Clinical Assessment of Fatigability in Multiple Sclerosis: A Shift from Perception to Performance

Seamon, Bryant A.; Harris‐Love, Michael O.

doi:10.3389/fneur.2016.00194

Cited by 16 publications

(10 citation statements)

References 35 publications

(49 reference statements)

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“…The NHPT is recommended as a gold standard to measure hand dexterity for its excellent psychometric properties. However, caution should be taken when assessing PwMS with low (EDSS < 3) or high disability (EDSS > 6) for its floor and ceiling effects, respectively (37). We reported an overall mean score of NHPT of 0.19 pegs/s ranging between 0.23 pegs/s of the mild-moderate group to 0.12 pegs/s of the severe non-ambulant group, which is below the cutoff values previously suggested (0.27 pegs/s) (15).…”

Section: Discussionmentioning

confidence: 99%

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Characterization of Upper Limb Impairments at Body Function, Activity, and Participation in Persons With Multiple Sclerosis by Behavioral and EMG Assessment: A Cross-Sectional Study

et al. 2020

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Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating and disabling disease which primarily affects individuals in their early life between 20 and 40 years of age. MS is a complex condition, which may lead to a variety of upper limb (UL) dysfunctions and functional deficits.Objective: To explore upper limb impairments at body function, activity, and participation in persons with MS (PwMS) and severe hand dexterity impairment by behavioral and surface electromyography (sEMG) assessments.Methods: This observational cross-sectional study involved 41 PwMS with severe hand dexterity impairment stratified according to the Expanded Disability Status Scale (EDSS) into mild-moderate (n = 17; EDSS, 1-5.5), severe ambulant (n = 15; EDSS, 6-6.5), and severe nonambulant (n = 9; EDSS, 7-9.5). Behavioral outcome measures exploring body function, activity, and participation were administered. The sEMG activity of six upper limb muscles of the most affected side was measured during a reaching task.Results: The most severe group was significantly older and more affected by secondary progressive MS than the other two groups. Positive significant associations between UL deterioration and impairments at different International Classification of Functioning, Disability, and Health domains were noted in the most severe group. The progressive decline in manual dexterity was moderately to strongly associated with the deterioration of the overall UL activity (ρ = 0.72; p < 0.001) and disuse (amount of use ρ = 0.71; p < 0.001; quality of movement ρ = 0.77; p < 0.001). There was a low correlation Valè et al.Upper Limb Impairments in Multiple Sclerosis between manual dexterity and UL function (ρ = 0.33; p = 0.03). The muscle activation pattern investigated by sEMG was characterized by a decrease in modularity and timing delay in the wrist extensor muscles activation in the severe ambulant patients (EDSS, 6-6.5). Similar impairments were observed in the proximal muscles (anterior deltoid) in the more advanced stages (EDSS ≥ 7). Conclusion:Behavioral assessment, together with measures of muscle activation patterns, allows investigating the pathophysiology of UL impairments in PwMS across progressive neurological disability severity to implement task-specific rehabilitation interventions.

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Section: Discussionmentioning

confidence: 99%

“…A possible explanation is that the UL disuse was likely to account for lower perceived fatigue. Fatigue is considered one of the most disabling symptoms affecting PwMS, leading to the limitation in UL activities and social participation (37). Both peripheral and central mechanisms have been described in MS-related fatigue (38).…”

Section: Discussionmentioning

confidence: 99%

Characterization of Upper Limb Impairments at Body Function, Activity, and Participation in Persons With Multiple Sclerosis by Behavioral and EMG Assessment: A Cross-Sectional Study

et al. 2020

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“…Such a model also allows possible underlying determinants of fatigue, perceived fatigability, and performance fatigability to be identified, and to be used in combination to inform the clinical decision-making process. Furthermore, simultaneous monitoring of each domain may provide a more comprehensive understanding of how fatigue and fatigability respond to specific interventions [74].…”

Section: Fatigue and Fatigability And Their Potential Interactions In...mentioning

confidence: 99%

Fatigability and the Role of Neuromuscular Impairments in Chronic Kidney Disease

et al. 2022

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Background: The combination of neuromuscular impairments plus psychosocial aspects of chronic kidney disease (CKD) may predispose these patients to greater risk for experiencing increased levels of fatigability. There has been extensive clinical and scientific interest in the problem of fatigue in CKD and end-stage kidney disease (ESKD) patients, whereas less attention has been directed to understanding fatigability. Accordingly, the primary purposes of this review are to (1) discuss fatigue and fatigability and their potential interactions in patients with CKD and ESKD, (2) provide evidence for increased fatigability in CKD and ESKD patients, (3) examine how commonly experienced neuromuscular impairments in CKD and ESKD patients may contribute to the severity of performance fatigability, and (4) highlight preliminary evidence on the effects of exercise as a potential clinical treatment for targeting fatigability in this population. Summary: Fatigue is broadly defined as a multidimensional construct encompassing a subjective lack of physical and/or mental energy that is perceived by the individual to interfere with usual or desired activities. In contrast, fatigability is conceptualized within the context of physical activity and is quantified as the interactions between reductions in objective measures of performance (i.e., performance fatigability) and perceptual adjustments regulating activity performance (i.e., perceived fatigability). We propose herein a conceptual model to extend current understandings of fatigability by considering the interactions among fatigue, perceived fatigability, and performance fatigability. Neuromuscular impairments reported in patients with CKD and ESKD, including reductions in force capacity, skeletal muscle atrophy, mitochondrial dysfunction, abnormal skeletal muscle excitability, and neurological complications, may each contribute to the greater performance fatigability observed in these patients. Key Messages: Considering the interactions among fatigue, perceived fatigability, and performance fatigability provides a novel conceptual framework to advance the understanding of fatigability in CKD and ESKD patients. Measures of fatigability may provide valuable clinical insights into the overall health status of CKD and ESKD patients. Existing data suggest that CKD and ESKD patients are at greater risk of experiencing increased fatigability, partly due to neuromuscular impairments associated with reduced kidney function. Further investigations are warranted to determine the potential clinical role fatigability measures can play in monitoring the health of CKD and ESKD patients, and in identifying potential treatments targeting fatigability in this patient population.

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“…It is unknown is whether GM volume loss occurs independently, or results from WM axonal transection with retrograde degeneration (49). Both cortical lesions and GM atrophy are independent predictors of cognitive impairment (50)(51)(52)(53)(54), epilepsy (55), fatigue (56,57), depression (58), and disability (59)(60)(61)(62). Assessment of baseline cognitive function was of less value in predicting the probability of future cognitive decline as were MRI measures (61)(62)(63).…”

Section: Discussionmentioning

confidence: 99%

Gray Matter Matters: A Longitudinal Magnetic Resonance Voxel-Based Morphometry Study of Primary Progressive Multiple Sclerosis

Rothstein

2020

Front. Neurol.

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Clinical Assessment of Fatigability in Multiple Sclerosis: A Shift from Perception to Performance

Cited by 16 publications

References 35 publications

Characterization of Upper Limb Impairments at Body Function, Activity, and Participation in Persons With Multiple Sclerosis by Behavioral and EMG Assessment: A Cross-Sectional Study

Characterization of Upper Limb Impairments at Body Function, Activity, and Participation in Persons With Multiple Sclerosis by Behavioral and EMG Assessment: A Cross-Sectional Study

Fatigability and the Role of Neuromuscular Impairments in Chronic Kidney Disease

Gray Matter Matters: A Longitudinal Magnetic Resonance Voxel-Based Morphometry Study of Primary Progressive Multiple Sclerosis

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