Difficulties with movement and strength of the upper body can have an impact on many daily activities such as lifting or holding an item, such as a cup. Previous research has shown people with MS may have less hand grip strength than people without MS and others may need to use more force or effort to hold onto or move things. As grip strength is often used as an indicator of upper body function, this study aimed to see if there was a difference in hand grip between the dominant and non-dominant hands and if grip was different in people more affected by MS.
30 people with MS and 16 control participants took part in the study. They completed several tests including muscle strength tests and hand grip measurements using a handheld device.
The study found that in people with MS there was no difference in strength between their two hands, in controls the dominant hand was stronger. People more severely affected by MS tired more easily when trying to hold a grip over a period of time, as their muscles became fatigued and so their grip on the device weakened over time. The controls and those with mild to moderate MS were able to maintain their grip for longer. The researchers suggest this could be due to several factors such as trouble with nerves or muscle weakness. They suggest further research is needed to work out if other upper body muscles not just the hands are affected, and the impact that problems with gripping for a long time could have on daily life, such as with eating or holding on to a walking stick and if exercise or other rehabilitation could help to increase muscle stamina.
Difficulties with movement and strength of the upper body, including the arms and hands can be found in people with MS. This can have an impact on many daily activities such as lifting or holding an item, such as a cup. Many may have less grip strength and others may use more force or effort to hold onto or move things. This will use more energy and can increase fatigue and muscle tiredness. As grip strength is often used as an indicator of upper body function this study aimed to see if there was a difference in hand grip between the dominant and non-dominant hands and if grip was different in people more affected by MS.
How this study was carried out
30 people with MS in Belgium took part in the study. They were matched for age and gender with a control participant recruited from their family and colleagues. 16 control participants were studied.
Participants completed several tests:
- their EDSS score, a common measure of disability was assessed by a neurologist.
- they completed the Modified Fatigue Impact Scale (MFIS) questionnaire which assesses the impact of fatigue on daily life.
- the Motricity Index (MI) was used to assess arm muscle strength. This involves several tests including holding an object or lifting their arm against gravity as well as resistance from the tester.
- hand grip measurements were assessed using a handheld device that measured the strength of the grip. This included doing 15 hand grip contractions as hard as they could and also holding their grip for a period of 30 seconds.
- the dominant hand of each participants was identified by asking them the questions "are you currently left or right handed?" and "has this changed due to MS?"
17 PwMS had an EDSS score of less than 6 so were considered to be mild to moderately affected by MS and 13 had an EDSS score of 6 or above, so were considered to be more severely affected.
What was found
The study found that the maximum grip strength was significantly stronger in dominant hand than the non-dominant one in the control participants. In people with MS there was no difference in strength between their two hands. Most of the people with MS had some detectable muscle weakness. People more severely affected by MS tired more easily when trying to hold a grip over a period of time, as their muscles became fatigued and so their grip on the device weakened over time. The controls and those with mild to moderate MS were able to maintain their grip for longer.
What does it mean?
The study found that the muscles required for gripping something for a long period of time tired and fatigued more quickly in people more severely affected by MS than in those who were mild or moderately affected. The researchers suggest this could be due to several factors such as trouble with nerves or muscle weakness. They suggest further research is needed to work out if other upper body muscles, not just the hands, are affected and the impact that problems gripping for a long time could have on daily life, such as with eating or holding on to a walking stick and if exercise or other forms of rehabilitation could help to increase muscle stamina.
Severijns D, Lamers I, Kerkhofs L , et al.
Hand grip fatigability in persons with multiple sclerosis according to hand dominance and disease progression.
J Rehabil Med. 2014 Sep 30.[Epub ahead of print]
Read the full text of this paper
More about upper body strength and function in MS
Many people are probably already aware that people with MS may have difficulties with their walking. However many of the symptoms that can make walking more difficult, such as weakness, spasm, spasticity (muscle stiffness) and sensory changes, can also affect the upper body as well, making things like lifting, holding and feeling more difficult. Other MS symptoms can also have a large impact on upper body strength and function, such as difficulties with pain, tremor and visual problems. For example, vision that is double, blurred or has altered depth perception can make it difficult to judge where cup of tea is on the table and make it difficult to pick it up safely.
If you are experiencing difficulties with your arms, hands or upper body, you can speak to your MS nurse or GP who may refer you to physiotherapy or occupational therapy services. The best way forward depends on what is causing the difficulties. Treatment may involve physiotherapy or drug treatments to alleviate specific underlying symptoms such as spasticity or pain.
Muscle weakness and fatigue can also affect the upper body. Muscles that are not used regularly become weakened and require more energy to do tasks leading to increased fatigue. This can lead to a cycle of decline, as an already weak muscle that is not used will become weakened further. As muscle weakness in MS is due to problems with getting messages along the nerves rather than within the muscle itself, expending a great deal of energy by exercising to the point of exhaustion doesn't help the problem and can make fatigue and weakness worse. Exercise that works on building up endurance and strength in muscles without increasing fatigue is considered beneficial.
You can view or download some arm and hand exercises and strength exercises for people with MS, or you can watch our exercise videos online or order the free DVD. If you are concerned about fatigue, you might like to read Living with fatigue which gives tips on managing fatigue and maximising energy.
Research by topic areas...
Causes of MS
Gustavsen M, Page C, Moen S, et al.
Environmental exposures and the risk of multiple sclerosis investigated in a Norwegian case-control study.
BMC Neurol. 2014 Oct 3;14(1):196. [Epub ahead of print]
Read the full text of this paper (PDF)
Gianfrancesco MA, Acuna B, Shen L, et al.
Obesity during childhood and adolescence increases susceptibility to multiple sclerosis after accounting for established genetic and environmental risk factors.
Obes Res Clin Pract. 2014 Sep-Oct;8(5):e435-47.
Snyder J, Adams K, Crooks VA, et al.
"I knew what was going to happen if I did nothing and so I was going to do something": Faith, hope, and trust in the decisions of Canadians with multiple sclerosis to seek unproven interventions abroad.
BMC Health Serv Res. 2014 Sep 30;14(1):445.
Read the full text of this paper
Disease modifying treatments
Plavina T, Subramanyam M, Bloomgren G, et al.
Anti-JCV antibody levels in serum or plasma further define risk of natalizumab-associated PML.
Ann Neurol. 2014 Oct 1. [Epub ahead of print]
Read the full text of this paper (PDF)
Gueguen A, Roux P, Deschamps R, et al.
Abnormal inflammatory activity returns after natalizumab cessation in multiple sclerosis.
J Neurol Neurosurg Psychiatry. 2014 Sep;85(9):1038-40.
Sabanciogullari V, Cevik S, Karacan K, et al.
Dermatoglyphic features in patients with multiple sclerosis.
Neurosciences (Riyadh). 2014 Oct;19(4):281-5.
Smith CM, M Fitzgerald HJ, Whitehead L.
How fatigue influences exercise participation in men with multiple sclerosis.
Qual Health Res. 2014 Oct 1. [Epub ahead of print]
Phillips LH, Henry JD, Nouzova E, et al.
Difficulties with emotion regulation in multiple sclerosis: links to executive function, mood, and quality of life.
J Clin Exp Neuropsychol. 2014 Oct 2:1-12. [Epub ahead of print]
McLoughlin J, Lord SR, Barr C, et al.
A dorsiflexion assist orthosis reduces the physiological cost and mitigates deterioration in strength and balance associated with walking in people with multiple sclerosis.
Arch Phys Med Rehabil. 2014 Sep 25. [Epub ahead of print]
Pardini M, Uccelli A, Grafman J, et al.
Isolated cognitive relapses in multiple sclerosis.
J Neurol Neurosurg Psychiatry. 2014 Sep;85(9):1035-7.