS). The study included 355 PwMS (218 women), average age 41.1 (SD = 13.5), disease duration 5.9 (SD = 7.3) years, and a median expanded disability status scale score of 2.5. We separately analyzed the sample group of fallers and non-fallers based on their fall history. Gait variability was measured by an electronic walkway and all participants completed a computerized cognitive test battery designed to evaluate multiple cognitive domains. Fallers (43.7%) demonstrated elevated step time variability (%CV), 5.0 (SD = 3.4) vs. 3.5 (SD = 1.6), P < 0.001 compared to the non-faller subjects. According to the regression analysis in the non-fallers' group, step time variability was found significantly associated with the global cognitive score (P = 0.001), executive function subcategory (P = 0.038), and motor skills subcategory (P < 0.001). No relationship between step time variability and any cognitive domain was demonstrated in the faller group. This study illustrated that the association between gait variability and cognition occurs only in PwMS without a fall history. From a clinical standpoint, these findings might help medical professionals to create improved assessment tests and rehabilitation strategies in the MS population.
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Gudesblatt M, Wissemann K, Zarif M, Bumstead B, Fafard L, Wilken J, Blitz K, Buhse M, Santra S, Hotermans C, Lee L. Improvement in Cognitive Function as Measured by NeuroTrax in Patients with Relapsing Multiple Sclerosis Treated with Natalizumab: A 2-Year Retrospective Analysis. CNS Drugs 2018; 32:1173-1181. [PMID: 30143944 PMCID: PMC6280854 DOI: 10.1007/s40263-018-0553-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cognitive impairment affects many patients with multiple sclerosis (MS). NeuroTrax, a computerized cognitive screen that can be administered during routine clinical care, provides a consistent, validated, objective cognitive profile measure with a global cognitive score (GCS) and seven individual domain scores. Natalizumab is an efficacious therapy for relapsing MS, demonstrating reductions in disability worsening and MS disease activity measured by magnetic resonance imaging. OBJECTIVE The aim of this study was to assess cognitive function as measured by NeuroTrax in MS patients treated with natalizumab for ≥ 2 years. METHODS This retrospective observational study included adult MS patients in the United States who received 300 mg intravenous natalizumab every 4 weeks for ≥ 2 years. NeuroTrax data were evaluated at baseline and yearly thereafter. Changes in GCS and the seven individual cognitive domain scores from baseline to after 24 infusions of natalizumab were analyzed. RESULTS In the study population at baseline (N = 52), 22 patients (42.3%) had disease duration of 0-5 years; 12 patients (23.1%) were treatment naive. GCS score improved significantly from baseline [mean 95.5, standard deviation (SD) 12.9] to year 2 (mean 98.9, SD 13.2; change from baseline 3.4; p = 0.003). After 2 years on natalizumab, 17 patients (32.7%) demonstrated clinically significant improvement (increase from baseline > 1 SD) in GCS. Results were similar regardless of whether patients had previously received MS therapy. CONCLUSIONS Patients treated with natalizumab demonstrated significant improvement in cognitive function, measured by NeuroTrax GCS, over 2 years of treatment.
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Affiliation(s)
| | | | - Myassar Zarif
- South Shore Neurologic Associates, Patchogue, NY USA
| | | | - Lori Fafard
- South Shore Neurologic Associates, Patchogue, NY USA
| | - Jeffrey Wilken
- Washington Neuropsychology Research Group LLC, Fairfax, VA USA
| | - Karen Blitz
- South Shore Neurologic Associates, Patchogue, NY USA
| | | | | | | | - Lily Lee
- Biogen, 225 Binney Street, Cambridge, MA, 02142, USA.
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Quinn G, Comber L, Galvin R, Coote S. The ability of clinical balance measures to identify falls risk in multiple sclerosis: a systematic review and meta-analysis. Clin Rehabil 2017; 32:571-582. [DOI: 10.1177/0269215517748714] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine the ability of clinical measures of balance to distinguish fallers from non-fallers and to determine their predictive validity in identifying those at risk of falls. Data sources: AMED, CINAHL, Medline, Scopus, PubMed Central and Google Scholar. First search: July 2015. Final search: October 2017. Review methods: Inclusion criteria were studies of adults with a definite multiple sclerosis diagnosis, a clinical balance assessment and method of falls recording. Data were extracted independently by two reviewers. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 scale and the modified Newcastle–Ottawa Quality Assessment Scale. Statistical analysis was conducted for the cross-sectional studies using Review Manager 5. The mean difference with 95% confidence interval in balance outcomes between fallers and non-fallers was used as the mode of analysis. Results: We included 33 studies (19 cross-sectional, 5 randomised controlled trials, 9 prospective) with a total of 3901 participants, of which 1917 (49%) were classified as fallers. The balance measures most commonly reported were the Berg Balance Scale, Timed Up and Go and Falls Efficacy Scale International. Meta-analysis demonstrated fallers perform significantly worse than non-fallers on all measures analysed except the Timed Up and Go Cognitive ( p < 0.05), but discriminative ability of the measures is commonly not reported. Of those reported, the Activities-specific Balance Confidence Scale had the highest area under the receiver operating characteristic curve value (0.92), but without reporting corresponding measures of clinical utility. Conclusion: Clinical measures of balance differ significantly between fallers and non-fallers but have poor predictive ability for falls risk in people with multiple sclerosis.
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Affiliation(s)
- Gillian Quinn
- Department of Clinical Therapies, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Laura Comber
- Department of Clinical Therapies, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- Department of Clinical Therapies, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Susan Coote
- Department of Clinical Therapies, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
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Mofateh R, Salehi R, Negahban H, Mehravar M, Tajali S. Effects of cognitive versus motor dual-task on spatiotemporal gait parameters in healthy controls and multiple sclerosis patients with and without fall history. Mult Scler Relat Disord 2017; 18:8-14. [PMID: 29141826 DOI: 10.1016/j.msard.2017.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/25/2017] [Accepted: 09/03/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of the current study was to compare the effects of cognitive or motor tasks on gait performance between healthy controls and multiple sclerosis (MS) patients with and without fall history. METHODS The investigation included MS patients with fall history (n = 25) and without fall history (n = 25) and matched healthy controls (n = 25). Participants walked at their preferred speed on a motorized treadmill under three walking conditions in a randomized order: walking only, walking while performing a concurrent cognitive task (counting backward aloud by 3s), and walking while performing a concurrent motor task (carrying a tray with glasses). RESULTS The findings showed that in patients with MS, regardless of fall history, spatiotemporal gait parameters were different compared to healthy controls. In contrast to average gait parameters, variability in stride length and stride time could discriminate between MS fallers and non-fallers. Simultaneous performance of cognitive task and walking resulted in higher dual-task costs (DTC) in gait performance compared to the motor dual-task. However, the pattern of change was not different among the three groups. All participants responded to the cognitive task challenges by increasing stride length and decreasing cadence and stride length variability while maintaining cognitive task performance. CONCLUSIONS The findings may reflect successful adaptation of locomotor system to preserve cognitive task performance under cognitive dual-task condition. Future studies should examine more complex concurrent cognitive and motor tasks to better understand the dual-task-related gait changes and their contribution to falls in patients with MS.
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Affiliation(s)
- Razieh Mofateh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Reza Salehi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Shirin Tajali
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Does fear of falling predict gait variability in multiple sclerosis? J Neurol Sci 2017; 380:212-214. [DOI: 10.1016/j.jns.2017.07.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/30/2017] [Accepted: 07/24/2017] [Indexed: 11/21/2022]
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Tajali S, Shaterzadeh-Yazdi MJ, Negahban H, van Dieën JH, Mehravar M, Majdinasab N, Saki-Malehi A, Mofateh R. Predicting falls among patients with multiple sclerosis: Comparison of patient-reported outcomes and performance-based measures of lower extremity functions. Mult Scler Relat Disord 2017; 17:69-74. [PMID: 29055478 DOI: 10.1016/j.msard.2017.06.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 06/09/2017] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Accurate fall screening tools are needed to identify those multiple sclerosis (MS) patients at high risk of falling. The present study aimed at determining the validity of a series of performance-based measures (PBMs) of lower extremity functions and patient-reported outcomes (PROs) in predicting falls in a sample of MS patients (n = 84), who were ambulatory independent. METHODS Patients were assessed using the following PBMs: timed up and go (TUG), timed 25-foot walk (T25FW), cognitive T25FW, 2-min walk (2MW), and cognitive 2MW. Moreover, a series of valid and reliable PROs were filled in by participants including the activities-specific balance confidence (ABC), 12-item multiple sclerosis walking scale (MSWS-12), fall efficacy scale international (FES-I), and modified fatigue impact scale (MFIS). The dual task cost (DTC) of 2MW and T25FW tests were calculated as a percentage of change in parameters from single to dual task conditions. Participants were classified as none-fallers and fallers (⩾1) based on their prospective fall occurrence. RESULTS In the present study, 41(49%) participants recorded ≥ 1 fall and were classified as fallers. The results of logistic regression analysis revealed that each individual test, except DTC of 2MW and T25FW, significantly predicted future falls. However, considering the area under the curves (AUCs), PROs were more accurate compared to PBMs. In addition, the results of multiple logistic regression with the first two factors extracted from principal component analysis revealed that both factor 1 (PROs) and factor 2 (PBMs) significantly predicted falls with a greater odds ratio (OR) for factor 1 (factor 1: P = <0.0001, OR = 63.41 (6.72-597.90)) than factor 2 (P <0.05, OR = 5.03 (1.33-18.99)). CONCLUSIONS The results of this study can be used by clinicians to identify and monitor potential fallers in MS patients.
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Affiliation(s)
- Shirin Tajali
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Research Institute MOVE, VU University, Amsterdam, The Netherlands
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nastaran Majdinasab
- Musculoskeletal Rehabilitation Research Center, Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amal Saki-Malehi
- Department of Biostatistics and Epidemiology, Health faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Razie Mofateh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Oh E, Hong GRS, Lee S, Han S. Fear of falling and its predictors among community-living older adults in Korea. Aging Ment Health 2017; 21:369-378. [PMID: 26479777 DOI: 10.1080/13607863.2015.1099034] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To explore the prevalence and predicting factors of fear of falling (FOF) among community-living older adults in Korea. METHODS Secondary data analysis of the 2011 Korean National Elderly Living Conditions and Welfare Desire Survey was used. Logistic regression analysis was conducted to examine the predictors of FOF. RESULTS In total, 75.6% of older adults with normal cognition have FOF. Factors associated with an increased risk of FOF in older adults are previous experience with falling (OR = 3.734, 95% CI = 2.996-4.655), limitations in the performance of exercise involving lower extremities (OR = 2.428, 95% CI = 2.063-2.858), being female (OR = 2.335, 95% CI = 2.023-2.694), having more than three chronic diseases (OR = 1.994, 95% CI = 1.625-2.446), limitations in instrumental activities of daily living (IADLs) (OR = 1.745, 95% CI = 1.230-2.477), limitations in the performance of exercise involving upper extremities (OR = 1.646, 95% CI = 1.357-1.997), living without a spouse (OR = 1.626, 95% CI = 1.357-1.948), having poor self-rated health (OR = 1.571, 95% CI = 1.356-1.821), limitations in muscle strength (OR = 1.455, 95% CI = 1.150-1.841), age (≥75 years) (OR = 1.320, 95% CI = 1.150-1.516), lower levels of education (0-6 years) (OR = 1.231, 95% CI = 1.075-1.409), and life satisfaction (OR = 1.104, 95% CI = 1.065-1.114). CONCLUSION A multidimensional construct of general characteristics, physical, and psychosocial variables act as risk factors for FOF. Preventive intervention should be developed to decrease the FOF among Korean older adults.
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Affiliation(s)
- Eunmi Oh
- a College of Nursing , Hanyang University , Seoul , Korea
| | | | - Seonhye Lee
- b Department of Nursing , Gyeongnam National University of Science and Technology , Jinju , Korea
| | - Soojeong Han
- c School of Nursing , Columbia University , NY , USA
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Perrochon A, Holtzer R, Laidet M, Armand S, Assal F, Lalive PH, Allali G. Postural control is associated with cognition and fear of falling in patients with multiple sclerosis. J Neural Transm (Vienna) 2016; 124:495-500. [DOI: 10.1007/s00702-016-1668-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
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Newland P, Wagner JM, Salter A, Thomas FP, Skubic M, Rantz M. Exploring the feasibility and acceptability of sensor monitoring of gait and falls in the homes of persons with multiple sclerosis. Gait Posture 2016; 49:277-282. [PMID: 27474948 DOI: 10.1016/j.gaitpost.2016.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/23/2016] [Accepted: 07/05/2016] [Indexed: 02/02/2023]
Abstract
Gait parameters variability and falls are problems for persons with MS and have not been adequately captured in the home. Our goal was to explore the feasibility and acceptability of monitoring of gait and falls in the homes of persons with MS over a period of 30 days. To test the feasibility of measuring gait and falls for 30days in the home of persons with MS, spatiotemporal gait parameters stride length, stride time, and gait speed were compared. A 3D infrared depth imaging system has been developed to objectively measure gait and falls in the home environment. Participants also completed a 16-foot GaitRite electronic pathway walk to validate spatiotemporal parameters of gait (gait speed (cm/s), stride length (cm), and gait cycle time(s)) during the timed 25 foot walking test (T25FWT). We also documented barriers to feasibility of installing the in-home sensors for these participants. The results of the study suggest that the Kinect sensor may be used as an alternative device to measure gait for persons with MS, depending on the desired accuracy level. Ultimately, using in-home sensors to analyze gait parameters in real time is feasible and could lead to better analysis of gait in persons with MS.
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Affiliation(s)
- Pamela Newland
- Goldfarb School of Nursing at Barnes Jewish College, 4483 Duncan Avenue, Mailstop 90-36-697, St. Louis, MO 63110F, United States.
| | - Joanne M Wagner
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, St. Louis University, St. Louis, MO 63104, United States.
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO 63110, United States.
| | - Florian P Thomas
- Neuroscience Institute at Hackensack University Medical Center (HUMC), New Jersey, United States.
| | - Marjorie Skubic
- Electrical and Computer Engineering, University of Missouri, Columbia, MO 65211, United States.
| | - Marilyn Rantz
- Curators' Professor Emerita Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, United States.
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The relationship between static posturography measures and specific cognitive domains in individuals with multiple sclerosis. Int J Rehabil Res 2016; 39:249-54. [DOI: 10.1097/mrr.0000000000000177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Allali G, Laidet M, Armand S, Elsworth-Edelsten C, Assal F, Lalive PH. Stride time variability as a marker for higher level of gait control in multiple sclerosis: its association with fear of falling. J Neural Transm (Vienna) 2016; 123:595-9. [DOI: 10.1007/s00702-016-1551-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/09/2016] [Indexed: 10/21/2022]
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Sanai SA, Saini V, Benedict RHB, Zivadinov R, Teter BE, Ramanathan M, Weinstock-Guttman B. Aging and multiple sclerosis. Mult Scler 2016; 22:717-25. [DOI: 10.1177/1352458516634871] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/01/2015] [Indexed: 01/30/2023]
Abstract
The life expectancy and average age of persons with multiple sclerosis (MS) have increased significantly during the last two decades. The introduction of disease-modifying therapies and a better delineation and understanding of the superimposed comorbidities often diagnosed in MS patients are probably the most important factors accountable for the increase in aging MS population worldwide. Healthcare teams must therefore address the problems arising due to advancing age superimposed on this chronic neurologic disease. In this review, we focus on the physiology of aging, its effects on MS disease course, and the pathological and immunological changes associated with aging and disease progression. Additionally, we discuss the common comorbidities that occur in aging persons with MS that may arise either as a result of the aging process or from relentless chronic MS disease progression as well as the challenges on differentiating the two processes for a more appropriate therapeutic approach.
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Affiliation(s)
- Shaik Ahmed Sanai
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Vasu Saini
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA/New York State MS Consortium, University at Buffalo, The State University of New York, Buffalo, NY, USA/Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Ralph HB Benedict
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA/New York State MS Consortium, University at Buffalo, The State University of New York, Buffalo, NY, USA/Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA/New York State MS Consortium, University at Buffalo, The State University of New York, Buffalo, NY, USA/Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Barbara E Teter
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA/New York State MS Consortium, University at Buffalo, The State University of New York, Buffalo, NY, USA/Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Murali Ramanathan
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA/New York State MS Consortium, University at Buffalo, The State University of New York, Buffalo, NY, USA/Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA/New York State MS Consortium, University at Buffalo, The State University of New York, Buffalo, NY, USA/Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Thordardottir B, Chiatti C, Ekstam L, Malmgren Fänge A. Heterogeneity of Characteristics among Housing Adaptation Clients in Sweden--Relationship to Participation and Self-Rated Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010091. [PMID: 26729145 PMCID: PMC4730482 DOI: 10.3390/ijerph13010091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 01/14/2023]
Abstract
The aim of the paper was to explore the heterogeneity among housing adaptation clients. Cluster analysis was performed using baseline data from applicants in three Swedish municipalities. The analysis identified six main groups: “adults at risk of disability”, “young old with disabilities”, “well-functioning older adults”, “frail older adults”, “frail older with moderate cognitive impairments” and “resilient oldest old”. The clusters differed significantly in terms of participation frequency and satisfaction in and outside the home as well as in terms of self-rated health. The identification of clusters in a heterogeneous sample served the purpose of finding groups with different characteristics, including participation and self-rated health which could be used to facilitate targeted home-based interventions. The findings indicate that housing adaptions should take person/environment/activity specific characteristics into consideration so that they may fully serve the purpose of facilitating independent living, as well as enhancing participation and health.
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Affiliation(s)
- Björg Thordardottir
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund 221 00, Sweden.
| | - Carlos Chiatti
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund 221 00, Sweden.
- Italian National Research Center on Aging, Via S. Margherita 5, Ancona 60124, Italy.
| | - Lisa Ekstam
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund 221 00, Sweden.
| | - Agneta Malmgren Fänge
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund 221 00, Sweden.
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