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Tramontano M, Casagrande Conti L, Orejel Bustos AS, Ferri N, Lelli T, Nocentini U, Grasso MG, Turolla A, Pillastrini P, Manzari L. Abnormal Vestibulo-Ocular Reflex Function Correlates with Balance and Gait Impairment in People with Multiple Sclerosis. Audiol Res 2024; 14:799-808. [PMID: 39311220 PMCID: PMC11417908 DOI: 10.3390/audiolres14050067] [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] [Received: 08/19/2024] [Revised: 08/30/2024] [Accepted: 09/06/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is the most prevalent autoimmune neurological condition in the world, leading to a wide variety of symptoms, including balance disorders. OBJECTIVE To evaluate the angular vestibulo-ocular reflex (aVOR) of all six semicircular canals (SCCs) through Head Impulse (HIMP) and Suppression HIMP (SHIMP) paradigms and any correlations with clinical balance scales. METHODS All participants were assessed using the Expanded Disability Status Scale (EDSS), Berg Balance Scale (BBS), and Mini-BESTest (MBT). Vestibular function was measured by video Head Impulse Test (vHIT), obtaining aVOR gain for each SSC. RESULTS Twenty-seven PwMS (mean age 47.93 ± 8.51 years old, 18 females) were recruited. Most of the patients (81.48%) presented abnormal aVOR gains for at least one SSC. A moderate to strong correlation between aVOR gains of the left anterior SSC and, respectively, the MBT and the BBS was found. The subgroup analysis, based on the EDSS class, confirmed the correlation with the BBS in the patients with the most significant disability. CONCLUSIONS People with MS may present impairments of the aVOR in one or more semicircular canals. The aVOR gain impairment of the vertical semicircular canals correlates with balance and gait disorders identified through clinical scales in PwMS.
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Affiliation(s)
- Marco Tramontano
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy; (N.F.); (A.T.); (P.P.)
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Laura Casagrande Conti
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, 00179 Rome, Italy; (L.C.C.); (A.S.O.B.); (T.L.); (U.N.); (M.G.G.)
| | - Amaranta Soledad Orejel Bustos
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, 00179 Rome, Italy; (L.C.C.); (A.S.O.B.); (T.L.); (U.N.); (M.G.G.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Nicola Ferri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy; (N.F.); (A.T.); (P.P.)
| | - Tommaso Lelli
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, 00179 Rome, Italy; (L.C.C.); (A.S.O.B.); (T.L.); (U.N.); (M.G.G.)
| | - Ugo Nocentini
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, 00179 Rome, Italy; (L.C.C.); (A.S.O.B.); (T.L.); (U.N.); (M.G.G.)
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Maria Grazia Grasso
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, 00179 Rome, Italy; (L.C.C.); (A.S.O.B.); (T.L.); (U.N.); (M.G.G.)
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy; (N.F.); (A.T.); (P.P.)
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy; (N.F.); (A.T.); (P.P.)
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Meldrum D, Kearney H, Hutchinson S, McCarthy S, Quinn G. Wearable sensor and smartphone assisted vestibular physical therapy for multiple sclerosis: usability and outcomes. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1406926. [PMID: 39050817 PMCID: PMC11267627 DOI: 10.3389/fresc.2024.1406926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/05/2024] [Indexed: 07/27/2024]
Abstract
Introduction Vertigo, dizziness, gaze instability and disequilibrium are highly prevalent in people with MS (PwMS) and head movement induced dizziness is commonly reported. Vestibular physical therapy (VPT) is a specialised, non-invasive and effective therapy for these problems but usually involves travel for the person to a specialist center with both personal and carbon costs. The use of wearable sensors to track head movement and smartphone applications to deliver and track programs has potential to improve VPT in MS. Methods This study investigated the usability and effects of a commercially available digital VPT system (wearable head sensor, smartphone app and clinician software) to deliver VPT to PwMS. A pre/post treatment design was employed and the primary outcome was the System Usability Scale (SUS). Other patient reported outcomes were the Service User Acceptability Questionnaire (SUTAQ), the Patient Enablement Instrument (PEI) and the Dizziness Handicap Inventory (DHI). Physical outcomes measurements included Mini-BESTest (MB), Modified Dynamic Gait Index (mDGI), Gait Speed (GS), Dynamic Visual Acuity (DVA) and head kinematics and symptoms during exercise. Results Sixteen PwMS (14 female), mean age 44(±14) years were recruited to the study and twelve completed VPT. Mean adherence to exercise, measured digitally was 60% (±18.4). SUS scores were high at 81 (±14) and SUTAQ scores also demonstrated high levels of satisfaction and acceptability of the system. Statistically significant improvements in MB (mean change 2.25; p = 0.004), mDGI (median change 1.00; p = 0.008), DVA (median change -1.00; p = 0.004) were found. Head frequencies significantly improved with concurrent decreased intensity of dizziness during head movements (mean change across 4 gaze stabilization exercises was 23 beats per minute; p < 0.05). Non-significant improvements were seen in DHI (p = 0.07) and GS (p = 0.15). 64.5% of follow up visits were conducted remotely (video or phone), facilitated by the system. Discussion This study had two main outcomes and benefits for PwMS. Firstly, we showed that the system used was both acceptable and could be used by PwMS. Secondly, we demonstrated an improvement in a range of dizziness, balance and gait metrics with remotely delivered care. This system has the potential to positively impact on MS physiotherapy service provision with the potential to deliver effective remote care.
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Affiliation(s)
- D. Meldrum
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - H. Kearney
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- MS Unit, Department of Neurology, St. James’s Hospital, Dublin, Ireland
| | - S. Hutchinson
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- MS Unit, Department of Neurology, St. James’s Hospital, Dublin, Ireland
| | - S. McCarthy
- Physiotherapy Department, St. James’s Hospital, Dublin, Ireland
| | - G. Quinn
- Physiotherapy Department, St. James’s Hospital, Dublin, Ireland
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Mildner S, Hotz I, Kübler F, Rausch L, Stampfer-Kountchev M, Panzl J, Brenneis C, Seebacher B. Effects of activity-oriented physiotherapy with and without eye movement training on dynamic balance, functional mobility, and eye movements in patients with Parkinson's disease: An assessor-blinded randomised controlled pilot trial. PLoS One 2024; 19:e0304788. [PMID: 38875243 PMCID: PMC11178185 DOI: 10.1371/journal.pone.0304788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/16/2024] [Indexed: 06/16/2024] Open
Abstract
OBJECTIVES To describe changes in balance, walking speed, functional mobility, and eye movements following an activity-oriented physiotherapy (AOPT) or its combination with eye movement training (AOPT-E) in patients with Parkinson's disease (PD). To explore the feasibility of a full-scale randomised controlled trial (RCT). METHODS Using an assessor-blinded pilot RCT, 25 patients with PD were allocated to either AOPT or AOPT-E. Supervised interventions were performed 30 minutes, 4x/weekly, for 4 weeks, alongside inpatient rehabilitation. Outcomes were assessed at baseline and post-intervention, including dynamic balance, walking speed, functional and dual-task mobility, ability to safely balance, health-related quality of life (HRQoL), depression, and eye movements (number/duration of fixations) using a mobile eye tracker. Freezing of gait (FOG), and falls-related self-efficacy were assessed at baseline, post-intervention, and 4-week follow-up. Effect sizes of 0.10 were considered weak, 0.30 moderate, and ≥0.50 strong. Feasibility was assessed using predefined criteria: recruitment, retention and adherence rates, adverse events, falls, and post-intervention acceptability using qualitative interviews. RESULTS Improvements were observed in dynamic balance (effect size r = 0.216-0.427), walking speed (r = 0.165), functional and dual-task mobility (r = 0.306-0.413), ability to safely balance (r = 0.247), HRQoL (r = 0.024-0.650), and depression (r = 0.403). Falls-related self-efficacy (r = 0.621) and FOG (r = 0.248) showed varied improvements, partly sustained at follow-up. Eye movement improvements were observed after AOPT-E only. Feasibility analysis revealed that recruitment was below target, with less than two patients recruited per month due to COVID-19 restrictions. Feasibility targets were met, with a retention rate of 96% (95% confidence interval [CI]: 77.68-99.79) and a 98.18% (95% CI: 96.12-99.20) adherence rate, exceeding the targets of 80% and 75%, respectively. One adverse event unrelated to the study intervention confirmed intervention safety, and interview data indicated high intervention acceptability. CONCLUSIONS AOPT-E and AOPT appeared to be effective in patients with PD. Feasibility of a larger RCT was confirmed and is needed to validate results.
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Affiliation(s)
- Sarah Mildner
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Isabella Hotz
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Franziska Kübler
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Linda Rausch
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | | | - Johanna Panzl
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Christian Brenneis
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
- Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Münster, Austria
| | - Barbara Seebacher
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
- Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Münster, Austria
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Beratto L, Bressy L, Agostino S, Malandrone F, Brichetto G, Ponzano M. The effect of exercise on mental health and health-related quality of life in individuals with multiple sclerosis: A Systematic review and meta-analysis. Mult Scler Relat Disord 2024; 83:105473. [PMID: 38320418 DOI: 10.1016/j.msard.2024.105473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND A large body of evidence has tested the effect of exercise interventions on mental health and health-related quality of life (HRQoL) in individuals with multiple sclerosis (PwMS). OBJECTIVE To determine the effect of exercise interventions on mental health and HRQoL in PwMS. METHODS We searched four databases up to April 2023, and included randomized controlled trials that: 1) involved PwMS ≥18 years old; 2) delivered an exercise intervention; 3) measured subjective well-being, psychological well-being, social well-being, or HRQoL as outcomes. We reported standardized differences in means (d) with a 95 % confidence interval (CI), for continuous outcomes and an incidence rate ratio (IRR) with a 95 % CI for dichotomous outcomes. RESULTS Forty-nine studies (n = 2,057 participants) were included. Exercise improved overall well-being (d = 0.78; 95 % CI 0.483, 1.077; moderate certainty evidence), subjective well-being (d = 0.666; 95 % CI 0.405, 0.928; moderate certainty evidence), social well-being (d = 1.046; 95 % CI 0.569, 1.523; low certainty evidence), and HRQoL (d = 0.568; 95 % CI 0.396, 0.74; moderate certainty evidence). CONCLUSION Exercise interventions can improve well-being and HRQoL in PwMS. Future studies should focus on PwMS ≥ 65 years or with higher level of impairments.
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Affiliation(s)
- Luca Beratto
- Department of Medical Sciences, University of Turin, Italy; School of Exercise and Sport Science, University of Turin, Italy
| | - Lara Bressy
- School of Exercise and Sport Science, University of Turin, Italy
| | - Samuel Agostino
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | | | | | - Matteo Ponzano
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada; International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), The University of British Columbia, Vancouver, BC, Canada.
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Cano-Sánchez J, Aibar-Almazán A, Hita-Contreras F, Afanador-Restrepo DF, Martínez-Amat A, Achalandabaso-Ochoa A, Carcelén-Fraile MDC. Is Resistance Training an Option to Improve Functionality and Muscle Strength in Middle-Aged People with Multiple Sclerosis? A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1378. [PMID: 38592200 PMCID: PMC10932173 DOI: 10.3390/jcm13051378] [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: 12/13/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Currently, it is essential to adopt physical therapy strategies, such as resistance training, to enhance muscle strength and gait in middle-aged individuals (ages 45-65) suffering from Multiple Sclerosis. This is crucial in combating the typical symptoms of neurodegenerative diseases associated with functional loss. The objective of this study is to determine the effects of resistance training interventions on walking and muscle strength in middle-aged people with Multiple Sclerosis. Methods: A systematic review with meta-analysis was conducted by searching specific keywords in the PubMed, Scopus, Cochrane, and Web of Science databases. For inclusion, studies had to incorporate resistance training as a primary or significant component of the overall intervention for middle-aged patients with MS. Out of the 3675 articles identified, 12 randomized clinical trials met the criteria for inclusion in the review, with resistance training being a consistent feature in all of them. Results: Muscle strength and gait were evaluated as the main variables, with fatigue and the quality of life as secondary variables. This review reveals that resistance training significantly improves muscle strength. Resistance training achieves modest and non-significant improvements in gait. Notably, studies combining resistance training with motor control exercises achieve results of greater clinical significance in terms of gait. However, resistance training yields variable positive effects on perceived fatigue and the quality of life. Conclusion: Resistance training is useful for improving muscle strength; however, walking needs to be combined with motor control training.
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Affiliation(s)
- Javier Cano-Sánchez
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain (A.A.-O.)
| | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain (A.A.-O.)
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain (A.A.-O.)
| | | | - Antonio Martínez-Amat
- Faculty of Health Sciences and Sport, University Foundation of the Área Andina-Pereira, Pereira 660004, Colombia
| | | | - María del Carmen Carcelén-Fraile
- Department of Education and Psychology, Faculty of Social Sciences, University of Atlántico Medio, 35017 Las Palmas de Gran Canaria, Spain
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Karanfil E, Salci Y, Fil Balkan A, Tuncer A, Karabudak R. The acute effect of cervical mobilization on balance in patients with multiple sclerosis: a single-blind, randomized, controlled trial. Neurol Res 2024; 46:65-71. [PMID: 37724548 DOI: 10.1080/01616412.2023.2257455] [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: 04/05/2023] [Accepted: 06/10/2023] [Indexed: 09/21/2023]
Abstract
The cervical region plays an important role in providing proprioceptive and vestibular input to the postural control system. OBJECTIVE To investigate the effect of cervical mobilization on balance in multiple sclerosis (MS) patients. METHODS The study was undertaken at the neurological rehabilitation unit with 36 MS participants who were assigned randomly to the study (n = 18) and control group (n = 18). While the study group received a single session of 15 minutes of cervical and soft tissue mobilization, no intervention was applied to the control group to investigate the learning effect of the assessment. Patients were evaluated using Computerized Dynamic Posturography (CDP) (Sensory Organization Test (SOT), Limits of Stability (LoS), and Adaptation Test (ADT)), which reflects postural stability. RESULTS In the study group, a treatment effect was found on the vestibular ratio (VEST) score (p < 0.001) and the composite score of SOT (p = 0.002). Improvements were achieved in all parameters of the LoS and ADT in the study group. There was no statistically significant difference in terms of CDP results in the control group. CONCLUSION Cervical mobilization has beneficial effects on balance in MS patients. Our findings support that cervical mobilization can be included in MS balance rehabilitation programs.
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Affiliation(s)
- Ecem Karanfil
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yeliz Salci
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ayla Fil Balkan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Aslı Tuncer
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Rana Karabudak
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Wolf F, Nielsen J, Saliger J, Hennecken E, Kröber P, Eschweiler M, Folkerts AK, Karbe H, Zimmer P. Multimodal agility-based exercise training (MAT) versus strength and endurance training (SET) to improve multiple sclerosis-related fatigue and fatigability during inpatient rehabilitation: a randomized controlled pilot and feasibility study [ReFEx]. BMC Neurol 2023; 23:388. [PMID: 37898772 PMCID: PMC10612282 DOI: 10.1186/s12883-023-03436-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Multimodal agility-based exercise training (MAT) is a group-based exercise training framework for persons with multiple sclerosis (pwMS) with a potential to impact fatigue and fatigability. In a mixed-methods design, this study evaluated the feasibility of implementing MAT in an inpatient rehabilitation setting and the feasibility of a randomized controlled trial (RCT) study protocol with 'traditional' strength and endurance training (SET) as an active control condition. Secondarily, preliminary outcome data was acquired. METHODS PwMS with low to moderate disability and self-reported fatigue were randomly allocated to either MAT or SET when starting inpatient rehabilitation (4-6 weeks). The MAT-participants exercised in a group following a MAT-manual (sessions were gym- (5x/week) and pool-based (3x/week)). SET-participants exercised individually 5x/week on a cycle ergometer, and 3x/week on strength training machines. Feasibility assessments focused on processes, resources, management, time, and scientific domains. Assessed clinical outcomes at admission and discharge included perceived fatigue, motor and cognitive fatigability, cognitive performance, motor function, and balance confidence. Perceived fatigue was reassessed 1, 4, and 12 weeks after discharge. Feasibility was determined regarding predetermined progression criteria. RESULTS Twenty-two participants were randomized. Both groups performed the minimum number of sessions (> 18), and retention was adequate (73-91%). SET-participants performed more sessions than MAT-participants (30.8 vs. 22.7) and stayed longer in the facility (34.2 vs. 31.6 days). Non-eligibility of admitted pwMS was high (74% non-eligible), mainly due to high EDSS and inability to attend pool-based sessions. Consequently, recruitment (1.8/month) was slower than the predetermined progression criterium. Baseline assessments took longer than required (only 50% completed within 3 days). Short-term fatigue reduction was similar for both groups. Motor fatigability also improved in both groups, whereas cognitive fatigability deteriorated. In MAT, average improvement in walking endurance (43.9 m) exceeded minimal important change values for individuals (> 26.9 m). CONCLUSIONS Progressing to a definitive RCT necessitates adaptation of eligibility criteria. In the present design it will also be difficult to attain similar dosing of interventions. A multicenter RCT focused only on gym-based MAT might be another option to assess the effect of MAT. The primary outcome measure should be able to measure change in perceived fatigue more robustly. TRIAL REGISTRATION German Clinical Trials Register: DRKS00023943, date of registration: 23 September 2021.
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Affiliation(s)
- Florian Wolf
- Neurological Rehabilitation Center Godeshoehe GmbH, Bonn, Germany.
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany.
| | - Jörn Nielsen
- Neurological Rehabilitation Center Godeshoehe GmbH, Bonn, Germany
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jochen Saliger
- Neurological Rehabilitation Center Godeshoehe GmbH, Bonn, Germany
| | - Eva Hennecken
- Neurological Rehabilitation Center Godeshoehe GmbH, Bonn, Germany
| | - Philipp Kröber
- Neurological Rehabilitation Center Godeshoehe GmbH, Bonn, Germany
| | | | - Ann-Kristin Folkerts
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hans Karbe
- Neurological Rehabilitation Center Godeshoehe GmbH, Bonn, Germany
| | - Philipp Zimmer
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
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Gitman V, Moss K, Hodgson D. A systematic review and meta-analysis of the effects of non-pharmacological interventions on quality of life in adults with multiple sclerosis. Eur J Med Res 2023; 28:294. [PMID: 37608400 PMCID: PMC10463700 DOI: 10.1186/s40001-023-01185-5] [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: 06/10/2022] [Accepted: 06/22/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic debilitating disease that targets the central nervous system. Globally it is estimated that 2.8 million people live with MS (2018) and as there is no known cure; therefore, identifying methods to increase a patient's quality of life (QoL) is of considerable importance. Non-pharmacological interventions are a viable and effective option to increase QoL in patients with MS, however, to date, the literature lacks a complete systematic review of these interventions. METHODS A literature search was conducted for studies published up until March 4th 2022 in Scopus, Web of Science, CINAHL Plus, The Cochrane Library, Medline, and Embase. Studies were included if they were randomized control trials (RCTs) assessing a non-pharmacological intervention in adults with MS and measured QoL using the MSQOL-54, SF-36 or MSQLI tools for at least two time points. Quality assessment of each study was completed as well as a review of publication bias. Where possible, meta-analysis was conducted using a random effects model and for other studies a qualitative synthesis was presented. RESULTS Thirty studies were included in the meta-analysis and eleven studies were summarized qualitatively. The pooled effects across all non-pharmacological interventions showed a modest improvement in both the physical and mental components of QoL, with a standardized mean difference (SMD) of 0.44 (95% CI 0.26-0.61) and 0.42 (95% CI 0.24-0.60), respectively. Non-pharmacological interventions based around a physical activity were found to be particularly effective in improving both the physical composite score (PCS) and mental composite score (MCS), with an SMD of 0.40 (95% CI 0.14-0.66) and 0.31 (95% CI 0.08-0.55), respectively. Interventions incorporating balance exercises presented a significant advantageous solution for improving QoL, with an SMD of 1.71 (95% CI 1.22, 2.20) and 1.63(95% CI 1.15-2.12) for PCS and MCS respectively. CONCLUSIONS This systematic review and meta-analysis identified that non-pharmacological interventions can be an effective method of improving QoL in patients with MS, especially modalities with a physical activity component and balance interventions.
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Affiliation(s)
- Victor Gitman
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Kasey Moss
- Department of Medicine, McMaster University, Hamilton, Canada
| | - David Hodgson
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Brincks J, Dalgas U, Franzén E, Callesen J, Wallin A, Johansson S. Unwrapping the "black box" of balance training in people with multiple sclerosis - A descriptive systematic review of intervention components, progression, and intensity. Mult Scler Relat Disord 2023; 69:104412. [PMID: 36399965 DOI: 10.1016/j.msard.2022.104412] [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: 09/24/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Delineating the specific components of the existing balance training interventions in people with multiple sclerosis (PwMS) may contribute to a framework for future design and reporting of such interventions. Thus, we aimed to systematically synthesize how balance training frequency, intensity, time, type, duration, and progression are reported in balance training interventions for PwMS. METHODS A systematic literature search was conducted in Medline, Embase, Web of Science, and Cinahl. Search terms were MS, postural balance, walking, gait, and randomized/quasi-randomized controlled or clinical trials. Articles including ambulatory PwMS and interventions designed to challenge the balance control system were eligible. Two investigators screened, selected, and extracted data independently. Data on study characteristics such as design, population, and balance training content were extracted. Categorization of balance training based on balance control components was performed. RESULTS We included 40 studies grouped under five balance training categories. Balance interventions were well described regarding frequency, session time, and duration, but only two interventions described training intensity, and no systematic, gradual progression approach was reported for balance training adaptation over time. However, the balance training interventions included many sensory and motor components of the balance control system. Still, little focus was on reactive motor strategies, vestibular sense, and cognitive dual-tasking. CONCLUSIONS Existing balance training interventions in PwMS primarily consist of practicing sensory and motor strategies. Future balance training interventions are encouraged to systematically monitor individual advancements in balance training adaptations and to apply the progressive overload principle (i.e. continuous increase in balance exercise stimulus over time). Furthermore, we suggest that balance training in PwMS is performed with high intensity near an individual's balance capacity limits. Finally, individualized balance training is recommended to cover all relevant components of balance control using the proposed framework.
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Affiliation(s)
- John Brincks
- Faculty of Health Science, Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Hedeager 2, Aarhus N 8200, Denmark.
| | - Ulrik Dalgas
- Department of Public Health - Exercise Biology, Aarhus University, Dalgas Avenue 4, Aarhus 8000, Denmark
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Jacob Callesen
- Faculty of Health Science, Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Hedeager 2, Aarhus N 8200, Denmark
| | - Andreas Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Rehab Station Stockholm, Research and Development Unit, Solna, Sweden
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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10
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Mobility and balance rehabilitation in multiple sclerosis: A systematic review and dose-response meta-analysis. Mult Scler Relat Disord 2023; 69:104424. [PMID: 36473240 DOI: 10.1016/j.msard.2022.104424] [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: 07/11/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the benefits of neurological rehabilitation and the dose-response relationship for the treatment of mobility and balance in multiple sclerosis. METHODS We included studies investigating the effects of neurological rehabilitation on mobility and balance with the following eligibility criteria for inclusion: Population, People with Multiple Sclerosis (PwMS); Intervention, method of rehabilitation interventions; Comparison, experimental (specific balance intervention) vs control (no intervention/no specific balance intervention); Outcome, balance clinical scales; Study Design, randomised controlled trials. We conducted a random effects dose-response meta-analysis to assess linear trend estimations and a one stage linear mixed effects meta-regression for estimating dose-response curves. RESULTS We retrieved 196 studies from a list of 5020 for full text review and 71 studies (n subjects=3306) were included. One study was a cross-over and 70 studies were randomized controlled trials and the mean sample size per study was 46.5 ± 28.6 (mean±SD) with a mean age of 48.3 ± 7.8years, disease duration of 11.6 ± 6.1years, and EDSS of 4.4 ± 1.4points. Twenty-nine studies (40.8%) had the balance outcome as the primary outcome, while 42 studies (59.1%) had balance as secondary outcome or did not specify primary and secondary outcomes. Thirty-three trials (46.5%) had no active intervention as comparator and 38 trials (53.5%) had an active control group. Individual level data from 20 studies (n subjects=1016) were analyzed showing a medium pooled effect size for balance interventions (SMD=0.41; 95% CIs 0.22 to 0.59). Moreover, we analyzed 14 studies (n subjects=696) having balance as primary outcome and BBS as primary endpoint yielding a mean difference of 3.58 points (95% CIs 1.79 to 5.38, p<0.0001). Finally, we performed meta regression of the 20 studies showing an association between better outcome, log of intensity defined as minutes per session (β=1.26; SEβ=0.51; p = 0.02) and task-oriented intervention (β=0.38; SEβ=0.17; p = 0.05). CONCLUSION Our analyses provide level 1 evidence on the effect of balance intervention to improve mobility. Furthermore, according to principles of neurological rehabilitation, high intensity and task-specific interventions are associated with better treatment outcomes.
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11
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Gaemelke T, Frandsen JJ, Hvid LG, Dalgas U. Participant characteristics of existing exercise studies in persons with multiple sclerosis - A systematic review identifying literature gaps. Mult Scler Relat Disord 2022; 68:104198. [PMID: 36257149 DOI: 10.1016/j.msard.2022.104198] [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: 08/18/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Exercise is a cornerstone in rehabilitation of persons with multiple sclerosis (pwMS), which is known to elicit beneficial effects on various symptoms and to have a potential disease-modifying effect. However, it remains to be elucidated if the existing MS exercise literature covers the full age and disability span of pwMS. OBJECTIVE To systematically review MS exercise studies and provide a detailed mapping of the demographic and clinical characteristics of the included pwMS. METHODS A systematic review of MS exercise studies were performed using MEDLINE and EMBASE. From the resulting MS exercise studies, mean sample characteristics were extracted. RESULTS 4576 records were identified, from which 202 studies were included. Of these, 166 studies (82.2%) enrolled pwMS aged 35-54 years, 10.9% enrolled pwMS <35 years, and 6.9% enrolled pwMS ≥55 years (only 1.5% enrolled pwMS ≥60 years). A total of 118 studies (58.4%) reported Expanded Disability Status Scale (EDSS), with 88.1% of included pwMS having an EDSS between 2.0 and 6.5, while only one study enrolled pwMS with an EDSS ≥7.0. Finally, 80% of the studies included pwMS having a disease duration of 5-14.5 years. CONCLUSION Exercise studies in pwMS included primarily middle-aged (35-54 years) pwMS having an EDSS of 2.0-6.5 and a disease duration of 5-14.5 years. Few exercise studies were identified in young and older pwMS, in pwMS with mild disability and severe disability, and in pwMS having shorter or longer disease durations. These findings highlight the need for further investigation of exercise in these specific subgroups of pwMS as benefits of exercise might not generalize across subpopulations.
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Affiliation(s)
- Tobias Gaemelke
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark.
| | - Jens Jakob Frandsen
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
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12
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Wolf F, Eschweiler M, Rademacher A, Zimmer P. Multimodal Agility-Based Exercise Training for Persons With Multiple Sclerosis: A New Framework. Neurorehabil Neural Repair 2022; 36:777-787. [PMID: 36373854 DOI: 10.1177/15459683221131789] [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: 11/16/2022]
Abstract
INTRODUCTION Multimodal agility-based exercise training (MAT) has been described as a framework for fall prevention in the elderly but might also be a valuable concept for exercise training in persons with Multiple Sclerosis (pwMS). THE PROBLEM Current recommendations advise pwMS to perform a multitude of different exercise training activities, as each of these has its separate evidence. However, pwMS struggle even more than the general population to be physically active. Additionally, Multiple Sclerosis often leads to co-occurring mobility and cognitive dysfunctions, for which simultaneous, time-efficient, and engaging training approaches are still limited in clinical practice and healthcare. THE SOLUTION The MAT framework has been developed to integratively improve cardiovascular, neuromuscular, and cognitive function by combining aspects of perception and orientation, change of direction, as well as stop-and-go patterns (ie, agility), in a group-training format. For pwMS, the MAT framework is conceptualized to include 3 Components: standing balance, dynamic balance (including functional leg strength), and agility-based exercises. Within these Components sensory, cognitive, and cardiovascular challenges can be adapted to individual needs. RECOMMENDATIONS We recommend investigating multimodal exercise interventions that go beyond easily standardized, unimodal types of exercise (eg, aerobic or resistance exercise), which could allow for time-efficient training, targeting multiple frequent symptoms of persons with mild disability at once. MAT should be compared to unimodal approaches, regarding sensor-based gait outcomes, fatigue-related outcomes, cognition, as well as neuroprotective, and (supportive) disease-modifying effects.
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Affiliation(s)
- Florian Wolf
- Neurological Rehabilitation Center Godeshoehe, Bonn, Germany.,Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | | | - Annette Rademacher
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Philipp Zimmer
- Department for Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
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13
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Hebert JR, Filley CM. Multisensory integration and white matter pathology: Contributions to cognitive dysfunction. Front Neurol 2022; 13:1051538. [PMID: 36408503 PMCID: PMC9668060 DOI: 10.3389/fneur.2022.1051538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/18/2022] [Indexed: 11/23/2022] Open
Abstract
The ability to simultaneously process and integrate multiple sensory stimuli is paramount to effective daily function and essential for normal cognition. Multisensory management depends critically on the interplay between bottom-up and top-down processing of sensory information, with white matter (WM) tracts acting as the conduit between cortical and subcortical gray matter (GM) regions. White matter tracts and GM structures operate in concert to manage both multisensory signals and cognition. Altered sensory processing leads to difficulties in reweighting and modulating multisensory input during various routine environmental challenges, and thus contributes to cognitive dysfunction. To examine the specific role of WM in altered sensory processing and cognitive dysfunction, this review focuses on two neurologic disorders with diffuse WM pathology, multiple sclerosis and mild traumatic brain injury, in which persistently altered sensory processing and cognitive impairment are common. In these disorders, cognitive dysfunction in association with altered sensory processing may develop initially from slowed signaling in WM tracts and, in some cases, GM pathology secondary to WM disruption, but also because of interference with cognitive function by the added burden of managing concurrent multimodal primary sensory signals. These insights promise to inform research in the neuroimaging, clinical assessment, and treatment of WM disorders, and the investigation of WM-behavior relationships.
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Affiliation(s)
- Jeffrey R. Hebert
- Physical Performance Laboratory, Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, CO, United States
| | - Christopher M. Filley
- Behavorial Neurology Section, Department of Neurology and Psychiatry, Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, CO, United States
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14
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Loyd BJ, Fangman A, Peterson DS, Gappmaier E, Thackeray A, Schubert MC, Dibble LE. Rehabilitation to Improve Gaze and Postural Stability in People With Multiple Sclerosis: A Randomized Clinical Trial. Neurorehabil Neural Repair 2022; 36:678-688. [PMID: 36113117 PMCID: PMC10518217 DOI: 10.1177/15459683221124126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND People with multiple sclerosis (PwMS) frequently experience dizziness and imbalance that may be caused by central vestibular system dysfunction. Vestibular rehabilitation may offer an approach for improving dysfunction in these people. OBJECTIVE To test the efficacy of a gaze and postural stability (GPS) retraining intervention compared to a strength and endurance (SAE) intervention in PwMS. METHODS About 41 PwMS, with complaints of dizziness or history of falls, were randomized to either the GPS or SAE groups. Following randomization participants completed 6-weeks of 3×/week progressive training, delivered one-on-one by a provider. Following intervention, testing was performed at the primary (6-weeks) and secondary time point (10-weeks). A restricted maximum likelihood estimation mixed effects model was used to examine changes in the primary outcome of the Dizziness Handicap Inventory (DHI) between the 2 groups at the primary and secondary time point. Similar models were used to explore secondary outcomes between groups at both timepoints. RESULTS Thirty-five people completed the study (17 GPS; 18 SAE). The change in the DHI at the primary time point was not statistically different between the GPS and SAE groups (mean difference = 2.33 [95% CI -9.18, 12.85]). However, both groups demonstrated significant improvement from baseline to 6-weeks (GPS -8.73; SAE -7.31). Similar results were observed for secondary outcomes and at the secondary timepoint. CONCLUSIONS In this sample of PwMS with complaints of dizziness or imbalance, 6-weeks of GPS training did not result in significantly greater improvements in dizziness handicap or balance compared to 6-weeks of SAE training.
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Affiliation(s)
- Brian J. Loyd
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
| | - Annie Fangman
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | | | - Eduard Gappmaier
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | - Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | - Michael C. Schubert
- Department of Otolaryngology-Head and Neck Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leland E. Dibble
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
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15
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Warutkar V, Gulrandhe P, Morghade S, Krishna Kovela R, Qureshi MI. Physiotherapy for Multiple Sclerosis Patients From Early to Transition Phase: A Scoping Review. Cureus 2022; 14:e30779. [DOI: 10.7759/cureus.30779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
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16
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Wolf F, Nielsen J, Saliger J, Hennecken E, Eschweiler M, Folkerts AK, Karbe H, Zimmer P. Randomised controlled pilot and feasibility study of multimodal agility-based exercise training (MAT) versus strength and endurance training (SET) to improve multiple sclerosis-related fatigue and fatigability during inpatient rehabilitation (ReFEx): study protocol. BMJ Open 2022; 12:e062160. [PMID: 36357342 PMCID: PMC9454066 DOI: 10.1136/bmjopen-2022-062160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/14/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Subjective fatigue and objectively assessed fatigability are common symptoms in persons with multiple sclerosis (pwMS). Recent work has suggested a positive effect of balance and motor control training (BMCT) in reducing fatigue. It is unclear whether this effect can also be attained during inpatient rehabilitation. Multimodal agility-based exercise training (MAT) has been developed as a framework that incorporates BMCT with added agility components but has not been applied to pwMS. Therefore, this study will evaluate the feasibility of a randomised controlled trial comparing MAT against strength and endurance training (SET) for the improvement of MS-related fatigue and fatigability in a German neurological rehabilitation centre. METHODS AND ANALYSIS A total of 24 pwMS (Expanded Disability Status Scale ≤5.0, Fatigue Scale for Motor and Cognitive Functions ≥53) will be randomly assigned to either SET or land and water-based MAT for 4-6 weeks during inpatient rehabilitation. Assessments of subjective fatigue, motor and cognitive fatigability, cognitive and cardiorespiratory performance, and balance confidence will be performed at admission and discharge. Subjective fatigue will also be assessed at 1, 4 and 12 weeks after discharge. Feasibility outcomes will include patients' acceptance of study procedures and interventions, recruitment rate, retention rate, time needed to complete baseline assessments, intervention adherence and fidelity. All quantitative outcomes will be reported descriptively. A total of 12 pwMS (6 per group) will be interviewed to gain insights into participants' experiences during study participation. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of the University of Bonn (reference number: 543/20). Dissemination of findings is planned via peer-reviewed journals, conferences and media releases. TRIAL REGISTRATION NUMBER DRKS00023943.
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Affiliation(s)
- Florian Wolf
- Neurological Rehabilitation Centre Godeshoehe, Bonn, Germany
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Jörn Nielsen
- Neurological Rehabilitation Centre Godeshoehe, Bonn, Germany
- Department of Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Jochen Saliger
- Neurological Rehabilitation Centre Godeshoehe, Bonn, Germany
| | - Eva Hennecken
- Neurological Rehabilitation Centre Godeshoehe, Bonn, Germany
| | - Mareike Eschweiler
- Neurological Rehabilitation Centre Godeshoehe, Bonn, Germany
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Ann-Kristin Folkerts
- Department of Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Hans Karbe
- Neurological Rehabilitation Centre Godeshoehe, Bonn, Germany
| | - Philipp Zimmer
- Division of Performance and Health (Sports Medicine), Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
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17
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Zhang S, Liu D, Tian E, Wang J, Guo Z, Kong W. Central vestibular dysfunction: don't forget vestibular rehabilitation. Expert Rev Neurother 2022; 22:669-680. [PMID: 35912850 DOI: 10.1080/14737175.2022.2106129] [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: 11/04/2022]
Abstract
INTRODUCTION Vestibular rehabilitation (VR) is now a subject of active studies and has been shown to be effective for multiple vestibular disorders, peripheral or central. VR is a physical therapy that helps train the central nervous system to compensate for vestibular dysfunction. There is moderate to strong evidence that VR is safe and effective for the management of peripheral vestibular dysfunction. Nonetheless, the studies on how VR works on central vestibular dysfunction remains scanty. AREAS COVERED This article addressed the rehabilitation strategies and possible mechanisms, including how central vestibular function might improve upon rehabilitation. In addition, it provides some examples concerning the effect of VR on central vestibular dysfunction. EXPERT OPINION VR works on the vestibular system through repetition of specific physical exercises that activate central neuroplastic mechanisms to achieve adaptive compensation of the impaired functions. VR has become a mainstay in the management of patients with dizziness and balance dysfunction. Individualized VR programs are a safe and effective treatment option for a large percentage of patients with central vestibular disease reporting imbalance and dizziness. Exploration of various treatment strategies and possible mechanisms will help develop the best and personalized VR treatment for patients with central vestibular dysfunction.
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Affiliation(s)
- Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Zhaoqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Key Laboratory of Neurological Disorders of Education Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
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18
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Harrison AM, Safari R, Mercer T, Picariello F, van der Linden ML, White C, Moss-Morris R, Norton S. Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis. Mult Scler 2021; 27:1657-1678. [PMID: 33876986 PMCID: PMC8474304 DOI: 10.1177/1352458521996002] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Fatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment. OBJECTIVE The aim of this systematic review with network meta-analyses was to estimate the relative effectiveness of both fatigue-targeted and non-targeted exercise, behavioural and combined (behavioural and exercise) interventions. METHODS Nine electronic databases up to August 2018 were searched, and 113 trials (n = 6909) were included: 34 were fatigue-targeted and 79 non-fatigue-targeted trials. Intervention characteristics were extracted using the Template for Intervention Description and Replication guidelines. Certainty of evidence was assessed using GRADE. RESULTS Pairwise meta-analyses showed that exercise interventions demonstrated moderate to large effects across subtypes regardless of treatment target, with the largest effect for balance exercise (SMD = 0.84). Cognitive behavioural therapies (CBTs) showed moderate to large effects (SMD = 0.60), with fatigue-targeted treatments showing larger effects than those targeting distress. Network meta-analysis showed that balance exercise performed significantly better compared to other exercise and behavioural intervention subtypes, except CBT. CBT was estimated to be superior to energy conservation and other behavioural interventions. Combined exercise also had a moderate to large effect. CONCLUSION Treatment recommendations for balance and combined exercise are tentative as the certainty of the evidence was moderate. The certainty of the evidence for CBT was high.
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Affiliation(s)
- Anthony M Harrison
- Department of Clinical and Health Psychology,
Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Reza Safari
- Health and Social Care Research Centre, College
of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - Tom Mercer
- Centre for Health, Activity and Rehabilitation
Research, Queen Margaret University, Edinburgh, UK
| | - Federica Picariello
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
| | | | - Claire White
- School of Population Health & Environmental
Sciences, Faculty of Life Sciences & Medicine, King’s College London,
London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
| | - Sam Norton
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
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19
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Torres-Costoso A, Martínez-Vizcaíno V, Reina-Gutiérrez S, Álvarez-Bueno C, Guzmán-Pavón MJ, Pozuelo-Carrascosa DP, Fernández-Rodríguez R, Sanchez-López M, Cavero-Redondo I. Effect of Exercise on Fatigue in Multiple Sclerosis: A Network Meta-analysis Comparing Different Types of Exercise. Arch Phys Med Rehabil 2021; 103:970-987.e18. [PMID: 34509464 DOI: 10.1016/j.apmr.2021.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/28/2021] [Accepted: 08/11/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE A network meta-analysis (NMA) of current evidence was conducted to determine if physical exercise has a positive influence on multiple sclerosis (MS) fatigue and type of exercise with the largest effect on fatigue also according to disease severity. DATA SOURCES MEDLINE, Embase, SPORTDiscus, Physiotherapy Evidence Database, Cochrane Library, and Web of Science. The search strategy combined relevant terms related to (1) MS; (2) clinical trials; (3) exercise; and (4) fatigue from inception to February 2021. STUDY SELECTION Randomized controlled trials concerning the effectiveness of different types of exercise on total and physical fatigue in people with MS were included. DATA EXTRACTION The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0), and the Grading of Recommendations, Assessment, Development, and Evaluation tool was used to evaluate the quality of the evidence. DATA SYNTHESIS A total of 58 studies were examined. Data were pooled using a random-effects model. A ranking of 7 and 8 different exercise interventions for physical and total fatigue scores, respectively, was achieved. The highest effects for pairwise comparisons were for combined exercise and resistance training vs control (ranging between -0.74 and -1.24). In the NMA, combined exercise (-1.51; 95% confidence interval [CI], -2.01 to -1.01) and resistance training (-1.15; 95% CI, -1.81 to -0.49) compared with the control group achieved the highest effects for physical and total fatigue, respectively. CONCLUSIONS Exercise should be considered an effective fatigue management strategy. Among the different exercise modalities, combined exercise is the most effective exercise modality for improving both physical and total fatigue. Resistance training is also an effective exercise for total fatigue among people diagnosed with MS.
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Affiliation(s)
- Ana Torres-Costoso
- Universidad de Castilla-La Mancha, Facultad de Fisioterapia y Enfermería, Toledo, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile.
| | - Sara Reina-Gutiérrez
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, Facultad de Enfermería de Cuenca, Cuenca, Spain; Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | | | - Diana P Pozuelo-Carrascosa
- Universidad de Castilla-La Mancha, Facultad de Fisioterapia y Enfermería, Toledo, Spain; Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha. Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Campus de Fábrica de Armas, Toledo, Spain
| | | | - Mairena Sanchez-López
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, School of Education, Ciudad Real, Spain
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, Facultad de Enfermería de Cuenca, Cuenca, Spain; Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Santiago, Chile
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20
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Cochrane GD, Christy JB, Motl RW. Central Vestibular Functions Correlate With Fatigue and Walking Capacity in People With Multiple Sclerosis. Phys Ther 2021; 101:pzab168. [PMID: 34174079 PMCID: PMC8485732 DOI: 10.1093/ptj/pzab168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/07/2021] [Accepted: 05/11/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Imbalance and fatigue are among the most common and disabling symptoms of multiple sclerosis (MS). Vestibular rehabilitation studies demonstrate not only improvements in balance but fatigue also, suggesting a relationship between central vestibular integration and fatigue. The objective of this study was to determine whether the relationship between balance and fatigue in people with MS is seen between other measures of central vestibular integration and fatigue and to understand how central vestibular integration measures interrelate. METHODS This cross-sectional study consisted of 40 people with MS (age = 27-55 years, Expanded Disability Severity Scale score = 1.0-6.5) who completed vestibular ocular reflex testing, subjective visual vertical testing, static posturography, dynamic gait, 2 self-report fatigue surveys, and a 6-Minute Walk Test to assess walking capacity/physical fatigue was completed. Spearman correlations were calculated between variables. RESULTS Measures of central vestibular integration were significantly correlated with measures of fatigue and walking capacity and with each other. The correlations between physical fatigue and central vestibular functions were larger than self-reported fatigue correlations with central vestibular functions. CONCLUSION The relationship between balance and fatigue extends to other measures requiring central vestibular integration, suggesting a deficit in central vestibular processing in people with MS. These measures may compliment balance assessment as outcome measures for vestibular rehabilitation in people with MS. Fatigue measures should be included in vestibular rehabilitation as secondary outcomes. IMPACT Correlations between central vestibular integration and fatigue in people with MS suggest that future studies of vestibular rehabilitation should include fatigue, as a secondary outcome measure as vestibular function and fatigue may share similar a similar etiology in people with MS.
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Affiliation(s)
- Graham D Cochrane
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Medical Scientist Training Program, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer B Christy
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert W Motl
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Characterizing gaze and postural stability deficits in people with multiple sclerosis. Mult Scler Relat Disord 2021; 55:103205. [PMID: 34438218 DOI: 10.1016/j.msard.2021.103205] [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: 03/24/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND People with Multiple Sclerosis (PwMS) experience a wide range of symptoms that can alter function and limit activity and community participation. Symptoms including sensory changes, weakness, fatigue and others have been well documented. However, symptoms related to changes in vestibular related function, including gaze and postural stability have not been fully explored. While some recent studies have begun to provide insight into these deficits in PwMS and have explored the use of rehabilitation paradigms for their management, much remains unknown about the full extent of these deficits. Therefore, this study aimed to characterize the presence of gaze and postural stability deficits in measures across the World Health Organization International Classification of Functioning, Disability, and Health (WHO ICF) and to examine how deficits in domains of body structure and function and activity contribute to participation level limitations. METHODS Baseline data from 41 PwMS (mean(SD) age = 53.9(11.2), 78% female) enrolled as part of a randomized clinical trial were used in this analysis. Measures of gaze and postural stability from the ICF domains of body structure and function (Vestibular ocular reflex [VOR] gain and postural sway area), activity (computerized dynamic visual acuity [cDVA] and MiniBEST test), and participation (Dizziness handicap inventory [DHI] and Activities Balance Confidence [ABC] scale) along with demographic data were used to characterize the sample. To explore relationships between ICF domains for gaze and postural stability, univariate correlations were performed between measures from each domain using Pearson's correlations. Separate multivariate regression models examined how measures from the body structure and function and activity domains contributed to the variance in the participation level outcomes. Variance explained by the models was quantified using R-squared statistic and contribution of the independent variables were quantified using the beta coefficient (p < 0.05). RESULTS Correlation analysis demonstrated significant relationships in the postural stability measures across domains. Specifically, between postural sway area on a firm surface and MiniBEST test score (r = -.48;p < 0.01) and MiniBEST test score and ABC score (r = 0.5;p < 0.01). Significant correlations were also found between the gaze stability measures of horizontal and vertical VOR gain (r = .68;p < 0.001), horizontal VOR gain and dynamic visual acuity (r = .38;p = 0.02), and vertical VOR gain and dynamic visual acuity (r = .54;p < 0.001). Regression models assessing postural stability, found that only the MiniBEST score significantly contributed to the variance in ABC score (p = 0.01) and the full model explained 34% of the variance in ABC score. Regression modeling of gaze stability outcomes did not produce any variable that significantly contributed to the variance in DHI score and the full model explained 18% of the variance in DHI score. CONCLUSIONS PwMS in this sample demonstrated deficits in gaze and postural stability across the domains of the WHO ICF compared to past samples of PwMS and healthy cohorts. Correlation between measures in the different domains were present, but no strong relationship between measures of body structure and function, activity and participation level outcomes were observed. This lack of relationship across the domains is likely contributed to the relatively small sample size, the high level of variability observed in the outcomes, and the diverse presentation often seen in PwMS.
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22
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Lotfi Y, Farahani A, Azimiyan M, Moossavi A, Bakhshi E. Comparison of efficacy of vestibular rehabilitation and noisy galvanic vestibular stimulation to improve dizziness and balance in patients with multiple sclerosis. J Vestib Res 2021; 31:541-551. [PMID: 33967075 DOI: 10.3233/ves-201609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dizziness and imbalance are common symptoms in patients with multiple sclerosis (PwMS), and rehabilitation interventions varying greatly in effectiveness. OBJECTIVE To compare the effectiveness of vestibular rehabilitation therapy (VRT) and noisy galvanic vestibular stimulation (nGVS) on dizziness and balance in PwMS. METHODS This was a single-blind, randomized controlled trial. Twenty-four PwMS were randomly divided into groups of VRT, nGVS, and Control. The VRT and the nGVS groups underwent the intervention program. The patients were assessed with the composite score in anteroposterior and lateral directions (CS AP and LAT) obtained by sensory organization test (SOT), Dizziness Handicap Inventory (DHI), and Activities-Specific Balance Confidence Scale (ABC). RESULTS The VRT group showed greater improvements in CS AP and LAT, DHI total score, and ABC total score compared with the nGVS group and the control group. No significant difference was found between the nGVS group and the control group. These results were approximately stable at the 4-week follow-up. CONCLUSIONS These findings provided evidence for effectiveness of the VRT in improvement of dizziness and balance in PwMS. These improvements were not associated with the nGVS. Further studies are needed to assess the effectiveness of the nGVS on dizziness and balance in PwMS.
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Affiliation(s)
- Yones Lotfi
- Department of Audiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Akram Farahani
- Department of Audiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mojtaba Azimiyan
- Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Abdollah Moossavi
- Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Enayatollah Bakhshi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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23
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Postural stability is a valid and meaningful disability metric in progressive MS with potential for use in neuroprotective therapy trials. Mult Scler Relat Disord 2021; 52:102946. [PMID: 33901968 DOI: 10.1016/j.msard.2021.102946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Balance impairment is observed in up to 70% of people with MS (pwMS) and worsens with disease progression. Posturography using a force platform is the current gold standard in the measurement of balance. However, posturography has not been adequately studied or widely accepted for use as a disability outcome measure for pwMS. Importantly, the recent emergence of both successful and failed neuroprotective therapy trials in progressive MS has emphasised the need for new disability outcome measures for people with progressive MS. The main objectives of this study were to evaluate the clinical validity, reliability and feasibility of posturography as a disability metric in progressive MS. METHODS This was a prospective cross-sectional study. We recruited 73 people with progressive MS (age 18-65 years, EDSS 3.5-6.0). Participants stood in the centre of a force platform, feet comfortably apart, under various conditions: (i) eyes open (EO), (ii) eyes closed (EC) - a single task, each lasting ninety seconds; and simultaneous EO with a cognitive test: (iii) N-Back, a three-minute test whereby participants were instructed to click the mouse when two identical letters were displayed consecutively on a screen, (iv) Sustained Attention Response Task, a five-minute test whereby participants were instructed to click the mouse for every number "1″ to "9″ except "3″ - i.e., dual-tasks. Additionally, we performed a battery of validated physical and cognitive outcome measures. Posturographic data was processed using Matlab. Statistical analysis was performed using SPSS version 26. We used multiple linear regression modelling to determine whether significant univariate correlations between posturography and clinical metrics were independent of covariates that may influence the associations seen. A two-tailed significance level of 0.05 was used. RESULTS Of 73 participants, mean age 52.4 (8.5) years, mean MS disease duration 13.8 (10.3) years, median EDSS 5.0 (IQR 4.0-6.0), 44 (60.4%) were female. EO-Path-Length independently predicted upper extremity function (9-Hole-Peg-Test) with a larger effect size (adjusted R2=20.0%, p = 0.001) than that for walking measures (Timed 25-Foot Walk, adjusted R2=1.6%, p = 0.01; Two-Minute Walk Test, adjusted R2=7.2%, p = 0.002), while controlling for age, disease duration, height, weight, and sex. The addition of EO-Mediolateral-Displacement to the MS Functional Composite (MSFC) created a four-component z-score that increased the variance explained for quality of life (QOL) by 62.1%. Postural stability was significantly lower with mediolateral vs anteroposterior direction of sway, removal of vision, increased body weight, male sex, and fampridine use. Postural stability improved during dual-tasks compared to EO single task. Posturography detected significant worsening of balance over a single prolonged stance. CONCLUSION Postural stability independently predicted a wide range of clinical metrics including upper extremity function, walking ability, cognition and QOL, therefore establishing construct and concurrent validity as a disability outcome measure for people with progressive MS. Additionally, posturography is a quantitative, non-invasive, quick-and-easy-to-administer, and highly sensitive device, demonstrating its high feasibility for use as a time- and resource-efficient disability metric in neuroprotective therapy trials for progressive MS.
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Abstract
PURPOSE OF REVIEW In the last three decades, the use of eye movements and vestibular testing in many neurological disorders has accelerated, primarily because of practical technologic developments. Although the acute vestibular syndrome is a prime example of this progress, more chronic neurologic and systemic disorders have received less attention. We focus here on recent contributions relating vestibular and ocular motor abnormalities in inflammatory, demyelinating, metabolic, and peripheral nervous system disorders RECENT FINDINGS: Vestibular abnormalities have been identified in acute demyelinating neuropathies (AIDP), in novel genetic mutations responsible for CANVAS (cerebellar ataxia, neuropathy vestibular areflexia syndrome), and in other inherited neuropathies (variants of Charcot-Marie-Tooth disease). In addition, there are differentiating characteristics between the most common CNS demyelinating disorders: multiple sclerosis and neuromyelitis optica (NMO). We summarize new information on Vitamin D metabolism in benign paroxysmal positional vertigo (BPPV), followed by a brief review of the vestibular and ocular motor findings in Wernicke's encephalopathy. We conclude with findings in several paraneoplastic/autoimmune disorders. SUMMARY This literature review highlights the impact of a careful vestibular and ocular motor evaluation in common neurologic disorder, not only for the initial diagnosis but also for monitoring disease and rehabilitation. A careful examination of eye movements and vestibular function, supplemented with new video techniques to quantify the findings, should be part of the standard neurologic examination.
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25
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Efficacy of Vestibular Rehabilitation in Patients With Neurologic Disorders: A Systematic Review. Arch Phys Med Rehabil 2020; 102:1379-1389. [PMID: 33383031 DOI: 10.1016/j.apmr.2020.11.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this systematic review is to critically assess the effectiveness of vestibular rehabilitation (VR) administered either alone or in combination with other neurorehabilitation strategies in patients with neurologic disorders. DATA SOURCES An electronic search was conducted by 2 independent reviewers in the following databases: MEDLINE (PubMed), the Physiotherapy Evidence Database, and the Cochrane Database of Systematic Reviews. STUDY SELECTION All clinical studies carried out on adult patients with a diagnosis of neurologic disorders who performed VR provided alone or in combination with other therapies were included. DATA EXTRACTION Screening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers. Included studies were quality appraised using a modified version of the Newcastle-Ottawa Scale. DATA SYNTHESIS The summary of results was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Twelve studies were included in the review. All the included studies, with 1 exception, report that improvements provided by customized VR in subject affected by a central nervous system diseases are greater than traditional rehabilitation programs alone. CONCLUSIONS Because of the lack of high-quality studies and heterogeneity of treatments protocols, clinical practice recommendations on the efficacy of VR cannot be made. Results show that VR programs are safe and could easily be implemented with standard neurorehabilitation protocols in patients affected by neurologic disorders. Hence, more high-quality randomized controlled trials of VR in patients with neurologic disorders are needed.
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26
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Seddighi-Khavidak M, Tahan N, Akbarzadeh-Baghban A. Comparing the effects of vestibular rehabilitation with and without lavender oil scents as an olfactory stimulus on balance, fear of falling down and activities of daily living of people with multiple sclerosis: a randomized clinical trial. Disabil Rehabil 2020; 44:3132-3138. [PMID: 33305625 DOI: 10.1080/09638288.2020.1858352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the effect of using lavender oil as an olfactory stimulus with vestibular rehabilitation (VR) on balance, fear of falling down, and activities of daily living of people with multiple sclerosis. METHODS Forty participants were randomly assigned into experimental and control groups. The experimental group did the VR exercises while smelling the lavender oil scents. The control group did the VR exercises without it. Both groups did the exercises in ten 45-min sessions. We assessed the participants with the timed up and go (TUG) test, Berg balance scale (BBS), fall efficacy scale - international (FES-I), and the 29-item multiple sclerosis impact scale (MSIS-29). We did the tests at the baseline and after the last exercise session. RESULTS The experimental group performed significantly better in the BBS (p = 0.007), TUG (p = 0.045), and FES-I (p = 0.016) tests as well as in the MSIS-29's psychological subscale (p = 0.034) than did the control group. CONCLUSIONS Using lavender oil as olfactory stimulus while doing the VR exercises can improve balance and reduce fear of falling down compared to doing the VR exercises without it in people with multiple sclerosis.Implications for rehabilitationIt seems that using lavender oil, as an olfactory stimulus, while doing vestibular rehabilitation exercises can improve balance and reduce fear of falling down in people with multiple sclerosis compared to doing the vestibular rehabilitation exercises without it.This treatment significantly alleviates the psychological effects of multiple sclerosis on daily life such as sleeping problems, feeling unwell, anxious, tense, depressed, etc.
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Affiliation(s)
- Maryam Seddighi-Khavidak
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nahid Tahan
- Department of Physiotherapy, Loghman Hakim Hospital, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh-Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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27
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Marsden J, Pavlou M, Dennett R, Gibbon A, Knight-Lozano R, Jeu L, Flavell C, Freeman J, Bamiou DE, Harris C, Hawton A, Goodwin E, Jones B, Creanor S. Vestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with booklet based vestibular rehabilitation for vestibulopathy and a 12 month observational cohort study of the symptom reduction and recurrence rate following treatment for benign paroxysmal positional vertigo. BMC Neurol 2020; 20:430. [PMID: 33243182 PMCID: PMC7694922 DOI: 10.1186/s12883-020-01983-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/28/2020] [Indexed: 01/21/2023] Open
Abstract
Background Symptoms arising from vestibular system dysfunction are observed in 49–59% of people with Multiple Sclerosis (MS). Symptoms may include vertigo, dizziness and/or imbalance. These impact on functional ability, contribute to falls and significant health and social care costs. In people with MS, vestibular dysfunction can be due to peripheral pathology that may include Benign Paroxysmal Positional Vertigo (BPPV), as well as central or combined pathology. Vestibular symptoms may be treated with vestibular rehabilitation (VR), and with repositioning manoeuvres in the case of BPPV. However, there is a paucity of evidence about the rate and degree of symptom recovery with VR for people with MS and vestibulopathy. In addition, given the multiplicity of symptoms and underpinning vestibular pathologies often seen in people with MS, a customised VR approach may be more clinically appropriate and cost effective than generic booklet-based approaches. Likewise, BPPV should be identified and treated appropriately. Methods/ design People with MS and symptoms of vertigo, dizziness and/or imbalance will be screened for central and/or peripheral vestibulopathy and/or BPPV. Following consent, people with BPPV will be treated with re-positioning manoeuvres over 1–3 sessions and followed up at 6 and 12 months to assess for any re-occurrence of BPPV. People with central and/or peripheral vestibulopathy will be entered into a randomised controlled trial (RCT). Trial participants will be randomly allocated (1:1) to either a 12-week generic booklet-based home programme with telephone support or a 12-week VR programme consisting of customised treatment including 12 face-to-face sessions and a home exercise programme. Customised or booklet-based interventions will start 2 weeks after randomisation and all trial participants will be followed up 14 and 26 weeks from randomisation. The primary clinical outcome is the Dizziness Handicap Inventory at 26 weeks and the primary economic endpoint is quality-adjusted life-years. A range of secondary outcomes associated with vestibular function will be used. Discussion If customised VR is demonstrated to be clinically and cost-effective compared to generic booklet-based VR this will inform practice guidelines and the development of training packages for therapists in the diagnosis and treatment of vestibulopathy in people with MS. Trial registration ISRCTN Number: 27374299 Date of Registration 24/09/2018 Protocol Version 15 25/09/2019 Supplementary Information The online version contains supplementary material available at 10.1186/s12883-020-01983-y.
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Affiliation(s)
- J Marsden
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK.
| | - M Pavlou
- Academic Department of Physiotherapy, King's College London, Room 3.5 Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - R Dennett
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - A Gibbon
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - R Knight-Lozano
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - L Jeu
- Academic Department of Physiotherapy, King's College London, Room 3.5 Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - C Flavell
- Academic Department of Physiotherapy, King's College London, Room 3.5 Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - J Freeman
- School of Health Professions, Faculty of Health: Medicine, Dentistry and Human Science, Peninsula Allied Health Centre, Derriford Rd, Derriford, Plymouth, PL6 8BH, UK
| | - D E Bamiou
- EAR Institute University College London, 332 Gray's Inn Rd, London, WC1X 8EE, UK
| | - C Harris
- Royal Eye Infirmary, Derriford Hospital, Plymouth, PL6 8DH, UK.,School of Psychology, University of Plymouth, Drakes Circus, Plymouth, PL4 8AA, UK
| | - A Hawton
- Health Economics Group, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - E Goodwin
- Health Economics Group, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - B Jones
- Medical Statistics Group and Peninsula Clinical Trials Unit, Faculty of Health: Medicine, Dentistry and Human Science, Plymouth Science Park, 1 Davy Rd, Derriford, Plymouth, PL6 8BX, UK
| | - S Creanor
- Medical Statistics Group and Peninsula Clinical Trials Unit, Faculty of Health: Medicine, Dentistry and Human Science, Plymouth Science Park, 1 Davy Rd, Derriford, Plymouth, PL6 8BX, UK
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28
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Drebinger D, Rasche L, Kroneberg D, Althoff P, Bellmann-Strobl J, Weygandt M, Paul F, Brandt AU, Schmitz-Hübsch T. Association Between Fatigue and Motor Exertion in Patients With Multiple Sclerosis-a Prospective Study. Front Neurol 2020; 11:208. [PMID: 32351439 PMCID: PMC7174662 DOI: 10.3389/fneur.2020.00208] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/09/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Fatigue in multiple sclerosis (MS) is conceived as a multidimensional construct. Objectives: This study aims to describe the changes of balance and gait parameters after 6 min of walking (6 MW) as potential quantitative markers for perceptions of state fatigue and trait fatigue in MS. Methods: A total of 19 patients with MS (17 with fatigue) and 24 healthy subjects underwent static posturography, gait analysis, and ratings of perceived exertion before and after 6 MW. Results: 6 MW was perceived as exhaustive, but both groups featured more dynamic comfortable speed walking after 6 MW. Shorter stride length at maximum speed and increased postural sway after 6 MW indicated fatigability of balance and gait in MS group only. While most changes were related to higher levels of perceived exertion after 6 MW (state fatigue), higher fatigue ratings (trait fatigue) were only associated with less increase in arm swing at comfortable speed. Further analysis revealed different associations of trait fatigue and performance fatigability with disability and motor functions. Performance fatigability was most closely related to the Expanded Disability Status Scale, while for trait fatigue, the strongest correlations were seen with balance function and handgrip strength. Conclusions: Fatigability of performance was closely related to perceptions of exertion after 6 MW (state fatigue) and disability in MS but distinct from fatigue ratings, conceived as trait fatigue. Our study identified postural sway, arm swing during gait, and hand grip strength as unexpected potential motor indicators of fatigue ratings in MS.
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Affiliation(s)
- Daniel Drebinger
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ludwig Rasche
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Park Clinic Weissensee, Berlin, Germany
| | - Daniel Kroneberg
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Patrik Althoff
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Weygandt
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Tanja Schmitz-Hübsch
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
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29
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Effectiveness of Vestibular Training for Balance and Dizziness Rehabilitation in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9020590. [PMID: 32098162 PMCID: PMC7074243 DOI: 10.3390/jcm9020590] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/08/2020] [Accepted: 02/08/2020] [Indexed: 12/30/2022] Open
Abstract
Postural instability and dizziness are commonly observed in people with multiple sclerosis (PwMS). The aim of this systematic review was to evaluate the evidence for the use of vestibular rehabilitation, in comparison with other exercise interventions or no intervention, to treat balance impairments and dizziness in PwMS. An electronic search was conducted by two independent reviewers in the following databases: MEDLINE (Pubmed), Scopus, the Physiotherapy Evidence Database (PEDro), Web of Science (WOS), Lilacs, CINHAL and the Cochrane Database of Systematic Reviews (CDSR). A quality assessment was performed using the PEDro scale and the Cochrane Risk of Bias Tool. When possible, the data were pooled in a meta-analysis (95%CI). This systematic review followed the PRISMA guideline statement and was registered in the PROSPERO database (CRD42019134230). Seven studies were included, with a total of 321 participants analysed. Compared with no intervention, vestibular rehabilitation was more effective for balance development (SMD = 2.12; 95% CI = 0.49, 3.75; p = 0.01; I2 = 89%) and dizziness symptoms improvement (SMD = −17.43; 95% CI = −29.99, −4.87; p= 0.007; I2= 66%). Compared with other exercise interventions, improvements in favour of the experimental group were observed, but statistical significance for the differences between groups was not reached.
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30
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Capone F, Capone G, Motolese F, Voci A, Caminiti ML, Musumeci G, Di Lazzaro V. Spinal cord dysfunction contributes to balance impairment in multiple sclerosis patients. Clin Neurol Neurosurg 2019; 184:105451. [DOI: 10.1016/j.clineuro.2019.105451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/01/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
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31
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Moss-Morris R, Harrison AM, Safari R, Norton S, van der Linden ML, Picariello F, Thomas S, White C, Mercer T. Which behavioural and exercise interventions targeting fatigue show the most promise in multiple sclerosis? A systematic review with narrative synthesis and meta-analysis. Behav Res Ther 2019; 137:103464. [PMID: 31780252 DOI: 10.1016/j.brat.2019.103464] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 01/12/2023]
Abstract
Fatigue is a common and highly debilitating symptom of multiple sclerosis (MS). This meta-analytic systematic review with detailed narrative synthesis examined randomised-controlled (RCTs) and controlled trials of behavioural and exercise interventions targeting fatigue in adults with MS to assess which treatments offer the most promise in reducing fatigue severity/impact. Medline, EMBASE and PsycInfo electronic databases, amongst others, were searched through to August 2018. Thirty-four trials (12 exercise, 16 behavioural and 6 combined; n = 2,434 participants) met inclusion criteria. Data from 31 studies (n = 1,991 participants) contributed to the meta-analysis. Risk of bias (using the Cochrane tool) and study quality (GRADE) were assessed. The pooled (SMD) end-of-treatment effects on self-reported fatigue were: exercise interventions (n = 13) -.84 (95% CI -1.20 to -.47); behavioural interventions (n = 16) -.37 (95% CI -.53 to -.22); combined interventions (n = 5) -.16 (95% CI: -.36 to .04). Heterogeneity was high overall. Study quality was very low for exercise interventions and moderate for behavioural and combined interventions. Considering health care professional time, subgroup results suggest web-based cognitive behavioural therapy for fatigue, balance and/or multicomponent exercise interventions may be the cost-efficient therapies. These need testing in large RCTs with long-term follow-up to help define an implementable fatigue management pathway in MS.
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Affiliation(s)
- Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, 5th Floor Bermondsey Wing, Guy's Campus, King's College London, SE1 9RT, UK.
| | - Anthony M Harrison
- Clinical Psychology Training Programme, Institute of Health Sciences, University of Leeds, School of Medicine, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Reza Safari
- Health and Social Care Research Centre, University of Derby, Kedleston Road, Derby, DE22 1GB, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, 5th Floor Bermondsey Wing, Guy's Campus, King's College London, SE1 9RT, UK
| | - Marietta L van der Linden
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU, UK
| | - Federica Picariello
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, 5th Floor Bermondsey Wing, Guy's Campus, King's College London, SE1 9RT, UK
| | - Sarah Thomas
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Christchurch Road, Bournemouth, Dorset, BH1 3LT, UK
| | - Claire White
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, SE1 1UL, UK
| | - Tom Mercer
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU, UK
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Callesen J, Cattaneo D, Brincks J, Kjeldgaard Jørgensen ML, Dalgas U. How do resistance training and balance and motor control training affect gait performance and fatigue impact in people with multiple sclerosis? A randomized controlled multi-center study. Mult Scler 2019; 26:1420-1432. [DOI: 10.1177/1352458519865740] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Despite a shared purpose of improving functional capacity, the principles of progressive resistance training (PRT) and balance and motor control training (BMCT) are fundamentally different. Objectives: To investigate the effects of PRT and BMCT on gait performance and fatigue impact in people with multiple sclerosis (PwMS). Methods: A multi-center, single-blinded, cluster-randomized controlled trial with two intervention groups (PRT and BMCT) and a control group (CON). The interventions lasted 10 weeks. A total of 71 participants with impaired mobility (Timed 25-Foot Walk (T25FW) > 5 seconds or Six Spot Step Test (SSST) > 8 seconds) were enrolled. Primary outcomes were the T25FW and the SSST. Fatigue impact, self-perceived gait function, 6-minute walk, balance, and muscle strength were secondary outcomes. Results: In total, 83% completed the study. The primary comparisons showed that BMCT, but not PRT, improved T25FW, SSST, and self-perceived gait function when compared to CON. Secondary comparisons showed that BMCT improved SSST more than PRT, while T25FW did not differ. Both BMCT and PRT reduced the fatigue impact. Finally, the effect of BMCT was superior to PRT on dynamic balance, while PRT was superior to BMCT on knee extensor muscle strength. Conclusion: BMCT, but not PRT, was superior to CON in improving gait performance, while both BMCT and PRT reduced fatigue.
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Affiliation(s)
- Jacob Callesen
- Department of Rehabilitation and Health Promotion Research, Faculty of Health Science, VIA University College, Aarhus N, Denmark/ Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - John Brincks
- Department of Rehabilitation and Health Promotion Research, Faculty of Health Science, VIA University College, Aarhus N, Denmark
| | | | - Ulrik Dalgas
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
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Loyd BJ, Fangman A, Peterson DS, Gappmaier E, Schubert MC, Thackery A, Dibble L. Rehabilitation to improve gaze and postural stability in people with multiple sclerosis: study protocol for a prospective randomized clinical trial. BMC Neurol 2019; 19:119. [PMID: 31179920 PMCID: PMC6556952 DOI: 10.1186/s12883-019-1353-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/31/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of vestibular rehabilitation principles in the management of gaze and postural stability impairments in people with multiple sclerosis (PwMS) has shown promise in pilot work completed in our lab and in a recently published randomized clinical trial (RCT). However, further work is needed to fully quantify the gaze and postural impairments present in people with multiple sclerosis and how they respond to rehabilitation. METHODS/DESIGN The study is a single blind RCT designed to examine the benefit of a gaze and postural stability (GPS) intervention program compared to a standard of care (SOC) rehabilitation program in dizzy and balance impaired PwMS. Outcomes will be collected across the domains of body structure and function, activity, and participation as classified by the World Health Organization International Classification of Functioning, Disability, and Health (ICF). Our primary outcomes are the Dizziness Handicap Inventory (DHI) and the Functional Gait Assessment (FGA). Secondary outcomes include other measures of gaze and postural stability, fatigue, and functional mobility. Participants who are interested and eligible for enrollment will be consented prior to completing a baseline assessment. Following the baseline assessment each participant will be randomized to either the GPS or SOC intervention group and will complete a 6 week treatment period. During the treatment period, both groups will participate in guided exercise 3x/week. Following the treatment period participants will be asked to return for a post-treatment evaluation and again for a follow-up assessment 1 month later. We anticipate enrolling 50 participants. DISCUSSION This study will be an innovative RCT that will utilize gaze and postural stability metrics to assess the efficacy of vestibular rehabilitation in PwMS. It will build on previous work by examining measures across the ICF and improve the current evidence base for treating PwMS. TRIAL REGISTRATION ClinicalTrials.gov, May 29th 2018, NCT03521557 .
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Affiliation(s)
- Brian J. Loyd
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, 520 Wakara Way, Salt Lake City, UT 84108 USA
| | - Annie Fangman
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, 520 Wakara Way, Salt Lake City, UT 84108 USA
| | - Daniel S. Peterson
- Arizona State University, College of Health Solutions, 550 N. 3rd Street, Phoenix, AZ 85004-0698 USA
- Phoenix VA Health Care System, 650 Indian School Rd., Phoenix, AZ 85012 USA
| | - Eduard Gappmaier
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, 520 Wakara Way, Salt Lake City, UT 84108 USA
| | - Michael C. Schubert
- Department of Otolaryngology Head and Neck Surgery, John Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287 USA
| | - Anne Thackery
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, 520 Wakara Way, Salt Lake City, UT 84108 USA
| | - Lee Dibble
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, 520 Wakara Way, Salt Lake City, UT 84108 USA
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Rezaee Z, Dutta A. Cerebellar Lobules Optimal Stimulation (CLOS): A Computational Pipeline to Optimize Cerebellar Lobule-Specific Electric Field Distribution. Front Neurosci 2019; 13:266. [PMID: 31031578 PMCID: PMC6473058 DOI: 10.3389/fnins.2019.00266] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 03/06/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Cerebellar transcranial direct current stimulation (ctDCS) is challenging due to the complexity of the cerebellar structure which is reflected by the well-known variability in ctDCS effects. Therefore, our objective is to present a freely available computational modeling pipeline for cerebellar lobules' optimal stimulation (CLOS). METHODS CLOS can optimize lobule-specific electric field distribution following finite element analysis (FEA) using freely available computational modeling pipelines. We modeled published ctDCS montages with 5 cm × 5 cm anode placed 3 cm lateral to inion, and the same sized cathode was placed on the: (1) contralateral supra-orbital area (called Manto montage), and (2) buccinators muscle (called Celnik montage). Also, a published (3) 4×1 HD-ctDCS electrode montage was modeled. We also investigated the effects of the subject-specific head model versus Colin 27 average head model on lobule-specific electric field distribution. Three-way analysis of variance (ANOVA) was used to determine the effects of lobules, montage, and head model on the electric field distribution. The differences in lobule-specific electric field distribution across different freely available computational pipelines were also evaluated using subject-specific head model. We also presented an application of our computational pipeline to optimize a ctDCS electrode montage to deliver peak electric field at the cerebellar lobules VII-IX related to ankle function. RESULTS Eta-squared effect size after three-way ANOVA for electric field strength was 0.05 for lobule, 0.00 for montage, 0.04 for the head model, 0.01 for lobule∗montage interaction, 0.01 for lobule∗ head model interaction, and 0.00 for montage∗head model interaction. The electric field strength of both the Celnik and the Manto montages affected the lobules Crus I/II, VIIb, VIII, and IX of the targeted cerebellar hemisphere where Manto montage had a spillover to the contralateral cerebellar hemisphere. The 4×1 HD-ctDCS montage primarily affected the lobules Crus I/II of the targeted cerebellar hemisphere. All three published ctDCS montages were found to be not optimal for ankle function (lobules VII-IX), so we presented a novel HD-ctDCS electrode montage. DISCUSSION Our freely available CLOS pipeline can be leveraged to optimize electromagnetic stimulation to target cerebellar lobules related to different cognitive and motor functions.
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Affiliation(s)
- Zeynab Rezaee
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
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Tramontano M, Martino Cinnera A, Manzari L, Tozzi FF, Caltagirone C, Morone G, Pompa A, Grasso MG. Vestibular rehabilitation has positive effects on balance, fatigue and activities of daily living in highly disabled multiple sclerosis people: A preliminary randomized controlled trial. Restor Neurol Neurosci 2019; 36:709-718. [PMID: 30412513 DOI: 10.3233/rnn-180850] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Balance disorders are present in patients with Multiple Sclerosis and part of these disorders could be of vestibular origin. Vestibular Rehabilitation was found to be effective in improving balance in patients with central vestibular dysfunction. OBJECTIVE To investigate the clinical effects of vestibular rehabilitation on balance skills and secondly on fatigue and activity of daily living in highly disabled multiple sclerosis people. METHODS Thirty hospitalized participants with severe multiple sclerosis (EDSS 6-7) were randomly assigned to the experimental group (15 patients -9F-; mean age 50.64±11.73) and the control group (15 patients -8F-; mean age 45.77±10.91). All patients were evaluated before and after treatment with the Expanded Disability Status Scale, Barthel Index Tinetti Balance and Gait scale, Berg Balance Scale, Fatigue Severity Scale, Two Minute Walking Test and Timed 25-foot walk test. Two follow-ups (i.e., at 30 and 60 days after treatment) were carried out with Barthel Index. RESULTS Significant improvement was found in the experimental group with respect to the control group (p < 0,05) in balance, fatigue perception, activities of daily living and short distance gait. No significant improvements were found for gait endurance as measured by Two Minute Walking Test. CONCLUSIONS Four weeks of Vestibular Rehabilitation training results in less fatigue, improved balance and performance of the activities of daily living in patients with severe Multiple Sclerosis.
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Affiliation(s)
- Marco Tramontano
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia (Scientific Institute for Research and Health Care), Rome, Italy
| | | | | | - Federico Francesco Tozzi
- IRCCS Santa Lucia Foundation, Rome, Italy.,Physiotherapy Degree, Tor Vergata University, Rome, Italy
| | - Carlo Caltagirone
- IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia (Scientific Institute for Research and Health Care), Rome, Italy
| | - Alessandra Pompa
- Multiple Sclerosis Unit, IRCCS Santa Lucia Foundation, Rome, Italy
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Vestibular rehabilitation: advances in peripheral and central vestibular disorders. Curr Opin Neurol 2019; 32:137-144. [DOI: 10.1097/wco.0000000000000632] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Bennett S, Leavitt VM. An intervention to improve balance in persons with multiple sclerosis. Neurology 2018; 90:403-404. [PMID: 29386278 DOI: 10.1212/wnl.0000000000005038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Susan Bennett
- From Rehabilitation Science Department (S.B.), University at Buffalo; and Multiple Sclerosis Cognitive Neuroscience Laboratory (V.M.L.), Department of Neurology, Columbia University Medical Center, New York, NY.
| | - Victoria M Leavitt
- From Rehabilitation Science Department (S.B.), University at Buffalo; and Multiple Sclerosis Cognitive Neuroscience Laboratory (V.M.L.), Department of Neurology, Columbia University Medical Center, New York, NY
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