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Isometric tests to evaluate upper and lower extremity functioning in people with multiple sclerosis: reliability and

Mehmet Uygur1, Donald A Barone2, Scott J Dankel1

  • 1Department of Health and Exercise Science, Rowan University, Glassboro, NJ 08028, United States.

Multiple Sclerosis and Related Disorders
|May 1, 2022
PubMed
Summary

Novel isometric tests reliably measure upper and lower limb function in people with multiple sclerosis (PwMS). The brief force pulse (BFP) protocol, particularly muscle relaxation speed, strongly predicts walking ability in PwMS.

Keywords:
Muscle forceRate of force development scaling factorRate of force relaxation scaling factorSpasticityWalking speed

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Area of Science:

  • Neurology
  • Rehabilitation Medicine
  • Biomedical Engineering

Background:

  • Motor symptoms in upper and lower extremities are prevalent in people with multiple sclerosis (PwMS).
  • Objective, reliable, and valid outcome measures are needed to assess neuromuscular functioning in PwMS.
  • This study evaluated standard and novel isometric tests for PwMS.

Purpose of the Study:

  • To assess the reliability and external validity of novel isometric tests for upper (grip force) and lower extremity (knee extensors) neuromuscular functioning in PwMS.
  • To determine the relationship between isometric measures and functional performance tests.
  • To identify predictors of functional outcomes in PwMS.

Main Methods:

  • Twenty-nine relapsing-remitting PwMS underwent two visits for isometric and functional testing.
  • Isometric tests included maximum voluntary contraction, rate of force development, and a novel brief force pulse (BFP) protocol measuring force development and relaxation scaling factors (RFD-SF, RFR-SF).
  • Functional tests included grip force, finger tapping, 25-ft walk test, timed up and go, 5-times sit-to-stand, and the Multiple Sclerosis Spasticity Scale.

Main Results:

  • Most isometric measures demonstrated high reliability (ICCs > 0.87).
  • In upper extremities, RFD-SF and RFR-SF correlated with functional tests (9-hole peg, finger tapping).
  • In lower extremities, RFR-SF showed the strongest correlations with functional tests (walking speed, TUG, sit-to-stand, spasticity scale) and EDSS score.

Conclusions:

  • The BFP protocol offers reliable and relevant outcome measures for assessing upper and lower extremity function in PwMS.
  • Muscle relaxation rate (RFR-SF) is a key predictor of walking speed in PwMS.
  • These findings support the use of BFP for evaluating neuromuscular deficits and functional capacity in multiple sclerosis.