1,721,632 research outputs found
Powered exoskeletons for walking in multiple sclerosis
No full textFeys, P (corresponding author), Hasselt Univ, Fac Rehabil Sci, REVAL Rehabil Res Ctr, Agoralaan Gebouw A, B-500 Hasselt, Belgium.
[email protected]
Motor and walking fatigability: assessment and implications for training
No full textIntroduction: Many MS clinical studies estimate the association between a treatment or other variable and the time to an event of interest. These times can be the time to next relapse, the time to disability progression or the time to EDSS landmarks. Time to event outcomes require specialized statistical techniques to properly estimate the associations. Objectives/Aims: To introduce statistical approaches for time to event outcomes in MS clinical studies, the assumptions required for these analyses, and sample size calculations. Methods: For this session, we will describe the special features of time to event outcomes in MS clinical studies through the use of examples from recent clinical trials and simulated datasets. The data-sets in this session will focus on the time to disability progression, which is a common outcome measure in progressive MS trials. Results: The most commonly used techniques for estimation of the associations between exposures and time to event outcomes include Kaplan-Meier curves, log rank tests, and Cox proportional hazards models. Each approach is valid in the presence of right censoring, which means that some subjects are not observed to have the event of interest. We will describe extensions to these techniques to account for different types of censoring as well as recurrent events. Finally, we will describe sample size calculations for the analysis of time to event outcomes. Conclusion: Many MS clinical studies have a time to event outcome as the primary outcome. The statistical techniques for these outcomes make several assumptions, but departures from the assumptions can be accounted for by using more complex approaches. Sample size calculations are also available in order to design studies with these outcomes. Introduction: Fatigue in multiple sclerosis (MS) can be distinguished between the subjective feeling of fatigue and fatigability, a decrease in performance over time. Further, people may experience motor and cognitive fatigability, either separately or in combination , which may limit activity performance and participation. Objectives/Aims: To describe methods of assessing and interventions to reduce cognitive fatigability in MS. Methods: In this educational session, after introducing a theoretical framework of fatigue and fatigability, we provide some examples of relevant and meaningful methods to assess cognitive fatigability in (virtual) reality situations to use in (future) clinical practice and research. Interventions targeting cognitive fatigability are described. Results: While subjective fatigue is assessed using questionnaires, cognitive fatigability is measured by the decline in performance during cognitive fatigue-inducing tasks. These tasks usually include neuropsychological tests like symbol digit modalities test (SDMT), paced auditory serial addition test (PASAT) or N-back task. However, these tasks do not reflect the complexity of real-life situations, therefore more ecological measures are indicated and may include virtual reality applications. Although sparse, interventions specifically designed for cognitive fatigability include pharmacological , magnetic stimulation or behavioral approaches. Conclusion: Assessing cognitive fatigue and fatigability is challenging , though important to provide tailormade (rehabilitation) interventions for people with MS. Introduction: Fatigability, or state fatigue, is defined as a change in performance over time, and can be abnormal in persons with MS (pwMS). It is prevalent in the motor domain at ICF body function level and during walking at ICF activity level in at least half of pwMS with moderate to severe disability. It is thought to also contribute to perception of fatigue or execution of activities of daily life. Objectives/Aims: The objective of the educational course is to understand how motor fatigability at body function level (f.e. decreased in maximal muscle force), and walking fatigability (f.e. reduced speed, changes in gait pattern) can be measured, what are underlying causes and what is the implication for rehabilitation programs. Methods: Based on literature review and experimental studies, measurement methods and cutoff scores are presented. Insights on concurrent validity with fatigue, perceived capacity and daily life performances are presented where applicable. Results: At body function level, static and dynamic fatigue indexes are available for lower and upper limbs with acceptable reliability. At activity level, methods for detecting abnormal slowing down (distance walked index) or changes in gait pattern and quality (f.e. reduced cadence or variability in step duration) are presented including reliability and cutoff scores. The definition of distance walked versus gait quality changes is discussed. The relations between indexes and fatigue (MFIS), perceived upper limb use (MAM) and walking (MSWS-12) or daily life physical activity (IPAQ, Pittsburgh fatigability scale) are presented Conclusion: Fatigability in the motor domain at body function level and during walking at activity level can be reliably measured and are advised to take into account in clinical reasoning and determining rehabilitation ingredients. Disclosure of interest: Lectures provided for Roche
Motor and walking fatigability: assessment and implications for training
No full textIntroduction: Many MS clinical studies estimate the association between a treatment or other variable and the time to an event of interest. These times can be the time to next relapse, the time to disability progression or the time to EDSS landmarks. Time to event outcomes require specialized statistical techniques to properly estimate the associations. Objectives/Aims: To introduce statistical approaches for time to event outcomes in MS clinical studies, the assumptions required for these analyses, and sample size calculations. Methods: For this session, we will describe the special features of time to event outcomes in MS clinical studies through the use of examples from recent clinical trials and simulated datasets. The data-sets in this session will focus on the time to disability progression, which is a common outcome measure in progressive MS trials. Results: The most commonly used techniques for estimation of the associations between exposures and time to event outcomes include Kaplan-Meier curves, log rank tests, and Cox proportional hazards models. Each approach is valid in the presence of right censoring, which means that some subjects are not observed to have the event of interest. We will describe extensions to these techniques to account for different types of censoring as well as recurrent events. Finally, we will describe sample size calculations for the analysis of time to event outcomes. Conclusion: Many MS clinical studies have a time to event outcome as the primary outcome. The statistical techniques for these outcomes make several assumptions, but departures from the assumptions can be accounted for by using more complex approaches. Sample size calculations are also available in order to design studies with these outcomes. Introduction: Fatigue in multiple sclerosis (MS) can be distinguished between the subjective feeling of fatigue and fatigability, a decrease in performance over time. Further, people may experience motor and cognitive fatigability, either separately or in combination , which may limit activity performance and participation. Objectives/Aims: To describe methods of assessing and interventions to reduce cognitive fatigability in MS. Methods: In this educational session, after introducing a theoretical framework of fatigue and fatigability, we provide some examples of relevant and meaningful methods to assess cognitive fatigability in (virtual) reality situations to use in (future) clinical practice and research. Interventions targeting cognitive fatigability are described. Results: While subjective fatigue is assessed using questionnaires, cognitive fatigability is measured by the decline in performance during cognitive fatigue-inducing tasks. These tasks usually include neuropsychological tests like symbol digit modalities test (SDMT), paced auditory serial addition test (PASAT) or N-back task. However, these tasks do not reflect the complexity of real-life situations, therefore more ecological measures are indicated and may include virtual reality applications. Although sparse, interventions specifically designed for cognitive fatigability include pharmacological , magnetic stimulation or behavioral approaches. Conclusion: Assessing cognitive fatigue and fatigability is challenging , though important to provide tailormade (rehabilitation) interventions for people with MS. Introduction: Fatigability, or state fatigue, is defined as a change in performance over time, and can be abnormal in persons with MS (pwMS). It is prevalent in the motor domain at ICF body function level and during walking at ICF activity level in at least half of pwMS with moderate to severe disability. It is thought to also contribute to perception of fatigue or execution of activities of daily life. Objectives/Aims: The objective of the educational course is to understand how motor fatigability at body function level (f.e. decreased in maximal muscle force), and walking fatigability (f.e. reduced speed, changes in gait pattern) can be measured, what are underlying causes and what is the implication for rehabilitation programs. Methods: Based on literature review and experimental studies, measurement methods and cutoff scores are presented. Insights on concurrent validity with fatigue, perceived capacity and daily life performances are presented where applicable. Results: At body function level, static and dynamic fatigue indexes are available for lower and upper limbs with acceptable reliability. At activity level, methods for detecting abnormal slowing down (distance walked index) or changes in gait pattern and quality (f.e. reduced cadence or variability in step duration) are presented including reliability and cutoff scores. The definition of distance walked versus gait quality changes is discussed. The relations between indexes and fatigue (MFIS), perceived upper limb use (MAM) and walking (MSWS-12) or daily life physical activity (IPAQ, Pittsburgh fatigability scale) are presented Conclusion: Fatigability in the motor domain at body function level and during walking at activity level can be reliably measured and are advised to take into account in clinical reasoning and determining rehabilitation ingredients. Disclosure of interest: Lectures provided for Roche
Rehabilitation in Spasticity
No full textThe severity of spasticity (mild, moderate and severe), its interference with body structure and functional activities, and the distribution of affected muscles (leg, back, arms) varies in every person with MS. Rehabilitation interventions should provide tailored information and treatment options based on goal-setting with the person with MS, with the aim of promoting self-management
Rehabilitation in Spasticity
No full textThe severity of spasticity (mild, moderate and severe), its interference with body structure and functional activities, and the distribution of affected muscles (leg, back, arms) varies in every person with MS. Rehabilitation interventions should provide tailored information and treatment options based on goal-setting with the person with MS, with the aim of promoting self-management
Clinical perspective on pain in multiple sclerosis
No full textPain is an important and frequent symptom in multiple sclerosis (MS), which leads to a low quality of life, increased disability level, and lack of employment and mental health. Recently, studies have shown increased interest in pain in MS and there is a growing evidence of its prevalence. However, the literature suffers from lack of experimental studies focusing on pain reduction. This topical review summarizes the current knowledge about pain in MS with its definitions, assessments, treatments and rehabilitation within a holistic perspective.The author(s) received no financial support for the research, authorship, and/or publication of this article
Walking-related performance fatigability in people with Multiple Sclerosis: Clinical manifestation and test-retest reliability of the assessment method
No full textChapter 18: Robot-Assisted Rehabilitation in Multiple Sclerosis: Overview of Approaches, Clinical Outcomes, and Perspectives
No full textThis chapter describes the use of robot-assisted rehabilitation in Multiple Sclerosis (MS) with the aim to assess or train gait or upper limb function.
For upper limb function, robot-assisted training led to improved movement quality on reaching tasks but clinical effects on traditional tests was not always found after multiple session training. Reflections on task-specific training and the involvement of the hands are made. An increasing number of RAGT studies reported effects of a multiple-weeks training program but often of equal magnitude as other conventional training programs. However, one needs to be aware of impact of body weight support by technological systems and providing different percentages of body weight support.
Overall, there is evidence supporting effects of robot- and technological-supported training but its superiority compared to other or conventional treatment programs is yet debatable. Research investigating impact of different technological settings and motor learning strategies implemented in technology are encouraged
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