Article

Quantitative measures detect sensory and motor impairments in multiple sclerosis.

Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
Journal of the neurological sciences (Impact Factor: 2.32). 03/2011; 305(1-2):103-11. DOI: 10.1016/j.jns.2011.03.003
Source: PubMed

ABSTRACT Sensory and motor dysfunction in multiple sclerosis (MS) is often assessed with rating scales which rely heavily on clinical judgment. Quantitative devices may be more precise than rating scales.
To quantify lower extremity sensorimotor measures in individuals with MS, evaluate the extent to which they can detect functional systems impairments, and determine their relationship to global disability measures.
We tested 145 MS subjects and 58 controls. Vibration thresholds were quantified using a Vibratron-II device. Strength was quantified by a hand-held dynamometer. We also recorded Expanded Disability Status Scale (EDSS) and Timed 25-Foot Walk (T25FW). t-tests and Wilcoxon-rank sum were used to compare group data. Spearman correlations were used to assess relationships between each measure. We also used a step-wise linear regression model to determine how much the quantitative measures explain the variance in the respective functional systems scores (FSS).
EDSS scores ranged from 0-7.5, mean disease duration was 10.4 ± 9.6 years, and 66% were female. In relapsing-remitting MS, but not progressive MS, poorer vibration sensation correlated with a worse EDSS score, whereas progressive groups' ankle/hip strength changed significantly with EDSS progression. Interestingly, not only did sensorimotor measures significantly correlate with global disability measures (i.e., EDSS), but they had improved sensitivity, as they detected impairments in up to 32% of MS subjects with normal sensory and pyramidal FSS.
Sensory and motor deficits in MS can be quantified using clinically accessible tools and distinguish differences among MS subtypes. We show that quantitative sensorimotor measures are more sensitive than FSS from the EDSS. These tools have the potential to be used as clinical outcome measures in practice and for future MS clinical trials of neurorehabilitative and neuroreparative interventions.

0 Bookmarks
 · 
89 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study investigated the between-rater reliability of the Berg Balance Scale (BBS), 6-Minute Walk test (6MW), and handheld dynamometry (HHD) in people with multiple sclerosis (MS). Previous studies that examined BBS and 6MW reliability in people with MS have not used more than two raters, or analyzed different mobility levels separately. The reliability of HHD has not been previously reported for people with MS. In this study, five physical therapists assessed eight people with MS using the BBS, 6MW, and HHD, resulting in 12 pairs of data. Data were analyzed using intraclass correlation coefficients (ICCs), Spearman correlation coefficients (SCCs), and Bland and Altman methods. The results suggest excellent agreement for the BBS (SCC = 0.95, mean difference between raters [d̄] = 2.08, standard error of measurement [SEM] = 1.77) and 6MW (ICC = 0.98, d̄ = 5.22 m, SEM = 24.76 m) when all mobility levels are analyzed together. Reliability is lower in less mobile people with MS (BBS SCC = 0.6, d̄ = -1.83; 6MW ICC = 0.95, d̄ = 20.04 m). Although the ICC and SCC results for HHD suggest good-to-excellent reliability (0.65-0.85), d̄ ranges up to 17.83 N, with SEM values as high as 40.95 N. While the small sample size is a limitation of this study, the preliminary evidence suggests strong agreement between raters for the BBS and 6MW and decreased agreement between raters for people with greater mobility problems. The mean differences between raters for HHD are probably too high for it to be applied in clinical practice.
    International journal of MS care. 04/2013; 15(1):1-6.
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND Spinal cord (SC) pathology is common in multiple sclerosis (MS), and measures of SC-atrophy are increasingly utilized. Normalization reduces biological variation of structural measurements unrelated to disease, but optimal parameters for SC volume (SCV)-normalization remain unclear. Using a variety of normalization factors and clinical measures, we assessed the effect of SCV normalization on detecting group differences and clarifying clinical–radiological correlations in MS. METHODS3T cervical SC-MRI was performed in 133 MS cases and 11 healthy controls (HC). Clinical assessment included expanded disability status scale (EDSS), MS functional composite (MSFC), quantitative hip-flexion strength (“strength”), and vibration sensation threshold (“vibration”). SCV between C3 and C4 was measured and normalized individually by subject height, SC-length, and intracranial volume (ICV). RESULTSThere were group differences in raw-SCV and after normalization by height and length (MS vs. HC; progressive vs. relapsing MS-subtypes, P < .05). There were correlations between clinical measures and raw-SCV (EDSS:r = –.20; MSFC:r = .16; strength:r = .35; vibration:r = –.19). Correlations consistently strengthened with normalization by length (EDSS:r = –.43; MSFC:r = .33; strength:r = .38; vibration:r = –.40), and height (EDSS:r = –.26; MSFC:r = .28; strength:r = .22; vibration:r = –.29), but diminished with normalization by ICV (EDSS:r = –.23; MSFC:r = –.10; strength:r = .23; vibration:r = –.35). In relapsing MS, normalization by length allowed statistical detection of correlations that were not apparent with raw-SCV. CONCLUSIONSSCV-normalization by length improves the ability to detect group differences, strengthens clinical–radiological correlations, and is particularly relevant in settings of subtle disease-related SC-atrophy in MS. SCV-normalization by length may enhance the clinical utility of measures of SC-atrophy.
    Journal of neuroimaging: official journal of the American Society of Neuroimaging 02/2014; · 1.82 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: To investigate the feasibility of Whole Body Vibration (WBV) intervention when compared to the same duration and dose of exercise (EXS) for people with Multiple Sclerosis (MS). METHODS: Seventeen people with MS (mean age 48.76 ± 2.7) with minimal gait impairments were randomly allocated to WBV (n = 8) or EXS (n = 9). Participants were measured before and after 8 weeks of intervention with muscle power, modified Nottingham Sensory Assessment, Timed Up and Go test (TUG), Berg Balance Scale (BBS), 6 Minute Walk test (6MWT), Multiple Sclerosis Impact Scale 29 (MSIS 29), and Modified Fatigue Impact Scale (MFIS). RESULTS: WBV group had statistically significant improvements in 6MWT (mean change 31.48, SD 28.2, p = 0.041) and BBS (median change 8, IQR 12, p = 0.027) that were not seen in the EXS group. WBV group improved significantly more on the BBS (p = 0.003) than the EXS group (median change 0, IQR 1). EXS group had a significant reduction in fatigue (mean change 12.33, SD 11.47, p = 0.012) that was not seen in the WBV group. CONCLUSIONS: The data may suggest a positive improvement due to WBV that, other than for BBS, is not significantly greater than that due to the same duration and dose of exercise. WBV plus exercise training is feasible and may have positive effects, however larger studies are required to establish whether it is more effective than or can augment traditional exercise.
    Physiotherapy Practice and Research. 01/2014; 35(2):75-86.

Full-text (2 Sources)

Download
6 Downloads
Available from
Nov 10, 2014