Impaired manual dexterity is frequent and disabling in patients with multiple sclerosis (MS), affecting activities of daily living (ADL) and quality of life.
Objective:
We aimed to evaluate the effectiveness of a standardized, home-based training program to improve manual dexterity and dexterity-related ADL in MS patients.
Methods:
This was a randomized, rater-blinded controlled trial. Thirty-nine MS patients acknowledging impaired manual dexterity and having a pathological Coin Rotation Task (CRT), Nine Hole Peg Test (9HPT) or both were randomized 1:1 into two standardized training programs, the dexterity training program and the theraband training program. Patients trained five days per week in both programs over a period of 4 weeks. Primary outcome measures performed at baseline and after 4 weeks were the CRT, 9HPT and a dexterous-related ADL questionnaire. Secondary outcome measures were the Chedoke Arm and Hand Activity Inventory (CAHAI-8) and the JAMAR test.
Results:
The dexterity training program resulted in significant improvements in almost all outcome measures at study end compared with baseline. The theraband training program resulted in mostly non-significant improvements.
Conclusion:
The home-based dexterity training program significantly improved manual dexterity and dexterity-related ADL in moderately disabled MS patients. Trial Registration NCT01507636.
KammCPUitdehaagBMPolmanCH. Multiple sclerosis: Current knowledge and future outlook. Eur Neurol2014; 72: 132–141.
2.
JohanssonSYtterbergCClaessonIM. High concurrent presence of disability in multiple sclerosis. Associations with perceived health. J Neurol2007; 254: 767–773.
3.
ChruzanderCJohanssonSGottbergK. A 10-year follow-up of a population-based study of people with multiple sclerosis in Stockholm, Sweden: Changes in disability and the value of different factors in predicting disability and mortality. J Neurol Sci2013; 332: 121–127.
4.
KierkegaardMEinarssonUGottbergK. The relationship between walking, manual dexterity, cognition and activity/participation in persons with multiple sclerosis. Mult Scler2012; 18: 639–646.
5.
AbbasDGehannoJFCaillardJF. Characteristics of patients suffering from multiple sclerosis according to professional situation. Ann Readapt Med Phys2008; 51: 386–393.
6.
SpoorenAITimmermansAASeelenHA. Motor training programs of arm and hand in patients with MS according to different levels of the ICF: A systematic review. BMC Neurol2012; 12: 49.
7.
CarpinellaICattaneoDBertoniR. Robot training of upper limb in multiple sclerosis: Comparing protocols with or without manipulative task components. IEEE Trans Neural Syst Rehabil Eng2012; 20: 351–360.
8.
KalronAGreenberg-AbrahamiMGelavS. Effects of a new sensory re-education training tool on hand sensibility and manual dexterity in people with multiple sclerosis. NeuroRehabilitation2013; 32: 943–948.
9.
PlatzTWinterTMüllerN. Arm ability training for stroke and traumatic brain injury patients with mild arm paresis: A single-blind, randomized, controlled trial. Arch Phys Med Rehabil2001; 82: 961–968.
RombergAVirtanenARuutiainenJ. Effects of a 6-month exercise program on patients with multiple sclerosis: A randomized study. Neurology2004; 63: 2034–2038.
12.
PolmanCHReingoldSCBanwellB. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol2011; 69: 292–302.
13.
MendozaJEApostolosGTHumphreysJD. Coin Rotation Task (CRT): A new test of motor dexterity. Arch Clin Neuropsychol2009; 24: 287–292.
14.
HeldnerMRVanbellingenTBohlhalterS. The Coin Rotation Task: A valid test for manual dexterity in multiple sclerosis. Phys Ther2014; Jun19. [Epub ahead of print]
15.
Oxford GriceKVogelKALeV. Adult norms for a commercially available Nine Hole Peg Test for finger dexterity. Am J Occup Ther2003; 57: 570–573.
16.
KurtzkeJF. Rating neurologic impairment in multiple sclerosis: An Expanded Disability Status Scale (EDSS). Neurology1983; 33: 1444–1452.
17.
Schmitz-HübschTdu MontcelSTBalikoL. Scale for the assessment and rating of ataxia: Development of a new clinical scale. Neurology2006; 66: 1717–1720. Erratum in Neurology 2006; 67: 299.
18.
BohannonRWSmithMB. Interrater reliability of a Modified Ashworth Scale of muscle spasticity. Phys Ther1987; 67: 206–207.
19.
NasreddineZSPhillipsNABédirianV. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53: 695–699.
20.
KruppLBLaRoccaNGMuir-NashJ. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol1989; 46: 1121–1123.
21.
Medical Research Council. Aids to the examination of the peripheral nervous system, Memorandum no. 45. London: Her Majesty’s Stationery Office, 1981.
22.
KammCPHeldnerMRVanbellingenT. Limb apraxia in multiple sclerosis: Prevalence and impact on manual dexterity and activities of daily living. Arch Phys Med Rehabil2012; 93: 1081–1085.
23.
Hanna-PladdyBMendozaJEApostolosGT. Lateralised motor control: Hemispheric damage and the loss of deftness. J Neurol Neurosurg Psychiatry2002; 73: 574–577.
24.
GebhardtAVanbellingenTBarontiF. Poor dopaminergic response of impaired dexterity in Parkinson’s disease: Bradykinesia or limb kinetic apraxia?Mov Disord2008; 23:1701–1706.
25.
VanbellingenTKerstenBBellionM. Impaired finger dexterity in Parkinson’s disease is associated with praxis function. Brain Cogn2011; 77: 48–52.
26.
YancosekKEHowellDJ. A narrative review of dexterity assessments. Hand Ther2009; 22: 258–269.
27.
SunderlandA. Recovery of ipsilateral dexterity after stroke. Stroke2000; 31: 430–433.
28.
BarrecaSRStratfordPWLambertCL. Test-retest reliability, validity, and sensitivity of the Chedoke arm and hand activity inventory: A new measure of upper-limb function for survivors of stroke. Arch Phys Med Rehabil2005; 86: 1616–1622.
29.
PaltamaaJWestHSarasojaT. Reliability of physical functioning measures in ambulatory subjects with MS. Physiother Res Int2005; 10: 93–109.
30.
BenjaminiYHochbergY. Controlling the false discovery rate: A practical and powerful approach to multiple testing. J Royal Stat Soc1995; 57: 289–300.
31.
CohenJ. Quantitative measures in psychology. Psychol Bull1992; 1: 155–159.
32.
RodgersHShawLPriceC. Study design and methods of the BoTULS trial: A randomized controlled trial to evaluate the clinical effect and cost effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A. Trials2008; 9: 59.
33.
KhanFPallantJFBrandC. Effectiveness of rehabilitation intervention in persons with multiple sclerosis: A randomised controlled trial. J Neurol Neurosurg Psychiatry2008; 79: 1230–1235.
34.
CraytonHHeymanRARossmanHS. A multimodal approach to managing the symptoms of multiple sclerosis. Neurology2004; 14: 12–18.
35.
PattiFCiancioMRCacopardoM. Effects of a short outpatient rehabilitation treatment on disability of multiple sclerosis patients – a randomised controlled trial. J Neurol2003; 250: 861–866.
