Pamukkale University, School of Physiotherapy and Rehabilitation, Denizli Turkiye.
Pamukkale University, School of Physiotherapy and Rehabilitation, Denizli Turkiye.
Mult Scler Relat Disord. 2018 Aug;24:101-106. doi: 10.1016/j.msard.2018.06.013. Epub 2018 Jun 28.
BACKGROUND: Multiple sclerosis (MS) involves impaired trunk control, leading to impaired upper-limb functionality, dexterity, and independence. Deciding early on a comprehensive approach pointing of functional disturbances and personal needs is essential for a multimodal, individualized, goal-oriented assessment and treatment program, recognizing the broad range of symptoms and disabilities associated with MS. In clinical practice, postural control of the trunk is purported to be an important contributor to voluntary upper-limb function, including motor control and dexterity. The objective of this study was to point out the impairments of and relationship between trunk control and comprehensive upper-limb functions in individuals with MS. METHODS: Tasks that were sought are optimal screening for deterioration in trunk control (Trunk Control Test [TCT] and Trunk Impairment Scale [TIS]) and upper-limb functionality by comparing them with the Expanded Disability Status Scale (EDSS), Nine Hole Peg Test (NHPT), Duruoz's Hand Index (DHI), and Functional Independence Measurement (FIM) results of 49 well-defined relapsing-remitting MS (RRMS) participants with those of 49 age-gender matched healthy subjects. RESULTS: Significant differences between the groups were evident across all tasks of the clinical tests studied (p < 0.05), except the TCT-balance in sitting position subscore. EDSS, NHPT, DHI, and FIM scores were highly correlated with the TCT subscores (rolling to weak side, sitting up from lying down) and TCT-total score, as well as TIS subscores (dynamic and coordination) and TIS total score (p ≤ 0.005). While TIS subscores were highly correlated with almost all parameters, just TIS-static subscore did not correlate with the DHI and FIM-cognitive scores. Also, DHI-hygiene subscore correlated poorly just with the TIS-coordination and TCT-coming to sitting position (p < 0.05). CONCLUSION: We found that patients with MS would present impaired upper-limb movement and decreased trunk control with high correlation between them, even in RRMS and in the very mild form of the disease. Identifying trunk control deficits provides better insight into dexterous difficulties of patients with MS and allows a more targeted neurorehabilitation focusing on upper limbs. In future studies, it would be of interest to examine the prognostic value of trunk control and upper-limb functionality in patients with MS using a longitudinal approach.
背景:多发性硬化症(MS)涉及躯干控制受损,导致上肢功能、灵活性和独立性受损。早期确定全面的方法,指出功能障碍和个人需求,对于多模式、个体化、以目标为导向的评估和治疗方案至关重要,因为 MS 与广泛的症状和残疾有关。在临床实践中,据推测躯干的姿势控制对自愿性上肢功能(包括运动控制和灵活性)有重要贡献。本研究的目的是指出 MS 患者躯干控制和综合上肢功能的损伤及其之间的关系。
方法:通过将 Trunk Control Test(TCT)和 Trunk Impairment Scale(TIS)与 Expanded Disability Status Scale(EDSS)、Nine Hole Peg Test(NHPT)、Duruoz's Hand Index(DHI)和 Functional Independence Measurement(FIM)的结果进行比较,寻找最佳的躯干控制恶化筛查方法,对 49 名明确诊断的复发缓解型多发性硬化症(RRMS)患者和 49 名年龄性别匹配的健康对照者进行研究。
结果:除了 TCT-坐位平衡亚分外,两组在所有研究的临床测试任务中均有显著差异(p<0.05)。EDSS、NHPT、DHI 和 FIM 评分与 TCT 子评分(向弱侧滚动、从卧位坐起)和 TCT 总分,以及 TIS 子评分(动态和协调)和 TIS 总分高度相关(p≤0.005)。虽然 TIS 子评分与几乎所有参数高度相关,但只有 TIS-静态子评分与 DHI 和 FIM-认知评分无关。此外,DHI-卫生子评分仅与 TIS-协调和 TCT-坐起位置相关(p<0.05)。
结论:我们发现,即使在 RRMS 和疾病的非常轻度形式中,MS 患者也会出现上肢运动受损和躯干控制能力下降,且二者之间存在高度相关性。识别躯干控制缺陷可以更好地了解 MS 患者的灵巧困难,并允许更有针对性的神经康复,重点是上肢。在未来的研究中,使用纵向方法检查 MS 患者躯干控制和上肢功能的预后价值将是很有意义的。
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