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Abou L, McCloskey C, Wernimont C, Fritz NE, Kratz AL. Nationwide Update on Prevalence of Falls, Injurious Falls, Concerns About Falling, and Fall Prevention in Persons With Multiple Sclerosis. Am J Phys Med Rehabil 2024; 103:811-818. [PMID: 38466198 DOI: 10.1097/phm.0000000000002454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE The aim of the study is to estimate the current nationwide prevalence of falls, injurious falls, concerns about falling, and information on fall prevention among people with multiple sclerosis. DESIGN This is a cross-sectional national web-based survey that included 965 adult people with multiple sclerosis. Participants self-reported falls and injurious falls experienced in the past 6 months. Participants also provided information on their concerns about falling and information on fall prevention received. RESULTS A total of 56% reported falling in the past 6 months. The prevalence of falls at the population level ranges between 53% and 59%. Most falls occur inside of participants' homes (68%). About 30% of fallers reported an injurious fall. Most respondents, 87% expressed being concerned about falling and 68% reported they had cut down on activities due to their concerns about falling. Among participants who received information about falling (64%), only 9% received a formal fall prevention course. CONCLUSIONS Despite advances in falls research over the last decades, falling continues to be a highly prevalent problem for people with multiple sclerosis. About one-third of those falls result in injuries. Concerns about falling among fallers and nonfallers affect the performance of daily activities and independence. Few people receive a formal falls prevention education or training.
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Affiliation(s)
- Libak Abou
- From the Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan (LA, CW, ALK); Department of Physical Medicine and Rehabilitation, Kaiser Permanente Health System, Redwood City, California (CM); and Departments of Health Care Sciences & Neurology, Wayne State University, Detroit, Michigan (NEF)
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Taul-Madsen L, Hvid LG, Sellebjerg F, Christensen JR, Ratzer R, Sejbæk T, Svendsen KB, Papp V, Højsgaard Chow H, Lundbye-Jensen J, Dawes H, Dalgas U. Study protocol: effects of exercise booster sessions on preservation of exercise-induced adaptations in persons with multiple sclerosis, a multicentre randomised controlled trial-the MS BOOSTER trial. BMJ Open 2024; 14:e085241. [PMID: 39153792 PMCID: PMC11331840 DOI: 10.1136/bmjopen-2024-085241] [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: 02/09/2024] [Accepted: 07/16/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) causes a broad range of symptoms, with physical function being one of the most disabling consequences according to patients themselves. Exercise effectively improves lower extremity physical function. Nonetheless, it is unknown which exercise modality is most effective and it remains challenging to keep persons with MS adhering to exercise over a longer period. Therefore, the present study aims to investigate how exercise booster sessions (EBS) influence the sustainability of exercise-induced effects on physical function, and furthermore, to investigate which exercise modality (aerobic training or resistance training) is most effective in terms of improving physical function. MATERIALS AND METHODS This study is a multi-arm, parallel-group, open-label multicentre randomised controlled trial investigating the effects of EBS. Participants (n=150) are initially randomised to 12 weeks of either resistance training+usual care, aerobic training+usual care or usual care. After 12 weeks of intervention, participants in the exercise groups will again be randomised to either EBS+usual care or usual care during a 40-week follow-up period. The primary outcome is physical function (composite score based on 6-min walk test and five-time sit to stand), and the secondary outcomes are fatigue, cognition, physical activity, symptoms of depression and quality of life. ETHICS AND DISSEMINATION The study is approved by the Central Denmark Region Committees on Health Research Ethics (1-10-72-237-21) and is registered at the Danish Data Protection Agency (2016-051-000001) and at Clinicaltrials.gov (NCT04913012). All study findings will be published in scientific peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER NCT04913012.
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Affiliation(s)
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus & Ry, Denmark
- The Danish MS Hospitals, Ry, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Centre, Rigshospitalet, Kobenhavn, Denmark
| | | | - Rikke Ratzer
- Danish Multiple Sclerosis Centre, Rigshospitalet, Kobenhavn, Denmark
| | - Tobias Sejbæk
- Department of Neurology, Sydvestjysk Sygehus, Esbjerg, Denmark
| | | | - Viktoria Papp
- Department of Neurology, Odense Universitetshospital, Odense, Denmark
| | | | - Jesper Lundbye-Jensen
- Department of Nutrition, Exercise and Sports, Københavns Universitet, Kobenhavn, Denmark
| | - Helen Dawes
- Medical School, University of Exeter, Exeter, UK
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Özgür S, Koçaslan Toran M, Toygar İ, Yalçın GY, Eraksoy M. A machine learning approach to determine the risk factors for fall in multiple sclerosis. BMC Med Inform Decis Mak 2024; 24:215. [PMID: 39080657 PMCID: PMC11289943 DOI: 10.1186/s12911-024-02621-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Falls in multiple sclerosis can result in numerous problems, including injuries and functional loss. Therefore, determining the factors contributing to falls in people with Multiple Sclerosis (PwMS) is crucial. This study aims to investigate the contributing factors to falls in multiple sclerosis using a machine learning approach. METHODS This cross-sectional study was conducted with 253 PwMS admitted to the outpatient clinic of a university hospital between February and August 2023. A sociodemographic data collection form, Fall Efficacy Scale (FES-I), Berg Balance Scale (BBS), Fatigue Severity Scale (FSS), Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale (MSIS-29), and Timed 25 Foot Walk Test (T25-FW) were used for data collection. Gradient-boosting algorithms were employed to predict the important variables for falls in PwMS. The XGBoost algorithm emerged as the best performed model in this study. RESULTS Most of the participants (70.0%) were female, with a mean age of 40.44 ± 10.88 years. Among the participants, 40.7% reported a fall history in the last year. The area under the curve value of the model was 0.713. Risk factors of falls in PwMS included MSIS-29 (0.424), EDSS (0.406), marital status (0.297), education level (0.240), disease duration (0.185), age (0.130), family type (0.119), smoking (0.031), income level (0.031), and regular exercise habit (0.026). CONCLUSIONS In this study, smoking and regular exercise were the modifiable factors contributing to falls in PwMS. We recommend that clinicians facilitate the modification of these factors in PwMS. Age and disease duration were non-modifiable factors. These should be considered as risk increasing factors and used to identify PwMS at risk. Interventions aimed at reducing MSIS-29 and EDSS scores will help to prevent falls in PwMS. Education of individuals to increase knowledge and awareness is recommended. Financial support policies for those with low income will help to reduce the risk of falls.
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Affiliation(s)
- Su Özgür
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Türkiye
- Ege University Faculty of Medicine, EgeSAM-Translational Pulmonary Research Center, Bornova, İzmir, Türkiye
| | - Meryem Koçaslan Toran
- Bahçeşehir University, Institution of Postgraduate Education, Istanbul, Türkiye
- Üsküdar University Faculty of Health Sciences, Istanbul, Türkiye
| | - İsmail Toygar
- Muğla Sıtkı Koçman University, Fethiye Faculty of Health Sciences , Fethiye, Muğla, Türkiye.
| | - Gizem Yağmur Yalçın
- Istanbul University-Cerrahpasa, Institute of Graduate Studies, Istanbul, Türkiye
| | - Mefkure Eraksoy
- Department of Neurology, Istanbul University Faculty of Medicine, Istanbul, Türkiye
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Bućma T, Sladojević I, Arambašić LT, Jeremić N, Tomić B. Impact of Anxious and/or Depressive Reactive State on the Effectiveness of Rehabilitation of Patients with Multiple Sclerosis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:941. [PMID: 38929558 PMCID: PMC11205805 DOI: 10.3390/medicina60060941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/26/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Rehabilitation is a part of the comprehensive treatment of multiple sclerosis (MS). If present, psychological reactive states limit the results of the rehabilitation. The objectives were to determine the impact of psychological reactive states in these patients on the functionality obtained by rehabilitation and QoL, and to determine the connection between the objective and subjective evaluation. Materials and Methods: Based on the Hospital anxiety and depression scale, the patients were divided into a group with anxious and/or depressive reactive state and a group without the reactive state. The values of functional scores-the Berg Balance Scale (BBS) and the Expanded Disability Status Scale (EDSS), as well as the parameters of the QoL-Physical health Component Score (PCS) and the Mental health Component Score (MCS)-were determined at the beginning and at the end of the rehabilitation. Results: There was a statistically significant difference between the BBS, EDSS, PCS, and MCS groups at the beginning and the end of the rehabilitation in both groups. A statistically significant difference at the beginning and the end of the rehabilitation between the groups was found only in PCS and MCS. A highly statistically significant correlation between EDSS and PCS, and EDSS and MCS, was found only in the group without the reactive state. Conclusions: Although rehabilitation leads to an objective improvement of functionality in patients with MS, the presence of the anxious and/or depressive reactive state limits the results of rehabilitation and leads to discrepancies in the aforementioned objective assessment and the patient's subjective experience through the evaluation of their QoL.
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Affiliation(s)
- Tatjana Bućma
- Institute for Physical Medicine, Rehabilitation and Orthopedic Surgery “Dr Miroslav Zotovic”, 78000 Banja Luka, Bosnia and Herzegovina; (L.T.A.); (N.J.); (B.T.)
- University of Banjaluka, Faculty of Medicine, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Igor Sladojević
- University of Banjaluka, Faculty of Medicine, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Lena Topić Arambašić
- Institute for Physical Medicine, Rehabilitation and Orthopedic Surgery “Dr Miroslav Zotovic”, 78000 Banja Luka, Bosnia and Herzegovina; (L.T.A.); (N.J.); (B.T.)
| | - Natalija Jeremić
- Institute for Physical Medicine, Rehabilitation and Orthopedic Surgery “Dr Miroslav Zotovic”, 78000 Banja Luka, Bosnia and Herzegovina; (L.T.A.); (N.J.); (B.T.)
| | - Bosa Tomić
- Institute for Physical Medicine, Rehabilitation and Orthopedic Surgery “Dr Miroslav Zotovic”, 78000 Banja Luka, Bosnia and Herzegovina; (L.T.A.); (N.J.); (B.T.)
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Ayvat E, Doğan M, Ayvat F, Kılınç ÖO, Sütçü G, Kılınç M, Yıldırım SA. Usefulness of the Berg Balance Scale for prediction of fall risk in multiple sclerosis. Neurol Sci 2024; 45:2801-2805. [PMID: 38217789 PMCID: PMC11081973 DOI: 10.1007/s10072-024-07318-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
INTRODUCTION The Berg Balance Scale, possibly the most widely used balance-related measure, has gained popularity in clinical trials. It provides information about patients' balance-related abilities and can be used to assess improvement or worsening after rehabilitation. The aim of this study is to determine the cut-off value of the Berg Balance Scale for the fall risk in patients with multiple sclerosis (MS). METHODS This study was designed as a prospective descriptive trial, and 186 patients with MS were included. Fall history was recorded by interview; balance was assessed using the Berg Balance Scale (BBS). RESULTS The mean ages of 96 patients with a fall history within the previous month and 90 patients without a fall history were 35.98 ± 8.58 and 35.71 ± 9.33 years, respectively. The mean value of the BBS score of the faller group was 49.44 ± 5.43 while 52.36 ± 3.53 in non-faller group. The cut-off value of the BBS for fall risk in patients with MS was determined as 50.50 points. CONCLUSIONS For patient safety and the success of rehabilitation, it is crucial to evaluate the risk of falling in patients with MS, one of the neurological patient groups where complaints about falling are most prevalent. The results showed that BBS is a sensitive and specific measure for identifying in patients with MS at risk of falling.
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Affiliation(s)
- Ender Ayvat
- Department of Neurological Rehabilitation, Faculty of Physical Therapy and Rehabilitation, University of Hacettepe, Ankara, Turkey.
| | - Mert Doğan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, University of Akdeniz, Antalya, Turkey
| | - Fatma Ayvat
- Department of Neurological Rehabilitation, Faculty of Physical Therapy and Rehabilitation, University of Hacettepe, Ankara, Turkey
| | - Özge Onursal Kılınç
- Department of Neurological Rehabilitation, Faculty of Physical Therapy and Rehabilitation, University of Hacettepe, Ankara, Turkey
| | - Gülşah Sütçü
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, University of Akdeniz, Antalya, Turkey
| | - Muhammed Kılınç
- Department of Neurological Rehabilitation, Faculty of Physical Therapy and Rehabilitation, University of Hacettepe, Ankara, Turkey
| | - Sibel Aksu Yıldırım
- Department of Neurological Rehabilitation, Faculty of Physical Therapy and Rehabilitation, University of Hacettepe, Ankara, Turkey
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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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Wang L, Li X, Peng Y, Han J, Zhang J. Balance Evaluation Based on Walking Experiments with Exoskeleton Interference. Bioengineering (Basel) 2024; 11:386. [PMID: 38671807 PMCID: PMC11048462 DOI: 10.3390/bioengineering11040386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
The impairment of walking balance function seriously affects human health and will lead to a significantly increased risk of falling. It is important to assess and improve the walking balance of humans. However, existing evaluation methods for human walking balance are relatively subjective, and the selected metrics lack effectiveness and comprehensiveness. We present a method to construct a comprehensive evaluation index of human walking balance. We used it to generate personal and general indexes. We first pre-selected some preliminary metrics of walking balance based on theoretical analysis. Seven healthy subjects walked with exoskeleton interference on a treadmill at 1.25 m/s while their ground reaction force information and kinematic data were recorded. One subject with Charcot-Marie-Tooth walked at multiple speeds without the exoskeleton while the same data were collected. Then, we picked a number of effective evaluation metrics based on statistical analysis. We finally constructed the Walking Balance Index (WBI) by combining multiple metrics using principal component analysis. The WBI can distinguish walking balance among different subjects and gait conditions, which verifies the effectiveness of our method in evaluating human walking balance. This method can be used to evaluate and further improve the walking balance of humans in subsequent simulations and experiments.
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Affiliation(s)
- Liping Wang
- Tianjin Key Laboratory of Intelligent Robotics, Institute of Robotics and Automatic Information System, Nankai University, Tianjin 300350, China; (L.W.); (X.L.); (Y.P.); (J.H.)
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China
| | - Xin Li
- Tianjin Key Laboratory of Intelligent Robotics, Institute of Robotics and Automatic Information System, Nankai University, Tianjin 300350, China; (L.W.); (X.L.); (Y.P.); (J.H.)
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China
| | - Yiying Peng
- Tianjin Key Laboratory of Intelligent Robotics, Institute of Robotics and Automatic Information System, Nankai University, Tianjin 300350, China; (L.W.); (X.L.); (Y.P.); (J.H.)
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China
| | - Jianda Han
- Tianjin Key Laboratory of Intelligent Robotics, Institute of Robotics and Automatic Information System, Nankai University, Tianjin 300350, China; (L.W.); (X.L.); (Y.P.); (J.H.)
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China
- School of Materials Science and Engineering, Smart Sensing Interdisciplinary Science Center, Nankai University, Tianjin 300350, China
| | - Juanjuan Zhang
- Tianjin Key Laboratory of Intelligent Robotics, Institute of Robotics and Automatic Information System, Nankai University, Tianjin 300350, China; (L.W.); (X.L.); (Y.P.); (J.H.)
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China
- School of Materials Science and Engineering, Smart Sensing Interdisciplinary Science Center, Nankai University, Tianjin 300350, China
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O'Malley N, Coote S, Clifford AM. Outcomes of importance to people with multiple sclerosis, Parkinson's disease and stroke following a falls prevention intervention: a qualitative study to inform a core outcome set. Disabil Rehabil 2024; 46:1580-1592. [PMID: 37092355 DOI: 10.1080/09638288.2023.2201513] [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: 11/18/2022] [Accepted: 04/06/2023] [Indexed: 04/25/2023]
Abstract
Purpose: Falls are a major issue for people with neurological conditions, and the evaluation of falls prevention interventions is of high priority. To date, the views of patient groups regarding outcomes of importance have been largely overlooked. The purpose of this study was to explore outcomes of interest among people with Multiple Sclerosis (MS), Parkinson's disease (PD) and stroke upon completion of falls prevention interventions to inform the development of a core outcome set (COS).Materials and methods: Five online focus groups and one semi-structured interview were conducted among people with PD (n = 10), MS (n = 7), and post-stroke (n = 3), one of whom also had PD. Transcripts were analysed using reflexive thematic analysis.Results: Four themes were developed; (1) Fall events are not homogeneous, (2) Exercise-based programmes are beneficial but falls services are not meeting user needs, (3) Programme success beyond the reduction in falls, and (4) Acquisition of skills to self-manage falls beyond the life of the programme.Conclusions: This study presents new perspectives across patient groups regarding important outcomes upon completion of falls prevention interventions. Taken together with the findings of a literature review, this data will inform the development of a COS.Implications for rehabilitationPeople with multiple sclerosis, Parkinson's disease and stroke consider the success of a falls prevention intervention to be dependent on improvements across a wide range of outcomes.The design and implementation of falls prevention interventions should align with patient preferences.Clinicians and researchers should consider the use of multidomain interventions to facilitate improvements in the desired outcomes of patients.
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Affiliation(s)
- Nicola O'Malley
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Susan Coote
- School of Allied Health, University of Limerick, Limerick, Ireland
- Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
- Multiple Sclerosis Society of Ireland, Limerick, Ireland
| | - Amanda M Clifford
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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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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Abou L, McCloskey C, Wernimont C, Fritz NE, Kratz AL. Examination of Risk Factors Associated With Falls and Injurious Falls in People With Multiple Sclerosis: An Updated Nationwide Study. Arch Phys Med Rehabil 2024; 105:717-724. [PMID: 38043675 DOI: 10.1016/j.apmr.2023.11.011] [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: 08/09/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To provide an update on risk factors associated with falls and injurious falls among people with multiple sclerosis (PwMS) in the United States. DESIGN Nationwide cross-sectional web-based survey. SETTING Community setting. PARTICIPANTS Adult PwMS (n=965). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants completed self-report surveys of demographics, clinical data, concerns about falling, occurrence of falls, factors associated with falls, and injurious falls in the past 6 months. Participants also completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures of depression, pain interference, and physical function, and the Fatigue Severity Scale. RESULTS The most common self-reported factors associated with falls included personal factors such as poor balance (75%), muscle weakness (54%), and/or fatigue (35%), environmental factors such as general surface conditions (37%) and/or distraction (15%), and activities-related factors such as urgency to complete a task (35%) and/or multitasking (27%). Logistic regression analyses indicated that higher fatigue severity (OR=1.19, P<.01) and higher pain interference (OR=1.02, P<.01) were associated with higher odds of experiencing at least 1 fall. Any level of concern, even minimal concern about falling was also significantly associated with a higher odd of experiencing at least 1 fall (ORs range 2.78 - 3.95, all P<.01). Fair to very high concerns about falling compared with no concern about falling (ORs range=5.17 - 10.26, all P<.05) was significantly associated with higher odds of sustaining an injurious fall. CONCLUSIONS Findings suggest falls prevention approaches in PwMS should be multifactorial and include personal, environmental, and activities-related factors. Particular attention on fatigue, pain, and concern about falling may be needed to reduce incidence of falls and injurious falls in this population.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI.
| | - Chloe McCloskey
- Department of Physical Medicine and Rehabilitation, Kaiser Permanente Health System, Redwood City, CA
| | - Cory Wernimont
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Nora E Fritz
- Departments of Health Care Sciences & Neurology, Wayne State University, Detroit, MI
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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Elie OS, Franz JR, Selgrade BP. The Effects of Optical Flow Perturbations on Standing Balance in People With Multiple Sclerosis. J Appl Biomech 2024; 40:122-128. [PMID: 37963452 DOI: 10.1123/jab.2022-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/22/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023]
Abstract
Multiple sclerosis is a neurodegenerative disease that causes balance deficits, even in early stages. Evidence suggests that people with multiple sclerosis (PwMS) rely more on vision to maintain balance, and challenging balance with optical flow perturbations may be a practical screening for balance deficits. Whether these perturbations affect standing balance in PwMS is unknown. Therefore, the purpose of this study was to examine how optical flow perturbations affect standing balance in PwMS. We hypothesized that perturbations would cause higher variability in PwMS compared with matched controls during standing and that standing balance would be more susceptible to anterior-posterior (A-P) perturbations than medial-lateral (M-L) perturbations. Thirteen PwMS and 13 controls stood under 3 conditions: unperturbed, M-L perturbation, and A-P perturbations. A-P perturbations caused significantly higher A-P trunk sway variability in PwMS than controls, although both groups had similar center-of-pressure variability. Both perturbations increased variability in A-P trunk sway and center of pressure. Trunk variability data supported the hypothesis that PwMS were more susceptible to optical flow perturbations than controls. However, the hypothesis that A-P perturbations would affect balance more than M-L perturbations was partially supported. These results suggest potential for optical flow perturbations to identify balance deficits in PwMS.
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Affiliation(s)
- Olivia S Elie
- Department of Sports Medicine and Human Performance, Westfield State University, Westfield, MA, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Brian P Selgrade
- Department of Sports Medicine and Human Performance, Westfield State University, Westfield, MA, USA
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Menkyova I, Stastna D, Novotna K, Saling M, Lisa I, Vesely T, Slezakova D, Valkovic P. Effect of Tai-chi on balance, mood, cognition, and quality of life in women with multiple sclerosis: A one-year prospective study. Explore (NY) 2024; 20:188-195. [PMID: 37596158 DOI: 10.1016/j.explore.2023.07.011] [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: 02/26/2023] [Revised: 07/22/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION One of the most debilitating problems encountered by people with multiple sclerosis (MS) is the loss of balance and coordination. Our study aimed to comprehensively evaluate the effectiveness of one year of Tai-chi exercise in patients with MS using both subjective and objective methods, including posturography. METHODS This was a single-group longitudinal one-year study performed from the 1st of January 2019 to the 1st of January 2020. The primary outcomes of interest were the Mini-Balance Evaluation Systems Test (Mini-BESTest) and static posturography measures as objective methods to detect subtle changes associated with postural control/balance impairment. Secondary outcomes were measures of depression, anxiety, cognitive performance, and quality of life. All objective and subjective parameters were assessed four times: at baseline, and after three, six and 12 months of regular Tai-chi training. The difference was calculated as a subtraction of baseline values from every timepoint value for each measurement. If the normality test was passed, parametric one-sample t-test was used, if failed, Wilcoxon signed ranks test was used to test the difference between the baseline and each timepoint. Alpha was set to 0.017 using Bonferroni correction for multiple comparisons. RESULTS Out of 25 patients with MS enrolled, 15 women with MS (mean age 44.27 years) were included for statistical analyses after completing the 12-month program. After 12 months, significant improvements were found in all objective balance and gait tests: Mini-BESTest (p<0.001), static posturography measures (total area of the centre of foot pressure - TA; p = 0.015), 25 Feet Walk Test (25FWT; p = 0.001), anxiety (Beck Anxiety Inventory - BAI; p = 0.005) and cognition tests (Paced Auditory Serial Addition Test - PASAT; p = 0.003). Measures of depression (Beck Depression Inventory - BDI; p = 0.071), cognition (Symbol Digit Modalities Test - SDMT; p = 0.079), and health-related quality of life (European Quality of Life 5-Dimensions Questionnaire - EQ-5D-5L; p = 0.095) showed a trend of improvement but were not significant, which could be the result of a small sample and increased bias due the type II error. CONCLUSION According to these preliminary results, this study indicates the possible beneficial effects of long-term Tai-chi training on patients with MS. Although these findings need to be confirmed by further studies with a larger sample of participants of both genders and require more rigorous randomized controlled trials (RCT) design, our findings support the recommendation of regular and long-term Tai-chi exercise in patients with MS. CLINICALTRIALS GOV IDENTIFIER (RETROSPECTIVELY REGISTERED) NCT05474209.
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Affiliation(s)
- Ingrid Menkyova
- Second Department of Neurology, Faculty of Medicine, Comenius University Bratislava, University Hospital Bratislava, Slovakia; Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Dominika Stastna
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Klara Novotna
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Marian Saling
- Second Department of Neurology, Faculty of Medicine, Comenius University Bratislava, University Hospital Bratislava, Slovakia
| | - Iveta Lisa
- Second Department of Neurology, Faculty of Medicine, Comenius University Bratislava, University Hospital Bratislava, Slovakia
| | - Tomas Vesely
- Department of Information and Communication Technologies in Medicine, Faculty of Biomedical Engineering, Czech Technical University in Prague, Czechia
| | - Darina Slezakova
- Second Department of Neurology, Faculty of Medicine, Comenius University Bratislava, University Hospital Bratislava, Slovakia
| | - Peter Valkovic
- Second Department of Neurology, Faculty of Medicine, Comenius University Bratislava, University Hospital Bratislava, Slovakia; Centre of Experimental Medicine, Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia.
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13
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Bruce JM, Cozart JS, Shook RP, Befort C, Siengsukon CF, Simon S, Lynch SG, Mahmoud R, Drees B, Posson P, Hibbing PR, Huebner J, Bradish T, Robichaud J, Bruce AS. Modifying diet and exercise in multiple sclerosis (MoDEMS): A randomized controlled trial for behavioral weight loss in adults with multiple sclerosis and obesity. Mult Scler 2023; 29:1860-1871. [PMID: 38018409 DOI: 10.1177/13524585231213241] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND Obesity is a risk factor for developing multiple sclerosis (MS) and MS-related disability. The efficacy of behavioral weight loss interventions among people with MS (pwMS) remains largely unknown. OBJECTIVE Examine whether a group-based telehealth weight loss intervention produces clinically significant weight loss in pwMS and obesity. METHODS Seventy-one pwMS were randomized to the weight loss intervention or treatment-as-usual (TAU). The 6-month program promoted established guidelines for calorie reduction and increased physical activity. Anthropometric measurements, mobility tasks, self-report questionnaires, and accelerometry were used to assess changes at follow-up. RESULTS Mean percent weight loss in the treatment group was 8.6% compared to 0.7% in the TAU group (p < .001). Sixty-five percent of participants in the intervention achieved clinically meaningful weight loss (⩾ 5%). Participants in the treatment group engaged in 46.2 minutes/week more moderate-to-vigorous physical activity than TAU participants (p = .017) and showed improvements in quality of life (p = .012). Weight loss was associated with improved mobility (p = .003) and reduced fatiguability (p = .008). CONCLUSION Findings demonstrate the efficacy of a behavioral intervention for pwMS and obesity, with clinically significant weight loss for two-thirds of participants in the treatment condition. Weight loss may also lead to improved mobility and quality of life.
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Affiliation(s)
- Jared M Bruce
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
- Departments of Neurology and Psychiatry, University Health, Kansas City, MO, USA
| | - Julia S Cozart
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Robin P Shook
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Christie Befort
- Department of Population Health, University Kansas Medical Center, Kansas City, KS, USA
| | - Catherine F Siengsukon
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Stephen Simon
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Sharon G Lynch
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rola Mahmoud
- Department of Neurology, Saint Luke's Hospital, Kansas City, MO, USA
- Department of Neurology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Betty Drees
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
- Graduate School of the Stowers Institute for Medical Research, Kansas City, MO, USA
| | - Paige Posson
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
| | - Paul R Hibbing
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Joanie Huebner
- Department of Community and Family Medicine, University Health Lakewood Medical Center, Kansas City, MO, USA
| | - Taylor Bradish
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jade Robichaud
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Amanda S Bruce
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
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14
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Abou L, Fritz NE, Kratz AL. Self-reported fatigue impact is associated with frequency of falls and injurious falls in people with multiple sclerosis. Mult Scler Relat Disord 2023; 78:104910. [PMID: 37499336 DOI: 10.1016/j.msard.2023.104910] [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: 01/05/2023] [Revised: 05/19/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Fatigue is the most common symptom associated with multiple sclerosis (MS). Fatigue as a risk factor for injurious falls and frequency of falls is understudied. Falling recurrently is associated with injurious falls which may lead to reduced functional independence and poor quality of life of people with MS. Identifying contributors of recurrent falls and injurious falls is clinically useful to develop effective interventions. OBJECTIVE To investigate the associations between fatigue impact and frequency of falls and injurious falls in people with MS. METHODS Fifty-one participants completed the Modified Fatigue Impact Scale (MFIS) and a survey of number of falls and injurious falls during the past year. Logistic regression analyses were conducted to investigate whether scores on the MFIS (Total, Physical, Cognitive, and Psychosocial) predicted odds of being a recurrent faller (> 2 falls) or infrequent faller (1- 2 falls) versus a non-faller, and odds of experiencing an injurious fall (yes/no). The analyses were adjusted for demographic and clinical characteristics and common symptoms of MS (depression, cognition, pain, and sleep disturbance). RESULTS Higher MFIS Total score was associated with higher odds of infrequent falls (OR = 1.07, 95% CI, 1.00 - 1.15, p = 0.05) and recurrent falls (OR = 1.10, 95% CI, 1.00 - 1.20, p = 0.04) relative to not falling in the past year. Higher scores on the MFIS Physical subscale were significantly associated with high odds of infrequent falls (OR = 1.15, 95% CI, 1.02 - 1.30, p = 0.03) and recurrent falls (OR = 1.19, 95% CI, 1.02 - 1.39, p = 0.03). MFIS Psychosocial subscale was significantly associated with higher odds of infrequent falls (OR = 2.01, 95% CI, 1.14 - 3.53, p = 0.02). MFIS Total and MFIS Cognitive subscale were significantly associated with higher odds of injurious falls (OR = 1.11, 95% CI, 1.00 - 1.23, p = 0.04) and (OR = 1.28, 95% CI, 1.02 - 1.60, p = 0.04), respectively. CONCLUSION The findings indicated self-reported fatigue impact and its specific domains were associated with an increased risk of falling and injurious falls. Further studies using prospective falls assessment and longitudinal evaluation of fatigue are warranted to extend our findings.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA.
| | - Nora E Fritz
- Departments of Health Care Sciences & Neurology, Wayne State University, Detroit, MI, USA
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
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15
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Bilgin YOU, Koskderelioglu A, Gedizlioglu M. Fall risk is related to cognitive functioning in ambulatory multiple sclerosis patients. Neurol Sci 2023; 44:3233-3242. [PMID: 36997775 DOI: 10.1007/s10072-023-06770-4] [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: 09/28/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND AND AIMS Patients with multiple sclerosis (PwMS) may suffer severely from falling and gait disturbance. Cognitive dysfunction, a common condition in MS patients, may also increase falling rates, regardless of physical disability. We planned this study to determine the fall rate and risk factors in MS patients, follow patients for falls, and reveal the relationship between falls and cognitive dysfunction. METHODS The study was conducted on 124 patients who have RRMS diagnoses. Patients' gait speed, simultaneous gait speed during other tasks, functions of the upper extremity, balance rating, and fear of falling were evaluated with dual-task Timed-Up-and-Go-3 versions (TUG, TUG-C, TUG-M), Timed 25 Foot Walk (T25WFT), Nine Hole Peg Test (9HPT), Berg Balance Scale (BBS) and Falls Efficacy Scale-International (FES-I) tests. Cognitive functions, fatigue levels, and quality of life were measured with the Symbol Digit Modalities Test (SDMT), Fatigue Severity Scale (FSS), and Multiple Sclerosis Quality of Life (MSQoL) test. Two groups were formed as "fallers" and "non-faller patients". We monitored the patients in six months period. RESULTS Forty-six patients fell at least once in the last one year before the study began. Fallers were older, less educated, had lower SDMT scores and higher disability scores. Non-faller patients scored lower in FES-I, TUG, and FSS tests. SDMT scores showed statistically significant, linear, positive, and moderate correlation with BBS and 9HPT scores (r = 0.307, p = 0.038, and r = 0.320, p = 0.030, respectively). CONCLUSION We determined that advanced age, lower education level, and cognitive dysfunction adversely affect gait speed and balance. Among the fallers, those with lower SDMT and MoCA scores had higher falling rates. We determined that EDSS and BBS scores are predictive factors for falls in patients with MS. In conclusion, patients with cognitive impairment should be closely monitored for the risk of falling. Consideration of falls during follow-up examinations might be predictive of cognitive deterioration in patients with MS.
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Affiliation(s)
- Yaprak Ozum Unsal Bilgin
- Department of Neurology, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey.
| | - Asli Koskderelioglu
- Department of Neurology, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
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16
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Monaghan PG, Monaghan AS, Hooyman A, Fling BW, Huisinga JM, Peterson DS. Using the Instrumented Sway System (ISway) to Identify and Compare Balance Domain Deficits in People With Multiple Sclerosis. Arch Phys Med Rehabil 2023; 104:1456-1464. [PMID: 37037293 PMCID: PMC10524722 DOI: 10.1016/j.apmr.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/27/2023] [Accepted: 02/24/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To develop a multiple sclerosis (MS)-specific model of balance and examine differences between (1) MS and neurotypical controls and (2) people with MS (PwMS) with (MS-F) and without a fall history (MS-NF). DESIGN AND SETTING A cross-sectional study was conducted at the Gait and Balance Laboratory at the University of Kansas Medical Center. Balance was measured from the instrumented sway system (ISway) assessment. PARTICIPANTS In total, 118 people with relapsing-remitting MS (MS-F=39; MS-NF=79) and 46 age-matched neurotypical controls. INTERVENTION Not applicable. OUTCOME MEASURES A total of 22 sway measures obtained from the ISway were entered into an exploratory factor analysis to identify underlying balance domains. The model-derived balance domains were compared between (1) PwMS and age-matched, neurotypical controls and (2) MS-F and MS-NF. RESULTS Three distinct balance domains were identified: (1) sway amplitude and velocity, (2) sway frequency and jerk mediolateral, and (3) sway frequency and jerk anteroposterior, explaining 81.66% of balance variance. PwMS exhibited worse performance (ie, greater amplitude and velocity of sway) in the sway velocity and amplitude domain compared to age-matched neurotypical controls (P=.003). MS-F also exhibited worse performance in the sway velocity and amplitude domain compared to MS-NF (P=.046). The anteroposterior and mediolateral sway frequency and jerk domains were not different between PwMS and neurotypical controls nor between MS-F and MS-NF. CONCLUSIONS This study identified a 3-factor, MS-specific balance model, demonstrating that PwMS, particularly those with a fall history, exhibit disproportionate impairments in sway amplitude and velocity. Identifying postural stability outcomes and domains that are altered in PwMS and clinically relevant (eg, related to falls) would help isolate potential treatment targets.
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Affiliation(s)
| | | | - Andrew Hooyman
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ
| | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO
| | - Jessie M Huisinga
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, KS
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, Phoenix, AZ; Phoenix VA Health Care Center, Phoenix, AZ.
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Özden F, Özkeskin M, Tümtürk İ, Yüceyar N. Comparison of physical performance, gait, balance, falls efficacy, and step reaction time in individuals with multiple sclerosis. Clin Neurol Neurosurg 2023; 232:107872. [PMID: 37451088 DOI: 10.1016/j.clineuro.2023.107872] [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: 08/11/2022] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The study aimed to investigate the physical performance, gait, balance, falls efficacy, and step reaction time in individuals with MS. METHODS A total of 60 individuals (30 individuals with MS and 30 age and sex-matched healthy controls) were enrolled. Individuals' physical performance was evaluated with the Timed Up and Go Test (TUG) and Five-Times-Sit-to-Stand Test (FTSTS). Activities-specific Balance Confidence (ABC) Scale, 12-item Multiple Sclerosis Walking Scale (MSWS-12v2) and Falls Efficacy Scale International (FES-I) were used to assess the balance, gait and fall efficacy of the participants. Individuals' step reaction time (SRT) was calculated with video-based software. The time between the step command and the first contact of the foot with the ground in the first step was recorded. RESULTS The mean age of the individuals with MS and the control group was 38.5 ± 9.4 years and 33.9 ± 11.7 years, respectively. Significant differences existed between the groups in SRT, FES-I, ABC, and FTSTS (p < 0.05). There was no significant correlation between SRT with any other parameter (p > 0.05). TUG was moderately correlated with MSWS-12 and FES-I (r1 =0.426, r2 =0.495, p < 0.05). Besides, there was a moderate correlation between ABC with TUG and FTSTS (r1 =-0.605, r2 =-0.468, p < 0.05). A high degree correlation was found between MSWS-12 with FES-I and ABC (r1 =0.843, r2 =-0.834, p < 0.05). CONCLUSION Individuals with MS have decreased SRTs. However, this condition was not found to be related to physical performance. Further studies should focus on the association of SRT with cognitive and psychosocial parameters.
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Affiliation(s)
- Fatih Özden
- Muğla Sıtkı Koçman University, Köyceğiz Vocational School of Health Services, Department of Health Care Services, Muğla, Turkey
| | - Mehmet Özkeskin
- Ege University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, İzmir, Turkey.
| | - İsmet Tümtürk
- Süleyman Demirel University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Isparta, Turkey
| | - Nur Yüceyar
- Ege University, Faculty of Medicine, Department of Neurology, İzmir, Turkey
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18
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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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Finlayson M, Feys P, Dalgas U, Kos D. Intermediate outcomes for clinical trials of multiple sclerosis rehabilitation interventions: Conceptual and practical considerations. Mult Scler 2023; 29:1186-1194. [PMID: 37555489 PMCID: PMC10413783 DOI: 10.1177/13524585231189674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Rehabilitation is an essential health care service and a critical component of comprehensive multiple sclerosis (MS) care. OBJECTIVE As part of a 2-day meeting hosted by the International Advisory Committee on Clinical Trials in MS in December 2022, a panel initiated a discussion on the conceptual and practical issues related to selecting intermediate outcomes for clinical trials of MS rehabilitation interventions. RESULTS The overarching goal of rehabilitation - optimal functioning - was acknowledged as a complex biopsychosocial phenomenon that varies with patient priorities and environmental context. This complexity means that multiple causal pathways and potential intermediate outcomes must be carefully considered during the design of clinical trials in MS rehabilitation that aim to improve functioning. In addition, practical issues must be considered such as psychometric properties of outcome measures, measure type, and characteristics of the target population, including severity of dysfunction. CONCLUSION This article uses the International Classification of Functioning, Disability and Health as a foundation for determining relevant intermediate outcomes for clinical trials of MS rehabilitation interventions.
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Affiliation(s)
- Marcia Finlayson
- School of Rehabilitation Therapy, Queen’s University, Kingston ON, Canada
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; UMSC Hasselt, Pelt, Belgium
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Daphne Kos
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; National Multiple Sclerosis Center Melsbroek, Steenokkerzeel, Belgium
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Caselli S, Sabattini L, Cattaneo D, Jonsdottir J, Brichetto G, Pozzi S, Lugaresi A, La Porta F. When 'good' is not good enough: a retrospective Rasch analysis study of the Berg Balance Scale for persons with Multiple Sclerosis. Front Neurol 2023; 14:1171163. [PMID: 37409022 PMCID: PMC10318536 DOI: 10.3389/fneur.2023.1171163] [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: 02/21/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Background The Berg Balance Scale (BBS) is one of the most used tools to quantify balance in Persons with Multiple Sclerosis, a population at high risk of falling. Aim To evaluate the measurement characteristics of the BBS in Multiple Sclerosis through Rasch analysis. Design Retrospective study. Setting Outpatients in three Italian Rehabilitation centers. Population Eight hundred and fourteen persons with Multiple Sclerosis able to stand independently for more than 3 s. Methods The sample (N = 1,220) was split into one validating (B1) and three confirmatory subsamples. Following the Rasch analysis performed on B1, the item estimates were exported and anchored to the three confirmatory subsamples. After obtaining the same final solution across all samples, we studied the convergent and discriminant validity of the final BBS-MS using the EDSS, the ABC scale, and the number of falls. Results The base analysis on the B1 subsample failed the monotonicity, local independence, and unidimensionality requirements and did not fit the Rasch model. After grouping locally dependent items, the BBS-MS fitted the model (χ28 = 23.8; p = 0.003) and satisfied all requirements for adequate internal construct validity (ICV). However, it was mistargeted to the sample, given the striking prevalence of higher scores (targeting index 1.922) with a distribution-independent Person Separation Index sufficient for individual measurements (0.962). The B1 item estimates were anchored to the confirmatory samples with confirmation of adequate fit (χ2 = [19.0, 22.8], value of ps = [0.015, 0.004]) and satisfaction of all ICV requirements for all subsamples. The final BBS-MS directly correlated with the ABC scale (rho = 0.523) and inversely with EDSS (rho = -0.573). The BBS-MS estimates significantly differed across groups according to the pre-specified hypotheses (between the three EDSS groups, between the ABC cut-offs, distinguishing 'fallers' vs. 'non-fallers', and between the 'low' vs. 'moderate' vs. 'high' levels of physical functioning; and, finally, between 'no falls' vs. 'one or more falls'). Conclusion This study supports the internal construct validity and reliability of the BBS-MS in an Italian multicentre sample of persons with Multiple Sclerosis. However, as the scale is slightly mistargeted to the sample, it represents a candidate tool to assess balance, mainly in more disabled people with an advanced walking disability.
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Affiliation(s)
- Serena Caselli
- Unità Operativa Complessa di Medicina Riabilitativa, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | - Davide Cattaneo
- LaRiCE lab (Gait and Balance Disorders Laboratory), Don Gnocchi Foundation IRCCS, Milan, Italy
| | - Johanna Jonsdottir
- LaRiCE lab (Gait and Balance Disorders Laboratory), Don Gnocchi Foundation IRCCS, Milan, Italy
| | | | - Stefania Pozzi
- DATER Riabilitazione Ospedaliera, Azienda USL di Bologna, Bologna, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Fabio La Porta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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21
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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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22
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Jones SL, van Emmerik REA. Impaired foot vibration sensitivity is related to altered plantar pressures during walking in people with multiple sclerosis. Mult Scler Relat Disord 2023; 75:104767. [PMID: 37216882 DOI: 10.1016/j.msard.2023.104767] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/05/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Balance and mobility impairment are two of the most common and debilitating symptoms among people with multiple sclerosis (MS). Somatosensory symptoms, including reduced plantar cutaneous sensation, have been identified in this cohort. Given the importance of the somatosensory system in gait, it is likely that impaired plantar sensation may play a role in the walking adaptations commonly observed in people with MS, including decreased stride length and increased stride width and dual support time, often described as a cautious gait strategy. Understanding the contributions of plantar sensation to these alterations may provide targets for interventions that seek to improve sensory feedback and normalize gait patterns. This cross-sectional study determined whether individuals with MS who demonstrate reduced sensitivity of the plantar surfaces also demonstrate altered plantar pressure distributions during walking compared to a control cohort. METHODS Twenty individuals with MS and twenty age- and sex-matched control participants walked barefoot at preferred and three matched speeds. Participants walked across a walkway with an embedded pressure plate used to quantify pressures within ten plantar zones. In addition, vibration perception thresholds were assessed at four sites on the plantar surface. RESULTS Individuals with MS demonstrated increased peak total plantar pressures compared to control participants, that increased with walking speed. For the MS group, plantar pressures were higher on the less sensitive foot, although pressures on both feet exceeded those of the control cohort. Positive correlations between vibration perception threshold and peak total pressure were evident, although generally stronger in the MS cohort. CONCLUSION A relationship between plantar vibration sensitivity and pressure could indicate that individuals with MS seek to increase plantar sensory feedback during walking. However, because proprioception may also be impaired, increased plantar pressure could result from inaccurate foot placement. Interventions targeting improved somatosensation may have the potential to normalize gait patterns and should be investigated.
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Affiliation(s)
- Stephanie L Jones
- Department of Kinesiology, 110 Totman Building, School of Public Health and Health Sciences, University of Massachusetts Amherst, 30 Eastman Lane, Amherst, MA 01003-9258, USA; Department of Exercise and Sport Studies, 410 Scott Gym, Smith College, 102 Lower College Lane, Northampton, MA 01063, USA.
| | - Richard E A van Emmerik
- Department of Kinesiology, 110 Totman Building, School of Public Health and Health Sciences, University of Massachusetts Amherst, 30 Eastman Lane, Amherst, MA 01003-9258, USA
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23
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VanDyk T, Meyer B, DePetrillo P, Donahue N, O'Leary A, Fox S, Cheney N, Ceruolo M, Solomon AJ, McGinnis RS. Digital Phenotypes of Instability and Fatigue Derived From Daily Standing Transitions in Persons With Multiple Sclerosis. IEEE Trans Neural Syst Rehabil Eng 2023; 31:2279-2286. [PMID: 37115839 PMCID: PMC10408384 DOI: 10.1109/tnsre.2023.3271601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Impairment in persons with multiple sclerosis (PwMS) can often be attributed to symptoms of motor instability and fatigue. Symptom monitoring and queued interventions often target these symptoms. Clinical metrics are currently limited to objective physician assessments or subjective patient reported measures. Recent research has turned to wearables for improving the objectivity and temporal resolution of assessment. Our group has previously observed wearable assessment of supervised and unsupervised standing transitions to be predictive of fall-risk in PwMS. Here we extend the application of standing transition quantification to longitudinal home monitoring of symptoms. Subjects (N=23) with varying degrees of MS impairment were recruited and monitored with accelerometry for a total of ∼ 6 weeks each. These data were processed using a preexisting framework, applying a deep learning activity classifier to isolate periods of standing transition from which descriptive features were extracted for analysis. Participants completed daily and biweekly assessments describing their symptoms. From these data, Canonical Correlation Analysis was used to derive digital phenotypes of MS instability and fatigue. We find these phenotypes capable of distinguishing fallers from non-fallers, and further that they demonstrate a capacity to characterize symptoms at both daily and sub-daily resolutions. These results represent promising support for future applications of wearables, which may soon augment or replace current metrics in longitudinal monitoring of PwMS.
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24
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Kristensen NM, Taul-Madsen L, Gaemelke T, Riemenschneider M, Dalgas U, Hvid LG. Neuromuscular rate of force development discriminates fallers in ambulatory persons with multiple sclerosis - an exploratory study. Mult Scler Relat Disord 2023; 75:104758. [PMID: 37192588 DOI: 10.1016/j.msard.2023.104758] [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: 01/19/2023] [Revised: 04/18/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Falls as well as fall-related injuries (e.g., bone fractures) are common in persons with multiple sclerosis (pwMS). Whilst some studies have identified lower extremity maximal muscle strength (Fmax) as one among several risk factors, no previous studies have investigated the association between rate of force development (RFD; ability to generate a rapid rise in muscle force) and falls in pwMS. Not only is RFD substantially compromised (and more so than Fmax) in pwMS, studies involving other neurodegenerative populations have shown that RFD - to a greater extent than Fmax - is crucial for counteracting unexpected perturbations and avoiding falling. OBJECTIVE To explore whether knee extensor RFD (and Fmax) can discriminate fallers from non-fallers in pwMS. METHODS Knee extensor neuromuscular function (comprising RFD50ms and RFD200ms (force developed in the interval 0-50 ms and 0-200 ms, respectively) as well as Fmax) of the weaker leg was assessed by isokinetic dynamometry. Falls were determined by 1-year patient recall, with pwMS subsequently being classified as non-fallers (0 falls), fallers (1-2 falls), or recurrent fallers (≥3 falls). RESULTS A total of n=53 pwMS were enrolled in the study, with n=24 classified as non-fallers (63% females, 48 years, EDSS 2.2), n=16 as fallers (88% females, 57 years, EDSS 3.3), and n=13 as recurrent fallers (46% females, 60 years, EDSS 4.2). Compared with non-fallers, neuromuscular function was reduced in both fallers (RFD50 -4.42 [-7.47;-1.37] Nm.s-1.kg-1, -48%; RFD200 -1.45 [-2.98;0.07] Nm.s-1.kg-1, -24%; Fmax -0.42 [-0.81;-0.03] Nm.kg-1, -21%) and recurrent fallers (RFD50 -5.69 [-8.94;-2.43] Nm.s-1.kg-1, -62%; RFD200 -2.26 [-3.89;-0.63] Nm.s-1.kg-1, -38%; Fmax -0.38 [-0.80;0.03] Nm.kg-1, -19%). Across all participants, associations were observed between RFD50ms and falls (rs = -0.46 [-0.67;-0.24], between RFD200ms and falls (rs = -0.34 [-0.59;-0.09]), and between Fmax and falls (rs = -0.24 [-0.48;0.01]). CONCLUSION In this exploratory study, knee extensor neuromuscular function was able to discriminate fallers from non-fallers in pwMS, with RFD being superior to Fmax. Routine assessment of lower extremity neuromuscular function (RFD50ms in particular) may be a helpful tool in identifying pwMS at future risk of falling.
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Affiliation(s)
- Nick M Kristensen
- Exercise Biology, Department of Public Health, Aarhus University, Denmark
| | | | - Tobias Gaemelke
- Exercise Biology, Department of Public Health, Aarhus University, Denmark
| | - Morten Riemenschneider
- Exercise Biology, Department of Public Health, Aarhus University, Denmark; The Danish MS Hospitals, Ry and Haslev, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Denmark; The Danish MS Hospitals, Ry and Haslev, Denmark.
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25
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Goffredo M, Pagliari C, Turolla A, Tassorelli C, Di Tella S, Federico S, Pournajaf S, Jonsdottir J, De Icco R, Pellicciari L, Calabrò RS, Baglio F, Franceschini M. Non-Immersive Virtual Reality Telerehabilitation System Improves Postural Balance in People with Chronic Neurological Diseases. J Clin Med 2023; 12:jcm12093178. [PMID: 37176618 PMCID: PMC10179507 DOI: 10.3390/jcm12093178] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND People with chronic neurological diseases, such as Parkinson's Disease (PD) and Multiple Sclerosis (MS), often present postural disorders and a high risk of falling. When difficulties in achieving outpatient rehabilitation services occur, a solution to guarantee the continuity of care may be telerehabilitation. This study intends to expand the scope of our previously published research on the impact of telerehabilitation on quality of life in an MS sample, testing the impact of this type of intervention in a larger sample of neurological patients also including PD individuals on postural balance. METHODS We included 60 participants with MS and 72 with PD. All enrolled subjects were randomized into two groups: 65 in the intervention group and 67 in the control group. Both treatments lasted 30-40 sessions (5 days/week, 6-8 weeks). Motor, cognitive, and participation outcomes were registered before and after the treatments. RESULTS All participants improved the outcomes at the end of the treatments. The study's primary outcome (Mini-BESTest) registered a greater significant improvement in the telerehabilitation group than in the control group. CONCLUSIONS Our results demonstrated that non-immersive virtual reality telerehabilitation is well tolerated and positively affects static and dynamic balance and gait in people with PD and MS.
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Affiliation(s)
- Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
| | - Chiara Pagliari
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, 40138 Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Sonia Di Tella
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Sara Federico
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy
| | - Sanaz Pournajaf
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
| | | | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | | | | | | | - Marco Franceschini
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00166 Rome, Italy
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Cortés-Pérez I, Osuna-Pérez MC, Montoro-Cárdenas D, Lomas-Vega R, Obrero-Gaitán E, Nieto-Escamez FA. Virtual reality-based therapy improves balance and reduces fear of falling in patients with multiple sclerosis. a systematic review and meta-analysis of randomized controlled trials. J Neuroeng Rehabil 2023; 20:42. [PMID: 37041557 PMCID: PMC10088228 DOI: 10.1186/s12984-023-01174-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE This study aims to conduct a meta-analysis to assess the effect of virtual reality-based therapy (VRBT) on balance dimensions and fear of falling in patients with multiple sclerosis (PwMS). Secondarily, to determine the most recommendable dose of VRBT to improve balance. METHODS PubMed Medline, Web of Science, Scopus, CINAHL and PEDro were screened, without publication date restrictions, until September 30th, 2021. Randomized controlled trials (RCTs) comparing the effectiveness of VRBT against other interventions in PwMS were included. Functional and dynamic balance, confidence of balance, postural control in posturography, fear of falling and gait speed were the variables assessed. A meta-analysis was performed by pooling the Cohen's standardized mean difference (SMD) with 95% confidence interval (95% CI) using Comprehensive Meta-Analysis 3.0. RESULTS Nineteen RCTs, reporting 858 PwMS, were included. Our findings reported that VRBT is effective in improving functional balance (SMD = 0.8; 95%CI 0.47 to 1.14; p < 0.001); dynamic balance (SMD = - 0.3; 95%CI - 0.48 to - 0.11; p = 0.002); postural control with posturography (SMD = - 0.54; 95%CI - 0.99 to - 0.1; p = 0.017); confidence of balance (SMD = 0.43; 95%CI 0.15 to 0.71; p = 0.003); and in reducing fear of falling (SMD = - 1.04; 95%CI - 2 to - 0.07; p = 0.035); but not on gait speed (SMD = - 0.11; 95%CI: - 0.35 to 0.14; p = 0.4). Besides, the most adequate dose of VRBT to achieve the greatest improvement in functional balance was at least 40 sessions, five sessions per week and 40-45 min per sessions; and for dynamic balance, it would be between 8 and 19 weeks, twice a week and 20-30 min per session. CONCLUSION VRBT may have a short-term beneficial role in improving balance and reducing fear of falling in PwMS.
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Affiliation(s)
- Irene Cortés-Pérez
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, Jaén, Spain
| | | | | | - Rafael Lomas-Vega
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, Jaén, Spain
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, Jaén, Spain.
| | - Francisco Antonio Nieto-Escamez
- Center for Neuropsychological Assessment and Neurorehabilitation (CERNEP), University of Almería, Almería, Spain
- Department of Psychology, University of Almería, Ctra. Sacramento, s/n, La Cañada, Almería, Spain
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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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Ventura L, Martinez G, Aiello E, Dvir Z, Deriu F, Manca A. Isokinetic Resistance Training for Ankle Plantarflexor Spasticity and Muscle Weakness in People With Multiple Sclerosis: A Proof-of-Concept Case Series. Phys Ther 2022; 103:pzac146. [PMID: 36222464 DOI: 10.1093/ptj/pzac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/24/2022] [Accepted: 08/19/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To the best of the authors' knowledge, no data are available about the use of isokinetic resistance training for managing ankle plantarflexor spastic hypertonia in people with multiple sclerosis (MS). The aim of this proof-of-concept study was to explore the feasibility and effects of concentric contractions on spasticity-related resistance to passive motion, strength, and mobility in people with MS and ankle plantarflexor spasticity. METHODS In this pretest/posttest case series, 5 people with MS (mean age = 53.6 [SD = 8.8] years; median Expanded Disability Status Scale score = 5; Modified Ashworth Scale range = 1-4) received 6 weeks of isokinetic resistance training of the spastic plantarflexors. Before and after the intervention, the following outcomes were assessed: average peak torque during passive robotic mobilization, isometric strength, surface electromyography (sEMG) from the spastic muscles, time to complete the 10-m Walk Test, and the Timed "Up & Go" Test. The standardized effect size was used to test pretest and posttest effects at the individual level. Group-level analyses were also performed. RESULTS Following the training, the average peak torque recorded from the plantarflexors during passive motion at a velocity of 150 degrees per second was found to be decreased by at least 1 SD in all participants but 1, with a significant reduction at the group level of 23.8%. Conversely, no changes in sEMG activity were detected. Group-level analyses revealed that the maximal strength of the trained plantarflexors increased significantly (31.4%). Fast walking speed increased and time to complete the Timed "Up & Go" Test decreased in 4 participants, although not significantly at the group level. CONCLUSION Isokinetic resistance training proved safe and feasible in people who had MS and ankle plantarflexor spasticity. The observed reductions in resistance to passive motion from the spastic plantarflexors in the absence of sEMG changes might suggest a mechanical rather than a neural effect of the training. IMPACT Based on these preliminary findings, isokinetic resistance training does not exacerbate hypertonia in people with MS and ankle plantarflexor spasticity and could be safely used to manage muscle weakness in this population.
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Affiliation(s)
- Lucia Ventura
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Gianluca Martinez
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Elena Aiello
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Zeevi Dvir
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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29
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Abou L, Peters J, Fritz NE, Sosnoff JJ, Kratz AL. Motor Cognitive Dual-Task Testing to Predict Future Falls in Multiple Sclerosis: A Systematic Review. Neurorehabil Neural Repair 2022; 36:757-769. [PMID: 36320121 DOI: 10.1177/15459683221131791] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Mobility and cognitive impairments are often associated with increased fall risk among people with multiple sclerosis (PwMS). However, evidence on the concurrent assessment of gait or balance and cognitive tasks (dual-task) to predict falls appears to be inconsistent. OBJECTIVE To summarize the ability of gait or balance dual-task testing to predict future falls among PwMS. METHODS Seven databases including PubMed, Embase, Web of Science, Scopus, CINHAL, SPORTDiscuss, and PsycINFO were searched from inception to May 2022. Two independent reviewers identified studies that performed a dual-task testing among adults with multiple sclerosis and monitored falls prospectively for at least 3 months. Both reviewers also evaluated the quality assessment of the included studies. RESULTS Eight studies with 484 participants were included in the review. Most studies (75%) indicated that dual-task testing and dual-task cost did not discriminate prospective fallers (⩾1 fall) and non-fallers (0 fall) and were not found as predictors of future falls. However, dual-task cost of walking velocity (OR = 1.23, 95% CI 0.98-4.45, P = .05) and dual-task of correct response rate of serial 7 subtraction (OR = 1.34, 95% CI 1.04-3.74, P = .02) were significantly associated with increased risk of recurrent falls (≥2 falls). Pattern of cognitive-motor interference was also associated with an increased risk of falling. All studies presented with strong quality. CONCLUSION The scarce evidence indicates that dual-task testing is not able to predict future falls among PwMS. Further research with more complex motor and cognitive tasks and longer-term fall monitoring is required before dual-task testing can be recommended as a predictor of future falls in this population.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joseph Peters
- Department of Kinesiology & Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Nora E Fritz
- Departments of Health Care Sciences & Neurology, Wayne State University, Detroit, MI, USA
| | - Jacob J Sosnoff
- Department of Physical Therapy, Rehabilitation Science, & Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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30
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Matsuda PN, Hoffman JM. Patient perspectives on falls in persons with multiple sclerosis. PM R 2022; 14:1474-1482. [PMID: 34676992 DOI: 10.1002/pmrj.12724] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/27/2021] [Accepted: 10/10/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Falls and their consequences are known to be major contributors to decreased health and well-being in older adults. Several studies suggest that fall rates are higher among individuals with disabling conditions such as multiple sclerosis (MS). However, there is a knowledge gap regarding how individuals with a disability define falls or understand their consequences. OBJECTIVE To gain the perspective of community-dwelling adults living with MS about falls and their consequences and to understand the conditions and circumstances surrounding falls, and to identify the specific attributes of a community fall-prevention program that would facilitate participation. DESIGN Focus groups or individual interviews were conducted with people with MS. SETTING/PARTICIPANTS Community-dwelling adults living with MS (n = 20) (men = 8 [34.7%], mean age 63.2 years [standard deviation (SD) 5.3, range 55-75]). Average time since diagnosis was 20.6 years (SD 9.6, range 9-44). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Not applicable. RESULTS All participants agreed that the definition of a fall required "ending up on the floor." However, the starting point differed depending on mobility ability and device use. When using the most common research definition, individuals reported an increase in their number of falls as compared to when using their personal definition. Most participants considered "fear of falling" to be different from "concern about falling." Participants wanted to learn how to fall and would not join a program with the word "fall" in the title. CONCLUSIONS Results suggest that fall data for individuals with MS may not be reported accurately. Health care providers would get more accurate data if they provide specific definitions for falls and ask specifically about fear and concern about falling. Patient-centered programming needs to be developed that includes both how to fall and how to engage people with MS, including potential facilitators and barriers to participation.
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Affiliation(s)
- Patricia Noritake Matsuda
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
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31
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Loyd BJ, Fangman A, Peterson DS, Gappmaier E, Thackeray A, Schubert MC, Dibble LE. Rehabilitation to Improve Gaze and Postural Stability in People With Multiple Sclerosis: A Randomized Clinical Trial. Neurorehabil Neural Repair 2022; 36:678-688. [PMID: 36113117 PMCID: PMC10518217 DOI: 10.1177/15459683221124126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND People with multiple sclerosis (PwMS) frequently experience dizziness and imbalance that may be caused by central vestibular system dysfunction. Vestibular rehabilitation may offer an approach for improving dysfunction in these people. OBJECTIVE To test the efficacy of a gaze and postural stability (GPS) retraining intervention compared to a strength and endurance (SAE) intervention in PwMS. METHODS About 41 PwMS, with complaints of dizziness or history of falls, were randomized to either the GPS or SAE groups. Following randomization participants completed 6-weeks of 3×/week progressive training, delivered one-on-one by a provider. Following intervention, testing was performed at the primary (6-weeks) and secondary time point (10-weeks). A restricted maximum likelihood estimation mixed effects model was used to examine changes in the primary outcome of the Dizziness Handicap Inventory (DHI) between the 2 groups at the primary and secondary time point. Similar models were used to explore secondary outcomes between groups at both timepoints. RESULTS Thirty-five people completed the study (17 GPS; 18 SAE). The change in the DHI at the primary time point was not statistically different between the GPS and SAE groups (mean difference = 2.33 [95% CI -9.18, 12.85]). However, both groups demonstrated significant improvement from baseline to 6-weeks (GPS -8.73; SAE -7.31). Similar results were observed for secondary outcomes and at the secondary timepoint. CONCLUSIONS In this sample of PwMS with complaints of dizziness or imbalance, 6-weeks of GPS training did not result in significantly greater improvements in dizziness handicap or balance compared to 6-weeks of SAE training.
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Affiliation(s)
- Brian J. Loyd
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
| | - Annie Fangman
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | | | - Eduard Gappmaier
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | - Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | - Michael C. Schubert
- Department of Otolaryngology-Head and Neck Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leland E. Dibble
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
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Schumann P, Scholz M, Trentzsch K, Jochim T, Śliwiński G, Malberg H, Ziemssen T. Detection of Fall Risk in Multiple Sclerosis by Gait Analysis-An Innovative Approach Using Feature Selection Ensemble and Machine Learning Algorithms. Brain Sci 2022; 12:1477. [PMID: 36358403 PMCID: PMC9688245 DOI: 10.3390/brainsci12111477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 10/15/2023] Open
Abstract
One of the common causes of falls in people with Multiple Sclerosis (pwMS) is walking impairment. Therefore, assessment of gait is of importance in MS. Gait analysis and fall detection can take place in the clinical context using a wide variety of available methods. However, combining these methods while using machine learning algorithms for detecting falls has not been performed. Our objective was to determine the most relevant method for determining fall risk by analyzing eleven different gait data sets with machine learning algorithms. In addition, we examined the most important features of fall detection. A new feature selection ensemble (FS-Ensemble) and four classification models (Gaussian Naive Bayes, Decision Tree, k-Nearest Neighbor, Support Vector Machine) were used. The FS-Ensemble consisted of four filter methods: Chi-square test, information gain, Minimum Redundancy Maximum Relevance and RelieF. Various thresholds (50%, 25% and 10%) and combination methods (Union, Union 2, Union 3 and Intersection) were examined. Patient-reported outcomes using specialized walking questionnaires such as the 12-item Multiple Sclerosis Walking Scale (MSWS-12) and the Early Mobility Impairment Questionnaire (EMIQ) achieved the best performances with an F1 score of 0.54 for detecting falls. A combination of selected features of MSWS-12 and EMIQ, including the estimation of walking, running and stair climbing ability, the subjective effort as well as necessary concentration and walking fluency during walking, the frequency of stumbling and the indication of avoidance of social activity achieved the best recall of 75%. The Gaussian Naive Bayes was the best classification model for detecting falls with almost all data sets. FS-Ensemble improved the classification models and is an appropriate technique for reducing data sets with a large number of features. Future research on other risk factors, such as fear of falling, could provide further insights.
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Affiliation(s)
- Paula Schumann
- Institute of Biomedical Engineering, TU Dresden, Fetscherstr. 29, 01307 Dresden, Germany
| | - Maria Scholz
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Katrin Trentzsch
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Thurid Jochim
- Institute of Biomedical Engineering, TU Dresden, Fetscherstr. 29, 01307 Dresden, Germany
| | - Grzegorz Śliwiński
- Institute of Biomedical Engineering, TU Dresden, Fetscherstr. 29, 01307 Dresden, Germany
| | - Hagen Malberg
- Institute of Biomedical Engineering, TU Dresden, Fetscherstr. 29, 01307 Dresden, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
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Meyer BM, Tulipani LJ, Gurchiek RD, Allen DA, Solomon AJ, Cheney N, McGinnis RS. Open-source dataset reveals relationship between walking bout duration and fall risk classification performance in persons with multiple sclerosis. PLOS DIGITAL HEALTH 2022; 1:e0000120. [PMID: 36812538 PMCID: PMC9931255 DOI: 10.1371/journal.pdig.0000120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/02/2022] [Indexed: 11/06/2022]
Abstract
Falls are frequent and associated with morbidity in persons with multiple sclerosis (PwMS). Symptoms of MS fluctuate, and standard biannual clinical visits cannot capture these fluctuations. Remote monitoring techniques that leverage wearable sensors have recently emerged as an approach sensitive to disease variability. Previous research has shown that fall risk can be identified from walking data collected by wearable sensors in controlled laboratory conditions however this data may not be generalizable to variable home environments. To investigate fall risk and daily activity performance from remote data, we introduce a new open-source dataset featuring data collected from 38 PwMS, 21 of whom are identified as fallers and 17 as non-fallers based on their six-month fall history. This dataset contains inertial-measurement-unit data from eleven body locations collected in the laboratory, patient-reported surveys and neurological assessments, and two days of free-living sensor data from the chest and right thigh. Six-month (n = 28) and one-year repeat assessment (n = 15) data are also available for some patients. To demonstrate the utility of these data, we explore the use of free-living walking bouts for characterizing fall risk in PwMS, compare these data to those collected in controlled environments, and examine the impact of bout duration on gait parameters and fall risk estimates. Both gait parameters and fall risk classification performance were found to change with bout duration. Deep learning models outperformed feature-based models using home data; the best performance was observed with all bouts for deep-learning and short bouts for feature-based models when evaluating performance on individual bouts. Overall, short duration free-living walking bouts were found to be the least similar to laboratory walking, longer duration free-living walking bouts provided more significant differences between fallers and non-fallers, and an aggregation of all free-living walking bouts yields the best performance in fall risk classification.
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Affiliation(s)
- Brett M. Meyer
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, United States of America
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America
| | - Lindsey J. Tulipani
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
| | - Reed D. Gurchiek
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vermont, United States of America
| | - Dakota A. Allen
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, United States of America
| | - Andrew J. Solomon
- Department of Computer Science, University of Vermont, Burlington, Vermont, United States of America
| | - Nick Cheney
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America
| | - Ryan S. McGinnis
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, United States of America
- * E-mail:
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34
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Connecting real-world digital mobility assessment to clinical outcomes for regulatory and clinical endorsement-the Mobilise-D study protocol. PLoS One 2022; 17:e0269615. [PMID: 36201476 PMCID: PMC9536536 DOI: 10.1371/journal.pone.0269615] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The development of optimal strategies to treat impaired mobility related to ageing and chronic disease requires better ways to detect and measure it. Digital health technology, including body worn sensors, has the potential to directly and accurately capture real-world mobility. Mobilise-D consists of 34 partners from 13 countries who are working together to jointly develop and implement a digital mobility assessment solution to demonstrate that real-world digital mobility outcomes have the potential to provide a better, safer, and quicker way to assess, monitor, and predict the efficacy of new interventions on impaired mobility. The overarching objective of the study is to establish the clinical validity of digital outcomes in patient populations impacted by mobility challenges, and to support engagement with regulatory and health technology agencies towards acceptance of digital mobility assessment in regulatory and health technology assessment decisions. METHODS/DESIGN The Mobilise-D clinical validation study is a longitudinal observational cohort study that will recruit 2400 participants from four clinical cohorts. The populations of the Innovative Medicine Initiative-Joint Undertaking represent neurodegenerative conditions (Parkinson's Disease), respiratory disease (Chronic Obstructive Pulmonary Disease), neuro-inflammatory disorder (Multiple Sclerosis), fall-related injuries, osteoporosis, sarcopenia, and frailty (Proximal Femoral Fracture). In total, 17 clinical sites in ten countries will recruit participants who will be evaluated every six months over a period of two years. A wide range of core and cohort specific outcome measures will be collected, spanning patient-reported, observer-reported, and clinician-reported outcomes as well as performance-based outcomes (physical measures and cognitive/mental measures). Daily-living mobility and physical capacity will be assessed directly using a wearable device. These four clinical cohorts were chosen to obtain generalizable clinical findings, including diverse clinical, cultural, geographical, and age representation. The disease cohorts include a broad and heterogeneous range of subject characteristics with varying chronic care needs, and represent different trajectories of mobility disability. DISCUSSION The results of Mobilise-D will provide longitudinal data on the use of digital mobility outcomes to identify, stratify, and monitor disability. This will support the development of widespread, cost-effective access to optimal clinical mobility management through personalised healthcare. Further, Mobilise-D will provide evidence-based, direct measures which can be endorsed by regulatory agencies and health technology assessment bodies to quantify the impact of disease-modifying interventions on mobility. TRIAL REGISTRATION ISRCTN12051706.
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35
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Ross BJ, Ross AJ, Lee OC, Waters TL, Familia MM, Sherman WF. Osteoporosis management and secondary fragility fracture rates in patients with multiple sclerosis: a matched cohort study. Osteoporos Int 2022; 33:1999-2010. [PMID: 35670832 DOI: 10.1007/s00198-022-06451-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 05/24/2022] [Indexed: 12/21/2022]
Abstract
UNLABELLED This study highlights the persistent osteoporosis treatment gap following fragility fractures. Patients with multiple sclerosis sustained more primary hip fractures than controls and exhibited significantly higher rates of falls within three years post-fracture. However, multiple sclerosis (MS) patients were significantly more likely to be diagnosed with osteoporosis and treated with medications. INTRODUCTION The purpose of this study was to compare rates of osteoporosis management, falls, and secondary fractures following primary fragility fractures among patients with MS versus matched controls. MATERIALS AND METHODS A retrospective matched cohort study was conducted using the PearlDiver database. Patients aged ≥ 50 years with primary fragility fractures were identified (n = 120,368). Within this population, patients with MS were matched 1:10 with controls across age, sex, and US region. Rates of osteoporosis diagnoses and pharmacologic treatment, low-energy falls, and secondary fragility fractures were compared at three years post-fracture via logistic regression. RESULTS A total of 1,232 patients with MS (mean age, 65.7 years) with primary fragility fractures were matched with 12,320 controls (mean age, 65.8 years). Primary hip fractures were significantly more common in the MS cohort (47.4% vs. 34.2%, p < 0.001). After the initial fracture, patients with MS were significantly more likely to receive a formal osteoporosis diagnosis (12.9% vs. 9.7%; OR 1.35; 95% CI, 1.13-1.61) and osteoporosis pharmacotherapy (14.4% vs. 11.9%; OR 1.24; 95% CI, 1.04-1.46). The MS cohort also exhibited significantly higher rates of falls (27.8% vs 22.7%; OR 1.15; 95% CI, 1.01-1.32). Rates of secondary fractures were comparable (6.3% vs. 5.0%; OR 1.10; 95% CI, 0.85-1.40). CONCLUSION Primary hip fragility fractures were significantly more common in patients with MS compared to matched controls. Following an initial fracture, patients with MS exhibited a significantly higher rate of falls but were more likely to be diagnosed with osteoporosis and treated with medications.
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Affiliation(s)
- Bailey J Ross
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Austin J Ross
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Olivia C Lee
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Orthopaedic Surgery, LSUHSC School of Medicine, New Orleans, LA, USA
- Department of Orthopaedic Surgery, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
| | - Timothy L Waters
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - McCayn M Familia
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - William F Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
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36
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Arpan I, Shah VV, McNames J, Harker G, Carlson-Kuhta P, Spain R, El-Gohary M, Mancini M, Horak FB. Fall Prediction Based on Instrumented Measures of Gait and Turning in Daily Life in People with Multiple Sclerosis. SENSORS (BASEL, SWITZERLAND) 2022; 22:5940. [PMID: 36015700 PMCID: PMC9415310 DOI: 10.3390/s22165940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
This study investigates the potential of passive monitoring of gait and turning in daily life in people with multiple sclerosis (PwMS) to identify those at future risk of falls. Seven days of passive monitoring of gait and turning were carried out in a pilot study of 26 PwMS in home settings using wearable inertial sensors. The retrospective fall history was collected at the baseline. After gait and turning data collection in daily life, PwMS were followed biweekly for a year and were classified as fallers if they experienced >1 fall. The ability of short-term passive monitoring of gait and turning, as well as retrospective fall history to predict future falls were compared using receiver operator curves and regression analysis. The history of retrospective falls was not identified as a significant predictor of future falls in this cohort (AUC = 0.62, p = 0.32). Among quantitative monitoring measures of gait and turning, the pitch at toe-off was the best predictor of falls (AUC = 0.86, p < 0.01). Fallers had a smaller pitch of their feet at toe-off, reflecting less plantarflexion during the push-off phase of walking, which can impact forward propulsion and swing initiation and can result in poor foot clearance and an increased metabolic cost of walking. In conclusion, our cohort of PwMS showed that objective monitoring of gait and turning in daily life can identify those at future risk of falls, and the pitch at toe-off was the single most influential predictor of future falls. Therefore, interventions aimed at improving the strength of plantarflexion muscles, range of motion, and increased proprioceptive input may benefit PwMS at future fall risk.
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Affiliation(s)
- Ishu Arpan
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- Advanced Imaging Research Center, Oregon Health & Science University Portland, OR 97239, USA
| | - Vrutangkumar V. Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- APDM Wearable Technologies-A Clario Company, 2828 S Corbett Ave, Ste 135, Portland, OR 97201, USA
| | - James McNames
- APDM Wearable Technologies-A Clario Company, 2828 S Corbett Ave, Ste 135, Portland, OR 97201, USA
- Department of Electrical and Computer Engineering, Portland State University, 1825 SW Broadway, Portland, OR 97201, USA
| | - Graham Harker
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | | | - Rebecca Spain
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Mahmoud El-Gohary
- APDM Wearable Technologies-A Clario Company, 2828 S Corbett Ave, Ste 135, Portland, OR 97201, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Fay B. Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- APDM Wearable Technologies-A Clario Company, 2828 S Corbett Ave, Ste 135, Portland, OR 97201, USA
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Yakut H, Maden TK, Akçalı AH. Comparing the effects of cognitive dual tasking on balance and gait motor performance in people with mild multiple sclerosis and healthy individuals. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims People with multiple sclerosis show both cognitive and postural impairment, and various static and dynamic postural activities may be affected under conditions of cognitive distraction. The aim of this study was to determine the effects of cognitive dual tasking on the balance and gait motor performance of people with mild multiple sclerosis (Expanded Disability Status Scale score of 2.0 ± 1.3) and healthy people and to compare these two groups in terms of performing single and dual tasks. Methods People with mild multiple sclerosis (n=39) and healthy individuals (n=33) performed static balance tests (Romberg's Test, tandem stance test, single-legged stance test) and dynamic balance tests (Functional Reach Test, Four Square Step Test, Timed Up and Go Test, 10-Metre Walk Test), with and without a word list generation test (single and dual tasks). Independent t-tests were used to evaluate differences between the two groups, and paired t-tests were used for single or dual tasks for all static and dynamic tests. The magnitude of differences in tasks between measures was expressed as Cohen's d. Results Dual task effects were more evident during dynamic balance tests in participants with multiple sclerosis and healthy participants (specifically the Timed Up and Go Test and 10-Metre Walk Test) (P<0.001). There was a significant difference between both groups only in terms of static balance (P<0.001). Conclusions Dynamic balance and gait were shown to be more affected when performing the dual cognitive task than static balance in people with multiple sclerosis. Dual tasks should be included in diagnoses.
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Affiliation(s)
- Hatice Yakut
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Süleyman Demirel University, Isparta, Turkey
| | - Tuba Kaplan Maden
- Department of Physical Therapy and Rehabilitation, Gaziantep University, Gaziantep, Turkey
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Wilkinson H, McGraw C, Chung K, Kyratsis Y. "Can I exercise? Would it help? Would it not?": exploring the experiences of people with relapsing remitting multiple sclerosis engaging with physical activity during a relapse: a qualitative study. Disabil Rehabil 2022:1-12. [PMID: 35727957 DOI: 10.1080/09638288.2022.2084774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Physical activity (PA) has been found to be beneficial for people with multiple sclerosis (pwMS) outside of the relapse period. However, little is known about how people experience PA during a relapse. This study investigates the experiences of pwMS engaging with PA during a relapse. MATERIALS AND METHODS The study followed an interpretivist approach, adopting a qualitative exploratory design. Semi-structured interviews were conducted with a purposive sample of 15 adults following a recent relapse. Transcripts were analysed in NVivo using framework analysis. RESULTS The experiences of participants were synthesised in three overarching themes: "on the road to recovery", "getting active but fearing repercussions", and "self-directed versus guided recovery". Barriers to PA included: feeling unwell, physical limitations, concerns about causing deterioration, worries that others would recognise their disability, and lack of professional support. Facilitators included: awareness of the benefits of PA, access to exercise resources, individualised advice and support from practitioners, and PA pitched at the right level. CONCLUSIONS Relapses can disrupt normal PA routines, making it challenging to return to PA. This article makes recommendations for supporting people to undertake PA, the timing and form of support, along with suggestions for further research exploring the safety of PA during a relapse. Implications for rehabilitationPeople with RRMS find it difficult to be physically active during a relapse.There are complex personal, social and environmental reasons why people find it hard to engage with physical activity (PA).Improved timely advice and customised support during a relapse can help reduce fears and enhance confidence with returning to PA.Physical activity recommendations should be tailored to individual's abilities to make them achievable, giving a sense of accomplishment and boosting motivation.
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Affiliation(s)
- Holly Wilkinson
- The National Hospital for Neurology and Neurosurgery, London, UK.,School of Health Sciences, City, University of London, London, UK
| | - Caroline McGraw
- School of Health Sciences, City, University of London, London, UK
| | - Karen Chung
- The National Hospital for Neurology and Neurosurgery, London, UK
| | - Yiannis Kyratsis
- Department of Organization Science, Faculty of Social Sciences, VU Amsterdam, Amsterdam, The Netherlands
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The 3-m backward walk test: reliability and validity in ambulant people with multiple sclerosis. Int J Rehabil Res 2022; 45:209-214. [PMID: 35638202 DOI: 10.1097/mrr.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To investigate: (a) the interrater and test-retest reliability of the 3-m backward walk test (3MBW) in ambulant people with multiple sclerosis (PwMS); (b) minimal detectable change (MDC); (c) concurrent and known-groups validity; and (d) the cutoff time to best discriminate fallers from nonfallers with multiple sclerosis (MS). Forty-nine PwMS and 36 healthy people were included in this cross-sectional study. The 3MBW was administered with the timed up and go test, Berg Balance Scale, four square step test, Falls Efficacy Scale-International, and Expanded Disability Status Scale. The 3MBW was simultaneously performed by two independent raters to examine the interrater reliability while was repeated after 7-10 days to examine the test-retest reliability. The 3MBW showed good interrater reliability [intraclass correlation coefficient (ICC) = 0.987-0.989] and excellent test-retest reliability (ICC = 0.854-0.889). The MDC was found to be 1.69 s. The 3MBW had moderate-to-strong correlations with the other measures. For the 3MBW, PwMS had worse performance than healthy people (P < 0.001), whereas fallers with MS had worse performance than nonfallers with MS (P < 0.001). The 3MBW time of 7.86 s was determined to best discriminate fallers from nonfallers with MS. The 3MBW is a reliable, simple, and easy-to-administer tool for assessing backward walking among ambulant PwMS.
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Cusin FS, Tomaz A, Ganança MM, Oliveira EM, Gonçalves ABF, Caovilla HH. Postural Control in Relapsing-Remitting Multiple Sclerosis. Int Arch Otorhinolaryngol 2022; 26:e592-e604. [PMID: 36405484 PMCID: PMC9668432 DOI: 10.1055/s-0041-1741026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction
Postural instability is considered one of the most disabling symptoms of relapsing-remitting multiple sclerosis (RRMS).
Objective
To evaluate postural control in patients with RRMS.
Method
A total of 79 individuals between 18 and 65 years old, of both genders, were distributed into an experimental group composed of patients with RRMS (
n
= 51) and in a control group composed by healthy individuals (
n
= 28). The evaluation consisted of anamnesis, Dizziness Handicap Inventory (DHI), visual vertigo analog scale (VVAS), and static posturography (Tetrax IBS).
Results
Patients with RRMS presented mild degree in the DHI and in the VVAS; in Tetrax IBS, they presented higher or lower values of the indices of general stability, weight distribution, synchronization of postural oscillation, fall risk, and frequency bands of postural oscillation in two, five or all eight sensory conditions, in relation to the control group. Vestibular, visual and/or somatosensory dysfunction of peripheral type (51.0%) prevailed over the central type. The RRMS group, with an expanded scale of disability status > 3 points, presented a higher fall risk than with a score ≤ 3 points (
p
= 0.003). There was a positive correlation of the Fall Risk Index with the total DHI Score (s = 0.380;
p
= 0.006) and with the VVAS score (s = 0.348;
p
= 0.012).
Conclusion
Patients with RRMS may present with inability to maintain postural control due to general instability, desynchronization and increased postural oscillation at frequencies that suggest deficiencies in the vestibular, visual, and somatosensory systems; as well as fall risk related to the state and intensity of functional disability and self-perception of the influence of dizziness on quality of life.
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Affiliation(s)
- Flavia Salvaterra Cusin
- Department of Otolaryngology and Head and Neck Surgery, Otology and Neurotology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Andreza Tomaz
- Department of Otolaryngology and Head and Neck Surgery, Otology and Neurotology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maurício Malavasi Ganança
- Department of Otolaryngology and Head and Neck Surgery, Otology and Neurotology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Enedina Maria Oliveira
- Department of Neurology and Neurosurgery, Demyelinating Diseases Outpatient Clinic, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Alessandra Billi Falcão Gonçalves
- Department of Neurology and Neurosurgery, Demyelinating Diseases Outpatient Clinic, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Heloisa Helena Caovilla
- Department of Otolaryngology and Head and Neck Surgery, Otology and Neurotology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Carratalá-Tejada M, Cuesta-Gómez A, Ortiz-Gutiérrez R, Molina-Rueda F, Luna-Oliva L, Miangolarra-Page JC. Reflex Locomotion Therapy for Balance, Gait, and Fatigue Rehabilitation in Subjects with Multiple Sclerosis. J Clin Med 2022; 11:jcm11030567. [PMID: 35160020 PMCID: PMC8836377 DOI: 10.3390/jcm11030567] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
This study evaluates the effects of a rehabilitation program based on reflex locomotion therapy (RLT) on balance, gait, and fatigue in patients with multiple sclerosis (MS). Twenty-three patients diagnosed with MS participated in this study. Reversal design was carried out. The assessment tools included the Berg Balance Scale (BBS), the Performance Oriented Mobility Assessment (POMA), the Fatigue Severity Scale (FSS) and the instrumental analysis of the gait recorded by Vicon Motion System®. We analyzed spatio-temporal parameters and kinematic variables of the hip, knee, and ankle joints. Additionally, the Client Satisfaction Questionnaire (CSQ-8) was administrated. We did find a significant improvement in balance and gait tools after the RLT period. Regarding instrumental analysis, the statistical analysis of spatio-temporal parameters showed a significant improvement in stride length, double support, and velocity after the RLT period. Concerning kinematic parameters, the analysis showed improvements in hip and knee range of motion (ROM) after RLT period. RLT could improve gait and balance in patients with MS. The patients reported a high level of satisfaction with the therapy received.
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Affiliation(s)
- María Carratalá-Tejada
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.C.-T.); (A.C.-G.); (L.L.-O.); (J.C.M.-P.)
| | - Alicia Cuesta-Gómez
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.C.-T.); (A.C.-G.); (L.L.-O.); (J.C.M.-P.)
| | - Rosa Ortiz-Gutiérrez
- Department of Physical Therapy and Nursing, Universidad Internacional Nebrija, 28015 Madrid, Spain;
| | - Francisco Molina-Rueda
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.C.-T.); (A.C.-G.); (L.L.-O.); (J.C.M.-P.)
- Correspondence:
| | - Laura Luna-Oliva
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.C.-T.); (A.C.-G.); (L.L.-O.); (J.C.M.-P.)
| | - Juan Carlos Miangolarra-Page
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.C.-T.); (A.C.-G.); (L.L.-O.); (J.C.M.-P.)
- Physical Medicine and Rehabilitation Service, University Hospital of Fuenlabrada, 28942 Madrid, Spain
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42
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Van der Linden ML, Van Schie PEM, Hjalmarsson E, Andreopoulou G, Verheul MHG, Von Walden F. Frame running to confidence: the athlete-perceived impact of an adapted physical activity on aspects of physical fitness, functional mobility and psychosocial outcomes. J Rehabil Med 2022; 54:jrm00273. [PMID: 35019994 PMCID: PMC8902585 DOI: 10.2340/jrm.v53.1393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Frame Running (RaceRunning) allows people with moderate-to-severe mobility impairments to participate in physical activity using a 3-wheeled frame with a saddle and handlebars. The aim of this study was to investigate athlete-perceived impact of Frame Running on aspects of physical fitness, functional mobility and psychosocial outcomes. Design Survey. Participants Frame Running athletes aged 5 years and over. Methods A survey was distributed to athletes through their club or sports organization. Results The survey was completed by 115 athletes (53 females). Median age was 17 years (range 5–62 years) and 64 (57%) used a wheelchair or walker for distances over 50 m. Many felt that Frame Running stretched their muscles (n = 93, 87%) and increased their self-confidence (n = 63, 93%). Four (4%) reported extreme fatigue or sore muscles after training (n = 17, 15%). Of the 110 athletes who had been participating in Frame Running for over 3 months, 46 (47%) reported being less out of breath during mobility tasks and 66 (66%) felt they had improved their functional mobility. However, 7 (7%) reported increased muscle tightness and 4 (4%) reported a Frame Running-related injury lasting more than 4 weeks. Conclusion Frame Running is a safe physical activity with athlete-perceived benefits on physical fitness, functional mobility and psychosocial outcomes.
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Affiliation(s)
- Marietta L Van der Linden
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh, EH21 6UU, UK.
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43
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Torkhani E, Dematte E, Slawinski J, Csillik A, Gay MC, Bensmaïl D, Heinzlef O, de Marco G. Improving Health of People With Multiple Sclerosis From a Multicenter Randomized Controlled Study in Parallel Groups: Preliminary Results on the Efficacy of a Mindfulness Intervention and Intention Implementation Associated With a Physical Activity Program. Front Psychol 2022; 12:767784. [PMID: 35002857 PMCID: PMC8740326 DOI: 10.3389/fpsyg.2021.767784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: The objective of this study is to investigate the efficacy of psychological Interventions – Mindfulness or Implementation Intention – associated with a Physical Activity program, delivered via internet, in reducing Multiple Sclerosis symptoms. Method: Thirty-five adults were randomly assigned to one of the three groups: a Mindfulness-Based Intervention group (N = 12), Implementation Intention group (N = 11), and a Control Group (N = 12). All the groups received the same Physical Activity program. The Mindfulness condition group received daily training in the form of pre-recorded sessions while the Implementation group elaborated their specific plans once a week. Mobility, fatigue, and the impact of the disease on the patient’s life were measured. Two measurement times are carried out in pre-post intervention, at baseline and after eight weeks. Results: Overall, after 8 weeks intervention, results show that there was a significant increase in Walking distance in the three groups. In addition, the within-group analysis showed a statistically significant improvement between pre and post intervention on the physical component of the Disease Impact scale in the Implementation Intention group (p = 0.023) with large effect size, in the Mindfulness-Based Intervention group (p = 0.008) with a medium effect size and in the control group (p = 0.028) with small effect size. In the Implementation Intention group, all physical, psychosocial and cognitive Fatigue Impact subscales scores decreased significantly (p = 0.022, p = 0.023, and p = 0.012, respectively) and the physical component was statistically and negatively correlated (r = −0.745; p = 0.008) when Implementation Intention group practice a mild to moderate physical activity. In the Mindfulness-Based Intervention group, the physical component (MFIS) showed a statistically significant improvement (p = 0.028) but no correlation with moderate-to-vigorous physical activity (MVPA); the control group outcomes did not reveal any significant change. Conclusion: The results of this study are very encouraging and show the feasibility of Mindfulness interventions associated with physical activity to improve the health of people with MS. Further study should assess Mindfulness interventions tailored to MS condition and using both hedonic and eudemonic measures of happiness.
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Affiliation(s)
- Eya Torkhani
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France
| | - Emilie Dematte
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France
| | - Jean Slawinski
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France.,French National Institute of Sport, Expertise and Performance, Sport, Expertise and Performance Laboratory, Paris, France
| | - Antonia Csillik
- iMSpire (International Multiple Sclerosis Partnership in Research) Special Interest Group, Paris Nanterre University, Nanterre, France.,Department of Psychology, Université Paris Nanterre, Nanterre, France
| | - Marie-Claire Gay
- iMSpire (International Multiple Sclerosis Partnership in Research) Special Interest Group, Paris Nanterre University, Nanterre, France.,Department of Psychology, Université Paris Nanterre, Nanterre, France
| | - Djamel Bensmaïl
- Department of Physical and Rehabilitation Medicine, Raymond Poincaré Hospital - APHP Paris Saclay, Garches, France.,UMR 1179 INSERM-UVSQ, Neuromuscular Handicap - University of Versailles, Montigny-le-Bretonneux, France
| | - Olivier Heinzlef
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France.,iMSpire (International Multiple Sclerosis Partnership in Research) Special Interest Group, Paris Nanterre University, Nanterre, France.,CHI de Poissy-St Germain, Conflans-Sainte-Honorine, France
| | - Giovanni de Marco
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France.,iMSpire (International Multiple Sclerosis Partnership in Research) Special Interest Group, Paris Nanterre University, Nanterre, France
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44
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Block VJ, Pitsch EA, Gopal A, Zhao C, Pletcher MJ, Marcus GM, Olgin JE, Hollenbach J, Bove R, Cree BAC, Gelfand JM. Identifying falls remotely in people with multiple sclerosis. J Neurol 2022; 269:1889-1898. [PMID: 34405267 PMCID: PMC8370664 DOI: 10.1007/s00415-021-10743-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND Falling is common in people with multiple sclerosis (MS) but tends to be under-ascertained and under-treated. OBJECTIVE To evaluate fall risk in people with MS. METHODS Ninety-four people with MS, able to walk > 2 min with or without an assistive device (Expanded Disability Status Scale (EDSS ≤ 6.5) were recruited. Clinic-based measures were recorded at baseline and 1 year. Patient-reported outcomes (PROs), including a fall survey and the MS Walking Scale (MSWS-12), were completed at baseline, 1.5, 3, 6, 9, and 12 months. Average daily step counts (STEPS) were recorded using a wrist-worn accelerometer. RESULTS 50/94 participants (53.2%) reported falling at least once. Only 56% of participants who reported a fall on research questionnaires had medical-record documented falls. Fallers had greater disability [median EDSS 5.5 (IQR 4.0-6.0) versus 2.5 (IQR 1.5-4.0), p < 0.001], were more likely to have progressive MS (p = 0.003), and took fewer STEPS (mean difference - 1,979, p = 0.007) than Non-Fallers. Stepwise regression revealed MSWS-12 as a major predictor of future falls. CONCLUSIONS Falling is common in people with MS, under-reported, and under-ascertained by neurologists in clinic. Multimodal fall screening in clinic and remotely may help improve patient care by identifying those at greatest risk, allowing for timely intervention and referral to specialized physical rehabilitation.
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Affiliation(s)
- Valerie J. Block
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Erica A. Pitsch
- grid.266102.10000 0001 2297 6811Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Arpita Gopal
- grid.266102.10000 0001 2297 6811Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Chao Zhao
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Mark J. Pletcher
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA ,grid.266102.10000 0001 2297 6811Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Gregory M. Marcus
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Jeffrey E. Olgin
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Jill Hollenbach
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Riley Bove
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Bruce A. C. Cree
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Jeffrey M. Gelfand
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
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45
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Hoang PD, Lord S, Gandevia S, Menant J. Exercise and Sports Science Australia (ESSA) position statement on exercise for people with mild to moderate multiple sclerosis. J Sci Med Sport 2021; 25:146-154. [PMID: 34538565 DOI: 10.1016/j.jsams.2021.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS), the most common chronic and progressive neurological condition of the central nervous system, affects 26,000 Australian adults. Exercise training has beneficial effects on MS-related impairments including reduced muscular strength, poor aerobic capacity and impaired mobility, and in consequence can improve quality of life. This Position Statement provides evidence-based recommendations for exercise prescription and delivery of exercise training for people with MS with mild to moderate disability. DESIGN AND METHODS Synthesis of published works within the field of exercise training in MS. RESULTS Exercise provides many benefits to people with MS. There is strong evidence that resistance and aerobic training, performed 2 to 3 times per week at a moderate intensity, are safe and can improve muscle strength, cardiorespiratory fitness, balance, fatigue, functional capacity, mobility and quality of life in people with MS with mild to moderate disability (Expanded Disease Severity Scale (EDSS) ≤ 6.5). However, the evidence for those with severe disability (EDSS >6.5) is less clear. The effects of exercise on MS pathogenesis, central nervous structures and other outcomes such as depression and cognitive impairment, have not been adequately investigated. Effective exercise interventions to improve balance, joint contractures and reduce falls in people with MS are also urgently needed as well as investigations of long-term (≥1 year) effects of exercise training. CONCLUSIONS Resistance and aerobic training exercises are effective to alleviate some characteristic signs and symptoms in MS and should be supplemented by balance exercise to prevent falls. Exercise training programs should be prescribed and delivered by qualified exercise professionals. It is important to recognise and accommodate exercise-associated complications such as fatigue and heat sensitivity.
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Affiliation(s)
- Phu D Hoang
- Neuroscience Research Australia (NeuRA), Australia; Australian Catholic University, Australia; Multiple Sclerosis Limited, Australia; School of Population Health, University of New South Wales, Australia.
| | - Stephen Lord
- Neuroscience Research Australia (NeuRA), Australia; School of Population Health, University of New South Wales, Australia
| | | | - Jasmine Menant
- Neuroscience Research Australia (NeuRA), Australia; School of Population Health, University of New South Wales, Australia
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46
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Henning DA, Edwards EM, Ansara M, Fritz NE. Validating the walking while talking test to measure motor, cognitive, and dual-task performance in ambulatory individuals with multiple sclerosis. Mult Scler Relat Disord 2021; 54:103123. [PMID: 34246023 DOI: 10.1016/j.msard.2021.103123] [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: 03/18/2021] [Revised: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Multiple Sclerosis (MS) is associated with demyelination of the central nervous system that negatively impacts both motor and cognitive function, resulting in difficulty performing simultaneous motor and cognitive tasks, or dual-tasks. Declines in dual-tasking have been linked with falls in MS; thus, dual-task assessment with the Walking While Talking Test (WWTT) is commonly utilized in the clinical setting. However, the validity and minimal detectable change (MDC) of the WWTT has not been established for persons with MS. The primary objective of the study was to establish the WWTT as a valid measure of dual-task function by examining concurrent validity with other motor, cognitive and dual-task measures, and to establish the MDC for both the simple and complex conditions of the WWTT. METHODS In a single visit, 38 adults (34 female, mean (SD) age 49.8(±9.1), Patient Determined Disease Steps (PDDS) mean 3, range 1-6) completed the WWTT simple (walk while reciting the alphabet) and complex (walk while reciting every other letter of the alphabet) conditions as well as a battery of cognitive and motor tests. Spearman correlations were used to examine concurrent validity. The sample was divided into low and high disability groups to determine the impact of disability severity on relationships among WWTT and cognitive and motor function. RESULTS Excellent concurrent validity (r ≥ 0.79; p < 0.001) was observed for the WWTT simple and complex with both motor (Timed Up-and-Go, Timed 25-Foot Walk, forward and backward walking velocity, Six-Spot Step Test) and dual-task measures (Timed Up-and-Go Cognitive). The WWTT-simple demonstrated moderate concurrent validity with measures of processing speed (Symbol Digit Modalities Test, p = 0.041) and was related to all motor and dual-task measures across disability levels. The WWTT complex was only related to complex motor tasks in the low disability group. Within the low disability group, WWTT was associated with processing speed (p = 0.045) and working memory (California Verbal Learning Test, p = 0.012). The MDC values were established for WWTT simple (6.9 s) and complex (8 s) conditions. DISCUSSION The WWTT is a quick, easy-to-administer clinical measure that captures both motor and cognitive aspects of performance for persons with MS. Clinicians should consider adding the WWTT to the evaluation of persons with MS to examine dual-task performance.
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Affiliation(s)
- David A Henning
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit MI, United States; Department of Health Care Sciences, Program in Physical Therapy, Wayne State University, Detroit MI, United States
| | - Erin M Edwards
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit MI, United States; Translational Neuroscience Program, Wayne State University, Detroit, MI, United States
| | - Melissa Ansara
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit MI, United States
| | - Nora E Fritz
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit MI, United States; Department of Health Care Sciences, Program in Physical Therapy, Wayne State University, Detroit MI, United States; Translational Neuroscience Program, Wayne State University, Detroit, MI, United States; Department of Neurology, Wayne State University, Detroit MI, United States.
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47
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Mosquera-Lopez C, Wan E, Shastry M, Folsom J, Leitschuh J, Condon J, Rajhbeharrysingh U, Hildebrand A, Cameron M, Jacobs PG. Automated Detection of Real-World Falls: Modeled From People With Multiple Sclerosis. IEEE J Biomed Health Inform 2021; 25:1975-1984. [PMID: 33245698 DOI: 10.1109/jbhi.2020.3041035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Falls are a major health problem with one in three people over the age of 65 falling each year, oftentimes causing hip fractures, disability, reduced mobility, hospitalization and death. A major limitation in fall detection algorithm development is an absence of real-world falls data. Fall detection algorithms are typically trained on simulated fall data that contain a well-balanced number of examples of falls and activities of daily living. However, real-world falls occur infrequently, making them difficult to capture and causing severe data imbalance. People with multiple sclerosis (MS) fall frequently, and their risk of falling increases with disease progression. Because of their high fall incidence, people with MS provide an ideal model for studying falls. This paper describes the development of a context-aware fall detection system based on inertial sensors and time of flight sensors that is robust to imbalance, which is trained and evaluated on real-world falls in people with MS. The algorithm uses an auto-encoder that detects fall candidates using reconstruction error of accelerometer signals followed by a hyper-ensemble of balanced random forests trained using both acceleration and movement features. On a clinical dataset obtained from 25 people with MS monitored over eight weeks during free-living conditions, 54 falls were observed and our system achieved a sensitivity of 92.14%, and false-positive rate of 0.65 false alarms per day.
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48
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Argento O, Spanò B, Pisani V, Incerti CC, Bozzali M, Foti C, Caltagirone C, Nocentini U. Dual-Task Performance in Multiple Sclerosis' Patients: Cerebellum Matters? Arch Clin Neuropsychol 2021; 36:517-526. [PMID: 33067615 DOI: 10.1093/arclin/acaa089] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/07/2020] [Accepted: 09/16/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Gait, cognitive impairments, and their mutual influence in dual tasking (cognitive-motor dual tasking, CM-DT) are important to address therapeutic approaches in patients with multiple sclerosis (PMS). CM-DT correlates have been widely investigated with variable and dissimilar results, due to differences in methods. However, although the cerebellum has recently shown to be involved in both motor and cognitive functions, few studies have explored its role in the integration of the concurrent execution of gait and cognition. This case-control study aims to explore the effects of adding a cognitive task to walking in PMS and to investigate the role of the cerebellum in the interfering process. METHODS In total, 20 patients and 18 healthy controls (HC) underwent clinical assessments, dual task (DT), and 3 T magnetic resonance imaging (MRI). DT was composed by three 2-min trials requiring fast walking. In 2 of them 2 different cognitive tasks were added. RESULTS Both groups evidenced the presence of cognitive-motor interference (CMI) for both cognitive conditions with a greater effect of word list generation task in PMS. Analysis of variance between HC and patients with high or low performances showed a significantly increased volume in Vermis lobules VIIIa and IX of high performers compared with HC. CONCLUSION Our results show that CMI is also present in healthy individuals but is significantly more disabling in PMS. Furthermore, MRI data point to the existence of an initial mechanism of cerebellar reorganization in PMS with lower interference. Subsequently, the failure of this mechanism due to the progression of disability leads to a more evident expression of symptoms.
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Affiliation(s)
- Ornella Argento
- Neurology and Neurorehabilitation Unit, I.R.C.C.S. "Santa Lucia" Foundation, Rome, Italy
| | - Barbara Spanò
- Neuroimaging Unit, I.R.C.C.S. "Santa Lucia" Foundation, Rome, Italy
| | - Valerio Pisani
- Neurology and Neurorehabilitation Unit, I.R.C.C.S. "Santa Lucia" Foundation, Rome, Italy
| | - Chiara C Incerti
- Neurology and Neurorehabilitation Unit, I.R.C.C.S. "Santa Lucia" Foundation, Rome, Italy
| | - Marco Bozzali
- Neuroimaging Unit, I.R.C.C.S. "Santa Lucia" Foundation, Rome, Italy.,Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Calogero Foti
- Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Caltagirone
- Clinical and Behavioural Neurology Unit, I.R.C.C.S. "Santa Lucia" Foundation, Rome, Italy
| | - Ugo Nocentini
- Neurology and Neurorehabilitation Unit, I.R.C.C.S. "Santa Lucia" Foundation, Rome, Italy.,Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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Meyer BM, Tulipani LJ, Gurchiek RD, Allen DA, Adamowicz L, Larie D, Solomon AJ, Cheney N, McGinnis RS. Wearables and Deep Learning Classify Fall Risk From Gait in Multiple Sclerosis. IEEE J Biomed Health Inform 2021; 25:1824-1831. [PMID: 32946403 DOI: 10.1109/jbhi.2020.3025049] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Falls are a significant problem for persons with multiple sclerosis (PwMS). Yet fall prevention interventions are not often prescribed until after a fall has been reported to a healthcare provider. While still nascent, objective fall risk assessments could help in prescribing preventative interventions. To this end, retrospective fall status classification commonly serves as an intermediate step in developing prospective fall risk assessments. Previous research has identified measures of gait biomechanics that differ between PwMS who have fallen and those who have not, but these biomechanical indices have not yet been leveraged to detect PwMS who have fallen. Moreover, they require the use of laboratory-based measurement technologies, which prevent clinical deployment. Here we demonstrate that a bidirectional long short-term (BiLSTM) memory deep neural network was able to identify PwMS who have recently fallen with good performance (AUC of 0.88) based on accelerometer data recorded from two wearable sensors during a one-minute walking task. These results provide substantial improvements over machine learning models trained on spatiotemporal gait parameters (21% improvement in AUC), statistical features from the wearable sensor data (16%), and patient-reported (19%) and neurologist-administered (24%) measures in this sample. The success and simplicity (two wearable sensors, only one-minute of walking) of this approach indicates the promise of inexpensive wearable sensors for capturing fall risk in PwMS.
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New methods of posturographic data analysis may improve the diagnostic value of static posturography in multiple sclerosis. Heliyon 2021; 7:e06190. [PMID: 33659736 PMCID: PMC7892908 DOI: 10.1016/j.heliyon.2021.e06190] [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: 10/14/2020] [Revised: 11/29/2020] [Accepted: 01/31/2021] [Indexed: 11/20/2022] Open
Abstract
Background Early and accurate diagnosis of multiple sclerosis (MS) is crucial for its effective treatment. In MS diagnostic, neuronal networks that control posture and movement are of particular importance, which performance can be assessed using static posturography. Unfortunately, most of the commercially available posturographic platforms are not equipped with the appropriate procedures. Methods To solve this problem, the postural sway trajectories have been recorded in 55 MS patients while standing quiet with eyes open (EO), and then with eyes closed (EC). The trajectories were analyzed using our novel methods of postural sway parametrization, including sway stability vector (SV), anteroposterior and mediolateral sway indices (DIAP and DIML). Results The results exhibited unique postural sway patterns that may be attributed to MS. Our novel parametrization methods of postural sway showed pathology specific increase of the postural sway velocity in EC tests. Additionally, we documented the abnormal alterations of the anteroposterior (AP) and the mediolateral (ML) sway indices that were also uniquely dependent on visual input. In EC tests, patients exhibited a characteristic pattern of sway increase in both AP and ML directions that correlated with the advance of the disease as measured by the EDSS Kurtzke scale and Functional System Scores. Conclusions The applied in the present study our novel posturographic metrics give the assessment a diagnostic value. It allows us to recommend the static posturography test as a simple and safe supplementary clinical tool in the diagnosis of MS. In the assessment of MS pathology or the effects of its treatment, the impact of vision on the sway stability vector seems the most important factor.
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