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Valè N1, Gandolfi M1, Dimitrova E1, Mazzoleni S2, Battini E2, Benedetti MD1, Gajofatto A1, Ferraro F3, Castelli M4, Camin M4, Filippetti M1, Corradi J1, De Paoli C1, Picelli A1, Smania N1
1University of Verona, Verona, Italy, 2Biorobotics Institute, Scuola Superiore Sant'Anna di Pisa, Pisa, Italy, 3Azienda Sociosanitaria di Mantova, Department of Neuroscience, Mantua, Italy, 4ATSM Centro Franca Martini, Trento, Italy
Background: The impairment of the function and activity of the upper limb (UL) represent one of the emerging research areas in patients with Multiple Sclerosis (PwMS). UL dysfunction affects quality of life and independence on a ICF point of view. Although the literature emphasizes the relevance of rehabilitation in decreasing these impairments and improving quality of life, to date, further research is needed to identify the nature of UL neuromusclar dysfunction.
Purpose: Primary aim was to evaluate UL deficits in a PwMS cohort stratified by neurological involvement according to the EDSS scale. Secondary aim was to investigate muscle activation using surface electromyography (sEMG) during a standardized motor task.
Methods: A cross-sectional study was conducted on 42 PwMS (mean age 51±11 years; EDSS = 2-8) with functional deficits of UL. The patients were stratified in three groups: "mild" (EDSS 2-4; n=10); "moderate" (EDSS 4.5-6; n=15); "severe" (EDSS 6.5-8; n=17). Primary outcome: Action Research Arm test (ARAT). Secondary outcomes: Nine-Hole Peg Test (NHPT); Motricity Index (MI); Fugl-Meyer Assessment (FMA); Motor Activity Log (MAL); Visual Analogue Scale for Fatigue (VAS-F); Assessment of Life Habits (LIFE-H); MS Quality of Life-54 (MSQOL-54); evaluation of muscle activity with poly-EMGds. The sEMG acquisition was performed in 6 muscles of the UL with greater FI (anterior/posterior deltoid, biceps/triceps brachial, flexor/extensor carpi radials) during a standardized task (Grasp section of ARAT) repeated for 3 times.
Clinical data were analyzed with non-parametric tests (SPSS ver.23). For the multiple comparisons, the Bonferroni correction was applied (p≤0.016). Poly-EMGs signal was processed using routines developed in the Matlab environment (Mathworks Inc USA) and was normalized with respect to the EMG signal detected in the rest and MVC conditions.
Results: The three groups differed from each other about the age (p=0.028), manual dexterity (p=0.042), FMA scale score (p=0.025), amount of limb use (p=0.012), quality of movement (p=0.004) and perception in performing motor tasks of daily life both in terms of difficulty (p 0.001) and satisfaction (p=0.007). Post-hoc comparison between the three groups showed that the "mild" and "moderate" groups did not differ statistically significantly in the different outcome measures. The "mild" group differed from the "severe" group in terms of age (p=0.016), UL function evaluated by FMA (p=0.016) and the use of UL as quantity (p=0.009) as in quality (p=0.003). Furthermore, the "mild" group and the "severe" group did not differ in manual dexterity evaluated at the NHPT (p=0.022). The "moderate" and "severe" groups showed no significant differences both in terms of quantity (p=0.024) and quality (p=0.025) of UL use.
Preliminary analysis of sEMG data showed a progressive lower modulation of muscle activity in the patients of the "moderate" and "severe" groups.
Conclusion(s): This study shows as one of the first disorders is the misuse of the limb, and providing interesting insights into the pathophysiology of UL dysfunctions in PwMS.
Implications: These results showed different neuromuscolar dysfunction in PwMS related to neurological impairment. The present findings are relevant to identify different rehabilitation strategies based on the level of the impairment of the UL.
Keywords: Multiple sclerosis, Upper limb, Surface electromiography
Funding acknowledgements: The study was supported by a FISM (Fondazione Italiana Sclerosi Multipla onlus) grant no. 2013/R/24
Purpose: Primary aim was to evaluate UL deficits in a PwMS cohort stratified by neurological involvement according to the EDSS scale. Secondary aim was to investigate muscle activation using surface electromyography (sEMG) during a standardized motor task.
Methods: A cross-sectional study was conducted on 42 PwMS (mean age 51±11 years; EDSS = 2-8) with functional deficits of UL. The patients were stratified in three groups: "mild" (EDSS 2-4; n=10); "moderate" (EDSS 4.5-6; n=15); "severe" (EDSS 6.5-8; n=17). Primary outcome: Action Research Arm test (ARAT). Secondary outcomes: Nine-Hole Peg Test (NHPT); Motricity Index (MI); Fugl-Meyer Assessment (FMA); Motor Activity Log (MAL); Visual Analogue Scale for Fatigue (VAS-F); Assessment of Life Habits (LIFE-H); MS Quality of Life-54 (MSQOL-54); evaluation of muscle activity with poly-EMGds. The sEMG acquisition was performed in 6 muscles of the UL with greater FI (anterior/posterior deltoid, biceps/triceps brachial, flexor/extensor carpi radials) during a standardized task (Grasp section of ARAT) repeated for 3 times.
Clinical data were analyzed with non-parametric tests (SPSS ver.23). For the multiple comparisons, the Bonferroni correction was applied (p≤0.016). Poly-EMGs signal was processed using routines developed in the Matlab environment (Mathworks Inc USA) and was normalized with respect to the EMG signal detected in the rest and MVC conditions.
Results: The three groups differed from each other about the age (p=0.028), manual dexterity (p=0.042), FMA scale score (p=0.025), amount of limb use (p=0.012), quality of movement (p=0.004) and perception in performing motor tasks of daily life both in terms of difficulty (p 0.001) and satisfaction (p=0.007). Post-hoc comparison between the three groups showed that the "mild" and "moderate" groups did not differ statistically significantly in the different outcome measures. The "mild" group differed from the "severe" group in terms of age (p=0.016), UL function evaluated by FMA (p=0.016) and the use of UL as quantity (p=0.009) as in quality (p=0.003). Furthermore, the "mild" group and the "severe" group did not differ in manual dexterity evaluated at the NHPT (p=0.022). The "moderate" and "severe" groups showed no significant differences both in terms of quantity (p=0.024) and quality (p=0.025) of UL use.
Preliminary analysis of sEMG data showed a progressive lower modulation of muscle activity in the patients of the "moderate" and "severe" groups.
Conclusion(s): This study shows as one of the first disorders is the misuse of the limb, and providing interesting insights into the pathophysiology of UL dysfunctions in PwMS.
Implications: These results showed different neuromuscolar dysfunction in PwMS related to neurological impairment. The present findings are relevant to identify different rehabilitation strategies based on the level of the impairment of the UL.
Keywords: Multiple sclerosis, Upper limb, Surface electromiography
Funding acknowledgements: The study was supported by a FISM (Fondazione Italiana Sclerosi Multipla onlus) grant no. 2013/R/24
Topic: Disability & rehabilitation; Neurology: multiple sclerosis; Musculoskeletal: upper limb
Ethics approval required: Yes
Institution: Azienda Ospedaliera Universitaria Integrata Verona
Ethics committee: Nucleo ricerca clinica - Research and Biostatistic Support Unit
Ethics number: 230CESC
All authors, affiliations and abstracts have been published as submitted.
