Assessment of Upper Extremity Function in Multiple Sclerosis: Review and Opinion

Abstract

Upper extremity (UE) dysfunction may be present in up to ~80% of individuals with multiple sclerosis (MS), although its importance may be under-recognized relative to walking impairment, which is the hallmark symptom of MS. Upper extremity dysfunction affects independence and can impact the ability to use walking aids. Under-recognition of UE dysfunction may result in part from limited availability of performance-based and patient self-report measures that are validated for use in MS and that can be readily incorporated into clinical practice for screening and regularly scheduled assessments. In addition to the 9-Hole Peg Test, which is part of the Multiple Sclerosis Functional Composite, there are several performance-based measures that are generally used in the rehabilitation setting. These measures include the Box and Block Test, the Action Research Arm Test, the Test d'Evaluation de la performance des Membres Supérieurs des Personnes Agées, and the Jebsen-Taylor Test of Hand Function. Several of these measures were developed for use in stroke, although in contrast to stroke, which is characterized by unilateral dysfunction, UE impairment in MS is generally bilateral, and should be assessed as such. Similarly, patient-reported UE measures are available, including Disabilities of the Arm, Shoulder, and Hand (DASH) and its shorter version, QuickDASH, the Manual Ability Measure, and ABILHAND, although none has been psychometrically validated for MS. Recently, item response theory was used to develop a Neuro-QOL (Quality of Life) UE measure and a Patient-Reported Outcomes Measurement Information System UE measure; neither of these have demonstrated sensitivity to change, limiting their use for longitudinal assessment. Consequently, although work is still needed to develop and validate performance-based and patient-reported measures of UE function that are suitable for use in daily MS clinical practice, currently available UE measures can be recommended for incorporation into MS management, albeit with an understanding of their limitations.

Factors affecting the usability of an assistive soft robotic glove after stroke or multiple sclerosis

“…In the interviews, the need for assistance in opening the hand and fingers was commonly reported by the participants within a wide range of functioning and not only as a matter related to putting on the glove, but for a number of everyday life activities. The ability to actively extend the wrist and fingers is commonly impaired after a CNS lesion with upper extremity paresis (37,39). Thus, to meet the needs of a vast population living with limited hand function due to CNS disorders, assistance in opening function is a crucial function in addition to the closing function of an assistive and/or rehabilitative robotic glove.…”

Preliminary Development of the Hand and Arm Function Measure for People With Neurological Conditions

“…Therapists and other professionals need hand and arm function measurement tools that are relevant to individuals with neurological condition (Kraft et al, 2014;Velozo, Seel, Magasi, Heinemann, & Romero, 2012). The term 'measure' is defined as 'a system or scale of standard measuring units' when used in reference to hand and arm function measurement.…”

“…The existing literature reviews on upper extremity function measures conducted in recent years have been primarily related to stroke (Ashford et al, 2008;Lemmens et al, 2012) and do not provide a clear picture of the measures used for other neurological conditions. Other reviews for diagnostic groups such as multiple sclerosis have been conducted but they are narrative reviews that include selected measures (Kraft et al, 2014). (Metcalf, Adams, Burridge, Yule, & Chappell, 2007;Velstra et al, 2011).…”

“…The measure was developed by filtering items from the DASH, TEMPA, ABILHAND and Sollerman Hand Function Test (Chen, 2005 (Cella, 2015 the PROMIS® physical function domain has been established. However, it has shown limited sensitivity to change and lacks utility in the clinical population (Kraft et al, 2014). The upper extremity short form has limited research to support its use independently.…”

Finger tapping impairments are highly sensitive for evaluating upper motor neuron lesions

“…Tasks involving the tapping of fingers, with varying techniques, have been widely studied in various domains such as neuropsychiatry and behavioral neurology (as a predictor of IQ and reaction time) [4, 5], traumatic brain injury and stroke (as an indicator of motor recovery) [6, 7], and perhaps most commonly in Parkinsonism (as an index of bradykinesia and hypokinesia) [8]. Upper extremity dysfunction has been reported in up to 80% of patients with multiple sclerosis (MS), the most common demyelinating disease of the central nervous system (CNS) [9]. Impairments of manual fine motor skills can significantly impact the quality of life of patients with MS. A number of studies have specifically examined upper extremity-related fine motor control tasks in patients with MS [10–12].…”