Adapted Timed Up and Go: A Rapid Clinical Test to Assess Gait and Cognition in Multiple Sclerosis

Abstract

Background/Aims: To measure the Timed Up and Go (TUG), imagined TUG (iTUG), and the difference of time between these two tests (delta time) in 20 patients with relapsing-remitting multiple sclerosis (RRMS) and 20 healthy age-matched controls and to examine whether an association with cognitive functions, motor impairment, and behavioral changes can be determined. Methods: The mean ± SD of TUG, iTUG and delta time were used as outcomes. Spatiotemporal gait parameters were recorded by a 12-camera optoelectronic system during straight walking at usual self-selected speed. Cognitive functions were assessed by a standardized neuropsychological examination. Results: Patients performed the TUG slower than the controls (10.00 ± 1.70 s vs. 8.71 ± 1.04 s, p = 0.01, respectively). The TUG was correlated with gait parameters, cognitive functions, and behavior, whereas delta time was correlated only with cognitive functions. Conclusion: TUG represents an interesting test to reveal subtle deficits in RRMS patients with low disability and is related to motor, cognitive, and behavioral functioning. Combining with the TUG, delta time could easily give additional information on specific cognitive functions in the assessment of patients with RRMS.

Gait Performance and Use of Mental Imagery as a Measure of Disease Progression in Amyotrophic Lateral Sclerosis

“…Both TUG and iTUG require cognitive and motor functions for their realizations and both have been correlated with these functions in previous studies [9][10][11]14] . TUG combines the 4 phases of sit-to-stand movement, initiation, acceleration and deceleration of gait, preparation of turning, turning and finally turning around to sit down [11] .…”

“…In schizophrenia, impaired TUG and iTUG were explained by alterations in executive function performances [10] . In relapsing-remitting multiple sclerosis, TUG was correlated with memory, attention and also with executive functions [11] . This study confirms the correlation between TUG and the ALSFRS-R shown by Montes et al [7] .…”

“…TUG combines the 4 phases of sit-to-stand movement, initiation, acceleration and deceleration of gait, preparation of turning, turning and finally turning around to sit down [11] . The iTUG involves an approach based on motor imagery, widely used by athletes to improve performance as well as in the rehabilitation for neurological diseases [15][16][17][18] .…”

“…However, to date, it has never been applied to explore gait abnormalities and disability in ALS. To study motor imagery of gait and balance, an imagined TUG (iTUG) has been validated in healthy older adults and in patients with neuropsychiatric conditions, and has been also associated with cognitive decline [9][10][11] . We hypothesized that both the TUG and iTUG are achievable in ALS patients and that they correlate with functional motor disability.…”

Sit-to-stand biomechanics of individuals with multiple sclerosis

“…It is currently unknown how muscle weakness affects STS movement mechanics for people with MS or the movement strategies people with MS use to perform the STS. Furthermore, prior investigations reporting leg strength deficits and slower movement times during the timed up and go and repeated STS movements have typically grouped all MS participants together regardless of leg strength (Allali et al, 2012;Dalgas et al, 2009). Not all persons with MS have leg strength deficits, and those who do not yet display leg weakness may not display the same STS movement mechanics or utilize the same movement strategies as persons with MS who have leg strength deficits.…”