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MS research update – Walking improves with mental rehearsal – 8 November 2018

Summary

Motor imagery (MI) is a technique where you visualise yourself doing an activity without actually moving.  This technique is used by athletes to improve their performance and also by physiotherapists to help people regain movements. 

This study assessed walking in people with mild to moderate disability (EDSS 1.5 to 4.5) before and after practising MI for four weeks.  Participants were divided into three groups to test the effect of adding additional cues or prompts: MI alone, MI combined with rhythmic music, and MI with music plus additional simple instructions. 

All of the groups had improvements in walking speed and walking distance, with the biggest improvements seen in the group which practised MI combined with music and instructions.  Fatigue and quality of life improved significantly using cued MI, with the greatest changes seen after MI plus music and instructions.  Both types of cued MI also resulted in better synchronization of walking to fast and slow music.

The study shows that, if your walking is mildly impaired, mentally rehearsing walking could improve actual walking and this effect can be enhanced if you imagine walking while listening to rhythmic music with additional verbal cues.


Background

Motor imagery (MI) is a technique where you visualise yourself doing an activity without actually moving.  There is evidence to show that mentally practicing a task uses similar brain areas as actually doing the task, so imagining you are doing it can help develop the nerve pathways that control a movement. This technique is commonly used by athletes to rehearse movements and skills to improve their performance.

Physiotherapists also use this technique to help people regain movements.  Providing additional prompts, or cues, to the motor imagery, such as listening to rhythmic music and verbal instructions, help to reinforce the imagined movements.  This study compared differently cued and non-cued MI on walking, fatigue and quality of life to get a better idea of how motor imagery might be working. 

How this study was carried out

60 people with MS with mild to moderate levels of disability (EDSS 1.5 – 4.5) were recruited from an MS clinic in Austria.  They were assigned to three different groups:

  • MVMI - music and verbally cued MI – given CDs that contained verbal instructions to imagine walking tasks, together with instrumental music and, in time with the music,  simple instructions such as “stamp-stamp” or “large step”
  • MMI - music cued MI - given CDs that contained verbal instructions to imagine walking tasks, together with instrumental music
  • MI - MI alone - given CDs that contained verbal instructions to imagine walking tasks

Participants were given training and then asked to use the CDs to practise MI at home while sitting down for 17 minutes a day, six times per week for 4 weeks.  The main measures were walking speed (timed 25 foot walk) and walking distance (6 minute walk test) before and after the 4 weeks of treatment.  Participants also completed questionnaires to assess their fatigue levels and quality of life before and after treatment.  Finally, participants were videoed walking in time to fast and slow paced music to test their ability to synchronise movements with music.

What was found

All of the groups had significant improvements in walking speed and walking distance, with the biggest improvements seen in the MVMI group.  Fatigue and quality of life improved significantly using cued MI, with the greatest changes seen after MVMI.  Both types of cued MI also resulted in better synchronization of walking to fast and slow music with more even step length and xxx

What does it mean?

Mentally rehearsing walking improves actual walking and this effect is enhanced when you imagine walking while listening to rhythmic music with additional verbal cues. 

The researchers acknowledge that the study only collected data before and after the 4 weeks of practising motor imagery; there was no follow-up data.  This means that it is not possible to tell whether a single four week course of motor imagery would have a long lasting effect or whether regular practise would be necessary to maintain improvements.

Seebacher B, et al.
Effects and mechanisms of differently cued and non-cued motor imagery in people with multiple sclerosis: A randomised controlled trial.
Mult Scler. 2018 Aug 14. [Epub ahead of print]
Abstract

More about walking difficulties 

 Many people with MS have some difficulties with walking. Walking problems vary considerably from one person with MS to another. Common difficulties are:

  • Unsteadiness on walking or turning
  • Slower, shorter steps
  • Less confidence
  • Needing support from walls, furniture or other people
  • Tripping and stumbling
  • A heavy feeling in the legs when stepping forward
  • Weakness of the leg when weight is on it
  • Difficulty placing the foot on the ground

A symptom called foot drop can be experienced by some people with MS.

In MS, many of these problems are initially caused by the slowed or altered nerve conduction, which results in muscle weaknessspasm or spasticity (muscle stiffness) and sensory changes. However, other MS symptoms can have a large impact on walking, such as difficulties with balancepaintremordizziness and visual problems. For example, vision that is double, blurred or has altered depth perception can make it difficult to place your feet or judge steps and kerbs.

The best way forward depends on what is causing the walking difficulties. A health professional, such as a GP, MS nurse or physiotherapist can advise. Treatment may involve physiotherapy or drug treatments to alleviate specific underlying symptoms such as spasticity.

Research by topic areas...

Carers

Appleton D, Robertson N, Mitchell L, et al.
Our disease: a qualitative meta-synthesis of the experiences of spousal/partner caregivers of people with multiple sclerosis.
Scand J Caring Sci. 2018 Aug 24. [Epub ahead of print]
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Causes of MS

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Andersen C, Søndergaard HB, Bang Oturai D, et al.
Alcohol consumption in adolescence is associated with a lower risk of multiple sclerosis in a Danish cohort.
Mult Scler. 2018 Aug 20:1352458518795418. [Epub ahead of print]
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Black LJ, Rowley C, Sherriff J, et al.
A healthy dietary pattern associates with a lower risk of a first clinical diagnosis of central nervous system demyelination.
Mult Scler. 2018 Aug 7:1352458518793524. [Epub ahead of print]
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Co-existing conditions

Jakimovski D, Gandhi S, Paunkoski I, et al.
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Eur J Neurol. 2018 Aug 13. [Epub ahead of print]
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Diagnosis

Högg T, Wijnands JMA, Kingwell E, et al.
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Mult Scler Relat Disord. 2018 Aug 8;25:232-240. [Epub ahead of print]
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Brownlee WJ, Miszkiel KA, Tur C, et al.
Inclusion of optic nerve involvement in dissemination in space criteria for multiple sclerosis.
Neurology. 2018 Sep 18;91(12):e1130-e1134.
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van der Vuurst de Vries RM, Mescheriakova JY, Wong YYM, et al.
Application of the 2017 revised mcdonald criteria for multiple sclerosis to patients with a typical clinically isolated syndrome.
JAMA Neurol. 2018 Aug 6. [Epub ahead of print]
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Disease modifying drugs

Syed YY.
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Fragoso YD, Adoni T, Brooks JBB, et al.
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Lebrun C, Rocher F.
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CNS Drugs. 2018 Oct;32(10):939-949.
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Gudesblatt M, Wissemann K, Zarif M, et al.
Improvement in cognitive function as measured by Neurotrax in patients with relapsing multiple sclerosis treated with natalizumab: a 2-year retrospective analysis.
CNS Drugs. 2018 Aug 24. [Epub ahead of print]
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Vollmer B, Ontaneda D, Bandyopadhyay A, et al.
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Neurol Clin Pract. 2018 Aug;8(4):292-301.
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Diem L, Nedeltchev K, Kahles T, et al.
Long-term evaluation of NEDA-3 status in relapsing-remitting multiple sclerosis patients after switching from natalizumab to fingolimod.
Ther Adv Neurol Disord. 2018 Aug 9;11:1756286418791103.
abstract
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Deeks ED.
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CNS Drugs. 2018 Aug;32(8):785-796.
abstract

Day GS, Rae-Grant A, Armstrong MJ, et al.
Identifying priority outcomes that influence selection of disease-modifying therapies in MS.
Neurol Clin Pract. 2018 Jun;8(3):179-185.
abstract

Kister I, Spelman T, Patti F, et al.
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J Neurol Sci. 2018 Aug 15;391:72-76.
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Wijburg MT, Warnke C, Barkhof F, et al.
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J Neurol Neurosurg Psychiatry. 2018 Aug 12. pii: jnnp-2018-318261. [Epub ahead of print]
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Epstein DJ, Dunn J, Deresinski S.
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Open Forum Infect Dis. 2018 Jul 16;5(8):ofy174.
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Coret F, Pérez-Miralles FC, Gascón F, et al.
Onset of secondary progressive multiple sclerosis is not influenced by current relapsing multiple sclerosis therapies.
Mult Scler J Exp Transl Clin. 2018 Jun 26;4(2):2055217318783347.
abstract
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Hendin Travis L, Okai A, Cavalier S, et al.
Real-world observational evaluation of hair thinning in patients with multiple sclerosis receiving teriflunomide: is it an issue in clinical practice?
Neurol Ther. 2018 Aug 6. [Epub ahead of print]
abstract
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Petersen ER, Søndergaard HB, Laursen JH, et al.
Smoking is associated with increased disease activity during natalizumab treatment in multiple sclerosis.
Mult Scler. 2018 Aug 2:1352458518791753. [Epub ahead of print]
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Papadopoulos D, Mitsikostas DD.
Oral disease-modifying treatments for relapsing multiple sclerosis: a likelihood to achieve no evidence of disease activity or harm analysis.
CNS Drugs. 2018 Aug 1. [Epub ahead of print]
abstract

Drugs in development

Fox RJ, Coffey CS, Conwit R, et al.
Phase 2 trial of ibudilast in progressive multiple sclerosis.
N Engl J Med. 2018 Aug 30;379(9):846-855.
abstract

Wolinsky JS, Montalban X, Hauser SL, et al.
Evaluation of no evidence of progression or active disease (NEPAD) in patients with primary progressive multiple sclerosis in the ORATORIO trial.
Ann Neurol. 2018 Oct;84(4):527-536.
abstract
Read the full text of this paper

Nicholas RS, Han E, Raffel J, et al.
Over three decades study populations in progressive multiple sclerosis have become older and more disabled, but have lower on-trial progression rates: A systematic review and meta-analysis of 43 randomised placebo-controlled trials.
Mult Scler. 2018 Aug 24:1352458518794063. [Epub ahead of print]
abstract

Epidemiology

Harding K, Anderson V, Williams O, et al.
A contemporary study of mortality in the multiple sclerosis population of south east Wales.
Mult Scler Relat Disord. 2018 Aug 2;25:186-191. [Epub ahead of print]
abstract

Families

Messmer Uccelli M, Ponzio M.
A case-control study assessing parenting sense of competence in people with multiple sclerosis.
Rehabil Psychol. 2018 Aug;63(3):431-437.
abstract

Other

Lavorgna L, De Stefano M, Sparaco M, et al.
Fake news, influencers and health-related professional participation on the Web: A pilot study on a social-network of people with multiple sclerosis.
Mult Scler Relat Disord. 2018 Jul 31;25:175-178. [Epub ahead of print]
abstract
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Other treatments

Filli L, Werner J, Beyer G, et al.
Predicting responsiveness to fampridine in gait-impaired patients with multiple sclerosis.
Eur J Neurol. 2018 Sep 1. [Epub ahead of print]
abstract

Gado F, Digiacomo M, Macchia M, et al.
Traditional uses of cannabinoids and new perspectives in the treatment of multiple sclerosis.
Medicines (Basel). 2018 Aug 15;5(3). pii: E91.
abstract
Read the full text of this paper

Klineova S, Farber R, Friedman J, et al.
Objective and subjective measures of dalfampridine efficacy in clinical practice.
Mult Scler J Exp Transl Clin. 2018 Jul 9;4(3):2055217318786742.
abstract
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Cordano C, Armezzani A, Veroni J, et al.
Osteopathic manipulative therapy and multiple sclerosis: a proof-of-concept study.
J Am Osteopath Assoc. 2018 Aug 1;118(8):531-536.
abstract

Paediatric MS

Fadda G, Brown RA, Longoni G, et al.
MRI and laboratory features and the performance of international criteria in the diagnosis of multiple sclerosis in children and adolescents: a prospective cohort study.
Lancet Child Adolesc Health. 2018 Mar;2(3):191-204.
abstract

Hintzen RQ.
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Lancet Child Adolesc Health. 2018 Mar;2(3):161-162.
abstract

O'Mahony J, Marrie RA, Laporte A, et al.
Pediatric-onset multiple sclerosis is associated with reduced parental health-related quality of life and family functioning.
Mult Scler. 2018 Aug 30:1352458518796676. [Epub ahead of print]
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Omrani F, Sahraian MA, Saeen AA, et al.
Early-onset multiple sclerosis: reports of 300 patients from Iran.
J Pediatr Neurosci. 2018 Apr-Jun;13(2):137-140.
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Pregnancy and childbirth

MacDonald SC, McElrath TF, Hernández-Díaz S.
Pregnancy Outcomes in Women with Multiple Sclerosis.
Am J Epidemiol. 2018 Aug 28. [Epub ahead of print]
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Prognosis

Rahn AC, Köpke S, Stellmann JP, et al.
Magnetic resonance imaging as a prognostic disability marker in clinically isolated syndrome: A systematic review.
Acta Neurol Scand. 2018 Aug 8. [Epub ahead of print]
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Hughes J, Jokubaitis V, Lugaresi A, et al.
Association of inflammation and disability accrual in patients with progressive-onset multiple sclerosis.
JAMA Neurol. 2018 Aug 6. [Epub ahead of print]
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Tomassini V, Fanelli F, Prosperini L, et al.
Predicting the profile of increasing disability in multiple sclerosis.
Mult Scler. 2018 Aug 2:1352458518790397. [Epub ahead of print]
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Read the full text of this paper

Bhan A, Jacobsen C, Myhr KM, et al.
Neurofilaments and 10-year follow-up in multiple sclerosis.
Mult Scler. 2018 Sep;24(10):1301-1307.
abstract


Psychological aspects

Gill S, Santo J, Blair M, et al.
Depressive symptoms are associated with more negative functional outcomes than anxiety symptoms in persons with multiple sclerosis.
J Neuropsychiatry Clin Neurosci. 2018 Sep 6:appineuropsych18010011. [Epub ahead of print]
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Harand C, Mondou A, Chevanne D, et al.
Evidence of attentional impairments using virtual driving simulation in multiple sclerosis.
Mult Scler Relat Disord. 2018 Aug 4;25:251-257. [Epub ahead of print]
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Stern BZ, Strober L, DeLuca J, et al.
Subjective well-being differs with age in multiple sclerosis: A brief report.
Rehabil Psychol. 2018 Aug;63(3):474-478.
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Calandri E, Graziano F, Borghi M, et al.
Young adults' adjustment to a recent diagnosis of multiple sclerosis: The role of identity satisfaction and self-efficacy.
Disabil Health J. 2018 Aug 1. pii: S1936-6574(18)30139-0. [Epub ahead of print]
abstract

Rehabilitation

Kalina JT, Hinojosa J, Strober L, et al.
Randomized controlled trial to improve self-efficacy in people with multiple sclerosis: the community reintegration for socially isolated patients (CRISP) program.
Am J Occup Ther. 2018 Sep/Oct;72(5):7205205030p1-7205205030p8.
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Stennett A, De Souza L, Norris M.
The meaning of exercise and physical activity in community dwelling people with multiple sclerosis.
Disabil Rehabil. 2018 Aug 20:1-7. [Epub ahead of print]
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Guillamó E, Cobo-Calvo Á, Oviedo GR, et al.
Feasibility and effects of structured physical exercise interventions in adults with relapsing-remitting multiple sclerosis: a pilot study.
J Sports Sci Med. 2018 Aug 14;17(3):426-436. eCollection 2018 Sep.
abstract
Read the full text of this paper

Seebacher B, Kuisma R, Glynn A, et al.
Effects and mechanisms of differently cued and non-cued motor imagery in people with multiple sclerosis: A randomised controlled trial.
Mult Scler. 2018 Aug 14:1352458518795332. [Epub ahead of print]
abstract

Young HJ, Mehta TS, Herman C, et al.
The effects of m2m and adapted yoga on physical and psychosocial outcomes in people with multiple sclerosis.
Arch Phys Med Rehabil. 2018 Aug 6. pii: S0003-9993(18)30924-9. [Epub ahead of print]
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Motl RW, Pekmezi D, Wingo BC.
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Mult Scler J Exp Transl Clin. 2018 Jul 9;4(3):2055217318786745.
abstract
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Rocca MA, Meani A, Fumagalli S, et al.
Functional and structural plasticity following action observation training in multiple sclerosis.
Mult Scler. 2018 Aug 7:1352458518792771. [Epub ahead of print]
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Relapses

Findling O, Rust H, Yaldizli Ö, et al.
Balance changes in patients with relapsing-remitting multiple sclerosis: a pilot study comparing the dynamics of the relapse and remitting phases.
Front Neurol. 2018 Aug 21;9:686.
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Stem cells

Snowden JA, Sharrack B, Akil M, et al.
Autologous haematopoietic stem cell transplantation (aHSCT) for severe resistant autoimmune and inflammatory diseases - a guide for the generalist.
Clin Med (Lond). 2018 Aug;18(4):329-334.
abstract
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Symptoms and symptom management

Pommerich UM, Brincks J, Christensen ME.
Is there an effect of dietary intake on MS-related fatigue? - A systematic literature review.
Mult Scler Relat Disord. 2018 Aug 21;25:282-291. [Epub ahead of print]
abstract

Welk B, Hickling D, McKibbon M, et al.
A pilot randomized-controlled trial of the urodynamic efficacy of mirabegron for patients with neurogenic lower urinary tract dysfunction.
Neurourol Urodyn. 2018 Aug 31. [Epub ahead of print]
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Cadden MH, Guty ET, Arnett PA.
Cognitive reserve attenuates the effect of disability on depression in multiple sclerosis.
Arch Clin Neuropsychol. 2018 Aug 28. [Epub ahead of print]
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Aktan R, Ozalevli S, Ozakbas S.
Effects of cigarette smoking on respiratory problems and functional levels in multiple sclerosis patients.
Mult Scler Relat Disord. 2018 Aug 17;25:271-275. [Epub ahead of print]
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Domingo S, Kinzy T, Thompson N, et al.
Factors associated with sexual dysfunction in individuals with multiple sclerosis: implications for assessment and treatment.
Int J MS Care. 2018 Jul-Aug;20(4):191-197.
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Barbu RM, Berard JA, Gresham LM, et al.
Longitudinal stability of cognition in early-phase relapsing-remitting multiple sclerosis: does cognitive reserve play a role?
Int J MS Care. 2018 Jul-Aug;20(4):173-179.
abstract
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Kotterba S, Neusser T, Norenberg C, et al.
Sleep quality, daytime sleepiness, fatigue, and quality of life in patients with multiple sclerosis treated with interferon beta-1b: results from a prospective observational cohort study.
BMC Neurol. 2018 Aug 24;18(1):123.
abstract
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Alali D, Ballard K, Bogaardt H.
The frequency of dysphagia and its impact on adults with multiple sclerosis based on patient-reported questionnaires.
Mult Scler Relat Disord. 2018 Aug 8;25:227-231. [Epub ahead of print]
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Hüsch T, Reitz A, Ulm K, et al.
Ice water test in multiple sclerosis: A pilot trial.
Int J Urol. 2018 Aug 13. [Epub ahead of print]
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Drake MJ, Canham L, Cotterill N, et al.
Results of a randomized, double blind, placebo controlled, crossover trial of melatonin for treatment of Nocturia in adults with multiple sclerosis (MeNiMS).
BMC Neurol. 2018 Aug 6;18(1):107.
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Solaro CM, Ferriero G.
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Lamis DA, Hirsch JK, Pugh KC, et al.
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Tudor KI, Seth JH, Liechti MD, et al.
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Clin Auton Res. 2018 Aug 3. [Epub ahead of print]
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