Sunday, 17 January 2016

Measuring hand effects.

Analysis of upper limb movement in Multiple Sclerosis subjects during common daily actions.Pellegrino L, Stranieri G, Tiragallo E, Tacchino A, Brichetto G, Coscia M, Casadio M.
Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:6967-6970.


The goal of this study was to investigate the movement and muscle activity of the upper limb during common activities of daily life in people withMultiple Sclerosis (PwMS) with low and mild-moderate level of upper limb impairments. We found significant changes in muscles activity in PwMS compared to healthy subjects when holding and lifting objects used in everyday life. These differences were particularly remarkable in subjects with moderate level of impairment, in which the disease affected also movement smoothness. Remarkably, the smoothness of the movement during the interaction with common objects of daily activities highly correlated with the subjects' ability measured with the Abilhand scale.

For too long outcomes have focussed on the EDSS as the major outcome for disability. This essentially a mobility scale heavily  focussed on walking and lower limb function. The regulators seem to welded to the hip on this one, but it has significant problems and  it takes a while to assess it properly and it is subject to wiggle and can change depending on various factors such as how many canes you use from day to day. Likewise it may not capture problems that are relevant to people with MS. It is also a stepwise scale and is not truely quantitative and insensitive to change. 
   The sanitized EDSS. 


Why are the regulators being dinosaurs?

However if you are immobile do you just get lumped into an EDSS 7-9 and if you are EDSS 7 this excludes you from many, many trials. 


Why can't we think outside the box and get upper body function as a main outcome. We have alot more nerves controlling our hands than our feet and our hands have alot more fine control than our feet.

This study looks a hand movements and can find influences in people with MS, some of these correlate with the Abihand scale  (click here to find out more about the Abihand scale). The Nine hole peg test are other outocmes or why not use computerised/ tablet/phone-based outcomes would allow you make distance assessments without having to travel to your neurologist. 


But why would you want to travel to your neurologist if all you get is sorry we can't do anything, surely there has to be a better way than this.

6 comments:

  1. I should read before I write.

    This is exactly the sort of thing I had in mind in my comment to the previous post :)

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  2. EDSS is far too generalized IMHO. I agree, its Jurassic best case. Its a summary not a granular mechanism based on no granular mechanism. It makes things near impossible to measure gains or losses until a real whammy happens that may well have been averted perhaps if a granular mechanism were in place. Stroke for example has many functional tests and thus real loss can be measured and gains via therapies as well.

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  3. This might really be something for The Kessler Foundation to pursue since they do a great deal of work towards mobility and disability thereof. A "standard" for measurements across a broadband and then more specific assessment towards a particular disorder or event such as stroke.

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  4. Why has it taken so long to recognise problems with hands? What's missing on the list is making phone calls, using a keyboard, ATM, calculator, door entry, holding a pen, lighting a match, self propelling wheelchair. No one has ever asked. I've mentioned just a few, but I spent some time out with my physio and she saw for herself the problems we encounter every day as part of our lives.

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  5. Anonymous 1:02:00 beat me to highlighting some of the missing activities from the Abilhand scale - but I also wondered why the Abilhand list was missing : texting, using a touch screen, using a hair dryer applying make up.

    Also easy, difficult, impossible as the only criteria doesn't take into account the various reasons for the difficulty - numbness, weakness, neuropathic pain, spasticity, spasm, tremor, paralysis.

    My arms and hands have been problematic for the past 18 months and affect my day to day living more than my mobility issues. My physio gives me exercises to do, supports and ultrasound to treat the various symptoms. Occupational therapy have not really been able to suggest products that could help and my neurologist just tells me the MRI scan doesn't show any new lesions.

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    Replies
    1. Anon 10:53 pm after I posted my blog, I had to wash my hair, because my hairdresser was unwell and I realised I'd forgotten hair and make up. My previous OT suggested I buy a self propelling wheelchair, I now have one that has a bit more understanding. I've found a company that sells products that are reasonably priced and are helpful. I'm not allowed to mention the name of the company here.

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