If disability is the gap between what an individual can do and what that individual would like to be able to do, then measures that assess only current ability fall short of describing the impact of ...disability on the individual.
The aim of this study was to examine a potential measure of disability, the gap between current movement ability and preferred movement ability, as recorded with the Movement Ability Measure (MAM). This investigation was performed by establishing the relationship between self-perceived current ability and other measures and examining the evidence of convergence or divergence between the gap and other measures.
This investigation was a descriptive study.
Thirty people who had multiple sclerosis and were ambulatory completed the MAM and 18 other measures of bodily function, activity, and participation. Item response theory methods were used to generate logit estimates of average current movement ability and separate abilities in the 6 dimensions of movement on the MAM. Pearson correlations were calculated between estimated abilities from the MAM and scores from measures expected to be associated with these estimated abilities, as well as between the MAM and additional measures in exploratory analyses of relationships.
The average current ability and the separate dimensions correlated moderately to strongly (.5-.8) with many of the measures expected to be related and showed additional moderately strong correlations in exploratory analyses. The average gap between current ability and preferred ability correlated moderately with pain (-.56) and a scale of current ability (.46) but diverged from many of the measures.
The limitations of this study included the lack of an intervention to assess the response of the gap to therapy and the use of multiple statistical tests with a small sample.
The evidence supports the convergent validity for current ability on the MAM but mostly the divergence of the gap. Additional research should compare the gap specifically with measures that assess patients' preferences when determining disability.
The purposes of this report were to: 1) determine the amount of upper extremity use in people with hemiparesis post stroke during their inpatient rehabilitation stay, and 2) to examine the ...relationships between upper extremity use and impairments and activity limitations at this early time point after stroke. We studied 34 subjects with mild-to-moderate acute hemiparesis (mean time since stroke = 9.3 days) and 10 healthy control subjects. Upper extremity use was measured over 24 hours using bilateral wrist accelerometers. Upper extremity impairments and activity limitations were measured using standard clinical techniques and tests. We found that healthy control subjects use their dominant and nondominant upper extremities 8-9 hours per day. Hemiparetic subjects used their affected and unaffected upper extremities substantially less than control subjects, 3.3 and 6.0 hours per day, respectively. Seven of ten impairment level measures and each of the activity level measures were related to affected upper extremity use. The impairment measures that were related to upper extremity use were those measures that assessed the ability to activate muscles (ie active range of motion and force production) and the measurement of shoulder pain. Our data show that affected upper extremity use is minimal during the inpatient rehabilitation stay, especially given that patients in this setting are required to have 3 hours of therapy per day. We speculate that accelerometer measurements of upper extremity use could be used in a variety of settings and that the objective information they provide would be of great value to clinicians as they select treatments and evaluate progress.
We studied how acute hemiparesis affects the ability to perform purposeful movements of proximal versus distal upper extremity segments. Given the gradient of corticospinal input to the spinal ...motoneuron pools, we postulated that movement performance requiring distal segment control (grasping) should be more impaired than movement performance requiring proximal segment control (reaching) in people with hemiparesis. We tested subjects with acute hemiparesis and control subjects performing reach and reach-to-grasp movements. Three characteristics of movement performance were quantified for each movement: speed, accuracy, and efficiency. For the reach, we calculated peak wrist velocity, endpoint error, and reach path ratio. For the grasp, we calculated peak aperture rate, aperture at touch, and aperture path ratio. To evaluate the relative deficits in reaching versus grasping, performance measures were converted to z-scores using control group means and standard deviations. For both the movements, movement times were longer and performance was more variable in the hemiparetic group compared to the control group. Hemiparetic z-scores indicated that relative deficits in movement speed were small in the two movements, with deficits in grasp being slightly greater than deficits in reach. Relative deficits in accuracy showed a trend for being larger in the reach compared to the grasp, but this difference did not reach statistical significance. In contrast, relative deficits in efficiency were larger in the grasp compared to the reach, with reaching efficiency near the range of normal performance. When considering data across all three movement characteristics, the ability to perform a purposeful movement with the distal segments was not clearly more disrupted than the ability to perform a purposeful movement with the proximal segments in people with acute hemiparesis.
We developed an influenza hemagglutinin (HA) pseudotype library encompassing Influenza A subtypes HA1-18 and Influenza B subtypes (both lineages) to be employed in influenza pseudotype ...microneutralization (pMN) assays. The pMN is highly sensitive and specific for detecting virus-specific neutralizing antibodies against influenza viruses and can be used to assess antibody functionality in vitro. Here we show the production of these viral HA pseudotypes and their employment as substitutes for wildtype viruses in influenza neutralization assays. We demonstrate their utility in detecting serum responses to vaccination with the ability to evaluate cross-subtype neutralizing responses elicited by specific vaccinating antigens. Our findings may inform further preclinical studies involving immunization dosing regimens in mice and may help in the creation and selection of better antigens for vaccine design. These HA pseudotypes can be harnessed to meet strategic objectives that contribute to the strengthening of global influenza surveillance, expansion of seasonal influenza prevention and control policies, and strengthening pandemic preparedness and response.
Highlights ► The immunity of the UK population to tetanus and diphtheria was evaluated. ► Increases in immunity were observed in accordance with the UK schedule. ► Glycoconjugate vaccines appear to ...have increased immunity in preschool age groups. ► Diphtheria immunity increased due to the change to the school-leaver booster. ► Currently there is a gap in immunity for both diseases in older adults.
Type 1 Gaucher disease (GD) is the most common lysosomal storage disorder. Previously, treatment for GD was limited to intravenous enzyme replacement therapies (ERTs). More recently, oral substrate ...reduction therapies (SRTs) were approved for treatment of GD. Although both therapies alleviate disease symptoms, attitudes toward SRTs and patient perceptions of health while using SRT have not been well established. Electronic surveys were administered to adults with GD and asked about treatment history, attitudes toward SRTs, and perception of health while using SRTs as compared to ERTs, if applicable to the participant. ERT users that were offered treatment with SRTs cited potential side effects, wanting more research on SRTs, and satisfaction with their current treatment regimen as reasons for declining SRTs. SRT users expressed convenience and less invasiveness as reasons for choosing SRTs. Additionally, those using SRTs most often perceived their health to be similar to when they previously used ERT. Participant responses illustrate that attitudes toward SRTs can be variable and that one particular treatment may not be ideal for all patients with GD depending on individual perceptions of factors such as convenience, invasiveness, or side effects. Thus, individuals with GD should be counseled adequately by healthcare providers about both ERTs and SRTs for treatment of GD now that SRTs are clinically available.
The aim of this study was to establish the concurrent validity and relative and absolute reliability, define the minimal detectable change, and evaluate the floor and ceiling effects of the Four ...Square Step Test (FSST) in ambulant persons with multiple sclerosis (pwMS). Twenty-five pwMS performed the FSST on two occasions, 8.1±4.1 days apart. During the first testing, session participants also reported their fall history, performed the Berg Balance Scale, Dynamic Gait Index, and completed the Activities-Specific Balance Confidence Scale. Performance on the FSST was significantly (P<0.001) and strongly associated with performance on the Berg Balance Scale (rs=-0.84), Dynamic Gait Index (rs=-0.81), and Activities-Specific Balance Confidence Scale (rs=-0.78). Relative reliability of the FSST was excellent (ICC2,1=0.922). The minimal detectable change estimate for the FSST was 4.6 s. The FSST is a valid and reliable measure of dynamic standing balance in ambulant pwMS. However, because a substantial change (43%) is required to demonstrate a real change in individual performance, the FSST is unlikely to be sensitive in detecting longitudinal change in dynamic standing balance.
Abstract Objective To investigate upper extremity muscle activation and recovery during the first few months after stroke. Methods Subjects with hemiparesis following stroke were studied performing a ...reaching task at an acute time point (mean = 9 days post-stroke) and then again at a subacute time point (mean = 109 days post-stroke). We recorded kinematics and electromyographic activity of six upper extremity muscles. Results At the acute time point, the hemiparetic group had delayed muscle onsets, lower modulation ratios, and higher relative levels of muscle activation (%MVIC) during reaching than controls. From the acute to the subacute time points, improvements were noted in all three variables. By the subacute phase, muscle onsets were similar to controls, while modulation ratios remained lower than controls and %MVIC showed a trend toward being greater in the hemiparetic group. Changes in muscle activation were differentially related to changes in reaching performance. Conclusions Our data show that improvements in muscle timing and decreases in the relative level of volitional activation may underlie improved reaching performance in the early months after stroke. Significance Given that stroke is one of the leading causes of persistent physical disability, it is important to understand how the ability to activate muscles changes during the early phases of recovery after injury.
The literature shows inconsistent evidence regarding the association between clinically assessed plantar-flexor (PF) spasticity and walking function in ambulatory persons with multiple sclerosis ...(pwMS). The use of a dynamometer-based spasticity measure (DSM) may help to clarify this association. Our cohort included 42 pwMS (27 female, 15 male; age: 42.9 +/- 10.1 yr) with mild clinical disability (Expanded Disability Status Scale score: 3.6 +/- 1.6). PF spasticity was assessed using a clinical measure, the modified Ashworth Scale (MAS), and an instrumented measure, the DSM. Walking function was assessed by the timed 25-foot walk test (T25FWT), the 6-minute walk test (6MWT), and the 12-item Multiple Sclerosis Walking Scale (MSWS-12). Spearman rho correlations were used to evaluate relationships between spasticity measures, measures of walking speed and endurance, and self-perceived limitations in walking. The correlation was small between PF spasticity and the T25FWT (PF maximum Max MAS rho = 0.27, PF Max DSM rho = 0.26), the 6MWT (PF Max MAS rho = -0.20, PF Max DSM rho = -0.21), and the MSWS-12 (PF Max MAS rho = 0.11, PF Max DSM rho = 0.26). Our results are similar to reports in other neurologic clinical populations, wherein spasticity has a limited association with walking dysfunction.
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