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Fernandes L, Coats RO, Mon-Williams M, Hafeez A, Holt R, Ford HL. A novel tool for characterising upper limb function in progressive multiple sclerosis through kinematic assessment. J Neurol Sci 2024; 462:123068. [PMID: 38850768 DOI: 10.1016/j.jns.2024.123068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/11/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Current upper limb assessment methods in MS rely on measuring duration in tasks like the nine-hole peg test (9HPT). Kinematic techniques may provide a more useful measure of functional change in clinical and research practice. The aim of this study was to assess upper limb function prospectively in people with progressive MS using a kinematic 3D motion capture system and compare with current measures. METHODS 42 people with progressive MS (PwPMS) and 15 healthy controls reached-and-grasped different objects whilst recorded by a kinematic assessment system. 9HPT, Expanded Disability Status Scale (EDSS), and patient reported outcome measures (PROs) were collected. All measures were taken at baseline for PwPMS and controls, and again at six months for PwPMS. RESULTS Relative to controls, PwPMS had significantly longer reaction (0.11 s, p < 0.05) and reach (0.25 s, p < 0.05) times. PwPMS took longer to pick-up (0.34 s, p < 0.05), move (0.14 s, p < 0.05), and place (0.18 s, p < 0.05) objects. PwPMS had lower peak velocities when reaching (7.4 cm/s, p < 0.05) and moving (7.3 cm/s, p < 0.05) objects. Kinematic assessment demonstrated consistent differences between PwPMS with mild and severe upper limb dysfunction as defined by PROs, which were not captured by 9HPT or EDSS in this group. PwPMS demonstrated altered grip apertures profiles, as measured by their ability to complete individual parts of the reach and grasp task, between the baseline and follow-up timepoints. CONCLUSIONS We have created and tested a novel upper limb function assessment tool which has detected changes and characteristics in hand function, not currently captured by the EDSS and 9HPT.
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Affiliation(s)
| | | | | | - Awais Hafeez
- University of Leeds, School of Mechanical Engineering, UK
| | - Raymond Holt
- University of Leeds, School of Mechanical Engineering, UK
| | - Helen L Ford
- Leeds Teaching Hospitals NHS Trust, Centre for Neurosciences, UK
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DelMastro HM, Robson A, Gromisch ES, Campo M, Simaitis LB, Lo AC, Dhari Z, Ruiz JA. Establishment of regression-based isometric strength reference values for the upper limb in persons with multiple sclerosis. PM R 2024. [PMID: 38995022 DOI: 10.1002/pmrj.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/11/2024] [Accepted: 05/02/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Muscle weakness is common and significantly affects persons with multiple sclerosis (PwMS), with dysfunction in upper limb (UL) muscle groups occurring in approximately 60% of PwMS. OBJECTIVE To develop gender-specific regression-based prediction equations, with 95% confidence intervals for maximal bilateral UL isometric strength (shoulder abduction and adduction, wrist flexion and extension) and hand grip strength in PwMS. DESIGN Cross-sectional study. SETTING Comprehensive MS center. PARTICIPANTS 256 PwMS. INTERVENTIONS Not Applicable. MAIN OUTCOME MEASURES Shoulder abduction and adduction and wrist flexion and extension isometric strength (Biodex System 4 Pro Dynamometer) and hand grip strength (Jamar handheld dynamometer) were measured. Disease characteristics (disability and disease duration) and demographics (age, height, and weight) were collected. Regression-based predictive equations were generated for the UL muscle groups for each gender and limb, using age, height, weight, disability, and disease duration as covariates. Variables were compared between genders using the Mann-Whitney U test. Maximal voluntary contraction (MVC) reference values (mean ± SD) were reported based on age (<30, 30-39, 40-49, 50-59, 60-69 years) and disability (mild, moderate, severe ambulant, and severe nonambulant) for each gender and limb. RESULTS Regression-based equations were developed for both genders' strongest and weakest limb, accounting for age, height, weight, disability, and disease duration. MVC was higher in men than women (p < .001) in all muscle groups. Overall, MVC was significantly related to age in 14, height in 5, weight in 6, disability in 14, and disease duration in none of the 20 models. CONCLUSION This is the first study to provide regression-based prediction equations for strongest and weakest MVC of UL muscle groups and demonstrated an inverse relationship between MVC with disability and age. Regression-based reference strength values can help clinicians understand muscular strength along a spectrum of PwMS and can aid in goal setting and education for realistic outcomes.
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Affiliation(s)
- Heather M DelMastro
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
| | - Abigail Robson
- Department of Physical Therapy, School of Health and Natural Sciences, Mercy College, Dobbs Ferry, New York, USA
- North Boulder Physical Therapy, Westminster, Colorado, USA
| | - Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
- Department of Medical Science, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Marc Campo
- Department of Physical Therapy, School of Health and Natural Sciences, Mercy College, Dobbs Ferry, New York, USA
| | - Laura B Simaitis
- Department of Physical Therapy, School of Health Sciences at Quinnipiac University, North Haven, Connecticut, USA
| | - Albert C Lo
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut, USA
| | - Zaenab Dhari
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
| | - Jennifer A Ruiz
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
- Department of Medical Science, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
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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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Thomson A, Stennett A, Metin C, Bestwick J, Giovannoni G, Dobson R. Under & Over: A randomised controlled study to develop an upper limb rehabilitation tool for people with Multiple Sclerosis. Mult Scler Relat Disord 2024; 85:105529. [PMID: 38447394 DOI: 10.1016/j.msard.2024.105529] [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: 11/22/2023] [Revised: 01/24/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Impairment of upper limb function is common in Multiple Sclerosis (MS). Rehabilitation remains a key strategy to manage symptoms and improve quality of life. The Under & Over study assessed the effectiveness of a rehabilitation programme in people with advanced MS. OBJECTIVE To determine if repeated use of Under & Over can improve upper limb function for people with MS. METHODS One hundred and six (N = 106) people with MS participated in this 3-month study. The primary outcome measure was the cardboard 9-hole peg test (c9HPT), with secondary outcomes including the EuroQol-5Dimensions, 5-Level Questionnaire (EQ5D-5 L) questionnaire. There were three arms: Arm 1a, the 'Daily Group', engaged with the Under & Over tool daily for 30 min. Arm 1b, the 'Free Use Group', used the same tool without time constraints, with the added feature of a community sharing platform. Arm 2, the 'Delayed Start Group', initially completed the c9HPT for three months before switching to the 'Free Use' programme. RESULTS 43/106 (41 %) of those randomised completed the primary end point. No significant difference between c9HPT at baseline and 3 months was seen in Arm 1a or 1b. Participants in Arm 2 who had been completing the c9HPT 5 days a week for 3 months showed a training effect in the dominant hand (mean speed at baseline 0.0455 (s-1), mean at 3 months 0.0341, difference 0.011; 95 % CI 0.0080 to 0.0148, p < 0.001). No significant difference was seen in c9HPT time following 3 months of active use of the Under & Over tool. The study faced significant limitations, notably in participant adherence, with fewer than half (43/106 (41 %)) completing the final assessment. CONCLUSIONS This study demonstrates how a small, engaged, and motivated group were able to complete a remote rehabilitation programme. Future remote intervention studies could benefit from incorporating adaptive engagement strategies, such as personalised reminders and participant-tailored activity adjustments, to enhance adherence and capture a broader spectrum of patient experiences.
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Affiliation(s)
- Alison Thomson
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Andrea Stennett
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Canan Metin
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jonathan Bestwick
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Ruth Dobson
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Webster A, Poyade M, Coulter E, Forrest L, Paul L. Views of Specialist Clinicians and People With Multiple Sclerosis on Upper Limb Impairment and the Potential Role of Virtual Reality in the Rehabilitation of the Upper Limb in Multiple Sclerosis: Focus Group Study. JMIR Serious Games 2024; 12:e51508. [PMID: 38669680 PMCID: PMC11087863 DOI: 10.2196/51508] [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: 08/02/2023] [Revised: 02/14/2024] [Accepted: 03/14/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Using virtual reality (VR) could be a solution to this challenge; however, there is a lack of reporting on the views of people with MS and clinicians on VR-based approaches and recommendations for games for rehabilitation. OBJECTIVE This study aims to identify common UL problems and their related current therapeutic approaches for people with MS, and to explore the opinions of people with MS and specialist clinicians on VR and obtain suggestions for the development and design of VR games. METHODS Separate focus groups were conducted with people with MS, recruited through the MS Society UK's research network, and clinicians, recruited through the MS Trust Therapists in MS network. A total of 10 people with MS (2 focus groups) and 8 clinicians (5 physiotherapists, 2 occupational therapists, and 1 MS nurse in 2 focus groups) were involved. The focus groups were recorded and transcriptions were analyzed using theme-based content analysis. RESULTS People with MS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many people with MS neglected UL exercise and found strategies for adapting to the UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a solution, as it was convenient for people with MS to access and it could provide a more engaging and disguised approach to exercise. There were shared concerns with cybersickness and disengagement with using VR approaches. Both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and people with MS suggesting more abstract activities. CONCLUSIONS VR was well received by both people with MS and clinicians for UL rehabilitation. Recommendations were made for the development of VR rehabilitation games which are personalized and customizable for the varying abilities of people with MS.
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Affiliation(s)
- Amy Webster
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Matthieu Poyade
- School of Simulation and Visualisation, Glasgow School of Art, Glasgow, United Kingdom
| | - Elaine Coulter
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Lisa Forrest
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
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Navarro-López V, Cano-de-la-Cuerda R, Fernández-González P, Marcos-Antón S, Blázquez-Fernández A, Fernández-Cañas M, Fernández-Vázquez D. Reliability and Construct Validity of a Mobile Application for the Finger Tapping Test Evaluation in People with Multiple Sclerosis. Brain Sci 2024; 14:407. [PMID: 38672056 PMCID: PMC11047887 DOI: 10.3390/brainsci14040407] [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: 04/03/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
The finger tapping test (FTT) is a tool to evaluate the motor performance of the hand and fingers and eye-hand coordination with applicability in people with multiple sclerosis (pwMS). The aim of this study was to evaluate the intra- and inter-rater reliability of the TappingPro® mobile app and the construct validity between this app and validated clinical scales for motor performance in healthy subjects and pwMS. 42 healthy subjects (mean age 25.05) and 13 pwMS (mean age 51.69, EDSS between 3 and 7.5E) participated. FTT was performed with the TappingPro® mobile app. All participants were examined twice, with a one-week interval between the two appointments. For the analysis of construct validity, the Jamar® hydraulic hand dynamometer, Box and Blocks Test (BBT), and Nine Hole Peg Test (NHPT) were used. The intra-rater reliability showed a good correlation (Intraclass Correlation Coefficient, ICC > 0.787) for both upper limbs and both times of FTT for healthy subjects, and an excellent correlation (ICC > 0.956) for upper limbs and both times of FTT for pwMS. The ICC for the inter-rater reliability was good (ICC = 0.869) for the non-dominant upper limb in the FTT 10 s of the healthy subjects, and excellent (ICC > 0.904) for all the other measurements of the healthy subjects and pwMS. However, the Bland-Altman plots showed disagreement between observers and measurements that should be considered in the interpretation of clinical evaluations. The correlation analysis for healthy subjects showed poor associations between all variables, except for the association between hand grip strength and the FTT 60 s in the non-dominant upper limb, which had a moderate coefficient. For pwMS, there were moderate to excellent associations between BBT and the NHPT and FTT for both upper limbs. The correlations between hand grip strength and FFT were poor. This mobile app could be a useful and low-cost assessment tool in pwMS, allowing a simple evaluation and follow-up that has excellent correlation with clinical scales validated in this pathology.
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Affiliation(s)
- Víctor Navarro-López
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain; (V.N.-L.); (D.F.-V.)
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM), Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain
| | - Roberto Cano-de-la-Cuerda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain; (V.N.-L.); (D.F.-V.)
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM), Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain
| | - Pilar Fernández-González
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain; (V.N.-L.); (D.F.-V.)
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM), Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain
| | - Selena Marcos-Antón
- Multiple Sclerosis Association of Leganés (ALEM), Leganés, 28915 Madrid, Spain; (S.M.-A.); (A.B.-F.); (M.F.-C.)
| | - Aitor Blázquez-Fernández
- Multiple Sclerosis Association of Leganés (ALEM), Leganés, 28915 Madrid, Spain; (S.M.-A.); (A.B.-F.); (M.F.-C.)
| | - María Fernández-Cañas
- Multiple Sclerosis Association of Leganés (ALEM), Leganés, 28915 Madrid, Spain; (S.M.-A.); (A.B.-F.); (M.F.-C.)
| | - Diego Fernández-Vázquez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain; (V.N.-L.); (D.F.-V.)
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM), Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain
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Blázquez-Fernández A, López-Hazas-Jiménez G, Fernández-Vázquez D, Navarro-López V, Fernández-González P, Marcos-Antón S, Molina-Rueda F, Cano-de-la-Cuerda R. Effects of the powerball® system on muscle strength, coordination, fatigue, functionality and quality of life in people with multiple sclerosis. A randomized clinical trial. J Neuroeng Rehabil 2024; 21:33. [PMID: 38431591 PMCID: PMC10908022 DOI: 10.1186/s12984-024-01325-w] [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: 07/28/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Although clinical and functional impairments in the lower limbs have been extensively studied in patients with MS, the upper limb (UL) are also frequently affected. Clinical impairment of the UL in patients with MS is very common with muscle strength and hand dexterity as critical factors in maintaining functional activities that are the basis for independence and quality of life in people with MS. OBJECTIVE To investigate the effects of a training protocol using the Powerball® system in combination with conventional physiotherapy on muscle strength, coordination, fatigue, functionality, and quality of life in persons with MS over an 8-week period. MATERIALS AND METHODS A double-blind randomized controlled trial was conducted. The control group received conventional treatment, while the experimental group received additional UL training using the Powerball® system. Both groups received the same number of sessions and weeks of intervention. The following outcome measures were used: isometric grip and pinch strength, Box and Block Test (BBT), Nine Hole Peg Test (NHPT), Abilhand scale, Fatigue Severity Scale (FSS), Multiple Sclerosis Impact Scale (MSIS-29), and Likert satisfaction questionnaire for the experimental group. All measures were administered at baseline, after the treatment, and during a 3-week follow-up period. RESULTS 25 patients completed the study (12 in the experimental and 13 in the control group). The experimental group showed significant improvements in coordination and manual dexterity of the more affected UL as measured by the BBT comparing pre- to post-treatment (p = 0.048) and pre-treatment to follow-up (p = 0.001), and on the less affected UP comparing pre-treatment to follow-up (p < 0.001) and post-treatment to follow-up (p = 0.034). The Likert-type satisfaction questionnaire obtained a mean score of 89.10 (± 8.54) out of 100 points. CONCLUSIONS Upper limb treatment protocol using the Powerball® system, in combination with conventional physiotherapy for 8 weeks resulted in significant improvements in the intra-group analysis for UL coordination and manual dexterity in favor of the experimental group. The experimental group showed excellent satisfaction to the treatment.
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Affiliation(s)
| | | | - Diego Fernández-Vázquez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
| | - Víctor Navarro-López
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Pilar Fernández-González
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
| | - Selena Marcos-Antón
- Multiple Sclerosis Association of Leganés. Leganés, Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Francisco Molina-Rueda
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Roberto Cano-de-la-Cuerda
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Van Laethem D, Denissen S, Costers L, Descamps A, Baijot J, Van Remoortel A, Van Merhaegen-Wieleman A, D'hooghe MB, D'Haeseleer M, Smeets D, Sima DM, Van Schependom J, Nagels G. The Finger Dexterity Test: Validation study of a smartphone-based manual dexterity assessment. Mult Scler 2024; 30:121-130. [PMID: 38140857 DOI: 10.1177/13524585231216007] [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] [Indexed: 12/24/2023]
Abstract
BACKGROUND The Nine-Hole Peg Test (9HPT) is the golden standard to measure manual dexterity in people with multiple sclerosis (MS). However, administration requires trained personnel and dedicated time during a clinical visit. OBJECTIVES The objective of this study is to validate a smartphone-based test for remote manual dexterity assessment, the icompanion Finger Dexterity Test (FDT), to be included into the icompanion application. METHODS A total of 65 MS and 81 healthy subjects were tested, and 20 healthy subjects were retested 2 weeks later. RESULTS The FDT significantly correlated with the 9HPT (dominant: ρ = 0.62, p < 0.001; non-dominant: ρ = 0.52, p < 0.001). MS subjects had significantly higher FDT scores than healthy subjects (dominant: p = 0.015; non-dominant: p = 0.013), which was not the case for the 9HPT. A significant correlation with age (dominant: ρ = 0.46, p < 0.001; non-dominant: ρ = 0.40, p = 0.002), Expanded Disability Status Scale (EDSS, dominant: ρ = 0.36, p = 0.005; non-dominant: ρ = 0.31, p = 0.024), and disease duration for the non-dominant hand (ρ = 0.31, p = 0.016) was observed. There was a good test-retest reliability in healthy subjects (dominant: r = 0.69, p = 0.001; non-dominant: r = 0.87, p < 0.001). CONCLUSIONS The icompanion FDT shows a moderate-to-good concurrent validity and test-retest reliability, differentiates between the MS subjects and healthy controls, and correlates with clinical parameters. This test can be implemented into routine MS care for remote follow-up of manual dexterity.
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Affiliation(s)
- Delphine Van Laethem
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Physical and Rehabilitation Medicine, UZ Brussel, Brussel, Belgium
| | - Stijn Denissen
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium/icometrix, Leuven, Belgium
| | - Lars Costers
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium/icometrix, Leuven, Belgium
| | | | - Johan Baijot
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Ann Van Remoortel
- Neurology Department, National Multiple Sclerosis Center, Melsbroek, Belgium
| | | | - Marie B D'hooghe
- Neurology Department, National Multiple Sclerosis Center, Melsbroek, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussel, Belgium
| | - Miguel D'Haeseleer
- Neurology Department, National Multiple Sclerosis Center, Melsbroek, Belgium
- Neurology Department, UZ Brussel, Brussel, Belgium/Center for Neurosciences, Vrije Universiteit Brussel, Brussel, Belgium
| | | | | | - Jeroen Van Schependom
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussel, Belgium
| | - Guy Nagels
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
- Neurology Department, UZ Brussel, Brussel, Belgium
- University of Oxford, Oxford, UK
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Boyko AN, Belova AN, Rahmanova EM, Siverzeva SA. [Questionnaires for arm function assessment in patients with multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:36-42. [PMID: 39072564 DOI: 10.17116/jnevro202412406136] [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] [Indexed: 07/30/2024]
Abstract
Arm dysfunction is one of the disabling manifestations of multiple sclerosis (MS), especially in later stages of the disease. Assessment of the functioning of the upper limbs is necessary to objectify the course of MS, determine the effectiveness of therapy, and individualize rehabilitation measures. The tools that assess the upper extremity dysfunction include tests and questionnaires. Questionnaires (patient-reported outcome measures) represent the special importance, since the opinions and preferences of patients themselves help to implement a patient-centered approach to treatment. The article presents a brief description of three multidimensional MS-specific and four unidimensional MS-nonspecific questionnaires that used in assessment of upper limb function in MS patients. The disease-specific unidimensional Arm Function in Multiple Sclerosis Questionnaire (AMSQ), specifically designed to assess the arm use in patients with MS, is discussed in more detail. The use of AMSQ in the Russian population is possible only after the procedure of cultural adaptation and validation of the Russian version.
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Affiliation(s)
- A N Boyko
- Pirogov National Medical Research University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - A N Belova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - E M Rahmanova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - S A Siverzeva
- Tyumen Regional Center for Multiple Sclerosis - AO MSCH "Neftyanik", Tyumen, Russia
- Ural State Medical University, Yekaterinburg, Russia
- Kirov State Medical University, Kirov, Russia
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Bhat SG, Shin AY, Kaufman KR. Upper extremity asymmetry due to nerve injuries or central neurologic conditions: a scoping review. J Neuroeng Rehabil 2023; 20:151. [PMID: 37940959 PMCID: PMC10634143 DOI: 10.1186/s12984-023-01277-7] [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: 10/21/2022] [Accepted: 11/01/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Peripheral nerve injuries and central neurologic conditions can result in extensive disabilities. In cases with unilateral impairment, assessing the asymmetry between the upper extremity has been used to assess outcomes of treatment and severity of injury. A wide variety of validated and novel tests and sensors have been utilized to determine the upper extremity asymmetry. The purpose of this article is to review the literature and define the current state of the art for describing upper extremity asymmetry in patients with peripheral nerve injuries or central neurologic conditions. METHOD An electronic literature search of PubMed, Scopus, Web of Science, OVID was performed for publications between 2000 to 2022. Eligibility criteria were subjects with neurological conditions/injuries who were analyzed for dissimilarities in use between the upper extremities. Data related to study population, target condition/injury, types of tests performed, sensors used, real-world data collection, outcome measures of interest, and results of the study were extracted. Sackett's Level of Evidence was used to judge the quality of the articles. RESULTS Of the 7281 unique articles, 112 articles met the inclusion criteria for the review. Eight target conditions/injuries were identified (Brachial Plexus Injury, Cerebral Palsy, Multiple Sclerosis, Parkinson's Disease, Peripheral Nerve Injury, Spinal Cord Injury, Schizophrenia, and stroke). The tests performed were classified into thirteen categories based on the nature of the test and data collected. The general results related to upper extremity asymmetry were listed for all the reviewed articles. Stroke was the most studied condition, followed by cerebral palsy, with kinematics and strength measurement tests being the most frequently used tests. Studies with a level of evidence level II and III increased between 2000 and 2021. The use of real-world evidence-based data, and objective data collection tests also increased in the same period. CONCLUSION Adequately powered randomized controlled trials should be used to study upper extremity asymmetry. Neurological conditions other than stroke should be studied further. Upper extremity asymmetry should be measured using objective outcome measures like motion tracking and activity monitoring in the patient's daily living environment.
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Affiliation(s)
- Sandesh G Bhat
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kenton R Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
- Motion Analysis Laboratory, Mayo Clinic, DAHLC 4-214A, 200 First Street SW, Rochester, MN, 55905, USA.
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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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Graves JS, Elantkowski M, Zhang YP, Dondelinger F, Lipsmeier F, Bernasconi C, Montalban X, Midaglia L, Lindemann M. Assessment of Upper Extremity Function in Multiple Sclerosis: Feasibility of a Digital Pinching Test. JMIR Form Res 2023; 7:e46521. [PMID: 37782540 PMCID: PMC10580133 DOI: 10.2196/46521] [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: 02/24/2023] [Accepted: 08/15/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND The development of touchscreen-based assessments of upper extremity function could benefit people with multiple sclerosis (MS) by allowing convenient, quantitative assessment of their condition. The Pinching Test forms a part of the Floodlight smartphone app (F. Hoffmann-La Roche Ltd, Basel, Switzerland) for people with MS and was designed to capture upper extremity function. OBJECTIVE This study aimed to evaluate the Pinching Test as a tool for remotely assessing upper extremity function in people with MS. METHODS Using data from the 24-week, prospective feasibility study investigating the Floodlight Proof-of-Concept app for remotely assessing MS, we examined 13 pinching, 11 inertial measurement unit (IMU)-based, and 13 fatigability features of the Pinching Test. We assessed the test-retest reliability using intraclass correlation coefficients [second model, first type; ICC(2,1)], age- and sex-adjusted cross-sectional Spearman rank correlation, and known-groups validity (data aggregation: median [all features], SD [fatigability features]). RESULTS We evaluated data from 67 people with MS (mean Expanded Disability Status Scale [EDSS]: 2.4 [SD 1.4]) and 18 healthy controls. In this cohort of early MS, pinching features were reliable [ICC(2,1)=0.54-0.81]; correlated with standard clinical assessments, including the Nine-Hole Peg Test (9HPT) (|r|=0.26-0.54; 10/13 features), EDSS (|r|=0.25-0.36; 7/13 features), and the arm items of the 29-item Multiple Sclerosis Impact Scale (MSIS-29) (|r|=0.31-0.52; 7/13 features); and differentiated people with MS-Normal from people with MS-Abnormal (area under the curve: 0.68-0.78; 8/13 features). IMU-based features showed similar test-retest reliability [ICC(2,1)=0.47-0.84] but showed little correlations with standard clinical assessments. In contrast, fatigability features (SD aggregation) correlated with 9HPT time (|r|=0.26-0.61; 10/13 features), EDSS (|r|=0.26-0.41; 8/13 features), and MSIS-29 arm items (|r|=0.32-0.46; 7/13 features). CONCLUSIONS The Pinching Test provides a remote, objective, and granular assessment of upper extremity function in people with MS that can potentially complement standard clinical evaluation. Future studies will validate it in more advanced MS. TRIAL REGISTRATION ClinicalTrials.gov NCT02952911; https://clinicaltrials.gov/study/NCT02952911.
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Affiliation(s)
- Jennifer S Graves
- Department of Neurosciences, University of California, San Diego, CA, United States
| | | | | | | | | | | | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Luciana Midaglia
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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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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van Munster CE, Jessica B, Steinheimer S, Kamm CP, D’Souza M, Diederich M, Dorn J, Walsh L, Dahlke F, Kappos L, Uitdehaag BM. Assessment of Multiple Aspects of Upper Extremity Function Independent From Ambulation in Patients With Multiple Sclerosis. Int J MS Care 2023; 25:226-232. [PMID: 37720262 PMCID: PMC10503816 DOI: 10.7224/1537-2073.2021-069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Upper extremity function (UEF) is often compromised in multiple sclerosis (MS), although its importance is regularly underrecognized relative to ambulation. We explored the concurrent presence of impairment in UEF and ambulation by examining various aspects of UEF across different levels of ambulation. METHODS The cohort consisted of 247 patients with clinically definite MS or clinically isolated syndrome according to the revised 2010 McDonald criteria. The Nine-Hole Peg Test and the Expanded Disability Status Scale were used to stratify patients into clinically different subgroups. For UEF, cerebellar function (finger-to-nose test), pyramidal function (pronator drift test), and the ability to perform a task of activities of daily living (drinking-from-cup test) were examined. Patient-reported limitations of UEF in daily life were assessed using the Arm Function in Multiple Sclerosis Questionnaire. RESULTS Patients in more severely impaired ambulation groups displayed poorer performance on all UEF measures. Although most patients had normal to mild (n = 147) or moderate (n = 46) ambulatory impairment, 87.7% exhibited some level of UEF impairment as defined using the Nine-Hole Peg Test. Most patients had mild UEF impairment (n = 174), accounting for the largest proportion in all ambulation groups (51.9%-77.8%). CONCLUSIONS A distinct pattern of impairment was found for ambulation and multiple aspects of UEF. Independent assessment of multiple aspects of disability may be helpful in treatment decision-making and could support the development of rehabilitation strategies that specifically target UEF impairment.
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Affiliation(s)
- Caspar E.P. van Munster
- From the Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, the Netherlands (CEPvM, JB, BMJU)
| | - Burggraaff Jessica
- From the Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, the Netherlands (CEPvM, JB, BMJU)
| | - Saskia Steinheimer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland (SS, CPK)
| | - Christian P. Kamm
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland (SS, CPK)
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland (CPK)
| | - Marcus D’Souza
- Neurology, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital Basel, Basel, Switzerland (MD’S, MD, LK)
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany (MD’S)
| | - Manuela Diederich
- Neurology, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital Basel, Basel, Switzerland (MD’S, MD, LK)
| | - Jonas Dorn
- Novartis Pharma AG, Basel, Switzerland (JD, LW, FD)
| | - Lorcan Walsh
- Novartis Pharma AG, Basel, Switzerland (JD, LW, FD)
| | - Frank Dahlke
- Novartis Pharma AG, Basel, Switzerland (JD, LW, FD)
| | - Ludwig Kappos
- Neurology, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital Basel, Basel, Switzerland (MD’S, MD, LK)
| | - Bernard M.J. Uitdehaag
- From the Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, the Netherlands (CEPvM, JB, BMJU)
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15
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Marcos-Antón S, Jardón-Huete A, Oña-Simbaña ED, Blázquez-Fernández A, Martínez-Rolando L, Cano-de-la-Cuerda R. sEMG-controlled forearm bracelet and serious game-based rehabilitation for training manual dexterity in people with multiple sclerosis: a randomised controlled trial. J Neuroeng Rehabil 2023; 20:110. [PMID: 37598176 PMCID: PMC10440030 DOI: 10.1186/s12984-023-01233-5] [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: 06/20/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Muscle strength and dexterity impairments are common among patients with multiple sclerosis (MS) producing limitations in activities of daily living related to the upper limb (UL). This study aimed to evaluate the effectiveness of serious games specifically developed for the MYO Armband® capture sensor in improving forearm and wrist mobility, UL muscle strength, dexterity, fatigue, functionality, quality of life, satisfaction, adverse effects and compliance. METHODS A double-blinded (allocation concealment was performed by a blinded investigator and by blinding for assessors) randomised controlled trial was conducted. The sample was randomised into two groups: an experimental group that received treatment based on UL serious games designed by the research team and controlled by the MYO Armband® gesture capture sensor, along with conventional rehabilitation and a control group that received the same conventional rehabilitation for the UL. Both groups received two 60-min sessions per week over an eight-week period. Wrist range of motion (goniometry), grip muscle strength (Jamar® dynamometer), coordination and gross UL dexterity (Box and Block Test), fatigue (Fatigue Severity Scale), functionality (ABILHAND), quality of life (Multiple Sclerosis Impact Scale-29), adverse effects (Simulator Sickness Questionnaire, SSQ), perceived workload (NASA-Task load index), satisfaction (Client Satisfaction Questionnaire-8 (CSQ-8), Satisfaction with Technology Scale, System Usability Scale (SUS) and QUEST 2.0) and compliance (attendance) were assessed in both groups pre-treatment, post-treatment and during a follow-up period of 2 weeks without receiving any treatment. RESULTS Significant differences were observed in the experimental group compared to the control group in the assessment of forearm supination (p = .004) and grip strength (p = .004). Adverse effects were minimal (SSQ: 7/100 points) and perceived workload was low (NASA-Task Load Index: 25/100 points) in the experimental group. The MYO Armband® technology proved to be useful for the participants (SUS: 80.66/100) and the satisfaction scales received high scores (QUEST 2.0: 59.4/70 points; Satisfaction with Technology: 84.36/100 points). There were significant differences between the groups in terms of attendance percentage (p = .029). CONCLUSIONS An experimental protocol using MYO Armband®-based serious games designed for UL rehabilitation showed improvements in active wrist range of motion and handgrip strength in patients with MS, with high satisfaction, minimal adverse effects and workload and excellent compliance. TRIAL REGISTRATION NUMBER This randomised controlled trial has been registered at ClinicalTrials.gov Identifier: NCT04171908.
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Affiliation(s)
- Selena Marcos-Antón
- Faculty of Health Sciences, International PhD School, Rey Juan Carlos University, 28008, Madrid, Spain.
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, 28922, Alcorcón, Madrid, Spain.
- Asociación de Leganés de Esclerosis Múltiple (ALEM), 28915, Leganés, Madrid, Spain.
| | - Alberto Jardón-Huete
- Robotics Lab, Department of Systems Engineering and Automation, University Carlos III of Madrid, 28911, Leganés, Madrid, Spain
| | - Edwin Daniel Oña-Simbaña
- Robotics Lab, Department of Systems Engineering and Automation, University Carlos III of Madrid, 28911, Leganés, Madrid, Spain
| | | | | | - Roberto Cano-de-la-Cuerda
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, 28922, Alcorcón, Madrid, Spain
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Marcu FM, Brihan I, Ciubara A, Lupu VV, Negrut N, Jurcau A, Lupu A, Burlea SL, Dragan F, Butnariu LI, Ignat AE, Ciubara AB. The Early Initiation Advantages of Physical Therapy in Multiple Sclerosis-A Pilot Study. Life (Basel) 2023; 13:1501. [PMID: 37511877 PMCID: PMC10381402 DOI: 10.3390/life13071501] [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: 05/07/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Multiple sclerosis (MS), a chronic progressive neurological disorder which affects the central nervous system (CNS), can result in disorders of all the functions controlled by the CNS: motor, sensory, cognitive and emotional. Physical therapy (PT), conducted through proprioceptive neuromuscular facilitation (PNF) techniques, can be customized to the individual patient's needs and has the potential to improve the patient's evolution. This study aims to establish if PT based on PNF techniques has a beneficial role in MS treatment. (2) Methods: We performed a prospective study on 40 patients who were diagnosed with MS and previously treated only with MS drug treatment (DT). These patients have participated in a PT program throughout one year. At the beginning and at the end of our study, after one year, we have assessed the following parameters: timed walk for 25 feet (Timed 25-Foot Walk test- T25FW test), dexterity of the upper limbs (9-Hole Peg Test-9HPT), disability level (Expanded Disability Status Scale-EDSS) and cognitive function (Paced Auditory Serial Addition Test-PASAT. (3) Results: In subjects in the early stages of MS, lower limb mobility improved significantly, T25FW decreasing from 6.46 to 5.80 (p < 0.001) and upper limb ability increased significantly in the dominant hand, 9HPT decreasing from 17.73 to 16.97 (p = 0.006) and not significantly in the non-dominant hand, 9HPT decreasing from 17.73 to 17.50 (p = 0.255). Furthermore, among these subjects, cognitive performance improved; their PASAT increased from 52.14 to 54.14 (p = 0.036), while the level of disability of these subjects improved only slightly, the EDSS scale evolving from 3.08 to 2.91 (p = 0.650). (4) Conclusions: In patients with early forms of MS, combining DT with a PT program based on PNF techniques results in: regaining muscle strength in the lower limbs, improving coordination while walking, correcting dexterity in the upper limbs and increasing the ability to concentrate.
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Affiliation(s)
- Florin Mihai Marcu
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Ilarie Brihan
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Anamaria Ciubara
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800008 Galati, Romania
| | - Vasile Valeriu Lupu
- Faculty of General Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Nicoleta Negrut
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Anamaria Jurcau
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Ancuta Lupu
- Faculty of General Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Stefan Lucian Burlea
- Public Health and Management Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Felicia Dragan
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
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17
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DelMastro HM, Simaitis LB, Gromisch ES, Gomes K, Ruiz JA. Establishment of regression-based normative isometric strength values for major lower limb muscle groups in persons with multiple sclerosis. Mult Scler Relat Disord 2023; 75:104772. [PMID: 37247487 DOI: 10.1016/j.msard.2023.104772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/20/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Limb weakness is a major impairment that affects mobility in persons with multiple sclerosis (PwMS). Specifically, lower limb (LL) weakness can greatly affect gait and balance, while increasing fall risk and decreasing quality of life. Numerous studies have compared LL strength of PwMS to healthy controls, however none have objectively measured strength in all major LL joints (hip, knee, and ankle) in a large number of PwMS. Additionally, while discrete normative values exist for knee extensors in PwMS, there has yet to be regression-based normative isometric strength values for all major LL muscle groups. Therefore, this study aimed to develop gender-specific regression-based normative prediction equations, with 95% confidence intervals, for maximal isometric peak torque of major LL muscles in PwMS. A secondary aim was to characterize the prevalence of LL weakness in PwMS, defined as ≥ 2 SD below values reported for healthy individuals. METHODS A convenience sample of 175 (women: n = 135) PwMS participated in a prospective, cross-sectional study where isometric peak torque of hip flexors, extensors, and abductors, knee flexors and extensors, and ankle plantarflexors and dorsiflexors were measured using the Biodex System 4 Pro-Dynamometer®. Demographics (age, height, and weight) and disease characteristics (disease duration and disability) were collected. Performances were separated for each muscle group into strongest limb and weakest limb. For each gender, regression-based equations were generated for the LL muscle groups by limb with age, height, weight, disability, and disease duration as the covariates. Descriptive statistics were used to examine the frequency of LL weakness by gender and disability level. For comparison purposes, age-stratified (<30, 30-39, 40-49, 50-59, 60-69, >70 years) and disability-stratified (mild, moderate, and severe ambulant) discrete peak torque values were also generated for each gender. RESULTS Regression-based normative data are presented for men and women, accounting for age, height, weight, disability, and disease duration. Men were significantly stronger (P < 0.001) than women for all LL, with the men's models accounting for a greater percent of muscle strength variation than women's models for all muscle groups, except for hip extension. Disability was inversely related to strength in all of the models. LL weakness was prevalent in hip flexion (m: 47.5%; w: 63.0%) and extension (m: 92.5%; w: 88.1%), knee extension (m: 30.0%; w: 33.3%) and flexion (m: 25.0%; w: 34.8%), and ankle plantarflexion (m: 15.0%; w: 10.4%) and dorsiflexion (m: 100.0%; w: 96.3%). PwMS with mild disability had a high prevalence of ankle dorsiflexion (94.9-100.0%) and hip extension (81.4-90.0%) weakness. CONCLUSIONS This study is the first to provide regression-based normative data of bilateral strength in all major LL muscle groups and clinically useful prevalence data on the occurrence of weakness in these muscles. Of note, PwMS had a high prevalence of ankle dorsiflexion and hip extension weakness even when they were only mildly disabled. These findings can help guide the direction of future interventions and treatments to improve muscle function in PwMS.
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Affiliation(s)
- Heather M DelMastro
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States.
| | - Laura B Simaitis
- Department of Physical Therapy, School of Health Sciences at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States
| | - Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States; Department of Neurology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, United States
| | - Kayla Gomes
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Rehabilitation Medicine, Department of Veterans Affairs, 555 Willard Avenue, Newington, CT, 06111 United States
| | - Jennifer A Ruiz
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States
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Pau M, Cocco E, Arippa F, Casu G, Porta M, Menascu S, Achiron A, Kalron A. An Immersive Virtual Kitchen Training System for People with Multiple Sclerosis: A Development and Validation Study. J Clin Med 2023; 12:jcm12093222. [PMID: 37176662 PMCID: PMC10179608 DOI: 10.3390/jcm12093222] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Rehabilitation via virtual reality (VR) training tools allows repetitive, intensive, and task-specific practice in a controlled and safe environment. Our goal was to develop and validate a novel immersive VR system based on the practice of real-life activities in a kitchen environment in people with multiple sclerosis (pwMS) with upper-limb dysfunction. The novel immersive VR kitchen application includes several tasks, i.e., tidying up the kitchen, preparing a hamburger and soup meal, and dish washing. Following the development phase, the system was tested for an 8-week intervention period on a small sample of pwMS suffering from upper-limb dysfunction. The Suitability Evaluation Questionnaire for VR systems served as the primary outcome. The scores for enjoyment, sense of comfort with the system, feelings of success and control, realism, easy-to-understand instructions, assists in rehabilitation therapy, were between 4.0 and 4.6, indicating a high satisfaction. The scores for eye discomfort, dizziness, nausea, and disorientation during practice were between 2.8 and 1.3, indicating a low-to-moderate interference of the system. The virtual kitchen training system is feasible and safe for upper-limb training in pwMS and paves the way for future RCTs to examine the benefits of the system compared with standard care, thus improving the functionality of the upper limbs in pwMS.
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Affiliation(s)
- Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09124 Cagliary, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Federico Arippa
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09124 Cagliary, Italy
| | - Giulia Casu
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09124 Cagliary, Italy
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09124 Cagliary, Italy
| | - Shay Menascu
- Multipe Sclerosis Center, Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - Anat Achiron
- Multipe Sclerosis Center, Sheba Medical Center, Tel-Hashomer 52621, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
- Sagol School of Neurocience, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Alon Kalron
- Multipe Sclerosis Center, Sheba Medical Center, Tel-Hashomer 52621, Israel
- Sagol School of Neurocience, Tel-Aviv University, Tel-Aviv 69978, Israel
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
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19
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Silveira SL, Froehlich-Grobe K, Motl RW. Formative evaluation of an exercise training program for persons with multiple sclerosis who are wheelchair users. EVALUATION AND PROGRAM PLANNING 2023; 97:102243. [PMID: 36696872 DOI: 10.1016/j.evalprogplan.2023.102243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/19/2022] [Accepted: 01/19/2023] [Indexed: 06/17/2023]
Abstract
Exercise training is an effective and safe second-line therapy for improving multiple sclerosis (MS) symptoms and disease progression among adults. This study aimed to determine the appropriateness of a novel exercise training program for wheelchair users with MS. Ten wheelchair users with MS were recruited from a previous cross-sectional research study to attend one of three focus groups with 3-4 participants that lasted between 69 and 87 min. The focus groups were conducted online using a semi-structured format and participants were invited to complete an evaluation survey. During the focus groups, participants provided qualitative feedback regarding the exercise prescription, exercise modes (resistance and aerobic), training manual, exercise equipment, fitness tracker, rating scale, newsletters, logbook, and coaching. Most feedback focused on minor considerations such as avoiding the color red as it can be an issue for individuals with optic neuritis. Among quantitative evaluation survey ratings, coaching calls were rated the highest 4.7 ± 0.4 on a 5-point scale, followed by the exercise prescription (4.4 ± 0.8) and fitness tracker (4.3 ± 0.9). Focus group participants provided invaluable feedback for finalizing a novel exercise training program for wheelchair users with MS and provided focal suggestions for further improvements.
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Affiliation(s)
- Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, 3810 Ridgeway Drive, Birmingham, AL 35209, USA; University of North Texas, Department of Kinesiology, Health Promotion, and Recreation, 35209, United States.
| | | | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, 3810 Ridgeway Drive, Birmingham, AL 35209, USA.
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20
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Zbytniewska-Mégret M, Kanzler CM, Raats J, Yilmazer C, Feys P, Gassert R, Lambercy O, Lamers I. Reliability, validity and clinical usability of a robotic assessment of finger proprioception in persons with multiple sclerosis. Mult Scler Relat Disord 2023; 70:104521. [PMID: 36701909 DOI: 10.1016/j.msard.2023.104521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 12/31/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multiple sclerosis often leads to proprioceptive impairments of the hand. However, it is challenging to objectively assess such deficits using clinical methods, thereby also impeding accurate tracking of disease progression and hence the application of personalized rehabilitation approaches. OBJECTIVE We aimed to evaluate test-retest reliability, validity, and clinical usability of a novel robotic assessment of hand proprioceptive impairments in persons with multiple sclerosis (pwMS). METHODS The assessment was implemented in an existing one-degree of freedom end-effector robot (ETH MIKE) acting on the index finger metacarpophalangeal joint. It was performed by 45 pwMS and 59 neurologically intact controls. Additionally, clinical assessments of somatosensation, somatosensory evoked potentials and usability scores were collected in a subset of pwMS. RESULTS The test-retest reliability of robotic task metrics in pwMS was good (ICC=0.69-0.87). The task could identify individuals with impaired proprioception, as indicated by the significant difference between pwMS and controls, as well as a high impairment classification agreement with a clinical measure of proprioception (85.00-86.67%). Proprioceptive impairments were not correlated with other modalities of somatosensation. The usability of the assessment system was satisfactory (System Usability Scale ≥73.10). CONCLUSION The proposed assessment is a promising alternative to commonly used clinical methods and will likely contribute to a better understanding of proprioceptive impairments in pwMS.
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Affiliation(s)
- Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - 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
| | - Joke Raats
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Universitair MS Centrum UMSC Hasselt, Pelt, Belgium
| | - Cigdem Yilmazer
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Universitair MS Centrum UMSC Hasselt, Pelt, Belgium
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Universitair MS Centrum UMSC Hasselt, Pelt, Belgium
| | - 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
| | - 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
| | - Ilse Lamers
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Universitair MS Centrum UMSC Hasselt, Pelt, Belgium; Noorderhart Rehabilitation and MS Centre, Pelt, Belgium
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21
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Thorning M, Lambertsen KL, Skov CD, Frich LH, Jensen HB, Holsgaard-Larsen A, Nielsen HH. Criterion validity of muscle strain analyses of skeletal muscle function in patients with multiple sclerosis. Mult Scler Relat Disord 2023; 70:104478. [PMID: 36603294 DOI: 10.1016/j.msard.2022.104478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite the wide range of existing performance measures to evaluate functional status of patients with multiple sclerosis, the heterogeneous nature of the disease hinders clinical characterization and monitoring of disease severity. Speckle tracking ultrasonography is a non-invasive technique to assess isolated muscle function by evaluating the contractile properties of muscle tissue, i.e. muscle strain. The aim of this study was to investigate whether muscle strain measured by speckle tracking ultrasonography could be a useful quantitative measure of muscle function in patients with multiple sclerosis. The criterion validity of muscle strain was compared to that of validated performance measures of upper and lower extremity function. METHODS This cross-sectional study used baseline data from an explorative observational cohort study (the MUST study). Participants recruited from a hospital outpatient MS clinic underwent speckle tracking ultrasonography of the biceps brachii, supraspinatus, and soleus muscles of the dominant side according to pre-defined submaximal isometric contractions. Participants also completed the Timed 25-Foot Walk Test, the Six Spot Step Test, the 2-minute walking test, the Nine-Hole Peg Test, the 12-item Multiple Sclerosis Walking Scale, and the Oxford Shoulder Score. Gaussian distribution was investigated by visual inspection of normal probability plots and the Shapiro-Wilk test. The Timed 25-Foot Walk Test and Nine-Hole Peg Test were selected as gold standards for function of the lower and upper extremities, respectively. Criterion validity was assessed using Spearman's rank-order correlation coefficient ρ (rho), comparing the muscle strain and performance measures against predefined gold standards. Differences in criterion validity were estimated using squared correlations on the Fischer's Z-scale, with non-parametric bootstrapping to obtain bias-corrected, accelerated bootstrap confidence intervals (95% BCa). RESULTS Criterion validity showed good to excellent correlations between the gold standard for lower extremity function and the 2-minute walking test and Six Spot Step Test, and a fair correlation to the 12-item Multiple Sclerosis Walking Scale. No significant correlation was found between the gold standard for upper extremity function and the performance measure. There were no significant correlations between the gold standards and muscle strain. CONCLUSION The absence of criterion validity for muscle strain alongside fair to strong criterion validity for the performance measures indicates that speckle tracking ultrasonography assessment of muscle strain is either invalid or evaluates other constructs of multiple sclerosis. Muscle strain assessed by speckle tracking ultrasonography cannot be recommended for the evaluation of treatment effects or disease progression in multiple sclerosis.
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Affiliation(s)
- Maria Thorning
- Department of Neurology, Odense University Hospital, J.B. Winsloews Vej 4, 5000 Odense C, Denmark; Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3., 5000 Odense C, Denmark; Department of Neurobiology Research, Department of Molecular Medicine, University of Southern Denmark, J.B. Winsloews Vej 21, st., 5000 Odense C, Denmark; BRIDGE - Brain Research - Inter Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3., 5000 Odense C, Denmark.
| | - Kate Lykke Lambertsen
- Department of Neurology, Odense University Hospital, J.B. Winsloews Vej 4, 5000 Odense C, Denmark; Department of Neurobiology Research, Department of Molecular Medicine, University of Southern Denmark, J.B. Winsloews Vej 21, st., 5000 Odense C, Denmark; BRIDGE - Brain Research - Inter Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3., 5000 Odense C, Denmark
| | - Cecilie Dollerup Skov
- Department of Neurology, Odense University Hospital, J.B. Winsloews Vej 4, 5000 Odense C, Denmark; Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3., 5000 Odense C, Denmark
| | - Lars Henrik Frich
- Department of Neurobiology Research, Department of Molecular Medicine, University of Southern Denmark, J.B. Winsloews Vej 21, st., 5000 Odense C, Denmark; Department of Orthopaedics, Hospital Soenderjylland, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B Winsloews Vej 19. 3,. 5000 Odense C, Denmark
| | - Henrik Boye Jensen
- Department of Brain and Nerve Diseases, Sygehus Lillebaelt, Sygehusvej 24, 6000, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B Winsloews Vej 19. 3,. 5000 Odense C, Denmark
| | - Anders Holsgaard-Larsen
- Department of Orthopaedics and Traumatology, Odense University Hospital, J.B. Winsloews Vej 4, 5000 Odense C, Denmark; Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3., 5000 Odense C, Denmark
| | - Helle Hvilsted Nielsen
- Department of Neurology, Odense University Hospital, J.B. Winsloews Vej 4, 5000 Odense C, Denmark; Department of Neurobiology Research, Department of Molecular Medicine, University of Southern Denmark, J.B. Winsloews Vej 21, st., 5000 Odense C, Denmark; BRIDGE - Brain Research - Inter Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3., 5000 Odense C, Denmark
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22
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Effects of multi-task training on motor and cognitive performances in multiple sclerosis patients without clinical disability: a single-blinded randomized controlled trial. Acta Neurol Belg 2023:10.1007/s13760-023-02172-7. [PMID: 36609834 DOI: 10.1007/s13760-023-02172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study aimed to investigate the effects of multi-task training on motor and cognitive performance in People with Multiple Sclerosis (PwMS) without clinical disability compared to single-task training and a control group. METHODS A total of 42 patients were randomly assigned to three groups labeled as Multi-Task Training Group (MTTG, n:14), Single-Task Training Group (STTG, n:14), and Control Group (CG, n:14). The STTG performed only motor tasks based on the task-oriented training program twice a week for 6 weeks while the MTTG performed the same tasks concurrently with additional motor and cognitive tasks. The CG performed relaxation exercises at home. Postural stability by posturography, walking by Timed Up-and-Go, manual dexterity by Nine-Hole Peg Test, mental tracking by Counting Backward, and verbal fluency by Word List Generation were assessed before and after the intervention under single and dual-task conditions. RESULTS In the MTTG, both single cognitive and single motor task performances increased, and, moreover, the cognitive Dual-Task Costs (DTCs) decreased although the motor DTCs were not changed significantly. There were significant group-by-time interactions in favor of MTTG only on the mental tracking DTC during walking compared to the STTG. Moreover, the changes in postural and walking DTCs were associated with changes in single-motor task performance. CONCLUSION This study suggests that multi-task training is effective in reducing cognitive DTC rather than motor DTC under dual-task conditions in PwMS without clinical disability. TRIAL REGISTRATION NUMBER NCT03512886.
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23
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Pau M, Porta M, Spinicci G, Frau J, Lorefice L, Coghe G, Cocco E. Change in upper limb function in people with multiple sclerosis treated with nabiximols: a quantitative kinematic pilot study. Neurol Sci 2023; 44:685-691. [PMID: 36260259 PMCID: PMC9842567 DOI: 10.1007/s10072-022-06456-3] [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: 09/09/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Nabiximols represents an increasingly employed add-on treatment option for spasticity in people with multiple sclerosis (PwMS) who either were unresponsive or reported excessive adverse reactions to other therapies. While several studies performed in the last decade demonstrated its effectiveness, safety, and tolerability, few quantitative data are available on the impact on motor dysfunctions. In this open-label, not concurrently controlled study, we aimed to assess the impact of a 4-week treatment with nabiximols on upper limb functionality. METHODS Thirteen PwMS (9 female, 4 male) with moderate-severe spasticity underwent a combination of clinical tests (i.e., Box and Block, BBT and Nine-Hole Peg test, 9HPT) and instrumental kinematic analysis of the "hand to mouth" (HTM) movement by means of optical motion capture system. RESULTS After the treatment, improvements in gross and fine dexterity were found (BBT + 3 blocks/min, 9HPT - 2.9 s, p < 0.05 for both cases). The kinematic analysis indicated that HTM movement was faster (1.69 vs. 1.83 s, p = 0.05), smoother, and more stable. A significant reduction of the severity of spasticity, as indicated by the 0-10 numerical rating scale (4.2 vs. 6.3, p < 0.001), was also observed. CONCLUSION The findings from the present pilot study suggest that a 4-week treatment with nabiximols ameliorates the spasticity symptoms and the overall motor function of upper limb in PwMS with moderate-severe spasticity. The use of quantitative techniques for human movement analysis may provide valuable information about changes originated by the treatment in realistic upper limb motor tasks involved in 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, 09123, Cagliari, Italy.
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Piazza d'Armi, 09123, Cagliari, Italy
| | - Gabriella Spinicci
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Jessica Frau
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giancarlo Coghe
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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24
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/08/2022] [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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25
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Graves JS, Ganzetti M, Dondelinger F, Lipsmeier F, Belachew S, Bernasconi C, Montalban X, van Beek J, Baker M, Gossens C, Lindemann M. Preliminary validity of the Draw a Shape Test for upper extremity assessment in multiple sclerosis. Ann Clin Transl Neurol 2022; 10:166-180. [PMID: 36563127 PMCID: PMC9930424 DOI: 10.1002/acn3.51705] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/15/2022] [Accepted: 11/05/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To validate the smartphone sensor-based Draw a Shape Test - a part of the Floodlight Proof-of-Concept app for remotely assessing multiple sclerosis-related upper extremity impairment by tracing six different shapes. METHODS People with multiple sclerosis, classified functionally normal/abnormal via their Nine-Hole Peg Test time, and healthy controls participated in a 24-week, nonrandomized study. Spatial (trace accuracy), temporal (mean and variability in linear, angular, and radial drawing velocities, and dwell time ratio), and spatiotemporal features (trace celerity) were cross-sectionally analyzed for correlation with standard clinical and brain magnetic resonance imaging (normalized brain volume and total lesion volume) disease burden measures, and for capacity to differentiate people with multiple sclerosis from healthy controls. RESULTS Data from 69 people with multiple sclerosis and 18 healthy controls were analyzed. Trace accuracy (all shapes), linear velocity variability (circle, figure-of-8, spiral shapes), and radial velocity variability (spiral shape) had a mostly fair/moderate-to-good correlation (|r| = 0.14-0.66) with all disease burden measures. Trace celerity also had mostly fair/moderate-to-good correlation (|r| = 0.18-0.41) with Nine-Hole Peg Test performance, cerebellar functional system score, and brain magnetic resonance imaging. Furthermore, partial correlation analysis related these results to motor impairment. People with multiple sclerosis showed greater drawing velocity variability, though slower mean velocity, than healthy controls. Linear velocity (spiral shape) and angular velocity (circle shape) potentially differentiate functionally normal people with multiple sclerosis from healthy controls. INTERPRETATION The Draw a Shape Test objectively assesses upper extremity impairment and correlates with all disease burden measures, thus aiding multiple sclerosis-related upper extremity impairment characterization.
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Affiliation(s)
- Jennifer S. Graves
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCaliforniaUSA
| | | | | | | | | | | | - Xavier Montalban
- Department of Neurology‐Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat)Hospital Universitari Vall d'HebronBarcelonaSpain
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26
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Tedesco Triccas L, Maris A, Lamers I, Calcius J, Coninx K, Spooren A, Feys P. Do people with multiple sclerosis perceive upper limb improvements from robotic-mediated therapy? A mixed methods study. Mult Scler Relat Disord 2022; 68:104159. [PMID: 36113274 DOI: 10.1016/j.msard.2022.104159] [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: 06/24/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Robot-mediated training is increasingly considered as a rehabilitation intervention targeting upper limb disability. However, experiences of such an intervention have been rarely explored in the multiple sclerosis population. This mixed methods study sought to explore the impact of an eight week upper limb robotic intervention on experiences of people with multiple sclerosis. METHODS Eleven participants (Median EDSS- score: 6.5) with moderate to severe upper limb impairment, performed eight week robot- mediated training of the most affected arm. The training involved a virtual learning platform called I-TRAVLE with duration of 30 min per training session, twice to three times per week. Two subjective questionnaires with items from the Intrinsic Motivation Inventory (IMI) and Credibility and Expectancy Questionnaire (CEQ) were collected bi-weekly during the intervention. Approximately one month after completing the training, three focus groups were conducted. Main themes were identified using thematic analysis. RESULTS Results from the IMI and CEQ indicated high patient satisfaction and expectation that the intervention will be beneficial for them. Two main themes were identified: (1) Effect of the intervention on impairment and activity in that participants felt that there was a positive impact of the training on strength, endurance and during activities of daily living and that it met their expectations; (2) Experiences based on system usage from the system in that participants expressed feelings of motivation and self-improvement. The participants also perceived the training as enjoyable and concluded that the use of games instigated a competitive spirit between the participants. CONCLUSIONS Robot-mediated training could have a motivating effect and induce a general positive experience while reducing disabilities of people with multiple sclerosis.
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Affiliation(s)
- L Tedesco Triccas
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.
| | - A Maris
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - I Lamers
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium; UMSC Hasselt-Pelt (Universitair MS centrum), Belgium
| | - J Calcius
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - K Coninx
- HCI and eHealth, Faculty of Sciences, Hasselt University, Diepenbeek, Belgium
| | - A Spooren
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - P Feys
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium; UMSC Hasselt-Pelt (Universitair MS centrum), Belgium
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Neurorehabilitation in Multiple Sclerosis-A Review of Present Approaches and Future Considerations. J Clin Med 2022; 11:jcm11237003. [PMID: 36498578 PMCID: PMC9739865 DOI: 10.3390/jcm11237003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Multiple sclerosis is an increasingly prevalent disease, representing the leading cause of non-traumatic neurological disease in Europe and North America. The most common symptoms include gait deficits, balance and coordination impairments, fatigue, spasticity, dysphagia and an overactive bladder. Neurorehabilitation therapeutic approaches aim to alleviate symptoms and improve the quality of life through promoting positive immunological transformations and neuroplasticity. The purpose of this study is to evaluate the current treatments for the most debilitating symptoms in multiple sclerosis, identify areas for future improvement, and provide a reference guide for practitioners in the field. It analyzes the most cited procedures currently in use for the management of a number of symptoms affecting the majority of patients with multiple sclerosis, from different training routines to cognitive rehabilitation and therapies using physical agents, such as electrostimulation, hydrotherapy, cryotherapy and electromagnetic fields. Furthermore, it investigates the quality of evidence for the aforementioned therapies and the different tests applied in practice to assess their utility. Lastly, the study looks at potential future candidates for the treatment and evaluation of patients with multiple sclerosis and the supposed benefits they could bring in clinical settings.
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The size and behavior of virtual objects have influence on functional exercise and motivation of persons with multiple sclerosis: a randomized study. Sci Rep 2022; 12:19375. [PMID: 36371421 PMCID: PMC9652596 DOI: 10.1038/s41598-022-24046-3] [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: 06/09/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
The consequences of multiple sclerosis are problems with limb movement, coordination, and vision. Heretofore a combination of therapy and additional medications can alter the course of the disease and reduce upper extremity disability. We developed a virtual environment for pick-and-place tasks as a supportive tool to address the problem of challenging task in occupational therapy. The primary objective of the study was to investigate the influence of size and bounce on proximal and fine motor performance and intrinsic motivation. The secondary objective was to examine how the absence of challenge may decrease intrinsic motivation and heart rate. The randomized trial involved 84/107 eligible inpatients with multiple sclerosis. They were divided into 4 groups by computer randomization: Group 1 small and bouncing, Group 2 small and non-bouncing, Group 3 large and bouncing, and Group 4 large and non-bouncing virtual cubes. Each participant completed 50 sessions of up to 2 min each in approximately 14 days. Before commencement of the study the participants completed visuospatial and cognitive tests. Participants' subjective experiences were assessed daily using the intrinsic motivation inventory. Before and after the study, the box and block test and the 9-hole peg test were administered. Kinematic analysis showed significant differences between groups (average manipulation time p = 0.008, inserted cubes p = 0.004). Group 4 was the most successful (inserted cubes > 9) and the fastest (63.4 SD 25.8 s), but had low pressure/tension and heart rate. Group 1 was the slowest (88.9 SD 28.2 s) but had increased interest/enjoyment in the task under higher pressure/tension. There were substantial differences in intrinsic motivation between the 1st and last sessions within groups (Cohen's U3 < 0.3 or > 0.8). The size and behavior of virtual objects may be important for training proximal movements and fine motor skills in people with multiple sclerosis. Furthermore, the demonstrated approach proved to be effective and may reduce upper extremity disability in the long term if intrinsic motivation can be sustained longer with a challenging task.Trial registration The small scale randomized pilot trial has been registered at ClinicalTrials.gov Identifier: NCT04266444, 12/02/2020, https://clinicaltrials.gov/ct2/show/NCT04266444 .
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Effects of immersive virtual reality on upper limb function in subjects with multiple sclerosis: A cross-over study. Mult Scler Relat Disord 2022; 65:104004. [DOI: 10.1016/j.msard.2022.104004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 11/19/2022]
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Pierella C, Pellegrino L, Muller M, Inglese M, Solaro C, Coscia M, Casadio M. Upper Limb Sensory-Motor Control During Exposure to Different Mechanical Environments in Multiple Sclerosis Subjects With No Clinical Disability. Front Neurorobot 2022; 16:920118. [PMID: 35898562 PMCID: PMC9309790 DOI: 10.3389/fnbot.2022.920118] [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: 04/14/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune and neurodegenerative disease resulting in motor impairments associated with muscle weakness and lack of movement coordination. The goal of this work was to quantify upper limb motor deficits in asymptomatic MS subjects with a robot-based assessment including performance and muscle synergies analysis. A total of 7 subjects (MS: 3 M−4 F; 42 ± 10 years) with clinically definite MS according to McDonald criteria, but with no clinical disability, and 7 age- and sex-matched subjects without a history of neurological disorders participated in the study. All subjects controlled a cursor on the computer screen by moving their hand or applying forces in 8 coplanar directions at their self-selected speed. They grasped the handle of a robotic planar manipulandum that generated four different environments: null, assistive or resistive forces, and rigid constraint. Simultaneously, the activity of 15 upper body muscles was recorded. Asymptomatic MS subjects generated less smooth and less accurate cursor trajectories than control subjects in controlling a force profile, while the end-point error was significantly different also in the other environments. The EMG analysis revealed different muscle activation patterns in MS subjects when exerting isometric forces or when moving in presence of external forces generated by a robot. While the two populations had the same number and similar structure of muscle synergies, they had different activation profiles. These results suggested that a task requiring to control forces against a rigid environment allows better than movement tasks to detect early sensory-motor signs related to the onset of symptoms of multiple sclerosis and to differentiate between stages of the disease.
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Affiliation(s)
- Camilla Pierella
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Children's Sciences (DINOGMI), University of Genoa, Genoa, Italy
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
- *Correspondence: Camilla Pierella
| | - Laura Pellegrino
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Margit Muller
- Department of Rehabilitation, C.R.R.F. “Mons. L. Novarese”, Moncrivello, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Children's Sciences (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Solaro
- Department of Rehabilitation, C.R.R.F. “Mons. L. Novarese”, Moncrivello, Italy
| | | | - Maura Casadio
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
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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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Eldemir S, Ozkul C, Eldemir K, Saygili F, Guclu-Gunduz A, Irkec C. The reliability and validity of the Turkish version of the dual-task questionnaire in patients with multiple sclerosis. Mult Scler Relat Disord 2022; 64:103942. [PMID: 35717901 DOI: 10.1016/j.msard.2022.103942] [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: 03/12/2022] [Revised: 05/19/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Activities of daily living often require performing dual-task (DT). People with Multiple Sclerosis (PwMS) may have difficulties during dual-task and these difficulties negatively affect their quality of life. However, the number of validated questionnaires to assess DT difficulties in Multiple Sclerosis (MS) is very few. Therefore, the study aimed to translate and adapt the Dual-Task Questionnaire (DTQ) into Turkish, thereafter analyzing the psychometric properties in PwMS. METHODS A total of 51 PwMS were recruited in the study. Cronbach's alpha coefficient was used to evaluate internal consistency. The test-retest reliability was determined using the intraclass correlation coefficient (ICC). Correlations of the DTQ with motor-dual task costs (DTCs) and cognitive-DTCs were used to assess construct validity. RESULTS The mean age was 36.84±10.47 years. The internal consistency of the DTQ was acceptable (α= 0.780). The test-retest reliability of all items and the total score of the DTQ were excellent (ICC>0.90). The relationships of DTQ-Total between some parameters of motor-DTCs (ρ=-0.409-(-0.495) for walking-DTCs, ρ=-0.313 for manual dexterity-DTC during mental tracking, and ρ=-0.353 for balance-DTC during mental tracking) and cognitive-DTCs (ρ=0.328 for mental tacking-DTC during balance, ρ=0.290-0.342 for all verbal fluency-DTCs) were low to moderately significant. CONCLUSION Turkish version of DTQ is a reliable and valid tool to measure DT difficulty in PwMS. Additionally, the questionnaire is a reliable and valid Patient Reported Outcomes Initiative for MS (PROMS) for Turkish-speaking PwMS.
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Affiliation(s)
- Sefa Eldemir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey.
| | - Cagla Ozkul
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Kader Eldemir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Fettah Saygili
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Arzu Guclu-Gunduz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Ceyla Irkec
- Lokman Hekim Hospitals Group, Ankara, Turkey
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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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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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Mui M, Ruben R, Ricker T, Dobryakova E, Sandry J. Ex-Gaussian Analysis of Simple Response Time as a Measure of Information Processing Speed and the Relationship with Brain Morphometry in Multiple Sclerosis. Mult Scler Relat Disord 2022; 63:103890. [DOI: 10.1016/j.msard.2022.103890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
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Ozdogar AT, Baba C, Kahraman T, Sagici O, Dastan S, Ertekin O, Ozakbas S. Effects and safety of exergaming in persons with multiple sclerosis during corticosteroid treatment: a pilot study. Mult Scler Relat Disord 2022; 63:103823. [PMID: 35523062 DOI: 10.1016/j.msard.2022.103823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/10/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is no information about the effects and usability of rehabilitation during corticosteroid treatment. This randomized clinical trial was conducted to evaluate and compare the effects and safety of exergaming and conventional rehabilitation (CR) on persons with multiple sclerosis (MS, pwMS) during corticosteroid treatment. METHODS The participants were randomly divided into two groups: Exergaming (n=15) and CR (n=15). Rehabilitation was applied by a physiotherapist who has expertise in MS. Measurements were done at baseline (T1), immediately after discharge (T2), and 1 month after discharge (T3). The outcome measures included upper extremity functions, walking, balance, cognitive functions, quality of life, depression, and fatigue. RESULTS The Nine Hole Peg Test, California Verbal Learning Test, Symbol Digit Modalities Test, MS Walking Scale-12, Six Spot Step Test showed a significant difference between T1 to T2 and T1 to T3 in the exergaming and CR groups (p < 0.05). The Timed 25 Foot Walk and Multiple Sclerosis International Quality of Life Questionnaire were significantly different between T1 to T3 in the exergaming and CR groups (p < 0.05). Brief Visuospatial Memory Test-Revised was significantly different between T1 to T3 and T2 to T3 in the exergaming and CR groups (p < 0.05). The MFIS showed a significant difference between T1 to T2 and T1 to T3 in the exergaming group (p < 0.05). CONCLUSIONS This study suggests that exergaming and CR are effective and safe methods for improving upper extremity, cognitive functions, fatigue, quality of life, balance, and walking ability in pwMS during the hospitalization period.
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Affiliation(s)
| | - Cavid Baba
- Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Ozge Sagici
- Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Seda Dastan
- Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Ozge Ertekin
- Department of Neurological Physiotherapy-Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Serkan Ozakbas
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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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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Kalron A, Frid L, Fonkatz I, Menascu S, Dolev M, Magalashvili D, Achiron A. Design, development, and testing of a virtual reality device for upper limb training in people with multiple sclerosis: a feasibility study (Preprint). JMIR Serious Games 2022; 10:e36288. [PMID: 36094809 PMCID: PMC9513692 DOI: 10.2196/36288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 06/21/2022] [Accepted: 08/11/2022] [Indexed: 01/16/2023] Open
Abstract
Background Multiple sclerosis (MS) is a common nontraumatic, neurological, disabling disease that often presents with upper limb dysfunction. Exercise training has resulted in improvement for patients; however, there can be a lack of compliance due to access because of location and lack of MS experts. Virtual reality (VR) is a promising technology that can offer exercise therapy/rehabilitation at a distance. This type of remote training can be motivational and effective for patients with MS and can improve range of motion and muscle strength for those with upper limb dysfunction. Objective The aim of this study is to evaluate the safety and feasibility of the XRHealth software and the Oculus Rift Station for patients with MS with upper limb motor dysfunction. Methods A single-center, prospective, feasibility study was conducted with patients with MS who had upper limb motor dysfunction. Patients participated in a single 45-minute digital environment session with VR and completed a questionnaire about the quality of the training and fatigability. The clinician also completed a questionnaire to evaluate the suitability and safety of the training. Results Overall, 30 patients were enrolled between the ages of 20 and 81 years. Patients reported that the training sessions within the digital environment were helpful, challenging, fun, and simple to understand, and that they would be willing to repeat the sessions again. The physical therapist that oversaw the patients reported that the training was suitable for 87% (n=26) of the patients. Anticipated adverse events were fatigue, temporary dizziness, and temporary nausea. The operator complications included that the cable of the head-mounted display interrupted the training (n=2, 7%) and fatigue that caused cessation of the VR training session (n=2, 7%). No serious adverse events were reported. Conclusions These preliminary results demonstrated that the use of the XRHealth software and Oculus Rift Station platform is feasible, safe, and engaging for patients, and has the potential to improve the functionality of the upper limbs in patients with MS. This study provides support for future studies of implementing a series of training sessions with virtual reality in a home-based environment.
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Affiliation(s)
- Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Lior Frid
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Iliya Fonkatz
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Ingram LA, Butler AA, Brodie MA, Hoang P, Gandevia SC, Lord SR. Original articleQuantifying upper-limb motor impairment in people with multiple sclerosis: a physiological profiling approach. Ann Phys Rehabil Med 2021; 65:101625. [PMID: 34958919 DOI: 10.1016/j.rehab.2021.101625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND . Upper-limb sensory and motor impairments are common in people with multiple sclerosis (MS), yet the current gold standard criteria for documenting functional impairment largely focuses on mobility, balance and postural stability. OBJECTIVE . We aimed to determine the validity of the upper-limb Physiological Profile Assessment (PPA) in people with MS by investigating whether the included domains of muscle strength, dexterity, arm stability, position sense, skin sensation and bimanual coordination 1) are sensitive in differentiating people with MS from healthy controls and 2) correlate with a validated measure of upper-limb function and a scale for quantifying disability in MS. METHODS . In a cross-sectional study, 40 participants with MS and 80 healthy controls completed all 13 of the upper-limb PPA tests within a single session. RESULTS . People with MS were impaired across all physiological domains tested. Performance in 4 of the 13 tests was correlated with a validated measure of self-reported upper-limb function (Pearson's r or Spearman's rho -0.333-0.441), whereas 3 tests were associated with the degree of MS-specific disability (Spearman's rho -0.318; 0.456). CONCLUSIONS . The upper-limb PPA offers a valid and clinically suitable assessment of upper-limb function in people with MS. Clinicians should prioritise assessments of motor speed, fine motor control and functional tasks in their assessment of upper-limb function in people with MS because these domains are the most commonly and significantly impaired.
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Affiliation(s)
- Lewis A Ingram
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of South Australia, Adelaide, South Australia, Australia.
| | - Annie A Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew A Brodie
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Phu Hoang
- Neuroscience Research Australia, Sydney, New South Wales, Australia; Multiple Sclerosis Limited, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
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Tavazzi E, Cazzoli M, Pirastru A, Blasi V, Rovaris M, Bergsland N, Baglio F. Neuroplasticity and Motor Rehabilitation in Multiple Sclerosis: A Systematic Review on MRI Markers of Functional and Structural Changes. Front Neurosci 2021; 15:707675. [PMID: 34690670 PMCID: PMC8526725 DOI: 10.3389/fnins.2021.707675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/03/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Motor rehabilitation is routinely used in clinical practice as an effective method to reduce progressive disability gain in multiple sclerosis (MS), but rehabilitation approaches are typically unstandardized, and only few studies have investigated the impact of rehabilitation on brain neuroplasticity. Objective: To summarize and critically analyze studies applying MRI markers of functional connectivity and structural changes to assess the effect of motor rehabilitation on brain neuroplasticity in MS. Methods: Literature search was performed using PubMed and EMBASE, selecting studies having as a subject motor rehabilitation and advanced MRI techniques investigating neuroplasticity in adult patients affected by MS. Results: Seventeen out of 798 papers were selected, of which 5 applied structural MRI (4 diffusion tensor imaging, 1 volumetric measurements), 7 applied functional fMRI (5 task-related fMRI, 2 resting-state fMRI) whereas the remaining 5 applied both structural and functional imaging. Discussion: The considerable data heterogeneity and the small sample sizes characterizing the studies limit interpretation and generalization of the results. Overall, motor rehabilitation promotes clinical improvement, paralleled by positive adaptive brain changes, whose features and extent depend upon different variables, including the type of rehabilitation approach. MRI markers of functional and structural connectivity should be implemented in studies testing the efficacy of motor rehabilitation. They allow for a better understanding of neuroplastic mechanisms underlying rehabilitation-mediated clinical achievements, facilitating the identification of rehabilitation strategies tailored to patients' needs and abilities.
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Affiliation(s)
- Eleonora Tavazzi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.,Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Marta Cazzoli
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | - Valeria Blasi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Marco Rovaris
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Niels Bergsland
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.,Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
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Cerebellar Contributions to Motor Impairments in People with Multiple Sclerosis. THE CEREBELLUM 2021; 21:1052-1060. [PMID: 34657272 DOI: 10.1007/s12311-021-01336-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 12/25/2022]
Abstract
Although Charcot characterized classic cerebellar symptoms in people with multiple sclerosis (PwMS) in 1877, the impact of cerebellar dysfunction on MS symptoms has predominately been evaluated in the last two decades. Recent studies have clearly demonstrated the association between cerebellar pathology, including atrophy and reduced fractional anisotropy in the peduncles, and motor impairments, such as reduced gait velocity and time to complete walking tasks. However, future studies using novel imaging techniques are needed to elucidate all potential pathophysiology that is associated with disability in PwMS. Additionally, future studies are required to determine the most effective treatments for motor impairments in PwMS, including the specific type and duration of exercise interventions, and potential means to amplify their effects, such as transcranial direct current stimulation (tDCS). This mini-review critically discusses the distinct role of cerebellar dysfunction in motor impairments in PwMS, potential treatments, and directions for future studies.
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Khaledi E, Noori T, Mohammadi-Farani A, Sureda A, Dehpour AR, Yousefi-Manesh H, Sobarzo-Sanchez E, Shirooie S. Trifluoperazine reduces cuprizone-induced demyelination via targeting Nrf2 and IKB in mice. Eur J Pharmacol 2021; 909:174432. [PMID: 34416238 DOI: 10.1016/j.ejphar.2021.174432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/19/2021] [Accepted: 08/16/2021] [Indexed: 12/21/2022]
Abstract
Multiple sclerosis (MS) is one of the most common neurodegenerative diseases. In this disease, the immune system attacks oligodendrocyte cells and the myelin sheath of myelinated neurons in the central nervous system, causing their destruction. These conditions lead to impaired conduction of nerve impulses and are manifested by symptoms such as weakness, fatigue, visual and motor disorders. This study aimed to evaluate the ability of trifluoperazine (TF) to improve cuprizone-induced behavioral and histopathological changes in the prefrontal cortex of C57BL/6 male mice. Demyelination was induced by adding 0.2% cuprizone (CPZ) to the standard animal diet for 6 weeks. Three doses of TF (0.5, 1 and 2 mg/kg/day; i.p.) were given once daily for the last 2 weeks of treatment. Treatment with CPZ induced a weight loss during 6 weeks of treatment compared to the control group, which was reversed by the administration of TF. Behavioral tests (pole test and rotarod performance test) showed a decrease in motor coordination and balance in the group treated with CPZ (P < 0.01). Treatment with TF during the last two weeks was able to improve these motor deficiencies. Histopathological examination also evidenced an increase in demyelination in the CPZ group, which was improved by TF administration. In addition, CPZ intake significantly decreased the cerebral cortex levels of p-Nrf2 (P < 0.001) and increased the levels of p-IKB (P < 0.001) and, these changes were normalized in the TF groups. TF administration also reversed the increased levels of nitrite and the reduced activity of the antioxidant enzyme superoxide dismutase associated with CPZ exposure. TF can to reduce the harmful effects of CPZ by reducing the demyelination and modulating the Nrf2 and NF-kB signaling pathways.
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Affiliation(s)
- Ehsan Khaledi
- Student Research Committee, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Tayebeh Noori
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ahmad Mohammadi-Farani
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Antoni Sureda
- Research Group on Community Nutrition and Oxidative Stress (NUCOX) and Health Research Institute of Balearic Islands (IdISBa), University of Balearic Islands-IUNICS, Palma de Mallorca E-07122, Balearic Islands, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain
| | - Ahmad Reza Dehpour
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hasan Yousefi-Manesh
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Eduardo Sobarzo-Sanchez
- Instituto de Investigación y Postgrado, Facultad de Ciencias de la Salud, Universidad Central de Chile, Chile; Department of Organic Chemistry, Faculty of Pharmacy, University of Santiago de Compostela, Spain
| | - Samira Shirooie
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Measuring Treatment Response in Progressive Multiple Sclerosis-Considerations for Adapting to an Era of Multiple Treatment Options. Biomolecules 2021; 11:biom11091342. [PMID: 34572555 PMCID: PMC8470215 DOI: 10.3390/biom11091342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022] Open
Abstract
Disability in multiple sclerosis accrues predominantly in the progressive forms of the disease. While disease-modifying treatment of relapsing MS has drastically evolved over the last quarter-century, the development of efficient drugs for preventing or at least delaying disability in progressive MS has proven more challenging. In that way, many drugs (especially disease-modifying treatments) have been researched in the aspect of delaying disability progression in patients with a progressive course of the disease. While there are some disease-modifying treatments approved for progressive multiple sclerosis, their effect is moderate and limited mostly to patients with clinical and/or radiological signs of disease activity. Several phase III trials have used different primary outcomes with different time frames to define disease progression and to evaluate the efficacy of a disease-modifying treatment. The lack of sufficiently sensitive outcome measures could be a possible explanation for the negative clinical trials in progressive multiple sclerosis. On the other hand, even with a potential outcome measure that would be sensitive enough to determine disease progression and, thus, the efficacy or failure of a disease-modifying treatment, the question of clinical relevance remains unanswered. In this systematic review, we analyzed outcome measures and definitions of disease progression in phase III clinical trials in primary and secondary progressive multiple sclerosis. We discuss advantages and disadvantages of clinical and paraclinical outcome measures aiming for practical ways of combining them to detect disability progression more sensitively both in future clinical trials and current clinical routine.
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Sime MM, Bissoli ALC, Lavino-Júnior D, Bastos-Filho TF. Usability, occupational performance and satisfaction evaluation of a smart environment controlled by infrared oculography by people with severe motor disabilities. PLoS One 2021; 16:e0256062. [PMID: 34388175 PMCID: PMC8362986 DOI: 10.1371/journal.pone.0256062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/31/2021] [Indexed: 11/21/2022] Open
Abstract
A smart environment is an assistive technology space that can enable people with motor disabilities to control their equipment (TV, radio, fan, etc.) through a human-machine interface activated by different inputs. However, assistive technology resources are not always considered useful, reaching quite high abandonment rate. This study aims to evaluate the effectiveness of a smart environment controlled through infrared oculography by people with severe motor disabilities. The study sample was composed of six individuals with motor disabilities. Initially, sociodemographic data forms, the Functional Independence Measure (FIMTM), and the Canadian Occupational Performance Measure (COPM) were applied. The participants used the system in their domestic environment for a week. Afterwards, they were reevaluated with regards to occupational performance (COPM), satisfaction with the use of the assistive technology resource (QUEST 2.0), psychosocial impact (PIADS) and usability of the system (SUS), as well as through semi-structured interviews for suggestions or complaints. The most common demand from the participants of this research was ‘control of the TV’. Two participants did not use the system. All participants who used the system (four) presented positive results in all assessment protocols, evidencing greater independence in the control of the smart environment equipment. In addition, they evaluated the system as useful and with good usability. Non-acceptance of disability and lack of social support may have influenced the results.
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Affiliation(s)
- Mariana Midori Sime
- Occupational Therapy Department, Federal University of Espirito Santo (UFES), Vitoria, Brazil
- * E-mail:
| | - Alexandre Luís Cardoso Bissoli
- Postgraduate Program in Electrical Engineering, Electrical Engineering Department, Federal University of Espirito Santo (UFES), Vitoria, Brazil
| | - Daniel Lavino-Júnior
- Electrical Engineering Department, Federal University of Espirito Santo (UFES), Vitoria, Brazil
| | - Teodiano Freire Bastos-Filho
- Postgraduate Program in Electrical Engineering, Electrical Engineering Department and Postgraduate Program in Biotechnology, Federal University of Espirito Santo (UFES), Vitoria, Brazil
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Grange E, Marengo D, Di Giovanni R, Mueller M, Brichetto G, Tacchino A, Bertoni R, Patti F, Pappalardo A, Prosperini L, Castelli L, Rosato R, Cattaneo D, Solaro C. Italian translation and psychometric validation of the ABILHAND-26 and its correlation with upper limb objective and subjective measures in multiple sclerosis subjects. Mult Scler Relat Disord 2021; 55:103160. [PMID: 34320388 DOI: 10.1016/j.msard.2021.103160] [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: 04/12/2021] [Revised: 06/25/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Upper limb (UL) function is affected in about 50% of people with Multiple Sclerosis (PwMS). In the last decade, Patient Reported Outcome Measures (PROM) are playing an important role in clinical trial and practice. ABILIHAND-26 is a PROM that assess self-perceived manual ability defined as the capacity to manage daily activities using the upper limbs. The aim of the study is to translate the ABILHAND-26 into Italian, to explore its psychometric properties examining the associations with demographics, clinical variables, 9-Hole Peg Test (9-HPT) and Manual Ability Measures-36 (MAM-36). MATERIALS AND METHODS Subjects were recruited in five Italian neurological centers. They were evaluated through ABILHAND-26, 9-HPT and MAM-36. Confirmatory factor analysis and Rasch analysis were adopted to investigate the psychometric properties of the ABILHAND-26. RESULTS Two hundred and forty-five patients were recruited. Rasch analyses showed adequate functioning and supported the unidimensionality of the scale. ABILHAND-26 showed negative correlations with age and disease duration, moderate negative correlation with EDSS and the 9-HPT scores for both arms and strong positive associations (ρ ≥ .84) with the MAM-36. Difference in ABILHAND-26 scores only emerged when comparing patients with severe disability (EDSS ≥ 6) with patients with either mild or moderate disability. t) and when comapring relapsing-remitting and secondary progressive patients. CONCLUSION The Italian version of the ABILHAND-26 is now available. It shows adequate reliability of the score, moderate criterion validity and strong convergent validity. ABILHAND-26 could represent a valid assessment for self-perceived ability to perform manual activity, especially for PwMS with moderate-to-high level of disability.
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Affiliation(s)
- Erica Grange
- Dept. of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
| | | | - Rachele Di Giovanni
- Dept. of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
| | - Margit Mueller
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy; Rehabilitation Centre, Italian Multiple Sclerosis Society, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - Rita Bertoni
- IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Francesco Patti
- MS Center Institute of Neurological Sciences - University of Catania, Italy
| | - Angelo Pappalardo
- Centro Disabilità Cronica Neurologica, Presidio Ambulatoriale, Azienda Sanitaria Provinciale Catania, Catania, Italy
| | - Luca Prosperini
- S. Camillo-Forlanini Hospital, Rome, Italy; Psychiatry, Sapienza University, Rome, Italy
| | - Letizia Castelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Davide Cattaneo
- IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy; Department of Physiopathology and Transplants, University of Milan, Milan, Italy
| | - Claudio Solaro
- Dept. of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
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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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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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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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Donzé C, Massot C. Rehabilitation in multiple sclerosis in 2021. Presse Med 2021; 50:104066. [PMID: 33989721 DOI: 10.1016/j.lpm.2021.104066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with multiple sclerosis, despite advances in therapy, often suffer from locomotor impairment that limits their mobility and affect quality of life. Rehabilitation is part of the treatment of MS and has shown its beneficial effects in numerous studies. While traditional rehabilitation techniques remain in the limelight, new technologies are emerging and make it possible to improve the management of disabling symptoms. The aim of this update is to synthesize the new therapy techniques proposed in rehabilitation for patients with multiple sclerosis according to the symptoms as balance, gait, upper limb disorders, fatigue, spasticity and disease progression published over the past 5 years. With regard to balance and walking disorders, neuromotor rehabilitation, physical exercise, rhythmic auditory stimulation, gait robot training and exergaming are effective. Only physical exercise has shown a positive effect on fatigue management. Spasticity is improved by classic rehabilitation techniques however non-invasive brain stimulation are promising. The rehabilitation of upper limb dysfunctions uses various effective techniques such as the repetition of functional tasks in real or virtual situations. In case of a more severe disability, arm robots can be used to relearn the impaired movement. Action observation training in real or virtual situations is also effective. Finally, under certain conditions the constraint induced movement therapy is proposed. The effects of rehabilitation are not only positive on the pyramidal symptoms and fatigue but also increase neuroplasticity and perhaps a neuroprotective effect as shown in some studies.
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Affiliation(s)
- Cécile Donzé
- Faculté de médecine et de maïeutique de Lille, service de médecine physique et réadaptation, hôpital Saint-Philibert, groupement des hôpitaux de l'institut catholique de Lille, Lomme, France.
| | - Caroline Massot
- Faculté de médecine et de maïeutique de Lille, service de médecine physique et réadaptation, hôpital Saint-Philibert, groupement des hôpitaux de l'institut catholique de Lille, Lomme, France
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Afshar S, Akbarfahimi N, Rassafiani M, Vahedi M, Azimian M, Pashang S, Etemadifar M. Validity and reliability of Persian version of the Arm Function in Multiple Sclerosis Questionnaire. Br J Occup Ther 2021. [DOI: 10.1177/03080226211008710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction This study aimed to determine the validity and reliability of the Persian version of the Arm Function in Multiple Sclerosis Questionnaire which is a self-report questionnaire for persons with multiple sclerosis (MS). Method This methodological study was performed in the following stages: translation, validity, internal consistency, and test–retest reliability of Persian-AMSQ. The Nine-Hole Peg Test (9HPT), Coin Rotation Task (CRT), and Functional Independence Measure (FIM) for construct validity were used. Psychometric testing was done to ascertain the validity and reliability of the questionnaire. Results In this study, 155 people with MS participated. There were no major linguistic or cultural difficulties in the translation of AMSQ. Face and content validity confirmed by experts and people with MS. The internal consistency was high (Cronbach’s α = 0.99). Test–retest reliability, as measured with intra-class coefficient, was 0.98. Correlations with 9HPT (r = 0.54), CRT (r = 0.16), and FIM (r = −0.54) were significant ( p < 0.05). Conclusion The Persian-AMSQ appears to be a valid and reliable questionnaire for measuring upper extremity dysfunction in MS.
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Affiliation(s)
- Sara Afshar
- Department of Occupational Therapy, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nazila Akbarfahimi
- Department of Occupational Therapy, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Rassafiani
- Department of Occupational Therapy, Faculty of Allied Health Sciences, Kuwait University, Kuwait
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohsen Vahedi
- Department of Biostatistics and Epidemiology, School of Rehabilitation, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Mojtaba Azimian
- MS Clinic, Rofeideh Hospital, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | | | - Masoud Etemadifar
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
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