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Saragih ID, Gervais W, Lamora JP, Batcho CS, Everard G. Effect of serious games over conventional therapy in the rehabilitation of people with multiple sclerosis - a systematic review and meta-analysis. Disabil Rehabil 2024:1-21. [PMID: 39421950 DOI: 10.1080/09638288.2024.2415328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 10/02/2024] [Accepted: 10/03/2024] [Indexed: 10/19/2024]
Abstract
PURPOSE This meta-analysis aimed to quantify the effect of serious games over conventional therapy on upper-limb activity, balance, gait, fatigue, and cognitive functions in people with multiple sclerosis. MATERIALS AND METHODS Search strategies were developed for PubMed, Embase, Cochrane Library, and Scopus. Studies were selected if participants were adults with multiple sclerosis; the intervention consisted of a virtual reality serious game-based program; the control group received conventional therapy; outcomes included upper limb activity, balance, gait, fatigue, or cognitive functions; and used a randomized controlled trial design. Data were synthesized using a standardized mean difference with a random-effects model. RESULTS From 2532 studies, seventeen trials were selected (n = 740). Overall, serious games programs effect on upper limb activity, gait, verbal memory, verbal fluency and attention seemed neutral. Balance functions appeared to be improved by semi-immersive virtual reality serious games (SMD = 0.48;95%CI = 0.12-0.84;p = 0.01;I2=0%), fatigue by treadmill serious games (SMD = 0.80;95%CI = 0.40-1.20;p < 0.001) and visuo-spatial memory by semi-immersive virtual reality general cognitive serious games (SMD = 0.35;95%CI = 0.04-0.65;p = 0.03;I2=0%). CONCLUSION This review suggests, with a very-low-to-low certainty of evidence, that while some specific serious games may improve balance, fatigue and visuo-spatial memory, their overall effect on upper limb activity, gait, and other cognitive functions appears neutral.
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Affiliation(s)
| | - Willy Gervais
- Institut de formation en masso-kinésithérapie La Musse, Saint Sébastien de Morsent, France
| | - Jean-Philippe Lamora
- Institut de formation en masso-kinésithérapie La Musse, Saint Sébastien de Morsent, France
| | - Charles Sebiyo Batcho
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Québec, Canada
- Department of rehabilitation, Faculty of medicine, Laval University, Quebec, QC, Canada
| | - Gauthier Everard
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Québec, Canada
- Department of rehabilitation, Faculty of medicine, Laval University, Quebec, QC, Canada
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Bruxelles, Belgium
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Sokratous D, Charalambous CC, Zamba—Papanicolaou E, Michailidou K, Konstantinou N. A 12-week in-phase bilateral upper limb exercise protocol promoted neuroplastic and clinical changes in people with relapsing remitting multiple sclerosis: A registered report randomized single-case concurrent multiple baseline study. PLoS One 2024; 19:e0299611. [PMID: 39418242 PMCID: PMC11486400 DOI: 10.1371/journal.pone.0299611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 09/11/2024] [Indexed: 10/19/2024] Open
Abstract
INTRODUCTION Relapsing-Remitting Multiple Sclerosis manifests various motor symptoms including impairments in corticospinal tract integrity, whose symptoms can be assessed using transcranial magnetic stimulation. Several factors, such as exercise and interlimb coordination, can influence the plastic changes in corticospinal tract. Previous work in healthy and chronic stroke survivors showed that the greatest improvement in corticospinal plasticity occurred during in-phase bilateral exercises of the upper limbs. Altered corticospinal plasticity due to bilateral lesions in the central nervous system is common after Multiple Sclerosis, yet the effect of in-phase bilateral exercise on the bilateral corticospinal plasticity in this cohort remains unclear. Our aim was to investigate the effects of in-phase bilateral exercises on central motor conduction time, motor evoked potential amplitude and latency, motor threshold and clinical measures in people with Relapsing-Remitting Multiple Sclerosis. METHODS Five people were randomized and recruited in this single case concurrent multiple baseline design study. The intervention protocol lasted for 12 consecutive weeks (30-60 minutes /session x 3 sessions / week) and included in-phase bilateral upper limb movements, adapted to different sports activities and to functional motor training. To define the functional relation between the intervention and the results, we conducted a visual analysis. If a potential sizeable effect was observed, we subsequently performed a statistical analysis. RESULTS Results demonstrated bilateral reduction of the motor threshold alongside with improvement of all clinical measures, but not in any other corticospinal plasticity measures. CONCLUSION Our preliminary findings suggest that in-phase bilateral exercise affects motor threshold in people with Relapsing-Remitting Multiple Sclerosis. Therefore, this measure could potentially serve as a proxy for detecting corticospinal plasticity in this cohort. However, future studies with larger sample sizes should validate and potentially establish the effect of in-phase bilateral exercise on the corticospinal plasticity and clinical measures in this cohort. TRIAL REGISTRATION Clinical trial registration: ClinicalTrials.gov NCT05367947.
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Affiliation(s)
- Dimitris Sokratous
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
- Physiotherapy Unit, Neurology Clinics, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | | | - Kyriaki Michailidou
- Biostatistics Unit, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Nikos Konstantinou
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Maden T, Polat H, Cengiz EK, Kahraman T. Validity and reliability of the Six-Minute Pegboard Ring Test for assessing functional capacity and upper limb function in persons with multiple sclerosis. Mult Scler Relat Disord 2024; 90:105836. [PMID: 39197349 DOI: 10.1016/j.msard.2024.105836] [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: 04/25/2024] [Revised: 07/24/2024] [Accepted: 08/19/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND The timed walk test is essential for assessing the functional capacity of persons with multiple sclerosis (MS). When a decline in ambulation ability and loss of function in the later stages of MS is observed, it is imperative to utilize alternative methods for measuring functional capacity. OBJECTIVE To investigate the validity and reliability of the Six-Minute Pegboard Ring Test (6PBRT) in persons with MS. METHODS Forty-three persons with MS were included in this study. Disease severity was quantified using the Expanded Disability Status Scale (EDSS). The 6PBRT was employed to assess upper extremity function during exercise stress, and vital signs were monitored pre- and post-test. Muscle strength was measured using a digital dynamometer for shoulder flexor, shoulder abductor, and grip strength, in addition to a hand dynamometer. Manual dexterity was evaluated through the 9-Hole Peg Test (9HPT), and walking endurance was assessed using the 2-Minute Walk Test (2MWT). Test-retest reliability was computed using the intraclass correlation coefficient (ICC). RESULTS The ICC value for the 6PBRT was 0.96 (95% CI 0.92-0.97), indicating excellent test-retest reliability. Significant differences in vital signs were observed before and after conducting the 6PBRT (p < 0.05). A strong negative correlation was found between the 6PBRT score and EDSS (r = -0.650, p < 0.001). The 9HPT of the dominant side demonstrated a moderate correlation with the 6PBRT score (r = -0.502, p = 0.001), whereas no significant correlation was shown between the non-dominant side 9HPT and the 6PBRT score (p > 0.05). Moreover, a positive moderate correlation was shown between the performance on the 2MWT and the 6PBRT score (r = 0.413, p = 0.006). However, no significant correlation was detected between the proximal muscle strength of the upper extremity, handgrip strength, and the 6PBRT score in individuals with multiple sclerosis (p > 0.05). CONCLUSION The 6PBRT is a reliable and valid tool to evaluate upper extremity function and exercise capacity in persons with MS.
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Affiliation(s)
- Tuba Maden
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gaziantep University, Gaziantep, Turkey.
| | - Hakan Polat
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, SANKO University, Gaziantep, Turkey.
| | | | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Turkey.
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Ranzani R, Razzoli M, Sanson P, Song J, Galati S, Ferrarese C, Lambercy O, Kaelin-Lang A, Gassert R. Feasibility of Adjunct Therapy with a Robotic Hand Orthosis after Botulinum Toxin Injections in Persons with Spasticity: A Pilot Study. Toxins (Basel) 2024; 16:346. [PMID: 39195756 PMCID: PMC11360205 DOI: 10.3390/toxins16080346] [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: 06/30/2024] [Revised: 07/28/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
Upper-limb spasticity, frequent after central nervous system lesions, is typically treated with botulinum neurotoxin type A (BoNT-A) injections to reduce muscle tone and increase range of motion. However, performing adjunct physical therapy post-BoNT-A can be challenging due to residual weakness or spasticity. This study evaluates the feasibility of hand therapy using a robotic hand orthosis (RELab tenoexo) with a mobile phone application as an adjunct to BoNT-A injections. Five chronic spastic patients participated in a two-session pilot study. Functional (Box and Block Test (BBT), Action Research Arm Test (ARAT)), and muscle tone (Modified Ashworth Scale (MAS)) assessments were conducted to assess functional abilities and impairment, along with usability evaluations. In the first session, subjects received BoNT-A injections, and then they performed a simulated unsupervised therapy session with the RELab tenoexo in a second session a month later. Results showed that BoNT-A reduced muscle tone (from 12.2 to 7.4 MAS points). The addition of RELab tenoexo therapy was safe, led to functional improvements in four subjects (two-cube increase in BBT as well as 2.8 points in grasp and 1.3 points in grip on ARAT). Usability results indicate that, with minor improvements, adjunct RELab tenoexo therapy could enhance therapy doses and, potentially, long-term outcomes.
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Affiliation(s)
- Raffaele Ranzani
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy;
- Cereneo, Center for Neurology and Rehabilitation, Seestrasse 18, 6354 Vitznau, Switzerland
| | - Margherita Razzoli
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Pierre Sanson
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Jaeyong Song
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Salvatore Galati
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6962 Lugano, Switzerland; (S.G.); (A.K.-L.)
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Carlo Ferrarese
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy;
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Alain Kaelin-Lang
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6962 Lugano, Switzerland; (S.G.); (A.K.-L.)
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
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Kanzler CM, Armand T, Simovic L, Sylvester R, Domnik N, Eilfort AM, Rohner C, Gassert R, Gonzenbach R, Lambercy O. Influence of virtual reality and task complexity on digital health metrics assessing upper limb function. J Neuroeng Rehabil 2024; 21:125. [PMID: 39068424 PMCID: PMC11282591 DOI: 10.1186/s12984-024-01413-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Technology-based assessments using 2D virtual reality (VR) environments and goal-directed instrumented tasks can deliver digital health metrics describing upper limb sensorimotor function that are expected to provide sensitive endpoints for clinical studies. Open questions remain about the influence of the VR environment and task complexity on such metrics and their clinimetric properties. METHODS We aim to investigate the influence of VR and task complexity on the clinimetric properties of digital health metrics describing upper limb function. We relied on the Virtual Peg Insertion Test (VPIT), a haptic VR-based assessment with a virtual manipulation task. To evaluate the influence of VR and task complexity, we designed two novel tasks derived from the VPIT, the VPIT-2H (VR environment with reduced task complexity) and the PPIT (physical task with reduced task complexity). These were administered in an observational longitudinal study with 27 able-bodied participants and 31 participants with multiple sclerosis (pwMS, VPIT and PPIT only) and the value of kinematic and kinetic metrics, their clinimetric properties, and the usability of the assessment tasks were compared. RESULTS Intra-participant variability strongly increased with increasing task complexity (coefficient of variation + 56%) and was higher in the VR compared to the physical environment (+ 27%). Surprisingly, this did not translate into significant differences in the metrics' measurement error and test-retest reliability across task conditions (p > 0.05). Responsiveness to longitudinal changes in pwMS was even significantly higher (effect size + 0.35, p < 0.05) for the VR task with high task complexity compared to the physical instrumented task with low task complexity. Increased inter-participant variability might have compensated for the increased intra-participant variability to maintain good clinimetric properties. No significant influence of task condition on concurrent validity was present in pwMS. Lastly, pwMS rated the PPIT with higher usability than the VPIT (System Usability Scale + 7.5, p < 0.05). CONCLUSION The metrics of both the VR haptic- and physical task-based instrumented assessments showed adequate clinimetric properties. The VR haptic-based assessment may be superior when longitudinally assessing pwMS due to its increased responsiveness. The physical instrumented task may be advantageous for regular clinical use due to its higher usability. These findings highlight that both assessments should be further validated for their ideal use-cases.
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Affiliation(s)
- Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
- Campus for Research Excellence And Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore.
| | - Tom Armand
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Leonardo Simovic
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | | | - Nadine Domnik
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Antonia M Eilfort
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Carola Rohner
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Campus for Research Excellence And Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore
| | | | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Campus for Research Excellence And Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore
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Solaro C, Di Giovanni R, Grange E, Brichetto G, Mueller M, Tacchino A, Bertoni R, Patti F, Pappalardo A, Prosperini L, Rosato R, Cattaneo D, Marengo D. Influence of cognition on the correlation between objective and subjective upper limb measures in people with multiple sclerosis. Neurol Sci 2024; 45:2783-2789. [PMID: 38175316 DOI: 10.1007/s10072-023-07286-7] [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: 04/24/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND A comprehensive assessment of upper limb (UL) function is mandatory in people with multiple sclerosis (PwMS), and the use of multiple objective and subjective measures is advisable. Findings on the role of cognitive impairment on the assessment of UL function are scant and inconclusive. The present study investigated the influence of cognitive function on the distribution of objective and subjective UL measures and on their association. METHODS In the cross-sectional study, subjects with a diagnosis of MS, age ≥ 18 years, right-hand dominance, no presence of orthopedic UL impairment, or other neurological diseases were recruited. The assessment protocol included the Nine-Hole Peg Test (9-HPT), Box and Block Test (BBT), and hand grip strength (HGS), a validated PROM (MAM-36), and the Symbol Digit Modalities Test (SDMT). RESULTS Two hundred forty-six PwMS were recruited (158 females, mean age = 51.65 ± 13.45 years; mean EDSS = 5.10 ± 1.88) Subject with mild-to-moderate cognitive impairment (SDMT ≤ - 2 SD of normative values) scored lower on the 9-HPT and higher on the BBT and MAM-36 when compared with subject with no cognitive impairment. Cognitive impairment showed a small but significant effect on the association between 9-HPT scores and the MAM-36. DISCUSSION Findings suggest that cognitive impairment is associated with subjects' performance on 9-HPT, BBT, and MAM-36 (but not HGS), resulting in scores indicating a poorer UL function. Interestingly, cognitive impairment slightly affected the congruence between subjective and objective UL measures, although only minor differences in the correlation pattern across groups reporting different cognitive performances emerged.
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Affiliation(s)
- Claudio Solaro
- CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
- Neurology Unit, Galliera Hospital, Genoa, Italy
| | | | - Erica Grange
- CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Margit Mueller
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Rita Bertoni
- IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Francesco Patti
- MS Center Institute of Neurological Sciences, University of Catania, Catania, Italy
| | - Angelo Pappalardo
- MS Center Institute of Neurological Sciences, University of Catania, Catania, Italy
| | - Luca Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy
| | - Davide Cattaneo
- IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy
- Department of Physiopathology and Transplants, University of Milan, Milan, Italy
| | - Davide Marengo
- Department of Psychology, University of Turin, Turin, Italy.
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Far SS, Amiri B, Sahebozamani M, Ebrahimi HA, Zemková E. The effect of multi-function swing suspension training on upper and lower extremities function and quality of life in multiple sclerosis women with different disability status. Mult Scler Relat Disord 2023; 80:105113. [PMID: 37924713 DOI: 10.1016/j.msard.2023.105113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) can lead to impaired upper and lower extremity function (ULEF), which reduces the quality of life (QoL). Exercise is beneficial for symptom management, but newer approaches like multi-function swing suspension training (MFSST) need further investigation. Additionally, tailoring exercises to individual needs remains a challenging area of investigation. AIM To investigate the effect of an MFSST program on ULEF, and QoL in MS women according to the expanded disability status scale (EDSS) score. METHODS Forty-seven MS women meeting selection criteria were randomly assigned to intervention groups A (EDSS 2-4) and B (EDSS 4.5-6.5), and the control group (EDSS 2-6.5). Intervention groups did an 8-week MFSST program with 3 × 1hr sessions/week. Prior to the intervention, and after 4, 6, and 8 weeks, the 9-hole peg test (9HPT) and the timed 25-foot walk (T25FW) test were performed for both the intervention groups and the control group. The Short Form questionnaire (SF-36) was used to measure their QoL. RESULTS Significant main effects for time were observed in both the 9HPT (F = 52.48, p = 0.001, Pη2 = 0.78) and the T25FW (F = 85.63, p = 0.000, Pη2 = 0.859). Speed increased between the pre-test, 4th week, 6th week, and 8th week in both tests. These tests revealed significant interaction effects between group and time. The 9HPT had an F-value of 9.01 (p = 0.001, Pη2 = 0.392), while the T25FW had an F-value of 13.812 (p = 0.000, Pη2 = 0.497). Across both tests, Group B, with higher EDSS scores, demonstrated greater speed improvement over the three-time measurements (4th week, 6th week, and 8th week) than Group A. The control group did not exhibit any improvement in speed. Intervention groups showed improvement in all QoL subscales except emotional role limitation. CONCLUSIONS An 8-week MFSST improves ULEF and QoL in women with MS, particularly those with higher EDSS scores (more than 4.5). Notably, significant improvements were observed after four weeks of the intervention. The incorporation of a variety of exercises in a single device provides a significant advantage over traditional exercise programs. Therefore, MFSST can be a valuable and efficient tool for improving symptoms and QoL in MS patients. TRIAL REGISTRATION IRCT20220526054997N1.
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Affiliation(s)
- Sara Sepehri Far
- Department of Sports Injuries and Corrective Exercises, Faculty of Physical Education and Sport, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Banafsheh Amiri
- Department of Sports Injuries and Corrective Exercises, Faculty of Physical Education and Sport, Shahid Bahonar University of Kerman, Kerman, Iran; Department of Biological and Medical Sciences, Faculty of Physical Education and Sport, Comenius University in Bratislava, Slovakia
| | - Mansour Sahebozamani
- Department of Sports Injuries and Corrective Exercises, Faculty of Physical Education and Sport, Shahid Bahonar University of Kerman, Kerman, Iran.
| | | | - Erika Zemková
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sport, Comenius University in Bratislava, Slovakia
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Ovacik U, Tarakci E, Ozdemir Z. Upper limb dysfunction in people with early-stage Multiple Sclerosis: Perceived performance can be misleading. Mult Scler Relat Disord 2023; 79:104944. [PMID: 37678130 DOI: 10.1016/j.msard.2023.104944] [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: 04/11/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Although the necessity of upper limb (UL) (dys)function assessment in people with Multiple Sclerosis (pwMS) has been demonstrated in recent years, this is still neglected at an early-stage. OBJECTIVE The aim of our study was to comprehensively examine bilateral UL in early-stage pwMS who are thought to have no or minimal involvement in activities of daily living for the UL. METHODS UL muscle strength, sensation and dexterity of 44 pwMS (EDSS score<4, disease duration<5 years, who did not report problems in daily living activities specifically for the UL) were evaluated bilaterally and compared with 44 healthy controls (HC). The relationship between UL function and muscle strength, sensation, cognitive function, fatigue, mood status, participation, EDSS, and disease duration were examined. The results of the outcome measures evaluating the UL function objectively and subjectively were analyzed. RESULTS Muscle strength, sensation and dexterity were similar in the dominant and nondominant extremities of pwMS and were affected compared to HC. A fair relationship was found between UL function and proximal muscle strength, fatigue, cognitive function, home participation and EDSS. According to the cut-off value (18 s) of Nine Hole Peg Test, only 9.09% of pwMS was unaffected, but 79.54% of affected pwMS had a full ABILHAND score. CONCLUSION Early-stage pwMS are unaware of the dysfunction since their UL involvement does not affect their daily living activities yet. Patient-reported outcome measures such as ABILHAND can be misleading and have a ceiling effect in the early-stage of the disease. Objective functional evaluations reveal that UL capacity is affected from the early period. Even if pwMS do not report UL involvement, clinicians and researchers should evaluate UL function and include it in the treatment program from an early-stage to prevent further disease burden.
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Affiliation(s)
- Ugur Ovacik
- Physiotherapy Program, Department of Medical Services and Techniques, Vocational School of Health Services, Istanbul Aydin University, Istanbul, Turkey; Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Ela Tarakci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, İstanbul, Turkey
| | - Zeynep Ozdemir
- Neurology Department, Bakırköy Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, İstanbul, Turkey
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Grange E, Solaro C, Di Giovanni R, Marengo D. The correlation between 9-HPT and patient-reported measures of upper limb function in multiple sclerosis: a systematic review and meta-analysis. J Neurol 2023; 270:4179-4191. [PMID: 37294322 PMCID: PMC10421783 DOI: 10.1007/s00415-023-11801-3] [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: 03/21/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
Upper limb function is one of the most affected domains in people with multiple sclerosis (PwMS), as self-reported by 50% of patients. Heterogeneous results have been found about the correlation between objective and subjective upper limb function. The aim of the present study is to perform a systematic review and meta-analysis of studies presenting data on the strength of association between the gold standard for 9-Hole Peg Test scores and Patient-Reported Outcome Measures (PROMs) of manual ability. Primary research studies including assessments of 9-Hole Peg Test scores and Patient-Reported Outcome Measures were searched in Scopus, Web of Science, and PubMed. Meta analytical calculations were performed using a random-effects model. We retrieved n = 27 studies including n = 75 distinct effect sizes (N of subjects = 3263). The central tendency analysis showed a strong correlation between 9-HPT scores and PROMs (r = 0.51, 95% CI [0.44, 0.58]). Moderator analysis showed the effect size to be significantly larger in studies with a mean or median EDSS level indicating severe disability. The publication bias hypothesis was not supported; instead, we noted that studies based on larger samples also tend to report stronger effect sizes. Results of the study indicate that the correlation between 9-HPT and PROMs is strong, although the constructs measured by these instrument does not fully overlap. The correlation between 9-HPT and PROMs was stronger in larger studies and when samples include a sizeable subgroup of PwMS with severe disability, pointing out the importance of sample diversity.
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Affiliation(s)
- Erica Grange
- CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Claudio Solaro
- CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
- Neurology Unit, Galliera Hospital, Genoa, Italy
| | | | - Davide Marengo
- Department of Psychology, University of Turin, Turin, Italy.
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10
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Pau M, Porta M, Bertoni R, Mattos FGM, Cocco E, Cattaneo D. Effect of immersive virtual reality training on hand-to-mouth task performance in people with Multiple Sclerosis: A quantitative kinematic study. Mult Scler Relat Disord 2023; 69:104455. [PMID: 36508937 DOI: 10.1016/j.msard.2022.104455] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/08/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although the use of Virtual Reality (VR) has received increasing interest as an add-on treatment in neurorehabilitation programs in the last fifteen years, there is scarce information about the effectiveness of fully immersive VR-based treatments on upper limb (UL) motor function in people with Multiple Sclerosis (PwMS). METHODS In this bicentric 2-period interventional crossover study, 19 PwMS with moderate to severe disability (mean EDSS score 5.5) and relevant UL impairment underwent 12 immersive-VR sessions over a period of 4 weeks, using commercially available VR platform (Oculus Quest) and games (Fruit Ninja, Beat Saber and Creed - Rise to Glory). Possible changes associated with the treatment were objectively assessed through instrumental kinematic analysis of the "hand-to-mouth" (HTM) movement by means of optical motion capture system. Clinical tests to assess gross and fine manual dexterity (i.e., the Box and Blocks and Nine Hole Peg Test) were also administered. RESULTS The results of the kinematic analysis suggest that the VR training positively impacted the ability of the tested PwMS to perform the HTM task. In particular, a significant reduction of the overall time required to complete the task of approximately 20% for both most and least affected limb, and an improved degree of precision and stability of the movement, as indicated by the reduced value of adjusting sway, especially for the most affected limb (-60%). CONCLUSION Based on the results of the quantitative analysis, a 4-week treatment with immersive VR is able to improve speed and stability of the HTM movement in PwMS. This suggests that such an approach might be considered suitable to facilitate an immediate transfer of the possible positive effects associated with the training to common activities of daily living.
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Affiliation(s)
- Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Piazza d'Armi, Cagliari 09123, Italy.
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Piazza d'Armi, Cagliari 09123, Italy
| | - Rita Bertoni
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, Milano 20148, Italy
| | | | - Eleonora Cocco
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Davide Cattaneo
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, Milano 20148, Italy; Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
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11
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Rios Rincon AM, Guptill C, Guevara Salamanca J, Liubaoerjijin Y, Figeys M, Gregson G, Miguel-Cruz A. Understanding the technology acceptance and usability of a new device for hand therapy: A qualitative description study (Preprint). JMIR Rehabil Assist Technol 2022; 9:e42385. [DOI: 10.2196/42385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/05/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
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12
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Kanzler CM, Sylvester R, Gassert R, Kool J, Lambercy O, Gonzenbach R. Goal-directed upper limb movement patterns and hand grip forces in multiple sclerosis. Mult Scler J Exp Transl Clin 2022; 8:20552173221116272. [PMID: 35982915 PMCID: PMC9380226 DOI: 10.1177/20552173221116272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Upper limb disability in persons with Multiple Sclerosis (pwMS) leads to increased dependence on caregivers. To better understand upper limb disability, observer-based or time-based clinical assessments have been applied. However, these only poorly capture the behavioural aspects underlying goal-directed task performance. Objective We aimed to document alterations in goal-directed upper limb movement patterns and hand grip forces in a cohort of pwMS (n = 123) with mild to moderate upper limb impairments. Methods We relied on the Virtual Peg Insertion Test (VPIT), a technology-aided assessment with a goal-directed pick-and-place task providing a set of validated digital health metrics. Results All metrics indicated significant differences to an able-bodied reference sample (p < 0.001), with smoothness, speed, and grip force control during object manipulation being most affected in pwMS. Such abnormalities negatively influenced the time to complete the goal-directed task (p < 0.001, R2 = 0.77), thereby showing their functional relevance. Lastly, abnormalities in movement patterns and grip force control were consistently found even in pwMS with clinically normal gross dexterity and grip strength. Conclusion This work provides a systematic documentation on goal-directed upper limb movement patterns and hand grip forces in pwMS, ultimately paving the way for an early detection of MS sign using digital health metrics.
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Affiliation(s)
- Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | | | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Jan Kool
- Rehabilitation Center Valens, Valens, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
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13
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Ovacik U, Tarakci E, Gungor F, Menengic KN, Leblebici G, Acar ZO, Soysal A. The Minnesota Manual Dexterity Test As A Bimanual Performance Measure in People with Multiple Sclerosis. Mult Scler Relat Disord 2022; 64:103943. [DOI: 10.1016/j.msard.2022.103943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/11/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022]
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14
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Quantification of upper limb dysfunction in the activities of the daily living in persons with multiple sclerosis. Mult Scler Relat Disord 2022; 63:103917. [PMID: 35671673 DOI: 10.1016/j.msard.2022.103917] [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] [Revised: 05/12/2022] [Accepted: 05/26/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dysfunction in upper limb (UL) function has been reported as an important indicator for disease progression in persons with multiple sclerosis (PwMS), thus a relevant outcome in clinical trials. However, standard assessment of UL function is limited to Nine-Hole Peg Test (NHPT) which assesses fine dexterity. This study aimed to deeply endophenotype UL involvement in PwMS and identify the most accurate set of measures needed to capture the complexity of UL dysfunction in the activities of daily living (ADL). METHODS 257 PwMS underwent an extensive UL assessment using standardized measures of grip strength and endurance, coordination, vibratory and tactile sensation, dexterity, capacity and functionality. Limitation in ADL was defined from an objective perspective using a timed test (Test d'Evaluation de la performance des Membres Supérieurs des Personnes Âgées: TEMPA) and from a subjective perspective using a questionnaire (Disabilities of the Arm, Shoulder and Hand: DASH). Disease severity subgroups were compared utilizing the Kruskal-Wallis test and frequencies determined the prevalence of abnormal UL for each measure. The Jonckheere-Terpstra test compared tested variables with disease severity. Then Receiver operating characteristic (ROC) curve analysis was used to test the accuracy of each tested variable in defining abnormality in the TEMPA and DASH. Cut-off scores were calculated using the Youden index. The predictive value of various tests over TEMPA and DASH were tested using a linear regression analysis. RESULTS UL dysfunction was highly prevalent in all the modalities tested, even in participants with no/mild disability. Box and Block Test (BBT), finger-nose test (FNT), and NHPT were independently selected with ROC analyses as the most accurate measures in detecting abnormalities in TEMPA and DASH. In multivariate regression models, BBT and FNT, and NHPT all contributed to predicting TEMPA (adj. R2 0.795, P < 0.001), while only BBT and FNT predicted DASH. CONCLUSIONS UL dysfunction is highly prevalent in PwMS, even when global disability is mild. BBT and FNT are time-efficient and cost-effective measures that complement the NHPT for more precise monitoring of PwMS at all disease stages.
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15
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Berardi A, Galeoto G, Pasquali F, Baione V, Crisafulli SG, Tofani M, Tartaglia M, Fabbrini G, Conte A. Evaluation of the Psychometric Properties of Jebsen Taylor Hand Function Test (JTHFT) in Italian Individuals With Multiple Sclerosis. Front Neurol 2022; 13:847807. [PMID: 35370923 PMCID: PMC8971517 DOI: 10.3389/fneur.2022.847807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The Jebsen Taylor Hand Function Test (JTHFT) is a non-diagnostic assessment scale for hand and upper limb dexterity that is commonly used in various countries around the world for diseases, such as muscular dystrophy, stroke, spinal cord injury, Parkinson, carpal tunnel syndrome, and rheumatoid arthritis. This study aimed to evaluate the psychometric properties of the JTHFT in Italian adults with Multiple Sclerosis (MS). Materials and Methods The test's internal consistency was evaluated with Cronbach's alpha, whereas its concurrent validity was evaluated by comparing the JTHFT with the Health Assessment Questionnaire (HAQ) and by calculating Pearson's correlation coefficient. Results The JTHFT was administered to 29 Italians with MS. The Cronbach's alpha showed that the nondominant hand has a value of 0.76 and 0.91 for the dominant hand. Pearson's correlation coefficient showed significant correlations between JTHFT and HAQ. Discussion The JTHFT is a reliable tool to evaluate the functionality of the upper limb and hand in patients with MS. This tool is useful for testing the effectiveness of a treatment in various diseases. The results obtained in this study are coherent with previous studies that are conducted in populations with different diseases. In particular, the correlation between JTHFT and HAQ showed that a disability related to the upper limbs can often have repercussions, not only on activities of daily living, but also on walking. Based on this correlation, the motor deficits that emerged may be linked to a brain marrow disease rather than a spinal disease, even if an essential deepening can confirm this hypothesis.
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Affiliation(s)
- Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- *Correspondence: Anna Berardi
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCSS Neuromed, Pozzilli, Italy
| | | | - Viola Baione
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Marco Tofani
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Matteo Tartaglia
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCSS Neuromed, Pozzilli, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCSS Neuromed, Pozzilli, Italy
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16
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Bertoni R, Cattaneo D, Grosso C, Baglio F, Jonsdottir J. Distribution and relation of two arm function tests, Box and Blocks test and Nine Hole Peg test, across disease severity levels and types of multiple sclerosis. Mult Scler Relat Disord 2022; 59:103683. [DOI: 10.1016/j.msard.2022.103683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/18/2021] [Accepted: 02/07/2022] [Indexed: 11/15/2022]
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17
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Raats J, Lamers I, Merken I, Boeckmans J, Soler B, Normann B, Arntzen EC, Feys P. The content and effects of trunk rehabilitation on trunk and upper limb performance in people with multiple sclerosis: a systematic review. Eur J Phys Rehabil Med 2022; 58:26-32. [PMID: 34468108 PMCID: PMC9980506 DOI: 10.23736/s1973-9087.21.06689-2] [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: 11/03/2020] [Revised: 07/27/2021] [Accepted: 09/01/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Persons with multiple sclerosis (pwMS) could have an impaired trunk and reduced postural control, which negatively impacts activities of daily living. Evidence is growing to consider the positive effects of trunk training on fall incidence and balance problems. Effects on trunk and upper limb performance is unknown. This systematic review provides an overview of trunk training programs and their effects in MS, specifically focusing on the content of training modalities and the effects on trunk and upper limb performance. EVIDENCE ACQUISITION Two electronic databases were used: PubMed and Web Of Science (WOS). Intervention studies (with- and without control group) published in English, investigating the effects of active trunk training on trunk and upper limb performance in pwMS, were included. EVIDENCE SYNTHESIS Sixteen studies met the criteria, investigating different rehabilitation modalities. The included interventions in the review varied between more generic postural interventions such as Pilates (N.=8) and Ai Chi (N.=1), with a focus on abdominal muscle activation, breathing, neutral position and lower extremity movements. Further, specifically developed trunk training programs like GroupCoreDIST/ SIT / CoDuSe (N.=6) and Bobath based trunk training (N.=1) are detected, with the main focus on trunk strengthening and dynamic movements. An overall improvement in trunk performance was reported in several tests on trunk strength, stability and coordination. While the majority of the programs integrated the upper limb, only half of them used upper limb outcome measures to evaluate the effect. Here, overall significant improvements were found for the upper limb. CONCLUSIONS This systematic review showed that different types of trunk training programs can improve trunk and upper limb function in PwMS. The findings of this review suggest that a focus on trunk training to achieve effects on upper limb is reasonable. Future research is needed to further explore relations and the effect sizes.
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Affiliation(s)
- Joke Raats
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium -
| | - Ilse Lamers
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Noorderhart Rehabilitation and MS Center, Pelt, Belgium
| | - Ine Merken
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Jolien Boeckmans
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Bernardita Soler
- Department of Neurology, Doctor Sótero del Río Hospital, Santiago, Chile
| | - Britt Normann
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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18
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Wijeyaratnam DO, Edwards T, Pilutti LA, Cressman EK. Assessing visually guided reaching in people with multiple sclerosis with and without self-reported upper limb impairment. PLoS One 2022; 17:e0262480. [PMID: 35061785 PMCID: PMC8782348 DOI: 10.1371/journal.pone.0262480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022] Open
Abstract
The ability to accurately complete goal-directed actions, such as reaching for a glass of water, requires coordination between sensory, cognitive and motor systems. When these systems are impaired, like in people with multiple sclerosis (PwMS), deficits in movement arise. To date, the characterization of upper limb performance in PwMS has typically been limited to results attained from self-reported questionnaires or clinical tools. Our aim was to characterize visually guided reaching performance in PwMS. Thirty-six participants (12 PwMS who reported upper limb impairment (MS-R), 12 PwMS who reported not experiencing upper limb impairment (MS-NR), and 12 age- and sex-matched control participants without MS (CTL)) reached to 8 targets in a virtual environment while seeing a visual representation of their hand in the form of a cursor on the screen. Reaches were completed with both the dominant and non-dominant hands. All participants were able to complete the visually guided reaching task, such that their hand landed on the target. However, PwMS showed noticeably more atypical reaching profiles when compared to control participants. In accordance with these observations, analyses of reaching performance revealed that the MS-R group was more variable with respect to the time it took to initiate and complete their movements compared to the CTL group. While performance of the MS-NR group did not differ significantly from either the CTL or MS-R groups, individuals in the MS-NR group were less consistent in their performance compared to the CTL group. Together these findings suggest that PwMS with and without self-reported upper limb impairment have deficits in the planning and/or control of their movements. We further argue that deficits observed during movement in PwMS who report upper limb impairment may arise due to participants compensating for impaired movement planning processes.
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Affiliation(s)
- Darrin O. Wijeyaratnam
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Thomas Edwards
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Lara A. Pilutti
- Interdisciplinary School of Health Science, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin K. Cressman
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Knippenberg E, Timmermans A, Coolen J, Neven K, Hallet P, Lemmens J, Spooren A. Efficacy of a technology-based client-centred training system in neurological rehabilitation: a randomised controlled trial. J Neuroeng Rehabil 2021; 18:184. [PMID: 34961531 PMCID: PMC8712106 DOI: 10.1186/s12984-021-00977-2] [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: 07/06/2021] [Accepted: 11/30/2021] [Indexed: 11/21/2022] Open
Abstract
Background A client-centred task-oriented approach has advantages towards motivation and adherence to therapy in neurorehabilitation, but it is costly to integrate in practice. An intelligent Activity-based Client-centred Training (i-ACT), a low-cost Kinect-based system, was developed which integrates a client-centred and task-oriented approach. The objectives were (1) to investigate the effect of additional i-ACT training on functioning. And (2) to assess whether training with i-ACT resulted in more goal oriented training. Methods A single-blind randomised controlled trial was performed in 4 Belgian rehabilitation centres with persons with central nervous system deficits. Participants were randomly allocated through an independent website-based code generator using blocked randomisation (n = 4) to an intervention or control group. The intervention group received conventional care and additional training with i-ACT for 3 × 45 min/week during 6 weeks. The control group received solely conventional care. Functional ability and performance, quality of life (QoL), fatigue, trunk movement, and shoulder active range of motion (AROM) were assessed at baseline, after 3 weeks and 6 weeks of training, and 6 weeks after cessation of training. Data were analysed using non-parametric within and between group analysis. Results 47 persons were randomised and 45 analysed. Both intervention (n = 25) and control (n = 22) group improved over time on functional ability and performance as measured by the Wolf Motor Function Test, Manual Ability Measure-36, and Canadian Occupational Performance Measure, but no major differences were found between the groups on these primary outcome measures. Regarding QoL, fatigue, trunk movement, and shoulder AROM, no significant between group differences were found. High adherence for i-ACT training was found (i.e. 97.92%) and no adverse events, linked to i-ACT, were reported. In the intervention group the amount of trained personal goals (88%) was much higher than in the control group (46%). Conclusions Although additional use of i-ACT did not have a statistically significant added value regarding functional outcome over conventional therapy, additional i-ACT training provides more individualised client-centred therapy, and adherence towards i-ACT training is high. A higher intensity of i-ACT training may increase therapy effects, and should be investigated in future research. Trial registration: ClinicalTrials.gov Identifier NCT02982811. Registered 29 November 2016.
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Affiliation(s)
- Els Knippenberg
- Department of Healthcare, Centre of Expertise - Innovation in Care, PXL University of Applied Sciences and Arts, Guffenslaan 39, 3500, Hasselt, Belgium. .,Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Agoralaan, Gebouw A, 3590, Diepenbeek, Belgium.
| | - Annick Timmermans
- Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Agoralaan, Gebouw A, 3590, Diepenbeek, Belgium
| | - Jolijn Coolen
- Noorderhart, Rehabilitation and MS Center, Boemerangstraat 2, 3900, Pelt, Belgium
| | - Katrien Neven
- St-Trudo Hospital, Diestersteenweg 100, 3800, St-Truiden, Belgium
| | - Peter Hallet
- Ziekenhuis Oost-Limburg, Campus Sint-Barbara, Bessemerstraat 478, 3620, Lanaken, Belgium
| | - Jolien Lemmens
- Department of Healthcare, Centre of Expertise - Innovation in Care, PXL University of Applied Sciences and Arts, Guffenslaan 39, 3500, Hasselt, Belgium.,Sint-Gerardus, Multifunctioneel Centrum, Sint-Gerardusdreef 1, 3590, Diepenbeek, Belgium
| | - Annemie Spooren
- Department of Healthcare, Centre of Expertise - Innovation in Care, PXL University of Applied Sciences and Arts, Guffenslaan 39, 3500, Hasselt, Belgium.,Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Agoralaan, Gebouw A, 3590, Diepenbeek, Belgium
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20
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Dillenseger A, Weidemann ML, Trentzsch K, Inojosa H, Haase R, Schriefer D, Voigt I, Scholz M, Akgün K, Ziemssen T. Digital Biomarkers in Multiple Sclerosis. Brain Sci 2021; 11:brainsci11111519. [PMID: 34827518 PMCID: PMC8615428 DOI: 10.3390/brainsci11111519] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022] Open
Abstract
For incurable diseases, such as multiple sclerosis (MS), the prevention of progression and the preservation of quality of life play a crucial role over the entire therapy period. In MS, patients tend to become ill at a younger age and are so variable in terms of their disease course that there is no standard therapy. Therefore, it is necessary to enable a therapy that is as personalized as possible and to respond promptly to any changes, whether with noticeable symptoms or symptomless. Here, measurable parameters of biological processes can be used, which provide good information with regard to prognostic and diagnostic aspects, disease activity and response to therapy, so-called biomarkers Increasing digitalization and the availability of easy-to-use devices and technology also enable healthcare professionals to use a new class of digital biomarkers-digital health technologies-to explain, influence and/or predict health-related outcomes. The technology and devices from which these digital biomarkers stem are quite broad, and range from wearables that collect patients' activity during digitalized functional tests (e.g., the Multiple Sclerosis Performance Test, dual-tasking performance and speech) to digitalized diagnostic procedures (e.g., optical coherence tomography) and software-supported magnetic resonance imaging evaluation. These technologies offer a timesaving way to collect valuable data on a regular basis over a long period of time, not only once or twice a year during patients' routine visit at the clinic. Therefore, they lead to real-life data acquisition, closer patient monitoring and thus a patient dataset useful for precision medicine. Despite the great benefit of such increasing digitalization, for now, the path to implementing digital biomarkers is widely unknown or inconsistent. Challenges around validation, infrastructure, evidence generation, consistent data collection and analysis still persist. In this narrative review, we explore existing and future opportunities to capture clinical digital biomarkers in the care of people with MS, which may lead to a digital twin of the patient. To do this, we searched published papers for existing opportunities to capture clinical digital biomarkers for different functional systems in the context of MS, and also gathered perspectives on digital biomarkers under development or already existing as a research approach.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tjalf Ziemssen
- Correspondence: ; Tel.: +49-351-458-5934; Fax: +49-351-458-5717
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21
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Prange-Lasonder GB, Alt Murphy M, Lamers I, Hughes AM, Buurke JH, Feys P, Keller T, Klamroth-Marganska V, Tarkka IM, Timmermans A, Burridge JH. European evidence-based recommendations for clinical assessment of upper limb in neurorehabilitation (CAULIN): data synthesis from systematic reviews, clinical practice guidelines and expert consensus. J Neuroeng Rehabil 2021; 18:162. [PMID: 34749752 PMCID: PMC8573909 DOI: 10.1186/s12984-021-00951-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/18/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Technology-supported rehabilitation can help alleviate the increasing need for cost-effective rehabilitation of neurological conditions, but use in clinical practice remains limited. Agreement on a core set of reliable, valid and accessible outcome measures to assess rehabilitation outcomes is needed to generate strong evidence about effectiveness of rehabilitation approaches, including technologies. This paper collates and synthesizes a core set from multiple sources; combining existing evidence, clinical practice guidelines and expert consensus into European recommendations for Clinical Assessment of Upper Limb In Neurorehabilitation (CAULIN). METHODS Data from systematic reviews, clinical practice guidelines and expert consensus (Delphi methodology) were systematically extracted and synthesized using strength of evidence rating criteria, in addition to recommendations on assessment procedures. Three sets were defined: a core set: strong evidence for validity, reliability, responsiveness and clinical utility AND recommended by at least two sources; an extended set: strong evidence OR recommended by at least two sources and a supplementary set: some evidence OR recommended by at least one of the sources. RESULTS In total, 12 measures (with primary focus on stroke) were included, encompassing body function and activity level of the International Classification of Functioning and Health. The core set recommended for clinical practice and research: Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT); the extended set recommended for clinical practice and/or clinical research: kinematic measures, Box and Block Test (BBT), Chedoke Arm Hand Activity Inventory (CAHAI), Wolf Motor Function Test (WMFT), Nine Hole Peg Test (NHPT) and ABILHAND; the supplementary set recommended for research or specific occasions: Motricity Index (MI); Chedoke-McMaster Stroke Assessment (CMSA), Stroke Rehabilitation Assessment Movement (STREAM), Frenchay Arm Test (FAT), Motor Assessment Scale (MAS) and body-worn movement sensors. Assessments should be conducted at pre-defined regular intervals by trained personnel. Global measures should be applied within 24 h of hospital admission and upper limb specific measures within 1 week. CONCLUSIONS The CAULIN recommendations for outcome measures and assessment procedures provide a clear, simple, evidence-based three-level structure for upper limb assessment in neurological rehabilitation. Widespread adoption and sustained use will improve quality of clinical practice and facilitate meta-analysis, critical for the advancement of technology-supported neurorehabilitation.
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Affiliation(s)
- Gerdienke B Prange-Lasonder
- Roessingh Research and Development, Enschede, The Netherlands.
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands.
| | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Ilse Lamers
- Rehabilitation Research Center (REVAL), UHasselt, Diepenbeek, Belgium
- Rehabilitation and MS Center, Pelt, Belgium
| | - Ann-Marie Hughes
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jaap H Buurke
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biosignals and Systems, University of Twente, Enschede, The Netherlands
| | - Peter Feys
- Rehabilitation Research Center (REVAL), UHasselt, Diepenbeek, Belgium
| | - Thierry Keller
- Neurorehabilitation Area at the Health Division of TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia - San Sebastian, Spain
| | | | - Ina M Tarkka
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Annick Timmermans
- Rehabilitation Research Center (REVAL), UHasselt, Diepenbeek, Belgium
| | - Jane H Burridge
- School of Health Sciences, University of Southampton, Southampton, UK
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22
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Pilloni G, Malik M, Malik R, Krupp L, Charvet L. Upper Extremity Motor Fatigability as an Early Indicator in Pediatric Onset Multiple Sclerosis. J Child Neurol 2021; 36:720-726. [PMID: 33736529 DOI: 10.1177/0883073821999889] [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: 01/10/2023]
Abstract
AIM To adopt a computer-based protocol to assess grip fatigability in patients with pediatric-onset multiple sclerosis to provide detection of subtle motor involvement identifying those patients most at risk for future decline. METHOD Pediatric-onset multiple sclerosis patients were recruited during routine outpatient visits to complete a grip assessment and compared to a group of healthy age- and sex-matched controls. All participants completed a computer-based measurement of standard maximal grip strength and repetitive and sustained grip performance measured by dynamic and static fatigue indices. RESULTS A total of 38 patients with pediatric-onset multiple sclerosis and 24 healthy controls completed the grip protocol (right-hand dominant). There were no significant group differences in maximal grip strength bilaterally (right: 21.8 vs 19.9 kg, P = .25; left: 20.4 vs 18.7 kg, P = .33), although males with pediatric-onset multiple sclerosis were significantly less strong than healthy controls (right: 26.53 vs 21.23 kg, P = .009; left; 25.13 vs 19.63 kg, P = .003). Both dynamic and static fatigue indices were significantly higher bilaterally in pediatric-onset multiple sclerosis compared with healthy control participants (left-hand dynamic fatigue index: 18.6% vs 26.7%, P = .003; right-hand static fatigue index: 28.3% vs 41.3%, P < .001; left-hand static fatigue index: 31.9% vs 42.6%, P < .001). CONCLUSION Brief repeatable grip assessment including measures of dynamic and sustained static output can be a sensitive indicator of upper extremity motor involvement in pediatric-onset multiple sclerosis, potentially identifying those in need of intervention to prevent future disability.
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Affiliation(s)
- Giuseppina Pilloni
- Department of Neurology, 12297NYU Grossman School of Medicine, New York, NY, USA
| | - Martin Malik
- Department of Neurology, 12297NYU Grossman School of Medicine, New York, NY, USA
| | - Raghav Malik
- St. Elizabeth's Department of Behavioral Health, Elizabeth, NJ, USA
| | - Lauren Krupp
- Department of Neurology, 12297NYU Grossman School of Medicine, New York, NY, USA
| | - Leigh Charvet
- Department of Neurology, 12297NYU Grossman School of Medicine, New York, NY, USA
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23
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Kahraman T, Çekok FK, Üğüt BO, Keskinoğlu P, Genç A. One-Year Change in the Physical Functioning of Older People According to the International Classification of Functioning Domains. J Geriatr Phys Ther 2021; 44:E9-E17. [PMID: 30883529 DOI: 10.1519/jpt.0000000000000234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE It is important to determine physical functioning declines in older people according to the International Classification of Functioning, Disability and Health (ICF) framework, given its advantages. This study was performed to investigate 1-year changes in the physical functioning of older people using the ICF framework. METHODS Eighty older people were enrolled and completed baseline measures in this longitudinal, single-group study while 33 of these participants were reassessed at 1 year. Reliable and valid methods commonly used in geriatric rehabilitation settings for determining physical functioning were applied to evaluate ICF domains including Body Functions, Activities (capacity), and Activities and Participation (performance). Body Functions were assessed by measuring lower extremity muscle strength and exercise tolerance test performance. The Activities (capacity) measures included walking, balance, mobility, sit-to-stand, and upper extremity functional performance. The Activities and Participation (performance) domain included the Falls Efficacy Scale-International, Modified Barthel Index, and Rapid Assessment of Physical Activity scale. RESULTS There were significant decreases in muscle strength in both hip abductors and knee extensors (P < .001, d > 0.80) at 1 year versus baseline, but there were no significant changes in exercise tolerance test parameters (P > .05, d = 0.44-0.71), with the exception of diastolic blood pressure (P = .019, d = 0.90). Significant deterioration was observed in all Activities (capacity) measures (P < .05, d > 0.80). No significant changes were observed in the Falls Efficacy Scale-International (P = .051, d = 0.72), Modified Barthel Index (P = .107, d = 0.59), or Rapid Assessment of Physical Activity-Flexibility and Strength subscale (P = .763, d = 0.11). CONCLUSIONS Significant declines were seen in lower extremity muscle strength, walking capacity, speed, mobility, sit-to-stand performance, upper extremity function, and balance performance at 1 year. On the contrary, no significant changes were observed in the levels of participation in activities of daily living, activities related to balance, or physical activity. According to the ICF framework, during 1 year, our sample of older people showed declines in the Body Functions and Activities (capacity) domains, but the Activities and Participation (performance) domain remained stable.
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Affiliation(s)
- Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | | | - Birön Onur Üğüt
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
- Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Pembe Keskinoğlu
- Department of Biostatistics and Medical Informatics, Dokuz Eylül University, Izmir, Turkey
| | - Arzu Genç
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
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24
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Saini A, Zucker-Levin A, McMillan B, Kumar P, Donkers S, Levin MC. A Descriptive Correlational Study to Evaluate Three Measures of Assessing Upper Extremity Function in Individuals with Multiple Sclerosis. Mult Scler Int 2021; 2021:5588335. [PMID: 34258067 PMCID: PMC8257389 DOI: 10.1155/2021/5588335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/21/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Activities of daily living and quality of life (QOL) are hindered by upper extremity (UE) impairments experienced by individuals with multiple sclerosis (iMS). The Nine-Hole Peg Test (9-HPT) is most frequently used to measure UE function. However, it does not measure peoples' ability to perform routine tasks in daily life and may not be useful in iMS who cannot pick up the pegs utilized in the 9-HPT. Therefore, we evaluated three measures to explore a more comprehensive assessment of UE function: Upper Extremity Function Scale (UEFS), Action Research Arm Test (ARAT), and the 9-HPT. The objectives were to quantitatively assess the relationship between these measures of UE function, understand if the measures correlate with QOL as calculated by the MS Quality of Life-54 (MSQOL-54), and to determine differences in the measures based on employment status. METHODS 112 (79 female) iMS were prospectively recruited for this descriptive correlational study. Inclusion criteria were as follows: confirmed diagnosis of MS or clinically isolated syndrome, age ≥ 18 years, and ability to self-consent. All statistical analyses including Spearman's correlation coefficient (r s ) and Kruskal-Wallis tests were performed using SPSS. RESULTS A moderate correlation (r s = -0.51; p < 0.001) was found between the ARAT and 9-HPT scores for the more impaired hand. Likewise, a moderate correlation was found between UEFS and the physical health composite scores (PHCSs) of MSQOL-54 (r s = -0.59; p < 0.001). Finally, performances on ARAT, 9-HPT, and UEFS differed between the employed individuals and those on long-term disability (p = 0.007, p < 0.001, and p = 0.001). CONCLUSION The UEFS moderately correlated with the QOL measure, and considering the UESF is a patient-reported outcome, it could be used to complement routinely captured measures of assessing UE function. Further study is warranted to determine which measure, or combination of measures, is more sensitive to changes in UE function over time.
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Affiliation(s)
- Aman Saini
- Office of the Saskatchewan MS Clinical Research Chair, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Audrey Zucker-Levin
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Benjamin McMillan
- Office of the Saskatchewan MS Clinical Research Chair, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Pawan Kumar
- College of Kinesiology, University of Saskatchewan, Saskatchewan, Canada
| | - Sarah Donkers
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Michael C. Levin
- Office of the Saskatchewan MS Clinical Research Chair, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
- Department of Medicine, Neurology Division, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
- Department of Anatomy, Physiology and Pharmacology, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
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25
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Use of wrist-worn accelerometers to quantify bilateral upper limb activity and asymmetry under free-living conditions in people with multiple sclerosis. Mult Scler Relat Disord 2021; 53:103081. [PMID: 34166981 DOI: 10.1016/j.msard.2021.103081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/01/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Although upper limb (UL) dysfunctions are quite common among people with Multiple Sclerosis (pwMS), there is a scarcity of information about actual UL usage under free-living conditions. The aim of the present study is to quantitatively assess 'real-world' activity time, intensity and possible asymmetry of use among dominant and non-dominant ULs in pwMS. METHODS Twenty-eight pwMS (20 women, 8 men, average EDSS 4.3) and 28 age- and sex-matched unaffected individuals were required to wear a tri-axial accelerometer on each wrist 24h/day for 2 weekdays. Raw accelerations were processed to calculate parameters associated with time and intensity of use of UL both when engaged in uni- or bilateral activities. RESULTS During the 2-day monitoring period, pwMS were characterized by significantly lower overall activity, they used their dominant limb for a significantly longer time and, while performing bilateral activities, their dominant limb expressed movements of superior intensity in a proportion higher than what was observed in unaffected individuals. CONCLUSION The instrumental monitoring of UL activity with two wrist-worn sensors may represent an effective tool for assessing the contribution of each limb to uni- and bilateral movements. Such data can be employed to monitor the progression of UL dysfunctions and the effectiveness of pharmacologic and rehabilitative treatments.
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26
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Di Giovanni R, Solaro C, Grange E, Masuccio FG, Brichetto G, Mueller M, Tacchino A. A comparison of upper limb function in subjects with multiple sclerosis and healthy controls using an inertial measurement unit. Mult Scler Relat Disord 2021; 53:103036. [PMID: 34051695 DOI: 10.1016/j.msard.2021.103036] [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: 03/09/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
Upper limbs (UL) dysfunction is frequent in people with Multiple Sclerosis (PwMS). Several objective measures of UL function are proposed; however, their use is mostly confined to assess subjects with mild-to-moderate disability and requires fine motor skills, often impaired in high disability level subjects. Thus, a tool to score UL function in the advanced disease stage is lacking. The aim of the study is to analyse and compare UL unilateral and bilateral movements of healthy control (HC) and PwMS, at different disability levels, using an instrumented version (Inertial Measurement Unit, IMU) of the 15-seconds finger-to-nose test (FNT). Each movement cycle was segmented in going/adjusting/returning phases. The inter-hand interval (IHI) allowed assessing bilateral coordination (i.e. synchrony) in each phase. The larger IHI, the more severe the bilateral coordination impairment is. After stratifying PwMS for disability level (PwMSLOW, Expanded Disability Status Scale, EDSS≤5.5 and PwMSHIGH, EDSS≥6), the ANOVA on IHI showed significant differences between PwMS and HC (p<0.001) in all phases. However, only the going phase IHI showed significantly higher asynchrony in PwMSHIGH than PwMSLOW and HC (p<0.001) and no differences between PwMSLOW and HC. The going phase IHI seems to be a clinical marker specific for high disability level PwMS. These findings suggest inertial sensors during FNT could be an easy-to-use method for a more detailed quantitative characterization of UL function in PwMS also in subjects with EDSS greater than 6.
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Affiliation(s)
| | - C Solaro
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy.
| | - E Grange
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy
| | - F G Masuccio
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy
| | - G Brichetto
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, 16149, Genoa, Italy
| | - M Mueller
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, 16149, Genoa, Italy
| | - A Tacchino
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, 16149, Genoa, Italy
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27
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Kinematic Analysis of Lower Limb Joint Asymmetry During Gait in People with Multiple Sclerosis. Symmetry (Basel) 2021. [DOI: 10.3390/sym13040598] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The majority of people with Multiple Sclerosis (pwMS), report lower limb motor dysfunctions, which may relevantly affect postural control, gait and a wide range of activities of daily living. While it is quite common to observe a different impact of the disease on the two limbs (i.e., one of them is more affected), less clear are the effects of such asymmetry on gait performance. The present retrospective cross-sectional study aimed to characterize the magnitude of interlimb asymmetry in pwMS, particularly as regards the joint kinematics, using parameters derived from angle-angle diagrams. To this end, we analyzed gait patterns of 101 pwMS (55 women, 46 men, mean age 46.3, average Expanded Disability Status Scale (EDSS) score 3.5, range 1–6.5) and 81 unaffected individuals age- and sex-matched who underwent 3D computerized gait analysis carried out using an eight-camera motion capture system. Spatio-temporal parameters and kinematics in the sagittal plane at hip, knee and ankle joints were considered for the analysis. The angular trends of left and right sides were processed to build synchronized angle–angle diagrams (cyclograms) for each joint, and symmetry was assessed by computing several geometrical features such as area, orientation and Trend Symmetry. Based on cyclogram orientation and Trend Symmetry, the results show that pwMS exhibit significantly greater asymmetry in all three joints with respect to unaffected individuals. In particular, orientation values were as follows: 5.1 of pwMS vs. 1.6 of unaffected individuals at hip joint, 7.0 vs. 1.5 at knee and 6.4 vs. 3.0 at ankle (p < 0.001 in all cases), while for Trend Symmetry we obtained at hip 1.7 of pwMS vs. 0.3 of unaffected individuals, 4.2 vs. 0.5 at knee and 8.5 vs. 1.5 at ankle (p < 0.001 in all cases). Moreover, the same parameters were sensitive enough to discriminate individuals of different disability levels. With few exceptions, all the calculated symmetry parameters were found significantly correlated with the main spatio-temporal parameters of gait and the EDSS score. In particular, large correlations were detected between Trend Symmetry and gait speed (with rho values in the range of −0.58 to −0.63 depending on the considered joint, p < 0.001) and between Trend Symmetry and EDSS score (rho = 0.62 to 0.69, p < 0.001). Such results suggest not only that MS is associated with significantly marked interlimb asymmetry during gait but also that such asymmetry worsens as the disease progresses and that it has a relevant impact on gait performances.
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28
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Webster A, Poyade M, Rooney S, Paul L. Upper limb rehabilitation interventions using virtual reality for people with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2021; 47:102610. [PMID: 33212400 DOI: 10.1016/j.msard.2020.102610] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/07/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Research on Virtual Reality (VR) based motor rehabilitation for people with multiple sclerosis (MS) is rapidly growing in popularity, although few studies have focused on the upper limb (UL). The aims of this review were to investigate the effect of VR interventions on UL function in people with MS and determine if the type of VR intervention influences intervention effect. METHOD Five databases (IEEE Xplore, MEDLINE, ProQuest Central (Health & Medical Collection), Science Direct and Web of Science Core Collection) were searched using keywords that relating to MS, VR and UL. RESULTS Ten articles were included, six randomised controlled trials, three cohort studies and one pilot observational study. Both commercial and custom VR technologies were used in interventions, along with combination approaches using robotics, electrical stimulation and occupational therapy. Using the Nine Hole Peg Test, two studies found significant improvements within groups, one found that VR was more effective than another gaming approach. Significant improvements in other UL measures were in the Fugl-Meyer Assessment for the proximal arm; handgrip; perceived strength; Jebsen-Taylor Hand Function Test; Wolf Motor Function Test; active range of motion and trajectory measures after VR intervention. There were conflicting results regarding if VR was more effective than conventional approaches. CONCLUSION There is therefore some evidence that VR is effective in improving motor function in the UL, however, there is no clear consensus on which VR based approaches are the most effective, or the optimum intervention duration and intensity. Moreover, as many of the studies had non-immersive approaches it is hard to determine how effective immersion based approaches maybe in such specific context.
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Affiliation(s)
- Amy Webster
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Matthieu Poyade
- School of Simulation and Visualisation, Glasgow School of Art, UK
| | - Scott Rooney
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
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29
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Ertekin O, Kahraman T, Aras M, Baba C, Ozakbas S. Cross-cultural adaptation and psychometric properties of the Turkish version of the Manual Ability Measure-36 (MAM-36) in people with multiple sclerosis. Neurol Sci 2020; 42:2927-2936. [PMID: 33236246 DOI: 10.1007/s10072-020-04927-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: 04/14/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The Manual Ability Measure-36 (MAM-36) has been used to assess subjective upper limb function in people with several neurological and non-neurological diseases. Besides, the MAM-36 is one of the most commonly used patient-reported outcome measures (PROMs) in people with multiple sclerosis (pwMS). The aim was to translate and conduct cross-cultural adaptation of the MAM-36 into Turkish and investigate its psychometric properties in pwMS. METHODS The MAM-36 was translated and culturally adapted into Turkish. Two hundred pwMS were recruited for the psychometric study. Hand skills, handgrip strength, upper limb spasticity, disability level, and quality of life were evaluated by the validated performance-based tests and questionnaires including the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) which is a validated MS-specific PROM to assess upper limb function. RESULTS MAM-36 was significantly correlated with the performance-based tests and questionnaires, EDSS, age, and disease duration (p < 0.05). MAM-36 and AMSQ were strongly correlated (rs = - 0.90, p < 0.01). PwMS with spasticity had significantly lower MAM-36 scores compared to those without spasticity (p < 0.01). Internal consistency (Cronbach's alpha = 0.97) and test-retest reliability (ICC = 0.97) was high. CONCLUSION The Turkish version of MAM-36 has been found as a valid and reliable method for measuring upper limb function in pwMS.
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Affiliation(s)
- Ozge Ertekin
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Mona Aras
- Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Cavid Baba
- Multiple Sclerosis Research Association, Izmir, Turkey
| | - Serkan Ozakbas
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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30
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Carmisciano L, Signori A, Pardini M, Novi G, Lapucci C, Nesi L, Gallo E, Laroni A, Cellerino M, Meli R, Sbragia E, Filippi L, Uccelli A, Inglese M, Sormani MP. Assessing upper limb function in multiple sclerosis using an engineered glove. Eur J Neurol 2020; 27:2561-2567. [PMID: 32805743 DOI: 10.1111/ene.14482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The importance of upper limb function in multiple sclerosis (MS) is increasingly recognized, especially for the evaluation of patients with progressive MS with reduced mobility. Two sensor-engineered gloves, able to measure quantitatively the timing of finger opposition movements, were previously used to assess upper limb disability in MS. The aims of the present study were: (1) to confirm the association between glove-derived variables and standard measures of MS disability in a larger cohort; (2) to assess the correlation with quantitative magnetic resonance imaging (MRI) and quality of life (QoL) measures; and (3) to determine if the glove-derived variables offer advantages over the standard measure for assessing upper limb function in MS, namely, the Nine-Hole Peg Test (9HPT). METHODS Sixty-five patients with MS, stable on disease-modifying treatment, were evaluated at baseline using the glove, and through clinical examination (Expanded Disability Status Scale, Symbol Digit Modalities Test, Timed 25-Foot Walk Test and 9HPT), MRI evaluation and QoL questionnaires. Correlations between the glove-derived variables and clinical, MRI and QoL variables were assessed using Spearman's rank correlation coefficient analysis. RESULTS Glove-derived variables significantly differed between patients with relapsing-remitting and those with progressive MS, with similar or slightly higher correlations of the 9HPT with clinical variables. We found greater correlations of the QoL physical component with glove-derived variables than with the 9HPT, and a significant correlation of its mental component with the glove-derived variables but not with the 9HPT. CONCLUSION The study results, confirming previous findings and showing advantages over the 9HPT, encourage the investigation of sensitivity to change in glove-derived variables in a longitudinal setting.
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Affiliation(s)
- L Carmisciano
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - A Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - G Novi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - C Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - L Nesi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - E Gallo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | - A Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - M Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - R Meli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - E Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - L Filippi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - A Uccelli
- Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - M Inglese
- Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - M P Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
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31
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Solaro C, Di Giovanni R, Grange E, Mueller M, Messmer Uccelli M, Bertoni R, Brichetto G, Tacchino A, Patti F, Pappalardo A, Prosperini L, Castelli L, Rosato R, Cattaneo D, Marengo D. Box and block test, hand grip strength and nine-hole peg test: correlations between three upper limb objective measures in multiple sclerosis. Eur J Neurol 2020; 27:2523-2530. [PMID: 32619066 DOI: 10.1111/ene.14427] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Limited data are available in the literature for upper limb impairment in multiple sclerosis (MS). This study aimed to report the distribution of values of hand grip strength (HGS), of the box and block test (BBT) and of the nine-hole peg test (9HPT) correlated with demographic and clinical data in subjects with MS. METHODS This study involved five Italian neurological centres. The inclusion criteria were age ≥ 18, MS diagnosis, stable disease phase, right-hand dominance. All subjects underwent HGS, BBT and 9-HPT evaluation. RESULTS In all, 202 subjects with MS were enrolled: 137 females; mean age 48.4 years; mean Expanded Disability Status Scale (EDSS) 4.17; mean disease duration 14.12 years; disease course 129 relapsing-remitting, 21 primary progressive and 52 secondary progressive MS subjects; mean right HGS 25.3 kg, left 23.2 kg; mean right BBT 45.7 blocks, left 44.9 blocks; mean right 9-HPT 30.7 s, left 33.4 s. All results were statistically significantly different compared to healthy controls. HGS, BBT and 9-HPT were associated with age, EDSS and disease duration, whilst disease course correlated with BBT and 9-HPT. The BBT and 9-HPT scores significantly differed according to level of disability (EDSS ≤3.0, 3.5-5.5, ≥6.0). CONCLUSION Hand grip strength and BBT value distribution in a large MS population is reported. Correlations between HGS, BBT and 9-HPT were generally low.
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Affiliation(s)
- C Solaro
- Department of Rehabilitation, CRRF 'Mons. Luigi Novarese', Moncrivello, Italy
| | - R Di Giovanni
- Department of Rehabilitation, CRRF 'Mons. Luigi Novarese', Moncrivello, Italy
| | - E Grange
- Department of Rehabilitation, CRRF 'Mons. Luigi Novarese', Moncrivello, Italy
| | - M Mueller
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - M Messmer Uccelli
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - R Bertoni
- IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy
| | - G Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - A Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - F Patti
- MS Center Institute of Neurological Sciences - University of Catania, Catania, Italy
| | - A Pappalardo
- MS Center Institute of Neurological Sciences - University of Catania, Catania, Italy
| | - L Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Roma, Italy
| | - L Castelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC neuroriabilitazione ad Alta Intensità, Roma, Italy
| | - R Rosato
- Department of Psychology, University of Turin, Torino, Italy
| | - D Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy
| | - D Marengo
- Department of Psychology, University of Turin, Torino, Italy
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Solaro C, Grange E, Di Giovanni R, Cattaneo D, Bertoni R, Prosperini L, Messmer Uccelli M, Marengo D. Nine Hole Peg Test asymmetry in refining upper limb assessment in multiple sclerosis. Mult Scler Relat Disord 2020; 45:102422. [PMID: 32731199 DOI: 10.1016/j.msard.2020.102422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/02/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Expanded Disability Status Scale (EDSS) is the most frequently used scale to measure neurologic impairment and quantify the level of disability in Multiple Sclerosis (MS) even though the scale focuses on ambulation and undervalues upper limb (UL) impairment. The 9-Hole Peg Test (9-HPT) is the gold standard for UL assessment in MS, calculating a mean score from right and left arms, even though subjects with MS often show a lateralization of neurological deficit. OBJECTIVE The study aimed to determine whether an interaction exists between mean right-left 9-HPT scores or 9HPT score asymmetry (difference between right and left side) in predicting EDSS in MS subjects. METHODS Demographic and disease variables and 9-HPT scores were obtained from medical records of individuals with MS collected in an ad-hoc database. Subjects with 9-HPT score ≤180 s for each arm were included. An asymmetry score was represented as the absolute value of the difference between 9-HPT scores for both arms. RESULTS 549 subjects were included: 67.8% female, mean age 45±13.14 years, mean EDSS 3.98±2.12, 356 relapsing-remitting, 68 primary and 125 secondary progressive, mean 9-HPT scores: right arm 30.20 ± 19.99 s, left arm 31.80 ± 20.35 s. Mean asymmetry was 9.35±18.20 s. Correlation between mean right-left 9-HPT scores and EDSS was 0.58 (p<.001). Significant interaction between mean right-left 9-HPT scores and 9-HPT asymmetry in predicting EDSS scores was found. Regression slope of EDSS on mean right-left 9-HPT score decreases as asymmetry value increases (non-significance area values ≥ 40.93 s). CONCLUSIONS Findings suggest interaction exists between mean right-left 9-HPT scores and asymmetry in predicting EDSS. A consequence of this is that, by disregarding information about asymmetry, studies exploring the association between mean right-left 9-HPT scores and global measures of disability may provide biased results. The bias tends to increase as asymmetry increases, and to be most prevalent among patients with EDSS scores > 6.
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Affiliation(s)
- C Solaro
- Department of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy.
| | - E Grange
- Department of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
| | - R Di Giovanni
- Department of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
| | - D Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy
| | - R Bertoni
- IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy
| | - L Prosperini
- Department of Neuroscience, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - D Marengo
- Department of Psychology, University of Turin, Torino, Italy
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Creagh AP, Simillion C, Scotland A, Lipsmeier F, Bernasconi C, Belachew S, van Beek J, Baker M, Gossens C, Lindemann M, De Vos M. Smartphone-based remote assessment of upper extremity function for multiple sclerosis using the Draw a Shape Test. Physiol Meas 2020; 41:054002. [DOI: 10.1088/1361-6579/ab8771] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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34
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Tacchino A, Ponzio M, Pedullà L, Podda J, Bragadin MM, Pedrazzoli E, Konrad G, Battaglia MA, Mokkink L, Brichetto G. Italian validation of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ). Neurol Sci 2020; 41:3273-3281. [DOI: 10.1007/s10072-020-04363-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 03/20/2020] [Indexed: 12/20/2022]
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35
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Solaro C, Di Giovanni R, Grange E, Brichetto G, Mueller M, Tacchino A, Bertoni R, Patti F, Pappalardo A, Prosperini L, Castelli L, Rosato R, Cattaneo D, Marengo D. Italian translation and psychometric validation of the Manual Ability Measure-36 (MAM-36) and its correlation with an objective measure of upper limb function in patients with multiple sclerosis. Neurol Sci 2020; 41:1539-1546. [DOI: 10.1007/s10072-020-04263-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 01/18/2020] [Indexed: 12/25/2022]
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36
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Proud EL, Miller KJ, Bilney B, Morris ME, McGinley JL. Construct validity of the 9-Hole Peg Test and Purdue Pegboard Test in people with mild to moderately severe Parkinson's disease. Physiotherapy 2019; 107:202-208. [PMID: 32026821 DOI: 10.1016/j.physio.2019.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/13/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the construct validity of two dexterity measures, the 9-Hole Peg Test (9HPT) and Purdue Pegboard Test (PPT) in people with Parkinson's disease (PD). DESIGN Cross-sectional observational study. SETTING Testing was conducted at the university or in participants' homes. PARTICIPANTS Thirty community dwelling people with mild to moderately severe PD and no major upper limb comorbidities or cognitive impairments. INTERVENTIONS Pegboard tests were administered in the 'on' and 'end-of-dose' phases of participants' PD medication cycles. Participants rated hand function with two self-report questionnaires - the Manual Ability Measure-36 (MAM-36) and a subset of upper limb items from the MDS-UPDRS. To explore construct validity, we compared 'on' phase pegboard scores with normative values for unimpaired men and women and investigated relationships between pegboard scores and hand function questionnaires. RESULTS In the 'on' phase, pegboard scores were poorer than normative values. Differences in individual subtest scores ranged between 10 and 41%. Correlations between self-reported hand function and pegboard scores were weak to moderately strong in the 'on' phase (r=0.21-0.51), and weak at 'end-of-dose' (r=0.13-0.22). Higher correlation coefficients were observed between hand function and PPT subtest scores than with hand function and 9HPT scores. Most participants reported difficulty with daily hand tasks. CONCLUSIONS We found evidence for construct validity supporting the use of the 9HPT and PPT to evaluate people with mild to moderately severe PD when 'on', but not at the 'end-of-dose'. Results also suggest that the PPT may be more sensitive to PD-related changes in dexterity than the 9HPT.
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Affiliation(s)
- Elizabeth L Proud
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia.
| | - Kimberly J Miller
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia; Sunny Hill Health Centre for Children, Vancouver, Canada
| | - Belinda Bilney
- School of Allied Health, Australian Catholic University, Ballarat, Australia
| | - Meg E Morris
- Healthscope and La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Australia
| | - Jennifer L McGinley
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia
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Is There Any Relationship between Upper and Lower Limb Impairments in People with Multiple Sclerosis? A Kinematic Quantitative Analysis. Mult Scler Int 2019; 2019:9149201. [PMID: 31687212 PMCID: PMC6803720 DOI: 10.1155/2019/9149201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/09/2019] [Accepted: 07/22/2019] [Indexed: 01/20/2023] Open
Abstract
Background In people with multiple sclerosis (pwMS), disability is generally assessed on the basis of ambulation abilities, whereas upper limb motor dysfunctions are less frequently considered. Nevertheless, they can severely affect the quality of life of pwMS. To date, it remains mostly unknown whether a relationship exists between upper and lower limb impairments. Aim To investigate the existence of a relationship between upper and lower limb impairments in pwMS based on two fundamental motor tasks, namely walking and hand-to-mouth (HTM) movement. Methods Twenty-eight pwMS with Expanded Disability Status Scale (EDSS) scores in the range of 1-6, and 21 healthy controls (HC) underwent a kinematic analysis of gait and HTM movement performed with a motion capture system. The spatiotemporal parameters for the two tasks were calculated and correlated using Spearman's rank correlation coefficients. Results The pwMS performed worse than HC on both tasks. Small to large correlations were found between the total HTM movement duration and most of the gait parameters (rho, 0.35-0.68; p < 0.05). Conclusions Both upper and lower limb motor abilities in pwMS worsen as disability increases. Nevertheless, their relationship is only moderate. This finding emphasizes the need for specific tests to quantify disability considering the overall motor function in pwMS.
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Boffa G, Tacchino A, Sbragia E, Schiavi S, Droby A, Piaggio N, Bommarito G, Girardi G, Mancardi GL, Brichetto G, Inglese M. Preserved brain functional plasticity after upper limb task‐oriented rehabilitation in progressive multiple sclerosis. Eur J Neurol 2019; 27:77-84. [DOI: 10.1111/ene.14059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/05/2019] [Indexed: 12/21/2022]
Affiliation(s)
- G. Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
| | - A. Tacchino
- Scientific Research Area Italian Multiple Sclerosis Foundation Genoa Italy
| | - E. Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
| | - S. Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
| | - A. Droby
- Department of Neurology and Neuroscience Icahn School of Medicine at Mount Sinai New York New York USA
| | - N. Piaggio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
| | - G. Bommarito
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
| | - G. Girardi
- Scientific Research Area Italian Multiple Sclerosis Foundation Genoa Italy
| | - G. L. Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
- IRCCS Istituti Clinici Scientifici Maugeri Pavia Italy
- Ospedale Policlinico San Martino-IRCCS Genoa Italy
| | - G. Brichetto
- Scientific Research Area Italian Multiple Sclerosis Foundation Genoa Italy
| | - M. Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
- Department of Neurology and Neuroscience Icahn School of Medicine at Mount Sinai New York New York USA
- Ospedale Policlinico San Martino-IRCCS Genoa Italy
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Burridge J, Alt Murphy M, Buurke J, Feys P, Keller T, Klamroth-Marganska V, Lamers I, McNicholas L, Prange G, Tarkka I, Timmermans A, Hughes AM. A Systematic Review of International Clinical Guidelines for Rehabilitation of People With Neurological Conditions: What Recommendations Are Made for Upper Limb Assessment? Front Neurol 2019; 10:567. [PMID: 31293493 PMCID: PMC6603199 DOI: 10.3389/fneur.2019.00567] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022] Open
Abstract
Background: Upper limb impairment is a common problem for people with neurological disabilities, affecting activity, performance, quality of life, and independence. Accurate, timely assessments are required for effective rehabilitation, and development of novel interventions. International consensus on upper limb assessment is needed to make research findings more meaningful, provide a benchmark for quality in clinical practice, more cost-effective neurorehabilitation and improved outcomes for neurological patients undergoing rehabilitation. Aim: To conduct a systematic review, as part of the output of a European COST Action, to identify what recommendations are made for upper limb assessment. Methods: We systematically reviewed published guidance on measures and protocols for assessment of upper limb function in neurological rehabilitation via electronic databases from January 2007–December 2017. Additional records were then identified through other sources. Records were selected for inclusion based on scanning of titles, abstracts and full text by two authors working independently, and a third author if there was disagreement. Records were included if they referred to “rehabilitation” and “assessment” or “measurement”. Reasons for exclusion were documented. Results: From the initial 552 records identified (after duplicates were removed), 34 satisfied our criteria for inclusion, and only six recommended specific outcome measures and /or protocols. Records were divided into National Guidelines and other practice guidelines published in peer reviewed Journals. There was agreement that assessment is critical, should be conducted early and at regular intervals and that there is a need for standardized measures. Assessments should be conducted by a healthcare professional trained in using the measure and should encompass body function and structure, activity and participation. Conclusions: We present a comprehensive, critical, and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers, and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions.
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Affiliation(s)
- Jane Burridge
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jaap Buurke
- Roessingh Research and Development, Enschede, Netherlands.,Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | | | | | - Ilse Lamers
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Lauren McNicholas
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Gerdienke Prange
- Roessingh Research and Development, Enschede, Netherlands.,Faculty of Engineering Technology, University of Twente, Enschede, Netherlands
| | - Ina Tarkka
- Faculty of Sport and Health Sciences, University of Jyväskylá, Jyväskylä, Finland
| | - Annick Timmermans
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Ann-Marie Hughes
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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40
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Solaro C, Cattaneo D, Brichetto G, Castelli L, Tacchino A, Gervasoni E, Prosperini L. Clinical correlates of 9-hole peg test in a large population of people with multiple sclerosis. Mult Scler Relat Disord 2019; 30:1-8. [DOI: 10.1016/j.msard.2019.01.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/23/2018] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
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41
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Kahraman T. Performance Measures for Upper Extremity Functions in Persons with Multiple Sclerosis. NORO PSIKIYATRI ARSIVI 2019; 55:S41-S45. [PMID: 30692854 DOI: 10.29399/npa.23317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Recent studies suggest that upper extremity dysfunction is a quite common symptom in multiple sclerosis (MS), and affects adversely the activities of daily living even in the early stages of the disease. It is an undeniable fact that assessment is a crucial component for a disease management. The performance is defined as "what an individual does in his or her current environment" according to the International Classification of Functioning, Disability and Health (ICF). Performance measures for upper extremity have been used relatively recent in persons with MS. ABILHAND, Manual Ability Measurement (MAM), Disabilities of the Arm Shoulder and Hand Outcome Measure, and Motor Activity Log are commonly used perceived performance measures for upper extremity functions in persons with MS. Because of their modern psychometric properties, ABILHAND and MAM stands out from other measures. Only available actual performance measures for upper extremity functions in persons with MS are accelerometers. In addition to their advantages, they have some disadvantages waiting to be solved.
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Affiliation(s)
- Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İzmir Katip Çelebi University, Turkey
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42
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Luijten MAJ, Eekhout I, D’Hooghe M, Uitdehaag BMJ, Mokkink LB. Development of the Arm Function in Multiple Sclerosis Questionnaire-Short Form (AMSQ-SF): A static 10-item version. Mult Scler 2018; 24:1892-1901. [PMID: 30411658 PMCID: PMC6282156 DOI: 10.1177/1352458518808197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Assessing arm and hand function of multiple sclerosis (MS) patients is important as impaired functioning may impact daily activities and reduce quality of life. OBJECTIVE A short-form of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ), a recently developed patient-reported outcome measure containing 31 items, is developed to allow non-adaptive application. METHODS Complete data from 690 patients with MS, recruited via outpatient clinics, a residential center or via a Dutch website aimed at MS patients, were included in the analyses. A graded response model was fit to these data to estimate item response theory (IRT) parameters, which were used to perform post hoc computerized adaptive test (CAT) simulations with a cutoff standard error of measurement (SEM) of 0.32. The optimal test length was determined by the correlation between the static short-form and full-length theta, the mean SEM, and the amount of patients reaching a satisfactory SEM in CAT simulations. RESULTS AND CONCLUSION Based on five selection criteria (i.e. discrimination parameters, total information, times selected in CAT simulations, raw item means, and item content), 10 items were selected for inclusion in the short-form. The score on the final 10-item short-form correlated strongly with the full-length AMSQ and provided reliable ability estimations, indicating its usefulness instrument in research and clinical settings.
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Affiliation(s)
- Michiel AJ Luijten
- Amsterdam UMC, Amsterdam Public Health Research Institute and Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Iris Eekhout
- Amsterdam UMC, Amsterdam Public Health Research Institute and Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands/Netherlands Organisation for Applied Scientific Research (TNO), Leiden, The Netherlands
| | - Marie D’Hooghe
- National MS Center Melsbroek, Melsbroek, Belgium/Center for Neurosciences and Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Bernard MJ Uitdehaag
- Amsterdam UMC, Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Lidwine B Mokkink
- Amsterdam UMC, Amsterdam Public Health Research Institute and Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
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43
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Lamers I, Feys P. Patient reported outcome measures of upper limb function in multiple sclerosis: A critical overview. Mult Scler 2018; 24:1792-1794. [DOI: 10.1177/1352458518809294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ilse Lamers
- Rehabilitation Research Center (REVAL), Biomedical Research Institute (BIOMED), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium/Rehabilitation and MS Center Overpelt, Overpelt, Belgium
| | - Peter Feys
- Rehabilitation Research Center (REVAL), Biomedical Research Institute (BIOMED), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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44
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Corona F, Gervasoni E, Coghe G, Cocco E, Ferrarin M, Pau M, Cattaneo D. Validation of the Arm Profile Score in assessing upper limb functional impairments in people with multiple sclerosis. Clin Biomech (Bristol, Avon) 2018; 51:45-50. [PMID: 29179033 DOI: 10.1016/j.clinbiomech.2017.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although upper limb (UL) impairments are widespread in people with Multiple Sclerosis (pwMS), there is limited quantitative evidence concerning their specific features. The aim of this study is to validate a synthetic measure based on kinematic data to define the degree of deviation from a physiologic pattern during the "hand to mouth" (HTM) task. METHODS Twenty pwMS (mean age 51.2 SD 11.1) years, Expanded Disability Status Scale (EDSS) score in the range 2-6.5, underwent a kinematic analysis of the HTM task using a motion capture system. Spatio-temporal parameters and synthetic indexes (Arm Variable Score, AVS and Arm Profile Score, APS) were calculated and compared with those of age-matched healthy individuals. Kinematic data were correlated with the EDSS score and clinical tests such as the Nine Hole Peg Test (NHPT) and hand-grip strength (HGS). FINDINGS PwMS exhibit reduced velocity, increased movement duration, sway of adjusting and frequency of direction changes as well as higher APS values (15.4° vs. 8.6°, P<0.001) with respect to controls due to alterations in trunk flexion-extension, shoulder abduction-adduction, flexion-extension and rotation and elbow flexion-extension. Moderate-to-large correlations were found between APS and EDSS (rho=0.609, P<0.001), NHPT (rho=0.468, P=0.03) and HGS (rho=-0.627 P<0.001). INTERPRETATION The kinematic analysis of HTM provides useful information in quantifying UL impairments in pwMS. The APS index appears suitable to represent UL movement deviations from the physiological pattern in pwMS and to assess disease progression or effectiveness of pharmacologic and rehabilitative treatments effectiveness.
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Affiliation(s)
- Federica Corona
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy.
| | - Elisa Gervasoni
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Foundation Don C. Gnocchi Onlus, IRCSS, Via Capecelatro 66, 20148 Milan, Italy
| | - Giancarlo Coghe
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maurizio Ferrarin
- Biomedical Technology Department, Foundation Don C. Gnocchi Onlus, IRCCS, Via Capecelatro 66, 20148 Milan, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Davide Cattaneo
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Foundation Don C. Gnocchi Onlus, IRCSS, Via Capecelatro 66, 20148 Milan, Italy
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45
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Feys P, Lamers I, Francis G, Benedict R, Phillips G, LaRocca N, Hudson LD, Rudick R. The Nine-Hole Peg Test as a manual dexterity performance measure for multiple sclerosis. Mult Scler 2017; 23:711-720. [PMID: 28206826 PMCID: PMC5405844 DOI: 10.1177/1352458517690824] [Citation(s) in RCA: 301] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Impaired manual dexterity is a frequently reported disability in people with multiple sclerosis (MS) and is increasingly prevalent with worsening disease. While various tests and patient-reported outcome measures are available, the Nine-Hole Peg Test (NHPT) is considered as a gold standard measure of manual dexterity and most frequently used in MS research and clinical practice. The MS Outcome Assessments Consortium (MSOAC) includes representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. Among the MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step for these neuroperformance metrics is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are deemed clinically meaningful. This article addresses the NHPT, the proposed MSOAC measure for upper extremity function. We find that the NHPT is reliable within and between test sessions, discriminates between healthy subjects and MS patients with different levels of upper limb impairment, and shows high convergent validity with other manual dexterity as well as more comprehensive upper limb measures. Ecological validity is established by its relation to perceived upper limb use in daily life and perceived difficulty in performing activities of daily living. The NHPT is responsive to deterioration in longitudinal studies, and research suggests that a 20% change in test score is commonly used to define clinically meaningful worsening, a definition that needs further validation in all stages of the disease.
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Affiliation(s)
- Peter Feys
- Rehabilitation Research Center (REVAL), Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Ilse Lamers
- Rehabilitation Research Center (REVAL), Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Gordon Francis
- Neuroscience Clinical Development, San Francisco, CA, USA
| | - Ralph Benedict
- Department of Neurology, University at Buffalo, Buffalo, NY, USA
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- Multiple Sclerosis Outcome Assessments Consortium (MSOAC), Critical Path Institute, Tucson, AZ, USA
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46
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Lamers I, Maris A, Severijns D, Dielkens W, Geurts S, Van Wijmeersch B, Feys P. Upper Limb Rehabilitation in People With Multiple Sclerosis. Neurorehabil Neural Repair 2016; 30:773-93. [DOI: 10.1177/1545968315624785] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background. There has been an increasing research interest in upper limb rehabilitation in multiple sclerosis (MS). The current changes in the research field inquire a new literature review. Objective. This systematic review aimed to provide an overview of the upper limb rehabilitation strategies in people with MS (PwMS). Methods. Articles published in PubMed and Web of Knowledge were selected when written in English, published in the past 25 years, peer reviewed, that included at least 5 PwMS, and described the effects of an intervention study including rehabilitation strategies targeting the upper limbs. Included articles were screened based on title/abstract and full text by 2 independent reviewers. Results. Thirty articles met the criteria and were included for data extraction. Only half of the included studies investigated the effects of a training program specially targeted toward the upper limbs, while in the other studies, a general whole body therapy was used. The therapy content and dosage varied greatly between the different included studies. Multidisciplinary and robot-based rehabilitation were the most investigated rehabilitation strategies and showed to improve upper limb capacity. Strength and endurance training improved the upper limb body functions and structures but did not influence the upper limb capacity and performance. Conclusions. The results of this systematic review indicated that different types of upper limb rehabilitation strategies can improve upper limb function in PwMS. Further research is necessary to compare directly the effects of different rehabilitation strategies and to investigate the optimal therapy dosage according to the upper limb disability level.
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Affiliation(s)
- Ilse Lamers
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Anneleen Maris
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Deborah Severijns
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Wouter Dielkens
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Sander Geurts
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Bart Van Wijmeersch
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Rehabilitation and MS Center, Overpelt, Belgium
| | - Peter Feys
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Zhong J, Nantes JC, Holmes SA, Gallant S, Narayanan S, Koski L. Abnormal functional connectivity and cortical integrity influence dominant hand motor disability in multiple sclerosis: a multimodal analysis. Hum Brain Mapp 2016; 37:4262-4275. [PMID: 27381089 DOI: 10.1002/hbm.23307] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 05/23/2016] [Accepted: 06/22/2016] [Indexed: 01/04/2023] Open
Abstract
Functional reorganization and structural damage occur in the brains of people with multiple sclerosis (MS) throughout the disease course. However, the relationship between resting-state functional connectivity (FC) reorganization in the sensorimotor network and motor disability in MS is not well understood. This study used resting-state fMRI, T1-weighted and T2-weighted, and magnetization transfer (MT) imaging to investigate the relationship between abnormal FC in the sensorimotor network and upper limb motor disability in people with MS, as well as the impact of disease-related structural abnormalities within this network. Specifically, the differences in FC of the left hemisphere hand motor region between MS participants with preserved (n = 17) and impaired (n = 26) right hand function, compared with healthy controls (n = 20) was investigated. Differences in brain atrophy and MT ratio measured at the global and regional levels were also investigated between the three groups. Motor preserved MS participants had stronger FC in structurally intact visual information processing regions relative to motor impaired MS participants. Motor impaired MS participants showed weaker FC in the sensorimotor and somatosensory association cortices and more severe structural damage throughout the brain compared with the other groups. Logistic regression analysis showed that regional MTR predicted motor disability beyond the impact of global atrophy whereas regional grey matter volume did not. More importantly, as the first multimodal analysis combining resting-state fMRI, T1-weighted, T2-weighted and MTR images in MS, we demonstrate how a combination of structural and functional changes may contribute to motor impairment or preservation in MS. Hum Brain Mapp 37:4262-4275, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jidan Zhong
- Research Institute of the McGill University Health Centre, 2155 Guy Street, 5th Floor, Montreal, Quebec, H3H 2R9, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, H3H 2R9, Canada
| | - Julia C Nantes
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, H3H 2R9, Canada.,Integrated Program in Neuroscience, McGill University, 3801 University Street, Room 141, Montreal, Quebec, H3A 2B4, Canada
| | - Scott A Holmes
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, H3H 2R9, Canada.,Integrated Program in Neuroscience, McGill University, 3801 University Street, Room 141, Montreal, Quebec, H3A 2B4, Canada
| | - Serge Gallant
- Research Institute of the McGill University Health Centre, 2155 Guy Street, 5th Floor, Montreal, Quebec, H3H 2R9, Canada
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, H3H 2R9, Canada
| | - Lisa Koski
- Research Institute of the McGill University Health Centre, 2155 Guy Street, 5th Floor, Montreal, Quebec, H3H 2R9, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, H3H 2R9, Canada.,Department of Psychology, McGill University, Montreal, Quebec, H3H 2R9, Canada
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Abstract
PURPOSE OF REVIEW The purpose of this study is to highlight the pathological features and clinical aspects of progressive multiple sclerosis (PMS) and also the results of clinical trial experience to date and review ongoing clinical trials and prospective new treatment options. This study will explain the challenges of clinical trial design in PMS. RECENT FINDINGS Multiple sclerosis (MS) has been identified as a chronic immune mediated disease, and the progressive phase of the disease appears to have significant neurodegenerative mechanisms. The classification of the course of PMS has been reorganized into categories of active vs. inactive inflammatory disease and the presence vs. absence of gradual disease progression. This differentiation allows clearer conceptualization of PMS and possibly even more efficient recruitment of PMS patients into clinical trials. Clinical trial experience to date in PMS has been negative with anti-inflammatory medications used in relapsing MS. Simvastatin was recently tested in a phase II trial and showed a 43% reduction of annualized atrophy progression in secondary progressive MS. Ongoing PMS trials are currently being conducted with the phosphodiesterase inhibitor ibudilast, S1P modulator siponimod and anti-B-cell therapy ocrelizumab. Several efforts for development of outcome measures in PMS are ongoing. SUMMARY PMS represents a significant challenge, as the pathogenesis of the disease is not well understood, no validated outcome metrics have been established and clinical trial experience to date has been disappointing. Advances in the understanding of the disease and lessons learned in previous clinical trials are paving the way for successful development of disease-modifying agents for this disease.
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Savin Z, Lejbkowicz I, Glass-Marmor L, Lavi I, Rosenblum S, Miller A. Effect of Fampridine-PR (prolonged released 4-aminopyridine) on the manual functions of patients with Multiple Sclerosis. J Neurol Sci 2015; 360:102-9. [PMID: 26723984 DOI: 10.1016/j.jns.2015.11.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Persons with MS (PwMS) commonly present ambulatory and manual dysfunctions. While ambulation is recognized as important to PwMS, manual dysfunction is only lately gaining attention. Fampridine-PR was approved for MS ambulatory impairments. Anecdotal evidences indicate possible therapeutic effects on manual function. OBJECTIVE To comprehensively assess the effect of Fampridine-PR on manual functions of PwMS. METHODS Twenty six PwMS with ambulatory and manual dysfunction assessed before, 1 and 3months after treatment with Fampridine-PR, applying Timed 25-Foot Walk (T25FW) for ambulation while manual functions were evaluated by several tools addressing the International Classification of Functioning (ICF) concepts. This includes hand grip and pinch strength, 9 Hole Peg Test (9HPT), Arthritis Hand Function Test (AHFT), activities of daily life (ADL) tests, ABILHAND questionnaire and Computerized Penmanship Evaluation Tool (ComPET). RESULTS Fampridine-PR increased dominant hand grip and pinch strength 1month following treatment initiation by 12% and 10% (p<0.05), respectively. 9HPT improved by 11.3% after 3months of treatment (p<0.05%) and ABILHAND improved by 16% and 31% (p<0.05%) after 1 and 3months of treatment. Mean stroke duration in air of the name writing task improved by 21% (p<0.05) following 3months of treatment. T25FW results were similar to previous reports. CONCLUSION The results of this pilot study suggest that Fampridine-PR improves manual function of PwMS. Methods herein indicate that an integrative approach may be useful for evaluation of manual function in MS and in additional neurological diseases.
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Affiliation(s)
- Ziv Savin
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron Street, Haifa, Israel.
| | - Izabella Lejbkowicz
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron Street, Haifa, Israel; Multiple Sclerosis & Brain Research Center, Carmel Medical Center, 7 Michal Street, Haifa, Israel.
| | - Lea Glass-Marmor
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron Street, Haifa, Israel; Multiple Sclerosis & Brain Research Center, Carmel Medical Center, 7 Michal Street, Haifa, Israel.
| | - Idit Lavi
- Department of Community Medicine and Epidemiology, Carmel Medical Center, 7 Michal Street, Haifa, Israel.
| | - Sara Rosenblum
- The Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, 199 Aba Khoushy Avenue, Haifa, Israel.
| | - Ariel Miller
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron Street, Haifa, Israel; Multiple Sclerosis & Brain Research Center, Carmel Medical Center, 7 Michal Street, Haifa, Israel.
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Ontaneda D, Fox RJ, Chataway J. Clinical trials in progressive multiple sclerosis: lessons learned and future perspectives. Lancet Neurol 2015; 14:208-23. [PMID: 25772899 PMCID: PMC4361791 DOI: 10.1016/s1474-4422(14)70264-9] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Progressive multiple sclerosis is characterised clinically by the gradual accrual of disability independent of relapses and can occur with disease onset (primary progressive) or can be preceded by a relapsing disease course (secondary progressive). An effective disease-modifying treatment for progressive multiple sclerosis has not yet been identified, and so far the results of clinical trials have generally been disappointing. Ongoing advances in the knowledge of pathogenesis, in the identification of novel targets for neuroprotection, and in improved outcome measures could lead to effective treatments for progressive multiple sclerosis. In this Series paper, we summarise the lessons learned from completed clinical trials and perspectives from trials in progress in progressive multiple sclerosis. We review promising clinical, imaging, and biological markers, along with novel designs, for clinical trials. The use of more refined outcomes and truly neuroprotective drugs, coupled with more efficient trial design, has the capacity to deliver a new era of therapeutic discovery in this challenging area.
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Affiliation(s)
- Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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