Evaluation of upper extremity ataxia through image processing in individuals with multiple sclerosis

ABSTRACT Background: Impaired dexterity is a frequently reported disability among people with ataxic multiple sclerosis (MS). Objective: To quantify and standardize the evaluation of upper extremity coordination disorder among patients with multiple sclerosis (MS), using the Tablet Ataxia Assessment Program (TAAP). Methods: The X and Y axis movements of 50 MS patients and 30 healthy individuals who were evaluated using the International Cooperative Ataxia Rating Scale (ICARS) were also assessed using TAAP. The functional times of the participants’ right and left hands were recorded using the nine-hole peg test (NHPT). The upper extremity coordination of individuals with MS was evaluated using the upper extremity kinetic functions section of ICARS. Results: The deviations for the X and Y axis movements of the MS group were greater than those of the control group (p<0.05). Significant correlations were shown between TAAP scores and NHPT and ICARS scores. The strongest correlation was found between NHPT and ICARS in the dominant hand (rnhpt=0.356, pnhpt=0.001; ricars=0.439, picars=0.000). In correlating the Y axis with ICARS, the deviations in the Y axis were found to be greater in the non-dominant hand than those in the X axis (ryright=0.402, pyright=0.004; ryleft=0.691, pyleft=0.000). Conclusion: Measurement using TAAP is more sensitive than other classical and current methods for evaluating ataxia. We think that TAAP is an objective tool that will allow neurorehabilitation professionals and clinicians to evaluate upper extremity coordination.

Avaliação da destreza manual de pessoas com esclerose múltipla usando o nine hole peg test

Objetivo: Avaliar a destreza manual de pessoas diagnosticadas com Esclerose Múltipla acompanhadas em um Centro de Referência. Método: Estudo de campo, exploratório, descritivo, com abordagem quantitativa, realizado em um público maior de 18 e menor de 60 anos, referente a 30% de 186 indivíduos cadastrados, totalizando uma amostra de 55 pacientes, caracterizada como não probabilística por conveniência. Possuiu como variável o tempo de diagnóstico e a pontuação na EDSS, utilizando o nine hole peg test e um roteiro para a coleta em prontuários como instrumentos. Os dados foram estatisticamentre analisados de forma descritiva e analítica. Resultados: Pacientes com escore na EDSS < 3 apresentaram melhor desempenho no teste, enquanto pacientes com escore > 3 obtiveram dificuldades acentuadas, necessitando de maior tempo para executá-lo. Conclusão: Com base nos resultados, verifica-se que o escore na EDSS é diretamente proporcional ao desempenho da coordenação motora fina dos membros superiores.

Evaluación de la funcionalidad del miembro superior en personas adultas con daño cerebral adquirido realizada por los/as profesionales de la terapia ocupacional en España, estudio transversal

Introducción: La evaluación de las actividades y la participación son dos elementos claves en la funcionalidad del miembro superior (MS) para el proceso de neurorrehabilitación. Conocer la evaluación que realizan los/as profesionales de la terapia ocupacional puede ser de utilidad para la rehabilitación. Por tanto, el objetivo principal del estudio fue describir el proceso de evaluación del MS en adultos con daño cerebral adquirido (DCA), realizado por terapeutas ocupacionales en España. Métodos: Se diseñó un estudio transversal con terapeutas ocupacionales españoles que trataban el MS en pacientes con DCA mediante una encuesta online, entre marzo y mayo del 2020. En ella, se recogió información sobre variables sociodemográficas, formativas, laborales y sobre el proceso de evaluación. Resultados: Un total de 47 terapeutas ocupacionales de una edad mediana de 31 años y mayoritariamente mujeres participaron en el estudio. El 57% reportó dedicar menos del 25% de su jornada a la tarea de evaluación. Se identificaron 110 escalas de evaluación, de las cuales el 62% se dedicaban a evaluar funciones y estructuras, el 19% actividades y 19% a participación. Las herramientas más utilizadas fueron Fulg Meyer Assessment, Nine Hole Peg Test y Disabilities of the Arm, Shoulder and Hand. Conclusiones: El tiempo dedicado a la evaluación fue escaso y un pequeño porcentaje de terapeutas ocupacionales evaluaron las actividades y participación.

Cervical and Thoracic Spondylotic Myelopathies

Spondylotic myelopathies are among the most common disorders of the spine, yet the clinical and treatment approach is far from standardized. This article discusses our current understanding of the epidemiology, pathophysiology, clinical assessment, natural history, and treatment options in degenerative myelopathies of the cervical and thoracic spine. We additionally review diagnostic modalities including imaging modalities of the spine and neurophysiological tools such as electromyography/nerve conduction studies, somatosensory-evoked potentials, and motor-evoked potentials. Assessment instruments that can be used for the assessment of myelopathies are reviewed, including the Japanese Orthopedic Association (JOA) score, modified-JOA scale, Nurick scale, nine-hole peg test, and 30-m walking test. We also review common disorders that mimic spondylotic myelopathies, as well as helpful diagnostic clues in differentiating spondylotic and nonspondylotic myelopathies.

Exploring hand dexterity in children with myelomeningocele

PURPOSE: To assess hand dexterity in children with myelomeningocele (MMC) and to explore factors related to hand dexterity in these children. METHODS: Ninety-four children with myelomeningocele, aged 4 to 18 years, were assessed. Demographic characteristics, disease factors, visual perception (Beery test of Visual Motor Integration), cognition (WeeFunctional Independence Measure), and self-care (Pediatric Evaluation of Disability Inventory) were assessed in relation to the Nine-Hole Peg Test (9HPT) for hand dexterity using Spearmen correlations and linear regressions. RESULTS: The children’s performance on the 9HPT in both hands was significantly slower than the norms for their age groups. Children without a shunt showed significantly better function in both hands (p = .005) than those with a shunt. Factors most related to hand dexterity were neurological spinal level of MMC, presence of shunt, age, cognitive ability, and years of mother’s education. CONCLUSION: Children with MMC appear to have poorer hand skills than typically developed children, which was related to pathology as well as functional and environmental factors. When addressing hand dexterity in children with MMC, it is important that rehabilitation professionals continue to work with these children as they get older, and put greater emphasis on parent education using materials that are adapted to varying educational levels.

Predicting disability progression and cognitive worsening in multiple sclerosis using patterns of grey matter volumes

ObjectiveIn multiple sclerosis (MS), MRI measures at the whole brain or regional level are only modestly associated with disability, while network-based measures are emerging as promising prognostic markers. We sought to demonstrate whether data-driven patterns of covarying regional grey matter (GM) volumes predict future disability in secondary progressive MS (SPMS).MethodsWe used cross-sectional structural MRI, and baseline and longitudinal data of Expanded Disability Status Scale, Nine-Hole Peg Test (9HPT) and Symbol Digit Modalities Test (SDMT), from a clinical trial in 988 people with SPMS. We processed T1-weighted scans to obtain GM probability maps and applied spatial independent component analysis (ICA). We repeated ICA on 400 healthy controls. We used survival models to determine whether baseline patterns of covarying GM volume measures predict cognitive and motor worsening.ResultsWe identified 15 patterns of regionally covarying GM features. Compared with whole brain GM, deep GM and lesion volumes, some ICA components correlated more closely with clinical outcomes. A mainly basal ganglia component had the highest correlations at baseline with the SDMT and was associated with cognitive worsening (HR=1.29, 95% CI 1.09 to 1.52, p<0.005). Two ICA components were associated with 9HPT worsening (HR=1.30, 95% CI 1.06 to 1.60, p<0.01 and HR=1.21, 95% CI 1.01 to 1.45, p<0.05). ICA measures could better predict SDMT and 9HPT worsening (C-index=0.69–0.71) compared with models including only whole and regional MRI measures (C-index=0.65–0.69, p value for all comparison <0.05).ConclusionsThe disability progression was better predicted by some of the covarying GM regions patterns, than by single regional or whole-brain measures. ICA, which may represent structural brain networks, can be applied to clinical trials and may play a role in stratifying participants who have the most potential to show a treatment effect.

Efficacy of motor therapy over sensorimotor therapy in upper limb functions of post stroke patients

Introduction and Aim:Strokeis one of the leading causes of death and disability in India. The incidence of stroke rapidly increases with age, doubling for each decade after 55.In the majority of patients the upper limb is severely impaired than lower limb. The aim of this study was to analyze the efficacy of motor therapy over sensorimotor therapy in upper limb functions of post stroke patients. Materials and Methods: This was an experimental study, of pre-post type, that was conducted in the outpatient department of Physiotherapy at ACS Medical College and Hospital,chennai.30 samples were selected from 45 volunteers according to inclusion criteria and the study was conducted for Group A received sensorimotor therapy for one session/day for 6 days a week for 12 weeks. Group B received motor therapy for one session/day for 6 days a week for 12 weeks. Pre and post measurement were done using motor assessment scale, stroke upper limb capacity scale, action research arm test and nine-hole peg test. Results: There was a significant difference in mean values of group A and B on comparison. Group A seems to be more effective than group B. Conclusion: The study concludes that both motor therapy and sensorimotor therapy are beneficial in stroke rehabilitation, but sensorimotor therapy is more effective in improving the gross and fine motor skills of the upper limb of stroke patients.

Motor and Basic Cognitive Functions in Children with Acute Lymphoblastic Leukemia Undergoing Induction or Consolidation Chemotherapy

Children with acute leukemia (ALL) often suffer from several disease and treatment related side-effects during treatment. The aim of the present study was to determine the gross and fine motor functioning and basic cognitive performance of children (n = 25) with ALL who were undergoing induction or consolidation chemotherapy and to compare these characteristics to a normative group (n = 21) of age-matched typically developing children. We assessed the children’s motor functions with the Bruininks-Oseretsky Test of Motor Proficiency Second Edition-Short Form and the Nine-hole Peg Test, and we used the Modified Mini-Mental State Exam (MMSE) to evaluate their cognitive performance. Compared to the normative group, children with ALL had lower scores on total motor proficiency and sub-tests scores of motor functions ( p < .05), and on the Nine-hole Peg Test performance ( p < .05); but their cognitive performance on the MMSE was not significantly different. Children with ALL would likely benefit from structured exercise and rehabilitative interventions during chemotherapy to prevent and/or ameliorate ALL-related motor dysfunction. We also suggest that their cognitive functioning should be further investigated with more extensive well-validated neurocognitive tests for children (e.g., the Wechsler intelligence scales).