Progressive resistance power training for gait and balance rehabilitation in multiple sclerosis: a pilot single-arm study.

Aims: The aim of the study was to evaluate the effectiveness of 4-weeks inpatient power training protocol on parameters of gait and balance in pwMS. Materials and methods. 26 subjects aged 18 65 years and Expanded Disability Status Scale (EDSS) score 2.0 to 6.5 Receiving standard rehabilitation with PRT was applied for 30 minutes, 5 days a week for 4 weeks in addition to other rehabilitation methods. The primary endpoint was the time of 6-minute walking test (6MWT) at week 4 (W4) compared to week 1 (W1). Secondary outcomes included the time in Timed 25-foot walking test (T25FW), Timed Up-n-Go test (TUG), 5 times sit-to-stand test (5TSST), Expanded disability status scale score (EDSS), muscle strength. Results. After the 4-week course of rehabilitation a significant improvement was reached in all tests. The most prominent was the improvement in the 6MWT with 20/25 (80%) patients showing the increase in the distance walked above the minimal clinically important difference (MCID). Changes in other tests were less manifest: 3/25 (12%) of patients improved above MCID in both TUG and 5TSST, 6/25 (24%) patients - in T25FW. After a 4-week course of rehabilitation, a significant improvement was acquired in the 6MWT. Changes in other tests were significantly less manifest. Muscle in hip flexors improved significantly on the left side (mean (SD) at W1 - 3,96 (0,67) vs W4 - 4,72 (0,46), p=0,04)) and showed the trend to significance of the right side: W1 - 3,68 (0,8); W4 - 4,52 (0,65), p=0,08. Conclusions: The most significant effect was achieved in the primary outcome that was the distance walked in 6MWT. Less disabled patients can show better improvement in further studies, as was defined by T25FW test. Regular exercise can improve daily activity using a program that patients can easily do at home on their own.

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Day-to-day reliability, agreement and discriminative validity of measuring walking-related performance fatigability in persons with multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458519872465 ◽

2019 ◽

Vol 26 (13) ◽

pp. 1785-1789 ◽

Cited By ~ 4

Author(s):

Fanny Van Geel ◽

Renee Veldkamp ◽

Deborah Severijns ◽

Ulrik Dalgas ◽

Peter Feys

Keyword(s):

Multiple Sclerosis ◽

Ecological Validity ◽

Intraclass Correlation ◽

Clinical Importance ◽

Healthy Controls ◽

Expanded Disability Status Scale ◽

Limits Of Agreement ◽

Discriminative Validity ◽

Walking Test ◽

Disability Status

Background: Day-to-day reliability and cut-off values to detect abnormal walking fatigability (WF) remain to be investigated in persons with multiple sclerosis (pwMS). Methods: In all, 49 pwMS (mean Expanded Disability Status Scale (EDSS) ± standard deviation (SD): 3.3 ± 1.9) and 28 matched healthy controls (HC) performed the six-minute walking test (6MWT) on two different days to determine day-to-day reliability (intraclass correlation coefficient (ICC)) and limits of agreement (LOA) for five different equations of WF. Objective: To examine day-to-day reliability, agreement and discriminative validity for measuring WF. Results and conclusion: WF expressed as the ratio between the first and sixth minute had the best day-to-day reliability (ICC’s range of 0.76–0.95 and 0.60–0.86, respectively) in both pwMS and HC, while LOA were 15% and 7%, respectively. Ecological validity and clinical importance should be further investigated.

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Reliability and Repeatability Analysis of Indices to Measure Gait Deterioration in MS Patients during Prolonged Walking

Sensors ◽

10.3390/s20185063 ◽

2020 ◽

Vol 20 (18) ◽

pp. 5063

Author(s):

Juri Taborri ◽

Valeria Studer ◽

Paola Grossi ◽

Laura Brambilla ◽

Fabrizio Patanè ◽

...

Keyword(s):

Strongly Correlated ◽

Expanded Disability Status Scale ◽

Experimental Protocol ◽

Walking Test ◽

Quantitative Indices ◽

Disability Status ◽

Limb Kinematics ◽

Good Repeatability ◽

The Difference ◽

Lower Limb Kinematics

Gait deterioration caused by prolonged walking represents one of the main consequences of multiple sclerosis (MS). This study aims at proposing quantitative indices to measure the gait deterioration effects. The experimental protocol consisted in a 6-min walking test and it involved nine patients with MS and twenty-six healthy subjects. Pathology severity was assessed through the Expanded Disability Status Scale. Seven inertial units were used to gather lower limb kinematics. Gait variability and asymmetry were assessed by coefficient of variation (CoV) and symmetry index (SI), respectively. The evolution of ROM (range of motion), CoV, and SI was computed analyzing data divided into six 60-s subgroups. Maximum difference among subgroups and the difference between the first minute and the remaining five were computed. The indices were analyzed for intra- and inter-day reliability and repeatability. Correlation with clinical scores was also evaluated. Good to excellent reliability was found for all indices. The computed standard deviations allowed us to affirm the good repeatability of the indices. The outcomes suggested walking-related fatigue leads to an always more variable kinematics in MS, in terms of changes in ROM, increase of variability and asymmetry. The hip asymmetry strongly correlated with the clinical disability.

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Clinical outcomes of patients with multiple sclerosis treated with ocrelizumab in a US community MS center: an observational study

BMJ Neurology Open ◽

10.1136/bmjno-2020-000108 ◽

2021 ◽

Vol 3 (2) ◽

pp. e000108

Author(s):

Kyle Smoot ◽

Chiayi Chen ◽

Tamela Stuchiner ◽

Lindsay Lucas ◽

Lois Grote ◽

...

Keyword(s):

Multiple Sclerosis ◽

Respiratory Infections ◽

Expanded Disability Status Scale ◽

Long Term Outcomes ◽

Community Based ◽

T2 Lesions ◽

Disability Status ◽

Disabled Patients ◽

Tract Infections

BackgroundTo monitor long-term outcomes of ocrelizumab treatment.ObjectiveTo evaluate safety and treatment outcomes of ocrelizumab in a community-based multiple sclerosis (MS) population.MethodsAdult patients with MS prescribed ocrelizumab were eligible. Chart reviews were conducted at the start of ocrelizumab treatment and every 6 months thereafter.ResultsOf the 355 patients enrolled, 71.9% were female; mean (SD) age was 51.8 (12.5) years; 78.3% had relapsing MS (RMS). Median baseline Expanded Disability Status Scale (EDSS) (IQR) was 3.0 (2.0–4.0) for RMS, 6.5 (6.0–7.5) for secondary progressive MS, and 6.5 (6.0–7.0) for primary progressive MS. Respiratory infections occurred in 40.1% and urinary tract infections in 33.1% of patients. There was no difference in the percentage of infections among patients <55 (68.5%, n=122), and those ≥55 of age (67.5%, n=104) (p=0.94). Twenty-five hospitalisations were due to infections; 69.2% of these patients were ≥55 with a mean EDSS of 5.7 (±1.86). Four patients have died. Serum IgM and IgG levels did not predict infection risk. Annualised relapse rate was 0.34 for the patients with RMS in the preceding 2 years and 0.09 in patients who received ≥2 ocrelizumab 600 mg courses. The first on-treatment MRI was stable in 262 (90.0%) patients, 6.9% had new T2 lesions, 2.7% had enlarging T2 lesions and 1.4% had gadolinium-enhancing lesions. Median EDSS at 12 months was unchanged.ConclusionOcrelizumab effectively controlled relapse risk and disability worsening. Although only 12.1% of patients have discontinued ocrelizumab, infections resulting in hospitalisation are a concern, especially in older and disabled patients.

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Advanced lightweight cooling-garment technology: functional improvements in thermosensitive patients with multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458506070648 ◽

2007 ◽

Vol 13 (2) ◽

pp. 232-237 ◽

Cited By ~ 35

Author(s):

A Meyer-Heim ◽

M Rothmaier ◽

M Weder ◽

J Kool ◽

P Schenk ◽

...

Keyword(s):

Multiple Sclerosis ◽

Motor Skills ◽

Clinical Symptoms ◽

Technical Information ◽

Fine Motor ◽

Expanded Disability Status Scale ◽

Walking Test ◽

Leg Strength ◽

Disability Status ◽

Cooling Garment

Cooling of thermosensitive patients with multiple sclerosis (MS) can improve clinical symptoms. In order to study the effectiveness of an advanced lightweight cooling-garment technology based on aquatic evaporation, a single-blinded balanced crossover study was performed on 20 patients with an Expanded Disability Status Scale score ≤6.5. The results using a tight-cuff cooling-garment prototype for peripheral cooling suggest improvement of a timed-walking test, leg-strength, fine-motor skills and subjective benefits. Preliminary data of the heart rate variability (HRV) including six patients suggest that the MS patients show an abnormal HRV after sham condition, which is normalized after cooling. Technical information was gained about the cooling activity and the practicability and handling of the device. These encouraging findings promote further adaptations of the prototype to increase its cooling properties and ameliorate the practicability of the cooling garment. Multiple Sclerosis 2007; 13: 232–237. http://msj.sagepub.com

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Changes in cognition, arm function and lower body function after Slow-Release Fampridine treatment

Multiple Sclerosis Journal ◽

10.1177/1352458514533844 ◽

2014 ◽

Vol 20 (14) ◽

pp. 1872-1880 ◽

Cited By ~ 36

Author(s):

HB Jensen ◽

M Ravnborg ◽

S Mamoei ◽

U Dalgas ◽

E Stenager

Keyword(s):

Disease Duration ◽

Slow Release ◽

Step Test ◽

Response To Treatment ◽

Lower Body ◽

Expanded Disability Status Scale ◽

Meaningful Change ◽

Sit To Stand ◽

Disability Status ◽

Multiple Outcome

Objective: We aimed to evaluate the effect of slow-release (SR) Fampridine on multiple outcome measures reflecting different domains, and to compare the responsiveness of the Six Spot Step Test (SSST) and the Timed 25 Foot Walk (T25FW). Methods: For this study 108 participants were included. On day 0 they were tested with the T25FW, the SSST, the 9-Hole Peg Test (9-HPT), the 5 Times Sit-To-Stand test (5-STS) and the Symbol Digit Modalities Test (SDMT). Four weeks of treatment with SR Fampridine 10 mg BID was commenced. Participants were tested again after 26–28 days of treatment. Results: Mean changes observed were: SSST −3.4±6.4s ( p<0.001), T25FW −1.2±3.7s ( p<0.001), 9-HPT −1.2±6.0s ( p<0.001), 5- STS −3.4±7.2s ( p<0.001) and SDMT 1.4±4.8 a.u. ( p=0.003). Change on the SSST differed significantly from T25FW (SSST 17.0±19.6% vs. T25FW 11.2±17.1%, p=0.0013). Some 48.6% were found to have a meaningful change on the SSST compared with 25.7% on the T25FW. The response to treatment with SR Fampridine did not correlate with age, sex, Expanded Disability Status Scale and disease duration. Conclusion: SR Fampridine treatment has significant effects on different domains including upper and lower body and cognition. Furthermore, the SSST is more responsive to the effect of SR Fampridine than is the T25FW. ClinicalTrials.gov identifier: NCT01656148

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Validierung von Selbstbewertungsskalen bei Multipler Sklerose: Brauchen wir noch die Expanded-Disability-Status-Scale (EDSS)?

Aktuelle Neurologie ◽

10.1055/s-2004-833096 ◽

2004 ◽

Vol 31 (S 1) ◽

Author(s):

K Ziegler ◽

C Borchers ◽

K Schulz ◽

S Gold ◽

I Wölfel ◽

...

Keyword(s):

Expanded Disability Status Scale ◽

Disability Status

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Relationship between Expanded Disability Status Scale scores and the presence of temporomandibular disorders in patients with multiple sclerosis

European Journal of Dentistry ◽

10.4103/ejd.ejd_91_17 ◽

2018 ◽

Vol 12 (01) ◽

pp. 144-148 ◽

Cited By ~ 2

Author(s):

Lucas Senra Correa Carvalho ◽

Osvaldo José Moreira Nascimento ◽

Luciane Lacerda Franco Rocha Rodrigues ◽

Andre Palma Da Cunha Matta

Keyword(s):

Multiple Sclerosis ◽

Temporomandibular Disorders ◽

Control Group ◽

Expanded Disability Status Scale ◽

Exact Test ◽

Disability Status ◽

Relapsing Remitting ◽

Scale Scores ◽

Axis I ◽

Relapsing Remitting Multiple Sclerosis

ABSTRACTObjectives: The objectives of this study were to assess the prevalence of temporomandibular disorders (TMDs) in patients with relapsing-remitting multiple sclerosis (MS) and to investigate whether an association exists between the presence of TMD symptoms and the degree of MS-related disability. Materials and Methods: In all, 120 individuals were evaluated: 60 patients with a diagnosis of relapsing-remitting MS and 60 age- and sex-matched controls without neurological impairments. A questionnaire recommended by the European Academy of Craniomandibular Disorders for the assessment of TMD symptoms was administered. For those who answered affirmatively to at least one of the questions, the RDC/TMD Axis I instrument was used for a possible classification of TMD subtypes. The Expanded Disability Status Scale (EDSS) was the measure of the degree of MS-related disability. Statistical Analysis Used: Fisher’s exact test was used to analyze the data. ANOVA was used to detect significant differences between means and to assess whether the factors influenced any of the dependent variables by comparing means from the different groups. Results: The prevalence of TMD symptoms in patients with MS was 61.7% versus 18.3% in the control group (CG). A diagnosis of TMD was established for 36.7% in the MS group and 3.3% in the CG (P = 0.0001). There were statistically significant differences between degrees of MS-related disability and the prevalence of TMD (P = 0.0288). Conclusions: The prevalence of both TMD and TMD symptoms was significantly greater in the MS group. EDSS scores and TMD prevalence rates were inversely related.

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Effects of lower limb resistance exercise on muscle strength, physical fitness, and metabolism in pre-frail elderly patients: a randomized controlled trial

BMC Geriatrics ◽

10.1186/s12877-021-02386-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaoxing Lai ◽

Lin Bo ◽

Hongwei Zhu ◽

Baoyu Chen ◽

Zhao Wu ◽

...

Keyword(s):

Muscle Strength ◽

Resistance Exercise ◽

Frail Elderly ◽

Lower Limb ◽

Intervention Group ◽

Control Group ◽

Walking Test ◽

Sit To Stand ◽

Femoris Muscle ◽

Activity Energy

Abstract Background Few studies examined interventions in frail elderly in China, while the awareness of applying interventions to prevent frailty in pre-frail elderly is still lacking. This study aimed to explore the effects of lower limb resistance exercise in pre-frail elderly in China. Methods This was a randomized controlled trial of patients with pre-frailty. The control group received routine care, while the exercise group received a 12-week lower limb resistance exercise based on routine care. The muscle strength in the lower limbs, physical fitness, and energy metabolism of the patients was evaluated at admission and after 12 weeks of intervention. Results A total of 60 pre-frail elderly were included in this study. The patients were divided into the exercise group (n = 30) and control group (n = 30) by random grouping. There were 17 men and 13 women aged 65.3 ± 13.4 in the exercise group, and 15 men and 15 women aged 67.6 ± 11.9 years in the control groups. The Barthel index was 80.3 ± 10.6 and 85.1 ± 11.6, respectively. The characteristics of the two groups were not significantly different before intervention (all p > 0.05). The results of repeated measurement ANOVA showed that there was statistically significant in crossover effect of group * time (all p < 0.05), that is, the differences of quadriceps femoris muscle strength, 6-min walking test, 30-s sit-to-stand test, 8-ft “up & go” test, daily activity energy expenditure and metabolic equivalent between the intervention group and the control group changed with time, and the variation ranges were different. The main effects of time were statistically significant (all p < 0.05), namely, femoris muscle strength, 6-min walking test, 30-s sit-to-stand test, 8-ft “up & go” test, daily activity energy expenditure and metabolic equivalent of the intervention group and the control group were significantly different before and after intervention. The main effects of groups were statistically significant (p < 0.05), namely, femoris muscle strength, 6-min walking test, 30-s sit-to-stand test, daily activity energy expenditure and metabolic equivalent before and after intervention were significantly different between the intervention group and the control group, while there was no significant differences in 8-ft “up & go” test between groups. Conclusion Lower limb resistance exercise used for the frailty intervention could improve muscle strength, physical fitness, and metabolism in pre-frail elderly. Trial registration ChiCTR, ChiCTR2000031099. Registered 22 March 2020, http://www.chictr.org.cn/edit.aspx?pid=51221&htm=4

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Determinants of therapeutic lag in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458520981300 ◽

2021 ◽

pp. 135245852098130

Author(s):

Izanne Roos ◽

Emmanuelle Leray ◽

Federico Frascoli ◽

Romain Casey ◽

J William L Brown ◽

...

Keyword(s):

Multiple Sclerosis ◽

Expanded Disability Status Scale ◽

Disability Progression ◽

Delayed Onset ◽

Disease Characteristics ◽

Disability Status ◽

Male Sex ◽

Pre Treatment ◽

Patient Subgroups

Background: A delayed onset of treatment effect, termed therapeutic lag, may influence the assessment of treatment response in some patient subgroups. Objectives: The objective of this study is to explore the associations of patient and disease characteristics with therapeutic lag on relapses and disability accumulation. Methods: Data from MSBase, a multinational multiple sclerosis (MS) registry, and OFSEP, the French MS registry, were used. Patients diagnosed with MS, minimum 1 year of exposure to MS treatment and 3 years of pre-treatment follow-up, were included in the analysis. Studied outcomes were incidence of relapses and disability accumulation. Therapeutic lag was calculated using an objective, validated method in subgroups stratified by patient and disease characteristics. Therapeutic lag under specific circumstances was then estimated in subgroups defined by combinations of clinical and demographic determinants. Results: High baseline disability scores, annualised relapse rate (ARR) ⩾ 1 and male sex were associated with longer therapeutic lag on disability progression in sufficiently populated groups: females with expanded disability status scale (EDSS) < 6 and ARR < 1 had mean lag of 26.6 weeks (95% CI = 18.2–34.9), males with EDSS < 6 and ARR < 1 31.0 weeks (95% CI = 25.3–36.8), females with EDSS < 6 and ARR ⩾ 1 44.8 weeks (95% CI = 24.5–65.1), and females with EDSS ⩾ 6 and ARR < 1 54.3 weeks (95% CI = 47.2–61.5). Conclusions: Pre-treatment EDSS and ARR are the most important determinants of therapeutic lag.

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