1,721,006 research outputs found
Cognitive-motor interference during walking in Multiple Sclerosis; On the assessment and rehabilitation
No full textMultiple sclerosis (MS) is a complex disease of the central nervous system where
inflammation, demyelination and neurodegenerative processes manifest in
heterogeneous clinical symptoms 1, 2
. Among the wide range of symptoms that
can manifest are pain, visual and sensory deficits, affective disturbances, fatigue
and impairments in cognitive and motor functioning1
, affecting participation and
quality of life 2-5
.
In daily life, the simultaneous performance of a motor and a cognitive task,
think of walking while talking, is a common act. Reduced performance in one or
both tasks during this cognitive-motor dual tasking is called interference 6
. Dual
task (DT) performance is usually investigated by using DT paradigms. In these
paradigms, participants perform a single motor task (e.g., walking, balancing,
etc.), a single cognitive task (e.g., talking, subtracting numbers, etc.) and a
combination of the used motor and cognitive task (e.g., subtracting numbers
while walking). The performance can then be quantified as absolute DT
performance or as DT cost (DTC). With the first quantifying how someone is
performing on the motor task (e.g., by gait speed) and on the cognitive task
(e.g., by number of correct answers) during the DT, and with the latter, the
DTC, quantifying the relative change in performance of the DT compared to the
single task.
MS might affect both motor and cognitive functioning, affecting both domains of
cognitive-motor dual tasking. The alterations in gait pattern due to the disease
might increase reliance on more cognitively controlled gait, while at the same
time the disease can result in cognitive deficits. This doctoral thesis, situated in
the rehabilitation sciences, therefore focuses on cognitive-motor dual tasking in
persons with MS. Whereby we aimed to increase knowledge on the assessment
of DT performance, and on the effects of various rehabilitation strategies on DT
performance in persons with MS.
In the first part, on assessment of DT performance, the test-retest reliability,
discriminative validity, paradigm-specific effects on the DT performances and
clinical characteristics related to the DT performance, were investigated within
multiple, various, DT paradigms. To these aims, twelve different DT conditions
were performed, consisting of four walking conditions (i.e., comfortable walking
[‘walk’], walking with a cup filled with water [‘cup’], walking over obstacles
[‘obstacles’] and walking crisscross [‘crisscross’]) that were combined with three
cognitive tasks (subtracting sevens, titrated digit span backwards and auditory
vigilance).
First, it was shown that an absolute measure of DT performance was more
reliable than the relative DTC, and that DT motor performance could in general
reliably be measured, while DT cognitive performance could not. Further, as
‘turning velocity’, the outcome measure for the crisscross conditions, was not
reliable for persons with MS, the ‘crisscross’ conditions were discarded from the
analysis in the other papers.
Second, walking while simultaneously performing a cognitive task overall led to worse performance (i.e., interference) for both persons with and without MS. Also, person with MS showed worse DT walking performance (e.g.,
slower walking speed) under all DT paradigms compared to healthy adults, but
no difference in relative decline (i.e., no difference in DTCs) between the groups.
Third, for persons with MS, the DTC in the motor domain was in general
greatest during usual DT walking, and declined with increasing complexity of the
walking condition. In contrast, both the motor and the cognitive DTC were
greater when the cognitive tasks used in the DT paradigm were more difficult.
Lastly, the motor DTC in the less complex walking conditions related mainly to
information processing speed, while in the more complex ‘obstacles’ conditions it
related to age. On the other hand, absolute DT gait speed was found to mainly
relate to walking endurance and perceived walking capacities, irrespective of the
DT walking condition.
In the second part, two randomized controlled trials (RCTs) were conducted in
which the first focused on targeting DT performance by integrated DT training
compared to single mobility training, and the second on ability for motor
sequence learning under implicit or explicit conditions and effects on
automatization, by examining DT performance. In the first RCT, we
demonstrated that an 8-week, standardized, individualized and progressive,
integrated DT training was, first of all, feasible and safe. Second, DT training
resulted in greater improvements in DT walking compared to single mobility
training, as shown by a reduction in motor DTC in all ‘walk’ conditions and an
increase in absolute DT gait speed in ‘walk’ and ‘obstacles’ conditions, which was
partly sustained over follow-up. In the second RCT, we demonstrated that
persons with MS are able to show motor sequence learning in a stepping task to
a similar degree as healthy adults, without a differential effect of implicit or
explicit learning conditions in which no information or explicit information on the
to-be-learned sequence was given beforehand, respectively. Moreover, the
increased task performance was retained 24 hours later and under various DT
conditions. However, it remains unclear whether automatization of the stepping
task took place considering the different results per type of DT paradigm
examined.
Persons with MS perceive in general more difficulties with dual tasking in daily
life than healthy adults and show worse absolute DT motor performance.
Assessing DT performance in MS is therefore endorsed for clinical practice.
Based on our results, examining absolute DT gait speed and the motor DTC of
gait speed in a preferred speed walking task combined with a mental tracking
task (involving working memory) is recommended as basis, as its reliability was
good, it led to interference and it could be improved after DT training.Multiple sclerose (MS) is een aandoening van het centraal zenuwstelsel, waarbij
inflammatie, demyelinisatie en neurodegeneratieve processen een rol spelen 1, 2
.
Dit kan zich manifesteren in een scala aan symptomen, waaronder pijn, visuele
en sensorische beperkingen, affectieve aandoeningen, vermoeidheid en
beperkingen van het cognitief en motorische functioneren 1
, die gevolgen
kunnen hebben voor participatie en kwaliteit van leven 2-5
.
In het dagelijks leven komt het vaak voor, dat men een motorische en een
cognitieve taak gelijktijdig uitvoert. Denk aan wandelen en praten tegelijkertijd.
Een verminderde prestatie op een of beide taken tijdens het uitvoeren van zo’n
cognitief-motorische dubbeltaak (DT) wordt interferentie genoemd 6
. DTprestatie wordt normaliter onderzocht door middel van DT-paradigma’s. Bij deze
paradigma’s voeren deelnemers een enkele motorische taak uit (e.g., wandelen,
balanceren etc.), een enkele cognitieve taak (e.g., praten, aftellen etc.) en een
combinatie van de gebruikte motorische en cognitieve taak (e.g., aftellen tijdens
het wandelen). De prestatie kan dan worden gekwantificeerd als absolute DTprestatie of als de DT-kost (DTK). De eerste is een maat voor hoe iemand
presteert op de motorische taak (bijvoorbeeld stapsnelheid) en op de cognitieve
taak (bijvoorbeeld het aantal correcte antwoorden) tijdens de uitvoering van de
DT. De laatste, de DTK, is een maat voor de relatieve verandering in prestatie
tijdens de DT ten opzichte van de enkele taak.
De motorische beperkingen door MS zouden kunnen leiden tot een bewuster
gecontroleerd stappatroon, terwijl de aandoening ook kan leiden tot beperkingen
van het cognitief functioneren. Beide domeinen van een cognitief-motorische DT
kunnen dus beïnvloed zijn. Deze doctoraatsthesis in de revalidatiewetenschappen betreft daarom de uitvoering van cognitief-motorische dubbeltaken
door personen met MS. Hierbij werd getracht de kennis op het gebied van het
meten van die DT-prestatie te vergroten, alsook de effecten van verschillende
revalidatie strategieën op die DT-prestatie te onderzoeken.
In het eerste gedeelte, aangaande het meten van de DT-prestatie, werden
twaalf DT-paradigma’s gebruikt, bestaande uit vier motorische condities (i.e.,
gewoon wandelen [‘wandel’], wandelen met een kop met water in de hand,
wandelen over obstakels heen en zigzaggend wandelen) gecombineerd met drie
cognitieve taken (aftellen met zeven, achterwaartse cijferspanne [‘titrated digit
span backwards’] en auditieve waakzaamheid [‘vigilance’]). Hiervan werden de
test-hertest betrouwbaarheid, de discriminatieve validiteit, de effecten van de
gebruikte DT-paradigma’s op de DT-prestaties en de klinische karakteristieken
gerelateerd aan de DT-prestaties, onderzocht.
Ten eerste waren absolute maten van DT-prestatie betrouwbaarder dan de
relatieve DTK en waren de metingen van motorische DT-prestaties over het
algemeen betrouwbaar, terwijl die van cognitieve DT-prestaties dat niet waren.
Verder was de uitkomstmaat ‘draaisnelheid’, die werd gebruikt voor de condities
met zigzaggend wandelen, niet betrouwbaar voor personen met MS. Deze
condities werden niet meer meegenomen in de volgende artikelen. Ten tweede resulteerde het tegelijkertijd uitvoeren van een cognitieve
taak tijdens een wandeltaak tot verminderde prestatie (i.e., interferentie) voor
zowel personen met als zonder MS. Daarnaast waren de motorische DTprestaties slechter voor personen met MS vergeleken met de gezonde
volwassenen, bijvoorbeeld door een lagere DT-stapsnelheid. De relatieve
verandering, gemeten met de DTK, verschilde echter niet tussen de groepen.
Ten derde was de motorische DTK voor personen met MS het grootste
tijdens de gewone ‘wandel’ condities en deze werd kleiner naarmate de
wandeltaak complexer werd. Daarentegen waren zowel de motorische als de
cognitieve DTK het grootste voor DT-condities met moeilijkere cognitieve taken.
Als laatste was de motorische DTK in de minder complexe wandelcondities
voornamelijk gerelateerd aan informatieverwerkingssnelheid, terwijl die in de
complexere wandelconditie ‘wandelen over obstakels’ gerelateerd was aan
leeftijd. De absolute motorische DT-stapsnelheid was echter voornamelijk
gerelateerd aan stapsnelheid en wandelvermogen en aan de ervaren stapcapaciteiten in het dagelijks leven, onafhankelijk van de DT-conditie.
In het tweede gedeelte werden twee gerandomiseerde, gecontroleerde
onderzoeken (RCT’s) uitgevoerd. De eerste richtte zich op het verbeteren van
DT-prestatie door een geïntegreerde DT-training in vergelijking met enkel
trainen van de mobiliteit, en de tweede op het vermogen tot het leren van
motorische sequenties onder impliciete of expliciete condities en de effecten
daarvan op automatisatie, gemeten door middel van de DT-prestatie. In de
eerste RCT bleek een 8-weekse, gestandaardiseerde, geïndividualiseerde en
progressieve, geïntegreerde DT-training mogelijk bij en veilig voor personen met
MS. Bovendien resulteerde deze in verbeterde DT-prestaties, aangezien er een
verminderde DTK werd gevonden in de ‘wandel’ condities en een verhoogde DTstapsnelheid in de ‘wandel’ en de ‘wandelen over obstakels’ condities, terwijl dit
in mindere mate het geval was na de enkel mobiliteit training. In de tweede RCT
werd gevonden dat personen met MS in staat waren tot motorisch sequentie
leren in dezelfde mate als gezonde volwassenen, en dat er geen verschil zat
tussen de condities waarbij de deelnemers van te voren geen informatie
(impliciete) of wel informatie (expliciete) over de taak hadden gekregen. Verder
bleven de verbeterde motorische prestaties en de geleerde motorische sequentie
behouden na 24 uur (retentie) en tijdens de DT-condities. Effecten op de
automatisatie behoeven echter verder onderzoek.
Personen met MS ervaren over het algemeen meer problemen met DT in het
dagelijks leven en hebben een verminderde motorische DT-prestatie dan
gezonde volwassenen. Gebaseerd op de resultaten wordt aangeraden als basis
de absolute DT-stapsnelheid en de motorische DTK van stapsnelheid te meten
tijdens een gewone wandeltaak, gecombineerd met een taak waarbij het
werkgeheugen een rol speelt, omdat de betrouwbaarheid hiervan goed was, de
taak tot interferentie leidde en de prestatie op de taak vatbaar was voor
verbetering door middel van een geïntegreerde DT-training
Cognitive-motor interference during walking in Multiple Sclerosis; On the assessment and rehabilitation
No full textMultiple sclerosis (MS) is a complex disease of the central nervous system where
inflammation, demyelination and neurodegenerative processes manifest in
heterogeneous clinical symptoms 1, 2
. Among the wide range of symptoms that
can manifest are pain, visual and sensory deficits, affective disturbances, fatigue
and impairments in cognitive and motor functioning1
, affecting participation and
quality of life 2-5
.
In daily life, the simultaneous performance of a motor and a cognitive task,
think of walking while talking, is a common act. Reduced performance in one or
both tasks during this cognitive-motor dual tasking is called interference 6
. Dual
task (DT) performance is usually investigated by using DT paradigms. In these
paradigms, participants perform a single motor task (e.g., walking, balancing,
etc.), a single cognitive task (e.g., talking, subtracting numbers, etc.) and a
combination of the used motor and cognitive task (e.g., subtracting numbers
while walking). The performance can then be quantified as absolute DT
performance or as DT cost (DTC). With the first quantifying how someone is
performing on the motor task (e.g., by gait speed) and on the cognitive task
(e.g., by number of correct answers) during the DT, and with the latter, the
DTC, quantifying the relative change in performance of the DT compared to the
single task.
MS might affect both motor and cognitive functioning, affecting both domains of
cognitive-motor dual tasking. The alterations in gait pattern due to the disease
might increase reliance on more cognitively controlled gait, while at the same
time the disease can result in cognitive deficits. This doctoral thesis, situated in
the rehabilitation sciences, therefore focuses on cognitive-motor dual tasking in
persons with MS. Whereby we aimed to increase knowledge on the assessment
of DT performance, and on the effects of various rehabilitation strategies on DT
performance in persons with MS.
In the first part, on assessment of DT performance, the test-retest reliability,
discriminative validity, paradigm-specific effects on the DT performances and
clinical characteristics related to the DT performance, were investigated within
multiple, various, DT paradigms. To these aims, twelve different DT conditions
were performed, consisting of four walking conditions (i.e., comfortable walking
[‘walk’], walking with a cup filled with water [‘cup’], walking over obstacles
[‘obstacles’] and walking crisscross [‘crisscross’]) that were combined with three
cognitive tasks (subtracting sevens, titrated digit span backwards and auditory
vigilance).
First, it was shown that an absolute measure of DT performance was more
reliable than the relative DTC, and that DT motor performance could in general
reliably be measured, while DT cognitive performance could not. Further, as
‘turning velocity’, the outcome measure for the crisscross conditions, was not
reliable for persons with MS, the ‘crisscross’ conditions were discarded from the
analysis in the other papers.
Second, walking while simultaneously performing a cognitive task overall led to worse performance (i.e., interference) for both persons with and without MS. Also, person with MS showed worse DT walking performance (e.g.,
slower walking speed) under all DT paradigms compared to healthy adults, but
no difference in relative decline (i.e., no difference in DTCs) between the groups.
Third, for persons with MS, the DTC in the motor domain was in general
greatest during usual DT walking, and declined with increasing complexity of the
walking condition. In contrast, both the motor and the cognitive DTC were
greater when the cognitive tasks used in the DT paradigm were more difficult.
Lastly, the motor DTC in the less complex walking conditions related mainly to
information processing speed, while in the more complex ‘obstacles’ conditions it
related to age. On the other hand, absolute DT gait speed was found to mainly
relate to walking endurance and perceived walking capacities, irrespective of the
DT walking condition.
In the second part, two randomized controlled trials (RCTs) were conducted in
which the first focused on targeting DT performance by integrated DT training
compared to single mobility training, and the second on ability for motor
sequence learning under implicit or explicit conditions and effects on
automatization, by examining DT performance. In the first RCT, we
demonstrated that an 8-week, standardized, individualized and progressive,
integrated DT training was, first of all, feasible and safe. Second, DT training
resulted in greater improvements in DT walking compared to single mobility
training, as shown by a reduction in motor DTC in all ‘walk’ conditions and an
increase in absolute DT gait speed in ‘walk’ and ‘obstacles’ conditions, which was
partly sustained over follow-up. In the second RCT, we demonstrated that
persons with MS are able to show motor sequence learning in a stepping task to
a similar degree as healthy adults, without a differential effect of implicit or
explicit learning conditions in which no information or explicit information on the
to-be-learned sequence was given beforehand, respectively. Moreover, the
increased task performance was retained 24 hours later and under various DT
conditions. However, it remains unclear whether automatization of the stepping
task took place considering the different results per type of DT paradigm
examined.
Persons with MS perceive in general more difficulties with dual tasking in daily
life than healthy adults and show worse absolute DT motor performance.
Assessing DT performance in MS is therefore endorsed for clinical practice.
Based on our results, examining absolute DT gait speed and the motor DTC of
gait speed in a preferred speed walking task combined with a mental tracking
task (involving working memory) is recommended as basis, as its reliability was
good, it led to interference and it could be improved after DT training.Multiple sclerose (MS) is een aandoening van het centraal zenuwstelsel, waarbij
inflammatie, demyelinisatie en neurodegeneratieve processen een rol spelen 1, 2
.
Dit kan zich manifesteren in een scala aan symptomen, waaronder pijn, visuele
en sensorische beperkingen, affectieve aandoeningen, vermoeidheid en
beperkingen van het cognitief en motorische functioneren 1
, die gevolgen
kunnen hebben voor participatie en kwaliteit van leven 2-5
.
In het dagelijks leven komt het vaak voor, dat men een motorische en een
cognitieve taak gelijktijdig uitvoert. Denk aan wandelen en praten tegelijkertijd.
Een verminderde prestatie op een of beide taken tijdens het uitvoeren van zo’n
cognitief-motorische dubbeltaak (DT) wordt interferentie genoemd 6
. DTprestatie wordt normaliter onderzocht door middel van DT-paradigma’s. Bij deze
paradigma’s voeren deelnemers een enkele motorische taak uit (e.g., wandelen,
balanceren etc.), een enkele cognitieve taak (e.g., praten, aftellen etc.) en een
combinatie van de gebruikte motorische en cognitieve taak (e.g., aftellen tijdens
het wandelen). De prestatie kan dan worden gekwantificeerd als absolute DTprestatie of als de DT-kost (DTK). De eerste is een maat voor hoe iemand
presteert op de motorische taak (bijvoorbeeld stapsnelheid) en op de cognitieve
taak (bijvoorbeeld het aantal correcte antwoorden) tijdens de uitvoering van de
DT. De laatste, de DTK, is een maat voor de relatieve verandering in prestatie
tijdens de DT ten opzichte van de enkele taak.
De motorische beperkingen door MS zouden kunnen leiden tot een bewuster
gecontroleerd stappatroon, terwijl de aandoening ook kan leiden tot beperkingen
van het cognitief functioneren. Beide domeinen van een cognitief-motorische DT
kunnen dus beïnvloed zijn. Deze doctoraatsthesis in de revalidatiewetenschappen betreft daarom de uitvoering van cognitief-motorische dubbeltaken
door personen met MS. Hierbij werd getracht de kennis op het gebied van het
meten van die DT-prestatie te vergroten, alsook de effecten van verschillende
revalidatie strategieën op die DT-prestatie te onderzoeken.
In het eerste gedeelte, aangaande het meten van de DT-prestatie, werden
twaalf DT-paradigma’s gebruikt, bestaande uit vier motorische condities (i.e.,
gewoon wandelen [‘wandel’], wandelen met een kop met water in de hand,
wandelen over obstakels heen en zigzaggend wandelen) gecombineerd met drie
cognitieve taken (aftellen met zeven, achterwaartse cijferspanne [‘titrated digit
span backwards’] en auditieve waakzaamheid [‘vigilance’]). Hiervan werden de
test-hertest betrouwbaarheid, de discriminatieve validiteit, de effecten van de
gebruikte DT-paradigma’s op de DT-prestaties en de klinische karakteristieken
gerelateerd aan de DT-prestaties, onderzocht.
Ten eerste waren absolute maten van DT-prestatie betrouwbaarder dan de
relatieve DTK en waren de metingen van motorische DT-prestaties over het
algemeen betrouwbaar, terwijl die van cognitieve DT-prestaties dat niet waren.
Verder was de uitkomstmaat ‘draaisnelheid’, die werd gebruikt voor de condities
met zigzaggend wandelen, niet betrouwbaar voor personen met MS. Deze
condities werden niet meer meegenomen in de volgende artikelen. Ten tweede resulteerde het tegelijkertijd uitvoeren van een cognitieve
taak tijdens een wandeltaak tot verminderde prestatie (i.e., interferentie) voor
zowel personen met als zonder MS. Daarnaast waren de motorische DTprestaties slechter voor personen met MS vergeleken met de gezonde
volwassenen, bijvoorbeeld door een lagere DT-stapsnelheid. De relatieve
verandering, gemeten met de DTK, verschilde echter niet tussen de groepen.
Ten derde was de motorische DTK voor personen met MS het grootste
tijdens de gewone ‘wandel’ condities en deze werd kleiner naarmate de
wandeltaak complexer werd. Daarentegen waren zowel de motorische als de
cognitieve DTK het grootste voor DT-condities met moeilijkere cognitieve taken.
Als laatste was de motorische DTK in de minder complexe wandelcondities
voornamelijk gerelateerd aan informatieverwerkingssnelheid, terwijl die in de
complexere wandelconditie ‘wandelen over obstakels’ gerelateerd was aan
leeftijd. De absolute motorische DT-stapsnelheid was echter voornamelijk
gerelateerd aan stapsnelheid en wandelvermogen en aan de ervaren stapcapaciteiten in het dagelijks leven, onafhankelijk van de DT-conditie.
In het tweede gedeelte werden twee gerandomiseerde, gecontroleerde
onderzoeken (RCT’s) uitgevoerd. De eerste richtte zich op het verbeteren van
DT-prestatie door een geïntegreerde DT-training in vergelijking met enkel
trainen van de mobiliteit, en de tweede op het vermogen tot het leren van
motorische sequenties onder impliciete of expliciete condities en de effecten
daarvan op automatisatie, gemeten door middel van de DT-prestatie. In de
eerste RCT bleek een 8-weekse, gestandaardiseerde, geïndividualiseerde en
progressieve, geïntegreerde DT-training mogelijk bij en veilig voor personen met
MS. Bovendien resulteerde deze in verbeterde DT-prestaties, aangezien er een
verminderde DTK werd gevonden in de ‘wandel’ condities en een verhoogde DTstapsnelheid in de ‘wandel’ en de ‘wandelen over obstakels’ condities, terwijl dit
in mindere mate het geval was na de enkel mobiliteit training. In de tweede RCT
werd gevonden dat personen met MS in staat waren tot motorisch sequentie
leren in dezelfde mate als gezonde volwassenen, en dat er geen verschil zat
tussen de condities waarbij de deelnemers van te voren geen informatie
(impliciete) of wel informatie (expliciete) over de taak hadden gekregen. Verder
bleven de verbeterde motorische prestaties en de geleerde motorische sequentie
behouden na 24 uur (retentie) en tijdens de DT-condities. Effecten op de
automatisatie behoeven echter verder onderzoek.
Personen met MS ervaren over het algemeen meer problemen met DT in het
dagelijks leven en hebben een verminderde motorische DT-prestatie dan
gezonde volwassenen. Gebaseerd op de resultaten wordt aangeraden als basis
de absolute DT-stapsnelheid en de motorische DTK van stapsnelheid te meten
tijdens een gewone wandeltaak, gecombineerd met een taak waarbij het
werkgeheugen een rol speelt, omdat de betrouwbaarheid hiervan goed was, de
taak tot interferentie leidde en de prestatie op de taak vatbaar was voor
verbetering door middel van een geïntegreerde DT-training
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]
Day-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
Test-retest reliability of motor and cognitive dual task cost in Multiple Sclerosis during various tasks
No full textSustained attention during prolonged walking in persons with multiple sclerosis
No full textIntroduction: Accelerated early CGMV loss occurs in interferon-treated RMS patients. Methods: CGMV was quantified in randomized phase 3 (SUNBEAM-NCT02294058, RADIANCE-NCT02047734) trials comparing oral ozanimod 0.92 and 0.46mg/day with intramuscular interferon 30μg/ week and an ongoing, open-label extension trial (DAYBREAK-NCT02576717) of ozanimod 0.92mg/day in RMS. MRI was performed at months 6 (SUNBEAM), 12 (RADIANCE/SUNBEAM), and 24 (RADIANCE), then every 12 months (DAYBREAK). CGMV was analyzed through DAYBREAK month 36. Results: The rate of CGMV loss was greater (P<0.001) with inter-feron than ozanimod 0.92mg during SUNBEAM/RADIANCE: LS mean percentage change from baseline was-0.67% vs-0.02%, respectively, at month 6 and-1.04% vs-0.16% at month 12 in SUNBEAM, and-0.80% vs-0.13% at month 12 and-1.26% vs-0.53% at month 24 in RADIANCE. Switching from interferon to ozanimod reversed CGMV loss in year 1 of DAYBREAK. Thereafter, annualized rates of CGMV loss were similar among participants who switched from interferon and those continuously treated with ozanimod. Patients continuously treated with ozani-mod lost less CGMV in DAYBREAK relative to RADIANCE/ SUNBEAM baseline than patients initially treated with interferon. Conclusion: Switching from interferon to ozanimod reversed CGMV loss. Earlier treatment with ozanimod led to less CGMV loss over 4-5 years, supporting early ozanimod use. This abstract has been previously presented at AAN 202
Sustained attention during prolonged walking in persons with multiple sclerosis
No full textIntroduction: Walking is a cognitively demanding activity, as has been shown in long-distance assessments. It is known that there is often a decrease in walking speed during long-distance walking in persons with multiple sclerosis (pwMS) which could be related to reduced sustained attention while performing simultaneously performing a prolonged motor task (i.e., long distance walking task). Objective: This study investigated sustained attention during prolonged walking in pwMS withdifferent levels of disabilityand compared it with healthy controls (HC). Methods: Thirty pwMS with mild disability (EDSS<4.0), 16 pwMS with moderate to severe disability (EDSS 4.0-6.5), and 27 age-gender matched HC performed the 6-Minute Walk Test (6MWT) with an auditory vigilance task. Participants were auditory provided a letter every 2.5s through a headphone and were instructed to say "yes" as fast as possible when they heard one of two selected letters (L and R) and asked to not respond on other letters to assess vigilance. The number of errors and average reaction time in the vigilance task, and distance walked per minute were measured. Distance Walked Index (DWI; change in walking distance between min 1 and min 6) was calculated to determine walking fatigability. Repeated measures ANOVAs (RMANOVAs) were conducted on each outcome variable with post-hoc corrections. Results: Significant group * time interaction effects were found for reaction times.Reaction times significantly increased in persons with mild disability and moderate to severe disability groups, with greater increase in pwMS with moderate to severe disability (13.22%). There was no change in reaction time between min 1 to min 6 in HCs. Significant time effects were found for walking distance and number of errors, but there was no group*time interaction. The DWI was not different between mildly disabled pwMS and HC (-10.22% vs.-6.54%), but those with moderate to severe disability showed a significantly greater change (-20.59%) than mildly disabled pwMS. Conclusion: Our findings showed that attention and walking speed deteriorated over time during the six minutes of walking, especially in pwMS with higher disabilities. Change in sustained attention may explain the decrease in walking speed, and it should be further examined
Hemodynamics of the pre-frontal cortex during walking, cognitive and dual-task in people with multiple sclerosis
No full textEffects of prolonged walking on dual-task walking performance in persons with multiple sclerosis
No full textObjective: Motor impairment and fatigue perception may affect walking automaticity. We aimed to investigate the effect of prolonged walking administered by the 6-Minute Walk Test (6MWT) on motor-cognitive dual-task performance in persons with multiple sclerosis (pwMS) with different levels of disability compared to healthy controls (HC). Methods: A total of 50 pwMS [30 mildly disabled (EDSS<4.0), 20 moderately-severely disabled (EDSS 4.0 to 6.5)] and 29 age-and sex-matched HC were included. Spatiotemporal gait parameters during single (overground walking for 30 sec) and dual-task walking (overground walking for 30 sec with word list generation task) were assessed before and immediately after the 6MWT using three inertial gait sensors. The dual-task cost (DTC) of gait parameters was calculated as change (in percentage) between the dual-task to the single-task conditions. Perceived walking difficulties , fatigue, history of falls, fear of falling, and perceived dual-task difficulties were evaluated via self-report questionnaires. Results: PwMS with moderate-to-severe disability group had a significant deterioration in cadence, speed, double support, and asymmetry during dual-task walking after the 6MWT. However, there was no change in mildly disabled pwMS, and HC demonstrated better scores in cadence, speed, and gait variability after the 6MWT. As for the DTC, while mildly disabled pwMS (in speed and gait variability) and HC (in double support, cadence, and gait variability) showed improvements, no significant difference was found in moderate to severely disabled pwMS. Cognitive task performance incremented solely in HC following the 6MWT. Change in DTC was correlated to self-reported walking disability, fatigue, and perceived dual-task difficulties (r =-0.301 to-0.337) in pwMS. Conclusion: Prolonged walking affects severely disabled pwMS regardless of the cognitive task. This suggests that they focus more on walking than cognitive task performance. Mildly disabled pwMS and HC could maintain gait automatization and even reduce DTC after 6MWT, suggesting that 6MWT may not be sufficient to induce performance fatigability as measured by dual-task performance in mildly disabled pwMS and may even make gait more dynamic. Progressive multifocal encephalopathy (PML) is a potentially fatal opportunistic infection of the central nervous system by John Cuningham virus. We report on a multidisciplinary rehabilitation in a 45-year-old female suffering from PML after 20 natalizumab infusions. After natalizumab discontinuation immune reconstitution inflammatory syndrome (IRIS) developed leading to additional deterioration of the neurological disability of the patient. Initial right sided hemiparesis slowly progressed to hemiplegia, later left sided hemipa-resis appeared as well as motoric dysphasia so she became bedridden and completely dependent in activities of daily living (ADL). Physiotherapy treatment focused on deterioration of posture control , sensorimotor skills of the right-sided limbs and gait pattern. Exercises for postural stability and movement control were performed. Occupational therapy (OT) focused on maintaining ADL, underlying fatigue and sensory-motor impairment in right upper limb. After the deterioration of her health condition, physiotherapists implemented gradual verticalization and bed-wheelchair transfer. OT then focused on body positioning and impairments in both upper limbs, along with improving attitude to her current life situation. Clinical psychologist was included to provide psychological support and improve communication. We used basic cogni-tive behavioural model, relaxation techniques, normalisation, guided imagery for stress relief and regulation of mood. Speech language pathologist treatment was indicated when deviations in the quality and intelligibility of speech and communication appeared. Communication was maintained through closed-ended, dichotomous questions. With the progression of speech apraxia, the Augmentative and Alternative Communication board was introduced. Apraxia of speech persists at the forefront and significantly disables the patient in everyday communication. Multidisciplinary rehabilitation was essential in maintaining patient's functional level, preventing further decline as well as helping the neurologist monitor disease progression of her primary diagnosis as well as IRIS and in this way influence further diagnostic and therapeutic decisions
Test-retest reliability of motor and cognitive dual task cost in Multiple Sclerosis during various tasks
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