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Assessing upper limb function with ALSFRS-R in amyotrophic lateral sclerosis patients
Susana Pinto1, Marta Gromicho1, Mamede de Carvalho1,2
1a Instituto de Medicina Molecular and Institute of Physiology, Faculty of Medicine , University of Lisbon , Lisbon , Portugal and.
Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration
|April 30, 2019
Summary
The revised functional ALS rating scale (ALSFRS-R) assesses functionality in ALS patients. However, hand dominance, particularly in right-handed individuals with left upper limb onset, can impact assessment accuracy and should be considered.
Area of Science:
- Neurology
- Neuroscience
- Clinical Medicine
Background:
- Amyotrophic Lateral Sclerosis (ALS) functionality is typically evaluated using the revised functional ALS rating scale (ALSFRS-R).
- The influence of upper limb (UL) onset laterality (dominant vs. non-dominant side) on functional outcomes in ALS has not been previously investigated.
- Understanding laterality is crucial for accurate functional assessment in ALS.
Purpose of the Study:
- To investigate the impact of dominant versus non-dominant upper limb onset on functional status in ALS patients.
- To compare functional outcomes based on the side of initial upper limb involvement (right, left, or bilateral).
- To determine if hand dominance influences the assessment of functional decline using the ALSFRS-R.
Main Methods:
- A cohort of 109 ALS patients with clear upper limb (UL) onset dominance was analyzed.
- Patients were categorized into right UL (RUL), left UL (LUL), and bilateral UL onset groups.
- Functional status was assessed using the ALSFRS-R and its subscores (respiratory, bulbar, UL, lower limb), with specific attention to writing ability (Q4). Statistical analyses included t-tests and chi-squared tests (p < 0.01).
Main Results:
- Patients with writing difficulties (n=87) exhibited significantly lower ALSFRS-R and ALSFRSul scores, with increased challenges in dressing and personal hygiene.
- Right-handed patients with right UL onset (RUL) showed significantly lower scores for writing ability (Q4) compared to left UL onset (LUL) patients (p=0.002).
- Hand dominance negatively influenced Q4 scores in RUL patients (p=0.007), while overall ALSFRS-R and ALSFRSul scores did not significantly differ between RUL and LUL groups.
Conclusions:
- The ALSFRS-R is a valuable tool for assessing functional UL involvement in ALS.
- Clinicians may face misleading assessments when using the ALSFRS-R for right-handed patients with initial left UL onset.
- Incorporating hand dominance into the functional assessment of ALS patients is recommended for improved accuracy.
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