Toward a Consensus on Rehabilitation Outcomes in MS: Gait and Fatigue

2009 ◽  
Vol 11 (2) ◽  
pp. 67-78 ◽  
Author(s):  
Brian Hutchinson ◽  
Susan J. Forwell ◽  
Susan Bennett ◽  
Theodore Brown ◽  
Herb Karpatkin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Outcome Measures ◽  
Consensus Conference ◽  
Timed Up And Go ◽  
Assessment Battery ◽  
Rehabilitation Professionals ◽  
Rehabilitation Outcomes ◽  
Dynamic Gait Index ◽  
Dynamic Gait

A multidisciplinary consensus conference was held on November 28–29, 2007, by the Consortium of Multiple Sclerosis Centers (CMSC) to determine the most appropriate outcome measures for gait and fatigue in people with multiple sclerosis (MS). The goals of this conference were to 1) improve understanding of gait and fatigue outcome measures being used by rehabilitation professionals treating people with MS; 2) establish consensus on outcome measures; and 3) establish consensus on required follow-up for transfer of this knowledge to rehabilitation professionals. The consensus conference and this document are the initial steps toward achieving the stated goals. Although many measures of fatigue exist, it was recommended that a global outcome measure for fatigue be developed that would 1) include a screen for the functional ramifications of fatigue for activities and participation; 2) be quick and easy to administer; 3) demonstrate psychometric integrity for MS; and 4) examine fatigue over a continuum of the MS disease course. In addition, it was recommended that an assessment battery for fatigue be developed. With respect to gait outcome measures, it was agreed that the following tools should be included in a preliminary chart for use in a clinical setting: the Timed 25-Foot Walk, Timed Up and Go test, Dynamic Gait Index, 6-Minute Walk, and self-reported 12-item Multiple Sclerosis Walking Scale. The global outcome fatigue measure and assessment battery are currently being developed, and work on a detailed gait outcome measures chart and additional research on commonly used gait outcome measures are in progress.

scholarly journals Evaluating Walking in Patients with Multiple Sclerosis

2011 ◽  
Vol 13 (1) ◽  
pp. 4-14 ◽  
Author(s):  
Francois Bethoux ◽  
Susan Bennett
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Setting ◽  
Disability Evaluation ◽  
Self Report ◽  
Timed Up And Go ◽  
Global Positioning ◽  
Walking Performance ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Patient Burden

Walking limitations are among the most visible manifestations of multiple sclerosis (MS). Regular walking assessments should be a component of patient management and require instruments that are appropriate from the clinician's and the patient's perspectives. This article reviews frequently used instruments to assess walking in patients with MS, with emphasis on their validity, reliability, and practicality in the clinical setting. Relevant articles were identified based on PubMed searches using the following terms: “multiple sclerosis AND (walking OR gait OR mobility OR physical activity) AND (disability evaluation)”; references of relevant articles were also searched. Although many clinician- and patient-driven instruments are available, not all have been validated in MS, and some are not sensitive enough to detect small but clinically important changes. Choosing among these depends on what needs to be measured, psychometric properties, the clinical relevance of results, and practicality with respect to space, time, and patient burden. Of the instruments available, the clinician-observed Timed 25-Foot Walk and patient self-report 12-Item Multiple Sclerosis Walking Scale have properties that make them suitable for routine evaluation of walking performance. The Dynamic Gait Index and the Timed Up and Go test involve other aspects of mobility, including balance. Tests of endurance, such as the 2- or 6-Minute Walk, may provide information on motor fatigue not captured by other tests. Quantitative measurement of gait kinetics and kinematics, and recordings of mobility in the patient's environment via accelerometry or Global Positioning System odometry, are currently not routinely used in the clinical setting.

scholarly journals The added value of cognition-targeted exercise versus symptom-targeted exercise for multiple sclerosis fatigue: A randomized controlled pilot trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0258752
Author(s):  
Azza Alketbi ◽  
Salah Basit ◽  
Nouran Hamza ◽  
Lori M. Walton ◽  
Ibrahim M. Moustafa
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Outcome ◽  
Outcome Measures ◽  
Recruitment Rate ◽  
Control Group ◽  
Entire Study ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Intervention Protocol

Background Fatigue is considered one of the most common symptoms of multiple sclerosis (MS) and lacks a current standardized treatment. Therefore, the aim of this study was to examine the feasibility and effectiveness of a cognition-targeted exercise versus symptom-targeted exercise for MS fatigue. Methods In this Pilot, parallel-group, randomized controlled trial, sixty participants with multiple sclerosis, were randomly assigned to either a Cognition-Targeted Exercise (CTE) (N = 30, mean age 41) or a Symptom-Targeted Exercise (STE) (N = 30, mean age 42). The participants in the experimental group received eight, 50-minute sessions of weekly Cognitive Behavior Therapy (CBT) in addition to a CTE Program; whereas, participants in the control group received eight, 50-minute sessions of weekly CBT in addition to the standardized physiotherapy program (STE Program). Feasibility was assessed through recruitment rate, participant retention, adherence and safety, in addition to clinical outcome measures, including: (1) Modified Fatigue Impact Scale (MFIS), (2) Work and Social Adjustment Scale (WSAS), (3) Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS). All outcome measures were assessed at baseline (pretreatment), following completion of the eight visit intervention protocol, and at 3-months follow-up. Results The recruitment rate was 60% and 93% of participants completed the entire study. The recruited participants complied with 98% of the required visits. No adverse events were recorded. A Generalized Estimation Equation Model revealed a significant difference over time as an interaction term during the post and follow up visit for all clinical outcome measures (p < .001). Conclusion The addition of CTE to CBT exhibited positive and more lasting influence on MS fatigue outcomes compared to Symptom-Targeted Exercise (STE). Feasibility and efficacy data from this pilot study provide support for a full-scale RCT of CTE as an integral component of Multiple Sclerosis fatigue management.

Identification of modified dynamic gait index cutoff scores for assessing fall risk in people with Parkinson disease, stroke and multiple sclerosis

2022 ◽  
Vol 91 ◽  
pp. 1-6
Author(s):  
Alessandro Torchio ◽  
Chiara Corrini ◽  
Denise Anastasi ◽  
Riccardo Parelli ◽  
Matteo Meotti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Parkinson Disease ◽  
Fall Risk ◽  
Cutoff Scores ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

Factors Associated With Rehabilitation Outcomes in Patients With Unilateral Vestibular Hypofunction: A Prospective Cohort Study

2020 ◽  
Vol 100 (11) ◽  
pp. 2009-2022
Author(s):  
Susan J Herdman ◽  
Courtney D Hall ◽  
Lisa Heusel-Gillig
Keyword(s):  
Gait Speed ◽  
Outcome Measure ◽  
Patient Characteristics ◽  
Meaningful Change ◽  
Balance Confidence ◽  
Factors Associated ◽  
Rehabilitation Outcomes ◽  
Vestibular Hypofunction ◽  
Dynamic Gait Index ◽  
Dynamic Gait

Abstract Objective The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR). Methods In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, percent of time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge. Results There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure, most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed, and falls after the onset of the unilateral vestibular hypofunction (UVH) predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-Specific Balance Confidence Scale (ABC) and Dynamic Gait Index scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of Dynamic Gait Index scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk. Conclusions Therapists may use these findings for patient education or to determine the need for adjunct therapy, such as counseling. Impact Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR; these findings will help therapists create better predictive models.

scholarly journals Effects of Fatigue on Balance and Mobility in Subjects with Multiple Sclerosis: A Brief Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Elisa Gervasoni ◽  
Davide Cattaneo ◽  
Angelo Montesano ◽  
Johanna Jonsdottir
Keyword(s):  
Multiple Sclerosis ◽  
Berg Balance Scale ◽  
Balance Performance ◽  
Before And After ◽  
Increase Risk ◽  
Risk Of Falls ◽  
Edss Score ◽  
The Difference ◽  
Dynamic Gait Index ◽  
Dynamic Gait

Purpose. People with Multiple Sclerosis (PwMS) tent to have increased levels of fatigue which can impact on their balance and increase risk of falls. However, the relationship between fatigue and balance is poorly understood. The aim of the present study was to assess if an experimentally induced fatigue had an immediate effect on balance. Methods. 37 inpatients with multiple sclerosis were recruited; the mean age (standard deviation) was 48.7 (9.6) years. The average onset of the pathology was 15.3 (9.8) years before the start of the study. The median (1°–3° quartile) Expanded Disability Status Scale (EDSS) score was 5.5 (4.5–6.0). Before and after a fatiguing treadmill, session, subjects were assessed with the Berg Balance Scale and Dynamic Gait Index. Results. After the treadmill, no statistically significant differences were found in balance before and after a treadmill session (monopodalic stance: before 5.3s (10.3) and after 7.7s (13.9); walk with horizontal head turns: before 11.6 (6.9) seconds and after 11.3 (7.7)). There was no correlation between the EDSS score and the difference in balance skills before and after treadmill. Conclusion. After treadmil PwMS were mentally and physically fatigued; however, their balance performance did not change, indicating no increase in risk of falling with fatigue.

scholarly journals Efeitos da prática mental associada à fisioterapia motora sobre a marcha e o risco de quedas na doença de Parkinson: estudo piloto

2019 ◽  
Vol 26 (2) ◽  
pp. 112-119 ◽  
Author(s):  
Liliane Pereira da Silva ◽  
Matheus Pereira de Souza Duarte ◽  
Caroline de Cássia Batista de Souza ◽  
Carla Cabral dos Santos Accioly Lins ◽  
Maria das Graças Wanderley de Sales Coriolano ◽  
...  
Keyword(s):  
Timed Up And Go ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

RESUMO O objetivo deste estudo piloto, realizado em um hospital universitário de referência em Pernambuco, foi avaliar os efeitos da prática mental associada à fisioterapia motora sobre a marcha e o risco de queda em pessoas com doença de Parkinson. A amostra da pesquisa foi composta por 18 sujeitos, de ambos os sexos, com doença de Parkinson idiopática, divididos em grupo experimental (8 indivíduos) e controle (10 indivíduos). Ambos os grupos realizaram 15 sessões de 40 minutos de fisioterapia motora, duas vezes por semana. No grupo de intervenção, a fisioterapia foi associada a prática mental (15 minutos). Em relação às variáveis de desfecho primário, o tempo de execução do timed up and go e do teste de caminhada de 10 metros reduziu, mas a diferença não foi significativa. Em relação à velocidade, cadência e escore do dynamic gait index, houve aumento após a intervenção no grupo experimental, com diferença significativa (p=0,02). O número de passos foi mantido em ambos os grupos. Os resultados sugerem que a prática mental associada à fisioterapia motora reduz o risco de quedas em comparação com a fisioterapia motora aplicada isoladamente.

scholarly journals Community Delivery of a Comprehensive Fall-Prevention Program in People with Multiple Sclerosis

2016 ◽  
Vol 18 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Cinda L. Hugos ◽  
Debra Frankel ◽  
Sara A. Tompkins ◽  
Michelle Cameron
Keyword(s):  
Multiple Sclerosis ◽  
Fall Prevention ◽  
Berg Balance Scale ◽  
Timed Up And Go ◽  
Balance Confidence ◽  
Balance Scale ◽  
Scale Scores ◽  
The Impact ◽  
Confidence Scale

Background: People with multiple sclerosis (MS) fall frequently. In 2011, the National Multiple Sclerosis Society launched a multifactorial fall-prevention group exercise and education program, Free From Falls (FFF), to prevent falls in MS. The objective of this study was to assess the impact of participation in the FFF program on balance, mobility, and falls in people with MS. Methods: This was a retrospective evaluation of assessments from community delivery of FFF. Changes in Activities-specific Balance Confidence scale scores, Berg Balance Scale scores, 8-foot Timed Up and Go performance, and falls were assessed. Results: A total of 134 participants completed the measures at the first and last FFF sessions, and 109 completed a 6-month follow-up assessment. Group mean scores on the Activities-specific Balance Confidence scale (F1,66 = 17.14, P &lt; .05, η2 = 0.21), Berg Balance Scale (F1,68 = 23.39, P &lt; .05, η2 = 0.26), and 8-foot Timed Up and Go (F1,79 = 4.83, P &lt; .05, η2 = 0.06) all improved significantly from the first to the last session. At the 6-month follow-up, fewer falls were reported (χ2 [4, N = 239] = 10.56, P &lt; .05, Phi = 0.21). Conclusions: These observational data suggest that the FFF group education and exercise program improves balance confidence, balance performance, and functional mobility and reduces falls in people with MS.

scholarly journals A influência das demandas atencionais no controle postural de hemiparéticos

2015 ◽  
Vol 23 (1) ◽  
pp. 62-67
Author(s):  
Viviane dos Santos Araújo ◽  
Erika Pedreira da Fonseca
Keyword(s):  
Timed Up And Go ◽  
Contrôle Postural ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

Objetivo. Investigar os efeitos da dupla tarefa com demanda cogni­tiva sobre o controle postural de indivíduos hemiparéticos após Aci­dente Vascular Cerebral (AVC). Método. Participaram 18 indivíduos (52,28±13,8 anos) hemiparéticos crônicos, capazes de deambular com ou sem dispositivo para o auxilio da marcha. Foram utilizados os testes Timed Up and Go (TUG), foi solicitado que o individuo se levantasse de uma cadeira, caminhasse três metros, retornasse para a cadeira e sentasse, e o Dynamic Gait Index (DGI) onde os indivíduos realizaram oito tarefas que envolviam a marcha em diferentes contextos senso­riais, com e sem associação de demanda cognitiva, para avaliar o equi­líbrio. Resultados. Verificou-se que a demanda cognitiva influenciou nos resultados dos testes, no DGI apresentou uma redução na pontu­ação (-3,05) e no TUG um tempo maior (2,60) para a realização de ambos com uma demanda cognitiva. Porém não houve diferença na redução da pontuação no DGI ou no aumento do tempo do TUG, na dupla tarefa, quando comparado com gênero (p=0,860 e p=0,069), escolaridade (p=0,973 e p=0,571), tipo de AVC (p=0,408 e p=0,408), e hemisfério acometido (p=0,798 e p=0,101). Conclusão. A realiza­ção da dupla tarefa com inserção de uma demanda cognitiva influen­cia no controle postural de indivíduos hemiparéticos após AVC.

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