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Seventy-six consecutive patients from our MS clinic with clinically isolated syndrome (CIS), relapsing-remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS), or primary progressive multiple sclerosis (PPMS) according to McDonald's criteria, Expanded Disability Status Scale (EDSS) score from 0 to 6.5 (inclusive), aged from 18 to 70 years, with or without immunomodulatory treatment, were included. We aimed to have an equal EDSS distribution from 0 to 6.5. Main
The characteristics of the study population regarding age, sex, disease duration, MS type, EDSS, relapse rate, and immunomodulatory therapy are presented in table 1. The EDSS of the study population was well distributed except for EDSS scores from 0 to 0.5 with 4 patients only. There were no relevant comorbidities. Apraxic (12 of 20) and nonapraxic (10 of 56) patients had ongoing physical therapy. Nonsteroidal anti-inflammatory drugs and antidepressants were the most common additional medical
Disability in MS usually results from a combination of several neurologic deficits, and knowledge of the miscellaneous deficits is essential for optimal pharmaceutic and nonpharmaceutic treatment of patients with MS. The EDSS is commonly performed to evaluate disability in MS. However, it primarily focuses on ambulation and does not sufficiently assess motor skills of the upper limbs.18 Limb apraxia is rarely considered in MS and has been, to the best of our knowledge, not evaluated with
Limb apraxia is a frequent and clinically significant symptom contributing to impaired manual dexterity and ADLs in patients with MS. Therefore, we advocate apraxia be routinely evaluated for MS patients, particularly if they self-report dexterous problems. Furthermore, recognizing apraxia opens up new avenues in neurorehabilitation by targeted interventions in occupational therapy.
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Andaloro et al., 2020; Saeki and Hachisuka, 2004) Therefore, limb apraxia may in individuals with MS result from lesions and degeneration of the subtending cortical areas and their connections. ( Kamm et al., 2012) In Kamm et al. survey, (MG Maggio et al., 2020) limb apraxia was found with a prevalence of 26% and increased proportionally to the Expanded Disability Status Scale (EDSS) scores. Furthermore, patients with primary and secondary progressive MS show more apraxic symptoms than patients with relapsing-remitting MS. These data highlight the importance of the early identification and management of apraxia, including an effective rehabilitation program.
The relevance of limb apraxia for neurorehabilitation becomes even more apparent when considering the fact that incidences have been reported in many of the most frequently occurring neurological disorders (Buchmann et al., 2020), e.g., after stroke (e.g., Buxbaum, Kyle, Grossman, & Coslett, 2007; Poeck, 1983; Randerath, Goldenberg, Spijkers, Li, & Hermsdorfer, 2010), dementia (e.g., Della Sala, Lucchelli, & Spinnler, 1987; Hodges, Bozeat, Ralph, Patterson, & Spatt, 2000; Johnen et al., 2016) and traumatic brain injury (Buchmann et al., 2020; Falchook et al., 2015; Schwartz et al., 1998). It also has been described or discussed for patients with Parkinson's disease (Kubel et al., 2017; Vanbellingen, Hofmänner, Kübel, & Bohlhalter, 2018), multiple sclerosis (Harscher, Hirth-Walther, Buchmann, Dettmers, & Randerath, 2017; Kamm et al., 2012; Medenica & Ivanovic, 2019; Staff, Lucchinetti, & Keegan, 2009) or psychiatric disorders like schizophrenia (Dutschke et al., 2018; Stegmayer et al., 2016). Classic tests to diagnose limb apraxia include gesturing tasks assessing the ability to imitate or pantomime gestures.
Finally, the development of bed-side tests may aid the detection of praxis deficits in clinical routine. A condensed version of the TULIA is available as short bed-side test of apraxia and has been tested in stroke, Parkinson's, Alzheimer's, and multiple sclerosis (Kamm et al., 2012; Ozkan, Adapinar, Elmaci, & Arslantas, 2013; Vanbellingen, Kersten, Bellion, et al., 2011; Vanbellingen, Kersten, Van de Winckel, et al., 2011; Vanbellingen et al., 2012). It might be worthwhile to evaluate its use in schizophrenia as well.
With progression of ambulatory impairment, preservation of upper extremity function (UEF) becomes more important to maintain mobility and the ability to perform activities of daily living (ADL). Also, UEF correlates with quality of life (Kamm et al., 2012; Salter et al., 2010), and employment status (Julian et al., 2008). Therefore, preservation of UEF is a clinically relevant treatment goal during all disease stages.
This is different for perceptual DM, a neural mechanism in which decisions are made in a more automatic fashion by analyzing sensory signals arguing in favor or against a decision (Hanks and Summerfield, 2017) such as when deciding whether a jacket is warm enough for today's weather based on a thermal percept. Importantly, perceptual DM is impaired in neurological conditions related to MS. Specifically, Evans et al. (2016) demonstrated that perceptual decisions in stroke patients with apraxia, a neurological condition that also occurs in MS (Kamm et al., 2012), were worse than decisions of HCs. Consequently, we conducted the first MS study on perceptual DM.
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In-press corrected proof published online on Mar 30, 2012, at www.archives-pmr.org.
Helder and Vanbellingen contributed equally to this article.