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Mañago MM, Will R, Strahler T, Van Valkenburgh L, Harris-Love MO, Forster JE, Cameron M, Christiansen CL. Blood Flow Restriction and Veterans With Multiple Sclerosis and Advanced Disability: Protocol for a Randomized Controlled Trial. Phys Ther 2024; 104:pzae037. [PMID: 38452199 DOI: 10.1093/ptj/pzae037] [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: 11/20/2023] [Accepted: 03/06/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE The purpose of this study will be to determine the efficacy of low intensity lower extremity resistance training with and without blood flow restriction (BFR) on quadriceps muscle strength and thickness in veterans with advanced multiple sclerosis (MS). METHODS This will be an assessor-blinded, 2-group (1 to 1 allocation) randomized controlled trial targeting an enrollment of 58 participants with advanced MS as defined by Patient-Determined Disease Steps scale levels 4 to 7. Both groups will complete 10 weeks of twice weekly low-load resistance training (20%-30% of 1-repetition max) targeting knee and hip extension, knee flexion, and ankle plantarflexion. The intervention group will perform all training using BFR, with limb occlusion pressures between 60% and 80% of maximal limb occlusion pressure. Primary outcomes will be quadriceps muscle strength and thickness. Secondary outcomes will include knee flexion and ankle plantarflexion strength, functional mobility, physical activity, and patient-reported measures. All outcomes will be assessed at baseline before the intervention, immediately after the intervention, and at a 2-month follow-up assessment. The change between groups postintervention and after the 2-month follow-up will be reported for all outcomes. All analyses will assume a 2-sided test of hypothesis (α = .05). IMPACT There is very little evidence for the efficacy of exercise interventions in people with MS who have advanced mobility disability. Resistance training with BFR may be an important approach for people with advanced MS who may not tolerate more conventional, moderate-to-high intensity resistance training. The results of this study will inform clinicians regarding exercise decisions for people with advanced MS and future investigations on the role of BFR in people with MS.
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Affiliation(s)
- Mark M Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Robert Will
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Talia Strahler
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Lauren Van Valkenburgh
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Michael O Harris-Love
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Data and Statistical Core, Aurora, Colorado, USA
| | - Michelle Cameron
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
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Brown AJ, Rachal Sant L. Blood flow restriction training for an individual with relapsing-remitting multiple sclerosis: a case report. Physiother Theory Pract 2024; 40:161-169. [PMID: 35854431 DOI: 10.1080/09593985.2022.2100848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND PURPOSE Individuals with Multiple Sclerosis (MS) often present with weakness, poor balance, and increased fatigue that affects physical function. Blood flow restriction training (BFRt) is a popular treatment method to improve strength in orthopedic patients. However, research is limited on the use of BFRt for individuals with MS. This case report describes the effects of BFRt for an individual with relapsing-remitting MS (RRMS). CASE DESCRIPTION A 30-year-old female with RRMS presented to physical therapy (PT) with weakness and balance difficulty. Initial PT interventions were ineffective at improving balance and strength to achieve specific functional standing and balance goals. BFRt was introduced at reevaluation and performed 2×/week for 8 weeks. Activities-specific Balance Confidence Scale, Modified Fatigue Impact Scale, Berg Balance, strength, and 10-meter walk were assessed at 4 and 8 weeks. OUTCOMES Measures of strength and balance improved with the addition of BFRt and no adverse events occurred. The addition of BFRt resulted in a meaningful improvement in the individual's ability to achieve her standing and balance goals. DISCUSSION This case report describes the successful application of BFRt to improve function in an individual with RRMS. Further research is warranted for the use of BFRt for individuals with MS.
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Affiliation(s)
- April J Brown
- Physical Therapy, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Lauren Rachal Sant
- Physical Therapy, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Mañago MM, Cohen ET, Alvarez E, Hager ER, Owens JG, Bade M. Feasibility of Low-Load Resistance Training Using Blood Flow Restriction for People With Advanced Multiple Sclerosis: A Prospective Cohort Study. Phys Ther 2024; 104:pzad135. [PMID: 37815934 PMCID: PMC10822774 DOI: 10.1093/ptj/pzad135] [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: 01/10/2023] [Revised: 06/03/2023] [Accepted: 08/05/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE The objective of this study was to determine the feasibility of low-load resistance training with blood flow restriction (BFR) for people with advanced disability due to multiple sclerosis (MS). METHODS In this prospective cohort study, 14 participants with MS (Expanded Disability Status Scale [EDSS] score = 6.0 to 7.0; mean age = 55.4 [SD = 6.2] years; 71% women) were asked to perform 3 lower extremity resistance exercises (leg press, calf press, and hip abduction) bilaterally twice weekly for 8 weeks using BFR. Feasibility criteria were as follows: enrollment of 20 participants, ≥80% retention and adherence, ≥90% satisfaction, and no serious adverse events related to the intervention. Other outcomes included knee extensor, ankle plantar flexor, and hip abductor muscle strength, 30-Second Sit-to-Stand Test, Berg Balance Scale, Timed 25-Foot Walk Test, 12-Item MS Walking Scale, Modified Fatigue Impact Scale, Patient-Specific Functional Scale, and daily step count. RESULTS Sixteen participants consented, and 14 completed the intervention, with 93% adherence overall. All participants were satisfied with the intervention. A minor hip muscle strain was the only intervention-related adverse event. There were muscle strength improvements on the more-involved (16%-28%) and less-involved (12%-19%) sides. There were also changes in the 30-Second Sit-to-Stand Test (1.9 repetitions; 95% CI = 1.0 to 2.8), Berg Balance Scale (5.3 points; 95% CI = 3.2 to 7.4), Timed 25-Foot Walk Test (-3.3 seconds; 95% CI = -7.9 to 1.3), Modified Fatigue Impact Scale (-8.8 points; 95% CI = -16.5 to -1.1), 12-Item MS Walking Scale (-3.6 points; 95% CI = -11.5 to 4.4), Patient-Specific Functional Scale (2.9 points; 95% CI = 1.9 to 3.8), and daily step count (333 steps; 95% CI = -191 to 857). CONCLUSION Low-load resistance training using BFR in people with MS and EDSS scores of 6.0 to 7.0 appears feasible, and subsequent investigation into its efficacy is warranted. IMPACT Although efficacy data are needed, combining BFR with low-load resistance training may be a viable alternative for people who have MS and who do not tolerate conventional moderate- to high-intensity training because of more severe symptoms, such as fatigue and weakness. LAY SUMMARY Low-load strength training with BFR was feasible in people who have advanced disability due to MS. Using BFR may provide an alternative for people with MS who do not tolerate higher intensity training due to more severe symptoms, such as fatigue and weakness.
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Affiliation(s)
- Mark M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Evan T Cohen
- Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Enrique Alvarez
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Emily R Hager
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | | | - Michael Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
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Mañago MM, Seamon BA, Boncella KL, Wallin MT, Maloni H, Hoover B, Blackman MR, Harris-Love MO. Ultrasound measures of muscle morphology in people with multiple sclerosis are associated with muscle performance and functional mobility. Mult Scler Relat Disord 2023; 75:104759. [PMID: 37192587 PMCID: PMC10330594 DOI: 10.1016/j.msard.2023.104759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Neurologically-based muscle weakness is a common symptom in people with multiple sclerosis MS (MS), who may also exhibit muscle morphology changes and intrinsic muscle dysfunction. Diagnostic ultrasound (sonography) is a non-invasive, inexpensive, and clinically feasible method to measure muscle morphology. The purpose of this study was to investigate possible asymmetries in lower limb muscle morphology and performance in people with MS, and to assess the relationships of muscle morphology measures with individual patient characteristics, muscle performance, and functional mobility. METHODS This cross-sectional study was conducted at the Washington, DC Veterans Affairs Medical Center. The study participants were 29 Veterans with MS (52% female, 79% African-American, 48.6 ± 11.2 years old, Mean Expanded Disability Status Scale: 3.6 ± 1.4) who completed seated knee extension isokinetic strength and power tests, functional assessments (Timed 25-Foot Walk - T25FW, 5-Times Sit-to-Stand - 5STS), and quantitative B-mode ultrasound image acquisition of the rectus femoris muscle to derive morphology measures (thickness and echogenicity). The limb with weaker knee extension strength was identified as the more-involved limb. Differences between the more and less-involved limb were quantified using a t-test for all muscle morphology and muscle performance measures. Relationships between muscle morphology and patient characteristics, muscle performance, and functional mobility were evaluated using bivariate and multivariate analyses. RESULTS The rectus femoris thickness from the more-involved limb was lower (p<0.001) than that of the less-involved limb, whereas echogenicity was not different between the two limbs (p=0.147). Rectus femoris thickness of the more-involved limb was directly related to age (r=-0.63, p<0.001), muscle strength (r=0.53, p=0.003) and power (r=0.53, p=0.003), and gait speed (r=0.42, p=0.024); whereas its echogenicity was positively associated only with muscle strength (r=-0.46, p=0.013) and power (r=-0.50, p=0.006). Together rectus femoris thickness and echogenicity of the more involved limb explained 44% and 48% of the variance in muscle strength and power, respectively (p<0.001). CONCLUSION This study supports the ability of sonography to measure muscle morphology in people with MS, identify asymmetries, and quantify associations with important clinical correlates. Compared with more invasive and costly alternatives, sonography is a clinically feasible, relatively low-cost tool that can be used to assess muscle morphology in people with MS. Further research is warranted to determine the potential clinical utility of sonographic measures of muscle morphology in evaluating changes due to disease progression or therapeutic interventions in this population.
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Affiliation(s)
- Mark M Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; VA Research Service, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.
| | - Bryant A Seamon
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA; Muscle Morphology, Mechanics and Performance Lab, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Research Service, Washington DC VA Medical Center, Washington, DC, USA
| | - Katie L Boncella
- Muscle Morphology, Mechanics and Performance Lab, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mitchell T Wallin
- VA Multiple Sclerosis Center of Excellence and Neurology Service, Washington DC VA Medical Center, Washington, DC, USA
| | - Heidi Maloni
- VA Multiple Sclerosis Center of Excellence and Neurology Service, Washington DC VA Medical Center, Washington, DC, USA
| | - Brian Hoover
- Muscle Morphology, Mechanics and Performance Lab, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Research Service, Washington DC VA Medical Center, Washington, DC, USA
| | - Marc R Blackman
- Research Service, Washington DC VA Medical Center, Washington, DC, USA; Departments of Medicine and Rehabilitation Medicine, Georgetown University, Washington, DC, USA; Department of Medicine, George Washington University, Washington, DC, USA
| | - Michael O Harris-Love
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; VA Research Service, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA; Muscle Morphology, Mechanics and Performance Lab, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Research Service, Washington DC VA Medical Center, Washington, DC, USA; Geriatric Service, Washington DC VA Medical Center, Washington, DC, USA
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Jawad A, Baattaiah BA, Alharbi MD, Chevidikunnan MF, Khan F. Factors contributing to falls in people with multiple sclerosis: The exploration of the moderation and mediation effects. Mult Scler Relat Disord 2023; 76:104838. [PMID: 37390785 DOI: 10.1016/j.msard.2023.104838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/12/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The prevalence of multiple sclerosis (MS) has significantly increased in recent decades. People with MS have a high risk of falling; these falls may lead to serious injuries, affecting their quality of life PURPOSE: The aim of this study is to assess the factors affecting falls in people with MS and map out the most significant ones. This study also aims to determine whether fatigue has a moderation effect and balance has a mediation effect on falls in people with MS METHODS: In total, 103 people with MS with a mean age of 32.09 ± 7.17 were enrolled. All subjects were assessed for multiple variables including balance using the Berg Balance Scale (BBS), speed of gait using the Timed Up and Go (TUG) test, fear of falling using the Falls Efficacy Scale-International (FES-I), level of fatigue using the Modified Fatigue Impact Scale (MFIS), and lower limb muscle strength using a handheld digital dynamometer RESULTS: Simple binary logistic regression analysis showed significant results for BBS (OR: 10.88; 95% CI: 4.24-27.96; p < 0.0001), TUG (OR: 1.18; 95% CI: 1.09-1.28; p < 0.0001), FES-I (OR: 1.06; 95% CI: 1.02-1.10; p = 0.001), and MFIS (OR: 1.04; 95% CI: 1.02-1.07; p < 0.0001) as factors affecting falls. According to multivariate analysis, balance (OR: 3.924; 95% CI: 1.307-11.780, p = 0.015), speed of gait (OR: 1.122; 95% CI: 1.023-1.231; p = 0.015), and fatigue (OR: 1.029; 95% CI: 1.002-1.058; p = 0.038) were the strongest predicting factors of falls. Hayes's PROCESS analysis showed that fatigue had a significant moderation effect on the relationship between gait speed and falls (MFIS; β; 0.10; p < 0.0001; 95% CI: 0.07-0.14) and balance had a mediation effect on the relationship between gait speed and falls (BBS; indirect effect; 0.08; 95% CI: 0.02-0.13) CONCLUSIONS: People with MS with impaired balance, slower gait speeds, higher levels of fatigue, and a fear of falling were at a high risk of falling. The relationship between gait speed and falls can be mediated by impaired balance and moderated by the level of fatigue. Our data suggest that targeting balance and fatigue while developing rehabilitation interventions could decrease the incidence of falls among people with MS.
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Affiliation(s)
- Adel Jawad
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia; Department of Physical Therapy, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Baian A Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Mutasim D Alharbi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Mohamed Faisal Chevidikunnan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia.
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Kline PW, Christiansen CL, Judd DL, Mañago MM. Clinical utility of the Trendelenburg Test in people with multiple sclerosis. Physiother Theory Pract 2023; 39:1016-1023. [PMID: 35073816 PMCID: PMC9536282 DOI: 10.1080/09593985.2022.2030446] [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: 02/28/2021] [Revised: 10/14/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The clinical utility of the Trendelenburg Test remains unknown in people with multiple sclerosis (MS). OBJECTIVE To measure (1) intra-rater reliability, (2) agreement of goniometer-assessed Trendelenburg pelvis-on-femur angle (POF) with motion capture, and (3) concurrent validity of Trendelenburg POF and hip abduction strength with POF during walking and step negotiation. METHODS Trendelenburg POF was measured in 20 people with MS using goniometry and motion analysis. In addition, peak POF was measured using motion analysis during walking, step ascent, and step descent. Intra-rater reliability of goniometer-assessed Trendelenburg POF and agreement with motion analysis-assessed POF were analyzed. Pearson's r was used to determine the relationships between Trendelenburg POF and hip abduction strength with peak POF during each functional activity. RESULTS Goniometer-assessed Trendelenburg POF demonstrated very strong reliability (ICC: 0.948), strong agreement with 3D motion analysis (ICC: 0.792), correlated moderately with peak POF during walking (r = 0.519) and step ascent (r = 0.572), and weakly with step descent (r = 0.463). Hip abductor strength correlated weakly with peak POF during step ascent (r = -0.307) and negligibly during walking (r = -0.270) and step descent (r = -0.249). CONCLUSIONS Goniometer-assessed Trendelenburg POF was reliable, agreed with motion analysis, and may provide insight into hip abduction muscle performance during functional activities in people with MS.
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Affiliation(s)
- Paul W. Kline
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC United States
| | - Cory L. Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
| | - Dana L. Judd
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States
| | - Mark M Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus Aurora, CO, United States
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Neurorehabilitation in Multiple Sclerosis-A Review of Present Approaches and Future Considerations. J Clin Med 2022; 11:jcm11237003. [PMID: 36498578 PMCID: PMC9739865 DOI: 10.3390/jcm11237003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Multiple sclerosis is an increasingly prevalent disease, representing the leading cause of non-traumatic neurological disease in Europe and North America. The most common symptoms include gait deficits, balance and coordination impairments, fatigue, spasticity, dysphagia and an overactive bladder. Neurorehabilitation therapeutic approaches aim to alleviate symptoms and improve the quality of life through promoting positive immunological transformations and neuroplasticity. The purpose of this study is to evaluate the current treatments for the most debilitating symptoms in multiple sclerosis, identify areas for future improvement, and provide a reference guide for practitioners in the field. It analyzes the most cited procedures currently in use for the management of a number of symptoms affecting the majority of patients with multiple sclerosis, from different training routines to cognitive rehabilitation and therapies using physical agents, such as electrostimulation, hydrotherapy, cryotherapy and electromagnetic fields. Furthermore, it investigates the quality of evidence for the aforementioned therapies and the different tests applied in practice to assess their utility. Lastly, the study looks at potential future candidates for the treatment and evaluation of patients with multiple sclerosis and the supposed benefits they could bring in clinical settings.
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Functional Performance, Leg Muscle Strength, and Core Muscle Endurance in Multiple Sclerosis Patients With Mild Disability: A Cross-Sectional Study. Motor Control 2022; 26:729-747. [PMID: 36068072 DOI: 10.1123/mc.2021-0129] [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: 11/22/2021] [Revised: 06/20/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022]
Abstract
This study aimed to investigate the relationship of sit-to-stand and walking performance with leg muscle strength and core muscle endurance in people with multiple sclerosis (PwMS) with mild disabilities. In this study, 49 PwMS (Expanded Disability Status Scale score = 1.59 ± 0.79) and 26 healthy controls were enrolled. The functional performances, including sit-to-stand and walking performances, were evaluated with the five-repetition sit-to-stand test, timed up and go test, and 6-min walking test. The PwMS finished significantly slower five-repetition sit-to-stand, timed up and go, and 6-min walking test than the healthy controls. In addition, the significant contributors were the weakest trunk lateral flexor endurance for five-repetition sit-to-stand; the Expanded Disability Status Scale score, and the weakest hip adductor muscle for timed up and go; the weakest hip extensor muscles strength for 6-min walking test. The functional performances in PwMS, even with mild disabilities, were lower compared with healthy controls. Decreases in both leg muscle strength and core muscle endurance are associated with lower functional performance in PwMS.
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Rahimibarghani S, Azadvari M, Emami-Razavi SZ, Harirchian MH, Rahimi-Dehgolan S, Fateh HR. Effects of Nonconsecutive Sessions of Transcranial Direct Current Stimulation and Stationary Cycling on Walking Capacity in Individuals With Multiple Sclerosis. Int J MS Care 2022; 24:202-208. [PMID: 36090241 PMCID: PMC9461723 DOI: 10.7224/1537-2073.2021-004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
BACKGROUND Exercise has been demonstrated to be safe and well-tolerated in individuals with multiple sclerosis (MS). Physical activity has been shown to enhance the therapeutic effects of transcranial direct current stimulation (tDCS). This study aimed to determine the efficacy of intermittent tDCS combined with riding a stationary bicycle to improve walking capacity in individuals with MS. METHODS This double-blind randomized controlled trial enrolled 50 eligible participants. Thirty-nine participants completed the study: 21 in the active group and 18 in the control group. Participants were assigned randomly to exercise on a stationary bike in conjunction with anodal tDCS or to exercise combined with a sham tDCS protocol. Walking capacity tests (2-Minute Walk Test, 5-Meter Walk Test, Timed Up and Go test), manual muscle testing, the Fatigue Severity Scale, and the Multiple Sclerosis Quality of Life-54 were used to determine outcomes. RESULTS In terms of observed changes in 2-Minute Walk Test and 5-Meter Walk Test values, the exercise + tDCS group achieved significantly higher posttreatment values than the exercise + sham tDCS group. After the intervention and 1 month later, the intervention group's mean Timed Up and Go test value decreased significantly (P = .002) compared with that of the control group. There was no difference in Fatigue Severity Scale score, Multiple Sclerosis Quality of Life-54 score, or manual muscle testing improvement between the 2 groups. CONCLUSIONS Nonconsecutive sessions of anodal tDCS combined with stationary cycling may have a greater effect on the walking capacity of individuals with MS than exercise alone.
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Affiliation(s)
- Sarvenaz Rahimibarghani
- From the Physical Medicine and Rehabilitation Department (SR, MA, SZE-R, SR-D, HRF), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohaddeseh Azadvari
- From the Physical Medicine and Rehabilitation Department (SR, MA, SZE-R, SR-D, HRF), Tehran University of Medical Sciences, Tehran, Iran
| | - Seyede Zahra Emami-Razavi
- From the Physical Medicine and Rehabilitation Department (SR, MA, SZE-R, SR-D, HRF), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Harirchian
- From the Iranian Center of Neurological Research, Neuroscience Institute (MHH), Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Rahimi-Dehgolan
- From the Physical Medicine and Rehabilitation Department (SR, MA, SZE-R, SR-D, HRF), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid R. Fateh
- From the Physical Medicine and Rehabilitation Department (SR, MA, SZE-R, SR-D, HRF), Tehran University of Medical Sciences, Tehran, Iran
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Mañago MM, Kline PW, Harris-Love MO, Christiansen CL. The Validity of the Single-Leg Heel Raise Test in People With Multiple Sclerosis: A Cross-Sectional Study. Front Neurol 2021; 12:650297. [PMID: 34354656 PMCID: PMC8333614 DOI: 10.3389/fneur.2021.650297] [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: 01/19/2021] [Accepted: 06/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The single-leg heel raise test is a common clinical assessment; however, little is known about its validity in people with multiple sclerosis (MS). This study investigated the validity of the single-leg heel raise test in a group of people with MS and a healthy control group (CTL). Materials and Methods: Twenty-one people with MS (49 ± 12 years, Expanded Disability Status Scale 1.5–5.5) and 10 healthy controls (48 ± 12 years) performed the single-leg heel raise test, ankle plantarflexion isometric strength assessment using electromechanical dynamometry, and mobility measures (Timed 25-Foot Walk, 2-Min Walk Test, Functional Stair Test). Results: Convergent validity between the heel raise test and strength was moderate for participants with MS completing <20 heel raises (r = 0.63, p = 0.001) but weak for the entire sample (r = 0.30, p = 0.020). Compared to the average CTL group values, the heel raise test differentiated between groups on the MS groups' weaker (p < 0.001) and stronger (p = 0.003) limbs, while strength only differentiated between groups on the weaker limb (p = 0.010). Considering the weaker and strong limbs from the MS group and the CTL group average values, the mobility measures had moderate-to-strong correlations with the heel raise test on the weaker MS limb + CTL (r = 0.71–0.78) and stronger MS limb + CTL (r = 0.62–0.70), and weak-to-moderate correlations with strength on the weaker MS limb + CTL (r = 0.49–0.58, p = 0.001–0.007). Discussion: In people with MS, the single-leg heel raise test may be clinically useful as it identified impaired muscle performance and differentiated muscle performance from a healthy control group and, together with the control group, correlated with functional mobility.
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Affiliation(s)
- Mark M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical, Aurora, CO, United States.,Department of Neurology, School of Medicine, University of Colorado Anschutz Medical, Aurora, CO, United States.,Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
| | - Paul W Kline
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical, Aurora, CO, United States.,Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States.,Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, United States
| | - Michael O Harris-Love
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical, Aurora, CO, United States.,Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical, Aurora, CO, United States.,Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
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11
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Moreno-Navarro P, Manca A, Martinez G, Ventura L, Barbado D, Vera-García FJ, Deriu F. Test-Retest Reliability and Known-Groups Validity of Trunk Muscle Tests in People With Multiple Sclerosis: A Cross-Sectional, Case-Control Study. Phys Ther 2021; 101:6128528. [PMID: 33538837 DOI: 10.1093/ptj/pzab049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/25/2020] [Accepted: 11/29/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Research on muscle performance testing reliability in people with multiple sclerosis (MS) has focused on limb performance while less is known about trunk strength and endurance. This work aims to 1) establish test-retest reliability of trunk flexion, lateral flexion, and extension strength tests, and plank, side bridge, and Biering-Sørensen endurance tests in people with MS and matched healthy controls (HCs); 2) analyze known-groups validity of these tests in people with MS and HCs; 3) to compare groups for side-to-side differences; and 4) to describe the relationships between trunk performance and functional mobility tests. METHODS Fifteen people with MS (median Expanded Disability Status Scale = 3) and 15 HCs underwent 2 trunk isometric strength and endurance testing sessions. Mobility was evaluated by Timed Up-and-Go test. Intraclass correlation coefficient, SEM, and minimal detectable change (MDC) were calculated. Between-group differences in trunk performance were tested using the t test for independent measures. Between-group differences in an asymmetry index were analyzed by independent t test. Bivariate correlations between trunk tests and mobility were also examined. RESULTS All trunk tests showed good-to-excellent relative reliability in both groups (intraclass correlation coefficient > 0.71). Regarding absolute reliability, strength tests were associated with low intersession variability in both groups (MDC: MS, 11.23%-36.45%; HCs, 26.60%-31.98%). Conversely, endurance tests showed higher variability scores in people with MS (MDC: MS, 69.55%-116.50%; HCs, 29.57%-54.40%). People with MS displayed significantly lower trunk performance. Likewise, the asymmetry index showed significantly higher scores in people with MS for endurance assessment but not in strength tests. Significant correlations were detected in people with MS between Timed Up-and-Go and several trunk tests (r = 0.63-0.70). CONCLUSIONS SEM and MDC scores revealed similar consistency and variability between groups for strength tests, whereas higher variability was observed for endurance tests in people with MS. Trunk strength tests are reliable and present discriminant validity to distinguish mildly disabled people with MS from HCs. Conversely, the high measurement error and variability of the endurance tests may hinder their application in intervention programs. IMPACT Determining the reliability and validity of the tests currently used to assess trunk function is of the greatest importance for people with MS (who show not only impaired trunk function but also wide fluctuations in performance), as it requires consistent and accurate measurements that are sensitive enough to detect minimal changes induced by rehabilitation.
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Affiliation(s)
- Pedro Moreno-Navarro
- Sports Research Centre, Department of Sport Sciences, Miguel Hernandez University of Elche, Alicante, Spain
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Italy
| | | | - Lucia Ventura
- Department of Biomedical Sciences, University of Sassari, Italy
| | - David Barbado
- Sports Research Centre, Department of Sport Sciences, Miguel Hernandez University of Elche, Alicante, Spain
| | - Francisco J Vera-García
- Sports Research Centre, Department of Sport Sciences, Miguel Hernandez University of Elche, Alicante, Spain
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Italy
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12
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Cohen ET, Cleffi N, Ingersoll M, Karpatkin HI. Blood-Flow Restriction Training for a Person With Primary Progressive Multiple Sclerosis: A Case Report. Phys Ther 2021; 101:6044313. [PMID: 33351952 DOI: 10.1093/ptj/pzaa224] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/17/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Blood flow restriction (BFR) training, in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb, coupled with low-intensity resistance training (LIRT) has resulted in gains comparable with traditional progressive resistive exercise in healthy populations. The use of BFR with LIRT may enable people with multiple sclerosis (MS) to improve strength without an increase in fatigue. The purpose of this case report is to describe the use of a BFR/LIRT program for a person with MS. METHODS The patient was a 54-year-old woman with a 13-year history of primary progressive MS with an Extended Disability Severity Score of 3.0 out of 10. She received a BFR/LIRT program for both lower extremities biweekly for 12 weeks. Outcomes measured at baseline and at 6 and 12 weeks included the 12-item Multiple Sclerosis Walking Scale (MSWS-12), Fatigue Severity Scale, Patient-Specific Functional Scale (PSFS) (goals: running for exercise and pleasure for 45 minutes, 100% confidence in negotiating a flight of stairs, confidently and safely drive without restriction), and 14 lower extremity strength tests. RESULTS The intervention was well tolerated without adverse events. After 6 weeks, the MSWS-12 score improved; however, it did not exceed minimum detectable change (MDC). Fatigue Severity Scale was unchanged. All PSFS goals improved beyond MDC, and improvements in strength exceeded MDC in 2 out of 14 tests. After 12 weeks, MSWS-12 improvements persisted and the Fatigue Severity Scale score improved, but neither exceeded MDC. The PSFS improvements persisted. There were improvements exceeding MDC for 8 out of 14 strength tests. The remaining 6 strength tests improved but did not exceed MDC. CONCLUSION The patient had measurable improvements following the use of a BFR/LIRT program. BFR/LIRT may be an option for strength training in people with MS; however, research is needed to determine its safety and effectiveness across the population of people with MS. IMPACT Traditional physical therapist interventions for people with MS have been shown to be beneficial; however, their usefulness has been limited by fatigue. A growing body of literature has demonstrated the effects of a BFR/LIRT program on strength and other measures of physical function in healthy populations and those with chronic disease. This case report adds missing information to the existing literature and suggests directions for research on the effectiveness of BFR/LIRT in people with primary progressive MS. LAY SUMMARY Blood flow restriction, which has been used to help improve strength in healthy adults and in some people with chronic disease, applies pressure around the arm or leg to limit the flow of blood to that body part during exercise, helping to reduce fatigue. Blood flow restriction coupled with low-intensity strengthening exercises can be used for a person with MS.
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Affiliation(s)
- Evan T Cohen
- Rutgers, The State University of New Jersey, Blackwood, New Jersey, USA
| | - Nicole Cleffi
- RWJ Sports Physical Therapy, Princeton, New Jersey, USA
| | | | - Herb I Karpatkin
- Hunter College - City University of New York, New York, New York, USA
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13
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Maugeri G, D’Agata V, Roggio F, Cortis C, Fusco A, Foster C, Mañago MM, Harris-Love MO, Vleck V, Piacentini MF, Musumeci G. The "Journal of Functional Morphology and Kinesiology" Journal Club Series: PhysioMechanics of Human Locomotion. J Funct Morphol Kinesiol 2020; 5:52. [PMID: 32935069 PMCID: PMC7489281 DOI: 10.3390/jfmk5030052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/23/2022] Open
Abstract
We are glad to introduce the Third Journal Club of Volume five, the third issue. This edition is focused on relevant studies published in the last years in the field of PhysioMechanics of Human Locomotion, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for the Sports Medicine and Movement Sciences seen also from the scientific point of view. The Editorial Board members wish you an inspiring lecture.
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Affiliation(s)
- Grazia Maugeri
- Department of Biomedical and Biotechnological Sciences, Anatomy, Histology and Movement Sciences Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (G.M.); (V.D.); (F.R.)
| | - Velia D’Agata
- Department of Biomedical and Biotechnological Sciences, Anatomy, Histology and Movement Sciences Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (G.M.); (V.D.); (F.R.)
| | - Federico Roggio
- Department of Biomedical and Biotechnological Sciences, Anatomy, Histology and Movement Sciences Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (G.M.); (V.D.); (F.R.)
| | - Cristina Cortis
- Department of Human Sciences, Society and Health, University of Cassino and Lazio Meridionale, 03043 Cassino, Italy; (C.C.); (A.F.)
| | - Andrea Fusco
- Department of Human Sciences, Society and Health, University of Cassino and Lazio Meridionale, 03043 Cassino, Italy; (C.C.); (A.F.)
| | - Carl Foster
- Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA;
| | - Mark M. Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO 80045, USA; (M.M.M.); (M.O.H.-L.)
| | - Michael O. Harris-Love
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO 80045, USA; (M.M.M.); (M.O.H.-L.)
- Geriatric Research, Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO 80045, USA
| | - Veronica Vleck
- CIPER, Faculdade de Motricidade Humana, University of Lisbon, 1499-002 Lisbon, Portugal;
| | - Maria Francesca Piacentini
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy;
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Anatomy, Histology and Movement Sciences Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (G.M.); (V.D.); (F.R.)
- Research Center on Motor Activities (CRAM), University of Catania, 95123 Catania, Italy
- Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
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14
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Knak KL, Sheikh AM, Andersen H, Witting N, Vissing J. Intrarater reliability and validity of outcome measures in myotonic dystrophy type 1. Neurology 2020; 94:e2508-e2520. [PMID: 32457208 DOI: 10.1212/wnl.0000000000009625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/05/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate intrarater reliability and concurrent and construct validity of muscle strength, balance, and functional mobility measures in individuals with noncongenital myotonic dystrophy type 1 (DM1). METHODS Seventy-eight adults with noncongenital DM1 participated in visit 1, and 73 of the them participated in visit 2 separated by 1 to 2 weeks. The assessments consisted of muscle strength tests with handheld dynamometry (HHD) and stationary dynamometry in the lower limb. The balance tests consisted of the step test, Timed Up and Go test, feet-together stance, tandem stance, 1-leg stance, and modified Clinical Test of Sensory Integration and Balance on a balance platform. The functional mobility tests consisted of the 10-m walk test (10mWT) and 10-times Sit-to-Stand test. RESULTS The HHD and stationary dynamometry had sufficient intrarater reliability for most muscle groups on a group (SEM% ≤15%) and individual (minimal detectable difference [MDD95%] ≤30%) level, but the HHD was most reliable. Stationary dynamometry measured a higher torque than HHD for all extensor muscles, but for single individuals, none of the devices were favored. Overall, intrarater reliability and validity were sufficient only for the dynamic balance tests, not the static balance tests. Both functional mobility tests were sufficiently reliable and valid, but the 10mWT was most reliable. CONCLUSION Overall, HHD is recommended as a reliable and valid tool for single individuals and for flexor muscles on a group level. For balance assessments, the dynamic balance tests are recommended as the most valid and reliable balance tests. Both functional mobility tests are recommended for valid and reliable outcomes, but the 10mWT was superior for reliability.
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Affiliation(s)
- Kirsten L Knak
- From the Department of Neurology (K.L.K., A.M.S., N.W., J.V.), Rigshospitalet, Copenhagen; and Department of Neurology (H.A.), Aarhus University Hospital, Denmark.
| | - Aisha M Sheikh
- From the Department of Neurology (K.L.K., A.M.S., N.W., J.V.), Rigshospitalet, Copenhagen; and Department of Neurology (H.A.), Aarhus University Hospital, Denmark
| | - Henning Andersen
- From the Department of Neurology (K.L.K., A.M.S., N.W., J.V.), Rigshospitalet, Copenhagen; and Department of Neurology (H.A.), Aarhus University Hospital, Denmark
| | - Nanna Witting
- From the Department of Neurology (K.L.K., A.M.S., N.W., J.V.), Rigshospitalet, Copenhagen; and Department of Neurology (H.A.), Aarhus University Hospital, Denmark
| | - John Vissing
- From the Department of Neurology (K.L.K., A.M.S., N.W., J.V.), Rigshospitalet, Copenhagen; and Department of Neurology (H.A.), Aarhus University Hospital, Denmark
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15
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Moreno-Navarro P, Gomez-Illán R, Carpena-Juan C, P. Sempere Á, Vera-Garcia FJ, Barbado D. Understanding the Deterioration of Gait, Postural Control, Lower Limb Strength and Perceived Fatigue Across the Disability Spectrum of People with Multiple Sclerosis. J Clin Med 2020; 9:E1385. [PMID: 32397278 PMCID: PMC7290682 DOI: 10.3390/jcm9051385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 02/07/2023] Open
Abstract
Disability progression is a prominent feature of multiple sclerosis (MS). However, little is known about the extent to which physical condition parameters and perceived fatigue evolve during the disease. We analyzed how strength, balance, core stability and perceived fatigue differ among different cohorts of people with MS (PwMS) with different disability degrees and how these contribute to patients' gait speed and functional mobility. Sixty-three PwMS divided into three groups according to the "Expanded Disability Status Scale" (MS1: EDSS ≤ 1.5; MS2: 2 ≤ EDSS ≤ 3.5; MS3: 4 ≤ EDSS ≤ 6) and 22 healthy controls (HC) participated in this study. MS1 showed lower balance and hip strength compared to HC. MS2 showed lower balance, core stability, gait speed, and functional mobility than MS1. MS3 showed lower gait speed, functional mobility, balance, and knee flexion strength than MS2. No between-group differences were observed in perceived fatigue. Relative weight analysis showed that strength, balance and core stability explained 60%-70% of the variance in gait speed and functional mobility. The decline of each parameter did not evolve at the same rate across the different stages of the disease, being knee flexion strength and balance the most influential factors in the disability progression. Overall, these results provide useful information to guide exercise prescription at different stages of MS.
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Affiliation(s)
- Pedro Moreno-Navarro
- Department of Sports Science, Miguel Hernández University of Elche, 03202 Elche, Spain; (P.M.-N.); (R.G.-I.); (C.C.-J.); (F.J.V.-G.)
| | - Ramón Gomez-Illán
- Department of Sports Science, Miguel Hernández University of Elche, 03202 Elche, Spain; (P.M.-N.); (R.G.-I.); (C.C.-J.); (F.J.V.-G.)
| | - Carmen Carpena-Juan
- Department of Sports Science, Miguel Hernández University of Elche, 03202 Elche, Spain; (P.M.-N.); (R.G.-I.); (C.C.-J.); (F.J.V.-G.)
| | - Ángel P. Sempere
- Department of Clinical Medicine, Miguel Hernández University of Elche, 03550 San Juan de Alicante, Spain;
- Department of Neurology, University General Hospital of Alicante, 03010 Alicante, Spain
| | - Francisco J. Vera-Garcia
- Department of Sports Science, Miguel Hernández University of Elche, 03202 Elche, Spain; (P.M.-N.); (R.G.-I.); (C.C.-J.); (F.J.V.-G.)
| | - David Barbado
- Department of Sports Science, Miguel Hernández University of Elche, 03202 Elche, Spain; (P.M.-N.); (R.G.-I.); (C.C.-J.); (F.J.V.-G.)
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16
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Mañago MM, Kline PW, Alvarez E, Christiansen CL. Trunk and pelvis movement compensation in people with multiple sclerosis: Relationships to muscle function and gait performance outcomes. Gait Posture 2020; 78:48-53. [PMID: 32200163 DOI: 10.1016/j.gaitpost.2020.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Problems with gait are common in people with multiple sclerosis (MS), but little is known about pelvis and trunk kinematics, especially in the frontal plane. RESEARCH QUESTION Are pelvis and trunk kinematics in people with MS related to muscle function, spatiotemporal parameters, and gait performance? METHODS In this cross-sectional study, 20 people with MS (Expanded Disability Status Scale 1.5-5.5) and 10 people with comparable age and sex (CTL) underwent threedimensional gait analysis, muscle function assessments (hip and trunk strength and endurance), and gait performance measures (Timed 25-Foot Walk - T25FW, 2-Minute Walk Test - 2MWT). Frontal and sagittal plane pelvis and trunk excursion during the stance period of walking were compared between groups; and in the MS group, associations were determined between kinematic variables, muscle function, spatiotemporal parameters, and gait performance. RESULTS Compared to the CTL group, the MS group had significantly greater sagittal plane trunk and pelvis excursion for both the stronger (p = 0.031) and weaker (p = 0.042) sides; less frontal plane trunk and pelvis excursion for both the stronger (p = 0.008) and weaker (p = 0.024) sides; and more sagittal plane trunk excursion for the stronger side (p = 0.047) during stance phase. There were low-to-moderate correlations in the MS group for sagittal plane pelvis excursion with muscle function (p = 0.019 to 0.030), spatiotemporal parameters (p < 0.001 to 0.005), and gait performance (p = < 0.001 to 0.001). Using linear regression, frontal and sagittal plane pelvis excursion were significant predictors of both T25FW and 2MWT, explaining 34 % and 46 % of the variance of each gait performance measure, respectively. SIGNIFICANCE Rehabilitation interventions may consider addressing pelvis movement compensations in order to improve spatiotemporal parameters and gait performance in people with MS.
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Affiliation(s)
- M M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop C244, 13121 E 17th Ave., Room 3108, Aurora, CO, 80045, United States; Department of Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Aurora, CO, 80045, United States.
| | - P W Kline
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop C244, 13121 E 17th Ave., Room 3108, Aurora, CO, 80045, United States; Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, 1700 N Wheeling St., Aurora, CO, 80045, United States
| | - E Alvarez
- Department of Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Aurora, CO, 80045, United States
| | - C L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop C244, 13121 E 17th Ave., Room 3108, Aurora, CO, 80045, United States; Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, 1700 N Wheeling St., Aurora, CO, 80045, United States
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17
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Mañago MM, Callesen J, Dalgas U, Kittelson J, Schenkman M. Does disability level impact the relationship of muscle strength to walking performance in people with multiple sclerosis? a cross-sectional analysis. Mult Scler Relat Disord 2020; 42:102052. [PMID: 32240963 DOI: 10.1016/j.msard.2020.102052] [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: 01/03/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Strength training can improve muscle weakness in people with multiple sclerosis (MS), but does not consistently improve walking. Disability level may impact the relationship of muscle weakness and walking performance in people with MS, but few studies have investigated the impact of disability on the relationship of strength and walking. The purpose of this study was to compare the relationships of strength in lower body and trunk muscles to walking performance between mild and moderate disability groups in people with MS. METHODS Data from 36 participants with MS who had mild disability (Expanded Disability Status Scale - EDSS 0 to 3.5) and 36 participants who had moderate disability (EDSS 4.0 to 5.5) were analyzed. Hand-held dynamometry measured strength in eight muscle groups from the ankle, knee, hip, and trunk. Timed 25-Foot Walk (T25FW) and 6-Minute Walk Test (6MWT) measured walking speed and endurance, respectively. Pearson correlations and beta coefficients (ß) were reported for each bivariate relationship of muscle strength to T25FW and 6MWT from both mild and moderate disability groups. Linear regression was then used to compare differences in beta coefficients (Δß) between disability groups for the relationship of each muscle variable to T25FW and 6MWT. A positive Δß indicated a stronger relationship of strength to walking performance in the mild disability group, while a negative Δß favored the moderate disability group. RESULTS Overall, there were stronger Pearson correlations between muscle strength variables to T25FW and 6MWT in the mild (r = 0.57 to 0.77) compared to moderate disability group (r = 0.10 to 0.54). The mild disability group had significantly greater beta coefficients for T25FW with ankle dorsiflexion (Δß = 0.67, 95%CI: 0.27-1.07), knee extension (Δß = 0.68, 95%CI: 0.28-1.08), and hip abduction (Δß = 0.77, 95%CI: 0.01-1.52); and for 6MWT with knee extension (Δß = 0.47, 95%CI: 0.06 to 0.88). DISCUSSION AND CONCLUSION For people with MS, muscle strength in the lower extremity and trunk may be a more important contributor to T25FW in mild versus moderate disability, but not for 6MWT. While more studies are needed, these results may help to inform rehabilitation intervention when prioritizing strength training to improve walking.
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Affiliation(s)
- Mark M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora, CO.
| | - Jacob Callesen
- VIA University College, Faculty of Health Science, Department of Rehabilitation and Health Promotion Research; Aarhus University, Department of Public Health, Section of Sport Science
| | - Ulrik Dalgas
- Aarhus University, Department of Public Health, Section of Sport Science
| | - John Kittelson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Margaret Schenkman
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora, CO
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18
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Mañago MM, Cameron M, Schenkman M. Association of the Dynamic Gait Index to fall history and muscle function in people with multiple sclerosis. Disabil Rehabil 2019; 42:3707-3712. [PMID: 31050569 DOI: 10.1080/09638288.2019.1607912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background and purpose: This study examined the association of a commonly used gait assessment, the Dynamic Gait Index, with falls and lower extremity and trunk muscle function in people with multiple sclerosis.Materials and methods: Cross-sectional data from 72 people with multiple sclerosis (Expanded Disability Status Scale 3.5 ± 1.14) were used. The ability of the Dynamic Gait Index to identify fallers was evaluated using the receiver operating characteristic curve. Multiple linear regression determined contributions of muscle function variables to Dynamic Gait Index scores.Results: Thirty-seven participants reported at least one fall in the previous 3 months (51%). The area under the curve for the Dynamic Gait Index was 0.80 (95% CI: 0.69-0.90), indicating a good ability to identify fallers with a cutoff of ≤19/24. After adjusting for age, sex, and disability level, a one standard deviation increase in ankle plantarflexion (15.2 repetitions) and trunk flexion (15.1 repetitions) endurance were associated with an increase in Dynamic Gait Index score of 0.73 (95% CI: 0.07-1.39) and 0.62 (95% CI: 0.002-1.25), respectively.Conclusions: The Dynamic Gait Index may be a useful tool to identify fallers, and was associated with ankle plantarflexion and trunk flexion endurance.Implications for rehabilitationThe Dynamic Gait Index appears to be a useful tool to identify people with multiple sclerosis at increased risk for falls using a cutoff score of ≤19/24.The ability to do fewer than 13 single leg heel raises had a moderate ability to identify fallers in this study.Out of 11 lower extremity and trunk muscles, only ankle plantarflexion and trunk flexion muscle endurance were significant predictors of Dynamic Gait Index scores.Clinicians may consider targeting ankle plantarflexion and trunk muscle endurance to improve dynamic gait and fall risk in patients with multiple sclerosis.
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Affiliation(s)
- Mark M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Michelle Cameron
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA.,VA Portland Health Care System, Portland, OR, USA
| | - Margaret Schenkman
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora, CO, USA
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Mañago MM, Glick S, Hebert JR, Coote S, Schenkman M. Strength Training to Improve Gait in People with Multiple Sclerosis: A Critical Review of Exercise Parameters and Intervention Approaches. Int J MS Care 2019; 21:47-56. [PMID: 31049034 DOI: 10.7224/1537-2073.2017-079] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background There are mixed reports on the effectiveness of strength training to improve gait performance in people with multiple sclerosis (MS), yet the reasons for these inconsistent results are not clear. Therefore, a critical review was conducted to explore dosage, frequency, mode, position, and muscle targets of studies that have included strength training in people with MS. Methods An electronic search was conducted through July 2017. Randomized controlled trials involving people with MS were included that implemented strength training with or without other interventions and assessed 1) strength in the lower extremities and/or trunk and 2) gait speed and/or endurance. Strength and gait results were extracted, along with exercise frequency, intensity, duration, mode, position, and muscle targets. Results Thirteen trials met the inclusion criteria; nine used dosing consistent with recommended guidelines. Overall, six studies reported significant between-group strength improvements, and four reported within-group changes. Four studies reported significant between-group gait improvements for gait speed and/or endurance, and two reported within-group changes. Most exercises were performed on exercise machines while sitting, supine, or prone. The most common intervention target was knee extension. Conclusions Studies generally improved strength, yet only two studies reported potentially meaningful between-group changes in gait. Future strength intervention studies designed to improve gait might consider dosing beyond that of the minimum intensity to improve strength and explore muscles targets, positions, and modes that are task-specific to walking.
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Feasibility of a targeted strengthening program to improve gait in people with multiple sclerosis: a brief report. Int J Rehabil Res 2019; 41:364-367. [PMID: 30044244 DOI: 10.1097/mrr.0000000000000306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aims to determine feasibility of strengthening muscles that are important contributors to gait for people with multiple sclerosis, yet are not routinely targeted in the literature. An 8-week strengthening intervention targeted ankle plantarflexion, hip abduction, and trunk muscles using a repeated-measures design. Outcomes included satisfaction, adherence, muscle strength, gait speed (timed 25-foot walk), gait endurance (6-min walk test), and self-reported gait-related participation (Multiple Sclerosis Walking Scale-12). Ten participants (Expanded Disability Status Scale: 3.5-5.5) completed the intervention. All participants were at least 'satisfied'; adherence was 87% (supervised sessions) and 75% (home sessions). All quantitative measures improved: muscle strength (23.1-47.6%, P<0.001-0.039), timed 25-foot walk (-13.4%, P<0.001), 6-min walk test (41.56 m, P=0.019), and Multiple Sclerosis Walking Scale-12 (-10.5, P=0.007). Strengthening of ankle plantarflexion, hip abduction, and trunk muscles was feasible and associated with improvements in gait performance.
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Mañago MM, Hebert JR, Kittelson J, Schenkman M. Contributions of Ankle, Knee, Hip, and Trunk Muscle Function to Gait Performance in People With Multiple Sclerosis: A Cross-Sectional Analysis. Phys Ther 2018; 98:595-604. [PMID: 29660080 DOI: 10.1093/ptj/pzy048] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 04/05/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND The relative importance of lower extremity and trunk muscle function to gait in people with multiple sclerosis (MS) is unknown. OBJECTIVE This study aimed to investigate the association of lower extremity and trunk muscle function with gait performance in people who have MS and mild-to-moderate disability. DESIGN This was a cross-sectional, observational study. METHODS Participants were people who had an Expanded Disability Status Scale score of ≤ 5.5. Eleven lower extremity and trunk muscles were assessed using handheld dynamometry or endurance tests. Gait performance was assessed with the Timed 25-Foot (7.62 m) Walk (T25FW) and 6-Minute Walk Test (6MWT). Regression analysis was used to quantify the association between gait outcomes and muscle variables. RESULTS Seventy-two participants with MS and a mean Expanded Disability Status Scale score of 3.5 (SD = 1.14) were enrolled. Adjusted for age and sex, the multivariate model including hip abduction, ankle plantar flexion, trunk flexion, and knee flexion explained 57% of the adjusted variance in the T25FW; hip abduction, ankle plantar flexion, and trunk flexion explained 61% of the adjusted variance in the 6MWT. The strongest predictors were ankle plantar flexion endurance for the T25FW and hip abduction strength for the 6MWT: a 1-SD increase in ankle plantar flexion (15.2 heel-raise repetitions) was associated with a 0.33-second reduction in the T25WT (95% CI = - 0.71 to - 0.14 seconds); a 1-SD increase in normalized hip abduction strength (0.14 kg/body mass index) was associated with a 54.4-m increase in the 6MWT (28.99 to 79.81 m). LIMITATIONS Different measurement scales for independent variables were included because the muscle function assessment used either force or endurance. CONCLUSIONS For the major muscles in the lower extremity and trunk, hip abduction, ankle plantar flexion, trunk flexion, and knee flexion were the strongest predictors of gait performance.
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Affiliation(s)
- Mark M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora, Colorado, and Department of Rehabilitation, University of Colorado Hospital, 1635 Aurora Ct, Aurora, CO 80045
| | - Jeffrey R Hebert
- Department of Physical Medicine and Rehabilitation and Department of Neurology, School of Medicine, University of Colorado Denver, Aurora. Dr. Hebert is a multiple sclerosis certified specialist through the Consortium of MS Centers
| | - John Kittelson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora
| | - Margaret Schenkman
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora. Dr Schenkman is a Catherine Worthingham Fellow of the American Physical Therapy Association
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