Changes in gait and fatigue from morning to afternoon in people with multiple sclerosis.

OBJECTIVES: The aim was to measure changes in walking patterns and self rated fatigue in people with multiple sclerosis (MS) compared with age matched control subjects, from the morning to the afternoon within a single day. METHODS: Fourteen patients with MS and the same number of matched control subjects performed four 10 m gait trials at their preferred walking speed at 10 00 am and then again at 3 00 pm on the same day. Gait speed, stride length, cadence, and the percentage of the gait cycle spent in double limb support were measured using a foot switch stride analyzer. Patients with MS also self rated their fatigue levels in the morning and afternoon using an 11 point scale. RESULTS: Compared with control subjects, patients walked very slowly, with reduced stride length and around twice as much variability in gait performance. Although self rated fatigue significantly increased from the morning to the afternoon, walking patterns remained consistent in both groups over the course of the day. CONCLUSIONS: These findings imply that mechanisms controlling locomotion are separate from those regulating perceived fatigue. Objective measures of performance, rather than self report, should be used to monitor change in patients with multiple sclerosis.

A study of performance of delayed intentions in multiple sclerosis.

The ability to remember and perform delayed intentions was investigated in a sample of 40 participants with Multiple Sclerosis (MS) and compared to a group of 36 healthy, neurologically intact, control participants. Using a model of task division, performance on both the prospective memory (PM) component (a failure to remember to do something at a specific time) and the retrospective memory (RM) component (a failure to remember the content of the intention) of two "naturalistic" delayed intention experimental tasks were examined. Significantly poorer performance of the MS group in completing one of the delayed intention tasks successfully appeared to be primarily attributable to retrospective memory deficits rather than prospective memory deficits. This proposition was further supported by group differences on RAVLT measures of retrospective memory. By utilising a paradigm that enables the nature of failure in performing delayed intention tasks to be identified, specific strategies for the clinical management of MS cognitive deficits can be developed.

Clinical tests of standing balance: performance of persons with multiple sclerosis.

OBJECTIVE: To investigate differences in performance between people with multiple sclerosis (MS) and control subjects on clinical tests of balance, and to assess performance consistency on balance tests in people with MS from morning to afternoon. STUDY DESIGN: Two factor repeated measures design with a two group sample of convenience. SETTING: Kingston Centre and the Camberwell Centre of the MS Society of Victoria, Australia. SUBJECTS: Fourteen people with MS and 14 control subjects matched for age, height, and sex. MAIN OUTCOME MEASURES: Subjects were measured on their ability to maintain standing balance in steady stance, (feet apart, feet together, stride stance, tandem stance, and single leg stance), during self-generated perturbations (functional reach, arm raise, and step tests) and in response to an external perturbation. Participants with MS were also asked to rate their fatigue level in the morning and afternoon. RESULTS: There were no differences between MS and control groups on the ability to maintain standing balance with feet apart, feet together, or in stride stance. Participants with MS performed more poorly than control subjects in tandem stance and single leg stance and in the functional reach test, arm raise test, step test, and in response to an external perturbation. There was little change in balance from morning to afternoon in participants with MS (ICCs (2,1) .70 to .94), despite an increase in self-rated fatigue (t(14) = -3.14, p = .008). CONCLUSION: The ability to maintain balance in standing is a marked problem in people with MS despite the consistency of their performance from morning to afternoon.

Memory impairment in rehabilitation.

Memory impairment is a common problem in patients with physical disabilitiy of neurological origin. The important features of two types of memory and learning impairment, Amnesic Syndrome and Frontal Lobe Dysfunction, are briefly summarized. Emphasis is placed on the variability of signs and the possibility of new learning within these two classes of memory disorder. The learning requirements of different physiotherapy techniques are discussed in terms of the difficulties they present for the learning-impaired patient Some suggestions are made to assist in the identification of those patients with abnormalities of memory and learning. Several ways in which the rehabilitation program can be modified for patients with memory impairment are discussed. The implications for overall management of these "multi-disabled" patients is considered. A final suggestion is made concerning the value of neuropsychological referral within an interdisciplinary approach to the rehabilitation and management of neurological disability.