Effect of Cognitive Demand on Functional Mobility in Ambulatory Individuals with Multiple Sclerosis

Abstract

CME/CNE Information Activity Available Online: To access the article, post-test, and evaluation online, go to http://www.cmscscholar.org. Target Audience: The target audience for this activity is physicians, physician assistants, nursing professionals, and other health-care providers involved in the management of patients with multiple sclerosis (MS). Learning Objectives: Accreditation Statement: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Consortium of Multiple Sclerosis Centers (CMSC), Nurse Practitioner Alternatives (NPA), and Delaware Media Group. The CMSC is accredited by the ACCME to provide continuing medical education for physicians. The CMSC designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurse Practitioner Alternatives (NPA) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. NPA designates this enduring material for 1.0 Continuing Nursing Education credit (none in the area of pharmacology). Laurie Scudder, DNP, NP, has served as Nurse Planner for this activity. She has disclosed no relevant financial relationships. Disclosures: Editor in Chief of the International Journal of MS Care (IJMSC), has served as Physician Planner for this activity. He has received consulting fees from Acorda Therapeutics and Atlas5D and has received research support from Acorda Therapeutics and Atlas5D.Francois Bethoux, MD, has served as Nurse Planner for this activity. She has disclosed no relevant financial relationships.Laurie Scudder, DNP, NP, has disclosed no relevant financial relationships.Marcia Aparecida Ciol, PhD, has disclosed no relevant financial relationships.Patricia Noritake Matsuda, PT, PhD, DPT, has received consulting fees from Mallinckrodt and has received research support from Mallinckrodt and Medtronics.Seema Rani Khurana, DO, has disclosed no relevant financial relationships.Melissa Jaclyn Cline, MD, has received research support from MC10, Inc, and Perimobile, Inc, and has an ownership interest in Intelliwheels, Inc.Jacob Jonathan Sosnoff, PhD, is a member of the Axon Council, Acorda Pharmaceuticals.George Howard Kraft, MD, MS, The anonymous peer reviewer for the IJMSC has disclosed no relevant financial relationships. The staff at the IJMSC, CMSC, NPA, and Delaware Media Group who are in a position to influence content have disclosed no relevant financial relationships. Method of Participation: Release Date: August 1, 2017 Valid for Credit Through: August 1, 2018 In order to receive CME/CNE credit, participants must: Statements of Credit are awarded upon successful completion of the post-test with a passing score of >70% and the evaluation. There is no fee to participate in this activity. Disclosure of Unlabeled Use: This CME/CNE activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. CMSC, NPA, and Delaware Media Group do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of CMSC, NPA, or Delaware Media Group. Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any medications, diagnostic procedures, or treatments discussed in this publication should not be used by clinicians or other health-care professionals without first evaluating their patients' conditions, considering possible contraindications or risks, reviewing any applicable manufacturer's product information, and comparing any therapeutic approach with the recommendations of other authorities.

Myelin status is associated with change in functional mobility following slope walking in people with multiple sclerosis

“…This may be due to small sample size or the unique characteristics of the downslope walking intervention that specifically targeted walking ability. Our findings may be consistent with the hypothesis that more complex motor tasks tend to require greater descending cortical control, 19 therefore a marker of abnormal brain myelin content in pwMS may be more likely associated with TUG test performance than EDSS score given the task demands required. Lesion volume was not related to change in functional mobility, suggesting that the degree of myelin disruption within a lesion rather than the total volume is more strongly related to intervention response.…”

“…The TUG test was used to assess functional mobility in the current study because the TUG provides greater task complexity than a simple walking task, includes sit-to-stand transition and turning, therefore more closely resembling the mobility demands of everyday life. 19 Although the majority of participants demonstrated an improvement in time needed to complete the TUG test after the DSW, we did not observe a statistically significant group effect of DSW on TUG scores. However, this finding is consistent with previous studies that have shown that response to interventions in pwMS are widely heterogeneous, and there is a need to better predict who will respond to a given treatment in order to tailor treatment plans to an individual patient.…”

“…The two-minute walk test was performed to determine gait speed for subsequent treadmill walking sessions. The Timed Up and Go (TUG) test was performed on Day 1 and Day 10 to measure change in functional mobility 19 following the DSW intervention.…”

Differential effects and discriminative validity of motor and cognitive tasks varying in difficulty on cognitive–motor interference in persons with multiple sclerosis

“…This finding is in agreement with Kirkland et al, 13 where subtracting sevens resulted in larger motor-DTCs compared to two other cognitive tasks in pwMS. In addition, Ciol et al 14 reported longer duration on the cognitive-TUG when using subtracting 3's compared with the alternating alphabet task. Unfortunately, these previous studies did not report on cognitive-DTCs.…”

An exploration of the experiences and utility of functional electrical stimulation for foot drop in people with multiple sclerosis

“…Wajada et al [30] found that gait speed reduced when people with MS engaged in cognitive tasks. Ciol et al [31] found that people with MS struggle to simultaneously engage in cognitive and motor tasks thus affecting mobility. Finlayson [32] suggests that disorders in sensory-motor function, working memory and attention contribute to people with MS requiring to increase conscious control and concentration, particularly in dual-task activities.…”