Spasticity is one of the most commonly seen symptoms in patients with multiple sclerosis. However, evaluation of the symptom often uses clinical scales that do not incorporate its impact on ...activities of daily living and quality of life. The everyday life of patients is affected primarily in actions related to mobility and walking capacity, such as the use of transport, gardening, household activities and, ultimately, basic activities such as bathing and dressing. Yet, so far, no study has described the impact of spasticity on the daily life of patients with multiple sclerosis. Nevertheless, assessing the effects of spasticity on such a young population would appear to be essential for meeting the needs of these patients with appropriate therapeutic interventions.
Multiple sclerosis (MS) is a chronic progressive disease which is the leading cause, after road traffic accidents, of handicap in young subjects. The large range of symptoms associated with MS lead ...to continuing decline in mood and quality of life. Despite therapeutic advances, functional impairments have significant consequences. Neurorehabilitation can be highly contributive in this disease with the goals of increasing independence and quality-of-life and improving functional capacities. Individualized programs elaborated by a multidisciplinary team of experts are the key to success of rehabilitation. Assessment is difficult because of the underlying conflict between the philosophies of rehabilitation and evidence-based medicine. The aim of this paper is to provide an overview of MS rehabilitation. Physical exercise is safe and should be encouraged for people with MS. Some studies have shown that supervised exercises have a beneficial effect on MS disability and quality of life. Inpatient rehabilitation for MS yields short-term benefits in function, mobility and quality of life; periodic hospitalization may be needed. In the future, rehabilitation professionals will have to learn how to anticipate patient needs and lay the groundwork for services and equipment in advance. Rehabilitation is one of the treatments of MS patients and should be viewed as an ongoing process to maintain and restore maximum function and quality of life.
Objective The origin of the AIS is unknown. Several studies in AIS have shown disturbances of orthostatic postural control and somatosensory modality. The orthostatic postural control is the ability ...to organize the upright position on the earth-vertical, by multisensory central integration, especially somatosensory information. Our hypothesis is that the somatosensory disturbances in the AIS involve change in the organization of orthostatic postural control, around an erroneous central representation of verticality. Our objective is to test, in the AIS, the existence of a disturbance of the somatosensory modality in orthostatic postural control by measuring the Subjective Postural Vertical (SPV). Methods Uncontrolled preliminary study on 8 adolescents with SIA (7 girls, 13.8 ± 0.83 years, 38.8 ± 10.4° angle). Test = SPV measurement, vision obscured, head-trunk-members strapped, sitting on a seat, fixed to a German vertical wheel athletic gymnastics (external diameter: 1.90 m), with electronic inclinometer that measures the rotational tilt of the seat, with reference to the gravitational vertical. From 45° inclination, the subject is tilted (1°/sec) and evaluates the alignment with the vertical gravitational. Results AIS SPV = 7.48 ± 4.86° with a tilt predominance to the right. It is impossible to realize statistical evaluation in this preliminary study. Our results are comparable with those reported in pusher patient. Discussion This preliminary study shows a disturbance in the assessment of SPV in the AIS. Disorders of the central integration of somatosensory modality could explain this result. The authors are grateful to the Harps Association's members, for their helpful comments.
•APA are often used in neurologic diseases to evaluate risk of fall.•MS patients presented APA alterations, even at an early stage of the disease.•The posterior displacement is reduced during APA in ...MS.•APA could be an objective tool to measure gait disorders in an early stage of MS.
Multiple sclerosis (MS) causes balance and walking disorders. Gait initiation is the complex transition between standing and walking and is characterized by two distinct phases: the anticipatory postural adjustment (APA) phase followed by the execution of the first step phase.
To determine alterations in the APA during gait initiation in patients with MS.
A systematic search was conducted in May 2018. The search was carried out by the use of the following databases: PubMed, Web of Science and the Cochrane Library. The following keywords were used: MS, gait initiation, step initiation, and postural adjustment(s). Outcomes of interest were the variables generally used to assess APA, including electromyography, force-plate data, or video-based data, duration of APA, and length of first step. The Ottawa scale was used to assess the quality of the studies.
Eight case-control studies were included; one was a transverse study. A total of 215 MS patients and 116 healthy subjects were included with ages ranging from 22 to 76 years old. In MS patients, Expanded Disability Status Scale (EDSS) scores ranged from 0 to 7. APA CoP displacements were smaller in the anteroposterior axis. Four studies evaluated muscle activation during APA. The latencies of all muscles were delayed, and smaller magnitudes of muscle activity during APA were found, even in the early stage of disease. The first step was shorter in MS patients than in healthy patients. No previous study has reported joint movement or trunk inclination during gait initiation.
This review illustrates the gap in knowledge of APA alterations in MS patients. APA assessment in the early stage of MS could be an interesting measure to characterize balance, dynamic control and risk of fall for such patients.
Most multiple sclerosis (MS) patients experience some bladder, sexual, and/or bowel dysfunction during the course of the disease, which has been closely associated with the quality-of-life scores, ...including in patients with otherwise low disability. This underlines the need for identifying and treating these problems. Bladder dysfunction produces symptoms of urgency, frequency, and urge incontinence (due to bladder over activity and incomplete emptying), and is found in up to 80% of patients with MS. These symptoms occur in the early stage of the disease and require screening and rigorous monitoring. For many patients, treatment is effective and has been shown to reduce the risks of urologic complications, improve levels of continence, and enhance the patient's quality of life. Sexual disturbances are also present from the beginning and have and greatly influence the quality of life of the MS patient. The findings in the literature show substantial evidence that people with MS experience high levels of sexual dysfunction, most of them with hypoactive sexual behavior often associated with dissatisfaction in the relationship. The most common problems in women are lack of sexual interest and decreased libido, often with problems in orgasmic capacity, while men report erectile dysfunction and also lack of sexual interest. Unlike bladder dysfunction, there have been rather limited advances in the treatment of fecal incontinence and constipation specifically for patients with MS, despite a prevalence of up to 50%. Until now, the management of these problems has been empirical, with a lack of evaluated therapeutic regimes. Biofeedback retraining is an effective treatment in some patients with MS complaining of constipation or fecal incontinence. A response is more likely in patients with limited disability and a nonprogressive disease course. Since treatments and preventive strategies can manage many of these problems, we suggest increasing the focus on these aspects of the disease when consulting patients, including at early stages.
Objective The AIS is a three-dimensional deformation of the spine, frequent, potentially progressive, with unknown etiology. It is generally accepted as being multifactorial origin, including ...neurosensorial factors, with orthostatic postural control disorders. In particular, Assaiante et al. showed a selective impaired of the dynamic proprioceptive tract. However, the procedures used to establish this impaired are complex and require motion analysis laboratories, inaccessible in routine clinical practice. Our objective is to determine whether, by clinical equilibration tests, simple, realizable in routine care, it is possible to find the same result. Methods A cross-sectional study comparing 114 adolescents with right thoracic AIS (including 94 girls, mean age: 14.5 ± 1.9 years, Cobb angle: 35.7 ± 15.3°) with 81 matched non-scoliotic adolescents (including 69 girls, mean age: 14.1 ± 1.9 years) was conducted between January 2013 and March 2015. Three clinical equilibration tests are performed: a dynamic test (Fukuda stepping test-Utenberger), two static tests (Romberg sensitized Support monopodal eyes closed). Results For the static tests, no significant difference between the 2 groups. The difference is significant for the dynamic test, for the distance travelled ( P < 0.01) and the deviation angle ( P < 0.0001). Discussion Our study confirms Assaiante's results, suggesting a specific impairment of dynamic proprioceptive tract in AIS. This clinical equilibration tests can be performed in daily practice. It is necessary to assess their validity as a biomarker for screening and progression of the AIS. The authors are grateful to the Harps Association's members, for their helpful comments.
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