Multiple sclerosis is an increasingly prevalent disease, representing the leading cause of non-traumatic neurological disease in Europe and North America. The most common symptoms include gait deficits, balance and coordination impairments, fatigue, spasticity, dysphagia and an overactive bladder. Neurorehabilitation therapeutic approaches aim to alleviate symptoms and improve the quality of life through promoting positive immunological transformations and neuroplasticity. The purpose of this study is to evaluate the current treatments for the most debilitating symptoms in multiple sclerosis, identify areas for future improvement, and provide a reference guide for practitioners in the field. It analyzes the most cited procedures currently in use for the management of a number of symptoms affecting the majority of patients with multiple sclerosis, from different training routines to cognitive rehabilitation and therapies using physical agents, such as electrostimulation, hydrotherapy, cryotherapy and electromagnetic fields. Furthermore, it investigates the quality of evidence for the aforementioned therapies and the different tests applied in practice to assess their utility. Lastly, the study looks at potential future candidates for the treatment and evaluation of patients with multiple sclerosis and the supposed benefits they could bring in clinical settings.

/pdf/neurorehabilitation-in-multiple-sclerosis-a-review-of-3b0tji6d.pdf

Neurorehabilitation in Multiple Sclerosis—A Review of Present Approaches and Future Considerations

Remyelinating activities of Carvedilol or alpha lipoic acid in the Cuprizone-Induced rat model of demyelination.

Background and Objective Multiple sclerosis (MS) is a chronic, progressive, and autoimmune disease of the central nervous system (CNS) characterized by inflammation, demyelination, and axonal injury. In patients with newly diagnosed MS (ndMS), ataxia can present either as mild or severe and can be difficult to diagnose in the absence of clinical disability. Such difficulties can be eliminated by using decision support systems supported by machine learning methods. The present study aimed to achieve early diagnosis of ataxia in ndMS patients by using machine learning methods with spatiotemporal parameters. Materials and Methods The prospective study included 32 ndMS patients with an Expanded Disability Status Scale (EDSS) score of≤2.0 and 32 healthy volunteers. A total of 14 parameters were elicited by using a Win-Track platform. The ndMS patients were differentiated from healthy individuals using multiple classifiers including Artificial Neural Network (ANN), Support Vector Machine (SVM), the k-nearest neighbors (K-NN) algorithm, and Decision Tree Learning (DTL). To improve the performance of the classification, a Relief-based feature selection algorithm was applied to select the subset that best represented the whole dataset. Performance evaluation was achieved based on several criteria such as Accuracy (ACC), Sensitivity (SN), Specificity (SP), and Precision (PREC). Results ANN had a higher classification performance compared to other classifiers, whereby it provided an accuracy, sensitivity, and specificity of 89, 87.8, 90.3% with the use of all parameters and provided the values of 93.7, 96.6%, and 91.1% with the use of parameters selected by the Relief algorithm, respectively. Significance To our knowledge, this is the first study of its kind in the literature to investigate the diagnosis of ataxia in ndMS patients by using machine learning methods with spatiotemporal parameters. The proposed method, i. e. Relief-based ANN method, successfully diagnosed ataxia by using a lower number of parameters compared to the numbers of parameters reported in clinical studies, thereby reducing the costs and increasing the performance of the diagnosis. The method also provided higher rates of accuracy, sensitivity, and specificity in the diagnosis of ataxia in ndMS patients compared to other methods. Taken together, these findings indicate that the proposed method could be helpful in the diagnosis of ataxia in minimally impaired ndMS patients and could be a pathfinder for future studies.

Quantitative Assessment of Ataxia in Multiple Sclerosis Patients using Spatiotemporal Parameters: A Relief-Based Machine Learning Analysis

/pdf/correlation-between-physical-performance-and-stabilometric-3eta90dy.pdf

Correlation between Physical Performance and Stabilometric Parameters in Older Adults

This study aimed to compare trunk position sense, spine posture and postural stability, among non-radiographic axial spondyloarthritis (nr-axSpA), ankylosing spondylitis (AS) patients and healthy controls and explore the potential relationships between these parameters and disease-related characteristics. Twenty four patients with AS, 23 patients with nr-axSpA, and 24 age and gender-matched healthy controls were participated in this study. A digital inclinometer was used to measure trunk repositioning error (TRE) and spine posture. Postural stability was evaluated with a stabilometric platform. In addition, disease activity, spinal mobility and functional capacity were evaluated with Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index and Bath Ankylosing Spondylitis Functional Index, respectively. The 47 patients mean age was 38.83 ± 9.3 years and were 34 females and 13 males. TRE was higher in AS and nr-axSpA patients compared to control (p < 0.001). AS and nr-axSpA patients presented higher thoracic curvature and lower lumbal lordosis compared to controls (p < 0.05) whereas there was no significant difference between nr-axSpA and AS (p = 0.97). The degree of thoracic curvature was higher in AS compared to nr-axSpA (p = 0.002). Mediolateral stability in eyes closed was significantly higher in AS and nraxSpA than control (p = 0.001). Time since onset of symptoms, which might affect radiographic spinal damage, was significantly associated with TRE in patients with AS (r = 0.703, p = 0.005). Radiographic status may alter spinal mobility, spine posture and trunk position sense in axSpA patients. Different approaches might need to improve these parameters in different subtypes of axSpA. 

Trunk position sense, spine posture and static postural sway in axial spondyloarthritis patients: Relation to disease metrology, activity and functional status

Objectives: To investigate the effects of coordination and balance problems on gait and plantar pressure distribution in multiple sclerosis patients. Methods: This was an observational, cross-sectional study. It was conducted at Necmettin Erbakan University between March and December 2017. Twenty-four individuals with coordination problems, 36 individuals with balance problems and 32 healthy individuals were included in the study. The EDSS, Functional Reach Test, Dynamic Gait Index, baropodometry and stabilometry evaluations were performed. Results: There were significant differences between the groups (velocity p = 0.000, cadence p = 0.000, step width p = 0.018, step length p = 0.000, foot angle p = 0.000). Multiple comparisons demonstrated that the velocities and cadences of the coordination group were lower, while their step widths were found to be higher, compared to the balance group (p = 0.012, p = 0.004, p = 0.017, respectively). In static plantar pressure distribution, lateral forefoot pressure, lateral hindfoot pressure and medial hindfoot pressure were significantly different between the groups (p = 0.002, p = 0.000, respectively) Multiple comparisons showed that the pressure on the lateral part of the hindfoot in the coordination group was found to be significantly higher compared to the balance group (p = 0.002). According to the dynamic plantar pressure distribution, lateral forefoot, medial forefoot, lateral hindfoot and medial hindfoot pressures were significantly different between the groups (p  Conclusion: Coordination and balance problems affect gait and plantar pressure distribution. The identification of these changes will help physiotherapists determine specific therapeutic targets.

https://nsj.org.sa/content/nsj/24/4/269.full.pdf

Examination of the effects of coordination and balance problems on gait in ataxic multiple sclerosis patients.

Introduction: Multiple sclerosis (MS) is an autoimmune disease that causes scar tissue in the nervous system and seriously affects the quality of life of people. Muscle weakness, spasticity and coordination problems are seen primarily in the lower extremities. Strengthening exercises improve muscle strength in people with multiple sclerosis, but there is no consensus on their effect on walking capacity.
Methods: To determine the relationship between gluteus maximus muscle strength, ataxia, balance and walking capacity in Multiple Sclerosis. An experimental study design was applied. Gluteus maximus muscle strength was measured using a dynamometer. Walking capacity was determined by the 6-minute walk test (6MWT) and dynamic gait index (DGI). Balance was evaluated with the one-leg standing test (SLS). The severity of ataxia was measured with the International Ataxia Rating Scale (ICARS). Fatigue was evaluated with VAS and quality of life of all patients with SF36 short form.
Results: EDSS mean of the study = 3.39 ± 1.4; 2 men and 16 women with mean age = 37.17 ± 9.16 years were included. 6MWT, DGI, ALS, ICARS, VAS were different before and after treatment (p<0.05). There was no significant difference other than physical function and general health among the sub-parameters of SF36 (p>0.05). Correlation of muscle strength with ataxia, gait and balance was not significant (p>0.05)
Conclusion: In individuals with MS, the fact that the treatment program consists of modalities that include balance and sensory exercises as well as muscle strengthening exercises increases the success of rehabilitation.

/pdf/effects-of-gluteus-maximus-muscle-strength-on-ataxia-gait-3tms8ttn.pdf

Effects of Gluteus Maximus Muscle Strength on Ataxia, Gait, and Equilibrium in Multiple Sclerosis

Amaç: Bu çalışma, engelli bireylerin sağlık hizmet sunucuları içinde önemli bir role sahip olan hastaneleri tercih nedenlerini araştırmak, hastane tercih nedenlerinin katılımcıların tanımlayıcı özelliklerine göre farklılaşıp farklılaşmadığını belirlemek amacıyla yapılmıştır. 
Gereç ve Yöntem: Tanımlayıcı tipte yapılan çalışmanın evrenini engelli bireyler oluşturmaktadır. Verilerin analizinde bağımsız örneklem t-testi, ANOVA testi; gruplar arasındaki farkların belirlenmesi için post hoc testler uygulanmıştır.
Bulgular: Katılımcıların %61,6’sının erkek, %54,4’ünün evli, %51,2’sinin bedensel engelli ve %38,4’ünün 21 yıl ve üzeri süredir engelli olduğu belirlenmiştir. Ayrıca katılımcıların %56,8’inin son bir yılda 1-4 kez hastane başvurusu yaptığı, %44’ünün genel olarak devlet hastanesi tercih ettiği, %86,4’ünün hastane seçiminde konuma önem verdiği belirlenmiştir. 
Sonuç: Çalışma sonucunda hastane tercihinde hizmet kalitesi ve tüketiciye maliyet boyutları ilk sıralarda yer alırken; tanınırlık ve fiziki unsur boyutları daha az önemli görülmüştür. Hastane tercihinde en çok önem verilen unsurun hijyen ve temizlik; en az etkili olan unsurun ise hastanenin tabelası/logosu/renkleri olduğu belirlenmiştir.

/pdf/influential-factors-of-hospital-selection-a-sample-of-people-1g9c2er3.pdf

Influential factors of hospital selection: A sample of people with disabilities


 
 Wheelchair users spend a significant portion of their daily time sitting. This can lead to postural changes, imbalances in sitting pressure, and discomfort. Regulating sitting pressure and providing proper postural support is important not only for preventing pressure sores but also for increasing user satisfaction and quality of life.
 
 
 
 This study aims to evaluate user satisfaction by comparing initial and final measurements of seating pressure in wheelchairs with postural alignment.
 
 
 
 Seventeen wheelchair users with a mean age of 45 ± 10.7 years participated in the pilot study. Seating pressures were measured using pressure sensors at baseline and after intervention. User satisfaction was measured using a standard questionnaire assessing comfort, ease of use, and perceived safety.
 
 
 
 
 Significant improvements were observed between baseline and final sitting pressures, particularly in the posterior regions (
 p
 < 0.005; Cohen’s d = 0.59–0.78). Increases were observed in user satisfaction in the areas of comfort and perceived safety, but the changes were not statistically significant (
 p
 > 0.05).
 
 
 
 
 Balancing seating pressure with a pressure-regulating wheelchair system may increase user comfort and satisfaction. Objective assessment of pressure distribution can help optimize wheelchair settings, thereby improving both safety and quality of life. Larger sample sizes and long-term follow-up studies are required.


Evaluation of wheelchair satisfaction with wheelchair initial-final sitting pressure

Evaluation of hand muscle strength, deficiency and hand sensation in individuals with type 2 diabetes

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