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Hagen AC, Acosta JS, Swanson CW, Fling BW. Interhemispheric inhibition and gait adaptation associations in people with multiple sclerosis. Exp Brain Res 2024; 242:1761-1772. [PMID: 38822825 DOI: 10.1007/s00221-024-06860-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/20/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Multiple sclerosis is a neurodegenerative disease that damages the myelin sheath within the central nervous system. Axonal demyelination, particularly in the corpus callosum, impacts communication between the brain's hemispheres in persons with multiple sclerosis (PwMS). Changes in interhemispheric communication may impair gait coordination which is modulated by communication across the corpus callosum to excite and inhibit specific muscle groups. To further evaluate the functional role of interhemispheric communication in gait and mobility, this study assessed the ipsilateral silent period (iSP), an indirect marker of interhemispheric inhibition and how it relates to gait adaptation in PwMS. METHODS Using transcranial magnetic stimulation (TMS), we assessed interhemispheric inhibition differences between the more affected and less affected hemisphere in the primary motor cortices in 29 PwMS. In addition, these same PwMS underwent a split-belt treadmill walking paradigm, with the faster paced belt moving under their more affected limb. Step length asymmetry (SLA) was the primary outcome measure used to assess gait adaptability during split-belt treadmill walking. We hypothesized that PwMS would exhibit differences in iSP inhibitory metrics between the more affected and less affected hemispheres and that increased interhemispheric inhibition would be associated with greater gait adaptability in PwMS. RESULTS No statistically significant differences in interhemispheric inhibition or conduction time were found between the more affected and less affected hemisphere. Furthermore, SLA aftereffect was negatively correlated with both average percent depth of silent period (dSP%AVE) (r = -0.40, p = 0.07) and max percent depth of silent period (dSP%MAX) r = -0.40, p = 0.07), indicating that reduced interhemispheric inhibition was associated with greater gait adaptability in PwMS. CONCLUSION The lack of differences between the more affected and less affected hemisphere indicates that PwMS have similar interhemispheric inhibitory capacity irrespective of the more affected hemisphere. Additionally, we identified a moderate correlation between reduced interhemispheric inhibition and greater gait adaptability. These findings may indicate that interhemispheric inhibition may in part influence responsiveness to motor adaptation paradigms and the need for further research evaluating the neural mechanisms underlying the relationship between interhemispheric inhibition and motor adaptability.
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Affiliation(s)
- Andrew C Hagen
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, 80523, USA
| | - Jordan S Acosta
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, 80523, USA
| | - Clayton W Swanson
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, 80523, USA.
- Molecular, Cellular, & Integrative Neuroscience Program, Colorado State University, Fort Collins, CO, USA.
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Daroszewski P, Kaczmarek K, Huber J. Monitoring of the pharmacological treatment availability in patients with multiple sclerosis in the Greater Poland population. Reumatologia 2024; 61:473-480. [PMID: 38322107 PMCID: PMC10839914 DOI: 10.5114/reum/177143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/16/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction There is no clear explanation for the availability of multiple sclerosis (MS) pharmacological treatment for patients in Greater Poland and it can be assumed that the same reason is common in most of the developed countries in the United Europe. As an autoimmune disease MS can overlap with other diseases especially rheumatic disease (RD) as well as some feature of RD may mimic MS, such as MS-like syndrome in the course of primary Sjögren's syndrome. Therefore proper diagnosis and sufficient treatment of MS is important not only for neurologists but also for other clinicians including rheumatologists.The study aims to provide insights that could help healthcare managers create more effective logistical guidelines to improve the timely initiation of pharmacological treatment for MS. Materials and methods The analysis of the treatment of MS patients has been conducted on a group of 500 patients who were under the management of one healthcare center in Greater Poland. Results The results point to the different factors influencing the delay in the undertaking the pharmacological treatment, among others the age of the patient, waiting time for clinical evaluation and the final diagnosis from first symptoms to diagnosis, and the patient's waiting time from diagnosis to referral for qualification for treatment. Conclusions The outcomes of this study have the potential to serve as a valuable resource for healthcare managers. The study's findings could be used as a foundation for developing logistical guidelines aimed at enhancing the pharmacological treatment of MS patients.Furthermore, the study suggests that the reasons behind treatment delays in MS patients might be prevalent in many countries across the United Europe region. However, it's important to note that confirming this conclusion requires additional comparative studies.
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Affiliation(s)
- Przemysław Daroszewski
- Department of Organization and Management in Health Care, University of Medical Sciences, Poznan, Poland
| | - Katarzyna Kaczmarek
- Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, Poznan, Poland
| | - Juliusz Huber
- Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, Poznan, Poland
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Chhabra S, Mehan S, Khan Z, Gupta GD, Narula AS. Matrine mediated neuroprotective potential in experimental multiple sclerosis: Evidence from CSF, blood markers, brain samples and in-silico investigations. J Neuroimmunol 2023; 384:578200. [PMID: 37774554 DOI: 10.1016/j.jneuroim.2023.578200] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
Multiple sclerosis (MS) is a debilitating, inflammatory, and demyelinating disease of the central nervous system influenced by environmental and genetic factors. Around 2.8 million people worldwide are affected by MS due to its challenging diagnosis and treatment. Our study investigates the role of the JAK/STAT and PPAR-gamma signaling pathways in the progression of multiple sclerosis. Inflammation and demyelination can be caused by dysregulation of these pathways. Modulating the STAT-3, mTOR, and PPAR-gamma signaling pathways may offer therapeutic potential for multiple sclerosis. Matrine (40 and 80 mg/kg, i.p.), a quinolizidine alkaloid derived from Sophora flavescens, has been investigated for its therapeutic potential in our laboratory. Matrine has been studied for its neuroprotective effect in neurodegenerative diseases. It inhibits inflammatory responses and promotes regeneration of damaged myelin sheaths, indicating its potential efficacy in treating multiple sclerosis. Matrine exerts its neuroprotective effect by inhibiting STAT-3 and mTOR and promoting PPAR-gamma expression.GW9662, a PPAR-gamma antagonist (2 mg/kg, i.p.), was administered to evaluate the involvement of PPAR-gamma and to compare the efficacy of matrine's potential neuroprotective effect. Matrine's interaction with the STAT-3, mTOR, and PPAR-gamma pathways in multiple Sclerosis was also validated and confirmed through insilico investigation. In addition, matrine altered the CBC profile, intensifying the clinical presentation of multiple sclerosis. In addition, we evaluated the diagnostic potential of various biological samples, including CSF, blood plasma, and brain homogenates (striatum, cortex, hippocampus, and midbrain). These samples were used to evaluate the neurochemical changes caused by neurobehavioral alterations during the progression of multiple sclerosis. These results indicate that matrine treatment ameliorated multiple sclerosis and that the mechanism underlying these effects may be closely related to the modulation of the STAT-3/mTOR/PPAR-gamma signaling pathway.
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Affiliation(s)
- Swesha Chhabra
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
| | - Sidharth Mehan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India.
| | - Zuber Khan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
| | | | - Acharan S Narula
- Narula Research, LLC, 107 Boulder Bluff, Chapel Hill, NC 27516, USA
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Jaatela J, Aydogan DB, Nurmi T, Vallinoja J, Mäenpää H, Piitulainen H. Limb-specific thalamocortical tracts are impaired differently in hemiplegic and diplegic subtypes of cerebral palsy. Cereb Cortex 2023; 33:10245-10257. [PMID: 37595205 PMCID: PMC10545439 DOI: 10.1093/cercor/bhad279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 08/20/2023] Open
Abstract
Thalamocortical pathways are considered crucial in the sensorimotor functioning of children with cerebral palsy (CP). However, previous research has been limited by non-specific tractography seeding and the lack of comparison between different CP subtypes. We compared limb-specific thalamocortical tracts between children with hemiplegic (HP, N = 15) or diplegic (DP, N = 10) CP and typically developed peers (N = 19). The cortical seed-points for the upper and lower extremities were selected (i) manually based on anatomical landmarks or (ii) using functional magnetic resonance imaging (fMRI) activations following proprioceptive-limb stimulation. Correlations were investigated between tract structure (mean diffusivity, MD; fractional anisotropy, FA; apparent fiber density, AFD) and sensorimotor performance (hand skill and postural stability). Compared to controls, our results revealed increased MD in both upper and lower limb thalamocortical tracts in the non-dominant hemisphere in HP and bilaterally in DP subgroup. MD was strongly lateralized in participants with hemiplegia, while AFD seemed lateralized only in controls. fMRI-based tractography results were comparable. The correlation analysis indicated an association between the white matter structure and sensorimotor performance. These findings suggest distinct impairment of functionally relevant thalamocortical pathways in HP and DP subtypes. Thus, the organization of thalamocortical white matter tracts may offer valuable guidance for targeted, life-long rehabilitation in children with CP.
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Affiliation(s)
- Julia Jaatela
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, FI-02150 Espoo, Finland
| | - Dogu Baran Aydogan
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, FI-02150 Espoo, Finland
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland
| | - Timo Nurmi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, FI-02150 Espoo, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, FI-40014 Jyväskylä, Finland
| | - Jaakko Vallinoja
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, FI-02150 Espoo, Finland
| | - Helena Mäenpää
- Pediatric Neurology, New Children’s Hospital, Helsinki University Hospital, FI-00029 Helsinki, Finland
| | - Harri Piitulainen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, FI-02150 Espoo, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, FI-40014 Jyväskylä, Finland
- Pediatric Neurology, New Children’s Hospital, Helsinki University Hospital, FI-00029 Helsinki, Finland
- Aalto NeuroImaging, Aalto University, FI-02150 Espoo, Finland
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Swanson CW, Fling BW. Links between Neuroanatomy and Neurophysiology with Turning Performance in People with Multiple Sclerosis. SENSORS (BASEL, SWITZERLAND) 2023; 23:7629. [PMID: 37688084 PMCID: PMC10490793 DOI: 10.3390/s23177629] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/14/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
Multiple sclerosis is accompanied by decreased mobility and various adaptations affecting neural structure and function. Therefore, the purpose of this project was to understand how motor cortex thickness and corticospinal excitation and inhibition contribute to turning performance in healthy controls and people with multiple sclerosis. In total, 49 participants (23 controls, 26 multiple sclerosis) were included in the final analysis of this study. All participants were instructed to complete a series of turns while wearing wireless inertial sensors. Motor cortex gray matter thickness was measured via magnetic resonance imaging. Corticospinal excitation and inhibition were assessed via transcranial magnetic stimulation and electromyography place on the tibialis anterior muscles bilaterally. People with multiple sclerosis demonstrated reduced turning performance for a variety of turning variables. Further, we observed significant cortical thinning of the motor cortex in the multiple sclerosis group. People with multiple sclerosis demonstrated no significant reductions in excitatory neurotransmission, whereas a reduction in inhibitory activity was observed. Significant correlations were primarily observed in the multiple sclerosis group, demonstrating lateralization to the left hemisphere. The results showed that both cortical thickness and inhibitory activity were associated with turning performance in people with multiple sclerosis and may indicate that people with multiple sclerosis rely on different neural resources to perform dynamic movements typically associated with fall risk.
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Affiliation(s)
- Clayton W. Swanson
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA;
- Department of Neurology, University of Florida, Gainesville, FL 32608, USA
| | - Brett W. Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80521, USA
- Molecular, Cellular, and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO 80521, USA
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Özkan E, Özler C, Akar K, Youssef H, Özmen K, Şen ZD, Vural A, Gürsoy-Özdemir Y. Individual-based predominance of visual input in multisensorial integration for balance is correlated with proprioceptive drift in rubber hand illusion. Sci Rep 2023; 13:11905. [PMID: 37488214 PMCID: PMC10366093 DOI: 10.1038/s41598-023-39253-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/22/2023] [Indexed: 07/26/2023] Open
Abstract
Rubber hand illusion (RHI) is a traditional task that examines multisensory integration. The visual capture of tactile stimulus given to the seen rubber hand was considered to predominate the sensory processing and interfere with the bottom-up proprioceptive and tactile inputs received from the unseen real hand that results in mislocalization of participants hand towards rubber hand, namely proprioceptive drift (PD). Another task that requires multisensorial integration and shows a predominance of visual input is the maintenance of body posture. However, if the predominance of visual input in one task is generalizable to another task is yet to be elucidated. We aimed to examine if individual dependency on visual inputs in multisensorial integration in balance correlated with PD in RHI. Twenty healthy participants were recruited for the study and completed the RHI task. The contribution of visual inputs to the static body balance was measured with the instrumented clinical test of sensory interaction for balance and indexed with Romberg Quotient (RQ). We found a moderate positive correlation between PD and RQ. Individuals with more dependence on visual information in maintaining body posture had higher PD in RHI. Our results indicate that there can be an individual-based dependence on particular domains of sensory input preserved during different tasks of multisensorial integration. Future studies must clarify whether this tendency relates to certain physical or physiological traits.
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Affiliation(s)
- Esra Özkan
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey.
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey.
| | - Ceyda Özler
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey
| | - Kardelen Akar
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey
| | - Hussein Youssef
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey
| | - Kaan Özmen
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey
| | - Zümrüt Duygu Şen
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health, DZP, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
| | - Atay Vural
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey
| | - Yasemin Gürsoy-Özdemir
- Koç University Research Center for Translational Medicine, Koç University Hospital, Zeytinburnu, 34010, Istanbul, Turkey
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey
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Hagen AC, Acosta JS, Geltser CS, Fling BW. Split-Belt Treadmill Adaptation Improves Spatial and Temporal Gait Symmetry in People with Multiple Sclerosis. SENSORS (BASEL, SWITZERLAND) 2023; 23:5456. [PMID: 37420623 DOI: 10.3390/s23125456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023]
Abstract
Multiple sclerosis (MS) is a neurodegenerative disease characterized by degradation of the myelin sheath resulting in impaired neural communication throughout the body. As a result, most people with MS (PwMS) experience gait asymmetries between their legs leading to an increased risk of falls. Recent work indicates that split-belt treadmill adaptation, where the speed of each leg is controlled independently, can decrease gait asymmetries for other neurodegenerative impairments. The purpose of this study was to test the efficacy of split-belt treadmill training to improve gait symmetry in PwMS. In this study, 35 PwMS underwent a 10 min split-belt treadmill adaptation paradigm, with the faster paced belt moving under the more affected limb. Step length asymmetry (SLA) and phase coordination index (PCI) were the primary outcome measures used to assess spatial and temporal gait symmetries, respectively. It was predicted that participants with a worse baseline symmetry would have a greater response to split-belt treadmill adaptation. Following this adaptation paradigm, PwMS experienced aftereffects that improved gait symmetry, with a significant difference between predicted responders and nonresponders in both SLA and PCI change (p < 0.001). Additionally, there was no correlation between SLA and PCI change. These findings suggest that PwMS retain the ability for gait adaptation, with those most asymmetrical at baseline demonstrating the greatest improvement, and that there may be separate neural mechanisms for spatial and temporal locomotor adjustments.
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Affiliation(s)
- Andrew C Hagen
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA
| | - Jordan S Acosta
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA
| | - Chaia S Geltser
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA
- Molecular, Cellular and Integrative Neurosciences Program, Colorado State University, Fort Collins, CO 80523, USA
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8
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Whittier TT, Patrick CM, Fling BW. Somatosensory Information in Skilled Motor Performance: A Narrative Review. J Mot Behav 2023; 55:453-474. [PMID: 37245865 DOI: 10.1080/00222895.2023.2213198] [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: 10/25/2022] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/30/2023]
Abstract
Historically, research aimed at improving motor performance has largely focused on the neural processes involved in motor execution due to their role in muscle activation. However, accompanying somatosensory and proprioceptive sensory information is also vitally involved in performing motor skills. Here we review research from interdisciplinary fields to provide a description for how somatosensation informs the successful performance of motor skills as well as emphasize the need for careful selection of study methods to isolate the neural processes involved in somatosensory perception. We also discuss upcoming strategies of intervention that have been used to improve performance via somatosensory targets. We believe that a greater appreciation for somatosensation's role in motor learning and control will enable researchers and practitioners to develop and apply methods for the enhancement of human performance that will benefit clinical, healthy, and elite populations alike.
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Affiliation(s)
- Tyler T Whittier
- Sensorimotor Neuroimaging Laboratory, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Christopher M Patrick
- Sensorimotor Neuroimaging Laboratory, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
- Molecular, Cellular and Integrative Neurosciences Program, Colorado State University, Fort Collins, CO, USA
| | - Brett W Fling
- Sensorimotor Neuroimaging Laboratory, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
- Molecular, Cellular and Integrative Neurosciences Program, Colorado State University, Fort Collins, CO, USA
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Courter RJ, Alvarez E, Enoka RM, Ahmed AA. Metabolic costs of walking and arm reaching in persons with mild multiple sclerosis. J Neurophysiol 2023; 129:819-832. [PMID: 36883754 PMCID: PMC10085565 DOI: 10.1152/jn.00373.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
Movement slowness is a common and disruptive symptom of multiple sclerosis (MS). A potential cause is that individuals with MS slow down to conserve energy as a behavioral adjustment to heightened metabolic costs of movement. To investigate this prospect, we measured the metabolic costs of both walking and seated arm reaching at five speeds in persons with mild MS (pwMS; n = 13; 46.0 ± 7.7 yr) and sex- and age-matched controls (HCs; n = 13; 45.8 ± 7.8 yr). Notably, the cohort of pwMS was highly mobile and no individuals required a cane or aid when walking. We found that the net metabolic power of walking was approximately 20% higher for pwMS across all speeds (P = 0.0185). In contrast, we found no differences in the gross power of reaching between pwMS and HCs (P = 0.492). Collectively, our results suggest that abnormal slowness of movement in MS-particularly reaching-is not the consequence of heightened effort costs and that other sensorimotor mechanisms are playing a considerable role in slowing.NEW & NOTEWORTHY Individuals with multiple sclerosis (MS) often move more slowly than those without the disease. A possible cause is that movements in MS are more energetically expensive and slowing is an adaptation to conserve metabolic resources. Here, we find that while walking is more costly for persons with MS, arm-reaching movements are not. These results bring into question the driving force of movement slowness in MS and implicate other motor-related networks contributing to slowing.
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Affiliation(s)
- Robert J Courter
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, United States
- Department of Mechanical Engineering, University of Colorado, Colorado, Boulder, United States
| | - Enrique Alvarez
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Roger M Enoka
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, United States
| | - Alaa A Ahmed
- Department of Mechanical Engineering, University of Colorado, Colorado, Boulder, United States
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Candray HA, Kinkel CL, Fox AL, Atler KE, Fling BW, Van Puymbroeck M, Crowe BM, Schmid AA. An Exploration of Yoga in Occupational Therapy Practice for Multiple Sclerosis. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:313-321. [PMID: 36377233 DOI: 10.1177/15394492221134033] [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: 11/17/2022]
Abstract
The purpose of this exploratory qualitative study was to provide insight on the use of yoga in occupational therapy (OT) for people with multiple sclerosis (PwMS). This study aimed to answer how and why OT practitioners (OTPs) integrate yoga into clinical practice for PwMS. Eight OTPs, half of whom have also completed yoga teacher training, participated in a semi-structured telephone interview. Interviews were transcribed verbatim, inductively open-coded, and analyzed using thematic data analysis. Themes that emerged were: (a) OT and yoga are a natural fit; (b) improved performance and participation; (c) leveraging personal ties to yoga; and (d) influenced by client factors and clinical environment. The qualitative data provide valuable information about OTPs' justification for, and unique application of, yoga in clinical practice for PwMS. Future researchers should further explore the use of yoga for OT-related outcomes and the experience of PwMS.
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Affiliation(s)
| | | | - Anna L Fox
- Colorado State University, Fort Collins, CO, USA
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Bilek F, Bahcecioglu-Turan G, Ozer Z. The effect of self-acupressure on quality of life, physical and cognitive function in relapsing remitting multiple sclerosis patients: A randomized controlled study. Explore (NY) 2023; 19:84-90. [PMID: 35351367 DOI: 10.1016/j.explore.2022.03.002] [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: 12/13/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study was conducted to evaluate the effectiveness of self-acupressure on quality of life, physical and cognitive functions in individuals with Relapsing-Remitting Multiple Sclerosis (RRMS). METHODS In our randomized controlled study; participants in the study group were asked to perform self-acupressure on 6 points. They were asked to perform a total of 16 sessions, 2 days a week, for an average of 27 min each session in the morning and evening. No intervention was made in the control group during the study. Data were collected using Descriptive Information Form, Multiple Sclerosis Functional Composite Test (MSFC), and Multiple Sclerosis Quality of Life 54 Scale (MSQL-54). RESULTS Thirty-one individuals with RRMS in each group, 25 women in the study group and 21 women in the control group, were included in the study. After the self-acupressure application, a positive and significant difference was detected in all MSFC sub-parameters (9-Hole Peg Test, Timed 25-foot Walk Test, Paced Auditory Serial Addition Test) values of the study group compared to the control group. In addition, after self-acupressure application, the study group was found to have statistically significantly higher scores in both the combined physical health and composite mental health sub-parameters of MSQOL-54 compared to the control group (p < 0.05). CONCLUSION We found that self-acupressure was effective in improving physical function, cognitive function and quality of life in RRMS patients. Additionally, self-acupressure is a feasible, accessible and inexpensive method in the disease management of multiple sclerosis, which needs to be treated or supported continuously.
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Affiliation(s)
- Furkan Bilek
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Fırat University, Elazığ, Turkey.
| | | | - Zulfunaz Ozer
- Department of Nursing, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
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Kostenko EV. [The use of botulinum toxin type A in symptomatic therapy and medical rehabilitation of patients with multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:17-25. [PMID: 37966435 DOI: 10.17116/jnevro202312310117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The review of the current state of the problem of symptomatic therapy and medical rehabilitation (MR) of patients with multiple sclerosis (MS) is presented. The search was conducted in the databases Medline, Web of Science, PubMed and Scopus. Information is given about the most common symptoms of MS, among which sensory and motor disorders, bladder dysfunction, and pain have the greatest impact on the quality of life of patients, their functioning and independence in everyday life. The clinical characteristics of spasticity syndrome in MS and its relationship with quality of life indicators are considered. The features of the use of botulinum therapy (BT) in MS are considered. A high level of effectiveness of the use of BT in the treatment of neurogenic hyperactivity of detrusor and neurogenic bladder (the level of persuasiveness of recommendation A) and spasticity (the level of persuasiveness of recommendation B) is shown. Symptomatic treatment of MS and MR with the use of multidisciplinary programs helps to reduce disability, improve the quality of life of patients. When choosing symptomatic treatment and MR methods, it is customary to focus on the needs of patients.
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Affiliation(s)
- E V Kostenko
- Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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Role of Cervical Spinal Magnetic Stimulation in Improving Posture and Functional Ambulation of Patients with Relapsing Remitting Multiple Sclerosis. Rehabil Res Pract 2022; 2022:6009104. [DOI: 10.1155/2022/6009104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/23/2022] Open
Abstract
Balance impairment is one of the hallmarks of early MS. Proprioceptive deficit was found to be one of the main causes of this imbalance. The cervical enlargement has a strong proprioceptive system, with its projections to the reticular formation and the central pattern generators, helping in rhythmic pattern generation and alternate leg movements. Repetitive trans-spinal magnetic stimulation (rTSMS) is a noninvasive technique, which can trigger massive proprioceptive afferents. Therefore, it has the potential of improving proprioceptive deficits and motor control. Objective. To determine the effectiveness of repetitive cervical magnetic stimulation in improving functional ambulation of patients with relapsing remitting multiple sclerosis (RRMS). Design. Prospective sequential clinical trial. Setting. University and academic hospital. Participants. A total of 32 participants (
) with RRMS. Interventions. Outpatient rehabilitation. The 32 patients received 10 sessions over two weeks of 20 Hz cervical spinal magnetic stimulation (SMS). Both groups were assessed at baseline, after 2 weeks, then one month later. Patients were enrolled as a control group at first and received Sham SMS, and then a wash out period of one month was done for all the patients, followed by a baseline assessment. Second, the same 32 patients rejoined as the active group, which received real magnetic stimulation. Both groups performed an intensive physical therapy program with the spinal magnetic stimulation. Main Outcome Measures. Extended Disability status score (EDSS), Timed up and Go test (TUG), Mini-Best test, dynamic posturography sensory organization composite score, and motor composite score. Results. Thirty-two RRMS patients with EDSS range from 1.5 to 6. They showed statistically significant difference between active and control groups in Mini-Best test score. We divided our patients according to EDSS into 3 subgroups: (a) mild: ≤2.5, (b) moderate: 3-5.5, and (c) severe: ≥6. Mild cases showed significant differences in EDSS score, TUG test, Mini-Best test, and dynamic posturography sensory composite scale. The effect size between the different patient subgroups was also measured and showed highly significant improvements in all measured parameters among our mild patients, indicating that this subgroup could be the best responders to cervical repetitive high-frequency magnetic stimulation. Moderate cases showed highly significant improvement in TUG score and Mini-Best test and significant change in EDSS score and the dynamic posturography sensory composite score. Severe cases showed only significant improvements in TUG, Mini-Best test, and sensory composite score. Conclusion. Cervical repetitive magnetic stimulation can help improve balance and functional ambulation and decreases the risk of falls in RRMS patients, especially in the mild, low disability cases.
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Riem L, Beardsley SA, Obeidat AZ, Schmit BD. Visual oscillation effects on dynamic balance control in people with multiple sclerosis. J Neuroeng Rehabil 2022; 19:90. [PMID: 35978431 PMCID: PMC9382748 DOI: 10.1186/s12984-022-01060-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/15/2022] [Indexed: 12/03/2022] Open
Abstract
Background People with multiple sclerosis (PwMS) have balance deficits while ambulating through environments that contain moving objects or visual manipulations to perceived self-motion. However, their ability to parse object from self-movement has not been explored. The purpose of this research was to examine the effect of medial–lateral oscillations of the visual field and of objects within the scene on gait in PwMS and healthy age-matched controls using virtual reality (VR). Methods Fourteen PwMS (mean age 49 ± 11 years, functional gait assessment score of 27.8 ± 1.8, and Berg Balance scale score 54.7 ± 1.5) and eleven healthy controls (mean age: 53 ± 12 years) participated in this study. Dynamic balance control was assessed while participants walked on a treadmill at a self-selected speed while wearing a VR headset that projected an immersive forest scene. Visual conditions consisted of (1) no visual manipulations (speed-matched anterior/posterior optical flow), (2) 0.175 m mediolateral translational oscillations of the scene that consisted of low pairing (0.1 and 0.31 Hz) or (3) high pairing (0.15 and 0.465 Hz) frequencies, (4) 5 degree medial–lateral rotational oscillations of virtual trees at a low frequency pairing (0.1 and 0.31 Hz), and (5) a combination of the tree and scene movements in (3) and (4). Results We found that both PwMS and controls exhibited greater instability and visuomotor entrainment to simulated mediolateral translation of the visual field (scene) during treadmill walking. This was demonstrated by significant (p < 0.05) increases in mean step width and variability and center of mass sway. Visuomotor entrainment was demonstrated by high coherence between center of mass sway and visual motion (magnitude square coherence = ~ 0.5 to 0.8). Only PwMS exhibited significantly greater instability (higher step width variability and center of mass sway) when objects moved within the scene (i.e., swaying trees). Conclusion Results suggest the presence of visual motion processing errors in PwMS that reduced dynamic stability. Specifically, object motion (via tree sway) was not effectively parsed from the observer’s self-motion. Identifying this distinction between visual object motion and self-motion detection in MS provides insight regarding stability control in environments with excessive external movement, such as those encountered in daily life.
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Affiliation(s)
- Lara Riem
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Scott A Beardsley
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Ahmed Z Obeidat
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA.
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15
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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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16
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Correale L, Montomoli C, Bergamaschi R, Ivaniski-Mello A, Peyré-Tartaruga LA, Buzzachera CF. Bilateral coordination of gait at self-selected and fast speed in patients with multiple sclerosis: a case-control study. Mult Scler Relat Disord 2022; 65:104027. [DOI: 10.1016/j.msard.2022.104027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/06/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022]
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17
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Little C, Moore C, Bean E, Peters DM, McGinnis RS, Kasser SL. Acute effects of axial loading on postural control during walking and turning in people with multiple sclerosis: A pilot study. Gait Posture 2022; 94:102-106. [PMID: 35259637 PMCID: PMC9086176 DOI: 10.1016/j.gaitpost.2022.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Impaired sensory integration is heavily involved in gait control and accentuates fall risk in individuals with multiple sclerosis (MS). While axial loading has been found beneficial, little is known about the effect of non-specific axial loads on gait parameters and mobility tasks in those with MS. RESEARCH QUESTION What are the effects of non-specific axial loading via weighted vests on walking and turning in those with MS. METHODS Twelve participants with MS and eleven age- and gender-matched healthy controls participated in a cross-sectional study. All participants completed five trials of continuous walking with turns wearing weighted vests at 0%, 2%, 4%, 5%, and then 0% of their body weight. Gait parameters were measured using wireless inertial sensors. A 2 (group) x 5 (vest weight) multivariate analysis of variance (MANOVA) was performed to determine any significant differences between groups and across weighted vests for each gait variable. Post-hoc analysis and paired t-tests with corresponding effect sizes were also conducted. RESULTS A significant between groups main effect was found for group (F (6100) = 14.74, p = .000) in multiple gait parameters (p < 0.05), although no significant main effect was found for weighted vest. Within group analyses indicated significantly increased cadence and gait speed across varying weighted vests for both MS and control groups (p < 0 >05). Increased vest weight from 0%PRE to 2% also had large effect on shortening double support time and increasing stride length in the MS group. SIGNIFICANCE This study provided preliminary evidence that non-specific axial loads of varying weights appear to improve certain gait parameters. As such, this modality may offer mobility benefit and serve as an accessible home-based intervention alternative aimed at improving walking in individuals with MS.
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Affiliation(s)
- Casey Little
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA
| | - Connor Moore
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA
| | - Emily Bean
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA
| | - Denise M Peters
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA
| | - Ryan S McGinnis
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, USA
| | - Susan L Kasser
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA.
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18
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Smith Fine A, Kaufman M, Goodman J, Turk B, Bastian A, Lin D, Fatemi A, Keller J. Wearable sensors detect impaired gait and coordination in LBSL during remote assessments. Ann Clin Transl Neurol 2022; 9:468-477. [PMID: 35257509 PMCID: PMC8994975 DOI: 10.1002/acn3.51509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/17/2021] [Accepted: 12/28/2021] [Indexed: 02/02/2023] Open
Abstract
Background Leukoencephalopathy with brainstem and spinal cord involvement and lactate elevation (LBSL) is a rare leukodystrophy with motor impairment due to biallelic mutations in DARS2, which encodes mitochondrial aspartyl tRNA synthetase. Progressive ataxia is the primary feature. Objective The study objective is to determine the feasibility of remotely collecting quantitative gait and balance measures in LBSL. Methods The study design uses wearable accelerometers and the scale for the assessment and rating of ataxia (SARA) scale to assess gait and postural sway in LBSL and control participants' homes through video conferencing. Results Lateral step variability (LSV), which indicates stride variability, and elevation of the step at mid‐swing are increased for LBSL patients during brief walking tests. During stance with the eyes closed, LBSL participants show rapid accelerations and decelerations of body movement covering a large sway area and path. Both the LSV and sway area during stance with the feet together and eyes closed correlate strongly with the SARA. Conclusions Wearable accelerometers are valid and sensitive for detecting ataxia in LBSL patients during remote assessments. The finding of large increases in the sway area during stance with the eyes closed is intriguing since dorsal column dysfunction is universally seen in LBSL. This approach can be applied to related rare diseases that feature ataxia.
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Affiliation(s)
- Amena Smith Fine
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Miriam Kaufman
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jordan Goodman
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Bela Turk
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Amy Bastian
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Doris Lin
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali Fatemi
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jennifer Keller
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
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19
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Barrett P, Quick TJ, Mudera V, Player DJ. Neuregulin 1 Drives Morphological and Phenotypical Changes in C2C12 Myotubes: Towards De Novo Formation of Intrafusal Fibres In Vitro. Front Cell Dev Biol 2022; 9:760260. [PMID: 35087826 PMCID: PMC8787273 DOI: 10.3389/fcell.2021.760260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Muscle spindles are sensory organs that detect and mediate both static and dynamic muscle stretch and monitor muscle position, through a specialised cell population, termed intrafusal fibres. It is these fibres that provide a key contribution to proprioception and muscle spindle dysfunction is associated with multiple neuromuscular diseases, aging and nerve injuries. To date, there are few publications focussed on de novo generation and characterisation of intrafusal muscle fibres in vitro. To this end, current models of skeletal muscle focus on extrafusal fibres and lack an appreciation for the afferent functions of the muscle spindle. The goal of this study was to produce and define intrafusal bag and chain myotubes from differentiated C2C12 myoblasts, utilising the addition of the developmentally associated protein, Neuregulin 1 (Nrg-1). Intrafusal bag myotubes have a fusiform shape and were assigned using statistical morphological parameters. The model was further validated using immunofluorescent microscopy and western blot analysis, directed against an extensive list of putative intrafusal specific markers, as identified in vivo. The addition of Nrg-1 treatment resulted in a 5-fold increase in intrafusal bag myotubes (as assessed by morphology) and increased protein and gene expression of the intrafusal specific transcription factor, Egr3. Surprisingly, Nrg-1 treated myotubes had significantly reduced gene and protein expression of many intrafusal specific markers and showed no specificity towards intrafusal bag morphology. Another novel finding highlights a proliferative effect for Nrg-1 during the serum starvation-initiated differentiation phase, leading to increased nuclei counts, paired with less myotube area per myonuclei. Therefore, despite no clear collective evidence for specific intrafusal development, Nrg-1 treated myotubes share two inherent characteristics of intrafusal fibres, which contain increased satellite cell numbers and smaller myonuclear domains compared with their extrafusal neighbours. This research represents a minimalistic, monocellular C2C12 model for progression towards de novo intrafusal skeletal muscle generation, with the most extensive characterisation to date. Integration of intrafusal myotubes, characteristic of native, in vivo intrafusal skeletal muscle into future biomimetic tissue engineered models could provide platforms for developmental or disease state studies, pre-clinical screening, or clinical applications.
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Affiliation(s)
- Philip Barrett
- Centre for 3D Models of Health and Disease, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Tom J Quick
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, London, United Kingdom.,UCL Centre for Nerve Engineering, University College London, London, United Kingdom
| | - Vivek Mudera
- Centre for 3D Models of Health and Disease, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Darren J Player
- Centre for 3D Models of Health and Disease, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom
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20
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Jaatela J, Aydogan DB, Nurmi T, Vallinoja J, Piitulainen H. Identification of Proprioceptive Thalamocortical Tracts in Children: Comparison of fMRI, MEG, and Manual Seeding of Probabilistic Tractography. Cereb Cortex 2022; 32:3736-3751. [PMID: 35040948 PMCID: PMC9433422 DOI: 10.1093/cercor/bhab444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022] Open
Abstract
Studying white matter connections with tractography is a promising approach to understand the development of different brain processes, such as proprioception. An emerging method is to use functional brain imaging to select the cortical seed points for tractography, which is considered to improve the functional relevance and validity of the studied connections. However, it is unknown whether different functional seeding methods affect the spatial and microstructural properties of the given white matter connection. Here, we compared functional magnetic resonance imaging, magnetoencephalography, and manual seeding of thalamocortical proprioceptive tracts for finger and ankle joints separately. We showed that all three seeding approaches resulted in robust thalamocortical tracts, even though there were significant differences in localization of the respective proprioceptive seed areas in the sensorimotor cortex, and in the microstructural properties of the obtained tracts. Our study shows that the selected functional or manual seeding approach might cause systematic biases to the studied thalamocortical tracts. This result may indicate that the obtained tracts represent different portions and features of the somatosensory system. Our findings highlight the challenges of studying proprioception in the developing brain and illustrate the need for using multimodal imaging to obtain a comprehensive view of the studied brain process.
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Affiliation(s)
- Julia Jaatela
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo FI-02150, Finland
| | - Dogu Baran Aydogan
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo FI-02150, Finland
- Department of Psychiatry, Helsinki University Hospital, Helsinki FI-00029, Finland
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio FI-70211, Finland
| | - Timo Nurmi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo FI-02150, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä FI-40014, Finland
| | - Jaakko Vallinoja
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo FI-02150, Finland
| | - Harri Piitulainen
- Address correspondence to Harri Piitulainen, associate professor, Harri Piitulainen, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. BOX 35, FI-40014, Finland.
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21
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Chen YC, Arnatkevičiūtė A, McTavish E, Pang JC, Chopra S, Suo C, Fornito A, Aquino KM. The individuality of shape asymmetries of the human cerebral cortex. eLife 2022; 11:75056. [PMID: 36197720 PMCID: PMC9668337 DOI: 10.7554/elife.75056] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/04/2022] [Indexed: 01/05/2023] Open
Abstract
Asymmetries of the cerebral cortex are found across diverse phyla and are particularly pronounced in humans, with important implications for brain function and disease. However, many prior studies have confounded asymmetries due to size with those due to shape. Here, we introduce a novel approach to characterize asymmetries of the whole cortical shape, independent of size, across different spatial frequencies using magnetic resonance imaging data in three independent datasets. We find that cortical shape asymmetry is highly individualized and robust, akin to a cortical fingerprint, and identifies individuals more accurately than size-based descriptors, such as cortical thickness and surface area, or measures of inter-regional functional coupling of brain activity. Individual identifiability is optimal at coarse spatial scales (~37 mm wavelength), and shape asymmetries show scale-specific associations with sex and cognition, but not handedness. While unihemispheric cortical shape shows significant heritability at coarse scales (~65 mm wavelength), shape asymmetries are determined primarily by subject-specific environmental effects. Thus, coarse-scale shape asymmetries are highly personalized, sexually dimorphic, linked to individual differences in cognition, and are primarily driven by stochastic environmental influences.
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Affiliation(s)
- Yu-Chi Chen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash UniversityMelbourneAustralia,Monash Biomedical Imaging, Monash UniversityMelbourneAustralia,Monash Data Futures Institute, Monash UniversityMelbourneAustralia
| | - Aurina Arnatkevičiūtė
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash UniversityMelbourneAustralia
| | - Eugene McTavish
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash UniversityMelbourneAustralia,Monash Biomedical Imaging, Monash UniversityMelbourneAustralia,Healthy Brain and Mind Research Centre, Faculty of Health Sciences, Australian Catholic UniversityFitzroyAustralia
| | - James C Pang
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash UniversityMelbourneAustralia,Monash Biomedical Imaging, Monash UniversityMelbourneAustralia
| | - Sidhant Chopra
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash UniversityMelbourneAustralia,Monash Biomedical Imaging, Monash UniversityMelbourneAustralia,Department of Psychology, Yale UniversityNew HavenUnited States
| | - Chao Suo
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash UniversityMelbourneAustralia,Monash Biomedical Imaging, Monash UniversityMelbourneAustralia,BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash UniversityMelbourneAustralia
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash UniversityMelbourneAustralia,Monash Biomedical Imaging, Monash UniversityMelbourneAustralia
| | - Kevin M Aquino
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash UniversityMelbourneAustralia,Monash Biomedical Imaging, Monash UniversityMelbourneAustralia,School of Physics, University of SydneySydneyAustralia,Center of Excellence for Integrative Brain Function, University of SydneySydneyAustralia,BrainKey IncSan FranciscoUnited States
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22
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Monaghan AS, Huisinga JM, Peterson DS. The relationship between plantar sensation and muscle onset during automatic postural responses in people with multiple sclerosis and healthy controls. Mult Scler Relat Disord 2021; 56:103313. [PMID: 34644600 DOI: 10.1016/j.msard.2021.103313] [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: 12/19/2020] [Revised: 09/09/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Plantar sensation is critical for balance control in people with multiple sclerosis (PwMS). While previous research has described its impact on standing balance, the influence of plantar sensation during automatic postural responses (APRs) is not well understood in PwMS. The purpose of this study was to characterize the relationship between plantar sensation and APRs in PwMS and controls. A secondary aim was to determine whether the relationship between plantar sensation and APRs is different across PwMS and control groups. METHODS 122 PwMS and 48 age-matched controls underwent forward and backward support-surface perturbations from stance. The onset of the tibialis anterior (TA) and medial gastrocnemius (MG) were the primary reactive balance outcome measures for backward and forward losses of balance, respectively. Plantar sensation was measured as the vibration sensation threshold (VT). RESULTS As expected, PwMS had significantly higher (i.e., worse) VT (p<0.001) and an increased MG and TA onset latency (TA: p<0.001, MG: p = 0.01) compared to the control group. A higher VT was related to increased MG (p<0.001) and TA latency (p<0.001) across all participants. However, no moderating effect of group (control or PwMS) was observed for the relationship between VT and muscle onset (MG: p = 0.14; TA: p = 0.34). CONCLUSION PwMS demonstrated poorer plantar sensation and delayed muscle onset during APRs compared to controls. Plantar sensation was also related to muscle onset after perturbations in all participants. Although this relationship was not moderated by group, this may be related to the lack of dynamic range of VT scores in controls. These results indicate that plantar sensation may be related to reactive balance and provides insight into a potential contributing factor of delayed automatic postural responses in people with MS.
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Affiliation(s)
- A S Monaghan
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - J M Huisinga
- University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science
| | - D S Peterson
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA; Phoenix VA Health Care Center, Phoenix, AZ, USA.
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23
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Haddas R, Kosztowski T, Mar D, Boah A, Lieberman IH. Balance effort, Cone of Economy, and dynamic compensatory mechanisms in common degenerative spinal pathologies. Gait Posture 2021; 89:67-73. [PMID: 34243138 DOI: 10.1016/j.gaitpost.2021.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Changes in balance are common in individuals with spinal disorders and may cause falls. Balance efficiency, is the ability of a person to maintain their center of gravity with minimal neuromuscular energy expenditure, oftentimes referred to as Cone of Economy (CoE). CoE balance is defined by two sets of measures taken from the center of mass (CoM) and head: 1) the range-of-sway (RoS) in the coronal and sagittal planes, and 2) the overall sway distance. This allows spine caregivers to assess the severity of a patient's balance, balance pattern, and dynamic posture and record the changes following surgical intervention. Maintenance of balance requires coordination between the central nervous and musculoskeletal systems. RESEARCH QUESTION To discern differences in balance effort values between common degenerative spinal pathologies and a healthy control group. METHODS Three-hundred and forty patients with degenerative spinal pathologies: cervical spondylotic myelopathy (CSM), adult degenerative scoliosis (ADS), sacroiliac dysfunction (SIJD), degenerative lumbar spondylolisthesis (DLS), single-level lumbar degeneration (LD), and failed back syndrome (FBS), and 40 healthy controls were recruited. A functional balance test was performed approximately one week before surgery recorded by 3D video motion capture. RESULTS Balance effort and compensatory mechanisms were found to be significantly greater in degenerative spinal pathologies patients compared to controls. Head and Center of Mass (CoM) overall sway ranged from 65.22 to 92.78 cm (p < 0.004) and 35.77-53.31 cm (p < 0.001), respectively in degenerative spinal pathologies patients and in comparison to controls (Head: 44.52 cm, CoM: 22.24 cm). Patients with degenerative spinal pathologies presented with greater trunk (1.61-2.98°, p < 0.038), hip (4.25-5.87°, p < 0.049), and knee (4.55-6.09°, p < 0.036) excursion when compared to controls (trunk: 0.95°, hip: 2.97°, and knee: 2.43°). SIGNIFICANCE The results of this study indicate that patients from a wide variety of degenerative spinal pathologies similarly exhibit markedly diminished balance (and compensatory mechanisms) as indicated by increased sway on a Romberg test and a larger Cone of Economy (CoE) as compared to healthy controls. Balance effort, as measured by overall sway, was found to be approximately double in patients with degenerative spinal pathologies compared to healthy matched controls. Clinicians can compare CoE parameters among symptomatic patients from the different cohorts using the Haddas' CoE classification system to guide their postoperative prognosis.
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Affiliation(s)
| | | | - Damon Mar
- Texas Back Institute, Plano, TX, USA
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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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Sokhangu MK, Rahnama N, Etemadifar M, Rafeii M, Saberi A. Effect of Neuromuscular Exercises on Strength, Proprioceptive Receptors, and Balance in Females with Multiple Sclerosis. Int J Prev Med 2021; 12:5. [PMID: 34084302 PMCID: PMC8106275 DOI: 10.4103/ijpvm.ijpvm_525_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/26/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Multiple sclerosis (MS) is the third most common cause of adult neurologic disabilities. The aim of this study was to determine the effect of 8 weeks of neuromuscular exercises on strength, proprioceptive receptors, and balance of women with MS. Methods: In this randomized controlled trial study, 20 female volunteers with relapsing-remitting MS were randomly assigned into the experimental group (n = 10) and control group (n = 10). Maximum muscular strength of knee extensor and flexor muscles, knee joint proprioceptive error (Biodex), and balance (Berg Balance Scale) was measured at baseline and after 8 weeks of neuromuscular exercise. The data were analyzed using paired t-test and independent t-test. Results: The results showed a significant improvement (P < 0.05) in the quadriceps strength, hamstring strength, proprioceptive receptor error, and the balance in the experimental group, but not in the control group. A significant difference was evident between the experimental and control groups in terms of strength, balance, and proprioceptive receptor error (P < 0.05). Conclusions: Neuromuscular exercise training is effective in improving balance, strength, and reducing the proprioceptive error in people with MS, and it could be recommended as modalities for these patients.
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Affiliation(s)
- Maryam K Sokhangu
- Department of Sport Injury and Corrective Exercises, Faculty of Sport Science, University of Isfahan, Isfahan, Iran
| | - Nader Rahnama
- Department of Sport Injury and Corrective Exercises, Faculty of Sport Science, University of Isfahan, Isfahan, Iran
| | - Masoud Etemadifar
- Department of Neurology, Medical School, Isfahan Research Committee of Multiple Sclerosis, Isfahan, Iran
| | - Mehdi Rafeii
- Faculty of Sport Science, University of Isfahan, Isfahan, Iran
| | - Ali Saberi
- Department of Sport Management, Faculty of Management, Farabi Campus, University of Tehran, Iran
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Sato S, Buonaccorsi J, Miehm JD, Lim J, Rajala C, Khalighinejad F, Ionete C, Kent JA, van Emmerik REA. Non-ambulatory measures of lower extremity sensorimotor function are associated with walking function in Multiple Sclerosis. Mult Scler Relat Disord 2021; 53:103051. [PMID: 34139463 DOI: 10.1016/j.msard.2021.103051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/26/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Disease progression of multiple sclerosis (MS) is often monitored by ambulatory measures, but how non-ambulatory sensorimotor measures differentially associate to walking measures in MS subtypes is unknown. We determined whether there are characteristic differences between relapsing-remitting MS (RRMS), progressive MS (PMS), and non-MS controls in lower extremity sensorimotor function and clinical walking tasks and the sensorimotor associations with walking function in each group. METHODS 18 RRMS, 13 PMS and 28 non-MS control participants were evaluated in their plantar cutaneous sensitivity (vibration perception threshold, Volts), proprioception during ankle joint position-matching (|∆°| in dorsiflexion), motor coordination (rapid foot-tap count/10 s), and walking function with three tests: Timed 25-foot walk (T25FW) at preferred and fast speeds (s), and timed-up-and-go (TUG, s). RESULTS Foot-tapping (p = 0.039, Mean difference (MD)= 5.65 taps) and plantar cutaneous sensation (p = 0.026, MD= -10.30 V) differed between the MS subtypes. For the RRMS group faster walking was related to better proprioceptive function (preferred T25FW: p = 0.019, Root mean square error (RMSE)=1.94; fast T25FW: p = 0.004, RMSE=1.65; TUG: p = 0.001, RMSE=2.12) and foot-tap performance (preferred T25FW: p = 0.033, RMSE = 2.74; fast T25FW: p = 0.010, RMSE=2.02). These associations were not observed in the PMS group. CONCLUSIONS Foot-tap performance and plantar cutaneous sensitivity but not ankle proprioception differed between MS subtypes. Lower walking performance was associated with lower foot-tapping and plantar cutaneous sensitivity in the RRMS but not the PMS group. This result suggests a change in the relationship of lower extremity sensorimotor function to walking performance in the PMS subtype.
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Affiliation(s)
- Sumire Sato
- Neuroscience and Behavior Program, University of Massachusetts Amherst, Amherst, MA, United States; Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, United States; Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - John Buonaccorsi
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, MA, United States
| | - Jules D Miehm
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, United States
| | - Jongil Lim
- Department of Counseling, Health, and Kinesiology, Texas A&M University - San Antonio, San Antonio, Texas, United States
| | - Caitlin Rajala
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, United States
| | - Farnaz Khalighinejad
- Department of Neurology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, United States
| | - Carolina Ionete
- Department of Neurology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, United States
| | - Jane A Kent
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, United States
| | - Richard E A van Emmerik
- Neuroscience and Behavior Program, University of Massachusetts Amherst, Amherst, MA, United States; Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, United States.
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The Effect of Total Body Resistance Exercise on Mobility, Proprioception, and Muscle Strength of the Knee in People With Multiple Sclerosis. J Sport Rehabil 2021; 29:192-199. [PMID: 30676232 DOI: 10.1123/jsr.2018-0303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/30/2018] [Accepted: 11/25/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Muscle weakness and sensory deficits cause impaired balance and walking abilities that are prerequisites for independent activity of daily living in people with multiple sclerosis (MS). Recent physical exercises tailored to improve the activity of daily living people with MS have focused on the functional training. OBJECTIVE To investigate the effect of total body resistance exercise suspension training on mobility, proprioception, and muscle strength of the knee in people with MS. DESIGN Single-blind pretest and posttest control group design. SETTING Referral Center of Multiple Sclerosis Society. PARTICIPANTS Thirty-four women with relapsing-remitting MS were participated in this study. The mean (SD) of their age was 36.44 (4.88) years, and the Expanded Disability Status Scale was 2.35 (0.94). The participants were divided into 2 groups: control group (n = 15) and training group (n = 19). INTERVENTION The training group performed the total body resistance exercise program for 8 weeks, 3 sessions per week. The control group received their usual care and daily activities. Outcomes were measured presessions and postsessions. MAIN OUTCOME MEASURES Mobility was assessed with Timed Up and Go test, 10-m walk maximum test, 2 minute walk test, and 5-time sit-to-stand test. Knee proprioception absolute error and isometric strength of knee flexor and extensor muscles were measured by using a biodex isokinetic dynamometer. RESULTS In the training group, mobility (P = .001), maximal voluntary isometric contraction of knee flexor and extensor muscles in both legs (P > .05), and the knee proprioception absolute error in nondominant leg at 60° knee flexion (P = .02) improved significantly compared with the control group. CONCLUSION Total body resistance exercise is a functional and safe intervention that can improve the mobility and muscles strength of the knee in a short period in people with MS.
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Rangwani R, Park H. A new approach of inducing proprioceptive illusion by transcutaneous electrical stimulation. J Neuroeng Rehabil 2021; 18:73. [PMID: 33941209 PMCID: PMC8094608 DOI: 10.1186/s12984-021-00870-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neurotraumas or neurodegenerative diseases often result in proprioceptive deficits, which makes it challenging for the nervous system to adapt to the compromised sensorimotor conditions. Also, in human machine interactions, such as prosthesis control and teleoperation, proprioceptive mismatch limits accuracy and intuitiveness of controlling active joints in robotic agents. To address these proprioceptive deficits, several invasive and non-invasive approaches like vibration, electrical nerve stimulation, and skin stretch have been introduced. However, proprioceptive modulation is still challenging as the current solutions have limitations in terms of effectiveness, usability, and consistency. In this paper, we propose a new way of modulating proprioception using transcutaneous electrical stimulation. We hypothesized that transcutaneous electrical stimulation on elbow flexor muscles will induce illusion of elbow joint extension. METHOD Eight healthy human subjects participated in the study to test the hypothesis. Transcutaneous electrodes were placed on different locations targeting elbow flexor muscles on human subjects and experiments were conducted to identify the best locations for electrode placement, and best electrical stimulation parameters, to maximize induced proprioceptive effect. Arm matching experiments and Pinocchio illusion test were performed for quantitative and qualitative analysis of the observed effects. One-way repeated ANOVA test was performed on the data collected in arm matching experiment for statistical analysis. RESULTS We identified the best location for transcutaneous electrodes to induce the proprioceptive illusion, as one electrode on the muscle belly of biceps brachii short head and the other on the distal myotendinous junction of brachioradialis. The results for arm-matching and Pinocchio illusion tests showed that transcutaneous electrical stimulation using identified electrode location and electrical stimulation parameters evoked the illusion of elbow joint extension for all eight subjects, which supports our hypothesis. On average, subjects reported 6.81° angular illusion of elbow joint extension in arm-matching tests and nose elongated to 1.78 × height in Pinocchio illusion test. CONCLUSIONS Transcutaneous electrical stimulation, applied between the the synergistic elbow flexor muscles, consistently modulated elbow joint proprioception with the illusion of elbow joint extension, which has immense potential to be translated into various real-world applications, including neuroprosthesis, rehabilitation, teleoperation, mixed reality, and etc.
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Affiliation(s)
- Rohit Rangwani
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Hangue Park
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, 77843, USA.
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Ali AS, Darwish MH, Shalaby NM, Abbas RL, Soubhy HZ. Efficacy of core stability versus task oriented trainings on balance in ataxic persons with multiple sclerosis. A single blinded randomized controlled trial. Mult Scler Relat Disord 2021; 50:102866. [PMID: 33652233 DOI: 10.1016/j.msard.2021.102866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/13/2020] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Balance and ataxic symptoms are commonly encountered in people with multiple sclerosis (PwMS). Many intervention approaches have been proposed to address balance in PwMS. The purpose of this study was to investigate the efficacy of adding core stability versus task oriented trainings on traditional approaches on balance in ataxic PwMS. METHODS Forty five ataxic relapsing-remitting PwMS from both sexes were randomly assigned into three identical groups. Control group (CG) treated with conventional balance exercise program; study groups I (GI) and II (GII) received respectively additional training using core stability exercises and task oriented trainings. Outcome measures recorded pre and post study period included stability index (SI), anterior posterior stability index (APSI), and mediolateral stability index (MLSI) using Biodex stability system in addition to the Berg balance scale (BBS). RESULTS Post treatment, the results indicated significant improvement in (SI) and (APSI) (p<0.05), and non-significant improvement (p>0.05) in (MLSI) and BBS in CG. In GI and GII there was a significant improvement in all balance measures (p<0.05). Comparison of post treatment results between groups indicated a significant improvement of GII compared to CG in all study measures, GI showed non- significant difference in all balance measures compared to the CG(P>0.05). CONCLUSION In PwMS balance rehabilitation should be multimodal; core stability exercises and task-oriented training in addition to conventional balance training are effective to improve balance and should be considered as an essential part of the training program for balance rehabilitation in ataxic PwMS. Task-oriented training in addition to conventional balance rehabilitation seem to be a favorable approach.
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Affiliation(s)
- Ahmed S Ali
- Department of Physical Therapy for Neuromuscular Disorders - Faculty of Physical therapy - Cairo University - Egypt; Department of Physical Therapy - Faculty of Health Sciences - Beirut Arab University - Lebanon.
| | - Moshera H Darwish
- Department of Physical Therapy for Neuromuscular Disorders - Faculty of Physical therapy - Cairo University - Egypt.
| | - Nevin M Shalaby
- Department of Neurology - Faculty of Medicine - Cairo University - Egypt.
| | - Rami L Abbas
- Department of Physical Therapy - Faculty of Health Sciences - Beirut Arab University - Lebanon.
| | - Habiba Z Soubhy
- Department of Physical Therapy for Neuromuscular Disorders - Faculty of Physical therapy - Cairo University - Egypt.
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Janshen L, Santuz A, Arampatzis A. Muscle Synergies in Patients With Multiple Sclerosis Reveal Demand-Specific Alterations in the Modular Organization of Locomotion. Front Hum Neurosci 2021; 14:593365. [PMID: 33584221 PMCID: PMC7873056 DOI: 10.3389/fnhum.2020.593365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022] Open
Abstract
For patients with multiple sclerosis (MS), deficits in gait significantly reduce the quality of life. Using the concept of muscle synergies, this study investigated the modular organization of motor control during level and inclined walking in MS patients (MSP) compared with healthy participants (HP) to identify the potential demand-specific adjustments in motor control in MSP. We hypothesized a widening of the time-dependent activation patterns (motor primitives) in MSP to increase the overlap of temporally-adjacent muscle synergies, especially during inclined walking, as a strategy to increase the robustness of motor control, thus compensating pathology-related deficits. We analyzed temporal gait parameters and muscle synergies from myoelectric signals of 13 ipsilateral leg muscles using non-negative matrix factorization. Compared with HP, MSP demonstrated a widening in the time-dependent coefficients (motor primitives), as well as altered relative muscle contribution (motor modules), in certain synergies during level and inclined walking. Moreover, inclined walking revealed a demand-specific adjustment in the modular organization in MSP, resulting in an extra synergy compared with HP. This further increased the overlap of temporally-adjacent muscle synergies to provide sufficient robustness in motor control to accomplish the more demanding motor task while coping with pathology-related motor deficits during walking.
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Affiliation(s)
- Lars Janshen
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alessandro Santuz
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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Brain networks associated with anticipatory postural adjustments in Parkinson's disease patients with freezing of gait. NEUROIMAGE-CLINICAL 2021; 28:102461. [PMID: 33395957 PMCID: PMC7575874 DOI: 10.1016/j.nicl.2020.102461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/13/2022]
Abstract
High hemodynamic response in the AI and SMA in the FoG when an APA was required. Connectivity between the right and left insulae was correlated with severity of FoG. Both groups showed different brain network organizations between SMA and bilateral AI. SMA was found to be a hub in patients with FoG when an APA was required.
Specific impairments of anticipatory postural adjustment (APA) during step initiation have been reported in patients with Parkinson’s disease (PD) and freezing of gait (FoG). Although APA disruption has been associated with FoG, there is scarce knowledge about its neural correlates. We sought to better understand the neural networks involved with APA in patients with FoG by assessing the level of hemodynamic response of specific brain regions and the functional connectivity during the leg lifting task. In the current investigation, APAs of patients with PD, with and without (nFoG) freezing were assessed during a leg lifting task in an event-related, functional magnetic resonance imaging (er-fMRI) protocol. Results identified a high hemodynamic response in the right anterior insula (AI) and supplementary motor area (SMA) in the FoG group when an APA was required. The nFoG had stronger connectivity between the right and left insulae than the FoG group. The strength of this connectivity was negatively correlated with the severity of FoG. Both groups showed different brain network organizations comprising the SMA and the bilateral AI. The SMA was found to be a hub in patients with FoG when an APA was required for the task. Our findings suggest that both groups used compensatory mechanism comprising the insulae during APA. Neither group used the entire network comprised of the insulae and SMA to accomplish the task. The FoG group relied more on SMA as a hub than as part of a broader network to exchange information during the APA.
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Richmond SB, Whittier TT, Peterson DS, Fling BW. Advanced characterization of static postural control dysfunction in persons with multiple sclerosis and associated neural mechanisms. Gait Posture 2021; 83:114-120. [PMID: 33129171 DOI: 10.1016/j.gaitpost.2020.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/03/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is an autoimmune-based chronic inflammatory disease characterized by the neurodegeneration of the central nervous system and produces postural dysfunction. Quiet or static standing is a complex task carried out through afferent sensory inputs and efferent postural corrective outputs. Currently the mechanisms underlying these outputs remain largely unknown. RESEARCH QUESTION Assess the relationship between multi-dimensional measures of postural control and microstructural integrity of the cortical sensorimotor pathway (CSP) in persons with MS (PwMS) and neurotypical adults. METHODS Postural control performance was assessed by both overall and directional time-to-boundary measures across four manipulated sensory stance conditions (eyes open/closed; stance firm/foam) in twenty-nine neurotypical and twenty-seven PwMS. These postural outcomes were evaluated with mixed-model repeated measures analysis of variance across group (MS and control) and stance condition. Postural performance was also correlated with magnetic resonance imaging diffusion tensor-derived measures of microstructural integrity of the CSP. RESULTS PwMS displayed significantly (p = 0.026) worse anterior-posterior postural control compared to their neurotypical counterparts across sensory testing conditions and poorer CSP microstructural integrity in comparison to neurotypical adults (p = 0.008). Additionally, PwMS displayed a significant association (2D (rho = -0.384, p = 0.048), AP (rho = -0.355, p = 0.035), and ML (rho = -0.365, p = 0.030) between integrity of the CSP and postural control performance during proprioceptive-based balance, such that those with worse cortical structure had poorer balance control. SIGNIFICANCE This is the first study to establish connections between the microstructural integrity of the CSP and multi-dimensional postural control performance. Results indicate that a reduction in the CSP microstructural integrity is associated with poorer postural control in PwMS. These outcomes identify neural underpinnings of postural control dysfunction in PwMS and provide new avenues for evaluating the efficacy of postural rehabilitation strategies in PwMS that express proprioceptive-based postural deficits.
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Affiliation(s)
- Sutton B Richmond
- College of Health and Human Sciences, Department of Health and Exercise Science, Colorado State University, 951 Plum St, Fort Collins, CO, 80523, USA.
| | - Tyler T Whittier
- College of Health and Human Sciences, Department of Health and Exercise Science, Colorado State University, 951 Plum St, Fort Collins, CO, 80523, USA
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, 425 N 5(th)Street, Phoenix, AZ, USA; Phoenix VA Health Care System, 650 Indian School Rd., Phoenix, AZ, USA
| | - Brett W Fling
- College of Health and Human Sciences, Department of Health and Exercise Science, Colorado State University, 951 Plum St, Fort Collins, CO, 80523, USA; Molecular, Cellular and Integrative Neurosciences Program, Colorado State University, 1675 Campus Delivery, Fort Collins, CO, 80523, USA
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Barrett P, Quick TJ, Mudera V, Player DJ. Generating intrafusal skeletal muscle fibres in vitro: Current state of the art and future challenges. J Tissue Eng 2020; 11:2041731420985205. [PMID: 34956586 PMCID: PMC8693220 DOI: 10.1177/2041731420985205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/12/2020] [Indexed: 01/18/2023] Open
Abstract
Intrafusal fibres are a specialised cell population in skeletal muscle, found within the muscle spindle. These fibres have a mechano-sensory capacity, forming part of the monosynaptic stretch-reflex arc, a key component responsible for proprioceptive function. Impairment of proprioception and associated dysfunction of the muscle spindle is linked with many neuromuscular diseases. Research to-date has largely been undertaken in vivo or using ex vivo preparations. These studies have provided a foundation for our understanding of muscle spindle physiology, however, the cellular and molecular mechanisms which underpin physiological changes are yet to be fully elucidated. Therefrom, the use of in vitro models has been proposed, whereby intrafusal fibres can be generated de novo. Although there has been progress, it is predominantly a developing and evolving area of research. This narrative review presents the current state of art in this area and proposes the direction of future work, with the aim of providing novel pre-clinical and clinical applications.
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Affiliation(s)
- Philip Barrett
- Centre for 3D Models of Health and Disease, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
| | - Tom J Quick
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, Stanmore, UK
- UCL Centre for Nerve Engineering, University College London, London, UK
| | - Vivek Mudera
- Centre for 3D Models of Health and Disease, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
| | - Darren J Player
- Centre for 3D Models of Health and Disease, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
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Djajadikarta ZJ, Dongés SC, Brooks J, Kennedy DS, Gandevia SC, Taylor JL. Impaired central drive to plantarflexors and minimal ankle proprioceptive deficit in people with multiple sclerosis. Mult Scler Relat Disord 2020; 46:102584. [PMID: 33296980 DOI: 10.1016/j.msard.2020.102584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/16/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND A common and disruptive symptom of multiple sclerosis is difficulty in walking. Deficits in ankle proprioception and in plantarflexor muscle function may contribute to these mobility issues. In this study, ankle proprioceptive ability and plantarflexor performance of people with multiple sclerosis (PwMS) were compared to healthy controls to determine whether multiple sclerosis causes impairments in these systems. METHODS PwMS (n = 30, median EDSS 4.0, IQR 2) were compared to age- and sex-matched healthy controls (n = 30) across tests of ankle proprioception and plantarflexor muscle performance. Proprioceptive tests: detection of passive movement, reaction time and ankle joint position sense. Plantarflexor performance: strength, fatigue, recovery and voluntary activation (level of neural drive) of the plantarflexor muscles, assessed through brief and sustained fatiguing (2 min) isometric maximal voluntary contractions with nerve stimulation to evoke superimposed and resting muscle twitches. RESULTS PwMS had unimpaired movement detection and joint position sense but had a slower reaction time to respond with plantarflexion to an imposed ankle movement (between group difference = 0.11 [95% CI; 0.05 to 0.17] s). During brief, maximal contractions PwMS produced lower torque (difference = -25.1 [-42.0 to -8.2] Nm) with reduced voluntary activation (difference = -14.6 [-25.1 to -4.1]%) but no impairment of the muscle itself (resting twitch torque difference = 0.3 [-2.8 to 2.2] Nm). At the end of the fatiguing contraction, neural drive decreased for PwMS (-19.5 [-27.1 to -11.9]%, p <0.0001) but not for controls (-2.5 [-6.9 to 1.8]%, p = 0.242). Fatigue did not affect the resting twitch size for controls (-1.3 [-2.7 to -0.03] Nm, p = 0.134) or PwMS (-0.1 [-1.1 to 1.0] Nm, p = 0.90). CONCLUSIONS PwMS showed no deficit in their ability to sense ankle position or imposed movements but were slow when a motor response was required. Their plantarflexor muscles produced similar torque with electrical stimulation but voluntary strength was impaired. Both groups experienced overall fatigue following the 2-minute maximal voluntary contraction but PwMS also had significantly reduced neural drive indicating central fatigue. PwMS showed mainly central deficits in motor output at the ankle with little impairment of proprioceptive acuity.
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Affiliation(s)
| | | | - Jack Brooks
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - David S Kennedy
- Neuroscience Research Australia, Sydney, NSW, Australia; Graduate School of Health, Physiotherapy, University of Technology Sydney, Australia.
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, NSW, Australia; University of New South Wales, Sydney, Australia.
| | - Janet L Taylor
- Neuroscience Research Australia, Sydney, NSW, Australia; Edith Cowan University, Joondalup, Perth, WA, Australia.
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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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Odom AD, Richmond SB, Fling BW. White Matter Microstructure of the Cerebellar Peduncles Is Associated with Balance Performance during Sensory Re-Weighting in People with Multiple Sclerosis. THE CEREBELLUM 2020; 20:92-100. [PMID: 32970313 DOI: 10.1007/s12311-020-01190-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 11/30/2022]
Abstract
People with multiple sclerosis (PwMS) exhibit impaired balance during different sensory environments and poor cerebellar peduncle microstructure. We aimed to examine associations between microstructures of the superior, middle and inferior cerebellar peduncles (CP) with visual, vestibular, and proprioceptive-based balance in PwMS. Twenty-seven PwMS and twenty-nine healthy controls (HC) underwent MRI and balance assessments. We assessed CP microstructure with radial diffusivity (RD) and fractional anisotropy (FA) and balance with center of pressure-derived measures of path length and root mean square of sway during proprioceptive (C2), visual (C3), and vestibular (C4) balance conditions of the modified clinical test of sensory integration on balance (mCTSIB). PwMS exhibited significantly lower FA (p < 0.001) and greater RD (p < 0.001) across all CP and greater path length (p < 0.05) in the mCTSIB compared with HC. In PwMS, significant associations were detected between inferior CP white matter microstructure and proprioceptive-based balance control (rho = -0.43, p < 0.05) and middle CP white matter microstructure and visual-based balance control (rho = 0.39, p < 0.05). PwMS may rely more on cerebellar-regulated proprioceptive- and visual-based balance control than HC.
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Affiliation(s)
- Arianna D Odom
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, 80526, USA
| | - Sutton B Richmond
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, 80526, USA
| | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, 80526, USA.
- Molecular, Cellular, and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO, 80526, USA.
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Miehm JD, Buonaccorsi J, Lim J, Sato S, Rajala C, Averill J, Khalighinejad F, Ionete C, Jones SL, Kent JA, van Emmerik RE. Sensorimotor function in progressive multiple sclerosis. Mult Scler J Exp Transl Clin 2020; 6:2055217320934835. [PMID: 32944271 PMCID: PMC7466899 DOI: 10.1177/2055217320934835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A sensitive test reflecting subtle sensorimotor changes throughout disease progression independent of mobility impairment is currently lacking in progressive multiple sclerosis. OBJECTIVES We examined non-ambulatory measures of upper and lower extremity sensorimotor function that may reveal differences between relapsing-remitting and progressive forms of multiple sclerosis. METHODS Cutaneous sensitivity, proprioception, central motor function and mobility were assessed in 32 relapsing-remitting and 31 progressive multiple sclerosis patients and 30 non-multiple sclerosis controls. RESULTS Cutaneous sensation differed between relapsing-remitting and progressive multiple sclerosis at the foot and to a lesser extent the hand. Proprioception function in the upper but not the lower extremity differed between relapsing-remitting and progressive multiple sclerosis, but was different for both upper and lower extremities between multiple sclerosis patients and non-multiple sclerosis controls. Foot-tap but not hand-tap speed was slower in progressive compared to relapsing-remitting multiple sclerosis, suggestive of greater central motor function impairment in the lower extremity in progressive multiple sclerosis. In addition, the non-ambulatory sensorimotor measures were more sensitive in detecting differences between relapsing-remitting and progressive multiple sclerosis than mobility assessed with the 25-foot walk test. CONCLUSION This study provides novel information about changes in sensorimotor function in progressive compared with relapsing-remitting forms of multiple sclerosis, and in particular the importance of assessing both upper and lower extremity function. Importantly, our findings showed loss of proprioceptive function in multiple sclerosis but also in progressive compared to relapsing-remitting multiple sclerosis.
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Affiliation(s)
- Jules D Miehm
- Department of Kinesiology, University of Massachusetts Amherst, USA
| | - John Buonaccorsi
- Department of Mathematics and Statistics, University of Massachusetts Amherst, USA
| | - Jongil Lim
- Department of Health and Kinesiology, Texas A&M University, San Antonio, USA
| | - Sumire Sato
- Neuroscience and Behavior Program, University of Massachusetts Amherst, USA
| | - Caitlin Rajala
- Department of Kinesiology, University of Massachusetts Amherst, USA
| | - Julianna Averill
- Department of Kinesiology, University of Massachusetts Amherst, USA
| | - Farnaz Khalighinejad
- Department of Neurology, University of Massachusetts Worcester Memorial Medical Center, USA
| | - Carolina Ionete
- Department of Neurology, University of Massachusetts Worcester Memorial Medical Center, USA
| | | | - Jane A Kent
- Department of Kinesiology, University of Massachusetts Amherst, USA
| | - Richard Ea van Emmerik
- Department of Kinesiology, University of Massachusetts, USA.,Neuroscience and Behavior Program, University of Massachusetts Amherst, USA
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Inojosa H, Schriefer D, Trentzsch K, Klöditz A, Ziemssen T. Visual Feedback and Postural Control in Multiple Sclerosis. J Clin Med 2020; 9:jcm9051291. [PMID: 32365769 PMCID: PMC7288335 DOI: 10.3390/jcm9051291] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 01/07/2023] Open
Abstract
As people with multiple sclerosis (pwMS) manifest heterogeneous demyelinating lesions that could affect somatosensory or vestibular ways, visual stimulus as feedback could be especially relevant to achieve postural control. This has clinical importance for the development of preventive measures and rehabilitation therapies in order to avoid falls and accidents in this group. In our study, we objectively evaluated the influence of visual feedback on the stabilization of balance in pwMS versus healthy controls (HC) and its potential utility in clinical evaluation. Static posturography tests were performed in 99 pwMS and 30 HC. Subjects stood on a force platform with open and closed eyes. During this procedure, three balance parameters were obtained for both vision conditions: average sway, average speed, and average speed of sway. Neurostatus-Expanded Disease Disability Score (EDSS) and Multiple Sclerosis Functional Composite (MSFC) were performed in parallel as well. A two-way mixed repeated measures ANCOVA, controlling for sex and age, was performed to evaluate the effect of vision, MS diagnosis, and the interaction of both in static posturography parameters. The difference between both closed and open eyes conditions was calculated for each parameter and further analyzed according to MS-relevant clinical variables. The magnitude of the vision effect differed between pwMS and HC as a significant interaction between the vision and the MS diagnosis in the delineated area (p < 0.001) and average speed of sway (p = 0.001) was seen. These parameters had a greater increase in pwMS than in HC after closing eyes. For the average sway, a significant main effect of vision was present (p = 0.047). Additionally, the differences obtained between open and closed eyes conditions assessed with the delineated area and average speed of sway were moderately correlated to the assessed clinical tests EDSS (r = 0.405 and r = 0.329, respectively) and the MSFC (r = −0.385 and r = −0.259, respectively). In our study, pwMS were more dependent of visual feedback than HC to maintain postural control. This easy and short evaluation by static posturography could support the development of targeted preventive measures and interventions in pwMS.
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Dogru Huzmeli E, Duman T. Somatosensory impairments in patients with multiple sclerosis: association with dynamic postural control and upper extremity motor function. Somatosens Mot Res 2020; 37:117-124. [PMID: 32295464 DOI: 10.1080/08990220.2020.1753685] [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: 10/24/2022]
Abstract
Purpose: We planned this study to bring attention to the somatosensory impairments in patients with multiple sclerosis (PwMS) and to investigate relationship of somatosensory impairments with dynamic postural stability and upper extremity motor function.Methods: Seven males and 23 females, 30 patients with mean EDSS 2.9 (SD = 1.4), aged between 18 and 65 years (mean = 41.43 ± 14.90 years) were included in this clinical study. Light touch sensorial assessment was made with Semmes Weinstein monofilament test and proprioception by distal proprioception test. Hand strength was measured by the Jamar dynamometer, fine motor skill was examined with nine-hole peg test, functional reach test in sitting and standing position was applied. Nottingham Extended Activities of Daily Living Scale (NEADLS) was used to measure everyday activities.Results: We found a negative and moderate correlation between FRT in standing and light touch of the middle of the heel (right: -0.515), metatarsal bone (right r: 0.453, left r: -0.426), and medial of the foot (right r: -0.462). There was a negative and moderate correlation between NEADLS and light touch of the metatarsal bone (right r: -0.564, left r: -0.472), medial of the foot (right r: -0.531, left r: -0.479), and lateral of the foot (right r: -0.526). We found a positive and moderate correlation between proprioception of the ankle (right r: 0.421 left r: 0.588) and NEADLS.Conclusions: We found impairment in light touch and proprioception and, associations between sensorial functions and dynamic postural stability in PwMS. Also impaired sensorial functions cause dependent patients in daily living activities. In the assessment of balance and falling risk, independency in daily living activities; foot light touch and proprioception sense should be taken into account, hence it may provide guidance in planning rehabilitation programmes.Abbreviations: MS: multiple sclerosis; PwMS: patients with multiple sclerosis; VAS: visual analogue scale; FRT: functional reach test; 9-HPT: Nine-hole peg test; EDSS: The Expanded Disability Status Scale; NEADLS: Nottingham Extended Activities of Daily Living Scale.
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Affiliation(s)
- Esra Dogru Huzmeli
- Physiotherapy and Rehabilitation, Department, Health Science Faculty, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Taskin Duman
- Neurologia Department, Tayfur Ata Sokmen Medicine Faculty, Hatay Mustafa Kemal University, Hatay, Turkey
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40
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Selgrade BP, Meyer D, Sosnoff JJ, Franz JR. Can optical flow perturbations detect walking balance impairment in people with multiple sclerosis? PLoS One 2020; 15:e0230202. [PMID: 32155225 PMCID: PMC7064213 DOI: 10.1371/journal.pone.0230202] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/24/2020] [Indexed: 12/04/2022] Open
Abstract
People with multiple sclerosis (PwMS) who exhibit minimal to no disability are still over twice as likely to fall as the general population and many of these falls occur during walking. There is a need for more effective ways to detect preclinical walking balance deficits in PwMS. Therefore, the purpose of this study was to investigate the effects of optical flow perturbations applied using virtual reality on walking balance in PwMS compared to age-matched controls. We hypothesized that susceptibility to perturbations–especially those in the mediolateral direction–would be larger in PwMS compared to controls. Fourteen PwMS and fourteen age-matched controls walked on a treadmill while viewing a virtual hallway with and without optical flow perturbations in the mediolateral or anterior-posterior directions. We quantified foot placement kinematics, gait variability, lateral margin of stability and, in a separate session, performance on the standing sensory organization test (SOT). We found only modest differences between groups during normal, unperturbed walking. These differences were larger and more pervasive in the presence of mediolateral perturbations, evidenced by higher variability in step width, sacrum position, and margin of stability at heel-strike in PwMS than controls. PwMS also performed worse than controls on the SOT, and there was a modest correlation between step width variability during perturbed gait and SOT visual score. In conclusion, mediolateral optical flow perturbations revealed differences in walking balance in PwMS that went undetected during normal, unperturbed walking. Targeting this difference may be a promising approach to more effectively detect preclinical walking balance deficits in PwMS.
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Affiliation(s)
- Brian P. Selgrade
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States of America
| | - Diane Meyer
- UNC Healthcare, UNC Center for Rehabilitation Care, Chapel Hill, NC, United States of America
| | - Jacob J. Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, IL, United States of America
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States of America
- * E-mail:
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41
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Inojosa H, Schriefer D, Klöditz A, Trentzsch K, Ziemssen T. Balance Testing in Multiple Sclerosis-Improving Neurological Assessment With Static Posturography? Front Neurol 2020; 11:135. [PMID: 32174886 PMCID: PMC7057229 DOI: 10.3389/fneur.2020.00135] [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: 12/12/2019] [Accepted: 02/06/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Balance problems can severely limit the quality of life for people with Multiple Sclerosis (pwMS) already in the early stages of the disease. PwMS are usually assessed with the Expanded Disability Status Scale (EDSS), which includes a Romberg test for assessing balance. As the EDSS assessments are subjective to the examining neurologist, the postural stability of pwMS could be objectively quantified by implementing static posturography to detect balance problems and address preventive medical care. Methods: In this cross-sectional study, we added static posturography to the neurological EDSS examination in pwMS and healthy subjects to determine how this technique could supply additional information during the evaluation of the cerebellar functional system of the neurostatus EDSS as clinical outcome already in early disease stages. Static posturography was performed with subjects standing on a force platform while outcome variables such as delineated area, average speed and average sway were obtained. Unpaired t-test as well as (Welch's) analysis of variance (ANOVA) with pairwise post-hoc comparisons according to Games-Howell were used. Spearman rank correlations were implemented to study associations of balance outcomes with EDSS-associated outcomes. Results: A total of 99 pwMS (mean age: 35.01 years; EDSS median: 2.0, 68.69% females) and 30 healthy subjects (mean age: 34.03 years; 70% females) were enrolled. PwMS had worse performances in the three evaluated balance parameters than the healthy group (all p < 0.001). Even patients without postural instability as documented in the Romberg test score of the EDSS assessment showed significantly worse outcome regarding the delineated area [+1.97 cm2, 95%-CI (0.61-3.34); p = 0.002] vs. healthy controls. Similar results were observed for the comparison between pwMS with normal cerebellar function EDSS-systems and healthy subjects. There were significant correlations with the EDSS, cerebellar function score and Romberg test for the delineated area and average speed (r's ranging from 0.330 to 0.537, p < 0.001). Conclusions: Static posturography can complement neurological assessment of EDSS as an objective and quantitative test, especially for MS patients in early stages of the disease.
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Affiliation(s)
- Hernan Inojosa
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
| | - Dirk Schriefer
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
| | - Antonia Klöditz
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
| | - Katrin Trentzsch
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
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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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43
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Iandolo R, Bommarito G, Falcitano L, Schiavi S, Piaggio N, Mancardi GL, Casadio M, Inglese M. Position Sense Deficits at the Lower Limbs in Early Multiple Sclerosis: Clinical and Neural Correlates. Neurorehabil Neural Repair 2020; 34:260-270. [PMID: 32028846 DOI: 10.1177/1545968320902126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background/Objective. Position sense, defined as the ability to identify joint and limb position in space, is crucial for balance and gait but has received limited attention in patients with multiple sclerosis (MS). We investigated lower limb position sense deficits, their neural correlates, and their effects on standing balance in patients with early MS. Methods. A total of 24 patients with early relapsing-remitting MS and 24 healthy controls performed ipsilateral and contralateral matching tasks with the right foot during functional magnetic resonance imaging. Corpus callosum (CC) integrity was estimated with diffusion tensor imaging. Patients also underwent an assessment of balance during quiet standing. We investigated differences between the 2 groups and the relations among proprioceptive errors, balance performance, and functional/structural correlates. Results. During the contralateral matching task, patients demonstrated a higher matching error than controls, which correlated with the microstructural damage of the CC and with balance ability. In contrast, during the ipsilateral task, the 2 groups showed a similar matching performance, but patients displayed a functional reorganization involving the parietal areas. Neural activity in the frontoparietal regions correlated with the performance during both proprioceptive matching tasks and quiet standing. Conclusion. Patients with early MS had subtle, clinically undetectable, position sense deficits at the lower limbs that, nevertheless, affected standing balance. Functional changes allowed correct proprioception processing during the ipsilateral matching task but not during the more demanding bilateral task, possibly because of damage to the CC. These findings provide new insights into the mechanisms underlying disability in MS and could influence the design of neurorehabilitation protocols.
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Affiliation(s)
- Riccardo Iandolo
- RBCS Department , Istituto Italiano di Tecnologia, Genova, Italy
- Department of Informatics, Bioengeneering, Robotics and System Engineering (DIBRIS), University of Genoa, Italy
| | - Giulia Bommarito
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, (DINOGMI) University of Genova, Italy
| | - Laura Falcitano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, (DINOGMI) University of Genova, Italy
| | - Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, (DINOGMI) University of Genova, Italy
| | - Niccolò Piaggio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, (DINOGMI) University of Genova, Italy
| | - Giovanni Luigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, (DINOGMI) University of Genova, Italy
| | - Maura Casadio
- RBCS Department , Istituto Italiano di Tecnologia, Genova, Italy
- Department of Informatics, Bioengeneering, Robotics and System Engineering (DIBRIS), University of Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, (DINOGMI) University of Genova, Italy
- Ospedale Policlinico San Martino-IRCCS, Genova, Italy
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Fang Q, Ghanouni P, Anderson SE, Touchett H, Shirley R, Fang F, Fang C. Effects of Exergaming on Balance of Healthy Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Games Health J 2020; 9:11-23. [PMID: 31800322 DOI: 10.1089/g4h.2019.0016] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Balance is critical for older adults to perform daily activities. However, age-related declines in balance increase the risk of falls and severe injuries, such as bone fractures and head injuries. Exergames have been widely applied to improve health-related outcomes in older adults. This meta-analysis aims to quantify the effects of exergaming interventions on balance performance in healthy older adults. A literature search was performed using PubMed, ScienceDirect, SPORTDiscus, COCHRANE, EBSCO, and EMBASE. A total of 16 experimental studies met inclusion criteria for a full-text review. Data synthesis examined balance functions, including static, dynamic, proactive, and perceived balance abilities when performing daily activities. Intervention protocols of the reviewed studies included an average of two to three 40-minute exergaming sessions per week for 8 weeks. A random effects model identified significant effects in favor of the exergaming group, with moderate effect size in dynamic balance (Hedges' g = 0.36, 95% CI = 0.26-1.30, P < 0.001), and perceived balance (Hedges' g = 0.31, 95% CI = 0.04-0.58, P = 0.02); and considerable effect size in Chair Stand Test (Hedges' g = 0.78, 95% CI = 0.26-1.30, P = 0.003), and balance test batteries (Hedges' g = 0.72, 95% CI = 0.42-1.02, P < 0.001). No significant effect was found in the static balance (Hedges' g = 0.22, 95% CI = -0.31 to 0.76, P = 0.42), or proactive balance (Hedges' g = 0.54, 95% CI = -0.12 to 1.20, P = 0.11). Meta-analysis identified exergaming-associated benefits in older adults' balance function and confidence. This finding supports the feasibility of exergaming as a supplementary approach to improve balance for healthy older adults. Health professionals may optimize treatment effect by integrating exergaming sessions into a traditional balance exercise program.
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Affiliation(s)
- Qun Fang
- Department of Kinesiology, Mississippi State University, Mississippi State, Mississippi
| | - Parisa Ghanouni
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia
| | - Sarah E Anderson
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Hilary Touchett
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas
| | - Rebekah Shirley
- Department of Kinesiology, Mississippi State University, Mississippi State, Mississippi
| | - Fang Fang
- Rehabilitation Center, Qing Dao Fu Wai Hospital, Qingdao, China
| | - Chao Fang
- Department of Pharmacology, the Fourth Military Medical University, Xi'an, China
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Gera G, Fling BW, Horak FB. Cerebellar White Matter Damage Is Associated With Postural Sway Deficits in People With Multiple Sclerosis. Arch Phys Med Rehabil 2020; 101:258-264. [DOI: 10.1016/j.apmr.2019.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/25/2019] [Accepted: 07/06/2019] [Indexed: 10/26/2022]
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Yang F, Liu X. Relative importance of vision and proprioception in maintaining standing balance in people with multiple sclerosis. Mult Scler Relat Disord 2019; 39:101901. [PMID: 31918240 DOI: 10.1016/j.msard.2019.101901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Balance impairment is common and a risk factor of falls in people with multiple sclerosis (MS). The purpose of this study was to evaluate the relative importance between vision and proprioception in maintaining standing body balance among individuals with MS compared with healthy individuals. METHODS Thirty people with MS (the mean ± standard deviation of the Patient Determined Disability Steps: 3.62 ± 1.67 out of 8) and 25 healthy adults participated in this cross-sectional study. They underwent a static posturography test, consisting of three sensory feedback conditions: eyes open on a firm surface, eyes closed on a firm surface, and eyes open on a compliant surface. Their standing balance performance, quantified by the 95% confidence ellipse area and the total length of the center of pressure trajectory during each sensory condition, was calculated based on the ground reaction force data. The Romberg's quotient (the ratio of the center of pressure measurements on the firm surface between eyes open and eyes closed conditions) and proprioception quotient (the ratio of the center of pressure measurements with eyes open between firm and compliant standing surfaces) were calculated and compared between groups. RESULTS Persons with MS demonstrated significantly larger postural sway under all three sensory conditions than their healthy counterparts. The reliance on the vision and proprioception systems in maintaining body balance was greater among people with MS compared to healthy adults. Both groups similarly relied more on the proprioceptive input to keep body balance than on the vision. CONCLUSIONS Like healthy individuals, persons with MS rely more on proprioception to maintain body balance than vision. Our findings could provide preliminary reference for optimizing balance improving programs aimed at person with MS.
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Affiliation(s)
- Feng Yang
- Department of Kinesiology and Health, Georgia State University, 125 Decatur St, Suite-137, Atlanta, GA 30303, USA.
| | - Xinyue Liu
- School of Mathematics, Georgia Institute of Technology, Atlanta, USA
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Massot C, Guyot MA, Donze C, Simoneau E, Gillet C, Leteneur S. Ankle dysfunction in multiple sclerosis and the effects on walking. Disabil Rehabil 2019; 43:2454-2463. [PMID: 31854195 DOI: 10.1080/09638288.2019.1702726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Even in the early stage of the disease, for patients suffering from multiple sclerosis (MS), the most common and reported biomechanical alterations in the lower limb are located at the ankle joint. However, the effects of these impairments on gait deterioration should be discussed. MATERIALS AND METHODS This review was written according to the PRISMA guidelines. The search focussed on biomechanical changes (kinetic, kinematic, and electromyographic data) at the ankle during gait in MS patients. The search was performed in the databases: Pubmed, Web of Science, and Cochrane Library. RESULTS Eleven studies were included. The reduction in the ankle range of motion (RoM) induced by increased cocontractions of the tibialis anterior and triceps surae muscles could be a compensatory strategy to improve body-weight support and balance during the stance phase. CONCLUSIONS Future rehabilitation programmes should consider the control of weight support at the ankle during gait training.Implications for rehabilitationThe ankle supports and stabilises the body during the stance phase of gait.The reduced ankle range of motion in multiple sclerosis (MS), even at an early stage of the disease, is due to cocontractions of tibialis anterior and triceps surae and could be a compensatory strategy to be more stable.Rehabilitation programmes for MS patients should focus on the control of body segments motion during the weight transfer above the ankle.
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Affiliation(s)
- Caroline Massot
- Service de Médecine Physique et de Réadaptation, Hôpital Saint Philibert, Lomme, France
| | - Marc-Alexandre Guyot
- Service de Médecine Physique et de Réadaptation, Hôpital Saint Philibert, Lomme, France
| | - Cécile Donze
- Service de Médecine Physique et de Réadaptation, Hôpital Saint Philibert, Lomme, France
| | - Emilie Simoneau
- Université Lille Nord de France, Lille, France.,UPHF, LAMIH, Valenciennes, France.,CNRS, UMR, Valenciennes, France
| | - Christophe Gillet
- Université Lille Nord de France, Lille, France.,UPHF, LAMIH, Valenciennes, France.,CNRS, UMR, Valenciennes, France
| | - Sébastien Leteneur
- Université Lille Nord de France, Lille, France.,UPHF, LAMIH, Valenciennes, France.,CNRS, UMR, Valenciennes, France
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Whittier TT, Richmond SB, Monaghan AS, Fling BW. Virtual time-to-contact identifies balance deficits better than traditional metrics in people with multiple sclerosis. Exp Brain Res 2019; 238:93-99. [DOI: 10.1007/s00221-019-05698-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
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Swanson CW, Fling BW. Associations between Turning Characteristics and Corticospinal Inhibition in Young and Older Adults. Neuroscience 2019; 425:59-67. [PMID: 31765624 DOI: 10.1016/j.neuroscience.2019.10.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 01/12/2023]
Abstract
The effects of aging are multifaceted including deleterious changes to the structure and function of the nervous system which often results in reduced mobility and quality of life. Turning while walking (dynamic) and in-place (stable) are ubiquitous aspects of mobility and have substantial consequences if performed poorly. Further, turning is thought to require higher cortical control compared to bouts of straight-ahead walking. This study sought to understand how relative amounts of corticospinal inhibition as measured by transcranial magnetic stimulation and the cortical silent period within the primary motor cortices are associated with various turning characteristics in neurotypical young (YA) and older adults (OA). In the current study, OA had reduced peak turn velocity and increased turn duration for both dynamic and stable turns. Further, OA demonstrated significantly reduced corticospinal inhibition within the right motor cortex. Finally, all associations between corticospinal inhibition and turning performance were specific to the right hemisphere, reflecting that those OA who maintained high levels of inhibition performed turning similar to their younger counterparts. These results compliment the right hemisphere model of aging and lateralization specification of cortically regulated temporal measures of dynamic movement. While additional investigations are required, these pilot findings provide an additional understanding as to the neural control of dynamic movements.
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Affiliation(s)
- Clayton W Swanson
- Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Brett W Fling
- Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, USA; Molecular, Cellular, and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO, USA.
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Sensory nerve stimulation causes an immediate improvement in motor function of persons with multiple sclerosis: A pilot study. Mult Scler Relat Disord 2019; 38:101508. [PMID: 31715503 DOI: 10.1016/j.msard.2019.101508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/26/2019] [Accepted: 11/04/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) symptoms reported in the first year of the disease include sensory impairment, fatigue, reduced mobility, and declines in hand function. The progressive reduction in motor function experienced by persons living with MS is invariably preceded by changes in sensory processing, which are strongly associated with the declines in both walking performance and manual dexterity. AIMS To assess the influence of concurrent sensory stimulation using augmented transcutaneous electrical nerve stimulation (aTENS) applied to leg and hand muscles on clinical tests of motor function in individuals whose mobility was compromised by MS. METHODS Thirteen persons with MS (52 ± 8 years; 6 women) and 12 age- and sex-matched healthy adults (52 ± 9 years) met the inclusion criteria. Participants visited the lab on two occasions with one week between visits. Each visit involved the participant performing four tests of motor function and completing two health-related questionnaires (PDDS and MSWS-12). The tests assessed walking performance (6-min test and 25-ft test), dynamic balance (chair-rise tes, and manual dexterity (grooved pegboard test). aTENS was applied through pads attached to the limbs over the tibialis anterior and rectus femoris muscles of the affected leg, and over the median nerve and the thenar eminence of the dominant hand. The pads were attached during both visits, but the current was only applied during the second visit. The stimulation comprised continuous asymmetrical biphasic pulses (0.2 ms) at a rate of 50 Hz and an intensity that elicited slight muscle contractions. RESULTS At baseline and during both treatment sessions, the performance on all four tests of motor function was worse for the MS group than the Control group. The MS group experienced significant improvements in all outcomes during the aTENS session with medium-to-large effect sizes. PDDS ratings improved (from 2.8 ± 1.3 to 2.0 ± 1.5; effect size d = -0.70) and the MSWS-12 scores declined (from 36 ± 11 to 28 ± 12; effect size d = -1.52). The concurrent application of aTENS enabled the MS group to walk further during the 6-min test (from 397 ± 174 m to 415 ± 172 m; effect size d = 0.81), to complete the 25-ft test in less time (6.7 ± 3.0 s to 6.3 ± 2.9 s; effect size d = -0.76), to increase the counts in the chair-rise test (from 11.2 ± 3.8 to 13.6 ± 4.8; effect size d = 1.52), and to perform the grooved pegboard test more quickly (from 110 ± 43 s to 99 ± 37 s; effect size d = -0.98). The only significant effect for the Control group was a significant increase in the 6-min walk distance (from 725 ± 79 to 740 ± 82 m; effect size d = 0.87). CONCLUSIONS Stimulation of sensory fibers with aTENS evoked clinically significant improvements in four tests of motor function and the self-reported level of walking limitations in persons who were moderately disabled by MS. Moreover, the improvements in function elicited by the concurrent application of aTENS were immediate.
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