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Fernandes L, Coats RO, Mon-Williams M, Hafeez A, Holt R, Ford HL. A novel tool for characterising upper limb function in progressive multiple sclerosis through kinematic assessment. J Neurol Sci 2024; 462:123068. [PMID: 38850768 DOI: 10.1016/j.jns.2024.123068] [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: 01/25/2024] [Revised: 05/11/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Current upper limb assessment methods in MS rely on measuring duration in tasks like the nine-hole peg test (9HPT). Kinematic techniques may provide a more useful measure of functional change in clinical and research practice. The aim of this study was to assess upper limb function prospectively in people with progressive MS using a kinematic 3D motion capture system and compare with current measures. METHODS 42 people with progressive MS (PwPMS) and 15 healthy controls reached-and-grasped different objects whilst recorded by a kinematic assessment system. 9HPT, Expanded Disability Status Scale (EDSS), and patient reported outcome measures (PROs) were collected. All measures were taken at baseline for PwPMS and controls, and again at six months for PwPMS. RESULTS Relative to controls, PwPMS had significantly longer reaction (0.11 s, p < 0.05) and reach (0.25 s, p < 0.05) times. PwPMS took longer to pick-up (0.34 s, p < 0.05), move (0.14 s, p < 0.05), and place (0.18 s, p < 0.05) objects. PwPMS had lower peak velocities when reaching (7.4 cm/s, p < 0.05) and moving (7.3 cm/s, p < 0.05) objects. Kinematic assessment demonstrated consistent differences between PwPMS with mild and severe upper limb dysfunction as defined by PROs, which were not captured by 9HPT or EDSS in this group. PwPMS demonstrated altered grip apertures profiles, as measured by their ability to complete individual parts of the reach and grasp task, between the baseline and follow-up timepoints. CONCLUSIONS We have created and tested a novel upper limb function assessment tool which has detected changes and characteristics in hand function, not currently captured by the EDSS and 9HPT.
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Affiliation(s)
| | | | | | - Awais Hafeez
- University of Leeds, School of Mechanical Engineering, UK
| | - Raymond Holt
- University of Leeds, School of Mechanical Engineering, UK
| | - Helen L Ford
- Leeds Teaching Hospitals NHS Trust, Centre for Neurosciences, UK
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Li X, Jin M, Zhang N, Hongman W, Fu L, Qi Q. Neural correlates of fine motor grasping skills: Longitudinal insights into motor cortex activation using fNIRS. Brain Behav 2024; 14:e3383. [PMID: 38376039 PMCID: PMC10784192 DOI: 10.1002/brb3.3383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/01/2023] [Accepted: 12/20/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Motor learning is essential for performing specific tasks and progresses through distinct stages, including the rapid learning phase (initial skill acquisition), the consolidation phase (skill refinement), and the stable performance phase (skill mastery and maintenance). Understanding the cortical activation dynamics during these stages can guide targeted rehabilitation interventions. METHODS In this longitudinal randomized controlled trial, functional near-infrared spectroscopy was used to explore the temporal dynamics of cortical activation in hand-related motor learning. Thirty-one healthy right-handed individuals were randomly assigned to perform either easy or intricate motor tasks with their non-dominant hand over 10 days. We conducted 10 monitoring sessions to track cortical activation in the right hemisphere (according to lateralization principles, the primary hemisphere for motor control) and evaluated motor proficiency concurrently. RESULTS The study delineated three stages of nondominant hand motor learning: rapid learning (days 1 and 2), consolidation (days 3-7), and stable performance (days 8-10). There was a power-law enhancement of motor skills correlated with learning progression. Sustained activation was observed in the supplementary motor area (SMA) and parietal lobe (PL), whereas activation in the right primary motor cortex (M1R) and dorsolateral prefrontal cortex (PFCR) decreased. These cortical activation patterns exhibited a high correlation with the augmentation of motor proficiency. CONCLUSIONS The findings suggest that early rehabilitation interventions, such as transcranial magnetic stimulation and transcranial direct current stimulation (tDCS), could be optimally directed at M1 and PFC in the initial stages. In contrast, SMA and PL can be targeted throughout the motor learning process. This research illuminates the path for developing tailored motor rehabilitation interventions based on specific stages of motor learning. NEW AND NOTEWORTHY In an innovative approach, our study uniquely combines a longitudinal design with the robustness of generalized estimating equations (GEEs). With the synergy of functional near-infrared spectroscopy (fNIRS) and the Minnesota Manual Dexterity Test (MMDT) paradigm, we precisely trace the evolution of neural resources during complex, real-world fine-motor task learning. Centering on right-handed participants using their nondominant hand magnifies the intricacies of right hemisphere spatial motor processing. We unravel the brain's dynamic response throughout motor learning stages and its potent link to motor skill enhancement. Significantly, our data point toward the early-phase rehabilitation potential of TMS and transcranial direct current stimulation on the M1 and PFC regions. Concurrently, SMA and PL appear poised to benefit from ongoing interventions during the entire learning curve. Our findings carve a path for refined motor rehabilitation strategies, underscoring the importance of timely noninvasive brain stimulation treatments.
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Affiliation(s)
- Xiaoli Li
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
| | - Minxia Jin
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
| | - Nan Zhang
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
| | - Wei Hongman
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
| | - LianHui Fu
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
| | - Qi Qi
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
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Ovacik U, Tarakci E, Ozdemir Z. Upper limb dysfunction in people with early-stage Multiple Sclerosis: Perceived performance can be misleading. Mult Scler Relat Disord 2023; 79:104944. [PMID: 37678130 DOI: 10.1016/j.msard.2023.104944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Although the necessity of upper limb (UL) (dys)function assessment in people with Multiple Sclerosis (pwMS) has been demonstrated in recent years, this is still neglected at an early-stage. OBJECTIVE The aim of our study was to comprehensively examine bilateral UL in early-stage pwMS who are thought to have no or minimal involvement in activities of daily living for the UL. METHODS UL muscle strength, sensation and dexterity of 44 pwMS (EDSS score<4, disease duration<5 years, who did not report problems in daily living activities specifically for the UL) were evaluated bilaterally and compared with 44 healthy controls (HC). The relationship between UL function and muscle strength, sensation, cognitive function, fatigue, mood status, participation, EDSS, and disease duration were examined. The results of the outcome measures evaluating the UL function objectively and subjectively were analyzed. RESULTS Muscle strength, sensation and dexterity were similar in the dominant and nondominant extremities of pwMS and were affected compared to HC. A fair relationship was found between UL function and proximal muscle strength, fatigue, cognitive function, home participation and EDSS. According to the cut-off value (18 s) of Nine Hole Peg Test, only 9.09% of pwMS was unaffected, but 79.54% of affected pwMS had a full ABILHAND score. CONCLUSION Early-stage pwMS are unaware of the dysfunction since their UL involvement does not affect their daily living activities yet. Patient-reported outcome measures such as ABILHAND can be misleading and have a ceiling effect in the early-stage of the disease. Objective functional evaluations reveal that UL capacity is affected from the early period. Even if pwMS do not report UL involvement, clinicians and researchers should evaluate UL function and include it in the treatment program from an early-stage to prevent further disease burden.
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Affiliation(s)
- Ugur Ovacik
- Physiotherapy Program, Department of Medical Services and Techniques, Vocational School of Health Services, Istanbul Aydin University, Istanbul, Turkey; Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Ela Tarakci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, İstanbul, Turkey
| | - Zeynep Ozdemir
- Neurology Department, Bakırköy Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, İstanbul, Turkey
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Tacchino A, Pedullà L, Podda J, Monti Bragadin M, Battaglia MA, Bisio A, Bove M, Brichetto G. Motor imagery has a priming effect on motor execution in people with multiple sclerosis. Front Hum Neurosci 2023; 17:1179789. [PMID: 37746058 PMCID: PMC10512728 DOI: 10.3389/fnhum.2023.1179789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Priming is a learning process that refers to behavioral changes caused by previous exposure to a similar stimulus. Motor imagery (MI), which involves the mental rehearsal of action representations in working memory without engaging in actual execution, could be a strategy for priming the motor system. This study investigates whether MI primes action execution in Multiple Sclerosis (MS). Here, 17 people with MS (PwMS) and 19 healthy subjects (HS), all right-handed and good imaginers, performed as accurately and quickly as possible, with a pencil, actual or mental pointing movements between targets of small (1.0 × 1.0 cm) or large (1.5 × 1.5 cm) size. In actual trials, they completed five pointing cycles between the left and right targets, whereas in mental trials, the first 4 cycles were imagined while the fifth was actually executed. The fifth cycle was introduced to assess the MI priming effect on actual execution. All conditions, presented randomly, were performed with both dominant (i.e., right) and non-dominant arms. Analysis of the duration of the first 4 cycles in both actual and mental trials confirmed previous findings, showing isochrony in HS with both arms and significantly faster mental than actual movements (anisochrony) in PwMS (p < 0.01) [time (s); HS right: actual: 4.23 ± 0.15, mental: 4.36 ± 0.16; left: actual: 4.32 ± 0.15, mental: 4.43 ± 0.18; PwMS right: actual: 5.85 ± 0.16, mental: 5.99 ± 0.21; left: actual: 6.68 ± 0.20, mental: 5.94 ± 0.23]; anisochrony in PwMS was present when the task was performed with the non-dominant arm. Of note, temporal analysis of the fifth actual cycle showed no differences between actual and mental trials for HS with both arms, whereas in PwMS the fifth actual cycle was significantly faster after the four actual cycles for the non-dominant arm (p < 0.05) [time (s); HS right: actual: 1.03 ± 0.04, mental: 1.03 ± 0.03; left: actual: 1.08 ± 0.04, mental: 1.05 ± 0.03; PwMS right: actual: 1.48 ± 0.04, mental: 1.48 ± 0.06; left: actual: 1.66 ± 0.05, mental: 1.48 ± 0.06]. These results seem to suggest that a few mental repetitions of an action might be sufficient to exert a priming effect on the actual execution of the same action in PwMS. This would indicate further investigation of the potential use of MI as a new motor-cognitive tool for MS neurorehabilitation.
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Affiliation(s)
- Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | | | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine, and Public Health, University of Siena, Siena, Italy
| | - Ambra Bisio
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
- Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy
| | - Marco Bove
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
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Grange E, Solaro C, Di Giovanni R, Marengo D. The correlation between 9-HPT and patient-reported measures of upper limb function in multiple sclerosis: a systematic review and meta-analysis. J Neurol 2023; 270:4179-4191. [PMID: 37294322 PMCID: PMC10421783 DOI: 10.1007/s00415-023-11801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
Upper limb function is one of the most affected domains in people with multiple sclerosis (PwMS), as self-reported by 50% of patients. Heterogeneous results have been found about the correlation between objective and subjective upper limb function. The aim of the present study is to perform a systematic review and meta-analysis of studies presenting data on the strength of association between the gold standard for 9-Hole Peg Test scores and Patient-Reported Outcome Measures (PROMs) of manual ability. Primary research studies including assessments of 9-Hole Peg Test scores and Patient-Reported Outcome Measures were searched in Scopus, Web of Science, and PubMed. Meta analytical calculations were performed using a random-effects model. We retrieved n = 27 studies including n = 75 distinct effect sizes (N of subjects = 3263). The central tendency analysis showed a strong correlation between 9-HPT scores and PROMs (r = 0.51, 95% CI [0.44, 0.58]). Moderator analysis showed the effect size to be significantly larger in studies with a mean or median EDSS level indicating severe disability. The publication bias hypothesis was not supported; instead, we noted that studies based on larger samples also tend to report stronger effect sizes. Results of the study indicate that the correlation between 9-HPT and PROMs is strong, although the constructs measured by these instrument does not fully overlap. The correlation between 9-HPT and PROMs was stronger in larger studies and when samples include a sizeable subgroup of PwMS with severe disability, pointing out the importance of sample diversity.
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Affiliation(s)
- Erica Grange
- CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Claudio Solaro
- CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
- Neurology Unit, Galliera Hospital, Genoa, Italy
| | | | - Davide Marengo
- Department of Psychology, University of Turin, Turin, Italy.
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Woelfle T, Bourguignon L, Lorscheider J, Kappos L, Naegelin Y, Jutzeler CR. Wearable Sensor Technologies to Assess Motor Functions in People With Multiple Sclerosis: Systematic Scoping Review and Perspective. J Med Internet Res 2023; 25:e44428. [PMID: 37498655 PMCID: PMC10415952 DOI: 10.2196/44428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/19/2022] [Accepted: 05/04/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Wearable sensor technologies have the potential to improve monitoring in people with multiple sclerosis (MS) and inform timely disease management decisions. Evidence of the utility of wearable sensor technologies in people with MS is accumulating but is generally limited to specific subgroups of patients, clinical or laboratory settings, and functional domains. OBJECTIVE This review aims to provide a comprehensive overview of all studies that have used wearable sensors to assess, monitor, and quantify motor function in people with MS during daily activities or in a controlled laboratory setting and to shed light on the technological advances over the past decades. METHODS We systematically reviewed studies on wearable sensors to assess the motor performance of people with MS. We scanned PubMed, Scopus, Embase, and Web of Science databases until December 31, 2022, considering search terms "multiple sclerosis" and those associated with wearable technologies and included all studies assessing motor functions. The types of results from relevant studies were systematically mapped into 9 predefined categories (association with clinical scores or other measures; test-retest reliability; group differences, 3 types; responsiveness to change or intervention; and acceptability to study participants), and the reporting quality was determined through 9 questions. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. RESULTS Of the 1251 identified publications, 308 were included: 176 (57.1%) in a real-world context, 107 (34.7%) in a laboratory context, and 25 (8.1%) in a mixed context. Most publications studied physical activity (196/308, 63.6%), followed by gait (81/308, 26.3%), dexterity or tremor (38/308, 12.3%), and balance (34/308, 11%). In the laboratory setting, outcome measures included (in addition to clinical severity scores) 2- and 6-minute walking tests, timed 25-foot walking test, timed up and go, stair climbing, balance tests, and finger-to-nose test, among others. The most popular anatomical landmarks for wearable placement were the waist, wrist, and lower back. Triaxial accelerometers were most commonly used (229/308, 74.4%). A surge in the number of sensors embedded in smartphones and smartwatches has been observed. Overall, the reporting quality was good. CONCLUSIONS Continuous monitoring with wearable sensors could optimize the management of people with MS, but some hurdles still exist to full clinical adoption of digital monitoring. Despite a possible publication bias and vast heterogeneity in the outcomes reported, our review provides an overview of the current literature on wearable sensor technologies used for people with MS and highlights shortcomings, such as the lack of harmonization, transparency in reporting methods and results, and limited data availability for the research community. These limitations need to be addressed for the growing implementation of wearable sensor technologies in clinical routine and clinical trials, which is of utmost importance for further progress in clinical research and daily management of people with MS. TRIAL REGISTRATION PROSPERO CRD42021243249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=243249.
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Affiliation(s)
- Tim Woelfle
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Lucie Bourguignon
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Johannes Lorscheider
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
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Temporiti F, Mandaresu S, Calcagno A, Coelli S, Bianchi AM, Gatti R, Galli M. Kinematic evaluation and reliability assessment of the Nine Hole Peg Test for manual dexterity. J Hand Ther 2023; 36:560-567. [PMID: 35232627 DOI: 10.1016/j.jht.2022.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Nine Hole Peg Test (NHPT) is one of the most frequently used tools to assess manual dexterity. However, no kinematic parameters are provided to describe the quality of the motor performance, since time is the only score. PURPOSE To investigate test-retest and intra-rater reliability, correlation with clinical test score, and discriminant validity of kinematic indexes during NHPT. STUDY DESIGN A clinical measurement study. METHODS Twenty-five healthy right-handed volunteers performed the NHPT. An experienced physiotherapist administered two sessions at a 6-hour interval with two trials for dominant and non-dominant upper limbs. An optoelectronic system was used to detect NHPT performance, which was divided into nine consecutive peg-grasp, peg-transfer, peg-in-hole, hand-return phases, and one final removing phase. Outcome measures were total and single phases times, normalized jerk, mean, peak and time-to-peak of velocity, curvature index during peg-grasp and hand-return phases, and trunk 3D displacement. The statistical analysis included Intraclass Correlation Coefficients (ICCs) for test-retest and intra-rater reliability, Pearson's coefficients for correlation with the NHPT score, and paired t-tests for discriminant validity. RESULTS Test-retest reliability was excellent for trunk rotation (ICC: 0.91) and good to moderate for the other indexes (ICCs: 0.89-0.61). Intra-rater reliability was excellent for total and removing times (ICCs: 0.91 and 0.94) and good to moderate for the other indexes (ICCs: 0.84-0.66), except for trunk inclination (ICC: 0.37). NHPT phases, normalized jerk, mean velocity, peak of velocity, time-to-peak and curvature index correlated with total time (r-score: 0.8-0.3). NHPT phases and most kinematic indexes discriminated the dominant from non-dominant upper limb, with the greatest effect size for normalized jerk during hand-return (d = 1.16). CONCLUSIONS Kinematic indexes during NHPT can be considered for manual dexterity assessment. These indexes may allow for the detection of kinematic changes responsible for NHPT score variations in healthy subjects or patients with upper limb impairments.
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Affiliation(s)
- Federico Temporiti
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano, Milan, Italy; Department of Electronic, Information and Bioengineering, Politecnico di Milano, via Ponzio 34, Milan, Italy.
| | - Serena Mandaresu
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, via Ponzio 34, Milan, Italy
| | - Alessandra Calcagno
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, via Ponzio 34, Milan, Italy
| | - Stefania Coelli
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, via Ponzio 34, Milan, Italy
| | - Anna Maria Bianchi
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, via Ponzio 34, Milan, Italy
| | - Roberto Gatti
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
| | - Manuela Galli
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, via Ponzio 34, Milan, Italy
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Delgado P, Melo F, de Vries L, Hartingsveldt M, Matias AR. Translation, Cross-Cultural Adaptation, and Psychometric Properties of Writing Readiness Inventory Tool in Context (WRITIC). CHILDREN 2023; 10:children10030559. [PMID: 36980119 PMCID: PMC10047591 DOI: 10.3390/children10030559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
This article describes the translation and cultural adaptation process of the WRITIC (Writing Readiness Inventory Tool in Context) into European Portuguese. We examined the content and convergent validity, test-retest, and interrater reliability on the norm-referenced subdomain of the Portuguese (PT) WRITIC Task Performance (TP). To establish content validity, we consulted six experts in handwriting. Internal consistency was found with 70 children, test-retest reliability with 65, inter-rater reliability with 69, and convergent validity with 87. All participants were typically developing kindergarten children. Convergent validity was examined with the Beery–Buktenica Developmental Test of Visual-Motor Integration (Beery™VMI-6) and the Nine Hole Peg-Test (9-HPT). On content validity, we found an agreement of 93%, a good internal consistency with Cronbach’s alpha of 0.72, and an excellent test-retest and inter-rater reliability with ICCs of 0.88 and 0.93. Correlations with Beery™VMI-6 and 9-HPT were moderate (r from 0.39 to 0.65). Translation and cross-cultural adaptation of WRITIC into European Portuguese was successful. WRITIC-PT-TP is stable over time and between raters; it has excellent internal consistency and moderate correlations with Beery™VMI-6 and 9-HPT. This analysis of the European Portuguese version of WRITIC gives us the confidence to start the implementation process of WRITIC-PT in Portugal.
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Affiliation(s)
- Paulo Delgado
- Comprehensive Health Research Centre (CHRC), Department of Sport and Health, School of Health and Human Development, University of Évora, 7004-516 Évora, Portugal;
| | - Filipe Melo
- Comprehensive Health Research Centre (CHRC), Faculty of Human Kinetics, University of Lisbon, 1649-004 Lisbon, Portugal;
| | - Liesbeth de Vries
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1000 CC Amsterdam, The Netherlands;
- Occupational Therapy Programme, Hanze University of Applied Sciences, 9714 CA Groningen, The Netherlands
| | - Margo Hartingsveldt
- Occupational Therapy Programme, Hanze University of Applied Sciences, 9714 CA Groningen, The Netherlands
- Correspondence: (M.H.); (A.R.M.)
| | - Ana Rita Matias
- Comprehensive Health Research Centre (CHRC), Department of Sport and Health, School of Health and Human Development, University of Évora, 7004-516 Évora, Portugal;
- Correspondence: (M.H.); (A.R.M.)
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Fitts' Tapping Task as a New Test for Cognition and Manual Dexterity in Multiple Sclerosis: Validation Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010029. [PMID: 36676653 PMCID: PMC9867060 DOI: 10.3390/medicina59010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/16/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022]
Abstract
Introduction. Studies suggest that people with multiple sclerosis (pwMS) experience continuous and subclinical physical worsening, even as early as their disease diagnosis. Validating sensitive and reproducible tests that can capture subclinical disease activity early in the disease are clinically useful and highly warranted. We aimed at validating the utility of Fitts’ Tapping Task (FTT) as reproducible measure of psychomotor performance in pwMS. Materials and Methods. Thirty newly-diagnosed pwMS (within 2 years of diagnosis and Expanded Disability Status Scale; EDSS ≤ 2.0), 30 people with migraine (pwMig), and 30 healthy controls (HCs) underwent a psychomotor assessment using the FTT, O’Connor hand dexterity test, and Visual Reaction Time Test (VRTT). Hand strength was measured using a hand-grip dynamometer. Subjects also provided patient-reported outcomes (PROs) using the 36-Item Short Form Survey (SF-36). Intrarater and interrater reproducibility was acquired on 5 HCs by two independent operators. Test−retest reproducibility was determined in 5 pwMS over a 1-week follow-up. Eight pwMS returned for the same test procedures 2 years after the baseline assessment. Bland−Altman plots were used to determine the minimally detectable change (MDC) and logistic regression models determined the ability to differentiate between newly-diagnosed pwMS and HCs. Results. FTT exhibited a high intrarater and interrater reproducibility (interclass correlation coefficient of 0.961, p < 0.001). The test−retest demonstrated an MDC of the average FTT at > 15%. PwMS had significantly a slower FTT time and O’Connor dexterity time when compared to pwMig and HCs (p < 0.001 for both). Higher Fitts’ difficulty levels (4th and 6th difficulty) and average performance on the O’Connor test were able to differentiate newly-diagnosed pwMS from HCs with 80% accuracy (p < 0.01). Slower FTT performance was correlated with worse PROs due to physical health. Over the 2-year follow-up, and despite being clinically stable (no change in EDSS), 6 out of 8 (75%) pwMS had more than a 15% worsening in their average FTT time. Conclusions. FTT is a highly-reproducible test for measuring psychomotor performance in newly-diagnosed pwMS. FTT can capture insidious worsening in psychomotor performance and cognitive function in early stages of MS.
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Ovacik U, Tarakci E, Gungor F, Menengic KN, Leblebici G, Acar ZO, Soysal A. The Minnesota Manual Dexterity Test As A Bimanual Performance Measure in People with Multiple Sclerosis. Mult Scler Relat Disord 2022; 64:103943. [DOI: 10.1016/j.msard.2022.103943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/11/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022]
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Wijeyaratnam DO, Edwards T, Pilutti LA, Cressman EK. Assessing visually guided reaching in people with multiple sclerosis with and without self-reported upper limb impairment. PLoS One 2022; 17:e0262480. [PMID: 35061785 PMCID: PMC8782348 DOI: 10.1371/journal.pone.0262480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022] Open
Abstract
The ability to accurately complete goal-directed actions, such as reaching for a glass of water, requires coordination between sensory, cognitive and motor systems. When these systems are impaired, like in people with multiple sclerosis (PwMS), deficits in movement arise. To date, the characterization of upper limb performance in PwMS has typically been limited to results attained from self-reported questionnaires or clinical tools. Our aim was to characterize visually guided reaching performance in PwMS. Thirty-six participants (12 PwMS who reported upper limb impairment (MS-R), 12 PwMS who reported not experiencing upper limb impairment (MS-NR), and 12 age- and sex-matched control participants without MS (CTL)) reached to 8 targets in a virtual environment while seeing a visual representation of their hand in the form of a cursor on the screen. Reaches were completed with both the dominant and non-dominant hands. All participants were able to complete the visually guided reaching task, such that their hand landed on the target. However, PwMS showed noticeably more atypical reaching profiles when compared to control participants. In accordance with these observations, analyses of reaching performance revealed that the MS-R group was more variable with respect to the time it took to initiate and complete their movements compared to the CTL group. While performance of the MS-NR group did not differ significantly from either the CTL or MS-R groups, individuals in the MS-NR group were less consistent in their performance compared to the CTL group. Together these findings suggest that PwMS with and without self-reported upper limb impairment have deficits in the planning and/or control of their movements. We further argue that deficits observed during movement in PwMS who report upper limb impairment may arise due to participants compensating for impaired movement planning processes.
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Affiliation(s)
- Darrin O. Wijeyaratnam
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Thomas Edwards
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Lara A. Pilutti
- Interdisciplinary School of Health Science, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin K. Cressman
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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12
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Mendoza-Sánchez S, Molina-Rueda F, Florencio LL, Carratalá-Tejada M, Cuesta-Gómez A. Reliability and agreement of the Nine Hole Peg Test in patients with unilateral spastic cerebral palsy. Eur J Pediatr 2022; 181:2283-2290. [PMID: 35212827 PMCID: PMC8873351 DOI: 10.1007/s00431-022-04423-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/02/2022] [Accepted: 02/13/2022] [Indexed: 02/02/2023]
Abstract
Upper extremity involvement is one of the most common motor impairments in children with unilateral spastic cerebral palsy (CP). One tool for the assessment of manual function in CP is the Nine Hole Peg Test (NHPT). However, the reliability of the NHPT in patients with unilateral CP is unknown. This study aimed to analyze the intra-rater inter-session reliability of the NHPT in unilateral spastic CP, for its use in clinical practice and research. A total of 27 participants with spastic unilateral CP were included. Reliability was verified by the intraclass correlation coefficient (ICC), standard error of measurement, and minimum detectable change. The agreement was analyzed by the Bland-Altman method. An excellent intra-rater reliability was observed for the non-affected side (ICC = 0.94) and the affected side (ICC = 0.96). The minimal detectable change was 4 and 12 s for the non-affected and affected side, respectively. There were no significant biases between repetitions. Conclusions: The NHPT showed excellent intra-rater inter-session reliability in patients with spastic unilateral CP. In addition, the test shows adequate agreement and proportionally small errors to assess manual dexterity. What is Known: • The Nine Hole Peg Test (NHPT) is widely used to assess dexterity in patients with neurological conditions. • The NHPT has demonstrated appropriate measurement properties in healthy children and adults with neurological conditions. What is New: • The NHPT presents excellent reliability, small measurement errors, and adequate agreement for the assessment of patients with cerebral palsy. • The measurement error of the NHPT in unilateral cerebral palsy may be up to 13% of the total time to perform it.
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Affiliation(s)
| | - Francisco Molina-Rueda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Lidiane Lima Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain.
| | - María Carratalá-Tejada
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Alicia Cuesta-Gómez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
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13
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The Influence of Self-Perception on Manipulative Dexterity in Adults with Multiple Sclerosis. Occup Ther Int 2021; 2021:5583063. [PMID: 34483781 PMCID: PMC8384504 DOI: 10.1155/2021/5583063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background Multiple sclerosis is a disorder which causes a loss of functionality, affecting the person's ability to perform activities of daily living, such as interpersonal interactions and relationship, dressing, self-care, or bathing, as well as having a negative impact on work and leisure activities. Aims This study examined the relationship (correlational or associations/predictive) between self-perceived quality of life and performance of manipulative dexterity. Also, this study sought to measure predictors of dexterity. Study Design. A cross-sectional study from two associations of MS within the Community of Madrid, Spain. Methods and Procedures. A final sample of 30 people with multiple sclerosis. The outcome measures used were the ABILHAND questionnaire, the Purdue Pegboard Test, the Nine Hole Peg Test, and the Box and Block Test. Results No significant correlations were found between dexterity and self-perception tests; however, correlations were found between perceived dexterity and quality of life (p < 0.001). Scores for the ABILHAND questionnaire, which measures the perception of skills in daily living, predicted up to 60% of the variance in the dexterity tests. Conclusions The results of this study suggest that interventions for improving the manipulative dexterity of people with multiple sclerosis should address the person's perception of improving their manipulative dexterity and the perceived of quality of life, as both factors may influence manipulative dexterity.
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14
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Amato A, Messina G, Feka K, Genua D, Ragonese P, Kostrzewa-Nowak D, Fischetti F, Iovane A, Proia P. Taopatch® combined with home-based training protocol to prevent sedentary lifestyle and biochemical changes in MS patients during COVID-19 pandemic. Eur J Transl Myol 2021; 31. [PMID: 34498450 PMCID: PMC8495370 DOI: 10.4081/ejtm.2021.9877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/04/2021] [Indexed: 01/14/2023] Open
Abstract
In Multiple sclerosis (MS) it is important to preserve the residual physiological functions of subjects. The aim of the present study was to investigate the influence of nanotechnological device treatment combined with home-based training program (TP) on lactate level, hand grip strength and cervical mobility on MS patients. Seventeen MS patients were enrolled in the study and randomly assigned to an experimental group (EG) in which the Taopatch® nanotechnological device was applied or to a control group (CG). All the participants carried out a cervical range of motion (1) assessment and the hand grip test at baseline (T0) and after TP (T1), also investigating the lactate levels to figure out if there could be a correlation with the possible changes in the investigated parameters. The results showed no significant differences in both groups for ROM. As regards the hand grip test, EG showed a statistically significant improvement on strength for both hands, dominant (p = 0.01) and non-dominant (p = 0.04), while the CG showed an improvement only for the non-dominant hand (p = 0.001). No correlation was found between baseline lactate level and cervical ROM change. We can definitely conclude that exercise and Taopatch® can help to improve and maintain hand strength in MS subjects and also can prevent sedentary lifestyle during the COVID-19 pandemic time. These are preliminary results that need further investigations, possibly increasing sample size and lengthening time of intervention.
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Affiliation(s)
- Alessandra Amato
- Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo.
| | - Giuseppe Messina
- Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo.
| | - Kaltrina Feka
- Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo.
| | - Diego Genua
- Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo.
| | - Paolo Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata) (Bi.N.D.), University of Palermo.
| | - Dorota Kostrzewa-Nowak
- Faculty of Physical Education and Health Promotion, University of Szczecin, Szczecin, Poland; Institute of Physical Culture Sciences, University of Szczecin, Szczecin.
| | - Francesco Fischetti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Study of Bari.
| | - Angelo Iovane
- Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo.
| | - Patrizia Proia
- Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo.
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15
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Parmar K, Fonov VS, Naegelin Y, Amann M, Wuerfel J, Collins DL, Gaetano L, Magon S, Sprenger T, Kappos L, Granziera C, Tsagkas C. Regional Cerebellar Volume Loss Predicts Future Disability in Multiple Sclerosis Patients. THE CEREBELLUM 2021; 21:632-646. [PMID: 34417983 PMCID: PMC9325849 DOI: 10.1007/s12311-021-01312-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 01/18/2023]
Abstract
Cerebellar symptoms in multiple sclerosis (MS) are well described; however, the exact contribution of cerebellar damage to MS disability has not been fully explored. Longer-term observational periods are necessary to better understand the dynamics of pathological changes within the cerebellum and their clinical consequences. Cerebellar lobe and single lobule volumes were automatically segmented on 664 3D-T1-weighted MPRAGE scans (acquired at a single 1.5 T scanner) of 163 MS patients (111 women; mean age: 47.1 years; 125 relapsing–remitting (RR) and 38 secondary progressive (SP) MS, median EDSS: 3.0) imaged annually over 4 years. Clinical scores (EDSS, 9HPT, 25FWT, PASAT, SDMT) were determined per patient per year with a maximum clinical follow-up of 11 years. Linear mixed-effect models were applied to assess the association between cerebellar volumes and clinical scores and whether cerebellar atrophy measures may predict future disability progression. SPMS patients exhibited faster posterior superior lobe volume loss over time compared to RRMS, which was related to increase of EDSS over time. In RRMS, cerebellar volumes were significant predictors of motor scores (e.g. average EDSS, T25FWT and 9HPT) and SDMT. Atrophy of motor-associated lobules (IV-VI + VIII) was a significant predictor of future deterioration of the 9HPT of the non-dominant hand. In SPMS, the atrophy rate of the posterior superior lobe (VI + Crus I) was a significant predictor of future PASAT performance deterioration. Regional cerebellar volume reduction is associated with motor and cognitive disability in MS and may serve as a predictor for future disease progression, especially of dexterity and impaired processing speed.
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Affiliation(s)
- Katrin Parmar
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland. .,Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland. .,Reha Rheinfelden, Rheinfelden, Switzerland.
| | - Vladimir S Fonov
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC, CA, USA
| | - Yvonne Naegelin
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Michael Amann
- Medical Image Analysis Center (MIAC AG), Basel, Switzerland.,Quantitative Biomedical Imaging Group (Qbig), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center (MIAC AG), Basel, Switzerland.,Quantitative Biomedical Imaging Group (Qbig), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - D Louis Collins
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC, CA, USA
| | - Laura Gaetano
- Neuroscience/Digital Medicine, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Stefano Magon
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Till Sprenger
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Neurology, DKD HELIOS Klinik Wiesbaden, Wiesbaden, Germany
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Charidimos Tsagkas
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
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16
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Pilloni G, Malik M, Malik R, Krupp L, Charvet L. Upper Extremity Motor Fatigability as an Early Indicator in Pediatric Onset Multiple Sclerosis. J Child Neurol 2021; 36:720-726. [PMID: 33736529 DOI: 10.1177/0883073821999889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM To adopt a computer-based protocol to assess grip fatigability in patients with pediatric-onset multiple sclerosis to provide detection of subtle motor involvement identifying those patients most at risk for future decline. METHOD Pediatric-onset multiple sclerosis patients were recruited during routine outpatient visits to complete a grip assessment and compared to a group of healthy age- and sex-matched controls. All participants completed a computer-based measurement of standard maximal grip strength and repetitive and sustained grip performance measured by dynamic and static fatigue indices. RESULTS A total of 38 patients with pediatric-onset multiple sclerosis and 24 healthy controls completed the grip protocol (right-hand dominant). There were no significant group differences in maximal grip strength bilaterally (right: 21.8 vs 19.9 kg, P = .25; left: 20.4 vs 18.7 kg, P = .33), although males with pediatric-onset multiple sclerosis were significantly less strong than healthy controls (right: 26.53 vs 21.23 kg, P = .009; left; 25.13 vs 19.63 kg, P = .003). Both dynamic and static fatigue indices were significantly higher bilaterally in pediatric-onset multiple sclerosis compared with healthy control participants (left-hand dynamic fatigue index: 18.6% vs 26.7%, P = .003; right-hand static fatigue index: 28.3% vs 41.3%, P < .001; left-hand static fatigue index: 31.9% vs 42.6%, P < .001). CONCLUSION Brief repeatable grip assessment including measures of dynamic and sustained static output can be a sensitive indicator of upper extremity motor involvement in pediatric-onset multiple sclerosis, potentially identifying those in need of intervention to prevent future disability.
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Affiliation(s)
- Giuseppina Pilloni
- Department of Neurology, 12297NYU Grossman School of Medicine, New York, NY, USA
| | - Martin Malik
- Department of Neurology, 12297NYU Grossman School of Medicine, New York, NY, USA
| | - Raghav Malik
- St. Elizabeth's Department of Behavioral Health, Elizabeth, NJ, USA
| | - Lauren Krupp
- Department of Neurology, 12297NYU Grossman School of Medicine, New York, NY, USA
| | - Leigh Charvet
- Department of Neurology, 12297NYU Grossman School of Medicine, New York, NY, USA
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17
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Saini A, Zucker-Levin A, McMillan B, Kumar P, Donkers S, Levin MC. A Descriptive Correlational Study to Evaluate Three Measures of Assessing Upper Extremity Function in Individuals with Multiple Sclerosis. Mult Scler Int 2021; 2021:5588335. [PMID: 34258067 PMCID: PMC8257389 DOI: 10.1155/2021/5588335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/21/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Activities of daily living and quality of life (QOL) are hindered by upper extremity (UE) impairments experienced by individuals with multiple sclerosis (iMS). The Nine-Hole Peg Test (9-HPT) is most frequently used to measure UE function. However, it does not measure peoples' ability to perform routine tasks in daily life and may not be useful in iMS who cannot pick up the pegs utilized in the 9-HPT. Therefore, we evaluated three measures to explore a more comprehensive assessment of UE function: Upper Extremity Function Scale (UEFS), Action Research Arm Test (ARAT), and the 9-HPT. The objectives were to quantitatively assess the relationship between these measures of UE function, understand if the measures correlate with QOL as calculated by the MS Quality of Life-54 (MSQOL-54), and to determine differences in the measures based on employment status. METHODS 112 (79 female) iMS were prospectively recruited for this descriptive correlational study. Inclusion criteria were as follows: confirmed diagnosis of MS or clinically isolated syndrome, age ≥ 18 years, and ability to self-consent. All statistical analyses including Spearman's correlation coefficient (r s ) and Kruskal-Wallis tests were performed using SPSS. RESULTS A moderate correlation (r s = -0.51; p < 0.001) was found between the ARAT and 9-HPT scores for the more impaired hand. Likewise, a moderate correlation was found between UEFS and the physical health composite scores (PHCSs) of MSQOL-54 (r s = -0.59; p < 0.001). Finally, performances on ARAT, 9-HPT, and UEFS differed between the employed individuals and those on long-term disability (p = 0.007, p < 0.001, and p = 0.001). CONCLUSION The UEFS moderately correlated with the QOL measure, and considering the UESF is a patient-reported outcome, it could be used to complement routinely captured measures of assessing UE function. Further study is warranted to determine which measure, or combination of measures, is more sensitive to changes in UE function over time.
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Affiliation(s)
- Aman Saini
- Office of the Saskatchewan MS Clinical Research Chair, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Audrey Zucker-Levin
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Benjamin McMillan
- Office of the Saskatchewan MS Clinical Research Chair, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Pawan Kumar
- College of Kinesiology, University of Saskatchewan, Saskatchewan, Canada
| | - Sarah Donkers
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Michael C. Levin
- Office of the Saskatchewan MS Clinical Research Chair, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
- Department of Medicine, Neurology Division, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
- Department of Anatomy, Physiology and Pharmacology, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
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18
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Use of wrist-worn accelerometers to quantify bilateral upper limb activity and asymmetry under free-living conditions in people with multiple sclerosis. Mult Scler Relat Disord 2021; 53:103081. [PMID: 34166981 DOI: 10.1016/j.msard.2021.103081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/01/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Although upper limb (UL) dysfunctions are quite common among people with Multiple Sclerosis (pwMS), there is a scarcity of information about actual UL usage under free-living conditions. The aim of the present study is to quantitatively assess 'real-world' activity time, intensity and possible asymmetry of use among dominant and non-dominant ULs in pwMS. METHODS Twenty-eight pwMS (20 women, 8 men, average EDSS 4.3) and 28 age- and sex-matched unaffected individuals were required to wear a tri-axial accelerometer on each wrist 24h/day for 2 weekdays. Raw accelerations were processed to calculate parameters associated with time and intensity of use of UL both when engaged in uni- or bilateral activities. RESULTS During the 2-day monitoring period, pwMS were characterized by significantly lower overall activity, they used their dominant limb for a significantly longer time and, while performing bilateral activities, their dominant limb expressed movements of superior intensity in a proportion higher than what was observed in unaffected individuals. CONCLUSION The instrumental monitoring of UL activity with two wrist-worn sensors may represent an effective tool for assessing the contribution of each limb to uni- and bilateral movements. Such data can be employed to monitor the progression of UL dysfunctions and the effectiveness of pharmacologic and rehabilitative treatments.
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19
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Di Giovanni R, Solaro C, Grange E, Masuccio FG, Brichetto G, Mueller M, Tacchino A. A comparison of upper limb function in subjects with multiple sclerosis and healthy controls using an inertial measurement unit. Mult Scler Relat Disord 2021; 53:103036. [PMID: 34051695 DOI: 10.1016/j.msard.2021.103036] [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: 03/09/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
Upper limbs (UL) dysfunction is frequent in people with Multiple Sclerosis (PwMS). Several objective measures of UL function are proposed; however, their use is mostly confined to assess subjects with mild-to-moderate disability and requires fine motor skills, often impaired in high disability level subjects. Thus, a tool to score UL function in the advanced disease stage is lacking. The aim of the study is to analyse and compare UL unilateral and bilateral movements of healthy control (HC) and PwMS, at different disability levels, using an instrumented version (Inertial Measurement Unit, IMU) of the 15-seconds finger-to-nose test (FNT). Each movement cycle was segmented in going/adjusting/returning phases. The inter-hand interval (IHI) allowed assessing bilateral coordination (i.e. synchrony) in each phase. The larger IHI, the more severe the bilateral coordination impairment is. After stratifying PwMS for disability level (PwMSLOW, Expanded Disability Status Scale, EDSS≤5.5 and PwMSHIGH, EDSS≥6), the ANOVA on IHI showed significant differences between PwMS and HC (p<0.001) in all phases. However, only the going phase IHI showed significantly higher asynchrony in PwMSHIGH than PwMSLOW and HC (p<0.001) and no differences between PwMSLOW and HC. The going phase IHI seems to be a clinical marker specific for high disability level PwMS. These findings suggest inertial sensors during FNT could be an easy-to-use method for a more detailed quantitative characterization of UL function in PwMS also in subjects with EDSS greater than 6.
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Affiliation(s)
| | - C Solaro
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy.
| | - E Grange
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy
| | - F G Masuccio
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy
| | - G Brichetto
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, 16149, Genoa, Italy
| | - M Mueller
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, 16149, Genoa, Italy
| | - A Tacchino
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, 16149, Genoa, Italy
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20
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Radecka A, Knyszyńska A, Łuczak J, Lubkowska A. Adaptive changes in muscle activity after cryotherapy treatment: Potential mechanism for improvement the functional state in patients with multiple sclerosis. NeuroRehabilitation 2021; 48:119-131. [PMID: 33386821 DOI: 10.3233/nre-201535] [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: 01/10/2023]
Abstract
BACKGROUND The available literature lacks data about the influence of whole body cryotherapy (WBC) on muscle activity in patients with sclerosis multiplex (MS). OBJECTIVE Assessment of the influence of the 20 WBC series on the surface electromyography (sEMG) signal and the relationship between it and the functional state in patients with MS. METHODS The study group was 114 of MS patients (aged 45.24±11.88yr.,) which 74 of them received 20 of WBC. An assessment was made of: the hand grip (HGS), Timed 25-Foot Walk, Fatigue Severity Scale, sEMG signal from the dominant limb. RESULTS After a series of 20 WBC: in the rest electromyograms, an increase of extensor carpi radialis (ECR) and a decrease of flexor carpi radialis (FCR) amplitude were demonstrated (non-normalized signal ECR p = 0.0001); significant differences in sEMG rest signals between ECR and FCR have decreased; for voluntary contraction in both assessed antagonistic muscle amplitude was significantly decreased (p = 0.0005; p = 0.0316, p = 0.0185); an increase of HGS (p < 0.001); gait improvement (p = 0.001); decrease fatigue (p = 0.024). No significant changes were observed in the control group. CONCLUSIONS Series of 20 WBC improves the functional state and reduces fatigue in patients with MS, which may be due to adaptive changes in bioelectrical muscle activity.
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Affiliation(s)
- Aleksandra Radecka
- Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Anna Knyszyńska
- Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Joanna Łuczak
- College of Engineering and Health in Warsaw, Faculty of Health Sciences, Warsaw, Poland.,Department of Cardiological Rehabilitation, Central Clinical Hospital of the Ministry of Internal Affairs and Administration in Warsaw, Warsaw, Poland
| | - Anna Lubkowska
- Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
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21
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A Descriptive Cross-Sectional Study of Manipulative Dexterity on Different Subtypes of Multiple Sclerosis. Occup Ther Int 2020; 2020:6193938. [PMID: 32425718 PMCID: PMC7211248 DOI: 10.1155/2020/6193938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Manipulative dexterity impairments affect 76% of individuals with multiple sclerosis (MS). Patients with MS can experience reduced skill when performing both basic activities of daily living and instrumental activities of daily living. Many studies consider that physical rehabilitation leads to a decrease in the level of disability, especially at the mild and moderate stages of the disease. However, most studies fail to distinguish between the different MS subtypes. Purpose Our aims were (1) to describe the manipulative skills of people according to the different subtypes of MS, (2) to analyze the correlation between dexterity and self-perception variables, and (3) to identify possible predictors of functionality. Study Design. A descriptive cross-sectional study. Methods 30 individuals with MS. The measurement tools used were the ABILHAND, the Purdue Pegboard Test (PPT), the Nine-Hole Peg Test, and the Box and Block Test. Results All subtypes of MS obtained lower scores for manipulative dexterity compared to normal skill levels, with individuals with primary progressive MS displaying the lowest values. However, the analysis of differences between the different subtypes did not reveal statistically significant intragroup differences. In addition, differences were found regarding the effect size of practically all the variables analyzed for both manipulative dexterity (PPT, NHPT, and BBT) and the self-perception of ADLs (ABILHAND), for which high values (d r = 0.72) and very high values (d r = 1.46) were obtained. Conclusions Although no significant differences were found between the different types of MS, the assessment of manual dexterity and perceived efficacy of daily activities must be considered as prognostic factors in the progression of the disease. These findings may help support further research on targeted interventions to improve dexterity deficiencies, as well as promote an improved quality of therapeutic interventions.
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Kahraman T. Performance Measures for Upper Extremity Functions in Persons with Multiple Sclerosis. NORO PSIKIYATRI ARSIVI 2019; 55:S41-S45. [PMID: 30692854 DOI: 10.29399/npa.23317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Recent studies suggest that upper extremity dysfunction is a quite common symptom in multiple sclerosis (MS), and affects adversely the activities of daily living even in the early stages of the disease. It is an undeniable fact that assessment is a crucial component for a disease management. The performance is defined as "what an individual does in his or her current environment" according to the International Classification of Functioning, Disability and Health (ICF). Performance measures for upper extremity have been used relatively recent in persons with MS. ABILHAND, Manual Ability Measurement (MAM), Disabilities of the Arm Shoulder and Hand Outcome Measure, and Motor Activity Log are commonly used perceived performance measures for upper extremity functions in persons with MS. Because of their modern psychometric properties, ABILHAND and MAM stands out from other measures. Only available actual performance measures for upper extremity functions in persons with MS are accelerometers. In addition to their advantages, they have some disadvantages waiting to be solved.
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Affiliation(s)
- Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İzmir Katip Çelebi University, Turkey
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Validation of the Nine Hole Peg Test as a measure of dexterity in myotonic dystrophy type 1. Neuromuscul Disord 2018; 28:947-951. [PMID: 30270126 DOI: 10.1016/j.nmd.2018.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022]
Abstract
We aimed to validate the Nine Hole Peg Test as a measure of dexterity in myotonic dystrophy type 1 (DM1). Fifty patients with adult-onset, genetically confirmed DM1 were evaluated by Nine Hole Peg Test and re-evaluated at one week. Myotonia was not a limiting factor. The first test was compared with that performed by normal subjects (n = 28). Contextually, patients underwent handgrip and three-finger pinch assessments by handheld dynamometer. The Nine Hole Peg Test showed high intra-rater and inter-rater reliability in DM1 [ICC 0.86/0.83 for dominant and 0.90/0.88 for non-dominant hand, respectively]. Inverse correlation with handgrip and pinch strength values (r = -0.4; p < 0.01) and direct correlation with Muscular Impairment Rating Scale (r = 0.4; p < 0.01) were found for both DH and NDH. The test was able to differentiate severe DM1 patients, stratified by extent of muscle impairment, from mildly affected and normal controls, with a sensitivity of 97% and 95% for dominant hand and non-dominant hand, respectively (p < 0.0001). In conclusion, we showed that the Nine Hole Peg Test is a reliable, valid and sensitive test of dexterity in DM1, and that it can be considered as a candidate outcome measure to monitor natural history of disease and, possibly, therapeutic response in clinical trials.
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Repnik E, Puh U, Goljar N, Munih M, Mihelj M. Using Inertial Measurement Units and Electromyography to Quantify Movement during Action Research Arm Test Execution. SENSORS (BASEL, SWITZERLAND) 2018; 18:E2767. [PMID: 30135413 PMCID: PMC6164634 DOI: 10.3390/s18092767] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022]
Abstract
In patients after stroke, ability of the upper limb is commonly assessed with standardised clinical tests that provide a complete upper limb assessment. This paper presents quantification of upper limb movement during the execution of Action research arm test (ARAT) using a wearable system of inertial measurement units (IMU) for kinematic quantification and electromyography (EMG) sensors for muscle activity analysis. The test was executed with each arm by a group of healthy subjects and a group of patients after stroke allocated into subgroups based on their clinical scores. Tasks were segmented into movement and manipulation phases. Each movement phase was quantified with a set of five parameters: movement time, movement smoothness, hand trajectory similarity, trunk stability, and muscle activity for grasping. Parameters vary between subject groups, between tasks, and between task phases. Statistically significant differences were observed between patient groups that obtained different clinical scores, between healthy subjects and patients, and between the unaffected and the affected arm unless the affected arm shows normal performance. Movement quantification enables differentiation between different subject groups within movement phases as well as for the complete task. Spearman's rank correlation coefficient shows strong correlations between patient's ARAT scores and movement time as well as movement smoothness. Weak to moderate correlations were observed for parameters that describe hand trajectory similarity and trunk stability. Muscle activity correlates well with grasping activity and the level of grasping force in all groups.
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Affiliation(s)
- Eva Repnik
- Faculty of Electrical Engineering, University of Ljubljana, Tržaška cesta 25, 1000 Ljubljana, Slovenia.
| | - Urška Puh
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia.
| | - Nika Goljar
- The University Rehabilitation Institute, Republic of Slovenia, Linhartova 51, 1000 Ljubljana, Slovenia.
| | - Marko Munih
- Faculty of Electrical Engineering, University of Ljubljana, Tržaška cesta 25, 1000 Ljubljana, Slovenia.
| | - Matjaž Mihelj
- Faculty of Electrical Engineering, University of Ljubljana, Tržaška cesta 25, 1000 Ljubljana, Slovenia.
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Lemmens J, Ferdinand S, Vandenbroucke A, Ilsbroukx S, Kos D. Dual-task cost in people with multiple sclerosis: A case–control study. Br J Occup Ther 2018. [DOI: 10.1177/0308022618757936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Limitations in fine motor functioning and cognitive performance are frequently reported in multiple sclerosis. Studies about dual-task costs in multiple sclerosis generally explore walking and postural performance. This study aims at exploring dual-task costs when simultaneously performing fine motor and cognitive tasks. Method Eighty people with multiple sclerosis and 80 matched controls performed the nine-hole peg test and the months backward test under single and dual-task conditions. Differences in performance over time were analysed with the paired t-test; differences in dual-task costs between groups were analysed with independent t-tests. Results People with multiple sclerosis and controls showed a significant decrease in fine motor and cognitive performance in dual-task conditions compared to single-task conditions ( P < 0.01). People with multiple sclerosis with limited hand capacity showed larger dual-task costs for cognitive performance compared to other hand capacity groups ( P < 0.05). Individuals with multiple sclerosis with lower cognitive capacity showed larger dual-task costs for fine motor performance ( P < 0.01). Conclusion Both people with multiple sclerosis and controls experience dual-task costs. People with multiple sclerosis with limited hand function showed an increased dual-task cost of cognitive performance and individuals with limited cognitive capacity showed a higher dual-task cost for fine motor performance. Therefore, occupational therapists should focus on cognitive or fine motor aspects during dual-task training dependent on individuals' capacities.
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Affiliation(s)
- Jolien Lemmens
- Occupational Therapist, Sint-Gerardus, Diepenbeek and University College PXL, Hasselt, Belgium; previous research student, KU Leuven (Rehabilitation Sciences), Leuven and University of Ghent (Faculty of Medicine and Health Sciences), Ghent, Belgium
| | - Sofie Ferdinand
- Head of Occupational Therapy Department, National Multiple Sclerosis Center, Melsbroek, Belgium
| | | | - Stephan Ilsbroukx
- Rehabilitation Physician, Hospital Gasthuis Zusters Antwerpen (GZA), Antwerp, Belgium
| | - Daphne Kos
- Professor in Occupational Therapy, KU Leuven, Leuven and AP University College Antwerp, Belgium
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Corona F, Gervasoni E, Coghe G, Cocco E, Ferrarin M, Pau M, Cattaneo D. Validation of the Arm Profile Score in assessing upper limb functional impairments in people with multiple sclerosis. Clin Biomech (Bristol, Avon) 2018; 51:45-50. [PMID: 29179033 DOI: 10.1016/j.clinbiomech.2017.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although upper limb (UL) impairments are widespread in people with Multiple Sclerosis (pwMS), there is limited quantitative evidence concerning their specific features. The aim of this study is to validate a synthetic measure based on kinematic data to define the degree of deviation from a physiologic pattern during the "hand to mouth" (HTM) task. METHODS Twenty pwMS (mean age 51.2 SD 11.1) years, Expanded Disability Status Scale (EDSS) score in the range 2-6.5, underwent a kinematic analysis of the HTM task using a motion capture system. Spatio-temporal parameters and synthetic indexes (Arm Variable Score, AVS and Arm Profile Score, APS) were calculated and compared with those of age-matched healthy individuals. Kinematic data were correlated with the EDSS score and clinical tests such as the Nine Hole Peg Test (NHPT) and hand-grip strength (HGS). FINDINGS PwMS exhibit reduced velocity, increased movement duration, sway of adjusting and frequency of direction changes as well as higher APS values (15.4° vs. 8.6°, P<0.001) with respect to controls due to alterations in trunk flexion-extension, shoulder abduction-adduction, flexion-extension and rotation and elbow flexion-extension. Moderate-to-large correlations were found between APS and EDSS (rho=0.609, P<0.001), NHPT (rho=0.468, P=0.03) and HGS (rho=-0.627 P<0.001). INTERPRETATION The kinematic analysis of HTM provides useful information in quantifying UL impairments in pwMS. The APS index appears suitable to represent UL movement deviations from the physiological pattern in pwMS and to assess disease progression or effectiveness of pharmacologic and rehabilitative treatments effectiveness.
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Affiliation(s)
- Federica Corona
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy.
| | - Elisa Gervasoni
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Foundation Don C. Gnocchi Onlus, IRCSS, Via Capecelatro 66, 20148 Milan, Italy
| | - Giancarlo Coghe
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maurizio Ferrarin
- Biomedical Technology Department, Foundation Don C. Gnocchi Onlus, IRCCS, Via Capecelatro 66, 20148 Milan, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Davide Cattaneo
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Foundation Don C. Gnocchi Onlus, IRCSS, Via Capecelatro 66, 20148 Milan, Italy
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Feys P, Lamers I, Francis G, Benedict R, Phillips G, LaRocca N, Hudson LD, Rudick R. The Nine-Hole Peg Test as a manual dexterity performance measure for multiple sclerosis. Mult Scler 2017; 23:711-720. [PMID: 28206826 PMCID: PMC5405844 DOI: 10.1177/1352458517690824] [Citation(s) in RCA: 263] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Impaired manual dexterity is a frequently reported disability in people with multiple sclerosis (MS) and is increasingly prevalent with worsening disease. While various tests and patient-reported outcome measures are available, the Nine-Hole Peg Test (NHPT) is considered as a gold standard measure of manual dexterity and most frequently used in MS research and clinical practice. The MS Outcome Assessments Consortium (MSOAC) includes representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. Among the MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step for these neuroperformance metrics is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are deemed clinically meaningful. This article addresses the NHPT, the proposed MSOAC measure for upper extremity function. We find that the NHPT is reliable within and between test sessions, discriminates between healthy subjects and MS patients with different levels of upper limb impairment, and shows high convergent validity with other manual dexterity as well as more comprehensive upper limb measures. Ecological validity is established by its relation to perceived upper limb use in daily life and perceived difficulty in performing activities of daily living. The NHPT is responsive to deterioration in longitudinal studies, and research suggests that a 20% change in test score is commonly used to define clinically meaningful worsening, a definition that needs further validation in all stages of the disease.
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Affiliation(s)
- Peter Feys
- Rehabilitation Research Center (REVAL), Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Ilse Lamers
- Rehabilitation Research Center (REVAL), Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Gordon Francis
- Neuroscience Clinical Development, San Francisco, CA, USA
| | - Ralph Benedict
- Department of Neurology, University at Buffalo, Buffalo, NY, USA
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- Multiple Sclerosis Outcome Assessments Consortium (MSOAC), Critical Path Institute, Tucson, AZ, USA
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Ortiz-Rubio A, Cabrera-Martos I, Rodríguez-Torres J, Fajardo-Contreras W, Díaz-Pelegrina A, Valenza MC. Effects of a Home-Based Upper Limb Training Program in Patients With Multiple Sclerosis: A Randomized Controlled Trial. Arch Phys Med Rehabil 2016; 97:2027-2033. [DOI: 10.1016/j.apmr.2016.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/05/2016] [Accepted: 05/17/2016] [Indexed: 11/30/2022]
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van Leeuwen LM, Mokkink LB, Kamm CP, de Groot V, van den Berg P, Ostelo RWJG, Uitdehaag BMJ. Measurement properties of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ): a study based on Classical Test Theory. Disabil Rehabil 2016; 39:2097-2104. [PMID: 27665841 DOI: 10.1080/09638288.2016.1213898] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The construct validity, test-retest reliability, and measurement error of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) were examined. Additionally, the influence of administration-method on reliability and measurement error was investigated. METHOD 112 Dutch adult MS-patients from an academic- and a residential care-facility participated. Questionnaires were administered on paper, online or as interview, and patients performed several performance tests. Construct validity was assessed by testing pre-defined hypotheses. Reliability was assessed using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurements (SEMs) and Smallest Detectable Changes (SDCs). RESULTS For construct validity (N = 105) 9 of 13 hypotheses were confirmed (69%). As expected, the AMSQ showed moderate to strong relationships with the instruments measuring similar constructs. The test-retest reliability coefficient was 0.96 (95% Confidence Interval 0.94-0.97); SEM was 6.3 (6.3% of scale range); SDC was 17.5 (on a sale from 0 to 100). Different administration-methods showed good reliability (ICC 0.88-0.94) and small standard errors (SEM 5.6-7.2). CONCLUSION The AMSQ shows satisfying results for validity and excellent reliability; allowing for proper use in research. Due to a large SDC value, caution is needed when using the AMSQ in individual patient care. Further research should determine whether the SDC is smaller than the minimal important change. Implications for Rehabilitation The Arm Function in Multiple Sclerosis Questionnaire (AMSQ) measures activity limitations due to hand and arm functioning in patients with Multiple Sclerosis (MS). Results of this study confirm adequate validity and reliability of the AMSQ in patient with MS. The equivalence of scores from online, paper or interview administration is supported. A change score of ≥18 points on the scale of the AMSQ (on a scale 0-100) needs to occur to be certain a change beyond measurement error has occurred in an individual patient.
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Affiliation(s)
- Lisette M van Leeuwen
- a Department of Otolaryngology - Head and Neck Surgery, Section Ear & Hearing , EMGO Institute for Health and Care Research, VU University Medical Center , Amsterdam , The Netherlands
| | - Lidwine B Mokkink
- b Department of Epidemiology and Biostatistics, EMGO institute for Health and Care Research , VU University Medical Center , Amsterdam , The Netherlands
| | - Christian P Kamm
- c Department of Neurology, Inselspital , Bern University Hospital, University of Bern , Bern , Switzerland.,d Department of Neurology , VU University Medical Center , Amsterdam , The Netherlands
| | - Vincent de Groot
- e Department of Rehabilitation Medicine , VU University Medical Center , Amsterdam , The Netherlands
| | | | - Raymond W J G Ostelo
- b Department of Epidemiology and Biostatistics, EMGO institute for Health and Care Research , VU University Medical Center , Amsterdam , The Netherlands.,g Department of Health Sciences, Faculty of Earth and Life Science , EMGO Institute for Health and Care Research, VU University Medical Center , Amsterdam , The Netherlands
| | - Bernard M J Uitdehaag
- d Department of Neurology , VU University Medical Center , Amsterdam , The Netherlands
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Hussain A, Balasubramanian S, Lamers I, Guy S, Feys P, Burdet E. Investigation of isometric strength and control of the upper extremities in multiple sclerosis. J Rehabil Assist Technol Eng 2016; 3:2055668316663977. [PMID: 31186906 PMCID: PMC6453098 DOI: 10.1177/2055668316663977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/08/2016] [Indexed: 11/30/2022] Open
Abstract
Isometric force assessment can provide insights into strength and motor control
in patients with neurological disabilities. This study investigated the
connection between isometric strength and control in nine multiple sclerosis
(MS) patients and four healthy subjects using a compact isometric setup. The
participants carried out isometric assessment tasks in both upper extremities in
six directions. Strength was measured through maximum voluntary force/torque
(MVF/T), while control ability was measured by applying a constant force/torque
of 25% of MVF/T. Isometric control was quantified using coefficient of
variation, force directing ability, sample-entropy and spectral bandwidth. The
MS patients were also assessed using two impairment measures (Motricity Index
and hand-grip strength), and two activity measures (Action Research Arm Test and
Nine Hole Peg Test). The results indicate that isometric strength and control
(measured by spectral bandwidth) were correlated in most directions. Among the
four control measures, spectral bandwidth – a measure introduced in this study –
was found to be strongly related to the force/torque regularity as measured by
sample-entropy. Isometric strength and spectral bandwidth for all directions
were well correlated with the impairment measures, but their correlation with
the activity scales was moderate and direction-dependent. Overall the results
show potential for using the isometric setup and protocol for assessment in MS
population.
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Affiliation(s)
- Asif Hussain
- Department of Bioengineering, Imperial
College of Science, Technology and Medicine, UK
- School of Mechanical and Aerospace
Engineering, Nanyang Technological University, Singapore
- Asif Hussain, School of Mechanical and
Aerospace Engineering, 50 Nanyang Avenue, Singapore, 639798
| | - Sivakumar Balasubramanian
- Department of Bioengineering, Imperial
College of Science, Technology and Medicine, UK
- Department of Bioengineering, Christian
Medical College Vellore, India
| | - Ilse Lamers
- Rehabilitation Research Center (REVAL),
Hasselt University, Belgium
| | - Sarah Guy
- Department of Bioengineering, Imperial
College of Science, Technology and Medicine, UK
| | - Peter Feys
- Rehabilitation Research Center (REVAL),
Hasselt University, Belgium
| | - Etienne Burdet
- Department of Bioengineering, Imperial
College of Science, Technology and Medicine, UK
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Severijns D, Lemmens M, Thoelen R, Feys P. Motor fatigability after low-intensity hand grip exercises in persons with multiple sclerosis. Mult Scler Relat Disord 2016; 10:7-13. [PMID: 27919502 DOI: 10.1016/j.msard.2016.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/23/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION During maximal, sustained contractions, persons with multiple sclerosis (PwMS) show higher motor fatigability in comparison with healthy persons. It is not known if motor fatigability is also different between PwMS and healthy persons during low-intensity exercises. Thus, the aim of this study was to determine the difference in hand grip fatigability between healthy persons and PwMS for both hands during low-intensity hand grip exercises. METHODS 19 PwMS and 19 healthy controls performed 18min of hand grip exercises at a maximum of 25% of the maximal voluntary strength, with an electronic hand dynamometer. Perceived fatigability, maximal hand grip strength and muscle activity (electromyography) of the wrist flexors and extensors were recorded in between these exercises for the dominant and non-dominant hand. RESULTS AND DISCUSSION There was a significant decrease in maximal hand grip strength after exercising in both groups and for both hands, mainly situated in the first 6min. In contrast to what was hypothesized, PwMS did not show more decline in strength than healthy controls, neither in the dominant nor the non-dominant hand. There was no group difference in the increase of the perceived fatigability in the dominant hand. However, for the non-dominant hand, the perceived fatigability after exercising increased more in PwMS than in healthy controls. Additionally, there was no relation between fatigue indices, as assessed with short maximal contractions and the strength decline after low-intensity repetitive exercises.
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Affiliation(s)
- Deborah Severijns
- REVAL-Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium.
| | - Mieke Lemmens
- Rehabilitation and MS centre, Boemerangsstraat 2, 3900 Overpelt, Belgium
| | - Ronald Thoelen
- Institute for Materials Research, Hasselt University, Wetenschapspark 1, 3590 Diepenbeek, Belgium; Division IMOMEC, IMEC vzw, Wetenschapspark 1, 3590 Diepenbeek, Belgium
| | - Peter Feys
- REVAL-Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium
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Block VAJ, Pitsch E, Tahir P, Cree BAC, Allen DD, Gelfand JM. Remote Physical Activity Monitoring in Neurological Disease: A Systematic Review. PLoS One 2016; 11:e0154335. [PMID: 27124611 PMCID: PMC4849800 DOI: 10.1371/journal.pone.0154335] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/11/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To perform a systematic review of studies using remote physical activity monitoring in neurological diseases, highlighting advances and determining gaps. METHODS Studies were systematically identified in PubMed/MEDLINE, CINAHL and SCOPUS from January 2004 to December 2014 that monitored physical activity for ≥24 hours in adults with neurological diseases. Studies that measured only involuntary motor activity (tremor, seizures), energy expenditure or sleep were excluded. Feasibility, findings, and protocols were examined. RESULTS 137 studies met inclusion criteria in multiple sclerosis (MS) (61 studies); stroke (41); Parkinson's Disease (PD) (20); dementia (11); traumatic brain injury (2) and ataxia (1). Physical activity levels measured by remote monitoring are consistently low in people with MS, stroke and dementia, and patterns of physical activity are altered in PD. In MS, decreased ambulatory activity assessed via remote monitoring is associated with greater disability and lower quality of life. In stroke, remote measures of upper limb function and ambulation are associated with functional recovery following rehabilitation and goal-directed interventions. In PD, remote monitoring may help to predict falls. In dementia, remote physical activity measures correlate with disease severity and can detect wandering. CONCLUSIONS These studies show that remote physical activity monitoring is feasible in neurological diseases, including in people with moderate to severe neurological disability. Remote monitoring can be a psychometrically sound and responsive way to assess physical activity in neurological disease. Further research is needed to ensure these tools provide meaningful information in the context of specific neurological disorders and patterns of neurological disability.
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Affiliation(s)
- Valerie A. J. Block
- Graduate Program in Physical Therapy, University of California San Francisco/ San Francisco State University, San Francisco, California, United States of America
| | - Erica Pitsch
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, United States of America
| | - Peggy Tahir
- University of California San Francisco Library, San Francisco, California, United States of America
| | - Bruce A. C. Cree
- Multiple Sclerosis and Neuroinflammation Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Diane D. Allen
- Graduate Program in Physical Therapy, University of California San Francisco/ San Francisco State University, San Francisco, California, United States of America
| | - Jeffrey M. Gelfand
- Multiple Sclerosis and Neuroinflammation Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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Perception of Muscular Effort During Dynamic Elbow Extension in Multiple Sclerosis. Arch Phys Med Rehabil 2016; 97:252-8. [DOI: 10.1016/j.apmr.2015.10.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 11/23/2022]
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Sampson P, Freeman C, Coote S, Demain S, Feys P, Meadmore K, Hughes AM. Using Functional Electrical Stimulation Mediated by Iterative Learning Control and Robotics to Improve Arm Movement for People With Multiple Sclerosis. IEEE Trans Neural Syst Rehabil Eng 2016; 24:235-48. [DOI: 10.1109/tnsre.2015.2413906] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Rice IM, Rice LA, Motl RW. Promoting Physical Activity Through a Manual Wheelchair Propulsion Intervention in Persons With Multiple Sclerosis. Arch Phys Med Rehabil 2015; 96:1850-8. [DOI: 10.1016/j.apmr.2015.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/11/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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Abstract
BACKGROUND People with multiple sclerosis (MS) are encouraged to engage in exercise programs but an increased experience of fatigue may impede sustained participation in training sessions. A high number of movements is, however, needed for obtaining optimal improvements after rehabilitation. METHODS This cross-sectional study investigated whether people with MS show abnormal fatigability during a robot-mediated upper limb movement trial. Sixteen people with MS and sixteen healthy controls performed five times three minutes of repetitive shoulder anteflexion movements. Movement performance, maximal strength, subjective upper limb fatigue and surface electromyography (median frequency and root mean square of the amplitude of the electromyography (EMG) signal of the anterior deltoid) were recorded during or in-between these exercises. After fifteen minutes of rest, one extra movement bout was performed to investigate how rest influences performance. RESULTS A fifteen minutes upper limb movement protocol increased the perceived upper limb fatigue and induced muscle fatigue, given a decline in maximal anteflexion strength and changes of both the amplitude and the median frequency of EMG the anterior deltoid. In contrast, performance during the 3 minutes of anteflexion movements did not decline. There was no relation between changes in subjective fatigue and the changes in the amplitude and the median frequency of the anterior deltoid muscle, however, there was a correlation between the changes in subjective fatigue and changes in strength in people with MS. People with MS with upper limb weakness report more fatigue due to the repetitive movements, than people with MS with normal upper limb strength, who are comparable to healthy controls. The weak group could, however, keep up performance during the 15 minutes of repetitive movements. DISCUSSION AND CONCLUSION Albeit a protocol of repetitive shoulder anteflexion movements did not elicit a performance decline, fatigue feelings clearly increased in both healthy controls and people with MS, with the largest increase in people with MS with upper limb weakness. Objective fatigability was present in both groups with a decline in the muscle strength and increase of muscle fatigue, shown by changes in the EMG parameters. However, although weak people with multiple sclerosis experienced more fatigue, the objective signs of fatigability were less obvious in weak people with MS, perhaps because this subgroup has central limiting factors, which influence performance from the start of the movements.
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Feys P, Coninx K, Kerkhofs L, De Weyer T, Truyens V, Maris A, Lamers I. Robot-supported upper limb training in a virtual learning environment : a pilot randomized controlled trial in persons with MS. J Neuroeng Rehabil 2015. [PMID: 26202325 PMCID: PMC4511982 DOI: 10.1186/s12984-015-0043-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Despite the functional impact of upper limb dysfunction in multiple sclerosis (MS), effects of intensive exercise programs and specifically robot-supported training have been rarely investigated in persons with advanced MS. Aim To investigate the effects of additional robot-supported upper limb training in persons with MS compared to conventional treatment only. Methods Seventeen persons with MS (pwMS) (median Expanded Disability Status Scale of 8, range 3.5–8.5) were included in a pilot RCT comparing the effects of additional robot-supported training to conventional treatment only. Additional training consisted of 3 weekly sessions of 30 min interacting with the HapticMaster robot within an individualised virtual learning environment (I-TRAVLE). Clinical measures at body function (Hand grip strength, Motricity Index, Fugl-Meyer) and activity (Action Research Arm test, Motor Activity Log) level were administered before and after an intervention period of 8 weeks. The intervention group were also evaluated on robot-mediated movement tasks in three dimensions, providing active range of motion, movement duration and speed and hand-path ratio as indication of movement efficiency in the spatial domain. Non-parametric statistics were applied. Results PwMS commented favourably on the robot-supported virtual learning environment and reported functional training effects in daily life. Movement tasks in three dimensions, measured with the robot, were performed in less time and for the transporting and reaching movement tasks more efficiently. There were however no significant changes for any clinical measure in neither intervention nor control group although observational analyses of the included cases indicated large improvements on the Fugl-Meyer in persons with more marked upper limb dysfunction. Conclusion Robot-supported training lead to more efficient movement execution which was however, on group level, not reflected by significant changes on standard clinical tests. Persons with more marked upper limb dysfunction may benefit most from additional robot-supported training, but larger studies are needed. Trial registration This trial is registered within the registry Clinical Trials GOV (NCT02257606).
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Affiliation(s)
- Peter Feys
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3590, Diepenbeek, Belgium.
| | - Karin Coninx
- Expertise Centre for Digital Media - tUL - iMinds, Hasselt University, Wetenschapspark 2, 3590, Diepenbeek, Belgium.
| | - Lore Kerkhofs
- Rehabilitation and MS Center Overpelt, 3900, Overpelt, Belgium.
| | - Tom De Weyer
- Expertise Centre for Digital Media - tUL - iMinds, Hasselt University, Wetenschapspark 2, 3590, Diepenbeek, Belgium.
| | - Veronik Truyens
- Rehabilitation and MS Center Overpelt, 3900, Overpelt, Belgium.
| | - Anneleen Maris
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3590, Diepenbeek, Belgium.
| | - Ilse Lamers
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3590, Diepenbeek, Belgium.
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Allart E, Benoit A, Blanchard-Dauphin A, Tiffreau V, Thevenon A, Zephir H, Outteryck O, Lacour A, Vermersch P. Sustained-released fampridine in multiple sclerosis: effects on gait parameters, arm function, fatigue, and quality of life. J Neurol 2015; 262:1936-45. [DOI: 10.1007/s00415-015-7797-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/23/2015] [Accepted: 05/25/2015] [Indexed: 12/20/2022]
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Development of Activity-Related Muscle Fatigue during Robot-Mediated Upper Limb Rehabilitation Training in Persons with Multiple Sclerosis: A Pilot Trial. Mult Scler Int 2015; 2015:650431. [PMID: 26090229 PMCID: PMC4458277 DOI: 10.1155/2015/650431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 05/01/2015] [Accepted: 05/02/2015] [Indexed: 11/18/2022] Open
Abstract
Robot-assisted rehabilitation facilitates high-intensity training of the impaired upper limb in neurological rehabilitation. It has been clinically observed that persons with Multiple Sclerosis (MS) have difficulties in sustaining the training intensity during a session due to the development of activity-related muscle fatigue. An experimental observational pilot study was conducted to examine whether or not the muscle fatigue develops in MS patients during one session of robot-assisted training within a virtual learning environment. Six MS patients with upper limb impairment (motricity index ranging from 50 to 91/100) and six healthy persons completed five training bouts of three minutes each performing lifting tasks, while EMG signals of anterior deltoid and lower trapezius muscles were measured and their subjective perceptions on muscle fatigue were registered. Decreased performance and higher subjective fatigue perception were present in the MS group. Increased mean EMG amplitudes and subjective perception levels on muscle fatigue were observed in both groups. Muscle fatigue development during 15′ training has been demonstrated in the arm of MS patients, which influences the sustainability of training intensity in MS patients. To optimize the training performance, adaptivity based on the detection of MS patient's muscle fatigue could be provided by means of training program adjustment.
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Bertoni R, Lamers I, Chen CC, Feys P, Cattaneo D. Unilateral and bilateral upper limb dysfunction at body functions, activity and participation levels in people with multiple sclerosis. Mult Scler 2015; 21:1566-74. [PMID: 25662346 DOI: 10.1177/1352458514567553] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 12/11/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND There has been limited research on upper limb dysfunction in people with multiple sclerosis (PwMS). OBJECTIVE The objective of this paper is to study unilateral and bilateral upper limb dysfunction at different International Classification of Functioning (ICF) levels according to overall disability in PwMS. METHODS A total of 105 PwMS (16 with EDSS<4 (mild); 17 with EDSS 4-5.5 (moderate); 37 with EDSS 6-6.5 (severe); 35 with EDSS>6.5 (severe non-ambulant)) were recruited from two rehabilitation centers and assessed in a cross-sectional study. RESULTS The whole sample showed a diminished sensory function (median (first/third interquartile)) score of 3 (2/3) on the Monofilament Test and a reduced strength 91 (76/100) points on the Motricity Index (Body-Function level). Sensory dysfunction did not increase with higher EDSS while strength decreased from 100 (86/100) in the mild subgroups to 91 (80/100) points in the severe subgroup. All showed diminished dexterity, scoring 0.28 peg/s (0.17/0.35) on the Nine-Hole Peg Test (NHPT) (activity level). Score was better for the mild (0.38 (0.35/0.46)) peg/s compared to the severe subgroup (0.28 (0.17/0.35)). Sixty-eight percent, 44% and 75% of PwMS showed bilateral disorders in sensation, strength and dexterity, respectively. The Community Integration Questionnaire (participation level) showed a 35% reduction in home activities, even among PwMS with EDSS<4. CONCLUSION This study showed uni-/bilateral upper limb abnormalities at all ICF levels increasing with the overall disability.
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Affiliation(s)
- Rita Bertoni
- LaRiCE lab: Gait and Balance Disorders Laboratory, Don Gnocchi Foundation, I.R.C.C.S., Italy
| | - Ilse Lamers
- REVAL - Rehabilitation Research Institute, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Christine C Chen
- Rehabilitation Sciences (Occupational Therapy), University of Texas at El Paso, El Paso, Texas
| | - Peter Feys
- REVAL - Rehabilitation Research Institute, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Davide Cattaneo
- LaRiCE lab: Gait and Balance Disorders Laboratory, Don Gnocchi Foundation, I.R.C.C.S., Italy
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Barrett L, Cano S, Zajicek J, Hobart J. Lending a hand: can DASH items help ABILHAND improve manual ability measurement in multiple sclerosis? Mult Scler 2015; 21:612-21. [PMID: 25583836 DOI: 10.1177/1352458514549396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Our examination in multiple sclerosis (MS) of the ABILHAND, a patient-reported outcome (PRO) instrument measuring manual ability, identified limited measurement range and precision. These deficiencies could lead to type II errors in clinical trials. OBJECTIVES This paper aims to determine if ABILHAND's measurement performance in MS can be improved by adding relevant items from the Disabilities of the Arm, Shoulder and Hand scale (DASH). METHODS The 23-item ABILHAND and 30-item DASH were administered to 461 people with MS. Data from the ABILHAND were combined with 16 DASH items to create a 39-item scale (AD-39). Using Rasch Measurement Theory methods, we compared the psychometric properties of AD-39 with ABILHAND. RESULTS Data were analysed from 300 people. AD-39 performed robustly as a measure and had greater measurement range, lower floor and ceiling effects, and higher reliability (person separation index 0.97) than ABILHAND. Surprisingly, AD-39 appeared no better than ABILHAND at detecting group differences in self-reported hand function. CONCLUSION Despite improving some psychometric properties, adding 16 DASH items to the ABILHAND did not improve its measurement performance to the degree expected. Our explanations for this anomaly emphasise the importance of evidence-based, conceptually driven scale modifications guided by hypothesis testing psychometric methods.
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Affiliation(s)
- Louise Barrett
- Clinical Neurology Research Group, Plymouth University Peninsula Schools of Medicine and Dentistry, UK
| | - Stefan Cano
- Clinical Neurology Research Group, Plymouth University Peninsula Schools of Medicine and Dentistry, UK
| | - John Zajicek
- Clinical Neurology Research Group, Plymouth University Peninsula Schools of Medicine and Dentistry, UK
| | - Jeremy Hobart
- Clinical Neurology Research Group, Plymouth University Peninsula Schools of Medicine and Dentistry, UK
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Associations of upper limb disability measures on different levels of the International Classification of Functioning, Disability and Health in people with multiple sclerosis. Phys Ther 2015; 95:65-75. [PMID: 25190063 DOI: 10.2522/ptj.20130588] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is unknown how impairments caused by multiple sclerosis (MS) affect upper limb capacity, performance, and community integration. OBJECTIVE The aim of this study was to investigate the extent to which impairments explained the variance in activity level and participation level measures of the International Classification of Functioning, Disability and Health (ICF) and the extent to which upper limb capacity measures explained perceived performance on the activity level in people with MS and different dexterity levels. DESIGN This was a cross-sectional study. METHODS A total of 105 people with MS (median Expanded Disability Status Scale=6.5) were assessed with measures on the ICF body functions and structures level (strength, active range of motion of the wrist, tactile sensitivity, tremor, spasticity, and pain), activity level (Nine-Hole Peg Test [NHPT], Action Research Arm Test, and Manual Ability Measure-36 [MAM-36]), and participation level (Community Integration Questionnaire). The sample was divided into low- and high-dexterity subgroups on the basis of the median score on the NHPT. RESULTS In the total group, muscle strength, tactile sensitivity of the thumb, and intention tremor explained 53% to 64% of the variance in activity level measures. In the low-dexterity subgroup, muscle strength and active range of motion explained 43% to 71% of the variance in activity level measures. In the high-dexterity subgroup, only 35% of the variance in the MAM-36 was explained by muscle strength. Capacity measures (NHPT and Action Research Arm Test) were moderately to highly associated with perceived performance (MAM-36) in the low-dexterity subgroup. LIMITATIONS Some outcome measures showed ceiling effects in people with MS and a high dexterity level. CONCLUSIONS Upper limb muscle strength is the most important impairment affecting capacity and perceived performance in daily life. Associations among outcome measures differ in people with MS and different dexterity levels.
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Abstract
BACKGROUND Impaired manual dexterity is frequent and disabling in people with multiple sclerosis (MS). Therefore, convenient, quick, and validated tests for manual dexterity in people with MS are needed. OBJECTIVE The aim of this study was to validate the Coin Rotation Task (CRT) for examining manual dexterity in people with MS. DESIGN This was a cross-sectional study. METHODS A total of 101 outpatients with MS were assessed with the CRT, the Expanded Disability Status Scale (EDSS), the Scale for the Assessment and Rating of Ataxia (SARA), and the Modified Ashworth Scale (MAS); muscle strength and sensory deficits of the hands were noted. The concurrent validity and diagnostic accuracy of the CRT were determined by comparison with the 9-Hole Peg Test (9HPT). Construct validity was determined by comparison with a valid dexterity questionnaire. Multiple regression analyses were done to explore correlations of the CRT with the EDSS, SARA, MAS, muscle strength, and sensory deficits. RESULTS The CRT correlated significantly with the 9HPT (r=.73, P<.0001), indicating good concurrent validity. The cutoff values for the CRT relative to the 9HPT were 18.75 seconds for the dominant hand (sensitivity=81.5%, specificity=80.0%) and 19.25 seconds for the nondominant hand (sensitivity=90.3%, specificity=81.8%); these values indicated good diagnostic accuracy. Furthermore, the CRT correlated significantly with the dexterity questionnaire (r=-.49, P<.0001), indicating moderate construct validity. Multiple regression analyses revealed that the EDSS was the strongest predictor for impaired dexterity. LIMITATIONS Most of the people examined had relapsing-remitting MS and EDSS scores of up to 7. CONCLUSIONS This study validated the CRT as a test that can be used easily and quickly to evaluate manual dexterity in people with MS.
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Lambercy O, Fluet MC, Lamers I, Kerkhofs L, Feys P, Gassert R. Assessment of upper limb motor function in patients with multiple sclerosis using the Virtual Peg Insertion Test: a pilot study. IEEE Int Conf Rehabil Robot 2014; 2013:6650494. [PMID: 24187309 DOI: 10.1109/icorr.2013.6650494] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Quantifying and tracking upper limb impairment is of key importance to the understanding of disease progress, establishing patient-tailored therapy protocols and for optimal care provision. This paper presents the results of a pilot study on the assessment of upper limb motor function in patients with multiple sclerosis (MS) with the Virtual Peg Insertion Test (VPIT). The test consists in a goal-directed reaching task using a commercial haptic display combined with an instrumented handle and virtual environment, and allows for the extraction of objective kinematic and dynamic parameters. Ten MS patients and eight age-matched healthy subjects performed five repetitions of the VPIT with their dominant and non-dominant hand. Upper limb movements were found to be significantly slower, less smooth and less straight compared to healthy controls, and the time to complete the VPIT was well correlated with the conventional Nine Hole Peg Test (r=0.658, p<0.01). Tremor in the range of 3-5 Hz could be detected and quantified using a frequency analysis in patients featuring intention tremor. These preliminary results illustrate the feasibility of using the VPIT with MS patients, and underline the potential of this test to evaluate upper limb motor function and discriminate characteristic MS related impairments.
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Kalron A, Greenberg-Avrahami M, Achiron A. Validity and test-retest reliability of a measure of hand sensibility and manual dexterity in people with multiple sclerosis: the ReSense test. Disabil Rehabil 2014; 37:914-20. [PMID: 25095901 DOI: 10.3109/09638288.2014.948128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the concurrent validity and reliability of the ReSense tool, a new clinical test aimed at determining sensory and functional deficits of the hand in people with multiple sclerosis (PwMS). METHODS Study participants included 90 PwMS, 58 women, characterized by significant sensory symptoms in one or both hands. Thirty healthy subjects, 19 women, served as controls. The ReSense evaluation tool measures the ability to perceive and recognize texture and spatial properties of specific elements. ReSense scores were compared with the two-point discrimination (2PD), Semmes-Weinstein monofilament (SWM), Nine-Hole Peg Test (9-HPT), Box and Block Test (BBT) and the Functional dexterity (FDT) tests. RESULTS The Cronbach alpha value for the ReSense test for PwMS was 0.84. The ReSense was significantly correlated with the 9-HPT; Pearson's R = -0.44 and FDT; Pearson's R = -0.35. Significant correlations were demonstrated between the ReSense score to SWM and 2PD. The strongest correlation was found with the 2PD performed on the dominant hand; Pearson's R = -0.55. CONCLUSIONS The ReSense is a valid tool developed for testing sensing properties of the hand in PwMS. We believe that the sensitivity and specificity values of this tool will assist the clinician to formulate decisions related to rehabilitation management of his/her patient.
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Affiliation(s)
- Alon Kalron
- Department of Physical Therapy, Tel-Aviv University , Tel-Aviv , Israel and
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Lamers I, Feys P. Assessing upper limb function in multiple sclerosis. Mult Scler 2014; 20:775-84. [DOI: 10.1177/1352458514525677] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 02/04/2014] [Indexed: 11/17/2022]
Abstract
The need to fully assess upper limb function in multiple sclerosis (MS) has become increasingly clear with recent studies revealing a high prevalence of upper limb dysfunction in persons with MS leading to increased dependency and reduced quality of life. It is important that clinicians and researchers use tailored outcome measures to systematically describe upper limb (dys)function and evaluate potential deterioration or improvement on treatment. This topical review provides a comprehensive summary of currently used upper limb outcome measures in MS, classified according to the levels of the International Classification of Functioning (ICF). The clinical utility, strengths, weaknesses and psychometric properties of common upper limb outcome measures are discussed. Based on this information, recommendations for selecting appropriate upper limb outcome measures are given. The current shortcomings in assessment which need to be addressed are identified.
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Affiliation(s)
- Ilse Lamers
- REVAL – Rehabilitation Research Institute, BIOMED – Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Peter Feys
- REVAL – Rehabilitation Research Institute, BIOMED – Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Belgium
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Lamers I, Kelchtermans S, Baert I, Feys P. Upper limb assessment in multiple sclerosis: a systematic review of outcome measures and their psychometric properties. Arch Phys Med Rehabil 2014; 95:1184-200. [PMID: 24631802 DOI: 10.1016/j.apmr.2014.02.023] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/30/2014] [Accepted: 02/25/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide an overview of applied upper limb outcome measures in multiple sclerosis (MS) according to the International Classification of Functioning, Disability and Health (ICF) levels and to review their psychometric properties in MS. DATA SOURCES PubMed and Web of Knowledge. STUDY SELECTION Articles published until June 2013 were selected when written in English, published in the last 25 years, peer reviewed, including >5 persons with MS, and including standardized clinical upper limb outcome measures. Included articles were screened based on title/abstract and full text by 2 independent reviewers. In case of doubt, feedback from a third independent reviewer was obtained. Additionally, references lists were checked for relevant articles. Of the articles, 109 met the selection criteria and were included for data extraction. DATA EXTRACTION All reported clinical upper limb outcome measures were extracted from the included studies and classified according to the ICF levels by 2 independent reviewers. In addition, available psychometric properties (reliability, validity, responsiveness) in MS were summarized and discussed. DATA SYNTHESIS A diversity of outcome measures assessing impairments on the body functions and structures level (n=33), upper limb capacity (n=11), and performance (n=8) on the activity level were extracted from 109 articles. Hand grip strength and the nine-hole peg test (NHPT) were the most frequently used outcome measures. However, multiple outcome measures are necessary to encapsulate the multidimensional character of the upper limb function. The psychometric properties were insufficiently documented for most of the outcome measures, except for the NHPT. CONCLUSIONS The results of this review may help with the selection of appropriate outcome measures and may guide future research regarding the psychometric properties in MS.
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Affiliation(s)
- Ilse Lamers
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
| | - Silke Kelchtermans
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Ilse Baert
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Peter Feys
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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La fonction du membre supérieur chez les patients atteints de sclérose en plaques. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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