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Girard-Côté L, Gallais B, Gagnon C, Roussel MP, Morin M, Hébert LJ, Monckton D, Leduc-Gaudet JP, Gouspillou G, Marcangeli V, Duchesne E. Resistance training in women with myotonic dystrophy type 1: a multisystemic therapeutic avenue. Neuromuscul Disord 2024; 40:38-51. [PMID: 38824906 DOI: 10.1016/j.nmd.2024.05.009] [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: 10/05/2023] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 06/04/2024]
Abstract
Myotonic dystrophy type 1 (DM1) is a hereditary disease characterized by muscular impairments. Fundamental and clinical positive effects of strength training have been reported in men with DM1, but its impact on women remains unknown. We evaluated the effects of a 12-week supervised strength training on physical and neuropsychiatric health. Women with DM1 performed a twice-weekly supervised resistance training program (3 series of 6-8 repetitions of squat, leg press, plantar flexion, knee extension, and hip abduction). Lower limb muscle strength, physical function, apathy, anxiety and depression, fatigue and excessive somnolence, pain, and patient-reported outcomes were assessed before and after the intervention, as well as three and six months after completion of the training program. Muscle biopsies of the vastus lateralis were also taken before and after the training program to assess muscle fiber growth. Eleven participants completed the program (attendance: 98.5 %). Maximal hip and knee extension strength (p < 0.006), all One-Repetition Maximum strength measures (p < 0.001), apathy (p = 0.0005), depression (p = 0.02), pain interference (p = 0.01) and perception of the lower limb function (p = 0.003) were significantly improved by training. Some of these gains were maintained up to six months after the training program. Strength training is a good therapeutic strategy for women with DM1.
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Affiliation(s)
- Laura Girard-Côté
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada; Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada
| | - Benjamin Gallais
- Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada; ÉCOBES - Research and Transfer, Cegep de Jonquière, Jonquière, Quebec, Canada
| | - Cynthia Gagnon
- Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada; CHU Sherbrooke Research Center, and Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Pier Roussel
- Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada; Department of Fundamental Sciences, University of Quebec at Chicoutimi, Saguenay, Quebec, Canada
| | - Marika Morin
- Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada
| | - Luc J Hébert
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Capitale-Nationale Integrated University Health and Social Services Center, Quebec, Quebec, Canada; Department of Radiology and Nuclear Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Darren Monckton
- Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow, UK
| | - Jean-Philippe Leduc-Gaudet
- Research Group in Cellular Signaling, Department of Medical Biology, University of Quebec at Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Gilles Gouspillou
- Département des sciences de l'activité physique, Faculté des sciences, University of Quebec at Montréal (UQAM), Montréal, Quebec, Canada
| | - Vincent Marcangeli
- Département des sciences de l'activité physique, Faculté des sciences, University of Quebec at Montréal (UQAM), Montréal, Quebec, Canada
| | - Elise Duchesne
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada; Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Capitale-Nationale Integrated University Health and Social Services Center, Quebec, Quebec, Canada; CHU de Québec - Université Laval Research Center, Québec, Québec, Canada.
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Aoussim A, Légaré C, Roussel MP, Madore AM, Morissette MC, Laprise C, Duchesne E. Towards the Identification of Biomarkers for Muscle Function Improvement in Myotonic Dystrophy Type 1. J Neuromuscul Dis 2023; 10:1041-1053. [PMID: 37694373 PMCID: PMC10657677 DOI: 10.3233/jnd-221645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is the most common muscular dystrophy in adults. In DM1 patients, skeletal muscle is severely impaired, even atrophied and patients experience a progressive decrease in maximum strength. Strength training for these individuals can improve their muscle function and mass, however, the biological processes involved in these improvements remain unknown. OBJECTIVE This exploratory study aims at identifying the proteomic biomarkers and variables associated with the muscle proteome changes induced by training in DM1 individuals. METHODS An ion library was developed from liquid chromatography-tandem mass spectrometry proteomic analyses of Vastus Lateralis muscle biopsies collected in 11 individuals with DM1 pre-and post-training. RESULTS The proteomic analysis showed that the levels of 44 proteins were significantly modulated. A literature review (PubMed, UniProt, PANTHER, REACTOME) classified these proteins into biological sub-classes linked to training-induced response, including immunity, energy metabolism, apoptosis, insulin signaling, myogenesis and muscle contraction. Linear models identified key variables explaining the proteome modulation, including atrophy and hypertrophy factors. Finally, six proteins of interest involved in myogenesis, muscle contraction and insulin signaling were identified: calpain-3 (CAN3; Muscle development, positive regulation of satellite cell activation), 14-3-3 protein epsilon (1433E; Insulin/Insulin-like growth factor, PI3K/Akt signaling), myosin-binding protein H (MYBPH; Regulation of striated muscle contraction), four and a half LIM domains protein 3 (FHL3; Muscle organ development), filamin-C (FLNC; Muscle fiber development) and Cysteine and glycine-rich protein 3 (CSRP3). CONCLUSION These findings may lead to the identification for DM1 individuals of novel muscle biomarkers for clinical improvement induced by rehabilitation, which could eventually be used in combination with a targeted pharmaceutical approach to improving muscle function, but further studies are needed to confirm those results.
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Affiliation(s)
- Amira Aoussim
- Département des sciences de la santé, Université du Québec à Chicoutimi, Québec, Canada
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay– Lac-Saint-Jean, Hôpital de Jonquière, Québec, Canada
- Centre intersectoriel en santé durable (CISD), Université du Québec à Chicoutimi, Québec, Canada
| | - Cécilia Légaré
- Département des sciences de la santé, Université du Québec à Chicoutimi, Québec, Canada
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay– Lac-Saint-Jean, Hôpital de Jonquière, Québec, Canada
- Centre intersectoriel en santé durable (CISD), Université du Québec à Chicoutimi, Québec, Canada
- RNA Institute, College of Arts and Sciences, University at Albany-SUNY, Albany, USA
| | - Marie-Pier Roussel
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay– Lac-Saint-Jean, Hôpital de Jonquière, Québec, Canada
- Centre intersectoriel en santé durable (CISD), Université du Québec à Chicoutimi, Québec, Canada
- Département des sciences fondamentales, Université du Québec à Chicoutimi, Québec, Canada
| | - Anne-Marie Madore
- Centre intersectoriel en santé durable (CISD), Université du Québec à Chicoutimi, Québec, Canada
- Département des sciences fondamentales, Université du Québec à Chicoutimi, Québec, Canada
| | - Mathieu C. Morissette
- Department of Medicine, Université Laval, Québec, Canada
- Quebec Heart and Lung Institute – Université Laval, Québec, Canada
| | - Catherine Laprise
- Centre intersectoriel en santé durable (CISD), Université du Québec à Chicoutimi, Québec, Canada
- Département des sciences fondamentales, Université du Québec à Chicoutimi, Québec, Canada
| | - Elise Duchesne
- Département des sciences de la santé, Université du Québec à Chicoutimi, Québec, Canada
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay– Lac-Saint-Jean, Hôpital de Jonquière, Québec, Canada
- Centre intersectoriel en santé durable (CISD), Université du Québec à Chicoutimi, Québec, Canada
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Raymond K, Gagnon C, Levasseur M. Multiple Case Study of Changes in Participation of Adults with Myotonic Dystrophy Type 1: Importance of Redesigning Accomplishment and Resilience. J Neuromuscul Dis 2022; 9:731-755. [DOI: 10.3233/jnd-210780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Myotonic dystrophy type 1 (DM1) is the most prevalent adult form of neuromuscular disorders, for which a decrease of participation with age is known. However, little is known about facilitators and barriers to participation, especially from the perspective of both patients and caregivers. Objective: This study explored and explained changes in participation post-diagnosis with myotonic dystrophy type 1 from the perspective of six adults, their relatives and nurse case managers. Methods: A multiple case study was carried out with these triads (n = 6) using semi-structured individual interviews, medical charts, and a participation patient-reported outcome measure. The six cases were built around three women and three men (age: 40–56 years; disease duration: 19–39 years). Their “relatives” were mainly family members. Nurse case managers had done annual follow-ups with all the adults for approximately ten years. Changes in participation were characterized generally by: 1) heterogeneity, 2) insidious increase in restrictions, and more specifically by: 3) redesigning accomplishment, 4) progressive social isolation, 5) restrictions in life-space mobility, and 6) increasingly sedentary activities. Results: Important facilitators of participation were the adult’s resilience, highly meaningful activities, social support, living arrangement, and willingness to use technical aids. Barriers were mostly related to symptoms and a precarious social network, and were affected by misfit and potential syndemic interactions between personal (e.g., comorbidities) and environmental (e.g., stigma) factors. Conclusion: This study identified key facilitators and barriers and their underlying processes, which should be integrated into the evaluation and intervention framework to optimize participation over time.
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Affiliation(s)
- Kateri Raymond
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada. 3001, 12 avenue Nord, Sherbrooke (Québec), J1H 5N4, Canada
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay–Lac-St-Jean, Jonquière, Canada. 2230, rue de l’Hôpital, C.P. 1200, Jonquière (Québec), G7X 7X2, Canada
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l’Estrie – Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada. 1036, rue Belvédère Sud, Sherbrooke (Québec), J1H 4C4, Canada
- Centre de recherche Charles-Le Moyne (CR-CLM), Centre intégré universitaire de santé et de services sociaux du Saguenay–Lac-St-Jean, Chicoutimi, Canada. 305, rue Saint-Vallier, Chicoutimi (Québec), G7H 5H6, Canada
| | - Cynthia Gagnon
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada. 3001, 12 avenue Nord, Sherbrooke (Québec), J1H 5N4, Canada
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay–Lac-St-Jean, Jonquière, Canada. 2230, rue de l’Hôpital, C.P. 1200, Jonquière (Québec), G7X 7X2, Canada
- Centre de recherche Charles-Le Moyne (CR-CLM), Centre intégré universitaire de santé et de services sociaux du Saguenay–Lac-St-Jean, Chicoutimi, Canada. 305, rue Saint-Vallier, Chicoutimi (Québec), G7H 5H6, Canada
| | - Mélanie Levasseur
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada. 3001, 12 avenue Nord, Sherbrooke (Québec), J1H 5N4, Canada
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l’Estrie – Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada. 1036, rue Belvédère Sud, Sherbrooke (Québec), J1H 4C4, Canada
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Gallais B, Roussel MP, Laberge L, Hébert LJ, Duchesne E. Impact of a 12-week strength training program on fatigue, daytime sleepiness, and apathy in men with myotonic dystrophy type 1. J Neuromuscul Dis 2022; 9:629-639. [DOI: 10.3233/jnd-221503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Myotonic dystrophy type 1 (DM1) is a multisystemic neuromuscular disorder causing a plea of impairments, of which fatigue and apathy are some of the most frequent non-muscular symptoms. No curative treatment exists to date, and patients only have access to limited effective care, which are intended to decrease the burden of specific symptoms in daily life. Objective: This study aimed to assess whether a 12-week strength-training program has an impact on fatigue/daytime sleepiness, apathy, and patient-reported health in men with DM1. Methods: Eleven participants completed the Fatigue and Daytime Sleepiness Scale (FDSS) and the Myotonic Dystrophy Health Index (MDHI) at baseline, at 6 and 12 weeks, and 6 and 9 months. Also, the Apathy Evaluation Scale (AES) was filled out at baseline, at 12 weeks, and 6 and 9 months. Results: Results show significant effects of the training program both on apathy and fatigue/daytime sleepiness, effects that are respectively greater at three and six months after the end of the program than at its very end. However, no difference was observed regarding the overall disease burden. Conclusion: These findings are promising for patients with DM1 considering that few non-pharmacological treatments are available.
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Affiliation(s)
- Benjamin Gallais
- ÉCOBES – Recherche et transfert, Cégep de Jonquière, Saguenay, Québec, Canada
- Groupe de recherche interdisciplinaire sur lesmaladies neuromusculaires (GRIMN), Centre intégréuniversitaire de santé et de services sociaux duSaguenay–Lac-St-Jean, Saguenay, Québec, Canada
- Centre de recherche Charles-Le Moyne – Saguenay–Lac-Saint-Jean sur les innovations en santé(CR-CSIS), Faculté de médecine et des sciences de lasanté de l’Université de Sherbrooke, Site Saguenay, Saguenay, Québec, Canada
| | - Marie-Pier Roussel
- Groupe de recherche interdisciplinaire sur lesmaladies neuromusculaires (GRIMN), Centre intégréuniversitaire de santé et de services sociaux duSaguenay–Lac-St-Jean, Saguenay, Québec, Canada
- Centre de recherche Charles-Le Moyne – Saguenay–Lac-Saint-Jean sur les innovations en santé(CR-CSIS), Faculté de médecine et des sciences de lasanté de l’Université de Sherbrooke, Site Saguenay, Saguenay, Québec, Canada
- Département dessciences fondamentales, Université du Québec à Chicoutimi, Saguenay, Québec, Canada
| | - Luc Laberge
- ÉCOBES – Recherche et transfert, Cégep de Jonquière, Saguenay, Québec, Canada
- Groupe de recherche interdisciplinaire sur lesmaladies neuromusculaires (GRIMN), Centre intégréuniversitaire de santé et de services sociaux duSaguenay–Lac-St-Jean, Saguenay, Québec, Canada
- Centre de recherche Charles-Le Moyne – Saguenay–Lac-Saint-Jean sur les innovations en santé(CR-CSIS), Faculté de médecine et des sciences de lasanté de l’Université de Sherbrooke, Site Saguenay, Saguenay, Québec, Canada
| | - Luc J. Hébert
- Groupe de recherche interdisciplinaire sur lesmaladies neuromusculaires (GRIMN), Centre intégréuniversitaire de santé et de services sociaux duSaguenay–Lac-St-Jean, Saguenay, Québec, Canada
- Centreinterdisciplinaire de recherche en réadaptation etintégration sociale (CIRRIS), Québec, Québec, Canada
- Départements de réadaptation et deradiologie et médecine nucléaire, Faculté demédecine, Université Laval, Québec, Québec, Canada
| | - Elise Duchesne
- Groupe de recherche interdisciplinaire sur lesmaladies neuromusculaires (GRIMN), Centre intégréuniversitaire de santé et de services sociaux duSaguenay–Lac-St-Jean, Saguenay, Québec, Canada
- Centre de recherche Charles-Le Moyne – Saguenay–Lac-Saint-Jean sur les innovations en santé(CR-CSIS), Faculté de médecine et des sciences de lasanté de l’Université de Sherbrooke, Site Saguenay, Saguenay, Québec, Canada
- Unité d’enseignement en physiothérapie, département des sciences de la santé, Université duQuébec à Chicoutimi, Saguenay, Québec, Canada
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Ravel-Chapuis A, Duchesne E, Jasmin BJ. Pharmacological and exercise-induced activation of AMPK as emerging therapies for myotonic dystrophy type 1 patients. J Physiol 2022; 600:3249-3264. [PMID: 35695045 DOI: 10.1113/jp282725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/07/2022] [Indexed: 11/08/2022] Open
Abstract
Myotonic dystrophy type 1 (DM1) is a multisystemic disorder with variable clinical features. Currently, there is no cure or effective treatment for DM1. The disease is caused by an expansion of CUG repeats in the 3' UTR of DMPK mRNAs. Mutant DMPK mRNAs accumulate in nuclei as RNA foci and trigger an imbalance in the level and localization of RNA-binding proteins causing the characteristic missplicing events that account for the varied DM1 symptoms, a disease mechanism referred to as RNA toxicity. In recent years, multiple signalling pathways have been identified as being aberrantly regulated in skeletal muscle in response to the CUG expansion, including AMPK, a sensor of energy status, as well as a master regulator of cellular energy homeostasis. Converging lines of evidence highlight the benefits of activating AMPK signalling pharmacologically on RNA toxicity, as well as on muscle histology and function, in preclinical DM1 models. Importantly, a clinical trial with metformin, an activator of AMPK, resulted in functional benefits in DM1 patients. In addition, exercise, a known AMPK activator, has shown promising effects on RNA toxicity and muscle function in DM1 mice. Finally, clinical trials involving moderate-intensity exercise also induced functional benefits for DM1 patients. Taken together, these studies clearly demonstrate the molecular, histological and functional benefits of AMPK activation and exercise-based interventions on the DM1 phenotype. Despite these advances, several key questions remain; in particular, the extent of the true implication of AMPK in the observed beneficial improvements, as well as how, mechanistically, activation of AMPK signalling improves the DM1 pathophysiology.
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Affiliation(s)
- Aymeric Ravel-Chapuis
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Eric Poulin Centre for Neuromuscular Disease, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Elise Duchesne
- Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada.,Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Jonquière, QC, Canada
| | - Bernard J Jasmin
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Eric Poulin Centre for Neuromuscular Disease, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Bélair N, Côté I, Gagnon C, Mathieu J, Duchesne E. Explanatory factors of dynamic balance impairment in myotonic dystrophy type 1. Muscle Nerve 2022; 65:683-687. [PMID: 35212003 DOI: 10.1002/mus.27527] [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: 06/11/2021] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION/AIMS Myotonic dystrophy type 1 (DM1) is a neuromuscular disease affecting many systems and for which muscle weakness is one of the cardinal symptoms. People with DM1 also present with balance-related impairments and high fall risk. The aim of this study was to explore explanatory factors of dynamic balance impairment in the DM1 population. METHODS A secondary analysis of data collected as part of a larger study was performed. The Mini Balance Evaluation System Test (Mini-BESTest) was used to assess dynamic balance. Age, sex, and CTG repeat length in blood were retrieved from medical records and research files. The maximal isometric muscle strength of five lower limb muscle groups (hip flexors and extensors, knee flexors and extensors, and ankle dorsiflexors) was quantitatively assessed as well as fatigue. Standard multiple regression analysis was used. RESULTS Fifty-two individuals (31 men) aged between 24 and 81 years were included. The final model explains 65.9% of the balance score; ankle dorsiflexor muscle strength was the strongest explanatory factor, followed by CTG repeat length, age and fatigue to a lesser extent. DISCUSSION Dynamic balance is impaired in people with DM1. Results of this study suggest that rehabilitation interventions aimed at improving strength of the ankle dorsiflexors and managing fatigue could help to improve dynamic balance in this specific population.
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Affiliation(s)
- Nicolas Bélair
- Unité d'enseignement en physiothérapie, Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Isabelle Côté
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Jonquière, Jonquière, Québec, Canada
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Jonquière, Jonquière, Québec, Canada.,Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CR-CHUS), Sherbrooke, Québec, Canada.,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Centre intersectoriel en santé durable (CISD), Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Jean Mathieu
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Jonquière, Jonquière, Québec, Canada.,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Elise Duchesne
- Unité d'enseignement en physiothérapie, Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Jonquière, Jonquière, Québec, Canada.,Centre intersectoriel en santé durable (CISD), Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada.,Centre de recherche Charles-Le Moyne (CRCLM), Sherbrooke, Québec, Canada
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Fujino H, Saito T, Takahashi MP, Takada H, Nakayama T, Imura O, Matsumura T. Quality of life and subjective symptom impact in Japanese patients with myotonic dystrophy type 1. BMC Neurol 2022; 22:55. [PMID: 35164706 PMCID: PMC8842550 DOI: 10.1186/s12883-022-02581-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although functional impairment in patients with myotonic dystrophy is an important determinant of the quality of life (QoL), patients' subjective evaluation of their symptoms may also affect their QoL. The aim of this study was to investigate the association between subjective symptom impact and the QoL of patients with myotonic dystrophy, after controlling for functional impairment. METHODS Eligible patients with myotonic dystrophy type 1 (DM1) were recruited from four hospitals in Japan. The subjective symptom impact of four symptoms (muscle weakness, fatigue, pain, and myotonia) and overall QoL were evaluated using the Individualized Neuromuscular Quality of Life (INQoL) questionnaire. Functional impairment was assessed using the modified Rankin Scale. RESULTS Seventy-seven patients with DM1 were included in this study. Overall QoL was significantly associated with subjective symptom impact of muscular weakness, fatigue, pain, myotonia, swallowing difficulty, and droopy eyelids. In the regression models, disease duration (beta = 0.11) and moderate to severe functional impairment (beta = 0.33) explained a significant part of the overall QoL. Furthermore, muscular weakness, fatigue, and myotonia significantly explained additional variance of the overall QoL (beta = 0.17-0.43). CONCLUSIONS Subjective symptom impact and functional impairment are independent features influencing the QoL of Japanese patients with DM1.
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Affiliation(s)
- Haruo Fujino
- Department of Child Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, 5650871, Japan. .,Department of Special Needs Education, Oita University, 700 Dannoharu, Oita, Japan. .,Graduate School of Human Sciences, Osaka University, 1-2 Yamadaoka, Suita, Japan.
| | - Toshio Saito
- Division of Child Neurology, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Japan.,Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Japan
| | - Masanori P Takahashi
- Department of Clinical Laboratory and Biomedical Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Japan.,Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Japan
| | - Hiroto Takada
- Department of Neurology, National Hospital Organization Aomori National Hospital, 155-1 Megasawa-Hirano, Aomori, Japan
| | - Takahiro Nakayama
- Department of Neurology, Yokohama Rosai Hospital, 3211 Kozukue, Yokohama, Japan
| | - Osamu Imura
- Graduate School of Human Sciences, Osaka University, 1-2 Yamadaoka, Suita, Japan.,Faculty of Social Sciences, Nara University, 1500 Misasagi, Nara, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Japan
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Muslemani S, Gagnon C, Gallais B. Instrumental activities of daily living in adults with the DM1 childhood phenotype: going beyond motor impairments. Neuromuscul Disord 2022; 32:313-320. [DOI: 10.1016/j.nmd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 10/19/2022]
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9
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Lessard I, Gaboury S, Gagnon C, Bouchard K, Chapron K, Lavoie M, Lapointe P, Duchesne E. Effects and Acceptability of an Individualized Home-Based 10-Week Training Program in Adults with Myotonic Dystrophy Type 1. J Neuromuscul Dis 2021; 8:137-149. [DOI: 10.3233/jnd-200570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Muscle weakness is a cardinal sign of myotonic dystrophy type 1, causing important functional mobility limitations and increasing the risk of falling. As a non-pharmacological, accessible and safe treatment for this population, strength training is an intervention of choice. Objective: To document the effects and acceptability of an individualized semi-supervised home-based exercise program on functional mobility, balance and lower limb strength, and to determine if an assistive training device has a significant impact on outcomes. Methods: This study used a pre-post test design and men with the adult form of DM1 were randomly assigned to the control or device group. The training program was performed three times a week for 10 weeks and included three exercises (sit-to-stand, squat, and alternated lunges). Outcome measures included maximal isometric muscle strength, 10-Meter Walk Test, Mini-BESTest, 30-Second Chair Stand Test and 6-minute walk test. Results: No outcome measures showed a significant difference, except for the strength of the knee flexors muscle group between the two assessments. All participants improved beyond the standard error of measurement in at least two outcome measures. The program and the device were well accepted and all participants reported many perceived improvements at the end of the program. Conclusions: Our results provide encouraging data on the effects and acceptability of a home-based training program for men with the adult form of DM1. These programs would reduce the financial burden on the health system while improving the clinical services offered to this population.
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Affiliation(s)
- Isabelle Lessard
- Département des sciences de la santé, physiothérapie, Université du Québec à Chicoutimi, Québec, Canada
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay–Lac-Saint-Jean, Québec, Canada
- Centre de recherche Charles-Le Moyne –Saguenay-Lac-St-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, Québec, Canada
| | - Sébastien Gaboury
- Laboratoire d’Intelligence Ambiante pour la Reconnaissance d’Activités (LIARA), Université du Québec à Chicoutimi, Québec, Canada
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay–Lac-Saint-Jean, Québec, Canada
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada
- Centre de recherche Charles-Le Moyne –Saguenay-Lac-St-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, Québec, Canada
| | - Kévin Bouchard
- Laboratoire d’Intelligence Ambiante pour la Reconnaissance d’Activités (LIARA), Université du Québec à Chicoutimi, Québec, Canada
| | - Kévin Chapron
- Laboratoire d’Intelligence Ambiante pour la Reconnaissance d’Activités (LIARA), Université du Québec à Chicoutimi, Québec, Canada
| | - Mélissa Lavoie
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay–Lac-Saint-Jean, Québec, Canada
- Département des sciences de la santé, module des sciences infirmières, Université du Québec à Chicoutimi, Québec, Canada
| | - Patrick Lapointe
- Laboratoire d’Intelligence Ambiante pour la Reconnaissance d’Activités (LIARA), Université du Québec à Chicoutimi, Québec, Canada
| | - Elise Duchesne
- Département des sciences de la santé, physiothérapie, Université du Québec à Chicoutimi, Québec, Canada
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay–Lac-Saint-Jean, Québec, Canada
- Centre de recherche Charles-Le Moyne –Saguenay-Lac-St-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, Québec, Canada
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10
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Raymond K, Levasseur M, Gallais B, Richer L, Laberge L, Petitclerc É, Mathieu J, Gagnon C. Predictors of participation restriction over a 9-year period in adults with myotonic dystrophy type 1. Disabil Rehabil 2020; 44:2615-2631. [PMID: 33135946 DOI: 10.1080/09638288.2020.1837264] [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] [Indexed: 10/23/2022]
Abstract
PURPOSE For slowly progressive neuromuscular disease, prognostic approach and long-term monitoring of participation is a crucial part of rehabilitation services. To improve the prognostic approach, professionals must identify individuals at risk of having higher participation restriction. This study aimed to identify personal and environmental predictors of participation restriction over nine years in adults with myotonic dystrophy type 1 (DM1). METHODS A secondary analysis of a longitudinal design comparing baseline with a follow-up nine years later was used with a multidimensional assessment of participation and personal and environmental factors. Based on theoretical models, multiple linear regressions were used. RESULTS One hundred and fourteen adults with DM1 were included in the study (63.2% women; 78.9% adult onset; mean (SD) age of 43.5 (10.4) years). When age, sex, phenotype, and education were controlled for, participation restriction was predicted by a longer time to stand and walk, lower grip strength, higher body mass index, absence of perceived impact of myotonia in daily living, use of adapted transportation from community services, and perception of obstacle in physical environment (p < 0.001, adjusted R2 = 0.50). CONCLUSIONS The majority of predictors of participation restriction can be advantageously modified by rehabilitation and environmental changes, such as politics targeting community services provision or physical environment and services accessibility.Implications for rehabilitationPredictors could better inform rehabilitation professional to recognize individuals at risk of higher participation restriction over time and to target specific interventions based on a prognostic approach.Rehabilitation professionals could inform the people living with myotonic dystrophy type 1 and their relatives of the multifactorial nature of occurrence of participation restriction to diminish the "fatality" associated with a genetic progressive disorder.Predictors allow professionals to assess and intervene in the management of specific factors depending on the rehabilitation goal.Identifying individual with myotonic dystrophy with higher risk of participation restriction could help implement a long-term community based rehabilitation intervention plan targeting both personal and environmental factors.
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Affiliation(s)
- Kateri Raymond
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Jonquière, Canada.,Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada.,Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Chicoutimi, Canada
| | - Mélanie Levasseur
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.,Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
| | - Benjamin Gallais
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Jonquière, Canada.,Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Chicoutimi, Canada.,ÉCOBES - Recherche et transfert, Cégep de Jonquière, Saguenay, Canada
| | - Louis Richer
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Jonquière, Canada.,Département des Sciences de la Santé, Université du Québec à Chicoutimi, Chicoutimi, Canada
| | - Luc Laberge
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Jonquière, Canada.,ÉCOBES - Recherche et transfert, Cégep de Jonquière, Saguenay, Canada.,Département des Sciences de la Santé, Université du Québec à Chicoutimi, Chicoutimi, Canada
| | - Émilie Petitclerc
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Jonquière, Canada
| | - Jean Mathieu
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Jonquière, Canada.,Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Chicoutimi, Canada
| | - Cynthia Gagnon
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Jonquière, Canada.,Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Chicoutimi, Canada
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11
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Simoncini C, Spadoni G, Lai E, Santoni L, Angelini C, Ricci G, Siciliano G. Central Nervous System Involvement as Outcome Measure for Clinical Trials Efficacy in Myotonic Dystrophy Type 1. Front Neurol 2020; 11:624. [PMID: 33117249 PMCID: PMC7575726 DOI: 10.3389/fneur.2020.00624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/28/2020] [Indexed: 01/18/2023] Open
Abstract
Increasing evidences indicate that in Myotonic Dystrophy type 1 (DM1 or Steinert disease), an autosomal dominant multisystem disorder caused by a (CTG)n expansion in DMPK gene on chromosome 19q13. 3, is the most common form of inherited muscular dystrophy in adult patients with a global prevalence of 1/8000, and involvement of the central nervous system can be included within the core clinical manifestations of the disease. Variable in its severity and progression rate over time, likely due to the underlying causative molecular mechanisms; this component of the clinical picture presents with high heterogeneity involving cognitive and behavioral alterations, but also sensory-motor neural integration, and in any case, significantly contributing to the disease burden projected to either specific functional neuropsychological domains or quality of life as a whole. Principle manifestations include alterations of the frontal lobe function, which is more prominent in patients with an early onset, such as in congenital and childhood onset forms, here associated with severe intellectual disabilities, speech and language delay and reduced IQ-values, while in adult onset DM1 cognitive and neuropsychological findings are usually not so severe. Different methods to assess central nervous system involvement in DM1 have then recently been developed, these ranging from more classical psychometric and cognitive functional instruments to sophisticated psycophysic, neurophysiologic and especially computerized neuroimaging techniques, in order to better characterize this disease component, at the same time underlining the opportunity to consider it a suitable marker on which measuring putative effectiveness of therapeutic interventions. This is the reason why, as outlined in the conclusive section of this review, the Authors are lead to wonder, perhaps in a provocative and even paradoxical way to arise the question, whether or not the myologist, by now the popular figure in charge to care of a patient with the DM1, needs to remain himself a neurologist to better appreciate, evaluate and speculate on this important aspect of Steinert disease.
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Affiliation(s)
- Costanza Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Spadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Lai
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenza Santoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Giulia Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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12
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Eriksson BM, Ekström AB, Peny-Dahlstrand M. Daily activity performance in congenital and childhood forms of myotonic dystrophy type 1: a population-based study. Dev Med Child Neurol 2020; 62:723-728. [PMID: 31701525 DOI: 10.1111/dmcn.14395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
Abstract
AIMS To identify and describe the profile characterizing motor and process skills during daily activity performance in individuals with congenital and childhood forms of myotonic dystrophy type 1 (DM1) and to investigate differences in performance between subgroups. METHOD Sixty participants (34 males, 26 females, mean age=17y 8mo, SD=6y 0mo, range 5y 8mo-29y 0mo) were divided into severe congenital (n=9), mild congenital (n=20), and childhood (n=31) DM1 subgroups. Daily activity performance was evaluated using a standardized observational instrument: the Assessment of Motor and Process Skills. RESULTS Deficits in performance were more pronounced in process than motor skills. Performance more than 2 SDs below age-specific norms was seen in 65% of participants for process skills and 33% of participants for motor skills. The cut-off scores indicated a potential need for assistance in daily activities for 79% of participants older than 18 years of age (n=28) due to deficient process skills. INTERPRETATION Extensive deficits in daily activity performance were found in congenital and childhood forms of DM1, mainly owing to deficient process skills. Such skills impact on the ability to perform daily activities and could explain dependency in individuals with DM1. Process skills should be considered when evaluating daily activity performance. WHAT THIS PAPER ADDS Young people with myotonic dystrophy type 1 show deficits in motor and process skills when performing daily activities, compared with normative data. Deficits in process skills were more pronounced than deficits in motor skills.
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Affiliation(s)
- Britt-Marie Eriksson
- Regional Pediatric Rehabilitation Center, Silvia Children's Hospital, Queen, Gothenburg
| | - Anne-Berit Ekström
- Regional Pediatric Rehabilitation Center, Silvia Children's Hospital, Queen, Gothenburg
| | - Marie Peny-Dahlstrand
- Regional Pediatric Rehabilitation Center, Silvia Children's Hospital, Queen, Gothenburg.,Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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13
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Roussel MP, Hébert LJ, Duchesne E. Strength-training effectively alleviates skeletal muscle impairments in myotonic dystrophy type 1. Neuromuscul Disord 2020; 30:283-293. [PMID: 32340814 DOI: 10.1016/j.nmd.2020.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 12/25/2022]
Abstract
Myotonic dystrophy type 1 (DM1) is a multisystemic disease characterized by progressive muscle weakness. The aim of this project is to evaluate the effects of a 12-week lower limb strength training program in 11 men with DM1. Maximal isometric muscle strength, 30-second sit-to-stand, comfortable and maximal 10-m walk test (10 mwt) were evaluated at baseline, 6 and 12 weeks, and at 6 and 9 months. The one-repetition maximum strength evaluation method of the training exercises was completed at baseline, 6 and 12 weeks. Muscle biopsies were taken in the vastus lateralis at baseline and 12 weeks to evaluate muscle fiber typing and size (including atrophy/hypertrophy factors). Performance in strength and functional tests all significantly improved by week 12. Maximal isometric muscle strength of the knee extensors decreased by month 9, while improved walking speed and 30 second sit-to-stand performance were maintained. On average, there were no significant changes in fiber typing or size after training. Further analysis showed that individual abnormal hypertrophy factor at baseline could explain the different changes in muscle size among participants. Strength training induces maximal isometric muscle strength and lasting functional gains in DM1. Abnormal hypertrophy factor could be a key component to identify high and low responders to hypertrophy in DM1.
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Affiliation(s)
- Marie-Pier Roussel
- Département des Sciences Fondamentales, Université du Québec à Chicoutimi, Saguenay, Québec, Canada; Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Québec, Canada; Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Faculté de médecine et des sciences de la santé de l'Université de Sherbrooke, Site Saguenay, Saguenay, Québec, Canada
| | - Luc J Hébert
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Québec, Québec, Canada; Départements de réadaptation et de radiologie et médecine nucléaire, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Elise Duchesne
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Québec, Canada; Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Faculté de médecine et des sciences de la santé de l'Université de Sherbrooke, Site Saguenay, Saguenay, Québec, Canada; Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boul. de l'Université, Saguenay, Québec G7H 2B1, Canada.
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14
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Lenzoni S, Bozzoni V, Burgio F, de Gelder B, Wennberg A, Botta A, Pegoraro E, Semenza C. Recognition of emotions conveyed by facial expression and body postures in myotonic dystrophy (DM). Cortex 2020; 127:58-66. [PMID: 32169676 DOI: 10.1016/j.cortex.2020.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/04/2019] [Accepted: 02/07/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Neuromuscular diseases may be of neuropsychological interest insofar as they may affect representations based on embodied cognition theories. Previous studies have shown impaired ability to recognize facial emotions and an association between facial emotion recognition and visuospatial abilities in myotonic dystrophy type 1 (DM1) patients. Here we examined the ability of both DM1 and DM2 patients to recognize emotions expressed by body postures and its relation, and their association with cognitive performance. METHODS Participants included 34 DM1 patients, 8 DM2 patients, and 24 healthy control subjects. Emotional recognition ability was assessed through two computerized matching tasks (face and bodies). A neuropsychological battery was used to measure cognition in three domains and global cognition. We used univariate and adjusted linear regression models to investigate the association between cognition and emotion recognition performance. RESULTS DM patients (combined DM1 and DM2) performed worse on emotional facial expression (p = .006) and body posture (p = .004) accuracy measures than healthy controls. In linear regression models, DM patients' facial expression accuracy was associated with executive function (p = .013) and visuospatial (p < .001) z-scores. Body posture accuracy was associated with visuospatial (p = .001) and memory (p = .012) z-scores. There were no associations among controls or between cognition and reaction time. DISCUSSION These findings suggest that impaired emotional recognition among DM patients is also extended to emotions conveyed by body postures. Consistent with embodied cognition theories, people affected in their body and its movement may have impaired sensorimotor representation in ways that have yet to be fully understood.
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Affiliation(s)
- Sabrina Lenzoni
- Department of Neurosciences (Padova Neuroscience Center), Università degli Studi di Padova, Italy.
| | - Virginia Bozzoni
- Department of Neurosciences (Padova Neuroscience Center), Università degli Studi di Padova, Italy.
| | | | | | - Alexandra Wennberg
- Department of Neurosciences (Padova Neuroscience Center), Università degli Studi di Padova, Italy.
| | - Annalisa Botta
- Department of Biomedicine and Prevention, Medical Genetics Section, University of Rome Tor Vergata, Rome, Italy.
| | - Elena Pegoraro
- Department of Neurosciences (Padova Neuroscience Center), Università degli Studi di Padova, Italy.
| | - Carlo Semenza
- Department of Neurosciences (Padova Neuroscience Center), Università degli Studi di Padova, Italy; IRCCS San Camillo Hospital, Venice, Italy.
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15
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Roussel MP, Hébert LJ, Duchesne E. Intra-Rater Reliability and Concurrent Validity of Quantified Muscle Testing for Maximal Knee Extensors Strength in Men with Myotonic Dystrophy Type 1. J Neuromuscul Dis 2019; 6:233-240. [PMID: 31127731 DOI: 10.3233/jnd-190388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is the most prevalent degenerative neuromuscular disease in adults. Knee extensor (KE) maximal strength loss is a strong indicator of physical limitations in DM1. A reliable, precise and accessible maximal strength evaluation method needs to be validated for this slowly progressive disease. OBJECTIVE This paper aims to assess the intra-rater reliability, the standard error of measurement (SEM), the minimal detectable change (MDC), and the concurrent validity of quantified muscle testing (QMT) using a handheld dynamometer with a gold standard: the Biodex isokinetic device. METHODS Nineteen men with the adult form of DM1 participated in this study by attending 2 visits spaced by one week. The evaluation of KE muscle strength with QMT was completed on the first visit and the same QMT evaluation in addition to the maximal muscle strength evaluation using an isokinetic device were performed on the second visit. RESULTS The intra-rater reliability was excellent with an intraclass correlation coefficient (ICC) of 0.98 (0.96-0.99 : 95% confidence interval). SEM and MDC values were 1.05 Nm and 2.92 Nm, respectively. Concurrent validity of QMT of KE muscle group with the Biodex was also excellent with a Spearman's correlation of ρ= 0.98. CONCLUSIONS The excellent concurrent validity and intra-rater reliability, and the small SEM and MDC of the QMT make this test a method of choice, in either a clinical or research setting, to precisely evaluate muscle strength impairments of the KE in men with DM1.
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Affiliation(s)
- Marie-Pier Roussel
- Département des sciences fondamentales, Université du Québec à Chicoutimi, Saguenay, Québec, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Québec, Canada.,Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Saguenay, Québec, Canada
| | - Luc J Hébert
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Québec, Québec, Canada.,Départements de réadaptation et de radiologie-médecine nucléaire, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Elise Duchesne
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Québec, Canada.,Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Saguenay, Québec, Canada.,Département des sciences de la santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada
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16
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Excessive daytime sleepiness and fatigue in neurological disorders. Sleep Breath 2019; 24:413-424. [DOI: 10.1007/s11325-019-01921-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/12/2022]
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17
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Roussel MP, Morin M, Girardin M, Fortin AM, Leone M, Mathieu J, Gagnon C, Duchesne E. Training program-induced skeletal muscle adaptations in two men with myotonic dystrophy type 1. BMC Res Notes 2019; 12:526. [PMID: 31429798 PMCID: PMC6700834 DOI: 10.1186/s13104-019-4554-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/10/2019] [Indexed: 01/03/2023] Open
Abstract
Objective The purpose of this side product of another unpublished research project, was to address the effects of a training program on skeletal muscle adaptations of people with myotonic dystrophy type 1 (DM1), under a multifaceted perspective. The objective of this study was to look at training induced muscular adaptations by evaluating changes in muscle strength, myofiber cross-sectional area (CSA), proportion of myofiber types and with indirect markers of muscle growth [proportion of centrally nucleated fibers (CNF) and density of neutrophils and macrophages]. Two men with DM1 underwent a 12-week strength/endurance training program (18 sessions). Two muscle biopsies were obtained pre- and post-training program. Results Muscular adaptations occurred only in Patient 1, who attended 72% of the training sessions compared to 39% for Patient 2. These adaptations included increase in the CSA of type I and II myofibers and changes in their proportion. No changes were observed in the percentage of CNF, infiltration of neutrophils and macrophages and muscle strength. These results illustrate the capacity of skeletal muscle cells to undergo adaptations linked to muscle growth in DM1 patients. Also, these adaptations seem to be dependent on the attendance. Trial registration Clinicaltrials.gov NCT04001920 retrospectively registered on June 26th, 2019
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Affiliation(s)
- Marie-Pier Roussel
- Département des sciences fondamentales, Université du Québec à Chicoutimi, Saguenay, QC, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Installations de Jonquière, Saguenay, QC, Canada.,Centre de recherche-Hôpital Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Saguenay, QC, Canada
| | - Marika Morin
- Département des sciences de la santé, Université du Québec à Chicoutimi, Saguenay, QC, Canada
| | - Mélina Girardin
- Département des sciences de la santé, Université du Québec à Chicoutimi, Saguenay, QC, Canada
| | - Anne-Marie Fortin
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Installations de Jonquière, Saguenay, QC, Canada
| | - Mario Leone
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Installations de Jonquière, Saguenay, QC, Canada.,Département des sciences de la santé, Université du Québec à Chicoutimi, Saguenay, QC, Canada
| | - Jean Mathieu
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Installations de Jonquière, Saguenay, QC, Canada.,Centre de recherche-Hôpital Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Saguenay, QC, Canada.,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Installations de Jonquière, Saguenay, QC, Canada.,Centre de recherche-Hôpital Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Saguenay, QC, Canada.,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Elise Duchesne
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Installations de Jonquière, Saguenay, QC, Canada. .,Centre de recherche-Hôpital Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Saguenay, QC, Canada. .,Département des sciences de la santé, Université du Québec à Chicoutimi, Saguenay, QC, Canada. .,Unité d'enseignement en physiothérapie, Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boulevard de l'Université, Saguenay, G7H 2B1, Quebec, Canada.
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18
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Jimenez-Moreno AC, Nikolenko N, Kierkegaard M, Blain AP, Newman J, Massey C, Moat D, Sodhi J, Atalaia A, Gorman GS, Turner C, Lochmüller H. Analysis of the functional capacity outcome measures for myotonic dystrophy. Ann Clin Transl Neurol 2019; 6:1487-1497. [PMID: 31402614 PMCID: PMC6689676 DOI: 10.1002/acn3.50845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives Defining clinically relevant outcome measures for myotonic dystrophy type 1 (DM1) that can be valid and feasible for different phenotypes has proven problematic. The Outcome Measures for Myotonic Dystrophy (OMMYD) group proposed a battery of functional outcomes: 6‐minute walk test, 30 seconds sit and stand test, timed 10 m walk test, timed 10 m walk/run test, and nine‐hole peg test. This, however, required a large‐scale investigation, Methods A cohort of 213 patients enrolled in the natural history study, PhenoDM1, was analyzed in cross‐sectional analysis and subsequently 98 patients were followed for longitudinal analysis. We aimed to assess: (1) feasibility and best practice; (2) intra‐session reliability; (3) validity; and (4) behavior over time, of these tests. Results OMMYD outcomes proved feasible as 96% of the participants completed at least one trial for all tests and more than half (n = 113) performed all three trials of each test. Body mass index and disease severity associate with functional capacity. There was a significant difference between the first and second trials of each test. There was a moderate to strong correlation between these functional outcomes and muscle strength, disease severity and patient‐reported outcomes. All outcomes after 1 year detected a change in functional capacity except the nine‐hole peg test. Conclusions These tests can be used as a battery of outcomes or independently based on the shown overlapping psychometric features and strong cross‐correlations. Due to the large and heterogeneous sample of this study, these results can serve as reference values for future studies.
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Affiliation(s)
- Aura Cecilia Jimenez-Moreno
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,Welcome Trust Mitochondrial Research Centre, Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nikoletta Nikolenko
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Marie Kierkegaard
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Alasdair P Blain
- Welcome Trust Mitochondrial Research Centre, Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Newman
- Welcome Trust Mitochondrial Research Centre, Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Charlotte Massey
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dionne Moat
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jas Sodhi
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Antonio Atalaia
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,Center of Research in Myology, Sorbonne Université, Paris, France
| | - Grainne S Gorman
- Welcome Trust Mitochondrial Research Centre, Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Turner
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hanns Lochmüller
- Department of Neuropediatrics and Muscle Disorders, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Centro Nacional de Análisis Genómico (CNAG-CRG), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain.,Research Institute, The Children's Hospital of Eastern Ontario, Ottawa, Canada.,Division of Neurology, Department of Medicine, Ottawa University, Ottawa, Canada
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19
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Battalio SL, Jensen MP, Molton IR. Secondary health conditions and social role satisfaction in adults with long-term physical disability. Health Psychol 2019; 38:445-454. [PMID: 31045428 DOI: 10.1037/hea0000671] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Individuals living with physical disability due to early acquired or traumatic conditions often experience a range of psychological and physical health problems that are associated with their condition but are not directly caused by it. Known as "secondary health conditions," these problems can interact with existing functional limitations and other medical comorbidities to limit social participation. The current study assessed the concurrent and longitudinal associations between secondary health conditions, chronic medical comorbidities, and functional limitations, with a PROMIS® measure of social role participation. METHODS A longitudinal survey study of community-dwelling adults with one of four chronic physical conditions (multiple sclerosis, muscular dystrophy, spinal cord injury, postpoliomyelitis syndrome). The baseline survey (T1) was mailed to 2041 individuals, and1862 baseline surveys were completed and returned (91% response rate). The follow-up survey (T2) was mailed roughly three years later; 1594 completed and returned the T2 survey (86% of T1 survey completers). RESULTS Multiple linear regression analyses revealed that secondary health conditions, functional impairments, and chronic medical comorbidities accounted for 52% of the variance in satisfaction with social roles concurrently at T1. The amount of variance of change in satisfaction with social roles over the ∼3-year period accounted for by these variables was 3%. Functional limitations and more psychologically oriented secondary conditions were the strongest predictors of satisfaction with social roles. CONCLUSIONS Findings suggest that, for people with disabilities, addressing psychologically oriented secondary health conditions may be as important as functional impairment in predicting long-term social health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington
| | - Ivan R Molton
- Department of Rehabilitation Medicine, University of Washington
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20
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Holmøy AKT, Johannessen CH, Hope S, van Walsem MR, Aanonsen NO, Hassel B. Uncovering health and social care needs among myotonic dystrophy patients: Utility of the Needs and Provisions Complexity Scale. Acta Neurol Scand 2019; 139:526-532. [PMID: 30848487 DOI: 10.1111/ane.13086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/21/2019] [Accepted: 03/04/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Myotonic dystrophy type 1 (DM1) is a slowly progressive multisystem disorder. Guidelines recommend multidisciplinary follow-up. We aimed to investigate the presence of unmet health and social care needs among patients with DM1 and whether unmet needs correlated with motor function, cognitive impairments, or quality of life. MATERIAL AND METHODS Patients were 22 adults with DM1. "Needs and Provisions Complexity Scale" (NPCS) was applied to evaluate the individual's needs and provision of health and social services. The Muscular Impairment Rating Scale (MIRS) was used to measure motor function and disease stage. All patients underwent neuropsychological testing. The EQ-5D-3L questionnaire was used to evaluate the patients' health-related quality of life (HRQoL). RESULTS Median time from diagnosis was 11 years (range: 1-40). Twenty patients had developed needs related to social care, personal care, and rehabilitation that had not been met, whereas need for medical follow-up was largely met. The more pronounced the muscular impairment, the more unmet needs were experienced by DM1 patients (r = 0.50, P = 0.019). Degree of unmet needs did not correlate with full-scale IQ (r = -0.27, P = 0.23) or HRQoL (r = -0.14, P = 0.55). CONCLUSION Using NPCS, we discovered that patients with DM1 had unmet needs with respect to social care, personal care, and rehabilitation although their need for medical follow-up was met. Thus, the use of NPCS helped bring our practice in better accordance with guidelines. A higher MIRS grade should alert the clinician to the likelihood of unmet needs.
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Affiliation(s)
| | - Cecilie Haggag Johannessen
- Department of Neurohabilitation Oslo University Hospital Ullevål Oslo Norway
- NORMENT, KG Jebsen Centre of Psychosis Research, Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Sigrun Hope
- Department of Neurohabilitation Oslo University Hospital Ullevål Oslo Norway
- NORMENT, KG Jebsen Centre of Psychosis Research, Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Marleen R. van Walsem
- Department of Neurohabilitation Oslo University Hospital Ullevål Oslo Norway
- Research center for Habilitation and Rehabilitation Models and Services, Institute of Health and Society University of Oslo Oslo Norway
| | - Nils Olav Aanonsen
- Department of Neurohabilitation Oslo University Hospital Ullevål Oslo Norway
| | - Bjørnar Hassel
- Department of Neurohabilitation Oslo University Hospital Ullevål Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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21
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Akyurek G, Bumin G, Crowe TK. The factors associated with community participation: Employment and education of people with disabilities in Turkey. Scand J Occup Ther 2019; 27:28-38. [DOI: 10.1080/11038128.2019.1587502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Gokcen Akyurek
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Turkey
| | - Gonca Bumin
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Turkey
| | - Terry K. Crowe
- School of Medicine, Occupational Therapy, University of New Mexico, Albuquerque, NM, USA
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22
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Winblad S, Lindberg C. Perceived fatigue in myotonic dystrophy type 1: a case-control study. BMC Neurol 2019; 19:45. [PMID: 30922263 PMCID: PMC6437849 DOI: 10.1186/s12883-019-1280-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/21/2019] [Indexed: 12/13/2022] Open
Abstract
Background The aim of this study was to explore perceived fatigue, experienced functional limitations due to fatigue and clinical correlates in patients with Myotonic Dystrophy type 1 (DM1). Methods In total, 32 consecutive patients with DM1 (14 women and 18 men) and 30 sex, age and education matched healthy control subjects participated. Perceived fatigue was rated on the Fatigue Impact Scale (FIS). Patients also completed a set of assessments aimed to characterize CTG-repeat size, muscle impairment, depression and cognitive functions. Non-parametric analysis were performed as appropriate, including Mann-Whitney U-test and Spearman correlation test. Results DM1 patients had higher FIS total score than healthy controls, suggesting higher fatigue levels. More specifically, DM1 patients scored higher on the FIS physical and psychosocial subscales than controls but not on the FIS cognitive scale. Scores on fatigue correlated significantly with muscle impairment and depression. Conclusions Perceived fatigue is significantly more common in patients with DM1 than in healthy controls. Higher ratings on depression and muscle impairment were associated with the condition. This indicates that both depression and muscle impairment may contribute to the experience of fatigue in DM1.
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Affiliation(s)
- Stefan Winblad
- Department of Psychology, University of Gothenburg, Box 500, 405 30, Gothenburg, Sweden.
| | - Christopher Lindberg
- Neuromuscular Centre, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
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23
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Hreha KP, Smith AE, Wong JL, Mroz TM, Fogelberg DJ, Molton I. Impact of secondary health conditions on social role participation for a long-term physical disability cohort. PSYCHOL HEALTH MED 2019; 24:1159-1170. [PMID: 30909732 DOI: 10.1080/13548506.2019.1595684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For people living with long-term physical disability (LTPD) social participation may involve managing physical impairments and secondary health conditions (SHCs) that are not due to the pathophysiology of the LTPD diagnosis itself. Prior research found a negative relationship between SHCs and participation in social roles in people with spinal cord injury (SCI). We expand on this research by investigating the influence of SHCs on participation in social roles for people with one of four LTPDs, controlling for co-variates. We (1) evaluated the associations between SHCs and participation in social roles; and (2) determined whether SHCs on individuals' ability to participate in social roles varies by type of diagnosis in those aging with either SCI, muscular sclerosis, muscular dystrophy, or post-polio syndrome. Cross-sectional, secondary data analysis from a return-by-mail survey. N = 1,573. Data were analyzed with multiple linear regressions (hypothesis 1), and then three moderated regressions (hypothesis 2). After controlling for demographics, SHCs were associated with lower ability to participate in social roles and accounted for 48% of the variance (all p's <.001). The relationship between depression and social role participation was moderated by diagnosis, such that depression was more negatively associated with social participation among individuals with SCI (p = .020). Thus, SHC negatively impact participation in social roles.
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Affiliation(s)
- Kimberly P Hreha
- Department of Rehabilitation Medicine, University of Washington Department of Rehabilitation Medicine , Seattle, WA , USA
| | - Amanda E Smith
- Department of Future Health Scenarios, Institute for Health Metrics and Evaluation , Seattle, WA , USA
| | - Jennifer L Wong
- Department of Rehabilitation Medicine, University of Washington Department of Rehabilitation Medicine , Seattle, WA , USA
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington Department of Rehabilitation Medicine , Seattle, WA , USA
| | - Donald J Fogelberg
- Department of Rehabilitation Medicine, University of Washington Department of Rehabilitation Medicine , Seattle, WA , USA
| | - Ivan Molton
- Department of Rehabilitation Medicine, University of Washington Department of Rehabilitation Medicine , Seattle, WA , USA
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24
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Roussel MP, Morin M, Gagnon C, Duchesne E. What is known about the effects of exercise or training to reduce skeletal muscle impairments of patients with myotonic dystrophy type 1? A scoping review. BMC Musculoskelet Disord 2019; 20:101. [PMID: 30836978 PMCID: PMC6402179 DOI: 10.1186/s12891-019-2458-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is a neuromuscular disease characterized by multisystemic involvements including a progressive loss of maximal muscle strength and muscle wasting. Poor lower-limb strength is an important factor explaining disrupted social participation of affected individuals. This review aims to map what is known about the effects of exercise and training programs undertaken to counteract skeletal muscle impairments in DM1 patients. METHODS Medline, CINAHL and EMBASE databases were searched. Regarding study eligibility, title and abstract of 704 studies followed by 45 full articles were reviewed according to the following eligibility criteria. Inclusion: (1) humans with DM1 and (2) experimental protocol relying on exercise or training. Exclusion: (1) studies that do not evaluate skeletal muscle responses or adaptations, (2) reviews covering articles already included and (3) pharmacological intervention at the same time of exercise or training program. RESULTS Twenty-one papers were selected for in-depth analysis. Different exercise or training protocols were found including: acute exercise, neuromuscular electric stimulation, strength training, aerobic training, balance training and multiple rehabilitation interventions. Seven studies reported clinical measurements only, five physiological parameters only and nine both types. CONCLUSION This scoping review offers a complete summary of the current scientific literature on the effect of exercise and training in DM1 and a framework for future studies based on the concomitant evaluation of the several outcomes in present literature. Although there were a good number of studies focusing on clinical measurements, heterogeneity between studies does not allow to identify what are the adequate training parameters to obtain exercise or training-induced positive impacts on muscle function. Scientific literature is even more scarce regarding physiological parameters, where much more research is needed to understand the underlying mechanisms of exercise response in DM1.
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Affiliation(s)
- Marie-Pier Roussel
- Département des sciences de la santé, physiothérapie, Université du Québec à Chicoutimi, 555, boulevard de l'Université, Chicoutimi, Quebec, G7H 2B1, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, 2230 rue de l'Hôpital, Saguenay, Québec, Canada.,Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, 2230 rue de l'Hôpital, Saguenay, Québec, Canada., Longueuil, Québec, Canada
| | - Marika Morin
- Département des sciences de la santé, physiothérapie, Université du Québec à Chicoutimi, 555, boulevard de l'Université, Chicoutimi, Quebec, G7H 2B1, Canada
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, 2230 rue de l'Hôpital, Saguenay, Québec, Canada.,Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, 2230 rue de l'Hôpital, Saguenay, Québec, Canada., Longueuil, Québec, Canada.,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec, Canada
| | - Elise Duchesne
- Département des sciences de la santé, physiothérapie, Université du Québec à Chicoutimi, 555, boulevard de l'Université, Chicoutimi, Quebec, G7H 2B1, Canada. .,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, 2230 rue de l'Hôpital, Saguenay, Québec, Canada. .,Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, 2230 rue de l'Hôpital, Saguenay, Québec, Canada., Longueuil, Québec, Canada.
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25
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van Dorst M, Okkersen K, Kessels RPC, Meijer FJA, Monckton DG, van Engelen BGM, Tuladhar AM, Raaphorst J. Structural white matter networks in myotonic dystrophy type 1. NEUROIMAGE-CLINICAL 2018; 21:101615. [PMID: 30522973 PMCID: PMC6413352 DOI: 10.1016/j.nicl.2018.101615] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/16/2018] [Accepted: 11/20/2018] [Indexed: 01/21/2023]
Abstract
The myriad of neuropsychiatric manifestations reported in myotonic dystrophy type 1 may have its origin in alterations of complex brain network interactions at the structural level. In this study, we tested the hypothesis that altered white matter microstructural integrity and network organisation were present in a cohort of individuals with DM1 compared to unaffected controls, which was expected to be associated with CNS related disease manifestations of DM1. We performed a cross-sectional neuropsychological assessment and brain MRI in 25 myotonic dystrophy type 1 (DM1) patients and 26 age, sex and educational level matched unaffected controls. Patients were recruited from the Dutch cohort of the OPTIMISTIC study, a concluded trial which had included ambulant, genetically confirmed DM1 patients who were severely fatigued. We applied graph theoretical analysis on structural networks derived from diffusion tensor imaging (DTI) data and deterministic tractography to determine global and local network properties and performed group-wise comparisons. Furthermore, we analysed the following variables from structural MRI imaging: semi-quantitative white matter hyperintensity load andwhite matter tract integrity using tract-based spatial statistics (TBSS). Structural white matter networks in DM1 were characterised by reduced global efficiency, local efficiency and strength, while the network density was compatible to controls. Other findings included increased white matter hyperintensity load, and diffuse alterations of white matter microstructure in projection, association and commissural fibres. DTI and network measures were associated (partial correlations coefficients ranging from 0.46 to 0.55) with attention (d2 Test), motor skill (Purdue Pegboard test) and visual-constructional ability and memory (copy subtest of the Rey-Osterrieth Complex Figure Test). DTI and network measures were not associated with clinical measures of fatigue (checklist individual strength, fatigue subscale) or apathy (apathy evaluation scale - clinician version). In conclusion, our study supports the view of brain involvement in DM1 as a complex network disorder, characterised by white matter network alterations that may have relevant neuropsychological correlations. This work was supported by the European Community's Seventh Framework Programme (FP7/2007-2013; grant agreement n° 305,697) and the Marigold Foundation.
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Affiliation(s)
- Maud van Dorst
- Department of Medical Psychology, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, the Netherlands; Vincent van Gogh Institute of Psychiatry, Stationsweg 46, 5803 AC Venray, the Netherlands.
| | - Kees Okkersen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen.
| | - Roy P C Kessels
- Department of Medical Psychology, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, the Netherlands; Department of Neuropsychology and Rehabilitation Psychology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Montessorilaan 3, Nijmegen 6525 HR, the Netherlands; Vincent van Gogh Institute of Psychiatry, Stationsweg 46, 5803 AC Venray, the Netherlands.
| | - Frederick J A Meijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, the Netherlands.
| | - Darren G Monckton
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Davidson BuildingUniversity Avenue, Glasgow G12 8QQ, UK.
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen.
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen.
| | - Joost Raaphorst
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen; Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands.
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26
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Akyurek G, Bumin G. The Measure of Quality of the Environments' Turkish Validity and Reliability. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2018; 39:239-246. [PMID: 30465466 DOI: 10.1177/1539449218812150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to translate the Measure of Quality of the Environment-Short Form (MQE-SF) into Turkish language and to evaluate the validity and reliability. The MQE-SF was culturally adapted via an internationally suggested method. A total of 185 volunteers with disabilities (age range = 18-55 y/o, 107 males; 78 females) from the Disabled People Association of Turkey completed the MQE-SF. To evaluate the MQE-SF's criterion/concurrent validity, the Craig Hospital Inventory of Environmental Factors (CHIEF) was also administered. Test-retest reliability was evaluated by administering MQE-SF to 85 participants a second time within 14 days of initial administration. The alpha coefficient measuring the internal consistency of the questionnaire were .84 and .83. The criterion-related validity was moderate between the MQE-SF Barriers and the CHIEF (r = -.46, p < .05). The questionnaire was moderately reliable in terms of the test-retest reliability (r = .69, .70 p < .05). The Turkish adaptation of the MQE-SF had good internal consistency and moderate criterion-related validity as well as test-retest reliability for people with disabilities.
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27
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Van Heugten C, Meuleman S, Hellebrekers D, Kruitwagen-van Reenen E, Visser-Meily J. Participation and the Role of Neuropsychological Functioning in Myotonic Dystrophy Type 1. J Neuromuscul Dis 2018; 5:205-214. [PMID: 29865086 DOI: 10.3233/jnd-170246] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Myotonic Dystrophy type 1 (DM1) is primarily a neuromuscular disease but can also have neuropsychological consequences (i.e.cognitive, emotional and behavioural) which can influence daily living and societal participation. Not much is known about the level of participation of DM1 patients and their relatives and the factors influencing participation. This information can guide the development of rehabilitation programs and identify those at risk of long-term participation problems. OBJECTIVE To investigate the level of participation of DM1 patients and their partners and the determinants. METHODS Cross-sectional study using the Utrecht Scale for Evaluation of Rehabilitation-Participation. Determinants were demographic, disease related, and neuropsychological characteristics. Spearman correlations and backward multiple regression analyses were performed. RESULTS Of the 66 DM1 participants, 54% reported severe fatigue and 47% apathy. Experienced participation restrictions were most prevalent in housekeeping (74%), sports (68%) and outdoor activities (55%). Participants were relatively satisfied with their level of participation, but dissatisfaction occurred mostly in housekeeping (58%), outdoor activities (55%), and sports (54%). Age and apathy were significant predictors of frequency of (R2 = 10.4) and restrictions in participation in the multivariate model (R2 = 14.4). Emotional functioning was the only significant predictor of satisfaction with participation (R2 = 23.8). CONCLUSIONS A considerable number of DM1 patients have Central Nervous System-related problems such as fatigue and apathy in addition to neuromuscular restrictions. Risk factors for lower participation are age, apathy, and emotional problems. Physical as well as neuropsychological rehabilitation programs are recommended.
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Affiliation(s)
- Caroline Van Heugten
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Susan Meuleman
- Merem Rehabilitation Center De Trappenberg, Almere, The Netherlands
| | - Danique Hellebrekers
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Esther Kruitwagen-van Reenen
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna Visser-Meily
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Romigi A, Franco V, Placidi F, Liguori C, Rastelli E, Vitrani G, Centonze D, Massa R. Comparative Sleep Disturbances in Myotonic Dystrophy Types 1 and 2. Curr Neurol Neurosci Rep 2018; 18:102. [DOI: 10.1007/s11910-018-0903-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Labayru G, Arenzana I, Aliri J, Zulaica M, López de Munain A, Sistiaga A. A. Social cognition in myotonic dystrophy type 1: Specific or secondary impairment? PLoS One 2018; 13:e0204227. [PMID: 30248121 PMCID: PMC6152965 DOI: 10.1371/journal.pone.0204227] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 09/05/2018] [Indexed: 11/19/2022] Open
Abstract
AIMS The cognitive profile of Myotonic Dystrophy type 1 (DM1) has been described in recent decades. Moreover, DM1 patients show lowered social engagement and difficulties in social-cognitive functions. The aim of the present study is to explore whether social cognition impairment is present in DM1 taking into account the overall cognitive condition. METHOD 38 patients and a control group paired in age and gender participated in the study. All the participants had an IQ within the normal range. Subjects were administered an abbreviated neuropsychological battery which comprised a facial emotion recognition test (POFA) and Faux Pas Test, as well as a self-report questionnaire on cognitive and affective empathy (TECA). RESULTS Statistically significant differences were found only for facial emotion recognition (U = 464.0, p = .006) with a moderate effect size (.31), with the controls obtaining a higher score than the patients. Analyzing each emotion separately, DM1 patients scored significantly lower than controls on the recognition of anger and disgust items. Emotion recognition did not correlate with genetic load, but did correlate negatively with age. No differences were found between patients and controls in any of the other variables related to Theory of Mind (ToM) and empathy. CONCLUSION DM1 does not manifest specific impairments in ToM since difficulties in this area predominantly rely on the cognitive demand of the tasks employed. However, a more basic process such as emotion recognition appears as a core deficit. The role of this deficit as a marker of aging related decline is discussed.
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Affiliation(s)
- Garazi Labayru
- Neuroscience Area, Biodonostia Research Institute, Donostia-San Sebastian, Gipuzkoa, Spain
- Personality, Assessment and Psychological Treatment Department, Psychology Faculty, University of the Basque Country (UPV/EHU), Donostia-San Sebastian, Gipuzkoa, Spain
| | - Irati Arenzana
- Master’s in Child and Adult Neuropsychology, Autonoma University of Barcelona, Spain
| | - Jone Aliri
- Department of Social Psychology and Methodology of Behavioral Sciences, University of the Basque Country (UPV/EHU), Donostia-San Sebastian, Gipuzkoa, Spain
| | - Miren Zulaica
- Neuroscience Area, Biodonostia Research Institute, Donostia-San Sebastian, Gipuzkoa, Spain
| | - Adolfo López de Munain
- Neuroscience Area, Biodonostia Research Institute, Donostia-San Sebastian, Gipuzkoa, Spain
- Neurology Department, Donostia University Hospital, Donostia-San Sebastian, Gipuzkoa, Spain
| | - Andone Sistiaga A.
- Neuroscience Area, Biodonostia Research Institute, Donostia-San Sebastian, Gipuzkoa, Spain
- Personality, Assessment and Psychological Treatment Department, Psychology Faculty, University of the Basque Country (UPV/EHU), Donostia-San Sebastian, Gipuzkoa, Spain
- * E-mail:
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Okkersen K, Jimenez-Moreno C, Wenninger S, Daidj F, Glennon J, Cumming S, Littleford R, Monckton DG, Lochmüller H, Catt M, Faber CG, Hapca A, Donnan PT, Gorman G, Bassez G, Schoser B, Knoop H, Treweek S, van Engelen BGM. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. Lancet Neurol 2018; 17:671-680. [PMID: 29934199 DOI: 10.1016/s1474-4422(18)30203-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/08/2018] [Accepted: 05/16/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Myotonic dystrophy type 1 is the most common form of muscular dystrophy in adults and leads to severe fatigue, substantial physical functional impairment, and restricted social participation. In this study, we aimed to determine whether cognitive behavioural therapy optionally combined with graded exercise compared with standard care alone improved the health status of patients with myotonic dystrophy type 1. METHODS We did a multicentre, single-blind, randomised trial, at four neuromuscular referral centres with experience in treating patients with myotonic dystrophy type 1 located in Paris (France), Munich (Germany), Nijmegen (Netherlands), and Newcastle (UK). Eligible participants were patients aged 18 years and older with a confirmed genetic diagnosis of myotonic dystrophy type 1, who were severely fatigued (ie, a score of ≥35 on the checklist-individual strength, subscale fatigue). We randomly assigned participants (1:1) to either cognitive behavioural therapy plus standard care and optional graded exercise or standard care alone. Randomisation was done via a central web-based system, stratified by study site. Cognitive behavioural therapy focused on addressing reduced patient initiative, increasing physical activity, optimising social interaction, regulating sleep-wake patterns, coping with pain, and addressing beliefs about fatigue and myotonic dystrophy type 1. Cognitive behavioural therapy was delivered over a 10-month period in 10-14 sessions. A graded exercise module could be added to cognitive behavioural therapy in Nijmegen and Newcastle. The primary outcome was the 10-month change from baseline in scores on the DM1-Activ-c scale, a measure of capacity for activity and social participation (score range 0-100). Statistical analysis of the primary outcome included all participants for whom data were available, using mixed-effects linear regression models with baseline scores as a covariate. Safety data were presented as descriptives. This trial is registered with ClinicalTrials.gov, number NCT02118779. FINDINGS Between April 2, 2014, and May 29, 2015, we randomly assigned 255 patients to treatment: 128 to cognitive behavioural therapy plus standard care and 127 to standard care alone. 33 (26%) of 128 assigned to cognitive behavioural therapy also received the graded exercise module. Follow-up continued until Oct 17, 2016. The DM1-Activ-c score increased from a mean (SD) of 61·22 (17·35) points at baseline to 63·92 (17·41) at month 10 in the cognitive behavioural therapy group (adjusted mean difference 1·53, 95% CI -0·14 to 3·20), and decreased from 63·00 (17·35) to 60·79 (18·49) in the standard care group (-2·02, -4·02 to -0·01), with a mean difference between groups of 3·27 points (95% CI 0·93 to 5·62, p=0·007). 244 adverse events occurred in 65 (51%) patients in the cognitive behavioural therapy group and 155 in 63 (50%) patients in the standard care alone group, the most common of which were falls (155 events in 40 [31%] patients in the cognitive behavioural therapy group and 71 in 33 [26%] patients in the standard care alone group). 24 serious adverse events were recorded in 19 (15%) patients in the cognitive behavioural therapy group and 23 in 15 (12%) patients in the standard care alone group, the most common of which were gastrointestinal and cardiac. INTERPRETATION Cognitive behavioural therapy increased the capacity for activity and social participation in patients with myotonic dystrophy type 1 at 10 months. With no curative treatment and few symptomatic treatments, cognitive behavioural therapy could be considered for use in severely fatigued patients with myotonic dystrophy type 1. FUNDING The European Union Seventh Framework Programme.
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Affiliation(s)
- Kees Okkersen
- Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.
| | | | - Stephan Wenninger
- Friedrich-Baur-Institute, Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ferroudja Daidj
- Neuromuscular Reference Centre, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jeffrey Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sarah Cumming
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Darren G Monckton
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hanns Lochmüller
- Institute of Genetic Medicine, University of Newcastle, Newcastle, UK; Department of Neuropediatrics and Muscle Disorders, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany; Centro Nacional de Análisis Genómico, Center for Genomic Regulation, Barcelona Institute of Science and Technology, Barcelona, Catalonia, Spain
| | - Michael Catt
- National Innovation Centre for Ageing, University of Newcastle, Newcastle, UK; Catt-Sci, Wellingborough, UK
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Adrian Hapca
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Gráinne Gorman
- Institute of Neuroscience, University of Newcastle, Newcastle, UK
| | - Guillaume Bassez
- Neuromuscular Reference Centre, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benedikt Schoser
- Friedrich-Baur-Institute, Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Hans Knoop
- Academic Medical Center, University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
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Jimenez-Moreno AC, Charman SJ, Nikolenko N, Larweh M, Turner C, Gorman G, Lochmüller H, Catt M. Analyzing walking speeds with ankle and wrist worn accelerometers in a cohort with myotonic dystrophy. Disabil Rehabil 2018; 41:2972-2978. [PMID: 29987963 PMCID: PMC6900209 DOI: 10.1080/09638288.2018.1482376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Accelerometers are accurate tools to assess movement and physical activity. However, interpreting standardly used outputs is not straightforward for populations with impaired mobility. Methods: The applicability of GENEActiv was explored in a group of 30 participants with myotonic dystrophy and compared to a group of 14 healthy-controls. All participants performed a set of tests while wearing four different accelerometers (wrists and ankles): [1] standing still; [2] ten-meters walk test; [3] six-minutes walking test; and, [4] ten-meters walk/run test. Results: Relevant findings were: [1] high intra-accelerometer reliability (i.e. 0.97 to 0.99; p < 0.001); [2] each test acceleration values differ significantly between each other; [3] no inter-accelerometer reliability between wrist-worn devices and ankle-worn; and [4] a significant difference between the myotonic dystrophy group and the healthy-controls detectable at each test (i.e. Left-ankle values at six-minutes walking test: 48±17 for the myotonic dystrophy group, vs, 74±16 for the healthy-controls; p < 0.001). Conclusions: GENEActiv demonstrated to be valid and reliable, capable of detecting walking periods and discriminating different speeds. However, inter-accelerometer reliability only applied when comparing opposite sides of the same limb. Specific movement characteristics of the myotonic dystrophy group were identified and muscle strength showed not to be a full determinant of limb acceleration.Implications for rehabilitation Rehabilitation professionals in the field of neuromuscular disorders should be aware of the potential use of objective monitoring tools such as accelerometers whilst acknowledging the implications of assessing populations with altered movement patterns. Researchers should be cautious when translating accelerometry outputs previously validated in healthy populations to functionally impaired cohorts like myotonic dystrophy. Accelerometers can objectively expose movement disturbances allowing further investigations for the source of these disturbances.
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Affiliation(s)
| | - Sarah J Charman
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Nikoletta Nikolenko
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom.,National Hospital for Neurology and Neurosurgery, University College London Hospital, London, United Kingdom
| | - Maxwell Larweh
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Chris Turner
- National Hospital for Neurology and Neurosurgery, University College London Hospital, London, United Kingdom
| | - Grainne Gorman
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Hanns Lochmüller
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Michael Catt
- National Innovation Centre for Ageing, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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A 9-year follow-up study of quantitative muscle strength changes in myotonic dystrophy type 1. J Neurol 2018; 265:1698-1705. [PMID: 29785524 DOI: 10.1007/s00415-018-8898-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
Myotonic dystrophy type 1 (DM1) is a neuromuscular disorder presenting with major muscle impairments. However, few studies have addressed muscle strength progression using quantitative methods. The aims of this study were to document muscle strength changes in eight muscle groups among adults with DM1 over a 9-year period, and to compare this progression between phenotypes (adult and late-onset) and sex. Patients with a genetic diagnosis of DM1 with the late-onset or the adult phenotype were recruited at baseline through the clinical registry of the Saguenay Neuromuscular Clinic. The maximum isometric muscle strength was measured at baseline and 9 years later using a standardized protocol of quantitative muscle testing. Muscle groups included were shoulder abductors, elbow flexors/extensors, wrist extensors, hip flexors, knee flexors/extensors, and ankle dorsiflexors. For the whole group, a mean loss of 24.5-52.8% was observed over the 9-year period for all muscle groups, except for hip flexors which remained stable. Generally, men were stronger and showed a significant greater rate of decline of muscle strength than women. The adult and late-onset phenotypes taken separately also showed a significant and similar decline over the 9-year period, except for the wrist and knee extensors where muscle strength of participants with the adult phenotype decreased faster than in the late-onset phenotype. The similar rate of decline of muscle strength loss observed between phenotypes highlights the need to develop interventions to prevent this decline, even for patients with the late-onset phenotype who are often considered as mildly impaired, and therefore neglected by the rehabilitation services.
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Kalra S, Montanaro F, Denning C. Can Human Pluripotent Stem Cell-Derived Cardiomyocytes Advance Understanding of Muscular Dystrophies? J Neuromuscul Dis 2018; 3:309-332. [PMID: 27854224 PMCID: PMC5123622 DOI: 10.3233/jnd-150133] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Muscular dystrophies (MDs) are clinically and molecularly a highly heterogeneous group of single-gene disorders that primarily affect striated muscles. Cardiac disease is present in several MDs where it is an important contributor to morbidity and mortality. Careful monitoring of cardiac issues is necessary but current management of cardiac involvement does not effectively protect from disease progression and cardiac failure. There is a critical need to gain new knowledge on the diverse molecular underpinnings of cardiac disease in MDs in order to guide cardiac treatment development and assist in reaching a clearer consensus on cardiac disease management in the clinic. Animal models are available for the majority of MDs and have been invaluable tools in probing disease mechanisms and in pre-clinical screens. However, there are recognized genetic, physiological, and structural differences between human and animal hearts that impact disease progression, manifestation, and response to pharmacological interventions. Therefore, there is a need to develop parallel human systems to model cardiac disease in MDs. This review discusses the current status of cardiomyocytes (CMs) derived from human induced pluripotent stem cells (hiPSC) to model cardiac disease, with a focus on Duchenne muscular dystrophy (DMD) and myotonic dystrophy (DM1). We seek to provide a balanced view of opportunities and limitations offered by this system in elucidating disease mechanisms pertinent to human cardiac physiology and as a platform for treatment development or refinement.
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Affiliation(s)
- Spandan Kalra
- Department of Stem Cell Biology, Centre for Biomolecular Sciences, University of Nottingham, UK
| | - Federica Montanaro
- Dubowitz Neuromuscular Centre, Department of Molecular Neurosciences, University College London - Institute of Child Health, London, UK
| | - Chris Denning
- Department of Stem Cell Biology, Centre for Biomolecular Sciences, University of Nottingham, UK
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Cheung J, Ruoff C, Moore H, Hagerman KA, Perez J, Sakamuri S, Warby SC, Mignot E, Day J, Sampson J. Increased EEG Theta Spectral Power in Sleep in Myotonic Dystrophy Type 1. J Clin Sleep Med 2018; 14:229-235. [PMID: 29394960 PMCID: PMC5786842 DOI: 10.5664/jcsm.6940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/24/2017] [Accepted: 10/23/2017] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Myotonic dystrophy type 1 (DM1) is a multisystemic disorder that involves the central nervous system (CNS). Individuals with DM1 commonly present with sleep dysregulation, including excessive daytime sleepiness and sleep-disordered breathing. We aim to characterize electroencephalogram (EEG) power spectra from nocturnal polysomnography (PSG) in patients with DM1 compared to matched controls to better understand the potential CNS sleep dysfunction in DM1. METHODS A retrospective, case-control (1:2) chart review of patients with DM1 (n = 18) and matched controls (n = 36) referred for clinical PSG at the Stanford Sleep Center was performed. Controls were matched based on age, sex, apnea-hypopnea index (AHI), body mass index (BMI), and Epworth Sleepiness Scale (ESS). Sleep stage and respiratory metrics for the two groups were compared. Power spectral analysis of the EEG C3-M2 signal was performed using the fast Fourier transformation. RESULTS Patients with DM1 had significantly increased theta percent power in stage N2 sleep compared to matched controls. Theta/beta and theta/alpha percent power spectral ratios were found to be significantly increased in stage N2, N3, all sleep stages combined, and all wake periods combined in patients with DM1 compared to controls. A significantly lower nadir O2 saturation was also found in patients with DM1 versus controls. CONCLUSIONS Compared to matched controls, patients with DM1 had increased EEG theta spectral power. Increased theta/beta and theta/alpha power spectral ratios in nocturnal PSG may reflect DM1 pathology in the CNS.
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Affiliation(s)
- Joseph Cheung
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Chad Ruoff
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Hyatt Moore
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Katharine A. Hagerman
- Department of Neurology, Stanford University Hospitals and Clinics, Stanford, California
| | - Jennifer Perez
- Department of Neurology, Stanford University Hospitals and Clinics, Stanford, California
| | - Sarada Sakamuri
- Department of Neurology, Stanford University Hospitals and Clinics, Stanford, California
| | - Simon C. Warby
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - John Day
- Department of Neurology, Stanford University Hospitals and Clinics, Stanford, California
| | - Jacinda Sampson
- Department of Neurology, Stanford University Hospitals and Clinics, Stanford, California
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Lecordier D, Cartron E, Jovic L. [Understanding people with Steinert’s disease to provide them with better care.]. Rech Soins Infirm 2018:13-28. [PMID: 29436800 DOI: 10.3917/rsi.131.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION the lifestyles of individuals with myotonic dystrophy type 1 (DM1), also known as Steinert’s disease, are poorly understood and yet they need to be considered when it comes to effective long-term care. The nursing care provided in referral centers is mindful of the clinical diversity of Steinert’s disease when it comes to interdisciplinary care, but the disease is more complex from a relational point of view. The objective of this qualitative study was to understand the life experiences of individuals with Steinert’s disease, by looking at the limitations of their bodies and the adaptation strategies they develop. METHOD this social science and nursing science study examines this problem of care, adopting an ethno-sociological perspective. RESULTS The study brought to light the changes that Steinert’s disease imposes on a body. These changes contribute to individuals’ construction of a body schema and social identity, which, despite allowing them to maintain a “normal” daily life for as long as possible, can also reach limits, requiring them to make radical life changes. The study’s results are discussed using an analytical framework based on the four different ways of interpreting the body proposed by Nicolas Vonarx: the “material body,” the “able body,” the “feeling body,” and the “knowing/judging body.” To discuss the role the body plays for people living with Steinert’s disease within a normative society, we propose that the concept of the “socializing body” be added to this framework.
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A More Efficient Transportable and Scalable System for Real-Time Activities and Exercises Recognition. SENSORS 2018; 18:s18010268. [PMID: 29346286 PMCID: PMC5795635 DOI: 10.3390/s18010268] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/24/2022]
Abstract
Many people in the world are affected by muscle wasting, especially the population hits by myotonic dystrophy type 1 (DM1). Those people are usually given a program of multiple physical exercises to do. While DM1 and many other people have difficulties attending commercial centers to realize their program, a solution is to develop such a program completable at home. To this end, we developed a portable system that patients could bring home. This prototype is an improved version of the previous one using Wi-Fi, as this new prototype runs on BLE technology. This new prototype conceptualized induces great results.
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Fujino H, Shingaki H, Suwazono S, Ueda Y, Wada C, Nakayama T, Takahashi MP, Imura O, Matsumura T. Cognitive impairment and quality of life in patients with myotonic dystrophy type 1. Muscle Nerve 2017; 57:742-748. [PMID: 29193182 DOI: 10.1002/mus.26022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 11/25/2017] [Accepted: 11/27/2017] [Indexed: 01/25/2023]
Abstract
INTRODUCTION This study sought to clarify whether specific cognitive abilities are impaired in patients with myotonic dystrophy type 1 (DM1) as well as to investigate the relationships among quality of life (QoL), cognitive function, and psychological factors. METHODS Sixty patients with DM1 were evaluated on cognitive functioning (abstract reasoning, attention/working memory, executive function, processing speed, and visuoconstructive ability), apathy, depression, excessive daytime sleepiness, fatigue, and QoL. QoL was assessed by 2 domains of the Muscular Dystrophy Quality of Life Scale (Psychosocial Relationships and Physical Functioning and Health). RESULTS More than half of the patients exhibited cognitive impairment in attention/working memory, executive function, processing speed, and visuoconstructive ability. The Psychosocial Relationships factor was associated with processing speed, attention/working memory, and apathy, whereas depression and fatigue were associated with 2 QoL domains. DISCUSSION Our study identified specific cognitive impairments in DM1. Specific cognitive functions and psychological factors may be potential contributors to QoL. Muscle Nerve 57: 742-748, 2018.
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Affiliation(s)
- Haruo Fujino
- Department of Special Needs Education, Oita University, 700 Dannoharu, Oita, Japan, 870-1192.,Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Honoka Shingaki
- Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Shugo Suwazono
- Department of Neurology, National Hospital Organization Okinawa Hospital, Okinawa, Japan
| | | | - Chizu Wada
- Department of Neurology, National Hospital Organization Akita National Hospital, Yurihonjo, Japan
| | | | - Masanori P Takahashi
- Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Osamu Imura
- Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Toneyama National Hospital, Osaka, Japan
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Abstract
BACKGROUND Myotonic dystrophy type 1 is an autosomal dominant condition affecting distal hand strength, energy, and cognition. Increasingly, patients and families are seeking information online. An online neuromuscular patient portal under development can help patients access resources and interact with each other regardless of location. It is unknown how individuals living with myotonic dystrophy interact with technology and whether barriers to access exist. We aimed to characterize technology use among participants with myotonic dystrophy and to determine whether there is interest in a patient portal. METHODS Surveys were mailed to 156 participants with myotonic dystrophy type 1 registered with the Canadian Neuromuscular Disease Registry. RESULTS Seventy-five participants (60% female) responded; almost half were younger than 46 years. Most (84%) used the internet; almost half of the responders (47%) used social media. The complexity and cost of technology were commonly cited reasons not to use technology. The majority of responders (76%) were interested in a myotonic dystrophy patient portal. CONCLUSIONS Patients in a Canada-wide registry of myotonic dystrophy have access to and use technology such as computers and mobile phones. These patients expressed interest in a portal that would provide them with an opportunity to network with others with myotonic dystrophy and to access information about the disease.
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Raymond K, Levasseur M, Mathieu J, Desrosiers J, Gagnon C. A 9-year follow-up study of the natural progression of upper limb performance in myotonic dystrophy type 1: A similar decline for phenotypes but not for gender. Neuromuscul Disord 2017; 27:673-682. [PMID: 28527585 DOI: 10.1016/j.nmd.2017.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 03/29/2017] [Accepted: 04/19/2017] [Indexed: 11/18/2022]
Abstract
This study aimed to document and compare the decline of upper limb performance among adults with myotonic dystrophy type 1 according to phenotype and gender. A longitudinal descriptive design compared upper limb performance at baseline and follow-up of 70 women and 38 men with the late-onset or adult phenotypes. Grip strength and pinch strength as well as gross dexterity and fine dexterity were assessed. All four performance measures decreased significantly (p <0.001). The decline over time was similar for individuals with the late-onset and adult-onset phenotypes, but differed according to gender. For late-onset and adult-onset phenotypes respectively, women lost less grip strength than men: 0.4 and minus 0.8 kg (2.0% and -9.4%) in women vs. minus 7.4 and minus 3.1 kg (-19.2% and -30.7%) in men. A similar situation was found for gross dexterity: minus 3.0 and minus 3.2 blocks (-4.6% and -5.9%) in women vs. minus 12.4 and minus 8.7 blocks (-19.4% and -16.6%) in men. Pinch gauge had the smallest standard deviations and was one of the only measurement tools with significant detectable changes in relation to the standard error of measurement. Given these results, health professionals and researchers should consider phenotype and gender differently when planning health services or future studies. Indeed, as their upper limb strength and dexterity differed, even if their decline was similar, the phenotypes should not be pooled. Finally, the use of the pinch gauge to assess long-term change in upper limb ability seems preferable to the three other measurements.
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Affiliation(s)
- Kateri Raymond
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, Québec, Canada J1H 5N4; Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Neuromuscular Clinic, Centre de réadaptation en déficience physique de Jonquière, Centre de santé et de services sociaux de Jonquière, rue de l'Hôpital, 2230, C.P. 1200, Jonquière, Québec, Canada G7X 7X2; Research Centre on Aging, Health and Social Services Centre, University Institute of Geriatrics of Sherbrooke, 1036 rue Belvédère Sud, Sherbrooke, Québec, Canada J1H 4C4; Centre de recherche-Hôpital Charles-Le Moyne, Centre de santé et de services sociaux du Saguenay-Lac-St-Jean, 305 rue Saint-Vallier, Chicoutimi, Québec, Canada G7H 5H6
| | - Mélanie Levasseur
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, Québec, Canada J1H 5N4; Research Centre on Aging, Health and Social Services Centre, University Institute of Geriatrics of Sherbrooke, 1036 rue Belvédère Sud, Sherbrooke, Québec, Canada J1H 4C4
| | - Jean Mathieu
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, Québec, Canada J1H 5N4; Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Neuromuscular Clinic, Centre de réadaptation en déficience physique de Jonquière, Centre de santé et de services sociaux de Jonquière, rue de l'Hôpital, 2230, C.P. 1200, Jonquière, Québec, Canada G7X 7X2; Centre de recherche-Hôpital Charles-Le Moyne, Centre de santé et de services sociaux du Saguenay-Lac-St-Jean, 305 rue Saint-Vallier, Chicoutimi, Québec, Canada G7H 5H6
| | - Johanne Desrosiers
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, Québec, Canada J1H 5N4; Research Centre on Aging, Health and Social Services Centre, University Institute of Geriatrics of Sherbrooke, 1036 rue Belvédère Sud, Sherbrooke, Québec, Canada J1H 4C4
| | - Cynthia Gagnon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, Québec, Canada J1H 5N4; Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Neuromuscular Clinic, Centre de réadaptation en déficience physique de Jonquière, Centre de santé et de services sociaux de Jonquière, rue de l'Hôpital, 2230, C.P. 1200, Jonquière, Québec, Canada G7X 7X2; Centre de recherche-Hôpital Charles-Le Moyne, Centre de santé et de services sociaux du Saguenay-Lac-St-Jean, 305 rue Saint-Vallier, Chicoutimi, Québec, Canada G7H 5H6.
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Gallais B, Gagnon C, Forgues G, Côté I, Laberge L. Further evidence for the reliability and validity of the Fatigue and Daytime Sleepiness Scale. J Neurol Sci 2017; 375:23-26. [PMID: 28320135 DOI: 10.1016/j.jns.2017.01.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/21/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is an inherited neuromuscular disease causing, among other symptoms, fatigue and excessive daytime sleepiness, which are frequently undifferentiated by patients and/or clinicians. The Fatigue and Daytime Sleepiness Scale (FDSS) has been devised to measure these two overlapping symptoms as a single clinical entity. OBJECTIVE To further examine the reliability and the construct validity of the FDSS in patients with DM1. METHODS The scale was administered to 48 DM1 patients on two occasions at a 2week-interval. Intra-rater reliability and internal consistency were established by calculating the intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. Construct validity was assessed by using the known-group method. More precisely, the mean FDSS score of patients with and without subjective complaints of fatigue and/or sleepiness was compared. RESULTS The FDSS showed good intra-rater reliability (ICC=0.83) and acceptable internal consistency (Cronbach's alpha =0.6). Also, the FDSS was able to distinguish between patients who had fatigue and sleepiness complaints from those who did not (mean FDSS score of 10.6 vs 8.0, p=0.01), suggesting good construct validity. CONCLUSION Overall, the present study supports the continued use of the FDSS as a reliable and valid instrument to measure fatigue and daytime sleepiness in patients with DM1 for either clinical or research purposes.
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Affiliation(s)
- Benjamin Gallais
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Saguenay, Québec, Canada; Centre de recherche Charles-Le-Moyne, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Saguenay, Québec, Canada; Centre de recherche Charles-Le-Moyne, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Geneviève Forgues
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Saguenay, Québec, Canada; Département des sciences de la santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada
| | - Isabelle Côté
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Saguenay, Québec, Canada
| | - Luc Laberge
- ÉCOBES - Recherche et transfert, Cégep de Jonquière, Saguenay, Québec, Canada; Département des sciences de la santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada.
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Wood L, Cordts I, Atalaia A, Marini-Bettolo C, Maddison P, Phillips M, Roberts M, Rogers M, Hammans S, Straub V, Petty R, Orrell R, Monckton DG, Nikolenko N, Jimenez-Moreno AC, Thompson R, Hilton-Jones D, Turner C, Lochmüller H. The UK Myotonic Dystrophy Patient Registry: facilitating and accelerating clinical research. J Neurol 2017; 264:979-988. [PMID: 28397002 PMCID: PMC5413526 DOI: 10.1007/s00415-017-8483-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 01/24/2023]
Abstract
Myotonic dystrophy type 1 (DM1) is the most frequent muscular dystrophy worldwide with complex, multi-systemic, and progressively worsening symptoms. There is currently no treatment for this inherited disorder and research can be challenging due to the rarity and variability of the disease. The UK Myotonic Dystrophy Patient Registry is a patient self-enrolling online database collecting clinical and genetic information. For this cross-sectional “snapshot” analysis, 556 patients with a confirmed diagnosis of DM1 registered between May 2012 and July 2016 were included. An almost even distribution was seen between genders and a broad range of ages was present from 8 months to 78 years, with the largest proportion between 30 and 59 years. The two most frequent symptoms were fatigue and myotonia, reported by 79 and 78% of patients, respectively. The severity of myotonia correlated with the severity of fatigue as well as mobility impairment, and dysphagia occurred mostly in patients also reporting myotonia. Men reported significantly more frequent severe myotonia, whereas severe fatigue was more frequently reported by women. Cardiac abnormalities were diagnosed in 48% of patients and more than one-third of them needed a cardiac implant. Fifteen percent of patients used a non-invasive ventilation and cataracts were removed in 26% of patients, 65% of which before the age of 50 years. The registry’s primary aim was to facilitate and accelerate clinical research. However, these data also allow us to formulate questions for hypothesis-driven research that may lead to improvements in care and treatment.
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Affiliation(s)
- Libby Wood
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.
| | - Isabell Cordts
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,Department of Neurology, RWTH Aachen University, Aachen, Germany
| | - Antonio Atalaia
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Chiara Marini-Bettolo
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Paul Maddison
- Department of Neurology, Queen's Medical Centre, Nottingham, UK
| | - Margaret Phillips
- Department of Rehabilitation Medicine, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Mark Roberts
- Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Mark Rogers
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - Simon Hammans
- Wessex Neurological Centre, University Hospital of Southampton, Southampton, UK
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Petty
- Department of Neurology, NHS Greater Glasgow and Clyde, Southern General Hospital, Glasgow, UK
| | - Richard Orrell
- Department of Neurology, Royal Free Hospital, London, UK
| | - Darren G Monckton
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Nikoletta Nikolenko
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Aura Cecilia Jimenez-Moreno
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel Thompson
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | | - Chris Turner
- UCL MRC Centre for Neuromuscular Diseases, Institute of Neurology, London, UK
| | - Hanns Lochmüller
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
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Gagnon C, Kierkegaard M, Blackburn C, Chrestian N, Lavoie M, Bouchard MF, Mathieu J. Participation restriction in childhood phenotype of myotonic dystrophy type 1: a systematic retrospective chart review. Dev Med Child Neurol 2017; 59:291-296. [PMID: 27671786 DOI: 10.1111/dmcn.13282] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 11/27/2022]
Abstract
AIM Myotonic dystrophy type 1 (DM1), a neuromuscular disorder, is divided into four clinical phenotypes: congenital; childhood; adult-onset, and late-onset. Publications about the childhood phenotype, especially the long-term outcome, are scarce. The aims of this study were to assess and describe participation outcomes in adults with the childhood phenotype. METHOD A retrospective chart methodology. Data were extracted from health records for 63 adults with childhood DM1 (32 males, 31 females; mean age 34y, standard deviation [SD] 11y 6mo; range 18-54y) who had attended the Saguenay Neuromuscular Clinic, Canada. RESULTS Thirty-four adults (54%) lived with their parents or in foster homes, and most patients needed services or help to live independently. A significant proportion (22%) were isolated in regard to friendship. Very few adults had children, although 33% lived with a spouse. The majority of patients (86%) relied on social security and only one person was currently working. Financial responsibilities were often an issue and 13 (21%) were under legal guardianship. INTERPRETATION This study showed that patients with the childhood phenotype present a guarded prognosis regarding long-term social participation. These participation restrictions could be related to behavioural, cognitive, and social stigma problems in childhood. This study illustrates the absolute necessity to pursue an interdisciplinary follow-up of these patients when they are reaching adulthood.
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Affiliation(s)
- Cynthia Gagnon
- Centre de recherche Charles-Le-Moyne, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Neuromuscular Clinic, Centre intégré universitaire de santé et services sociaux du Saguenay-Lac-St-Jean, Hôpital Jonquière, Saguenay, QC, Canada
| | - Marie Kierkegaard
- Centre de recherche Charles-Le-Moyne, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Catherine Blackburn
- Neuromuscular Clinic, Centre intégré universitaire de santé et services sociaux du Saguenay-Lac-St-Jean, Hôpital Jonquière, Saguenay, QC, Canada
| | - Nicolas Chrestian
- Department of Paediatric Neurology, Paediatric Neuromuscular Disorder, Centre Mère Enfant Soleil, Laval University, QC, Canada
| | - Mélissa Lavoie
- Centre de recherche Charles-Le-Moyne, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Neuromuscular Clinic, Centre intégré universitaire de santé et services sociaux du Saguenay-Lac-St-Jean, Hôpital Jonquière, Saguenay, QC, Canada
| | - Marie-Frédéric Bouchard
- Centre de recherche Charles-Le-Moyne, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean Mathieu
- Centre de recherche Charles-Le-Moyne, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Neuromuscular Clinic, Centre intégré universitaire de santé et services sociaux du Saguenay-Lac-St-Jean, Hôpital Jonquière, Saguenay, QC, Canada
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Hesterlee S, Amur S, Bain LJ, Carulli J, Clarke S, Day JW, Gagnon C, Hagerman K, Heatwole C, Johnson NE, Moxley R, Patel N, Thornton C, Kessel W, White M. Patient-Centered Therapy Development for Myotonic Dystrophy: Report of the Myotonic Dystrophy Foundation-Sponsored Workshop. Ther Innov Regul Sci 2017; 51:516-522. [PMID: 30227044 DOI: 10.1177/2168479016683988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Myotonic dystrophy (DM) is an autosomal dominant, repeat expansion, progressive disorder with no drug therapies. Consequently, to better define a regulatory pathway in anticipation of new treatment strategies under investigation, the Myotonic Dystrophy Foundation convened a workshop entitled "Patient-Centered Therapy Development for Myotonic Dystrophy" in September 2015. Participants included representatives from academia, industry, the patient community, the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). Presenters described the symptom burden of the disease, and existing data on DM biomarkers, endpoints, natural history, and benefit-risk considerations. FDA participants helped clarify the regulatory requirements for new drug treatment approvals and DM-specific issues such as variability, slow progression, and low prevalence. Workshop attendees gained a better understanding of DM and the current status of existing data and tools to support therapeutic drug research and development.
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Affiliation(s)
| | - Shashi Amur
- 2 Office of Translational Sciences, CDER, FDA, Silver Spring, MD, USA
| | | | - John Carulli
- 4 Precision Medicine, Biogen, Cambridge, MA, USA
| | | | - John W Day
- 6 Department of Neurology, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Cynthia Gagnon
- 7 School of Rehabilitation, Université de Sherbrooke, Quebec, Canada
| | - Katharine Hagerman
- 6 Department of Neurology, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Chad Heatwole
- 8 Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Nicholas E Johnson
- 9 Department of Neurology, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Richard Moxley
- 8 Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Nikunj Patel
- 10 Office of New Drugs, CDER, FDA, Silver Spring, MD, USA
| | - Charles Thornton
- 8 Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Woodie Kessel
- 1 Myotonic Dystrophy Foundation, San Francisco, CA, USA
| | - Molly White
- 1 Myotonic Dystrophy Foundation, San Francisco, CA, USA
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Kierkegaard M, Petitclerc E, Hébert LJ, Gagnon C. Is one trial enough for repeated testing? Same-day assessments of walking, mobility and fine hand use in people with myotonic dystrophy type 1. Neuromuscul Disord 2017; 27:153-158. [DOI: 10.1016/j.nmd.2016.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/05/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
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Petitclerc É, Hébert LJ, Mathieu J, Desrosiers J, Gagnon C. Lower limb muscle strength impairment in late-onset and adult myotonic dystrophy type 1 phenotypes. Muscle Nerve 2016; 56:57-63. [PMID: 27784130 DOI: 10.1002/mus.25451] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Lower limb strength has never been characterized separately for late-onset and adult myotonic dystrophy type 1 (DM1) phenotypes. METHODS The purpose of this study was to: (1) describe and compare lower limb strength between the 2 DM1 phenotypes; and (2) compare the impairment profiles obtained from 2 assessment methods [manual (MMT) and quantitative (QMT) muscle testing] among 107 patients. RESULTS Both MMT and QMT showed more pronounced weakness in the adult phenotype. In the late-onset phenotype, although MMT showed normal strength, QMT revealed a loss of 11.7%-20.4%. Participants with grade 1 or 2 on the Muscle Impairment Rating Scale had weakness detected using QMT, which suggests earlier muscle impairment than MMT alone would suggest. CONCLUSIONS To avoid muscle wasting, physical activity recommendations should be made for the late-onset phenotype and in the early stages of the disease for the adult phenotype. MMT is not recommended for use in clinical trials. Muscle Nerve 56: 57-63, 2017.
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Affiliation(s)
- Émilie Petitclerc
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Luc J Hébert
- Faculty of Medicine, Rehabilitation (Physiotherapy) and Radiology Department, Université Laval, Québec City, Québec, Canada
| | - Jean Mathieu
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Johanne Desrosiers
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Cynthia Gagnon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Myotonic Dystrophy and Huntington's Disease Care: "We Like to Think We're Making a Difference". Can J Neurol Sci 2016; 43:678-86. [PMID: 27670211 DOI: 10.1017/cjn.2016.257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patient-centered care for individuals with myotonic dystrophy (DM1) and Huntington's disease (HD)-chronic, progressive, and life-limiting neurological conditions-may be challenged by patients' cognitive and behavioral impairments. However, no research has explored health care providers' (HCPs') perspectives about patient-centered care provision for these patients along their disease trajectory. METHODS Constructivist grounded theory informed the iterative data collection and analysis process. Eleven DM1 or HD HCPs participated in semistructured interviews, and three stages of coding were used to analyze their interview transcripts. Codes were collapsed into themes and categories. RESULTS Three categories including an evolving care approach, fluid roles, and making a difference were identified. Participants described that their clinical care approach evolved depending on the patient's disease stage and caregivers' degree of involvement. HCPs described that their main goal was to provide hope to patients and caregivers through medical management, crisis prevention, support, and advocacy. Despite the lack of curative treatments, HCPs perceived that patients benefited from ongoing clinical care provided by proactive clinicians. CONCLUSIONS Providing care for individuals with DM1 and HD is a balancing act. HCPs must strike a balance between (1) the frustrations and rewards of patient-centered care provision, (2) addressing symptoms and preventing and managing crises while focusing on patients' and caregivers' quality of life concerns, and (3) advocating for patients while addressing caregivers' needs. This raises important questions: Is patient-centered care possible for patients with cognitive decline? Does chronic neurological care need to evolve to better address patients' and caregivers' complex needs?
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Ballert CS, Hopfe M, Kus S, Mader L, Prodinger B. Using the refined ICF Linking Rules to compare the content of existing instruments and assessments: a systematic review and exemplary analysis of instruments measuring participation. Disabil Rehabil 2016; 41:584-600. [PMID: 27414962 DOI: 10.1080/09638288.2016.1198433] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Existing instruments measuring participation may vary with respect to various aspects. This study aimed to examine the comparability of existing instruments measuring participation based on the International Classification of Functioning, Disability and Health (ICF) by considering aspects of content, the perspective adopted and the categorization of response options. METHODS A systematic literature review was conducted to identify instruments that have been commonly used to measure participation. Concepts of identified instruments were then linked to the ICF following the refined ICF Linking Rules. Aspects of content, perspective adopted and categorization of response options were documented. RESULTS Out of 315 instruments identified in the full-text screening, 41 instruments were included. Concepts of six instruments were linked entirely to the ICF component Activities and Participation; of 10 instruments still 80% of their concepts. A descriptive perspective was adopted in most items across instruments (75%), mostly in combination with an intensity rating. An appraisal perspective was found in 18% and questions from a need or dependency perspective were least frequent (7%). CONCLUSION Accounting for aspects of content, perspective and categorization of responses in the linking of instruments to the ICF provides detailed information for the comparison of instruments and guidance on narrowing down the choices of suitable instruments from a content point of view. Implications for Rehabilitation For clinicians and researchers who need to identify a specific instrument for a given purpose, the findings of this review can serve as a screening tool for instruments measuring participation in terms of the following: • Their content covered based on the ICF. • The perspective adopted in the instrument (e.g., descriptive, need/dependency or appraisal). • The categorization of their response options (e.g., intensity or frequency).
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Affiliation(s)
- Carolina S Ballert
- a Swiss Paraplegic Research, ICF Unit , Nottwil , Switzerland.,b Department of Health Sciences and Health Policy , University of Lucerne , Lucerne , Switzerland
| | - Maren Hopfe
- a Swiss Paraplegic Research, ICF Unit , Nottwil , Switzerland.,b Department of Health Sciences and Health Policy , University of Lucerne , Lucerne , Switzerland
| | - Sandra Kus
- c Department of Medical Informatics, Biometry and Epidemiology - IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health , Ludwig-Maximilians-University (LMU) , Munich , Germany
| | - Luzius Mader
- b Department of Health Sciences and Health Policy , University of Lucerne , Lucerne , Switzerland
| | - Birgit Prodinger
- a Swiss Paraplegic Research, ICF Unit , Nottwil , Switzerland.,b Department of Health Sciences and Health Policy , University of Lucerne , Lucerne , Switzerland.,d ICF Research Branch a Cooperation Partner within the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI) , Nottwil , Switzerland
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Why stay home? Temporal association of pain, fatigue and depression with being at home. Disabil Health J 2015; 9:218-25. [PMID: 26750976 DOI: 10.1016/j.dhjo.2015.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Community participation is important to most people with disabilities despite the fact that common secondary conditions like pain, fatigue and depression may increase the difficulty of leaving home. Despite decades of research on these secondary conditions, little is known about how they are associated with being at home. OBJECTIVE We used Ecological Momentary Assessment data to examine within subject fluctuation in these secondary conditions to examine their effect on the likelihood that participants remain at or return home. METHODS Participants (n = 139) were recruited from a population based sampling frame to complete an Ecological Momentary Assessment that queried their location and experience with secondary conditions six times a day for two weeks. RESULTS Between subjects secondary condition ratings averaged across time periods indicated that pain and depression were associated with the share of measurement periods that respondents reported being at home. Within subject results indicated that a standard unit increase in pain, fatigue and depression was associated with being home one to two days later. Within day results indicated that increases in pain and fatigue were associated with increased likelihood of being home later, but increases in depression were associated with lower likelihood of being home later. CONCLUSION These results suggest there may be a complicated relationship among these secondary conditions and community participation with effects observed both across and within days. One interpretation suggests that secondary condition severity is tempered by adjusting participation. These results may have implications for intervening on these secondary conditions.
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Prevalence and correlates of apathy in myotonic dystrophy type 1. BMC Neurol 2015; 15:148. [PMID: 26296336 PMCID: PMC4546188 DOI: 10.1186/s12883-015-0401-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 08/07/2015] [Indexed: 01/09/2023] Open
Abstract
Background Apathy in DM1 has long been acknowledged in clinical practice. However, a major drawback is that the concept has been only sparsely explored in previous specific studies. This study aimed to determine the prevalence of apathy in myotonic dystrophy (DM1), to compare it with facioscapulohumeral dystrophy (FSHD) patients and normal healthy controls, and explore its relationship to psychopathological features and cognitive function. Methods Levels of apathy in 38 DM1 patients with adult phenotypes were compared with 19 patients with FSHD and 20 matched controls. Patient participants were consecutively recruited, regarding their interdisciplinary annual evaluation at the neuromuscular pathology reference center (Institute of Myology, Paris, France), within an 18-month period. Additional measurements included motor disability, fatigue, depression, anxiety, and cognitive abilities. Inter-group comparisons were performed using non-parametric Kruskal-Wallis tests and Mann–Whitney U Tests. Intra-group comparisons were carried out with the Wilcoxon Signed rank and Friedman tests. Also, Spearman’s correlations were used to assess the strength of linear relationships between pairs of variables. The significance level was set at 0.05. Results Global score of apathy was significantly higher in DM1 patients than in FSHD patients (p < 0.01) and in controls (p < 0.001). Sixteen of 38 DM1 patients (39.5 %) met the criterion for apathy, contrasting with only 4 of the 19 (21.1 %) FSHD patients. No control subject was apathetic. Moreover, apathy in DM1 patients was negatively correlated to MMSE (r = −.46, p < .05) and Stroop Word (r = −.55, p < .01) scores, but not with age, educational level, disease duration, CTG repeats, motor functional disability, fatigue, depression, and anxiety. Conclusions Apathy is a frequent symptom in DM1 (almost 40 %). It is more prevalent than in a similarly disabled group of patients with FSHD and in controls. Results also show that apathy in DM1 is independent of the psychopathological domain, fatigue, age, and motor disability, but associated to general cognitive status. These results altogether could suggest a central cause for apathy in DM1 rather than an adjustment process to cope with the progressive and debilitating nature of the disease. Data emphasize the importance to evaluate this symptom in routine clinical management of DM1 patients. Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0401-6) contains supplementary material, which is available to authorized users.
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Rakocevic-Stojanovic V, Peric S, Basta I, Dobricic V, Ralic V, Kacar A, Peric M, Novakovic I. Variability of multisystemic features in myotonic dystrophy type 1--lessons from Serbian registry. Neurol Res 2015; 37:939-44. [PMID: 26184384 DOI: 10.1179/1743132815y.0000000068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is a rare disease. Creating registry for such a disease is of outstanding importance since it provides us with a full spectrum of the disorder. AIM To assess variability of different multisystemic features in a large cohort of patients with DM1. PATIENTS AND METHOD Data from the Serbian registry for myotonic dystrophies were used in the study. Final number of included DM1 subjects was 275. RESULTS Registry included 53.8% of male patients. Age at enrollment was 47.2 ± 9.9 years, mean disease duration 20.4 ± 9.9 years, and mean CTG repeats number 598.3 ± 269.8.Progression of muscle weakness was pretty slow, slower in proximal than distal muscles, and slower in arms than in legs. Severe ECG abnormality was found in 25.0% of patients and pacemaker was implanted in 9.5%. Lens opacities were observed in 83.5% of DM1 patients and 35.3% had ocular hypotony. Metabolic disturbances were very common, while 19.5% of patients had hypokalemia and 37.8% hypochloremia. Sterility was found in 20.5% of males and 4.1% of females. Cholelithiasis was found in 36.4% of patients and constipation in 29.9%. CONCLUSIONS We defined the most common characteristics of our DM1 patients and observed some treatable symptoms that have been neglected previously. Certain findings deserve further investigations in terms of their causes and consequences. Besides this, presented data analysis directs us to make further improvements of the registry.
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