Ambulatory Multiple Sclerosis Patients Research Articles

Does the Multiple Sclerosis Impact Scale-29 (MSIS-29) have the range to capture the experience of fully ambulatory multiple sclerosis patients? Learnings from the ASCLEPIOS studies.

Trials of disease-modifying therapies (DMTs) for multiple sclerosis (MS) often include patients with minimal disability. Patient-reported outcome instruments used in these trials have often not captured physical and psychological treatment effects concomitant with observed clinical benefits. To examine whether the Multiple Sclerosis Impact Scale-29 (MSIS-29) captures changes in the impact of MS in a sample of patients enrolled in the Phase 3 ASCLEPIOS studies (ofatumumab vs. teriflunomide). Measurement properties (i.e. item fit, reliability, and targeting) of the MSIS-29 were analyzed using Rasch measurement theory (RMT) in data from two phase 3 ofatumumab clinical trials including patients with relapsing-remitting or secondary progressive MS (N = 1882). Targeting of the MSIS-29 items to the patient population was explored within groups categorized by Expanded Disability Status Scale (EDSS) scores. Under RMT analyses, both the Physical and Psychological Impact scales of the MSIS-29 were not appropriately targeted to the overall sample of patients. In particular, 49% and 30% of patients with an EDSS score ≤ 2.5 had fewer physical and psychological impacts, respectively, than would typically be captured by these MSIS-29 items compared to patients with EDSS scores of ≥ 3. The MSIS-29 is commonly used to evaluate the patient-reported physical and psychological impact of MS. However, it may be limited in evaluating changes associated with DMTs in patients with minimal disability.

Fall risk is related to cognitive functioning in ambulatory multiple sclerosis patients.

Patients with multiple sclerosis (PwMS) may suffer severely from falling and gait disturbance. Cognitive dysfunction, a common condition in MS patients, may also increase falling rates, regardless of physical disability. We planned this study to determine the fall rate and risk factors in MS patients, follow patients for falls, and reveal the relationship between falls and cognitive dysfunction. The study was conducted on 124 patients who have RRMS diagnoses. Patients' gait speed, simultaneous gait speed during other tasks, functions of the upper extremity, balance rating, and fear of falling were evaluated with dual-task Timed-Up-and-Go-3 versions (TUG, TUG-C, TUG-M), Timed 25 Foot Walk (T25WFT), Nine Hole Peg Test (9HPT), Berg Balance Scale (BBS) and Falls Efficacy Scale-International (FES-I) tests. Cognitive functions, fatigue levels, and quality of life were measured with the Symbol Digit Modalities Test (SDMT), Fatigue Severity Scale (FSS), and Multiple Sclerosis Quality of Life (MSQoL) test. Two groups were formed as "fallers" and "non-faller patients". We monitored the patients in six months period. Forty-six patients fell at least once in the last one year before the study began. Fallers were older, less educated, had lower SDMT scores and higher disability scores. Non-faller patients scored lower in FES-I, TUG, and FSS tests. SDMT scores showed statistically significant, linear, positive, and moderate correlation with BBS and 9HPT scores (r = 0.307, p = 0.038, and r = 0.320, p = 0.030, respectively). We determined that advanced age, lower education level, and cognitive dysfunction adversely affect gait speed and balance. Among the fallers, those with lower SDMT and MoCA scores had higher falling rates. We determined that EDSS and BBS scores are predictive factors for falls in patients with MS. In conclusion, patients with cognitive impairment should be closely monitored for the risk of falling. Consideration of falls during follow-up examinations might be predictive of cognitive deterioration in patients with MS.

Reliability and validity of the glittre activities of daily living test in fully ambulatory multiple sclerosis patients.

Evaluation of activities of daily living (ADL) and functional exercise capacity in patients with multiple sclerosis (pwMS) is crucial in demonstrating the effectiveness of interventions. To investigate the reliability and validity of the Glittre ADL Test in pwMS. Twenty-five pwMS and 26 healthy adults were included in this methodological study. The Glittre ADL Test was applied. Six-Minute Walk Test (6MWT) and Nottingham Extended Activities of Daily Living Index (NEADL) were applied for concurrent validity. Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), Mini Balance Evaluation Systems Test (Mini BESTest), Multiple Sclerosis Quality of Life Scale-54 (MSQoL-54), and Five Times Sit-to-Stand Test (5 STST) were applied for construct validity. The Glittre ADL Test was repeated after 3-6days for test-retest reliability. The test-retest reliability of the Glittre ADL Test was excellent (ICC = 0.941). There was strong correlation of the Glittre ADL Test with 6MWT (rho = - 0.710, p < 0.001), NEADL (rho = - 0.841, p < 0.001), EDSS, (rho = 0.836, p = < 0.001), Mini BESTest (rho = 0.792, p < 0.001), and 5 STST scores (rho = 0.720, p < 0.001). There was a moderate correlation between the Glittre ADL Test and the physical health sub-item score of the MSQoL-54 (rho = - 0.591, p = 0.002). No correlation was found between the Glittre ADL Test and FSS (rho = 0.348, p = 0.096). There was a difference in the Glittre ADL Test results between the pwMS and the healthy adults (p = 0.001). The Glittre ADL Test has excellent reliability and strong construct and criterionvalidity for assessing functional exercise capacity and ADL in fully ambulatory pwMS. TRN: NCT04182269.

Chapter 9 - Multiple Sclerosis and related disorders

Multiple Sclerosis (MS) is a common neuroinflammatory disorder which is associated with disabling clinical consequences. The MS disease process may involve neural centers implicated in the control of breathing, leading to ventilatory disturbances during both wakefulness and sleep. In this chapter, a brief overview of MS disease mechanisms and clinical sequelae including sleep disorders is provided. The chapter then focuses on obstructive sleep apnea-hypopnea (OSAH) which is the most prevalent respiratory control abnormality encountered in ambulatory MS patients. The diagnosis, prevalence, and clinical consequences as well as data on effects of OSAH treatment in MS patients are discussed, including the impact on the disabling symptom of fatigue and other clinical sequelae. We also review pathophysiologic mechanisms contributing to OSAH in MS, and in turn mechanisms by which OSAH may impact on the MS disease process, resulting in a bidirectional relationship between these two conditions. We then discuss central sleep apnea, other respiratory control disturbances, and the pathogenesis and management of respiratory muscle weakness and chronic hypoventilation in MS. We also provide a brief overview of Neuromyelitis Optica Spectrum Disorders and review current data on respiratory control disturbances and sleep-disordered breathing in that condition.

Long-term outcomes of intrathecal baclofen in ambulatory multiple sclerosis patients: A single-center experience

Background: Intrathecal baclofen (ITB) is traditionally reserved for non-ambulatory patients. Objective: To investigate outcomes of ITB in ambulatory multiple sclerosis (MS) patients. Methods: Changes in outcome measures were estimated by a mixed effect model, while the complication rate was calculated using a logistic regression. Predictors of non-ambulatory status were identified by Cox model. Results: In all, 256 patients received an ITB test injection and 170 underwent ITB surgery. Aggregate Modified Ashworth Scale (MAS) scores for the ambulatory ITB cohort decreased from 13.5 ± 6.96 to 4.54 ± 4.18 at 5 years (p < 0.001). There was no significant change in walking speed 1 year post ITB surgery (0.45 m/second ± 0.30 vs 0.38 m/second ± 0.39, p = 0.80) with 77.8% of patients remaining ambulatory which decreased to 41.7% at year 5. Longer MS disease duration (hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.01–1.07; p = 0.018) and lower hip flexor strength (HR: 0.40; 95% CI: 0.27–0.57; p < 0.001) predicted non-ambulatory status after surgery. Complications were more likely in the ambulatory cohort (odds ratio (OR): 3.30, 95% CI: 2.17–5.02; p = 0.017). Conclusion: ITB is effective for ambulatory MS patients without compromising short-term walking speed, although a higher complication rate was observed in this cohort.

Brain activation patterns of female multiple sclerosis patients with voiding dysfunction.

We compared brain activation patterns between female multiple sclerosis (MS) patients with voiding dysfunction (VD) and those without. We aim to expand current knowledge of supraspinal correlates of voiding initiation within a cohort of female MS patients with and without VD. Twenty-eight ambulatory female MS patients with stable disease and lower urinary tract dysfunction were recruited for this study. Subjects were divided into group 1, without VD (n = 14), and group 2, with VD (n = 14), defined as postvoid residual urine of ≥40% of maximum cystometric capacity or need for self-catheterization. We recorded brain activity via functional magnetic resonance imaging (fMRI) with simultaneous urodynamic testing. Average fMRI activation maps (the Student t test) were created for both groups, and areas of significant activation were identified (P < .05). A priori regions of interest (ROIs), identified by prior meta-analysis to be involved in voiding, were selected. Group-averaged blood-oxygen level-dependent (BOLD) activation maps demonstrated significant differences between groups 1 and 2 during initiation of voiding with group 2 showing significantly lower levels of activation in all ROIs except for the left cerebellum and right cingulate gyrus. Interestingly, group 2 displayed negative BOLD signals, while group 1 displayed positive signals in the right and left pontine micturition center, right periaqueductal gray, left thalamus, and left cingulate gyrus. The activation map of group 1 was similar to healthy controls. Our results support the hypothesis that distinct supraspinal activation patterns exist between female MS patients with VD and those without.

Physical activity is associated with neuromuscular and physical function in patients with multiple sclerosis independent of disease severity

Purpose Examine the association between physical activity and neuromuscular and physical function in patients with multiple sclerosis when also considering disease severity. Methods 91 patients with multiple sclerosis were enrolled. Assessments included physical activity by 7-day thigh-worn accelerometry, knee extensor neuromuscular function by dynamometry (maximal isometric muscle strength, rate of force development (0–50 ms)), and physical function by 5× sit-to-stand, 2-min walk test, and timed 25 ft walk test. Physical activity tertile comparisons along with simple and multiple regressions (adjusting for age, gender, EDSS, time since diagnosis) were performed. Results Physical activity tertiles revealed differences (p < 0.05) in maximal muscle strength (1.77 ≈ 1.97 < 2.28 Nm/kg), rate of force development (4.66 < 8.03 ≈ 10.55 Nm/kg/s), 5× sit-to-stand (11.4 ≈ 9.7 > 8.5 s), 2-min walk test (153 < 183 < 207 m), and timed 25 ft walk test (6.3 > 4.4 > 4.3 s). Moreover, physical activity was associated (p < 0.05) with maximal muscle strength and rate of force development (r 2 = 0.13–0.15) along with 5× sit-to-stand, 2-min walk test, and timed 25 ft walk test (r 2 = 0.18–0.24), also after adjusting for age + gender + EDSS + time since diagnosis (r 2 = 0.25–0.37 and 0.24–0.52), with physical activity consistently being a strong predictor. Conclusions Higher levels of physical activity are associated with greater neuromuscular and physical function in ambulatory patients with multiple sclerosis independent of disease severity. These findings emphasize the importance of performing regular physical activity at all stages of multiple sclerosis. IMPLICATIONS FOR REHABILITATION Physical activity is associated with neuromuscular and physical function, independent of disease severity. Physical activity may be important in improving or preserving neuromuscular and physical function at all stages of ambulatory multiple sclerosis patients, yet longitudinal studies are warranted. Clinicians and rehabilitation professionals should encourage ambulatory patients at all stages of their disease to be as physically active as possible.

Fall related self efficacy: A significant barrier for physical activity in ambulatory multiple sclerosis patients

Aim: Increasing the level of physical activity in multiple sclerosis (MS) patients is very important to cope with the symptoms associated with disease. The aim of this study was to analyze the psychosocial and physical barriers related to physical activities in MS patients.Material and Methods: Fifty four MS patients who were able to walk at least 100 meters without walking aids were enrolled in this study. The patients were evaluated for their level of physical activity, walking distance, severity of pain and fatigue, fall related self-efficacy and their level of social support.Results: There were no correlation was found between the level of physical activity and the negative symptoms of pain and fatigue (rho: 0.-256 p: 0.06- rho: -0.218 p: 0.112 respectively). While the correlation of the level of physical activity with the level of ambulation was low, that of the fall related self-efficacy was found to be moderate (rho: -0.590, p=0.000). Additionally, no correlation was found with the level of social support (rho: -0.185, p=0.181). Conclusion: Pain and fatigue alone do not effect physical activity level in MS patients. However, fall related self-efficacy is a significant predictor of physical activity. It should not be ignored in programs aimed towards increasing physical activity.

PD04-02 SUPRASPINAL CONTROL VARIAITONS IN MULTIPLE SCLEROSIS PATIENTS WHO VOID SPONTANOUSLY VERUS PATIENTS WITH VOIDING DYSFUNCTION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction I1 Apr 2018PD04-02 SUPRASPINAL CONTROL VARIAITONS IN MULTIPLE SCLEROSIS PATIENTS WHO VOID SPONTANOUSLY VERUS PATIENTS WITH VOIDING DYSFUNCTION Rose Khavari, Christof Karmonik, and Timothy Boone Rose KhavariRose Khavari More articles by this author , Christof KarmonikChristof Karmonik More articles by this author , and Timothy BooneTimothy Boone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.280AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this study, we seek to compare brain activity processes at the time of initiation of voiding in Multiple Sclerosis (MS) patients who are voiders versus patients with voiding dysfunction. We hypothesize that female MS patients with voiding dysfunction have a distinct Blood Oxygen Level Dependent (BOLD) pattern activation in specific a priori regions of interest (ROIs) at the time of initiation of voiding when compared to patients who void spontaneously. METHODS Twenty seven ambulatory female MS patients with lower urinary tract dysfunction were recruited for this IRB approved study: Group 1; voiders (n=15) and group 2; voiding dysfunction (n=12) which was defined as patients with postvoid residual urine of = 40% of their maximum cystometric capacity or patients who performed self-catheterization. We recorded brain activity via fMRI with simultaneous urodynamic testing (UDS). From the transformed datasets, average fMRI activation maps (student t-test) for both groups were created, and areas of significant activation were identified (p<0.05). A priori ROIs identified by a prior meta-analysis to be involved in voiding were selected. RESULTS Group-averaged BOLD activation maps indicated distinct differences in activation patterns between groups (figure 1a). A reversed (negative) BOLD effect was noted in the PMC, PAG, left cingulate, left thalamus and the reticular formation. Interpretation of results Earlier positron emission topography studies have identified right dorsomedial pontine tegmentum and the right inferior frontal gyrus to be associated with significantly increased blood flow in healthy women at the time of voiding. Our results are consistent with these preliminary data in the literature where PMC, PAG, left cingulate, left thalamus and the reticular formation seem to have different pattern of activation between female MS voiders and the ones with voiding dysfunction. CONCLUSIONS Our preliminary group and network analyses demonstrate that distinct supraspinal patterns of activation and deactivation exists between MS patients who are voiders and who have voiding dysfunction. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e77-e78 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Rose Khavari More articles by this author Christof Karmonik More articles by this author Timothy Boone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Is the impact of fatigue related to walking capacity and perceived ability in persons with multiple sclerosis? A multicenter study

BackgroundThe relationship between fatigue impact and walking capacity and perceived ability in patients with multiple sclerosis (MS) is inconclusive in the existing literature. A better understanding might guide new treatment avenues for fatigue and/or walking capacity in patients with MS. ObjectiveTo investigate the relationship between the subjective impact of fatigue and objective walking capacity as well as subjective walking ability in MS patients. MethodsA cross-sectional multicenter study design was applied. Ambulatory MS patients (n = 189, age: 47.6 ± 10.5 years; gender: 115/74 women/men; Expanded Disability Status Scale (EDSS): 4.1 ± 1.8 [range: 0–6.5]) were tested at 11 sites. Objective tests of walking capacity included short walking tests (Timed 25-Foot Walk (T25FW), 10-Metre Walk Test (10mWT) at usual and fastest speed and the timed up and go (TUG)), and long walking tests (2- and 6-Minute Walk Tests (MWT). Subjective walking ability was tested applying the Multiple Sclerosis Walking Scale-12 (MSWS-12). Fatigue impact was measured by the self-reported modified fatigue impact scale (MFIS) consisting of a total score (MFIStotal) and three subscales (MFISphysical, MFIScognitive and MFISpsychosocial). Uni- and multivariate regression analysis were performed to evaluate the relation between walking and fatigue impact. ResultsMFIStotal was negatively related with long (6MWT, r = −0.14, p = 0.05) and short composite (TUG, r = −0.22, p = 0.003) walking measures. MFISphysical showed a significant albeit weak relationship to walking speed in all walking capacity tests (r = −0.22 to −0.33, p < .0001), which persisted in the multivariate linear regression analysis. Subjective walking ability (MSWS-12) was related to MFIStotal (r = 0.49, p < 0.0001), as well as to all other subscales of MFIS (r = 0.24–0.63, p < 0.001), showing stronger relationships than objective measures of walking. ConclusionsThe physical impact of fatigue is weakly related to objective walking capacity, while general, physical, cognitive and psychosocial fatigue impact are weakly to moderately related to subjective walking ability, when analysed in a large heterogeneous sample of MS patients.

A group-delivered self-management program reduces spasticity in people with multiple sclerosis: A randomized, controlled pilot trial.

BackgroundSpasticity affects more than 80% of people with multiple sclerosis (MS), affecting activity, participation, and quality of life. Based on an international guideline, an MS spasticity group education and stretching program, MS Spasticity: Take Control (STC), has been developed.ObjectiveThe objective of this paper is to determine whether STC with home stretching is associated with greater changes in spasticity than usual care (UC), consisting of an illustrated stretching booklet and home stretching but without group instruction or support, in people with MS.MethodsAmbulatory MS patients with self-reported spasticity interfering with daily activities were randomized to STC or UC. Individuals completed questionnaires regarding MS, spasticity, walking, fatigue and mood, and physical measures of spasticity and walking.ResultsThirty-eight of 40 participants completed both assessments. Mean total score and scores on two subscales of the MS Spasticity Scale-88 improved more with STC than with UC (p < 0.03). There was no significant change in the Modified Ashworth Scale in either group. Mean scores on the Modified Fatigue Impact Scale, the Beck Depression Inventory-II, and the physical component of the Multiple Sclerosis Impact Scale-29 showed statistically and clinically significant improvements in the STC group only.ConclusionsParticipation in STC improved self-reported impact of spasticity more than UC and provided encouraging improvements in other measures.

A Microsoft Kinect-Based Point-of-Care Gait Assessment Framework for Multiple Sclerosis Patients

Gait impairment is a prevalent and important difficulty for patients with multiple sclerosis (MS), a common neurological disorder. An easy to use tool to objectively evaluate gait in MS patients in a clinical setting can assist clinicians to perform an objective assessment. The overall objective of this study is to develop a framework to quantify gait abnormalities in MS patients using the Microsoft Kinect for the Windows sensor; an inexpensive, easy to use, portable camera. Specifically, we aim to evaluate its feasibility for utilization in a clinical setting, assess its reliability, evaluate the validity of gait indices obtained, and evaluate a novel set of gait indices based on the concept of dynamic time warping. In this study, ten ambulatory MS patients, and ten age and sex-matched normal controls were studied at one session in a clinical setting with gait assessment using a Kinect camera. The expanded disability status scale (EDSS) clinical ambulation score was calculated for the MS subjects, and patients completed the Multiple Sclerosis walking scale (MSWS). Based on this study, we established the potential feasibility of using a Microsoft Kinect camera in a clinical setting. Seven out of the eight gait indices obtained using the proposed method were reliable with intraclass correlation coefficients ranging from 0.61 to 0.99. All eight MS gait indices were significantly different from those of the controls (p-values less than 0.05). Finally, seven out of the eight MS gait indices were correlated with the objective and subjective gait measures (Pearson's correlation coefficients greater than 0.40). This study shows that the Kinect camera is an easy to use tool to assess gait in MS patients in a clinical setting.

The effect of menarche age, parity and lactation on bone mineral density in premenopausal ambulatory multiple sclerosis patients

Although pregnancy and breast-feeding do not have any deleterious effect on disease activity in female multiple sclerosis (MS) patients, their role on bone mineral density (BMD) and osteoporosis risk is unknown. We investigated the role of age at menarche, parity and lactation on BMD expressed as percentage of the mean BMD (%BMD) in 46 pre-menopausal ambulatory female MS patients using dual-energy X-ray absorptiometry (DXA) scans in lumbar spine (LS) and hip. MS female patients with age at menarche ≥13 years old had reduced %BMD compared to those with menarche age <13 years (95.2±10.7 vs 102.1±13.3, p=0.05 in LS; 90.5±12.6 vs 99.8±12.6, p=0.02 in hip). Parity did not result in any statistically significant changes in either LS or hip. Patients that breastfed their offspring compared to those that did not had significantly lower BMD in both LS (93.9±9.3 vs 110.7±15.6, p=0.004) and hip (91.6±10.7 vs 105.6±15.3, p=0.02). MS female patients with menarche at age≥13 years and those who breastfed their offspring may have reduced BMD. Larger studies are needed to verify these findings and establish a definite role of menarche age and breast feeding with BMD.

A 3 meter Timed Tandem Walk is an early marker of motor and cerebellar impairment in fully ambulatory MS patients

BackgroundMobility assessment in Multiple Sclerosis (MS) is crucial for trials and individual patient counseling. Up to now, standard tests as the Timed 25-Foot Walk (T25FW) are restricted by floor effects in mildly disabled patients. The 3-meter Timed Tandem Walk (TTW) as a possibly more sensitive measure has not been investigated yet. ObjectiveTo investigate sensitivity and specificity of the TTW and T25FW to detect mild clinical impairment in a large cohort of MS patients. MethodsWe extracted T25FW, TTW and EDSS from our UMC patient database (2009–2012). After randomization into an explorative (n=497) and validation (n=228) cohort, we calculated change rates and performed ROC analyses of gait tests and EDSS including Functional System Scores. ResultsBetween disability stages of EDSS 0–2.5 and EDSS 3.0–4.0, the mean TTW difference was 4s (T25FW=0.9s). The accuracy to separate between EDSS groups was moderate but identical for both tests (ROC–AUC T25FW=0.79, TTW=0.80, p=0.4). TTW had a higher sensitivity and specificity to differentiate between asymptomatic and symptomatic patients concerning FS motor/cerebellar scores (ROC–AUC T25FW=0.71, TTW=0.75, p<0.05). All hypotheses could be validated in the second cohort. ConclusionA 3-m Timed Tandem Walk is a standardized test that is easy to implement to detect impairment of the motor or cerebellar system in fully ambulatory MS patients. Based on the complex-task character, TTW is a potential new outcome measure for MS mobility in mildly disabled patients and can act as easily accessible and significant additional information in patient counseling.

Yoga therapy and ambulatory multiple sclerosis Assessment of gait analysis parameters, fatigue and balance

Gait impairment, falls due to balance problems and fatigue are among the most important complaints in patients with multiple sclerosis (MS) and cause significant functional limitation. Use of complementary and alternative medicine (CAM) to help symptom management and to improve quality of life is growing among MS patients. Yoga is widely used as one of these CAM interventions, however, the number of studies that show the efficacy of yoga training in MS is inadequate. In this study, we aimed to evaluate the effects of a short term yoga program on fatigue, balance and gait in patients with MS. Eight volunteer ambulatory MS patients with clinically definite relapsing remitting MS whose Expanded Disability Status Score (EDSS) is less than or equal to 6.0, and eight healthy subjects were included in the study. Patients participated in 12 weeks of a bi-weekly yoga program under supervision. At their baseline and after yoga therapy, the Fatigue Severity Scale (FSS) and Berg Balance Scale (BBS) are used to assess fatigue and balance. Three dimensional gait analysis is done using the Vicon 612 system with six cameras and two Bertec force plates, before and after therapy. After short term yoga therapy, statistically significant achievements were obtained in fatigue, balance, step length and walking speed. Although sagittal plane pelvis and hip angles, ankle plantar flexor moment, powers generated at the hip and ankle joints at the pre-swing were improved, the improvements were not statistically significant. Yoga therapy is a safe and beneficial intervention for improving fatigue, balance and spatiotemporal gait parameters in patients with MS. Further studies with a larger sample size and longer follow-up will be needed to evaluate the long term effects of yoga therapy.

A Comparison between the Immediate Effects of Hip Flexion Assist Orthosis and Conventional AFO on Gait Parameters in Ambulatory Multiple Sclerosis Patients

چکیده مقدمه: بیماری ام اس، بیماری خودایمنی سیستم اعصاب مرکزی است. در اثر این بیماری، گاهی عصب-های نخاعی و عصب-های بینایی آسیب می‌بینند. درمان ارتوزی، با توجه به ضعف عضلات مچ و هیپ و به دنبال افتادگی مچ پا، بصورت متداول در ایران استفاده ازAFO می-باشد. بنابر مطالعات، بسیاری از بیماران از ارتوز AFO استفاده نمی-نمایند. از طرف دیگر ارتوزی به نام لگنی- مچ پایی در تحقیقات با ادعای کاهش مشکلات این گروه از بیماران مطرح شده است. هدف از مطالعه حاضر مقایسه تأثیر فوری ارتوز AFO مرسوم و ارتوز لگنی- مچ پایی بر پارامترهای راه رفتن در افراد مبتلا به بیماری ام اس می-باشد. مواد و روش ­ ها: در این مطالعه 17 فرد مبتلا به بیماری ام اس با درگیری یکطرفه در اندام تحتانی شرکت کردند. پارامتر های راه رفتن شامل سرعت و تقارن گام پس از آزمون 2 دقیقه-ای راه رفتن در حالت بدون ارتوز و با ارتوز AFOمرسوم و ارتوز لگنی- مچ پایی محاسبه گردید. تأثیر شاخص جثه، میزان اثربخشی ارتوز و رضایت از طریق پرسشنامه نیز در این افراد مورد بررسی قرار گرفت. یافته‌ها‌: نتایج آزمونt زوج نشان داد، سرعت راه رفتن و تقارن گام با ارتوز AFOمرسوم و حالت بدون ارتوز دارای اختلاف معنادار نمی-باشد، در حالی­که هنگام استفاده از ارتوز لگنی- مچ پایی بطور معنادار بهبود می-یابد. همچنین میزان رضایت از ارتوز لگنی- مچ پایی بیشتر از ارتوز AFO مرسوم بود. در ارتباط با تأثیر شاخص جثه با اثربخشی مداخلات انجام شده بر روی سرعت و تقارن گام، اختلاف آماری معناداری مشاهده نگردید. نتیجه‌گیری: نتایج مطالعه حاضر نشان می­دهد که ارتوز لگنی– مچ پایی بصورت آنی، در بیماران ام اس با ضعف عضلات مچ پا و هیپ سبب بهبود در تقارن گام و افزایش سرعت راه رفتن می­گردد. همینطور به نظر می­رسد شاخص جثه عامل اثرگذاری در تجویز این ارتوز نمی­باشد. کلید واژه­ها: مولتیپل اسکلروزیس، ام اس، ارتوز، ارتوز لگني- مچ پايي، AFO

Relationship between lower extremity isometric muscle strength and standing balance in patients with multiple sclerosis

Muscle strength and standing balance decrease in patients with Multiple Sclerosis (MS). The aim of the present study was to investigate the relationship between the lower extremity isometric muscle strength and standing balance in patients with MS. Forty-seven patients with MS and 10 healthy volunteers were included. Neurological disability level was assessed using Expanded Disability Status Scale (EDSS). Isometric strength of seven lower extremity muscles (hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor) was assessed using hand-held dynamometer. Duration of static one-leg standing balance was measured using digital chronometer. Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength, and duration of one-leg standing balance were decreased in patients with MS when compared with controls (p < 0.05). All assessed lower extremity isometric muscle strength and EDSS level was related duration of one-leg standing balance in patients with MS. All assessed lower extremity isometric muscle strength (except ankle dorsal flexor) was related with EDSS. Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength decreases in ambulatory MS patients. Lower extremity muscle weakness and neurological disability level are related with imbalance in MS population. Hip and knee region muscles weakness increases the neurological disability level. For the better balance and decrease neurological disability level whole lower extremity muscle strengthening should be included in rehabilitation programs.

Adapted exercise interventions for persons with progressive multiple sclerosis

Multiple sclerosis (MS) is an immune-mediated neurodegenerative disease that results in a myriad of physical and mental symptoms. Current disease-modifying therapies do not prevent long-term disability accumulation and are particularly ineffective for patients with a progressive disease onset. Exercise may represent an alternative strategy for managing symptoms and disability accumulation, particularly in progressive MS. Whereas the benefits of exercise have been established primarily in ambulatory MS patients with a relapsing disease course, few studies have investigated the benefits of exercise for patients with progressive MS with greater impairment. Therefore, the purpose of this dissertation was to determine the short-term, long-term, and maintenance effects of adapted exercise interventions for patients with progressive MS of high disability, which was addressed by conducting 2 adapted exercise interventions. The first intervention examined the effects of 24 weeks of body-weight-supported treadmill training (BWSTT) on outcomes of physical and mental functioning, fatigue, quality of life (QoL), and brain health. Outcomes were evaluated at baseline, 12 weeks, and 24 weeks following the intervention, and again 12 weeks postintervention. The second intervention evaluated and compared the effects of 12 weeks of total-body recumbent stepper training (TBRST) with BWSTT on outcomes of safety, physical and mental functioning, fatigue, QoL, and equipment preference. Safety of BWSTT and TBRST was established. Significant improvements in fatigue and QoL were observed with both training modalities; however, neither significantly improved physical function. There was some evidence to suggest that long-term BWSTT may improve cognitive performance and brain health, and that TBRST was the preferred exercise modality. Furthermore, most beneficial effects of long-term BWSTT tended not to be maintained when exercise was discontinued. This dissertation established evidence for the potential benefits of BWSTT and TBRST in patients with progressive MS with high disability. BWSTT and TBRST may represent viable alternative strategies for disease management.

Obstructive sleep apnea is associated with fatigue in multiple sclerosis

Background: Multiple sclerosis (MS) patients often suffer from fatigue. Objective: We evaluated the relationship of obstructive sleep apnea (OSA) to fatigue and sleepiness in MS patients. Methods: Ambulatory MS patients without known sleep disorders and healthy controls underwent diagnostic polysomnography and a multiple sleep latency test (objective sleepiness measure). Fatigue was measured with the Fatigue Severity Scale (FSS) and the Multidimensional Fatigue Inventory (MFI), and subjective sleepiness by Epworth Sleepiness Scale. Covariates included age, sex, body mass index, Expanded Disability Status Scale (EDSS), depression, pain, nocturia, restless legs syndrome, and medication. Results: OSA (apnea–hypopnea index ≥15) was found in 36 of 62 MS subjects and 15 of 32 controls. After adjusting for confounders, severe fatigue (FSS ≥5) and MFI-mental fatigue (>group median) were associated with OSA and respiratory-related arousals in MS, but not control subjects. Subjective and objective sleepiness were not related to OSA in either group. In a multivariate model, variables independently associated with severe fatigue in MS were severe OSA [OR 17.33, 95% CI 2.53–199.84], EDSS [OR 1.88, 95% CI 1.21–3.25], and immunomodulating treatment [OR 0.14, 95% CI 0.023–0.65]. Conclusions: OSA was frequent in MS and was associated with fatigue but not sleepiness, independent of MS-related disability and other covariates.

Which walking capacity tests to use in multiple sclerosis? A multicentre study providing the basis for a core set

Background: Many different walking capacity test formats are being used. It is unclear whether walking speed, obtained from short tests, and walking distance, obtained from long tests, provide different clinical information. Objectives: To determine the differential effect of various short and long walk test formats on gait velocity, and the actual relationship between walking speed and walking distance in multiple sclerosis (MS) patients with diverse ambulation status. Methods: A cross-sectional multicentre study design was applied. Ambulatory MS patients (Expanded Disability Status Scale (EDSS) 0–6.5; n = 189) were tested at 11 sites. Short tests consisted of the Timed 25-Foot Walk (static start, fastest speed) and 10-Metre Walk Test (dynamic start, usual and fastest speed). Long tests consisted of the 2- and 6-Minute Walk Tests (fastest speed). Subjects were divided into mild (EDSS 0–4; n = 99) or moderate (EDSS 4.5–6.5; n = 79) disability subgroups. Results: In both subgroups, the start protocol, instructed pace and length of test led to significantly different gait velocities. Fastest walking speed and 6-Minute walking distance showed the strongest correlation (R2 = 0.78 in mild and R2 = 0.81 in moderate MS; p < 0.01). Short tests’ relative estimation errors for 6-Minute walking distance were 8–12% in mildly and 15–16% in moderately affected subjects. Based on the 2-Minute Walk Test, estimation errors significantly reduced to approximately 5% in both subgroups. Conclusions: A single short test format at fastest speed accurately describes an MS patient’s general walking capacity. For intervention studies, a long test is to be considered. We propose the Timed 25-Foot Walk and 2-Minute Walk Test as standards. Further research on responsiveness is needed.