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IMPAIRED: arm function and loss of manual dexterity can lead to decreased independence in activities of daily living in persons with Multiple Sclerosis (MS). In this study we verified the feasibility and efficacy of a serious games approach to supervised upper limb rehabilitation of the more affected arm in persons with MS and the cross-over effect to the nontreated arm.Eighteen persons with moderate to severe MS symptoms participated (mean age 56.1 (range 28-73) years; mean disease duration 17.6 (4-35) years). Each participant received 12 supervised sessions of serious games (45 min, 12 sessions) aimed at improving the most affected upper limb. Primary outcomes were the Nine Hole Peg Test (9HPT) and the Box and Blocks Test (BBT). Perceived health was evaluated pre and post intervention with SF-12 and the VAS of the EuroQual-5DL. Non parametric tests were used and P was set at 0.05.After the serious games training participants improved dexterity and arm function bilaterally (10-18%), however, there was a statistically significant improvement only in the treated arm (P0.05). Perceived menthal health improved follwing training (P0.05) but not perceived physical health.An in clinic intervention with a serious-games virtual reality approach positively influenced arm recovery in persons moderately to severely affected by MS, improving mainly the treated arm but with positive effects on the nontreated arm. The persons were motivated during the intervention and expressed being willing to continue this kind of training at home as part of continuity of care.

The Expanded Disability Status Scale (EDSS) is the most frequently used scale to measure neurologic impairment and quantify the level of disability in Multiple Sclerosis (MS) even though the scale focuses on ambulation and undervalues upper limb (UL) impairment. The 9-Hole Peg Test (9-HPT) is the gold standard for UL assessment in MS, calculating a mean score from right and left arms, even though subjects with MS often show a lateralization of neurological deficit.The study aimed to determine whether an interaction exists between mean right-left 9-HPT scores or 9HPT score asymmetry (difference between right and left side) in predicting EDSS in MS subjects.Demographic and disease variables and 9-HPT scores were obtained from medical records of individuals with MS collected in an ad-hoc database. Subjects with 9-HPT score ≤180 s for each arm were included. An asymmetry score was represented as the absolute value of the difference between 9-HPT scores for both arms.549 subjects were included: 67.8% female, mean age 45±13.14 years, mean EDSS 3.98±2.12, 356 relapsing-remitting, 68 primary and 125 secondary progressive, mean 9-HPT scores: right arm 30.20 ± 19.99 s, left arm 31.80 ± 20.35 s. Mean asymmetry was 9.35±18.20 s. Correlation between mean right-left 9-HPT scores and EDSS was 0.58 (p.001). Significant interaction between mean right-left 9-HPT scores and 9-HPT asymmetry in predicting EDSS scores was found. Regression slope of EDSS on mean right-left 9-HPT score decreases as asymmetry value increases (non-significance area values ≥ 40.93 s).Findings suggest interaction exists between mean right-left 9-HPT scores and asymmetry in predicting EDSS. A consequence of this is that, by disregarding information about asymmetry, studies exploring the association between mean right-left 9-HPT scores and global measures of disability may provide biased results. The bias tends to increase as asymmetry increases, and to be most prevalent among patients with EDSS scores6.

s / Gait & Posture 37 (2013) S1–S31 S21 Results and Discussion: The study confirmed by means of the analysis of the objective data: (a) the propulsive effect of the CSF along the SA direction (the increment of the Acceleration peaks was higher than 15% in mean value both in the x and y direction) and the stabilization effect along the ML direction (the decrement of the Acceleration peaks was higher than 13% in mean value in z direction). All the subjects indicated both a high degree of acceptance of the methodology and self perception of the improvement with the use of the CSF. The study from a global point of view shows how the collaboration between the Biomedical Engineer with the expert in the Orthopedic techniques could improve the medical-knowledge with interesting perspectives in studies with epidemiological impact.