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Ismail MA, Elsayed NM. Diffusion-Weighted Images and Contrast-Enhanced MRI in the Diagnosis of Different Stages of Multiple Sclerosis of the Central Nervous System. Cureus 2023; 15:e41650. [PMID: 37575819 PMCID: PMC10420334 DOI: 10.7759/cureus.41650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Multiple sclerosis (MS) is one of the most prevalent disorders of the central nervous system (CNS), and it can be observed in the field of radiological cross-sectional magnetic resonance imaging (MRI). The prevalence of MS in Saudi Arabia has increased as compared to the past few years. MRI is the gold standard non-invasive modality of choice in MS diagnosis according to the National Multiple Sclerosis Society (NMSS), New York City. This study aimed to highlight the significance of using diffusion-weighted images (DWIs) and the use of contrast media in the MS protocol, as well as the importance of identifying the suitable time of imaging after contrast enhancement to detect active lesions. Methods A retrospective cross-sectional study was conducted of 100 MS patients with an age range of 17 to 56 years. The data set included 41 active cases and 59 inactive cases. All patients had an MRI standard protocol of both the brain and spine in addition to DWI sequence and contrast agent (CA) injection, with images taken in early and delayed time. Results Of the patients, 71% were female and 29% were male. Active MS disease was more significant at younger ages than at older ages. Active lesions were significantly enhanced in delayed contrast images and showed high signal intensity in both the DWI and apparent diffusion coefficient (ADC) map, while inactive lesions showed no enhancement after contrast injection and showed an iso-signal intensity in both the DWI and ADC map. Conclusion The use of CA has developed over the years in the diagnosis of MS patients. In this study, the relationship between active lesions, DWI, and delayed contrast enhancement is very strong. In future research, we recommend adding a DWI sequence for the suspected active MS spine lesions in addition to delayed enhancement time in active MS after contrast injection to increase MRI sensitivity toward active MS lesions of the brain and spinal cord as well.
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Affiliation(s)
- Mashael A Ismail
- Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdullah Medical Complex, Ministry of Health, Jeddah, SAU
| | - Naglaa M Elsayed
- Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, SAU
- Diagnostic Radiology, Faculty of Medicine, Cairo University, Cairo, EGY
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Santoyo-Medina C, Janer Cabo M, Xaudaró DF, Sanmillan GL, Sanchez Pous S, Cartaña IG, Meza Murillo ER, Sastre-Garriga J, Montalban X. Effect of Nordic Walking Training on Walking Capacity and Quality of Life for People With Multiple Sclerosis. Int J MS Care 2023; 25:118-123. [PMID: 37250195 PMCID: PMC10211352 DOI: 10.7224/1537-2073.2021-070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Although there is emerging evidence that aerobic training improves walking capacity in persons with multiple sclerosis (MS), data are limited about the potential benefits of Nordic walking (NW) for this population. This study evaluates the effectiveness of outdoor NW training on walking capacity and related quality of life for people with MS compared with cycloergometer and treadmill aerobic training. METHODS A single-blinded (evaluator), randomized, 2-arm clinical trial was designed. RESULTS A total of 57 patients with MS (38 women and 19 men; mean ± SD age, 51.98 ± 9.93 years; mean ± SD disease duration, 14.75 ± 8.52 years) were included. Both therapeutic modalities improved walking distance as measured by the 6-Minute Walk Test after the training period. The NW group showed significant improvement on the physical and emotional subscales of the Multiple Sclerosis Quality of Life-54 compared with the cycloergometer and treadmill group, which showed improvement only on the physical subscale. CONCLUSIONS Both training modalities proved to be of equal benefit in improving the walking capacity of people with MS, but outdoor NW training also seems to have a beneficial effect on the emotional component of health-related quality of life.
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Affiliation(s)
- Carme Santoyo-Medina
- From the Neurology-Neuroimmunology Department and Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia, Vall d’Hebron University Hospital Barcelona, Barcelona, Spain (CS-M, MJC, DFX, GLS, SSP, IGC, ERMM, JS-G, XM)
- Department of Physiotherapy, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain (CS-M)
| | - Montserrat Janer Cabo
- From the Neurology-Neuroimmunology Department and Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia, Vall d’Hebron University Hospital Barcelona, Barcelona, Spain (CS-M, MJC, DFX, GLS, SSP, IGC, ERMM, JS-G, XM)
| | - Dolors Fàbregas Xaudaró
- From the Neurology-Neuroimmunology Department and Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia, Vall d’Hebron University Hospital Barcelona, Barcelona, Spain (CS-M, MJC, DFX, GLS, SSP, IGC, ERMM, JS-G, XM)
| | - Gaizka Loyola Sanmillan
- From the Neurology-Neuroimmunology Department and Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia, Vall d’Hebron University Hospital Barcelona, Barcelona, Spain (CS-M, MJC, DFX, GLS, SSP, IGC, ERMM, JS-G, XM)
| | - Samuel Sanchez Pous
- From the Neurology-Neuroimmunology Department and Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia, Vall d’Hebron University Hospital Barcelona, Barcelona, Spain (CS-M, MJC, DFX, GLS, SSP, IGC, ERMM, JS-G, XM)
| | - Ingrid Galan Cartaña
- From the Neurology-Neuroimmunology Department and Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia, Vall d’Hebron University Hospital Barcelona, Barcelona, Spain (CS-M, MJC, DFX, GLS, SSP, IGC, ERMM, JS-G, XM)
| | - Edwin Roger Meza Murillo
- From the Neurology-Neuroimmunology Department and Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia, Vall d’Hebron University Hospital Barcelona, Barcelona, Spain (CS-M, MJC, DFX, GLS, SSP, IGC, ERMM, JS-G, XM)
| | - Jaume Sastre-Garriga
- From the Neurology-Neuroimmunology Department and Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia, Vall d’Hebron University Hospital Barcelona, Barcelona, Spain (CS-M, MJC, DFX, GLS, SSP, IGC, ERMM, JS-G, XM)
| | - Xavier Montalban
- From the Neurology-Neuroimmunology Department and Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia, Vall d’Hebron University Hospital Barcelona, Barcelona, Spain (CS-M, MJC, DFX, GLS, SSP, IGC, ERMM, JS-G, XM)
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Hadouiri N, Monnet E, Gouelle A, Sagawa Y, Decavel P. Locomotor Strategy to Perform 6-Minute Walk Test in People with Multiple Sclerosis: A Prospective Observational Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:3407. [PMID: 37050467 PMCID: PMC10099238 DOI: 10.3390/s23073407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/04/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
Two-thirds of people with Multiple Sclerosis (PwMS) have walking disabilities. Considering the literature, prolonged tests, such as the 6 min walk test, better reflect their everyday life walking capacities and endurance. However, in most studies, only the distance traveled during the 6MWT was measured. This study aims to analyze spatio-temporal (ST) walking patterns of PwMS and healthy people in the 6MWT. Participants performed a 6MWT with measures of five ST variables during three 1 min intervals (initial: 0'-1', middle: 2'30″-3'30″, end: 5'-6') of the 6MWT, using the GAITRite system. Forty-five PwMS and 24 healthy people were included. We observed in PwMS significant changes between initial and final intervals for all ST parameters, whereas healthy people had a rebound pattern but the changes between intervals were rather negligible. Moreover, ST variables' changes were superior to the standard measurement error only for PwMS between initial and final intervals for all ST parameters. This result suggests that the modification in PwMS' walking pattern is effectively due to their walking ability and not to a measurement, and suggests that PwMS could not manage their walking efficiently compared to healthy people, who could maintain their rhythm throughout the 6MWT. Further studies are needed to detect these patterns changes in the early evolution of the disease, identify clinical determinants involved in PwMS' walking pattern, and investigate whether interventions can positively impact this pattern.
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Affiliation(s)
- Nawale Hadouiri
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, 25000 Besançon, France
- Clinical Investigation Center, INSERM 1431, University Hospital of Besançon, 25000 Besançon, France
- Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Elisabeth Monnet
- Clinical Investigation Center, INSERM 1431, University Hospital of Besançon, 25000 Besançon, France
- EA4266 Agents Pathogènes et Inflammation, University of Bourgogne-Franche-Comte, 25000 Besançon, France
| | - Arnaud Gouelle
- Laboratory Performance, Santé, Métrologie, Société (PSMS), UFR STAPS, 51000 Reims, France
| | - Yoshimasa Sagawa
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, 25000 Besançon, France
- Clinical Investigation Center, INSERM 1431, University Hospital of Besançon, 25000 Besançon, France
- Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, 25000 Besançon, France
| | - Pierre Decavel
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, 25000 Besançon, France
- Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, 25000 Besançon, France
- Rehabilitation Department, HFR, 1700 Fribourg, Switzerland
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Cederberg KLJ, Schuetz ML, Mathison B, Motl RW. Restless legs syndrome severity associated with reduced physical function in adults with multiple sclerosis. Gait Posture 2022; 97:56-61. [PMID: 35882097 DOI: 10.1016/j.gaitpost.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Restless legs syndrome (RLS) is a sleep disorder that occurs in approximately 26 % of adults with multiple sclerosis (MS) and may be associated with reduced physical function. RESEARCH QUESTION The present study examined the relationship between RLS symptomology (i.e., overall severity, frequency, and occurrence) and physical function outcomes in adults with MS who had RLS. METHODS Participants (N = 22) with MS who had RLS came into the laboratory for a single session wherein a rater performed a brief neurological examination for scoring the Expanded Disability Status Scale (EDSS) and completed a demographics questionnaire, the International Restless Legs Syndrome Study Group Scale (IRLS), and the Restless Legs Syndrome Scale-6 (RLS-6) followed by the Short Physical Performance Battery (SPPB) and the Six-minute Walk Test (6 MW). RESULTS Bivariate Spearman's rho correlation analyses indicated total IRLS had a strong, negative association with total distance traveled during the 6 MW (ρ = -0.50) and a moderate association with SPPB scores (ρ = -0.43), but not EDSS scores (ρ = 0.28). RLS severity during the day while active had strong, negative associations with total distance traveled during the 6 MW (ρ = -0.61) and SPPB scores (ρ = -0.52), but not EDSS scores (ρ = 0.13). SIGNIFICANCE We observed associations between worse overall RLS severity and RLS severity during the day while active with reduced performance during the 6 MW and lower SPPB scores. The management of RLS may offer an opportunity for mitigating reductions in physical function in adults with MS who have RLS.
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Affiliation(s)
- Katie L J Cederberg
- Department of Physical Therapy, University of Alabama at Birmingham, 1720 Second Avenue South, AL, USA.
| | - Morgan L Schuetz
- Department of Physical Therapy, University of Alabama at Birmingham, 1720 Second Avenue South, AL, USA
| | - Brianna Mathison
- Department of Physical Therapy, University of Alabama at Birmingham, 1720 Second Avenue South, AL, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition University of Illinois Chicago.
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Dreyer-Alster S, Menascu S, Aloni R, Givon U, Dolev M, Achiron A, Kalron A. Motoric cognitive risk syndrome in people with multiple sclerosis: prevalence and correlations with disease-related factors. Ther Adv Neurol Disord 2022; 15:17562864221109744. [PMID: 35813608 PMCID: PMC9260572 DOI: 10.1177/17562864221109744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background: The motoric cognitive risk (MCR) syndrome, defined as the coexistence of slow
gait and subjective cognitive complaints, has as yet not been researched in
people with multiple sclerosis (pwMS). Objective: To examine the prevalence of the MCR syndrome in pwMS and its association
with disability, disease duration, perceived fatigue, and fear of
falling. Methods: The study comprised 618 pwMS [43.7 (SD = 12.6) years, 61.7% females]. Gait
speed was measured by the GAITRite™ electronic walkway (CIR Systems, Inc.
Haverton, PA, USA). Cognitive status was defined according to the global
cognitive score computed by the NeuroTrax™ cognitive battery (NeuroTrax
Corporation, Medina, NY, USA). The sample was divided into four main groups:
‘normal’, ‘cognitively impaired’, ‘gait impaired’ or ‘MCR’. Perceived
fatigue was assessed by the Modified Fatigue Impact Scale; fear of falling
by the Falls Efficacy Scale International. Results: Sixty-three (10.2%) patients were diagnosed with MCR. The percentage of
subjects categorized as MCR was 26.0% in severely disabled pwMS compared
with 10.9%, 6.0%, and 4.6% in moderately, mildly and very mildly disabled
pwMS, respectively. Subjects in the MCR group presented with elevated
fatigue compared with patients classified as normal [49.7 (SD = 23.3) vs
26.5 (SD = 19.2), p < 0.001]. Fear of falling was
significantly higher in the MCR and gait impairment groups compared with the
cognitively impaired and normal groups. Conclusions: The current study corroborates the presence of MCR in pwMS. Nevertheless,
future longitudinal research is warranted to better understand its
application.
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Affiliation(s)
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Aloni
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Uri Givon
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Efficacy of Transcranial Direct Current Stimulation (tDCS) on Balance and Gait in Multiple Sclerosis Patients: A Machine Learning Approach. J Clin Med 2022; 11:jcm11123505. [PMID: 35743575 PMCID: PMC9224780 DOI: 10.3390/jcm11123505] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/05/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) has emerged as an appealing rehabilitative approach to improve brain function, with promising data on gait and balance in people with multiple sclerosis (MS). However, single variable weights have not yet been adequately assessed. Hence, the aim of this pilot randomized controlled trial was to evaluate the tDCS effects on balance and gait in patients with MS through a machine learning approach. In this pilot randomized controlled trial (RCT), we included people with relapsing−remitting MS and an Expanded Disability Status Scale >1 and <5 that were randomly allocated to two groups—a study group, undergoing a 10-session anodal motor cortex tDCS, and a control group, undergoing a sham treatment. Both groups underwent a specific balance and gait rehabilitative program. We assessed as outcome measures the Berg Balance Scale (BBS), Fall Risk Index and timed up-and-go and 6-min-walking tests at baseline (T0), the end of intervention (T1) and 4 (T2) and 6 weeks after the intervention (T3) with an inertial motion unit. At each time point, we performed a multiple factor analysis through a machine learning approach to allow the analysis of the influence of the balance and gait variables, grouping the participants based on the results. Seventeen MS patients (aged 40.6 ± 14.4 years), 9 in the study group and 8 in the sham group, were included. We reported a significant repeated measures difference between groups for distances covered (6MWT (meters), p < 0.03). At T1, we showed a significant increase in distance (m) with a mean difference (MD) of 37.0 [−59.0, 17.0] (p = 0.003), and in BBS with a MD of 2.0 [−4.0, 3.0] (p = 0.03). At T2, these improvements did not seem to be significantly maintained; however, considering the machine learning analysis, the Silhouette Index of 0.34, with a low cluster overlap trend, confirmed the possible short-term effects (T2), even at 6 weeks. Therefore, this pilot RCT showed that tDCS may provide non-sustained improvements in gait and balance in MS patients. In this scenario, machine learning could suggest evidence of prolonged beneficial effects.
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Dillenseger A, Weidemann ML, Trentzsch K, Inojosa H, Haase R, Schriefer D, Voigt I, Scholz M, Akgün K, Ziemssen T. Digital Biomarkers in Multiple Sclerosis. Brain Sci 2021; 11:brainsci11111519. [PMID: 34827518 PMCID: PMC8615428 DOI: 10.3390/brainsci11111519] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022] Open
Abstract
For incurable diseases, such as multiple sclerosis (MS), the prevention of progression and the preservation of quality of life play a crucial role over the entire therapy period. In MS, patients tend to become ill at a younger age and are so variable in terms of their disease course that there is no standard therapy. Therefore, it is necessary to enable a therapy that is as personalized as possible and to respond promptly to any changes, whether with noticeable symptoms or symptomless. Here, measurable parameters of biological processes can be used, which provide good information with regard to prognostic and diagnostic aspects, disease activity and response to therapy, so-called biomarkers Increasing digitalization and the availability of easy-to-use devices and technology also enable healthcare professionals to use a new class of digital biomarkers-digital health technologies-to explain, influence and/or predict health-related outcomes. The technology and devices from which these digital biomarkers stem are quite broad, and range from wearables that collect patients' activity during digitalized functional tests (e.g., the Multiple Sclerosis Performance Test, dual-tasking performance and speech) to digitalized diagnostic procedures (e.g., optical coherence tomography) and software-supported magnetic resonance imaging evaluation. These technologies offer a timesaving way to collect valuable data on a regular basis over a long period of time, not only once or twice a year during patients' routine visit at the clinic. Therefore, they lead to real-life data acquisition, closer patient monitoring and thus a patient dataset useful for precision medicine. Despite the great benefit of such increasing digitalization, for now, the path to implementing digital biomarkers is widely unknown or inconsistent. Challenges around validation, infrastructure, evidence generation, consistent data collection and analysis still persist. In this narrative review, we explore existing and future opportunities to capture clinical digital biomarkers in the care of people with MS, which may lead to a digital twin of the patient. To do this, we searched published papers for existing opportunities to capture clinical digital biomarkers for different functional systems in the context of MS, and also gathered perspectives on digital biomarkers under development or already existing as a research approach.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tjalf Ziemssen
- Correspondence: ; Tel.: +49-351-458-5934; Fax: +49-351-458-5717
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Cohen ET, Huser S, Barone K, Barone DA. Trekking Poles to Aid Multiple Sclerosis Walking Impairment: An Exploratory Comparison of the Effects of Assistive Devices on Psychosocial Impact and Walking. Int J MS Care 2021; 23:135-141. [PMID: 34177386 DOI: 10.7224/1537-2073.2020-064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Walking dysfunction is reported by two-thirds of persons with multiple sclerosis (MS). Assistive devices are frequently recommended to improve walking; however, it is uncommon to consider their psychosocial impact, although many users abandon their assistive devices. The psychosocial impact, walking, balance, and fatigue associated with three assistive devices were compared to guide clinical decision making. Methods Twenty-five persons with MS (median Expanded Disability Status Scale score, 4.0; range, 2.5-6.0) who reported walking difficulty were trained in the use of three assistive devices-a single-point cane (SPC), a four-point cane (FPC), and a trekking pole (TP)-at 1- to 2-week intervals, then used the assistive device for their usual activities. Outcome measures included the Psychosocial Impact of Assistive Devices Scale (PIADS), the 6-Minute Walk Test (6MWT), walking speed, cadence, stride length, stride time, the 12-item Multiple Sclerosis Walking Scale (MSWS-12), the Activities-specific Balance Confidence (ABC) scale, the 5-item Modified Fatigue Impact Scale (MFIS-5), and a visual analogue scale of fatigue (VAS-F). Results The SPC and TP were more positive in the PIADS adaptability, competence, and self-esteem subscales. The SPC and TP resulted in higher 6MWT, walking speed, cadence, stride length, stride time, and MSWS-12 scores compared with the FPC. No differences were found in ABC scale, MFIS-5, or VAS-F scores. Conclusions Participants reported more positive psychosocial impact, and walked faster and with higher quality, with the SPC and TP than with the FPC. Clinicians should consider suggesting an SPC or TP to patients who may benefit from assistive device use and for whom psychosocial impact is an important consideration.
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Block VJ, Gopal A, Rowles W, -Yueh C, Gelfand JM, Bove R. CoachMS, an innovative closed-loop, interdisciplinary platform to monitor and proactively treat MS symptoms: A pilot study. Mult Scler J Exp Transl Clin 2021; 7:2055217321988937. [PMID: 33796329 PMCID: PMC7970691 DOI: 10.1177/2055217321988937] [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: 09/09/2020] [Accepted: 12/01/2021] [Indexed: 12/02/2022] Open
Abstract
Background There are numerous challenges to treating co-occurring symptoms in multiple sclerosis (MS). Objective To pilot the feasibility of a novel symptom management platform, CoachMS, to monitor MS symptoms (bladder function, ambulation, and mood: BAM) and respond to changes in real-time. Methods In this 12-week randomized controlled pilot trial, participants’ symptoms were monitored using weekly questionnaires and remote ambulatory monitoring (Fitbit Flex2®). Behavioral change principles used included shared goal setting at 2 weeks. Between weeks 2-12, the CoachMS group received targeted contact and interventions if symptoms worsened; the control group were treated through usual clinic practice. Our outcomes were feasibility (retention, adherence and acceptability; primary) and proportion of recommended treatments pursued (secondary); efficacy was explored. Results Of 21 participants enrolled, 13 (62%) completed the study; protocol adherence was excellent. CoachMS participants demonstrated greater follow-through with clinical recommendations than controls (OR 9.3, 95% CI (0.9, 97.6)). As a cohort, each BAM symptom tended to improve. Suicidality was detected in one control participant, resulting in urgent evaluation and hospitalization. Conclusions The innovative CoachMS platform was feasible and acceptable in this cohort with baseline BAM symptoms. It could represent an accessible, cost-effective tool to monitor MS symptoms in real-time; a larger trial is planned.
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Affiliation(s)
- Valerie J Block
- UCSF Weill Institute for Neurosciences, MS and Neuroinflammation Clinic, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Arpita Gopal
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, USA
| | - William Rowles
- UCSF Weill Institute for Neurosciences, MS and Neuroinflammation Clinic, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Chu -Yueh
- UCSF Weill Institute for Neurosciences, MS and Neuroinflammation Clinic, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey M Gelfand
- UCSF Weill Institute for Neurosciences, MS and Neuroinflammation Clinic, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Riley Bove
- UCSF Weill Institute for Neurosciences, MS and Neuroinflammation Clinic, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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Sattelmayer M, Chevalley O, Steuri R, Hilfiker R. Over-ground walking or robot-assisted gait training in people with .multiple sclerosis: does the effect depend on baseline walking speed and disease related disabilities? A systematic review and meta-regression. BMC Neurol 2019; 19:93. [PMID: 31068151 PMCID: PMC6506946 DOI: 10.1186/s12883-019-1321-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 04/29/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND It was suggested that robot-assisted gait training (RAGT) should not be routinely provided to disabled patients in place of conventional over-ground walking training (CGT). There exist several randomised controlled trials reporting on RAGT for people with multiple sclerosis. However, the effectiveness of RAGT varies between studies with the effectiveness pointing in different directions. It might be possible that the effectiveness of RAGT and CGT depends on the disease related disabilities of the people included in the clinical studies. We aimed to systematically search RCTs and to perform a meta-regression to compare the effects of robot-assisted gait training in people with less and higher disease related disabilities. The Expanded Disability Status Scale (EDSS) scores were used to classify level of disability. METHODS A systematic search was developed to search four electronic databases (MEDLINE, CENTRAL, EMBASE and CINAHL) for eligible articles. A random effects model was applied to meta-analyse the effects of the interventions. Meta-regression was performed with an uni-variable random effects model using baseline walking speed and EDSS to predict the between group effect. RESULTS The search on databases resulted in 596 records and finally nine studies were included into the review. The pooled estimates of the effects for performance over short and long distance tests were small and non-significant: -0.08 SMD (95% CI: -0.51 to 0.35) and - 0.24 SMD (95% CI: -0.67 to 0.19). Neither baseline walking speed or disease related disability were related to the mean effect size. DISCUSSION Future studies are needed to help clinicians to decide, which intervention should be allocated to the individual patient.
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Affiliation(s)
- Martin Sattelmayer
- University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), School of Health Sciences, Leukerbad, Switzerland
| | - Odile Chevalley
- University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), School of Health Sciences, Leukerbad, Switzerland
| | - Ruedi Steuri
- University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), School of Health Sciences, Leukerbad, Switzerland
| | - Roger Hilfiker
- University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), School of Health Sciences, Leukerbad, Switzerland
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Kasser SL, Kosma M. Social Cognitive Factors, Physical Activity, and Mobility Impairment in Adults with Multiple Sclerosis. Behav Med 2018; 44:306-313. [PMID: 28862920 DOI: 10.1080/08964289.2017.1368441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Among those with multiple sclerosis (MS), mobility impairment is common and significantly affects independent functioning and quality of life. The purpose of the study was to examine the role of physical activity in mobility impairment in individuals with MS and explore the social cognitive factors of social support, outcome expectations, and self-efficacy that facilitate physical activity among those with the disease. A sample of 319 individuals with MS were assessed on the following: family and friend social support, self-efficacy, and physical and social outcome expectations. Self-reported physical activity, perceived ambulation disability, balance confidence, and fall history were also measured. The structural model fit the data (χ2 (29) = 24.49, p = 0.70; Root Mean Square Error of Approximation < 0.01; Comparative Fit Index = 1.0; Normed Fit Index = 0.96; Goodness of Fit Index = 0.98; Standardized Root Mean Square Residual = 0.03). The primary findings of the study revealed that physical activity was strongly linked to mobility impairment (path coefficient, -0.43), such that increasing levels of physical activity were associated with less mobility impairment. The most important predictors of health-promoting levels of physical activity were self-efficacy (path coefficient, 0.48) and social support (path coefficient, 0.38), with support from friends being a stronger indicator of social support than support from family. It may be prudent to design interventions aimed at increasing physical activity, especially in regard to helping individuals become more efficacious and building larger social networks, as this may serve to forestall advancing mobility impairment in those with MS.
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Affiliation(s)
- Susan L Kasser
- a From the Department of Rehabilitation and Movement Science , University of Vermont , Burlington , VT
| | - Maria Kosma
- b School of Kinesiology , Louisiana State University , Baton Rouge , LA
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Ghai S, Ghai I. Effects of Rhythmic Auditory Cueing in Gait Rehabilitation for Multiple Sclerosis: A Mini Systematic Review and Meta-Analysis. Front Neurol 2018; 9:386. [PMID: 29942278 PMCID: PMC6004404 DOI: 10.3389/fneur.2018.00386] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/11/2018] [Indexed: 12/15/2022] Open
Abstract
Rhythmic auditory cueing has been shown to enhance gait performance in several movement disorders. The "entrainment effect" generated by the stimulations can enhance auditory motor coupling and instigate plasticity. However, a consensus as to its influence over gait training among patients with multiple sclerosis is still warranted. A systematic review and meta-analysis was carried out to analyze the effects of rhythmic auditory cueing in studies gait performance in patients with multiple sclerosis. This systematic identification of published literature was performed according to PRISMA guidelines, from inception until Dec 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Of 602 records, five studies (PEDro score: 5.7 ± 1.3) involving 188 participants (144 females/40 males) met our inclusion criteria. The meta-analysis revealed enhancements in spatiotemporal parameters of gait i.e., velocity (Hedge's g: 0.67), stride length (0.70), and cadence (1.0), and reduction in timed 25 feet walking test (-0.17). Underlying neurophysiological mechanisms, and clinical implications are discussed. This present review bridges the gaps in literature by suggesting application of rhythmic auditory cueing in conventional rehabilitation approaches to enhance gait performance in the multiple sclerosis community.
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Affiliation(s)
- Shashank Ghai
- Institute of Sports Science, Leibniz University Hanover, Hanover, Germany
| | - Ishan Ghai
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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Sola-Valls N, Blanco Y, Sepúlveda M, Martinez-Hernandez E, Saiz A. Telemedicine for Monitoring MS Activity and Progression. Curr Treat Options Neurol 2015; 17:47. [PMID: 26423914 DOI: 10.1007/s11940-015-0377-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OPINION STATEMENT Telemedicine (TM) is defined as the exchange of medical information between two different physical places. The aims of TM are to provide services that cannot easily be provided face-to-face and improve the efficiency of existing ones. Multiple sclerosis (MS) is a chronic demyelinating disease characterized by a heterogeneous array of symptoms that can lead to severe impairment and may impact on accessibility to medical services, patient's ability to function, and overall health-related quality of life (HRQoL). The use of TM to clinically monitor MS patients has demonstrated benefits by improving HRQoL and reducing associated medical costs. Patient-reported outcome (PRO) measures have been used in TM interventions, registries, and cost-efficiency studies because they offer valuable information about patient's perspective of MS disease burden. Moreover, TM has shown acceptable reliability in the assessment of the neurological impairment by Kurtzke expanded disability status scale (EDSS) and has the potential to develop more sensitive measures, such as average daily walking activity, to closely monitor MS disease progression in real environment. It is likely that the use of TM will continue to increase in the following years but larger and controlled studies are necessary to confirm the beneficial effects of TM to deliver an optimal care for patients with MS.
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Affiliation(s)
- Nuria Sola-Valls
- Center of Neuroimmunology and Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Center of Neuroimmunology and Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain. .,Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Center of Neuroimmunology, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Maria Sepúlveda
- Center of Neuroimmunology and Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Eugenia Martinez-Hernandez
- Center of Neuroimmunology and Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain.,Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Center of Neuroimmunology, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Albert Saiz
- Center of Neuroimmunology and Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain.,Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Center of Neuroimmunology, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
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