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Walking fatigability in persons with Multiple Sclerosis
No full textMultiple Sclerosis (MS) is a chronic auto-immune inflammatory progressive
disease, causing neurodegeneration of the central nervous system. Consequently,
it can affect many different systems of the human body, manifesting in different
symptoms and deficits. Fatigue is one of the first symptoms present, and reported
up to 80% in persons with MS (pwMS). Next, walking is reported as one of the
most important bodily functions according to pwMS. Both symptoms can seriously
impact quality of life, and can occur together, which is known as walking
fatigability. The overall aim of this PhD project was to elaborate the clinical
assessment methods for assessing walking fatigability and gain insight into the
possible related factors, to explore rehabilitation strategies.
Chapter 1 shows that walking fatigability is measured via different methods in
different populations, where a decline from the first to the last part of a walking
task, was mostly reported. The six-minute walking test (6MWT) was mostly used
in amongst different populations. Chapter 2 shows that walking fatigability could
be reliably measured by calculating the percentage decline in distance between
the first and the last minute of the 6MWT, with the possibility to discriminate
between a walking fatigability group (WF) and non-walking fatigability group
(NWF).
The following exploratory study in chapter 3 indicates in general that walking
fatigability manifest itself in perceived symptoms (mostly motor), but
recuperation occurs within 10 minutes. Chapter 4 and 5 show that lower maximal
strength, muscle fatigability during dynamic contractions and interlimb
coordination deficits could contribute to walking fatigability. Chapter 6 shows that
cognitive fatigability and walking fatigability may be distinct symptoms as they do
not show any significant associations. However, cognitive alertness does show a
relation to walking. The main conclusion therefore is that we should investigate
and treat walking fatigability from a holistic point of view, taking related factors
and symptoms into account.
Chapter 7 and 8 explore pilot interventions, with walking fatigability as an
outcome measure. Both interventions seem to have an effect on different possible
related factors of walking fatigability, but due to a low sample size and not much
patients with walking fatigability, no clear conclusion towards treatment for
walking fatigability can be made based upon these results.Multiple Sclerose (MS) is een chronische auto-immuun inflammatoire progressieve
ziekte die neurodegeneratie van het centrale zenuwstelsel veroorzaakt. Bijgevolg
kan het veel verschillende systemen van het menselijk lichaam beïnvloeden en
zich uiten in verschillende symptomen. Vermoeidheid is vaak een van de eerste
symptomen en wordt tot 80% gerapporteerd bij personen met MS (pwMS).
Vervolgens wordt wandelen gerapporteerd als een van de belangrijkste
lichaamsfuncties. Beide symptomen kunnen de kwaliteit van leven ernstig
beïnvloeden en kunnen ook samen voorkomen, wat bekend staat als
wandelvermoeibaarheid. Het algemene doel van dit doctoraatsproject was het
uitwerken van de klinische beoordelingsmethoden voor wandelvermoeibaarheid
en inzicht verkrijgen in de mogelijke gerelateerde factoren, om
revalidatiestrategieën voor te stellen.
Hoofdstuk 1 laat zien dat wandelvermoeibaarheid wordt gemeten via verschillende
methoden in verschillende populaties, waarbij een afname van het eerste ten
opzichte van laatste deel van een wandeltaak meestal werd gerapporteerd. De
zes minuten wandeltest (6MWT) werd hiervoor meestal aangehaald. Hoofdstuk 2
laat zien dat wandelvermoeibaarheid betrouwbaar kan worden gemeten door de
percentuele afname in afstand tussen de eerste en de laatste minuut van de 6MWT
te berekenen, met de mogelijkheid om onderscheid te maken tussen een groep
met (WF) en zonder wandelvermoeibaarheid (NWF).
De volgende verkennende studie in hoofdstuk 3 geeft in het algemeen aan dat
vermoeidheid tijdens het wandelen zich manifesteert in andere gerapporteerde
symptomen (meestal motorisch), maar dat algemeen herstel binnen 10 minuten
optreedt. Hoofdstuk 4 en 5 laten zien dat een lagere maximale kracht,
spiervermoeibaarheid tijdens dynamische contracties en verstoringen in
coördinatie van de benen kunnen bijdragen aan wandelvermoeibaarheid.
Hoofdstuk 6 laat zien dat cognitieve vermoeibaarheid en wandelvermoeibaarheid
verschillende symptomen zijn, aangezien ze geen significante associaties tonen.
Cognitieve alertheid vertoont echter wel een verband met wandelen. De
belangrijkste conclusie is daarom dat we wandelvermoeibaarheid moeten
onderzoeken en behandelen vanuit een holistisch standpunt, rekening houdend
met gerelateerde factoren en symptomen.
Hoofdstuk 7 en 8 stellen pilootinterventies voor, met wandelvermoeibaarheid als
uitkomstmaat. Beide interventies lijken een effect te hebben op verschillende mogelijks gerelateerde factoren van wandelvermoeibaarheid, maar vanwege een
lage steekproefomvang en weinig patiënten met wandelvermoeibaarheid, kan op
basis van deze resultaten geen duidelijke conclusie worden getrokken over de
behandeling van wandelvermoeibaarheid
Walking fatigability in persons with Multiple Sclerosis
No full textMultiple Sclerosis (MS) is a chronic auto-immune inflammatory progressive
disease, causing neurodegeneration of the central nervous system. Consequently,
it can affect many different systems of the human body, manifesting in different
symptoms and deficits. Fatigue is one of the first symptoms present, and reported
up to 80% in persons with MS (pwMS). Next, walking is reported as one of the
most important bodily functions according to pwMS. Both symptoms can seriously
impact quality of life, and can occur together, which is known as walking
fatigability. The overall aim of this PhD project was to elaborate the clinical
assessment methods for assessing walking fatigability and gain insight into the
possible related factors, to explore rehabilitation strategies.
Chapter 1 shows that walking fatigability is measured via different methods in
different populations, where a decline from the first to the last part of a walking
task, was mostly reported. The six-minute walking test (6MWT) was mostly used
in amongst different populations. Chapter 2 shows that walking fatigability could
be reliably measured by calculating the percentage decline in distance between
the first and the last minute of the 6MWT, with the possibility to discriminate
between a walking fatigability group (WF) and non-walking fatigability group
(NWF).
The following exploratory study in chapter 3 indicates in general that walking
fatigability manifest itself in perceived symptoms (mostly motor), but
recuperation occurs within 10 minutes. Chapter 4 and 5 show that lower maximal
strength, muscle fatigability during dynamic contractions and interlimb
coordination deficits could contribute to walking fatigability. Chapter 6 shows that
cognitive fatigability and walking fatigability may be distinct symptoms as they do
not show any significant associations. However, cognitive alertness does show a
relation to walking. The main conclusion therefore is that we should investigate
and treat walking fatigability from a holistic point of view, taking related factors
and symptoms into account.
Chapter 7 and 8 explore pilot interventions, with walking fatigability as an
outcome measure. Both interventions seem to have an effect on different possible
related factors of walking fatigability, but due to a low sample size and not much
patients with walking fatigability, no clear conclusion towards treatment for
walking fatigability can be made based upon these results.Multiple Sclerose (MS) is een chronische auto-immuun inflammatoire progressieve
ziekte die neurodegeneratie van het centrale zenuwstelsel veroorzaakt. Bijgevolg
kan het veel verschillende systemen van het menselijk lichaam beïnvloeden en
zich uiten in verschillende symptomen. Vermoeidheid is vaak een van de eerste
symptomen en wordt tot 80% gerapporteerd bij personen met MS (pwMS).
Vervolgens wordt wandelen gerapporteerd als een van de belangrijkste
lichaamsfuncties. Beide symptomen kunnen de kwaliteit van leven ernstig
beïnvloeden en kunnen ook samen voorkomen, wat bekend staat als
wandelvermoeibaarheid. Het algemene doel van dit doctoraatsproject was het
uitwerken van de klinische beoordelingsmethoden voor wandelvermoeibaarheid
en inzicht verkrijgen in de mogelijke gerelateerde factoren, om
revalidatiestrategieën voor te stellen.
Hoofdstuk 1 laat zien dat wandelvermoeibaarheid wordt gemeten via verschillende
methoden in verschillende populaties, waarbij een afname van het eerste ten
opzichte van laatste deel van een wandeltaak meestal werd gerapporteerd. De
zes minuten wandeltest (6MWT) werd hiervoor meestal aangehaald. Hoofdstuk 2
laat zien dat wandelvermoeibaarheid betrouwbaar kan worden gemeten door de
percentuele afname in afstand tussen de eerste en de laatste minuut van de 6MWT
te berekenen, met de mogelijkheid om onderscheid te maken tussen een groep
met (WF) en zonder wandelvermoeibaarheid (NWF).
De volgende verkennende studie in hoofdstuk 3 geeft in het algemeen aan dat
vermoeidheid tijdens het wandelen zich manifesteert in andere gerapporteerde
symptomen (meestal motorisch), maar dat algemeen herstel binnen 10 minuten
optreedt. Hoofdstuk 4 en 5 laten zien dat een lagere maximale kracht,
spiervermoeibaarheid tijdens dynamische contracties en verstoringen in
coördinatie van de benen kunnen bijdragen aan wandelvermoeibaarheid.
Hoofdstuk 6 laat zien dat cognitieve vermoeibaarheid en wandelvermoeibaarheid
verschillende symptomen zijn, aangezien ze geen significante associaties tonen.
Cognitieve alertheid vertoont echter wel een verband met wandelen. De
belangrijkste conclusie is daarom dat we wandelvermoeibaarheid moeten
onderzoeken en behandelen vanuit een holistisch standpunt, rekening houdend
met gerelateerde factoren en symptomen.
Hoofdstuk 7 en 8 stellen pilootinterventies voor, met wandelvermoeibaarheid als
uitkomstmaat. Beide interventies lijken een effect te hebben op verschillende mogelijks gerelateerde factoren van wandelvermoeibaarheid, maar vanwege een
lage steekproefomvang en weinig patiënten met wandelvermoeibaarheid, kan op
basis van deze resultaten geen duidelijke conclusie worden getrokken over de
behandeling van wandelvermoeibaarheid
Walking-related performance fatigability in people with Multiple Sclerosis: Clinical manifestation and test-retest reliability of the assessment method
No full textWalking-related performance fatigability in people with Multiple Sclerosis: Clinical manifestation and test-retest reliability of the assessment method
No full textDay-to-day reliability, agreement and discriminative validity of measuring walking-related performance fatigability in persons with Multiple Sclerosis
No full textBackground: 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.The author(s) received no financial support for the research, authorship, and/or publication of this article
Effects of a 10-week multimodal dance and art intervention program leading to a public performance in persons with multiple sclerosis - A controlled pilot-trial
No full textBackground: : Dance therapy is increasingly reported in neurological diseases for improving several motor and cognitive functions, but was mostly studied in partner dance. No individual choreo-based dance program has ever been reported in MS. Objectives: : The aim of this pilot study is to investigate effects of a ten-week choreo-based dance intervention on different impairments in MS. Participants: : Seventeen participants with MS were allocated to a dance group (DG) or an art group (AG) for a ten-week intervention program, with a public live performance at the end of the intervention. Methods: : The DG received choreo-based dance courses twice a week for 90 min, while the active control AG weekly contributed to the production by painting, music, spoken word and photo- or videography. Measurements for fatigue and fatigability, physical capacity and coordination, sensory function, cognitive capacity, quality of life and dual task performance took place before and after the intervention. Differences were analysed with Wilcoxon Signed Rank test. Results: : Both groups improved significantly on executive cognitive performance during dual task and fatigue. Only the DG improved significantly on functional lower limb strength, hand function, coordination, self-reported balance and walking, and showed a trend towards improving on cognition (PASAT). The AG showed significant improvements in on cognitive function (SDMT). Conclusion: : A ten-week multimodal dance intervention has positive effects on impact of fatigue, physical capacity and coordination, and cognitive performance during a dual task. Larger samples, follow-up measurements and research in different disability groups is recommended.We would like to acknowledge and thank all the participants/dancers/artists that contributed to this performance and new research data. Besides, we would also like to thank Linda Ramon, Yves Van Geel, the research team of Prof. Dr. Peter Feys and the physiotherapist of Fit Up for their constant guidance, presence and support during this project. We also acknowledge the support of Fit Up Plus and Altena (Kontich) for allowing us to use their space and rooms to prepare this project. Lastly, we would like to sincerely thank the masterthesis students Katrien Van Den Broeck and Sofie Cardeynaels, for their assistance in testing, data curation, data digitalisation, data analysis and interpretation, for which without them this study and data analysis could not have been possible.Van Geel, F (corresponding author), Hasselt Univ, Fac Rehabil Sci, REVAL Rehabil Res Ctr, Hasselt, Belgium.
[email protected]; [email protected]; [email protected]
Measuring walking-related performance fatigability in clinical practice : a systematic review
No full textINTRODUCTION: Fatigability, a change in performance according to tasks and circumstances, can contribute to walking limitations in daily life. Walking-related fatigability (WF) has been assessed subjectively, but current knowledge on best objective measurement methods is limited. The aim of this study was to provide an overview of objective clinical measurement methods assessing WF in different populations.
EVIDENCE ACQUISITION: Articles were searched in Pubmed and Web Of Science by two independent raters. Studies were included when meeting inclusion criteria of measuring WF objectively in a clinical setting, with no exclusion towards any population. Case studies and reviews were not included in the review (systematic review registration number: PROSPERO - CRD42017074121). In total, 28 articles were included. The study populations were older adults (N.=7), multiple sclerosis (N.=14), spinal muscle atrophy (N.=3), osteoarthritis (N.=3), interstitial lung diseases (N.=1), and myasthenia gravis (N.=1). Data about patient characteristics, walking task, WF formula and interpretation (cut-off values and/or psychometric properties) got extracted from included literature. Every included article got checked for quality and risk of bias.
EVIDENCE SYNTHESIS: WF was mostly measured during longer walking test such as six-minute walking test (6MWT) and 500 or 400-m walking test, by comparing the first and last minute or lap for spatiotemporal or kinematic changes in well-defined formulas. No gold standard is however available yet given different tasks or outcome measures across study populations.
CONCLUSIONS: Longer walking test were most often used, with a preference towards the 6MWT, thereby comparing the changes over the last and first part of the test. Psychometric properties need more documentation before inclusion as experimental outcome
Feasibility study of a 10-week community -based program using the WalkWithMe application on physical activity, walking, fatigue and cognition in persons with Multiple Sclerosis
No full textBackground: People with Multiple Sclerosis (pwMS) show diverse symptoms, such as fatigue and decline in motor and cognitive function. Physical activity shows to have a positive impact on many of these symptoms. However, many pwMS lead sedentary lives. Objectives of this study were to evaluate the feasibility of prolonged use of the WalkWithMe, a personalized mobile application that supports pwMS in walking at home, and its e ffect on physical activity, walking, fatigue and cognition in persons with MS. Methods: Nineteen pwMS were enrolled in a 10 -week home -based intervention with the WalkWithMe applica- tion after setting personal goals based on baseline testing values, where twelve patients completed the program. Before and after the intervention, motor (6MWT, T25FW, 5 -STS, NHPT) and cognitive function (PASAT and SDMT) were evaluated, together with the patient reported impact on walking, physical activity, quality of life and fatigue by MSWS-12, IPAQ, SF -36, MSIS-29, MFIS and FSS, respectively. Results: Signi ficant improvement was seen for some parts of self -reported physical activity and quality of life (IPAQ: walking, p = 0.04, leisure, p = 0.02; SF -36: physical functioning, p = 0.02), cognition (SDMT, p = 0.01), cognitive fatigability (PASAT, p = 0.05), lower limb strength (5 -STS, p = 0.05) and dominant hand function (NHPT, p = 0.002). Conclusion: This feasibility study was successful at improving categories of self -reported physical activity, lower limb functional strength, hand function and cognition, but results need to be interpreted with caution, given the small and not always clinically relevant changes. Larger sample sizes in a controlled experimental design are needed to con firm these results
Interlimb coordination performance in seated position in persons with multiple sclerosis : reduced amplitude over 6 min and higher coordination variability in persons with walking fatigability
Full text linkBackground: Walking fatigability is prevalent in MS and can be measured by a percentage distance decline during a 6-min walking test. Walking is characterized by an accurate and consistent interlimb antiphase coordination pattern. A decline in coordination each minute during a 6-min walking test is observed in persons with MS (pwMS). Measuring coordination during a 6-min seated coordination task with minimized balance and strength requirements, is assumed to examine a more fundamental interlimb antiphase coordination pattern in pwMS. This research aimed to answer the following research question: How does interlimb antiphase coordination pattern change during a seated coordination task in pwMS with walking fatigability (WF), non-walking fatigability (NWF) and Healthy Controls (HC)?
Methods: Thirty-five pwMS and 13 HC participated. Interlimb coordination was assessed by a seated 6-min coordination task (6MCT) with the instruction to perform antiphase lower leg movements as fast as possible. Outcomes were Phase Coordination Index (PCI) and movement parameters (amplitude, frequency).
Results: Mixed models revealed a significant effect of time for the the variability of generating interlimb movements, with a difference in mean values between WF and HC. A significant group∗time interaction effect was found for movement amplitude, represented by a significant decrease in movement amplitude in the WF group from minute 1 to the end of the task.
Conclusion: The higher variability in interlimb coordination and decrease in movement amplitude over time during the 6MCT in the WF group could be an indicator of decreased control of fundamental antiphase coordination pattern in pwMS with walking fatigability
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