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Hermle D, Schubert R, Barallon P, Ilg W, Schüle R, Reilmann R, Synofzik M, Traschütz A. Multifeature quantitative motor assessment of upper limb ataxia including drawing and reaching. Ann Clin Transl Neurol 2024; 11:1097-1109. [PMID: 38590028 DOI: 10.1002/acn3.52024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/18/2024] [Accepted: 02/03/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE Voluntary upper limb movements are an ecologically important yet insufficiently explored digital-motor outcome domain for trials in degenerative ataxia. We extended and validated the trial-ready quantitative motor assessment battery "Q-Motor" for upper limb movements with clinician-reported, patient-focused, and performance outcomes of ataxia. METHODS Exploratory single-center cross-sectional assessment in 94 subjects (46 cross-genotype ataxia patients; 48 matched controls), comprising five tasks measured by force transducer and/or position field: Finger Tapping, diadochokinesia, grip-lift, and-as novel implementations-Spiral Drawing, and Target Reaching. Digital-motor measures were selected if they discriminated from controls (AUC >0.7) and correlated-with at least one strong correlation (rho ≥0.6)-to the Scale for the Assessment and Rating of Ataxia (SARA), activities of daily living (FARS-ADL), and the Nine-Hole Peg Test (9HPT). RESULTS Six movement features with 69 measures met selection criteria, including speed and variability in all tasks, stability in grip-lift, and efficiency in Target Reaching. The novel drawing/reaching tasks best captured impairment in dexterity (|rho9HPT| ≤0.81) and FARS-ADL upper limb items (|rhoADLul| ≤0.64), particularly by kinematic analysis of smoothness (SPARC). Target hit rate, a composite of speed and endpoint precision, almost perfectly discriminated ataxia and controls (AUC: 0.97). Selected measures in all tasks discriminated between mild, moderate, and severe impairment (SARA upper limb composite: 0-2/>2-4/>4-6) and correlated with severity in the trial-relevant mild ataxia stage (SARA ≤10, n = 20). INTERPRETATION Q-Motor assessment captures multiple features of impaired upper limb movements in degenerative ataxia. Validation with key clinical outcome domains provides the basis for evaluation in longitudinal studies and clinical trial settings.
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Affiliation(s)
- Dominik Hermle
- Division Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
| | | | | | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, Tübingen, Germany
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany
| | - Rebecca Schüle
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Division of Neurodegenerative Disease, Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurodegenerative Diseases, Center of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ralf Reilmann
- George-Huntington-Institute, Münster, Germany
- Department of Neurodegenerative Diseases, Center of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Matthis Synofzik
- Division Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Andreas Traschütz
- Division Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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Keita M, McIntyre K, Rodden LN, Schadt K, Lynch DR. Friedreich ataxia: clinical features and new developments. Neurodegener Dis Manag 2022; 12:267-283. [PMID: 35766110 PMCID: PMC9517959 DOI: 10.2217/nmt-2022-0011] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/15/2022] [Indexed: 11/21/2022] Open
Abstract
Friedreich's ataxia (FRDA), a neurodegenerative disease characterized by ataxia and other neurological features, affects 1 in 50,000-100,000 individuals in the USA. However, FRDA also includes cardiac, orthopedic and endocrine dysfunction, giving rise to many secondary disease characteristics. The multifaceted approach for clinical care has necessitated the development of disease-specific clinical care guidelines. New developments in FRDA include the advancement of clinical drug trials targeting the NRF2 pathway and frataxin restoration. Additionally, a novel understanding of gene silencing in FRDA, reflecting a variegated silencing pattern, will have applications to current and future therapeutic interventions. Finally, new perspectives on the neuroanatomy of FRDA and its developmental features will refine the time course and anatomical targeting of novel approaches.
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Affiliation(s)
- Medina Keita
- Departments of Pediatrics & Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kellie McIntyre
- Departments of Pediatrics & Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Layne N Rodden
- Departments of Pediatrics & Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kim Schadt
- Departments of Pediatrics & Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David R Lynch
- Departments of Pediatrics & Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Romano A, Favetta M, Summa S, Schirinzi T, Bertini ES, Castelli E, Vasco G, Petrarca M. Upper Body Physical Rehabilitation for Children with Ataxia through IMU-Based Exergame. J Clin Med 2022; 11:jcm11041065. [PMID: 35207341 PMCID: PMC8876617 DOI: 10.3390/jcm11041065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Children with ataxia experience balance and movement coordination difficulties and needs intensive physical intervention to maintain functional abilities and counteract the disorder. Exergaming represents a valuable strategy to provide engaging physical intervention to children with ataxia, sustaining their motivation to perform the intervention. This paper aims to describe the effect of a home-conducted exergame-based exercise training for upper body movements control of children with ataxia on their ataxic symptoms, walking ability, and hand dexterity. Methods: Eighteen children with ataxia were randomly divided into intervention and control groups. Participants in the intervention group were asked to follow a 12-week motor activity program at home using the Niurion® exergame. Blind assessments of participants’ ataxic symptoms, dominant and non-dominant hand dexterity, and walking ability were conducted. Results: On average, the participants performed the intervention for 61.5% of the expected time. At the end of the training, participants in the intervention group showed improved hand dexterity that worsened in the control group. Conclusion: The presented exergame enhanced the participants’ hand dexterity. However, there is a need for exergames capable of maintaining a high level of players’ motivation in playing. It is advisable to plan a mixed intervention to take care of the multiple aspects of the disorder.
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Affiliation(s)
- Alberto Romano
- Movement Analysis and Robotics Laboratory (MAR Lab), Intensive Neurorehabilitation and Robotics Department, “Bambino Gesù” Children’s Hospital, IRCCS, 00050 Rome, Italy; (A.R.); (M.F.); (E.C.); (G.V.); (M.P.)
| | - Martina Favetta
- Movement Analysis and Robotics Laboratory (MAR Lab), Intensive Neurorehabilitation and Robotics Department, “Bambino Gesù” Children’s Hospital, IRCCS, 00050 Rome, Italy; (A.R.); (M.F.); (E.C.); (G.V.); (M.P.)
| | - Susanna Summa
- Movement Analysis and Robotics Laboratory (MAR Lab), Intensive Neurorehabilitation and Robotics Department, “Bambino Gesù” Children’s Hospital, IRCCS, 00050 Rome, Italy; (A.R.); (M.F.); (E.C.); (G.V.); (M.P.)
- Correspondence:
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Enrico Silvio Bertini
- Unit of Neuromuscolar and Neurodegenerative Diseases, Department of Neurosciences, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Enrico Castelli
- Movement Analysis and Robotics Laboratory (MAR Lab), Intensive Neurorehabilitation and Robotics Department, “Bambino Gesù” Children’s Hospital, IRCCS, 00050 Rome, Italy; (A.R.); (M.F.); (E.C.); (G.V.); (M.P.)
| | - Gessica Vasco
- Movement Analysis and Robotics Laboratory (MAR Lab), Intensive Neurorehabilitation and Robotics Department, “Bambino Gesù” Children’s Hospital, IRCCS, 00050 Rome, Italy; (A.R.); (M.F.); (E.C.); (G.V.); (M.P.)
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MAR Lab), Intensive Neurorehabilitation and Robotics Department, “Bambino Gesù” Children’s Hospital, IRCCS, 00050 Rome, Italy; (A.R.); (M.F.); (E.C.); (G.V.); (M.P.)
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Krishna R, Pathirana PN, Horne MK, Szmulewicz DJ, Corben LA. Objective Assessment of Progression and Disease Characterization of Friedreich Ataxia via an Instrumented Drinking Cup: Preliminary Results. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2365-2377. [PMID: 34727035 DOI: 10.1109/tnsre.2021.3124869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The monitoring of disease progression in certain neurodegenerative conditions can significantly be quantified with the help of objective assessments. The severity assessment of diseases like Friedreich ataxia (FRDA) are usually based on different subjective measures. The ability of a participant with FRDA to perform standard neurological tests is the most common way of assessing disease progression. In this feasibility study, an Ataxia Instrumented Measurement-Cup (AIM-C) is proposed to quantify the disease progression of 10 participants (mean age 39 years, onset of disease 16.3 years) in longitudinal timepoints. The device consists of a sensing system with the provision of extracting both kinetic and kinematic information while engaging in an activity closely associated with activities of daily living (ADL). A common functional task of simulated drinking was used to capture features that possesses disease progression information as well as certain other features which intrinsically correlate with commonly used clinical scales such as the modified Friedreich Ataxia Rating Scale (mFARS), the Functional Staging of Ataxia score and the ADL scale. Frequency and time-frequency domain features allowed the longitudinal assessment of participants with FRDA. Furthermore, both kinetic and kinematic measures captured clinically relevant features and correlated 85% with clinical assessments.
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Mueller A, Paterson E, McIntosh A, Praestgaard J, Bylo M, Hoefling H, Wells M, Lynch DR, Rummey C, Krishnan ML, Schultz M, Malanga CJ. Digital endpoints for self-administered home-based functional assessment in pediatric Friedreich's ataxia. Ann Clin Transl Neurol 2021; 8:1845-1856. [PMID: 34355532 PMCID: PMC8419399 DOI: 10.1002/acn3.51438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 01/18/2023] Open
Abstract
Background Friedreich’s ataxia is an inherited, progressive, neurodegenerative disease that typically begins in childhood. Disease severity is commonly assessed with rating scales, such as the modified Friedreich’s Ataxia Rating Scale, which are usually administered in the clinic by a neurology specialist. Objective This study evaluated the utility of home‐based, self‐administered digital endpoints in children with Friedreich’s ataxia and unaffected controls and their relationship to standard clinical rating scales. Methods In a cross‐sectional study with 25 participants (13 with Friedreich’s ataxia and 12 unaffected controls, aged 6–15 years), home‐based digital endpoints that reflect activities of daily living were recorded over 1 week. Domains analyzed were hand motor function with a digitized drawing, automated analysis of speech with a recorded oral diadochokinesis test, and gait and balance with wearable sensors. Results Hand‐drawing and speech tests were easy to conduct and generated high‐quality data. The sensor‐based gait and balance tests suffered from technical limitations in this study setup. Several parameters discriminated between groups or correlated strongly with modified Friedreich’s Ataxia Rating Scale total score and activities of daily living total score in the Friedreich’s ataxia group. Hand‐drawing parameters also strongly correlated with standard 9‐hole peg test scores. Interpretation Deploying digital endpoints in home settings is feasible in this population, results in meaningful and robust data collection, and may allow for frequent sampling over longer periods of time to track disease progression. Care must be taken when training participants, and investigators should consider the complexity of the tasks and equipment used.
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Affiliation(s)
- Arne Mueller
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Elaine Paterson
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | | | | | - Mary Bylo
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - Holger Hoefling
- NIBR Informatics, Novartis Institute of Biomedical Research, Basel, Switzerland
| | - McKenzie Wells
- Division of Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - David R Lynch
- Division of Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Michelle L Krishnan
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Meredith Schultz
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - C J Malanga
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
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Naeije G, Rovai A, Pandolfo M, De Tiège X. Hand Dexterity and Pyramidal Dysfunction in Friedreich Ataxia, A Finger Tapping Study. Mov Disord Clin Pract 2021; 8:85-91. [PMID: 33426162 DOI: 10.1002/mdc3.13126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/27/2020] [Accepted: 11/08/2020] [Indexed: 11/07/2022] Open
Abstract
Background Loss of hand dexterity has a profound impact on disability in patients with cerebellar, pyramidal, or extrapyramidal diseases. Analysis of multiple finger tapping (FT) parameters can contribute to identify the underlying physiopathology, while providing a quantitative clinical assessment tool, particularly in patients not reliably evaluated using clinical rating scales. Here, we used an automated method of FT analysis in Friedreich ataxia (FRDA) to disentangle cerebellar (prominent FT rate variability), extrapyramidal (FT progressive amplitude reduction without slowing of tapping rate), and pyramidal (progressive decrease of FT rate and amplitude) contribution to upper limb loss of dexterity. FT parameters were then related to FRDA clinical parameters and upper limbs motor evoked potential (MEPs). Methods Twenty-four FRDA patients and matched healthy subjects performed FT with the dominant hand for 90 seconds. FT rate, FT rate variability, FT amplitude, and linear regressions of FT movement parameters were automatically computed. Eleven patients underwent MEPs, measured at the first dorsal interosseous of the dominant hand to determine central motor conduction time (CMCT). Results FRDA patients had slower and more regular FT rate than controls. Eleven FRDA patients showed FT rate slowing. Those patients had longer disease duration and higher Scale for the Assessment and Rating of Ataxia (SARA) scores. Seven patients with FT rate slowing had MEP and all displayed prolonged CMCT, whereas the 4 other patients with constant FT rate had normal CMCT. Conclusion This study provides evidence for a prominent involvement of pyramidal dysfunction in upper limb dexterity loss as well as a potential outcome measure for clinical studies in FRDA.
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Affiliation(s)
- Gilles Naeije
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute Université libre de Bruxelles (ULB) Brussels Belgium
- Department of Neurology, CUB Hôpital Erasme Université libre de Bruxelles (ULB) Brussels Belgium
| | - Antonin Rovai
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute Université libre de Bruxelles (ULB) Brussels Belgium
| | - Massimo Pandolfo
- Department of Neurology, CUB Hôpital Erasme Université libre de Bruxelles (ULB) Brussels Belgium
- Laboratoire de Neurologie Expérimentale, ULB Neuroscience Institute Université libre de Bruxelles (ULB) Brussels Belgium
| | - Xavier De Tiège
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute Université libre de Bruxelles (ULB) Brussels Belgium
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Corben LA, Nguyen KD, Pathirana PN, Horne MK, Szmulewicz DJ, Roberts M, Delatycki MB. Developing an Instrumented Measure of Upper Limb Function in Friedreich Ataxia. THE CEREBELLUM 2021; 20:430-438. [PMID: 33400236 DOI: 10.1007/s12311-020-01228-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 11/26/2022]
Abstract
Upper limb function for people with Friedreich ataxia determines capacity to participate in daily activities. Current upper limb measures available do not fully capture impairments related to Friedreich ataxia. We have developed an objective measure, the Ataxia Instrumented Measure-Spoon (AIM-S), which consists of a spoon equipped with a BioKin wireless motion capture device, and algorithms that analyse these signals, to measure ataxia of the upper limb during the pre-oral phase of eating. The aim of this study was to evaluate the AIM-S as a sensitive and functionally relevant clinical outcome for use in clinical trials. A prospective longitudinal study evaluated the capacity of the AIM-S to detect change in upper limb function over 48 weeks. Friedreich ataxia clinical severity, performance on the Nine-Hole Peg Test and Box and Block Test and responses to a purpose-designed questionnaire regarding acceptability of AIM-S were recorded. Forty individuals with Friedreich ataxia and 20 control participants completed the baseline assessment. Thirty individuals with Friedreich ataxia completed the second assessment. The sensitivity of the AIM-S to detect deterioration in upper limb function was greater than other measures. Patient-reported outcomes indicated the AIM-S reflected a daily activity and was more enjoyable to complete than other assessments. The AIM-S is a more accurate, less variable measure of upper limb function in Friedreich ataxia than existing measures. The AIM-S is perceived by individuals with Friedreich ataxia to be related to everyday life and will permit individuals who are non-ambulant to be included in future clinical trials.
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Affiliation(s)
- Louise A Corben
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, 3052, Australia.
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.
- School of Psychological Sciences, Monash University, Clayton, Australia.
| | - Khoa D Nguyen
- School of Engineering, Deakin University, Waurn Ponds, Victoria, Australia
| | - Pubudu N Pathirana
- School of Engineering, Deakin University, Waurn Ponds, Victoria, Australia
| | - Malcolm K Horne
- Parkinson's Disease Laboratory, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - David J Szmulewicz
- Balance Disorders & Ataxia Service, Royal Victorian Eye & Ear Hospital, St Andrews Place, East Melbourne, Victoria, Australia
- Cerebellar Ataxia Clinic, Alfred Health, Caulfield, Australia
| | - Melissa Roberts
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, 3052, Australia
- Physiotherapy Department, Monash Health, Cheltenham, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- School of Psychological Sciences, Monash University, Clayton, Australia
- Victorian Clinical Genetics Services, Melbourne, Australia
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Measurements of Hand Function in Degenerative Cerebellar Disease: A Case-Control Pilot Study. Am J Phys Med Rehabil 2020; 99:795-800. [PMID: 32167956 DOI: 10.1097/phm.0000000000001411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The aim of the study was to determine the association of Nine Hole Peg Test, Box and Block Test, Jebsen-Taylor Hand Function Test, and kinematic measures of a simple reaching task with ataxia severity in adults with degenerative cerebellar disease. DESIGN Fourteen adults with cerebellar degeneration were recruited, and ataxia severity was determined using the Scale for the Assessment and Rating of Ataxia. The median Scale for the Assessment and Rating of Ataxia score was used to divide participants into less and more severe ataxia groups. The two groups' average scores on the hand function tests were compared, and correlation of each test with ataxia severity was determined. RESULTS The Nine Hole Peg Test, Box and Block Test, and Jebsen-Taylor Hand Function Test all differentiated between less and more severe ataxia groups, and the Nine Hole Peg Test performed with the participant's dominant hand had the highest correlation with ataxia severity (rs = 0.92, P < 0.01). Although accuracy, precision, and number of submovements were statistically different between healthy individuals and the more ataxic participant group, most kinematic measures were not significantly different between the less and more severe ataxic groups. CONCLUSION Overall, our results indicate that all three clinical tests correlate with ataxia severity. Larger future studies should examine the reliability and validity of these hand function measures in adults with degenerative cerebellar disease.
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Hutchinson MJ, Phillips JLK, Mason BS, Goosey-Tolfrey VL, Beckman EM. Measures of impairment applicable to the classification of Paralympic athletes competing in wheelchair sports: A systematic review of validity, reliability and associations with performance. J Sports Sci 2020; 39:40-61. [PMID: 32912039 DOI: 10.1080/02640414.2020.1815957] [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: 10/23/2022]
Abstract
A fundamental aspect of classification systems in Paralympic sport is having valid and reliable measures of impairment. However, minimal consensus exists for assessing impaired strength, coordination and range of motion. This review aimed to systematically identify measures of upper body strength, coordination and range of motion impairments that meet the requirements for use in evidence-based classification systems in wheelchair sports. Three electronic databases were searched from 2003 until 31 August 2019 for studies that assessed upper body function of participants and used a measurement tool that assessed strength, coordination or range of motion. The body of evidence for each identified measure was appraised using the Grading of Recommendations Assessment, Development and Evaluation framework. Twenty-three studies were included: ten measured strength and coordination, and six measured range of motion. There was "moderate" confidence in using isometric strength for assessing strength impairment. Tapping tasks for the assessment of coordination impairment received a "low" confidence rating. All other identified measures of coordination and range of motion impairment received a "very low" confidence rating. Several potential measures were identified for assessing upper body strength, coordination and range of motion impairments. Further research is warranted to investigate their use for classification in Paralympic wheelchair sports.
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Affiliation(s)
- Michael J Hutchinson
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Jamie-Lee K Phillips
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Barry S Mason
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Victoria L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emma M Beckman
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
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Nguyen KD, Corben LA, Pathirana PN, Horne MK, Delatycki MB, Szmulewicz DJ. The Assessment of Upper Limb Functionality in Friedreich Ataxia via Self-Feeding Activity. IEEE Trans Neural Syst Rehabil Eng 2020; 28:924-933. [DOI: 10.1109/tnsre.2020.2977354] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Arcuria G, Marcotulli C, Amuso R, Dattilo G, Galasso C, Pierelli F, Casali C. Developing an objective evaluating system to quantify the degree of upper limb movement impairment in patients with severe Friedreich's ataxia. Neurol Sci 2020; 41:1577-1587. [PMID: 31993871 DOI: 10.1007/s10072-020-04249-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/09/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The use of standardized tools and objective measurements is essential to test the effectiveness of new drugs or rehabilitative protocols. Friedreich's ataxia (FRDA) patients with severe disease are often unable to perform the quantitative measurement tests currently used. AIM The purpose of our study was to develop an easy-to-use application, for touchscreen devices, able to quantify the degree of upper limb movement impairment in patients with severe Friedreich's ataxia. The APP, which we named "Twelve-Red-Squares App-Coo-Test" (12-RSACT), assesses the upper limb ataxia by measuring the test execution time. METHODS All patients were clinically evaluated using the Composite Cerebellar Functional Severity (CCFS) and the Scale for the Assessment and Rating of Ataxia (SARA). We recruited 92 healthy subjects and 36 FRDA patients with a SARA mean value of 28.8.1 ± 8.2. All participants in our study underwent upper limb movement assessment using the new 12-RSACT, the Click Test, and a well-established system, i.e., the Nine-Hole Peg Test (9HPT). RESULTS We observed a strong linear correlation between the measurements obtained with the 12-RSACT and those obtained with 9HPT, Click Test, CCFS, and SARA. The 12-RSACT was characterized by excellent internal consistency and intra-rater and test-retest reliability. The minimal detectable change (MDC%) was excellent too. Additionally, the 12-RSACT turned out to be faster and easier to perform compared with the 9HPT. CONCLUSION The 12-RSACT is an inexpensive test and is easy to use, which can be administered quickly. Therefore, 12-RSACT is a promising tool to assess the upper limb ataxia in FRDA patients and even those with severe diseases.
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Affiliation(s)
- Giuseppe Arcuria
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza - University of Rome - Polo Pontino, Via Faggiana 34, 40100, Latina, Italy.
| | - Christian Marcotulli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza - University of Rome - Polo Pontino, Via Faggiana 34, 40100, Latina, Italy
| | - Raffaele Amuso
- Department of Science and Information Technology, I.I.S. Ettore Majorana, Piazza Sen. Marescalchi 2, Piazza Armerina, EN, Italy
| | - Giuliano Dattilo
- Department of Mathematical, Physical and Natural Sciences, University of Rome "Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Claudio Galasso
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza - University of Rome - Polo Pontino, Via Faggiana 34, 40100, Latina, Italy
| | | | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza - University of Rome - Polo Pontino, Via Faggiana 34, 40100, Latina, Italy
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Nguyen KD, Corben LA, Pathirana PN, Horne MK, Delatycki MB, Szmulewicz DJ. An Instrumented Measurement Scheme for the Assessment of Upper Limb Function in Individuals with Friedreich Ataxia. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:317-320. [PMID: 31945905 DOI: 10.1109/embc.2019.8857107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Continuous and objective assessment is essential for accurate monitoring of the progression of neurodegenerative conditions such as Friedreich ataxia. However, current clinical assessments predominantly rely on the ability of the affected individual to complete specific clinical tests which may not capture the intricate kinematic details associated with ataxia Moreover, such testing often consists of a level of subjectivity of the assessing clinician. In this paper, we propose an objective measuring instrument, in the form of a spoon, equipped with the Internet-of-Things (IoT) based system and relevant machine learning techniques to quantitatively assess impairment levels while engaged in routine daily activity. In a clinical study involving individuals diagnosed with Friedreich ataxia, movement patterns during a simulated eating task were captured and kinematic biomarkers were extracted that were consistent with the frequently-used clinical rating scales. Multivariate analysis of these biomarkers allows us to accurately classify individuals with Friedreich ataxia and control subjects to an accuracy of 91%. Furthermore, the kinematic information captured from the spoon can be used to introduce an alternative assessment scheme with a greater sensitivity to ataxic movements and with less inter-rater discrepancy.
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Application of Quantitative Motor Assessments in Friedreich Ataxia and Evaluation of Their Relation to Clinical Measures. THE CEREBELLUM 2019; 18:896-909. [DOI: 10.1007/s12311-019-01073-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Corben LA, Yiu EM, Tai G, Milne SC, Lynch B, Delatycki MB. Probing the multifactorial source of hand dysfunction in Friedreich ataxia. J Clin Neurosci 2019; 64:71-76. [DOI: 10.1016/j.jocn.2019.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/22/2019] [Accepted: 04/12/2019] [Indexed: 11/29/2022]
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Ward PGD, Harding IH, Close TG, Corben LA, Delatycki MB, Storey E, Georgiou-Karistianis N, Egan GF. Longitudinal evaluation of iron concentration and atrophy in the dentate nuclei in friedreich ataxia. Mov Disord 2019; 34:335-343. [PMID: 30624809 DOI: 10.1002/mds.27606] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/26/2018] [Accepted: 12/06/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Friedreich ataxia is a recessively inherited, progressive neurological disease characterized by impaired mitochondrial iron metabolism. The dentate nuclei of the cerebellum are characteristic sites of neurodegeneration in the disease, but little is known of the longitudinal progression of abnormalities in these structures. METHODS Using in vivo magnetic resonance imaging, including quantitative susceptibility mapping, we investigated changes in iron concentration and volume in the dentate nuclei in individuals with Friedreich ataxia (n = 20) and healthy controls (n = 18) over a 2-year period. RESULTS The longitudinal rate of iron concentration was significantly elevated bilaterally in participants with Friedreich ataxia relative to healthy controls. Atrophy rates did not differ significantly between groups. Change in iron concentration and atrophy both correlated with baseline disease severity or duration, indicating sensitivity of these measures to disease stage. Specifically, atrophy was maximal in individuals early in the disease course, whereas the rate of iron concentration increased with disease progression. CONCLUSIONS Progressive dentate nucleus abnormalities are evident in vivo in Friedreich ataxia, and the rates of change of iron concentration and atrophy in these structures are sensitive to the disease stage. The findings are consistent with an increased rate of iron concentration and atrophy early in the disease, followed by iron accumulation and stable volume in later stages. This pattern suggests that iron dysregulation persists after loss of the vulnerable neurons in the dentate. The significant changes observed over a 2-year period highlight the utility of quantitative susceptibility mapping as a longitudinal biomarker and staging tool. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Phillip G D Ward
- Monash Biomedical Imaging, Monash University, Melbourne, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia
| | - Ian H Harding
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| | - Thomas G Close
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Louise A Corben
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Martin B Delatycki
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Victorian Clinical Genetics Service, Parkville, Australia
| | - Elsdon Storey
- Department of Medicine, Monash University, Melbourne, Australia
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| | - Gary F Egan
- Monash Biomedical Imaging, Monash University, Melbourne, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia
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Julien M, D'Amours J, Leduc MP, Côté AC, Oziel Rodier R, Demers L, Desrosiers J. Responsiveness of the Box and Block Test with Older Adults in Rehabilitation. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2017. [DOI: 10.1080/02703181.2017.1356897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marjorie Julien
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Justine D'Amours
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-Pier Leduc
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Annie-Claude Côté
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Rachel Oziel Rodier
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Louise Demers
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
| | - Johanne Desrosiers
- Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Rehabilitation, North av, Sherbrooke, Quebec, Canada; Research Centre on Aging, Sherbrooke, Quebec, Canada
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How does performance of the Friedreich Ataxia Functional Composite compare to rating scales? J Neurol 2017; 264:1768-1776. [DOI: 10.1007/s00415-017-8566-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/02/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
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Germanotta M, Vasco G, Petrarca M, Rossi S, Carniel S, Bertini E, Cappa P, Castelli E. Robotic and clinical evaluation of upper limb motor performance in patients with Friedreich's Ataxia: an observational study. J Neuroeng Rehabil 2015; 12:41. [PMID: 25900021 PMCID: PMC4448881 DOI: 10.1186/s12984-015-0032-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Friedreich's ataxia (FRDA) is the most common hereditary autosomal recessive form of ataxia. In this disease there is early manifestation of gait ataxia, and dysmetria of the arms and legs which causes impairment in daily activities that require fine manual dexterity. To date there is no cure for this disease. Some novel therapeutic approaches are ongoing in different steps of clinical trial. Development of sensitive outcome measures is crucial to prove therapeutic effectiveness. The aim of the study was to assess the reliability and sensitivity of quantitative and objective assessment of upper limb performance computed by means of the robotic device and to evaluate the correlation with clinical and functional markers of the disease severity. METHODS Here we assess upper limb performances by means of the InMotion Arm Robot, a robot designed for clinical neurological applications, in a cohort of 14 children and young adults affected by FRDA, matched for age and gender with 18 healthy subjects. We focused on the analysis of kinematics, accuracy, smoothness, and submovements of the upper limb while reaching movements were performed. The robotic evaluation of upper limb performance consisted of planar reaching movements performed with the robotic system. The motors of the robot were turned off, so that the device worked as a measurement tool. The status of the disease was scored using the Scale for the Assessment and Rating of Ataxia (SARA). Relationships between robotic indices and a range of clinical and disease characteristics were examined. RESULTS All our robotic indices were significantly different between the two cohorts except for two, and were highly and reliably discriminative between healthy and subjects with FRDA. In particular, subjects with FRDA exhibited slower movements as well as loss of accuracy and smoothness, which are typical of the disease. Duration of Movement, Normalized Jerk, and Number of Submovements were the best discriminative indices, as they were directly and easily measurable and correlated with the status of the disease, as measured by SARA. CONCLUSIONS Our results suggest that outcome measures obtained by means of robotic devices can improve the sensitivity of clinical evaluations of patients' dexterity and can accurately and efficiently quantify changes over time in clinical trials, particularly when functional scales appear to be no longer sensitive.
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Affiliation(s)
- Marco Germanotta
- Don Carlo Gnocchi Onlus Foundation, Piazzale Morandi 6, 20121, Milan, Italy.
| | - Gessica Vasco
- Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Units, IRCCS Bambino Gesù Children's Hospital, Via Torre di Palidoro, 00050, Passoscuro (Fiumicino), Rome, Italy. .,Unit of Neuromuscular and Neurodegenerative Disorders, Laboratory of Molecular Medicine, IRCCS Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Units, IRCCS Bambino Gesù Children's Hospital, Via Torre di Palidoro, 00050, Passoscuro (Fiumicino), Rome, Italy.
| | - Stefano Rossi
- Department of Economics and Management - Industrial Engineering (DEIM), University of Tuscia, Via del Paradiso 47, 01100, Viterbo, Italy.
| | - Sacha Carniel
- Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Units, IRCCS Bambino Gesù Children's Hospital, Via Torre di Palidoro, 00050, Passoscuro (Fiumicino), Rome, Italy.
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Laboratory of Molecular Medicine, IRCCS Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Paolo Cappa
- Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Units, IRCCS Bambino Gesù Children's Hospital, Via Torre di Palidoro, 00050, Passoscuro (Fiumicino), Rome, Italy. .,Department of Mechanical and Aerospace Engineering, "Sapienza", University of Rome, Via Eudossiana 18, 00184, Roma, Italy.
| | - Enrico Castelli
- Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Units, IRCCS Bambino Gesù Children's Hospital, Via Torre di Palidoro, 00050, Passoscuro (Fiumicino), Rome, Italy.
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Gagnon C, Lavoie C, Lessard I, Mathieu J, Brais B, Bouchard JP, Fluet MC, Gassert R, Lambercy O. The Virtual Peg Insertion Test as an assessment of upper limb coordination in ARSACS patients: a pilot study. J Neurol Sci 2014; 347:341-4. [PMID: 25439167 DOI: 10.1016/j.jns.2014.09.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 09/18/2014] [Accepted: 09/19/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This paper introduces a novel assessment tool to provide clinicians with quantitative and more objective measures of upper limb coordination in patients suffering from Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS). The Virtual Peg Insertion Test (VPIT) involves manipulating an instrumented handle in order to move nine pegs into nine holes displayed in a virtual environment. The main outcome measures were the number of zero-crossings of the hand acceleration vector, as a measure of movement coordination and the total time required to complete the insertion of the nine pegs, as a measure of overall upper limb performance. RESULTS 8\9 patients with ARSACS were able to complete five repetitions with the VPIT. Patients were found to be significantly less coordinated and slower than age-matched healthy subjects (p<0.01). Performance of ARSACS patients was positively correlated with the Nine-Hole Peg Test (r=0.85, p<0.01) and with age (r=0.93, p<0.01), indicative of the degenerative nature of the disease. CONCLUSION(S) This study presents preliminary results on the use of a robotics and virtual reality assessment tool with ARSACS patients. Results highlight its potential to assess impaired coordination and monitor its progression over time.
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Affiliation(s)
- Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Québec, Canada; Centre hospitalier affilié universitaire régional (CAUR) de Chicoutimi, Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, Québec, Canada; School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada.
| | - Caroline Lavoie
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Québec, Canada; Clinique des maladies neuromusculaires, Centre de réadaptation en déficience physique Le Parcours du Centre de santé et de services sociaux de Jonquière, Québec, Canada; Centre hospitalier affilié universitaire régional (CAUR) de Chicoutimi, Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, Québec, Canada; School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Isabelle Lessard
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Québec, Canada; Clinique des maladies neuromusculaires, Centre de réadaptation en déficience physique Le Parcours du Centre de santé et de services sociaux de Jonquière, Québec, Canada; Centre hospitalier affilié universitaire régional (CAUR) de Chicoutimi, Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, Québec, Canada; School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Jean Mathieu
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Québec, Canada; Clinique des maladies neuromusculaires, Centre de réadaptation en déficience physique Le Parcours du Centre de santé et de services sociaux de Jonquière, Québec, Canada; Centre hospitalier affilié universitaire régional (CAUR) de Chicoutimi, Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, Québec, Canada; School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Bernard Brais
- Montreal Neurological Institute, McGill University, Québec, Canada
| | | | | | - Roger Gassert
- Rehabilitation Engineering Laboratory, ETH Zurich, Switzerland
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Norman KE, Héroux ME. Measures of fine motor skills in people with tremor disorders: appraisal and interpretation. Front Neurol 2013; 4:50. [PMID: 23717299 PMCID: PMC3650669 DOI: 10.3389/fneur.2013.00050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/24/2013] [Indexed: 12/04/2022] Open
Abstract
People with Parkinson's disease, essential tremor, or other movement disorders involving tremor have changes in fine motor skills that are among the hallmarks of these diseases. Numerous measurement tools have been created and other methods devised to measure such changes in fine motor skills. Measurement tools may focus on specific features - e.g., motor skills or dexterity, slowness in movement execution associated with parkinsonian bradykinesia, or magnitude of tremor. Less obviously, some tools may be better suited than others for specific goals such as detecting subtle dysfunction early in disease, revealing aspects of brain function affected by disease, or tracking changes expected from treatment or disease progression. The purpose of this review is to describe and appraise selected measurement tools of fine motor skills appropriate for people with tremor disorders. In this context, we consider the tools' content - i.e., what movement features they focus on. In addition, we consider how measurement tools of fine motor skills relate to measures of a person's disease state or a person's function. These considerations affect how one should select and interpret the results of these tools in laboratory and clinical contexts.
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Affiliation(s)
- Kathleen E. Norman
- School of Rehabilitation Therapy, Queen’s UniversityKingston, ON, Canada
- Centre for Neuroscience Studies, Queen’s UniversityKingston, ON, Canada
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Low SC, Corben LA, Delatycki MB, Ternes AM, Addamo PK, Georgiou-Karistianis N. Excessive motor overflow reveals abnormal inter-hemispheric connectivity in Friedreich ataxia. J Neurol 2013; 260:1757-64. [PMID: 23463366 DOI: 10.1007/s00415-013-6869-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 01/26/2013] [Accepted: 02/06/2013] [Indexed: 11/24/2022]
Abstract
This study sought to characterise force variability and motor overflow in 12 individuals with Friedreich ataxia (FRDA) and 12 age- and gender-matched controls. Participants performed a finger-pressing task by exerting 30 and 70 % of their maximum finger force using the index finger of the right and left hand. Control of force production was measured as force variability, while any involuntary movements occurring on the finger of the other, passive hand, was measured as motor overflow. Significantly greater force variability in individuals with FRDA compared with controls is indicative of cortico-cerebellar disruption affecting motor control. Meanwhile, significantly greater motor overflow in this group provides the first evidence of possible abnormal inter-hemispheric activity that may be attributable to asymmetrical neuronal loss in the dentate nucleus. Overall, this study demonstrated a differential engagement in the underlying default processes of the motor system in FRDA.
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Affiliation(s)
- Sze-Cheen Low
- Experimental Neuropsychology Research Unit, School of Psychology and Psychiatry, Monash University, Clayton, VIC 3800, Australia
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Fischer H, Zapletal B, Neuhold S, Rützler K, Fleck T, Frantal S, Theiler L, Stumpf D, Havel C, Greif R. Single rescuer exertion using a mechanical resuscitation device: a randomized controlled simulation study. Acad Emerg Med 2012; 19:1242-7. [PMID: 23167854 DOI: 10.1111/acem.12008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/28/2012] [Accepted: 06/18/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The goal of this experimental study was to investigate rescuer exertion when using "Animax," a manually operated hand-powered mechanical resuscitation device (MRD) for cardiopulmonary resuscitation (CPR), compared to standard basic life support (BLS). METHODS This was a prospective, open, randomized, crossover simulation study. After being trained, 80 medical students with substantial knowledge in BLS performed one-rescuer CPR using either the MRD or the standard BLS for 12-minute intervals in random order. The main outcome parameter was the heart rate pressure product (RPP) as an index of cardiac work. Secondary outcome parameters were physical exhaustion quantified by the Borg scale (measurement of perceived exertion), Nine Hole Peg Test (NHPT; measurement of fine motor skills), and capillary lactate concentration during testing. RESULTS While no significant difference could be found for the RPP, a significantly increased mean heart rate during the final minute of standard BLS compared to the MRD was found (139 ± 22 beats/min vs. 135 ± 26 beats/min, p = 0.027). By contrast, subjective exertion using the MRD was rated significantly higher on the Borg scale (15.1 ± 2.4 vs. 14.6 ± 2.6, p = 0.027). Mean serum lactate concentration was significantly higher when the MRD was used compared to standard BLS (3.4 ± 1.5 mmol/L vs. 2.1 ± 1.3 mmol/L, p ≤ 0.001). CONCLUSIONS Use of the MRD leads to a RPP of the rescuers comparable to standard BLS. These findings suggest that there is no clinically relevant reduction of exertion if this MRD is used by a single rescuer. If this kind of MRD is used for CPR, frequent changeovers with a second rescuer should be considered as the guidelines suggest for standard CPR.
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Affiliation(s)
- Henrik Fischer
- Department of Anesthesia; General Intensive Care and Pain Control; Division of Cardiothoracic and Vascular Anesthesia and Intensive Care; Vienna Austria
| | - Bernhard Zapletal
- Department of Anesthesia; General Intensive Care and Pain Control; Division of Cardiothoracic and Vascular Anesthesia and Intensive Care; Vienna Austria
| | - Stephanie Neuhold
- Department of Anesthesia; General Intensive Care and Pain Control; Division of Cardiothoracic and Vascular Anesthesia and Intensive Care; Vienna Austria
| | - Kurt Rützler
- Department of Anesthesia; General Intensive Care and Pain Control; Division of Cardiothoracic and Vascular Anesthesia and Intensive Care; Vienna Austria
| | | | - Sophie Frantal
- The Center for Medical Statistics; Informatics and Intelligent Systems; Vienna Austria
| | - Lorenz Theiler
- The Department of Anesthesiology; Perioperative Medicine and Pain Management; University of Miami; Miller School of Medicine Division of Neuroanesthesia Division of Translational Research; Miami FL
| | | | | | - Robert Greif
- The Department of Anesthesiology and Pain Therapy; University Hospital Bern and University; Bern Switzerland
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Rosen KM, Folker JE, Vogel AP, Corben LA, Murdoch BE, Delatycki MB. Longitudinal change in dysarthria associated with Friedreich ataxia: a potential clinical endpoint. J Neurol 2012; 259:2471-7. [PMID: 22669353 DOI: 10.1007/s00415-012-6547-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 05/02/2012] [Accepted: 05/04/2012] [Indexed: 01/10/2023]
Abstract
CNS functions that show change across short periods of time are particularly useful clinical endpoints for Friedreich ataxia. This study determined whether there is measurable acoustical change in the dysarthria associated with Friedreich ataxia across yearly intervals. A total of 29 participants diagnosed with Friedreich ataxia were recorded across 4 years at yearly intervals. A repeated measures ANOVA was used to determine which acoustic measures differed across time, and pairwise t tests were used to assess the consistency of the change across the time intervals. The relationship between the identified measures with perceptual severity was assessed with stepwise regression. Significant longitudinal change was observed with four measures that relate to the utterance duration and spectral changes in utterances. The spectral measures consistently detected change across time intervals of two or more years. The four measures combined moderately predicted perceptual severity. Together, the results implicate longitudinal change in speaking rate and utterance duration. Changes in speech associated with Friedreich ataxia can be measured across intervals of 2 years and therefore show rich potential for monitoring disease progression and therapy outcomes.
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Affiliation(s)
- Kristin M Rosen
- School of Health and Rehabilitation Science, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
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Marelli C, Figoni J, Charles P, Anheim M, Tchikviladze M, Vincitorio CM, du Montcel ST, Brice A, Golmard JL, Dürr A. Annual change in Friedreich's ataxia evaluated by the Scale for the Assessment and Rating of Ataxia (SARA) is independent of disease severity. Mov Disord 2011; 27:135-8. [PMID: 22076850 DOI: 10.1002/mds.23879] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 05/12/2011] [Accepted: 06/20/2011] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The objective of the study was to evaluate the sensitivity to change of the Scale for the Assessment and Rating of Ataxia (score, 0-40) in Friedreich's ataxia. METHODS This was a follow-up study in adult patients with genetically confirmed Friedreich's ataxia evaluated at least twice (minimum interval, 6 months). Participants were outpatients at the Center for Neurogenetics of the Pitie-Salpêtrière Hospital in Paris. RESULTS We included 84 patients; 60% had 3 or more evaluations. The mean score on first assessment was 22.7 ± 9, and the mean follow-up was 1.84 ± 1.10 years. The mean increase was 1.36 ± 2.3 points/year; this variation was not significantly linked to factors known to influence disease severity such as age at onset, disease duration, GAA expansion length, and wheelchair use. CONCLUSIONS In adult Friedreich's ataxia patients the Scale for the Assessment and Rating of Ataxia can detect annual changes independently of disease severity. In future therapeutic trials no patient stratification is globally required.
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Affiliation(s)
- Cecilia Marelli
- Université Pierre et Marie Curie-Paris6, Centre de Recherche de l'Institut du Cerveau et de la Moelle epiniere, UMR-S975, Paris, France
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Evans-Galea MV, Corben LA, Hasell J, Galea CA, Fahey MC, du Sart D, Delatycki MB. A novel deletion-insertion mutation identified in exon 3 of FXN in two siblings with a severe Friedreich ataxia phenotype. Neurogenetics 2011; 12:307-13. [PMID: 21830088 DOI: 10.1007/s10048-011-0296-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 07/22/2011] [Indexed: 10/17/2022]
Abstract
Friedreich ataxia (FRDA) is an autosomal recessive neurodegenerative disease most commonly caused by a GAA trinucleotide repeat expansion in the first intron of FXN, which reduces expression of the mitochondrial protein frataxin. Approximately 98% of individuals with FRDA are homozygous for GAA expansions, with the remaining 2% compound heterozygotes for a GAA expansion and a point mutation within FXN. Two siblings with early onset of symptoms experienced rapid loss of ambulation by 8 and 10 years. Diagnostic testing for FRDA demonstrated one GAA repeat expansion of 1010 repeats and one non-expanded allele. Sequencing all five exons of FXN identified a novel deletion-insertion mutation in exon 3 (c.371_376del6ins15), which results in a modified frataxin protein sequence at amino acid positions 124-127. Specifically, the amino acid sequence changes from DVSF to VHLEDT, increasing frataxin from 211 residues to 214. Using the known structure of human frataxin, a theoretical 3D model of the mutant protein was developed. In the event that the modified protein is expressed and stable, it is predicted that the acidic interface of frataxin, known to be involved in iron binding and interactions with the iron-sulphur cluster assembly factor IscU, would be impaired.
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Affiliation(s)
- Marguerite V Evans-Galea
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia
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Abstract
PURPOSE OF REVIEW Degenerative ataxias are a heterogeneous group of disorders that are clinically characterized by progressive ataxia. They can be subdivided into three major groups: the acquired ataxias, which are due to exogenous or endogenous nongenetic causes, the hereditary ataxias, and the nonhereditary degenerative ataxias. On the basis of a review of the literature published in 2009 and 2010, this review gives an update of the most recent developments in the field of ataxia. RECENT FINDINGS Using advanced methods of molecular genetic analysis, novel genes for recessive and dominant ataxias were identified. Recent imaging studies in dominantly inherited spinocerebellar ataxias (SCAs) focussed on the analysis of connectivity in the brain. Novel clinical assessment methods were developed and validated in large patient cohorts. Although a phase 3 trial of idebenone in Friedreich ataxia (FRDA) failed, a smaller phase 2 trial of riluzole in a mixed population of ataxia patients suggested a possible antiataxic action of this compound. SUMMARY Recent molecular advances underline the diversity of degenerative ataxias. With the progress in the development of clinical assessment methods for ataxia, the methodological requirements to run large interventional trials are now met.
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