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MS research update - Hands, arms and shoulders: the effects of MS - 01 November 2012

This study looked at how well the upper extremity (meaning the hand, arm and shoulder) functioned. It looked at someone's strength and also whether they experienced sensations in the hand in a similar way to a person who did not have MS.

How the study was carried out

22 people with MS took part in the study. The average age was 39 but ranged from 30 to 47. Disability was measured using the EDSS scale and averaged 2.0. This means that this group was not severely affected by MS as, on average, they had minimal disability in one functional system, such as vision or bowel and bladder function, and could walk unaided. You can read more about the eight functional systems and the EDSS score in the A-Z of MS. Ten healthy controls also took part.

Upper extremity function was tested using the nine hole peg test. In this test, you sit at a table with a small, shallow container holding nine pegs and a block containing nine empty holes. You are asked to pick up the nine pegs, one at a time, as quickly as possible, put them in the nine holes and, once they are in the holes, remove them again as quickly as possible one at a time, replacing them into the shallow container. The total time to complete the task is recorded. You can watch a video (26 seconds) of the test here.

Testing upper extremity strength included looking at strength and mobility in the shoulder and the elbow, the ability to grip with the hand and to pinch together the fingers and thumb.

The ability to feel sensations on the skin was tested in three ways. Firstly, the threshold at which someone could feel light touch; secondly, how long they could feel the vibration of a tuning fork; thirdly how short a distance could be distinguished between two impressions on the skin.

What was found

The researchers found that people with MS performed less well on the tests of strength and function of the upper limb and also on the tests of light touch, distinguishing two points on the skin and sensing vibrations.

They also found that the results on some of the test results were related, meaning that if someone performed better or worse on one test, they also performed correspondingly better or worse on certain other tests. In this study, performance on the light touch pressure sensation tests of the thumb and index fingers, the two point discrimination of the index finger and the elbow flexion (bending the elbow) strength test were related to the upper extremity function (nine hole peg) test results.

What does it mean?

The study showed that the ability to feel sensations in the hand, as well as the strength and function of the upper limb were affected in people with MS although their overall level of disability was low. The study also showed that some of these changes are related. The researchers comment that exercises that strengthen the upper extremity and also sensorial training of the hand may be helpful in maintaining upper extremity function.

Guclu-Gunduz A, Citaker S, Nazliel B, et al.
Upper extremity function and its relation with hand sensation and upper extremity strength in patients with multiple sclerosis.
NeuroRehabilitation. 2012;30(4):369-74.
abstract

More about sensory changes and keeping mobile

You can read more about sensory changes, also known as dysaesthesia, in the A-Z of MS.

There are suggestions on suitable exercise for people with MS including the Move it for MS DVD.

Physiotherapy can be helpful for managing spasticity, spasms and balance as well as maximising mobility. Rehabilitation can also help someone to live their life as fully as possible. 

Research by topic areas...

Symptoms and symptom management

Pokryszko-Dragan A, Bilińska M, Gruszka E, et al.
Sleep disturbances in patients with multiple sclerosis.
Neurol Sci. 2012 Oct 30. [Epub ahead of print]
abstract

Disease modifying treatments

Rinaldi F, Seppi D, Calabrese M, et al.
Switching therapy from natalizumab to fingolimod in relapsing-remitting multiple sclerosis: clinical and magnetic resonance imaging findings.
Mult Scler. 2012 Nov;18(11):1640-3.
abstract

Assessment tools

Sjonnesen K, Berzins S, Fiest KM, et al.
Evaluation of the 9-item Patient Health Questionnaire (PHQ-9) as an assessment instrument for symptoms of depression in patients with multiple sclerosis.
Postgrad Med. 2012 Sep;124(5):69-77.
abstract

Barrett L, Cano S, Zajicek J, et al.
Can the ABILHAND handle manual ability in MS?
Mult Scler. 2012 Oct 24. [Epub ahead of print]
abstract

Amtmann D, Bamer AM, Noonan V, et al.
Comparison of the psychometric properties of two fatigue scales in multiple sclerosis.
Rehabil Psychol. 2012 May;57(2):159-66.
abstract

Phan-Ba R, Calay P, Grodent P, et al.
A corrected version of the Timed-25 Foot Walk Test with a dynamic start to capture the maximum ambulation speed in multiple sclerosis patients.
NeuroRehabilitation. 2012;30(4):261-6.
abstract

Quality of life

Beckerman H, Kempen JC, Knol DL, et al.
The first 10 years with multiple sclerosis: The longitudinal course of daily functioning.
J Rehabil Med. 2012 Oct 25. doi: 10.2340/16501977-1079. [Epub ahead of print]
abstract

Causes of MS

Martínez-Sernández V, Figueiras A.
Central nervous system demyelinating diseases and recombinant hepatitis B vaccination: a critical systematic review of scientific production.
J Neurol. 2012 Oct 20. [Epub ahead of print]
abstract

Paediatric MS

Spiro DB.
Early onset multiple sclerosis: a review for nurse practitioners.
J Pediatr Health Care. 2012 Nov;26(6):399-408.
abstract

Psychological aspects

Skokou M, Soubasi E, Gourzis P.
Depression in multiple sclerosis: a review of assessment and treatment approaches in adult and pediatric populations.
ISRN Neurol. 2012;2012:427102.
abstract

Physical activity

Mark VW, Taub E, Uswatte G, et al.
Constraint-induced movement therapy for the lower extremities in multiple sclerosis: case series with 4-year follow-up.
Arch Phys Med Rehabil. 2012 Oct 27. doi:pii: S0003-9993(12)01063-5. 10.1016/j.apmr.2012.09.032. [Epub ahead of print]
abstract

Pregnancy and childbirth

Giannini M, Portaccio E, Ghezzi A, et al.
Pregnancy and fetal outcomes after glatiramer acetate exposure in patients with multiple sclerosis: a prospective observational multicentric study.
BMC Neurol. 2012 Oct 22;12(1):124. [Epub ahead of print]
abstract

Bone health

Dobson R, Ramagopalan S, Giovannoni G, et al.
Risk of fractures in patients with multiple sclerosis: A population-based cohort study.
Neurology. 2012 Oct 30;79(18):1934-5.
abstract

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