Manifestations of walking fatigability in people with multiple sclerosis based on gait quality and distance walked during the six minutes walking test.

BACKGROUND: Distance walking fatigability (DWF) in people with multiple sclerosis (pwMS) is defined as a decrease in the distance walking over time. However, declines in gait quality (i.e., gait quality fatigability- GQF) may occur independently or alongside DWF. OBJECTIVE: i) to investigate how walking fatigability manifests and its prevalence in pwMS; ii) to describe the temporal pattern of the changes of specific gait characteristics during the 6-minute walking test (6MWT) METHODS: Eighty-eight pwMS (EDSS 4[0-6.5], 49[21-70] years) and 47 healthy controls (HC- 46[25-60] years) performed the 6MWT wearing inertial measurement units. Gait characteristics (stride length, sensor-based gait speed, cadence, double support, step duration, stance phase, step duration asymmetry, step duration variability, foot-strike, toe-off, and leg circumduction) and walking distance were recorded in 1-minute intervals. A fatigability index was calculated by comparing the last and first minute of the 6MWT to identify abnormal worsening based on cutoff scores. The manifestation of walking fatigability was counted. The temporal pattern of worsening of gait characteristics during the 6MWT was examined in pwMS exceeding the cutoff values, compared to pwMS without abnormal changes and HC, using a two-way ANOVA (group vs. minutes) RESULTS: Thirty-five pwMS presented both DWF and GQF, 2 presented isolated DWF, 27 presented isolated GQF, and 24 presented non-walking fatigability. PwMS having GQF presented worsening in gait characteristics (cadence, step duration, step duration variability, or toe-off angle) from minute 2 onwards of the 6MWT, while HCs and pwMS without abnormal changes stabilized gait from minute 2 towards the end of the 6MWT. CONCLUSION: Walking fatigability in pwMS manifests not only as a decrease in walking distance but also as changes in gait quality. Understanding changes in gait characteristics during walking can help tailor rehabilitation interventions.

Shoulder kinematics during cyclic overhead work are affected by a passive arm support exoskeleton.

PURPOSE: We investigated the influence of passive arm-support exoskeleton (ASE) with different levels of torque (50, 75, and 100%) on upper arm osteokinematics. METHODS: Twenty participants completed a cyclic overhead drilling task with and without ASE. Task duration, joint angles, and angular acceleration peaks were analyzed during ascent and descent phases of the dominant upper arm. RESULTS: Maximum ASE torque was associated with decreased peak acceleration during ascent (32.2%; SD 17.8; p < 0.001) and descent phases (38.8%; SD 17.8; p < 0.001). Task duration remained consistent. Increased torque led to a more flexed (7.2°; SD 5.5; p > 0.001) and internally rotated arm posture (17.6°; SD 12.1; p < 0.001), with minimal changes in arm abduction. CONCLUSION: The small arm accelerations and changes in osteokinematics we observed, support the use of this ASE, even while performing overhead cyclic tasks with the highest level of support.

Cyclogram-based evaluation of inter-limb gait symmetry in Prader-Willi Syndrome.

BACKGROUND: Prader-Willi syndrome (PWS) is characterized by a complex clinical condition, whose typical features lead to impaired motor and functional skills. To date, limited data is available as regards symmetry of gait in PWS. RESEARCH QUESTION: The aim of this study was to characterize lower-limb asymmetry during gait in a group of Prader-Willi Syndrome (PWS) individuals by using the synchronized cyclograms and to compare it with those of two different control groups, a normal-weight group and an obese group. METHODS: A total of 18 PWS, 30 normal weight (NW) and 28 obese individuals (OG) matched for age, sex and height were assessed via 3D gait analysis. Gait spatio-temporal parameters were computed together with angle-angle diagrams, characterized in terms of their geometric features (i.e. area, orientation, and trend symmetry index). RESULTS: Individuals with PWS exhibit reduced speed, stride length and cadence and increased duration of both stance and double support phase than the other groups. OG was characterized by the same pattern when compared to NW. With respect to inter-limb symmetry, individuals with PWS exhibited significantly larger cyclogram areas at hip joint with respect to the other two groups (203.32 degrees2 vs. 130.73 degrees2 vs. 111.59 degrees2) and significantly higher orientation angle (4.17° vs. 2.11° vs. 1.22°) and Trend Symmetry (3.72 vs. 2.02 vs. 1.21) with respect to the other two groups at knee joint; no differences were found at ankle joint. Both individuals with PWS and those of OG exhibited reduced ROM at knee and ankle joints with respect with normal weight, but no statistically significant differences were observed between PWS and OG. SIGNIFICANCE: The obtained results may provide novel and useful insights to understand better the impairments in motor control associated with this pathological state, supporting clinics in the identification of the best rehabilitation program for this rare pathological state, aimed to improve stability and motor control.

Segmental Mandibulectomy and Mandibular Reconstruction with Fibula-Free Flap Using a 3D Template.

INTRODUCTION: The present study evaluates the influence of virtual surgical planning with a preoperative 3D resin model on aesthetic and functional outcomes in patients treated by segmental mandibulectomy and reconstruction with fibula-free flap for oral cancer. METHODS: All consecutive patients who underwent segmental mandibulectomy and mandibular reconstruction with a fibula-free flap using a 3D template at our department from January 2021 to January 2023 were included in the study. "Patients control" were patients treated by reconstruction with a fibula-free flap without using a 3D template. Three-dimensional modeling was performed by converting from preoperative computed tomography to a stereolithography format to obtain the resin 3D models. Qualitative analysis of anatomical and aesthetic results consisted of the evaluation of the patients' aesthetic and functional satisfaction and the symmetry of the mandibular contour observed at clinical examination. Quantitative analysis was based on the assessment of the accuracy and precision of the reconstruction by comparing preoperative and postoperative computed tomograms as objective indicators. RESULTS: Seven patients (five males and two females, mean age of 65.1 years) were included in the study. All patients showed a symmetric mandibular contour based on the clinical examination. After recovery, six patients (85.7%) considered themselves aesthetically satisfied. The quantitative analysis (assessed in six/seven patients) showed that the mean difference between preoperative and postoperative intercondylar distance, intergonial angle distance, anteroposterior dimension, and gonial angle improved in the 3D template-assisted group. CONCLUSION: The 3D-printed template for mandibular reconstruction with microvascular fibula-free flap can improve aesthetic outcomes in comparison with standard approaches.

An integrated approach to the assessment of balance and functional mobility in individuals with history of severe traumatic brain injury.

Individuals who experienced severe Traumatic Brain Injury (sTBI) are often characterized by relevant motor dysfunctions which are likely to negatively affect activities of daily living and quality of life and often persist for years. However, detailed objective information about their magnitude are scarce. The aim of this study was to quantitatively assess the extent of motor deficits in terms of postural control effectiveness under static and dynamic conditions and to investigate the existence of possible correlations between the results of clinical tests and instrumental measures. Postural sway and functional mobility (i.e., instrumented Timed Up and Go test, iTUG) were objectively measured in 18 individuals with sTBI and 18 healthy controls using a pressure plate and a wearable inertial sensor. Additionally, participants with history of sTBI completed the Rivermead Mobility Index (RMI). One-way ANOVA and Spearman's rank correlation analysis were employed to examine differences between the two groups and determine potential correlations between the instrumental tests and clinical scales. The results show that people with sTBI were characterized by larger sway area and longer iTUG walking sub-phase. Significant correlations were also detected between RMI scores and iTUG total duration, as well as the walking phase. Taken together, these findings suggest that, even years after the initial injury, individuals with sTBI appear characterized by impaired postural control and functional mobility, which appears correlated with the RMI score. The integration of instrumental measures with clinical scales in the routine assessment and treatment of individuals with sTBI would result in more comprehensive, objective, and sensitive evaluations, thus improving precision in treatment planning, enabling ongoing progress monitoring, and highlighting the presence of motor deficits even years after the initial injury. Such integration is of importance for enhancing the long-term quality of life for individuals with sTBI.

Cybersickness in People with Multiple Sclerosis Exposed to Immersive Virtual Reality.

Together with the wide range of possible benefits for the rehabilitation/training of people with multiple sclerosis (pwMS) and other neurologic conditions, exposure to immersive virtual reality (VR) has often been associated with unpleasant symptoms, such as transient dizziness, headache, nausea, disorientation and impaired postural control (i.e., cybersickness). Since these symptoms can significantly impact the safety and tolerability of the treatment, it appears important to correctly estimate their presence and magnitude. Given the existing data scarcity, this study aims to assess the existence and severity of possible adverse effects associated with exposure to immersive VR in a cohort of pwMS using both objective measurements of postural control effectiveness and subjective evaluations of perceived symptoms. To this aim, postural sway under upright quiet posture (in the presence and absence of visual input) of 56 pwMS with an Expanded Disability Status Scale score (EDSS) in the range of 0-6.5 (mean EDSS 2.3) and 33 unaffected individuals was measured before and after a 10-min immersive VR session and at 10 min follow-up on the basis of center of pressure (COP) trajectories. The severity of cybersickness symptoms associated with VR exposure was also self-rated by the participants using the Italian version of the Simulator Sickness Questionnaire (SSQ). Temporary impairments of postural control in terms of significantly increased sway area were observed after the VR session only in pwMS with mild-moderate disability (i.e., EDSS in the range of 2.5-6.5) in the presence of visual input. No changes were observed in pwMS with low disability (EDSS 0-2) and unaffected individuals. In contrast, when the visual input was removed, there was a decrease in sway area (pwMS with mild-moderate disability) and COP path length relating to the use of VR (pwMS with mild-moderate disability and unaffected individuals), thus suggesting a sort of "balance training effect". Even in this case, the baseline values were restored at follow-up. All participants, regardless of their status, experienced significant post-VR side effects, especially in terms of blurred vision and nausea. Taken together, the findings of the present study suggest that a short immersive VR session negatively (eyes open) and positively (eyes closed) impacts the postural control of pwMS and causes significant disorientation. However, such effects are of limited duration. While it is reasonable to state that immersive VR is sufficiently safe and tolerable to not be contraindicated in the rehabilitation/training of pwMS, in order to reduce possible negative effects and maximize the efficacy, safety and comfort of the treatment, it appears necessary to develop specific guidelines that consider important factors like individual susceptibility, maximum exposure time according to the specific features of the simulation, posture to adopt and protocols to assess objective and perceived effects on participants.

Between-Day Reliability of the Gait Characteristics and Their Changes During the 6-Minute Walking Test in People With Multiple Sclerosis.

BACKGROUND: Gait characteristics and their changes during the 6-minute walking test (6MWT) in people with multiple sclerosis (pwMS) have been described in the literature, which one may refer to as walking fatigability in the body function level of the International Classification of Functioning, Disability, and Health. However, whether these metrics are reliable is unknown. OBJECTIVE: To investigate the between-day reliability of the gait characteristics and their changes in pwMS and healthy controls (HCs). METHODS: Forty-nine pwMS (EDSS 4.82 ± 1.22 and 54.7 ± 9.36 years) and 23 HCs (50.6 ± 6.1 years) performed the 6MWT, as fast as possible but safely while wearing Inertial Measurement Units. Gait characteristics were measured in the pace, rhythm, variability, asymmetry, kinematics, coordination, and postural control domains and were obtained in intervals of 1 minute during the 6MWT. In addition, gait characteristics change in the last minute compared with the first minute were calculated for all gait variables using a fatigability index (ie, distance walking index). The intraclass correlation coefficient (ICC), Bland-Altman Plots, and Standard error of measurement were applied to investigate reliability. RESULTS: Reliability of gait characteristics, minute-by-minute, and for their changes (ie, using the fatigability index) ranged from poor to excellent (pwMS: ICC 0.46-0.96; HC: ICC 0.09-0.97 and pwMS: ICC 0-0.72; HC: ICC 0-0.77, respectively). CONCLUSION: Besides coordination, at least 1 variable of each gait domain showed an ICC of moderate or good reliability for gait characteristics changes in both pwMS and HC. These metrics can be incorporated into future clinical trials and research on walking fatigability.Clinical Trial Registration: NCT05412043.

Cognitive Reserve, Physical Reserve, and Cognitive Efficiency of Older People Living in the Sardinian Blue Zone. An Exploratory Study.

This study mainly intended to disentangle the role played by physical reserve as a mediator of the relationship between cognitive reserve and global cognitive functioning in older people aging well. A sample of 120 67-101-year-old community-dwellers was recruited in the Sardinian Blue Zone, an area characterized by the extreme longevity of its inhabitants. Each respondent completed a battery of tests examining cognitive functioning, perceived physical health, cognitive reserve, and physical reserve (objectively assessed through accelerometric-derived measures). Significant associations were found among measures of cognitive reserve, physical reserve, perceived physical health, and cognition. Besides, two mediational analyses pointed out that physical reserve and distinct indexes of cognitive reserve explained 18% and 32% of the variance associated with global cognitive functioning. In conclusion, the combination of high cognitive reserve and more preserved motor functioning seems to contribute to the maintenance of healthy cognition in older people aging well.

Comparison of Two Therapeutic Approaches of Cerebellar Transcranial Direct Current Stimulation in a Sardinian Family Affected by Spinocerebellar Ataxia 38: a Clinical and Computerized 3D Gait Analysis Study.

Spinocerebellar ataxia 38 (SCA 38) is a very rare autosomal dominant inherited disorder caused by a mutation in ELOV5 gene, specifically expressed in cerebellar Purkinje cells, encoding an enzyme involved in the synthesis of fatty acids. Seven symptomatic SCA 38 patients of a Sardinian family were administered 15 sessions of cerebellar anodal transcranial direct current stimulation (tDCS) in a cross-over study, employing deltoid cerebellar-only (C-tDCS) and cerebello-spinal (CS-tDCS) cathodal montage. Clinical evaluation was performed at baseline (T0), after 15 sessions of tDCS (T1) and after 1 month of follow-up (T2). Modified International Cooperative Ataxia Rating Scale (MICARS) and the Robertson dysarthria profile were used to rate ataxic and dysarthric symptoms, respectively. Alertness and split attention tests from Zimmermann test battery for attentional performance were employed to rate attentive functions. Moreover, 3D computerized gait analysis was employed to obtain a quantitative measure of efficacy of tDCS on motor symptoms. While clinical data showed that both CS and C-tDCS improved motor, dysarthric, and cognitive scores, the quantitative analysis of gait revealed significant improvement in spatio-temporal parameters only for C-tDCS treatment. Present findings, yet preliminary and limited by the small size of the tested sample, confirm the therapeutic potential of cerebellar tDCS in improving motor and cognitive symptoms in spinocerebellar ataxias and underline the need to obtain quantitative and objective measures to monitor the efficacy of a therapeutic treatment and to design tailored rehabilitative interventions. ClinicalTrials.gov identifier: NCT05951010.

Is Cognitive Reserve a Determinant of Functional and Mental Health in Older People of the Sardinian Blue Zone? A Mediational Approach.

The main purpose of this study was to examine the mediating role of cognitive reserve in the relationship between functional health (expressed through the amount and intensity of performed physical activity objectively assessed using wearable accelerometers) and psychological well-being (i.e., assessed in terms of self-reported depressive signs) of older people living in an area of exceptional longevity, the so-called Sardinian Blue Zone. A further goal was to investigate the impact of gender on the cognitive reserve and physical health of our participants, using global cognitive functioning as a covariate. A battery of tests assessing motor efficiency, cognitive reserve, global cognitive functioning, and self-reported depressive symptoms was individually presented to 120 community dwellers (Mage = 82 years, SD = 8.4 years) of the Sardinian Blue Zone. Significant associations were found between cognitive reserve, motor efficiency, and self-reported depressive signs. Moreover, three mediation analyses documented that distinct indexes of cognitive reserve and motor efficiency explain 27.2-31% of the variance in the self-reported depression condition. Following this, it was also found that people with scarce cognitive reserve tended to exhibit significant signs of depression and showed worse motor abilities. In addition, after controlling for the effect of global cognitive functioning, motor efficiency, and cognitive reserve were generally more preserved in males than in females. Overall, these findings suggest that cognitive reserve is a compensatory resource that contributes significantly to the enhancement of health-related quality of life in the last decades of life.

Quantitative Characterization of Gait Patterns in Individuals with Spinocerebellar Ataxia 38.

Spinocerebellar ataxia 38 (SCA 38) is a rare autosomal neurological disease whose clinical features include, among others, severe gait disturbances that have not yet been fully characterized. In this study, we employed a computerized 3D gait analysis to obtain spatio-temporal parameters of gait and the kinematics in the sagittal plane in the hip, knee, and ankle joints of seven individuals with SCA 38, which were then compared with those of twenty unaffected individuals matched for age, sex, and anthropometric features. The results show that, in comparison with unaffected individuals, those with SCA 38 are characterized by a significantly reduced speed, stride length, and duration of the swing phase, as well as an increased step width and stance and double support phase durations. The point-by-point comparison of the angular trends at the hip, knee, and ankle joints revealed significant alterations during most part of the stance phase for hip joint and at pre-swing/swing phases for knee and ankle joints. For these latter joints, a significantly reduced dynamic range of motion was also found. Such findings provide some new insights into hip and knee kinematics for this specific form of ataxia and may be useful for monitoring the disease's progression and designing specific, tailored rehabilitative interventions.

Motor and cognitive skills implicated in the Motor Observation Questionnaire for Teachers (MOQ-T): A multidisciplinary approach.

This study was designed to determine the relationship between an observational measure of motor skills for teachers (i.e., MOQ-T), age, and some objectively assessed cognitive and motor indices. Two further goals were to examine which motor and cognitive factors predicted MOQ-T scores and to explore whether pupils with very low motor skills identified through MOQ-T also exhibited lower scores on objectively assessed motor and visuo-spatial tasks. A sample of 156 pupils aged 8.4 years-11.3 years and attending Italian primary school completed a battery of tests assessing writing speed, visuo-spatial abstract reasoning, fluency, and static balance abilities objectively assessed by measuring postural sway. Small to medium associations were found between MOQ-T scores and age, motor, and cognitive parameters, respectively. Moreover, approximately 26% of the variance in MOQ-T was predicted by sway area in the eyes-open condition, visuo-spatial fluency, and writing speed. Finally, pupils at risk of developmental coordination disorder exhibited poorer writing speed, and motor and higher-order visuo-spatial deficits. In conclusion, the synergistic use of objective measures of motor and cognitive functioning and observational screening questionnaires such as MOQ-T should be encouraged at school to identify pupils at risk of developmental coordination disorder.

Characterization of upper limb use in health care workers during regular shifts: A quantitative approach based on wrist-worn accelerometers.

Despite the high prevalence of upper limb (UL) work-related musculoskeletal disorders (WRMSD) among health care workers (HCWs), little is known about their relationship with exposure to biomechanical risk factors. This study aimed to assess UL activity features under actual working conditions using two wrist-worn accelerometers. Accelerometric data were processed to obtain duration, intensity, and asymmetry of UL use in 32 HCWs during the execution of commonly performed tasks (e.g., patient hygiene, transfer, and meal distribution) within a regular shift. The results show that such tasks are characterized by significantly different patterns of UL use, in particular, higher intensities and larger asymmetries were observed respectively for patient hygiene and meal distribution. The proposed approach appears, thus, suitable to discriminate tasks characterized by different UL motion patterns. Future studies could benefit from the integration of such measures with self-reported workers' perception to elucidate the relationship between dynamic UL movements and WRMSD.

An Immersive Virtual Kitchen Training System for People with Multiple Sclerosis: A Development and Validation Study.

Rehabilitation via virtual reality (VR) training tools allows repetitive, intensive, and task-specific practice in a controlled and safe environment. Our goal was to develop and validate a novel immersive VR system based on the practice of real-life activities in a kitchen environment in people with multiple sclerosis (pwMS) with upper-limb dysfunction. The novel immersive VR kitchen application includes several tasks, i.e., tidying up the kitchen, preparing a hamburger and soup meal, and dish washing. Following the development phase, the system was tested for an 8-week intervention period on a small sample of pwMS suffering from upper-limb dysfunction. The Suitability Evaluation Questionnaire for VR systems served as the primary outcome. The scores for enjoyment, sense of comfort with the system, feelings of success and control, realism, easy-to-understand instructions, assists in rehabilitation therapy, were between 4.0 and 4.6, indicating a high satisfaction. The scores for eye discomfort, dizziness, nausea, and disorientation during practice were between 2.8 and 1.3, indicating a low-to-moderate interference of the system. The virtual kitchen training system is feasible and safe for upper-limb training in pwMS and paves the way for future RCTs to examine the benefits of the system compared with standard care, thus improving the functionality of the upper limbs in pwMS.

Smoothness of Gait in Overweight (But Not Obese) Children Aged 6-10.

Excessive body mass represents a serious threat to the optimal psychophysical development of children, and it is known to be able to significantly affect their locomotor capabilities, making them more prone to the development of musculoskeletal disorders. However, despite the relevant number of existing studies, a clear gait pattern of overweight children has not been defined yet, particularly in the case of a mass excess that is relatively small (i.e., in those not obese). In the present study, we employed a wearable inertial measurement unit placed on the low back to derive spatio-temporal parameters and quantify the smoothness of gait (by means of harmonic ratio) from trunk accelerations acquired during gait trials carried out by 108 children aged 6-10 (46% males), stratified into two groups according to their body mass index (normal weight, n = 69 and overweight, n = 39). The results show that while gait speed, stride length, cadence and double support duration were found to be almost identical in the two groups, significant differences were observed in terms of harmonic ratio. In particular, overweight children exhibited a reduced harmonic ratio in the antero-posterior direction and higher harmonic ratio in the medio-lateral direction. While the significantly lower harmonic ratio in the antero-posterior direction is likely to be indicative of a loss of smoothness in the walking direction, probably due to a combination of factors associated with the altered movement biomechanics, the higher harmonic ratio in the medio-lateral direction might be associated with specific strategies adopted to increase lateral stability. Although further studies are necessary to elucidate the specific mechanisms that influence the smoothness of gait, it is noteworthy that harmonic ratios appear sensitive even to subtle change in locomotor control in overweight children characterized by apparently regular spatio-temporal parameters of gait and might be employed to assess the effectiveness of interventions designed to improve mobility functions.

Movement Behavior and Health Outcomes among Sedentary Adults: A Cross-Sectional Study.

BACKGROUND: Sedentary behavior, which is highly prevalent among office workers, is associated with multiple health disorders, including those of the musculoskeletal and cardiometabolic systems. Although prior studies looked at postures or physical activity during work or leisure time, few analyzed both posture and movement throughout the entire day. OBJECTIVE: This cross-sectional pilot study examined the movement behavior of sedentary office workers during both work and leisure time to explore its association with musculoskeletal discomfort (MSD) and cardiometabolic health indicators. METHODS: Twenty-six participants completed a survey and wore a thigh-based inertial measuring unit (IMU) to quantify the time spent in different postures, the number of transitions between postures, and the step count during work and leisure time. A heart rate monitor and ambulatory blood pressure cuff were worn to quantify cardiometabolic measures. The associations between movement behavior, MSD, and cardiometabolic health indicators were evaluated. RESULTS: The number of transitions differed significantly between those with and without MSD. Correlations were found between MSD, time spent sitting, and posture transitions. Posture transitions had negative correlations with body mass index and heart rate. CONCLUSIONS: Although no single behavior was highly correlated with health outcomes, these correlations suggest that a combination of increasing standing time, walking time, and the number of transitions between postures during both work and leisure time was associated with positive musculoskeletal and cardiometabolic health indicators among sedentary office workers and should be considered in future research.

Influence of Foot Morphology on the Center of Pressure Pattern in Patients with Down Syndrome.

BACKGROUND: The primary aim of this study was to assess how different conformations of the foot in individuals with Down syndrome affected the CoP during walking, and the secondary aim was to evaluate the effect of an excess of mass in young adults and children with Down syndrome and flat foot. The greater investigation of these aspects will allow for more targeted rehabilitation treatments to improve a patient's quality of life. METHODS: The tests were carried out on 217 subjects with Down syndrome, 65 children and 152 young adults, and on 30 healthy individuals, 19 children and 11 young adults. All subjects underwent gait analysis, and the group with Down syndrome was also assessed with baropodometric tests to evaluate foot morphology. RESULTS: The statistical analysis showed that within both the young adult and child groups, the CoP pattern in the anterior-posterior direction reflected a difficulty in proceeding in the walking direction compensated by a medio-lateral swing. The gait of children with Down syndrome was more impaired than that of young adults. In both young adults and children, a higher severity of impairment was found in overweight and obese female individuals. CONCLUSIONS: These results suggest that the sensory deficits and the development of hypotonic muscles and lax ligaments of the syndrome lead to morphological alterations of the foot that, combined with the physical characteristics of short stature and obesity, negatively impact the CoP pattern of people with Down syndrome during walking.

Effect of immersive virtual reality training on hand-to-mouth task performance in people with Multiple Sclerosis: A quantitative kinematic study.

BACKGROUND: Although the use of Virtual Reality (VR) has received increasing interest as an add-on treatment in neurorehabilitation programs in the last fifteen years, there is scarce information about the effectiveness of fully immersive VR-based treatments on upper limb (UL) motor function in people with Multiple Sclerosis (PwMS). METHODS: In this bicentric 2-period interventional crossover study, 19 PwMS with moderate to severe disability (mean EDSS score 5.5) and relevant UL impairment underwent 12 immersive-VR sessions over a period of 4 weeks, using commercially available VR platform (Oculus Quest) and games (Fruit Ninja, Beat Saber and Creed - Rise to Glory). Possible changes associated with the treatment were objectively assessed through instrumental kinematic analysis of the "hand-to-mouth" (HTM) movement by means of optical motion capture system. Clinical tests to assess gross and fine manual dexterity (i.e., the Box and Blocks and Nine Hole Peg Test) were also administered. RESULTS: The results of the kinematic analysis suggest that the VR training positively impacted the ability of the tested PwMS to perform the HTM task. In particular, a significant reduction of the overall time required to complete the task of approximately 20% for both most and least affected limb, and an improved degree of precision and stability of the movement, as indicated by the reduced value of adjusting sway, especially for the most affected limb (-60%). CONCLUSION: Based on the results of the quantitative analysis, a 4-week treatment with immersive VR is able to improve speed and stability of the HTM movement in PwMS. This suggests that such an approach might be considered suitable to facilitate an immediate transfer of the possible positive effects associated with the training to common activities of daily living.

The contribution of motor efficiency to drawing performance of older people with and without signs of cognitive decline.

In clinical practice, different drawing tests are used for the assessment of cognitive efficiency in the geriatric population. However, so far, the contribution of motor skills to drawing performance has not been sufficiently examined in the late adult life span. This study was aimed at disentangling the role played by motor functioning in three well-known drawing tests that in the clinical field are commonly used to detect some signs of cognitive impairment of older individuals. One hundred and forty-nine community dwellers (Mage = 77.4 years, SD = 5.9 years) completed a battery of tests assessing global cognitive efficiency, drawing skills (i.e., Clock Drawing, Visuo-spatial Drawing ACE-R, Copy Figures Tests), handgrip muscular strength (HGS), and functional mobility (assessed through the Timed-Up-and-Go test). Significant relationships were found among those measures. Moreover, handgrip strength and functional mobility explained 12-19% of the variance in each drawing condition. Finally, participants exhibiting poorer HGS performed worse the drawing tasks and were successively recognized as cognitively deteriorated. In conclusion, these findings highlight that motor skills can significantly impact the assessment of cognitive efficiency in late adulthood. Therefore, in clinical practice, the concurrent assessment of basic motor functions (in terms of muscular strength and functional mobility) and cognitive efficiency of the geriatric population at risk for cognitive decline should be encouraged.

Change in upper limb function in people with multiple sclerosis treated with nabiximols: a quantitative kinematic pilot study.

OBJECTIVES: Nabiximols represents an increasingly employed add-on treatment option for spasticity in people with multiple sclerosis (PwMS) who either were unresponsive or reported excessive adverse reactions to other therapies. While several studies performed in the last decade demonstrated its effectiveness, safety, and tolerability, few quantitative data are available on the impact on motor dysfunctions. In this open-label, not concurrently controlled study, we aimed to assess the impact of a 4-week treatment with nabiximols on upper limb functionality. METHODS: Thirteen PwMS (9 female, 4 male) with moderate-severe spasticity underwent a combination of clinical tests (i.e., Box and Block, BBT and Nine-Hole Peg test, 9HPT) and instrumental kinematic analysis of the "hand to mouth" (HTM) movement by means of optical motion capture system. RESULTS: After the treatment, improvements in gross and fine dexterity were found (BBT + 3 blocks/min, 9HPT - 2.9 s, p < 0.05 for both cases). The kinematic analysis indicated that HTM movement was faster (1.69 vs. 1.83 s, p = 0.05), smoother, and more stable. A significant reduction of the severity of spasticity, as indicated by the 0-10 numerical rating scale (4.2 vs. 6.3, p < 0.001), was also observed. CONCLUSION: The findings from the present pilot study suggest that a 4-week treatment with nabiximols ameliorates the spasticity symptoms and the overall motor function of upper limb in PwMS with moderate-severe spasticity. The use of quantitative techniques for human movement analysis may provide valuable information about changes originated by the treatment in realistic upper limb motor tasks involved in activities of daily living.