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The consequences of multiple sclerosis (MS), particularly gait and walking dysfunction, may obfuscate (i.e., make unclear in meaning) the measurement of physical activity using body-worn motion sensors, notably accelerometers. This paper is based on an invited keynote lecture given at the 8th International Conference on Ambulatory Monitoring of Physical Activity and Movement, June 2022, and provides an overview of studies applying accelerometers for the measurement of physical activity behavior in MS. The overview includes initial research uncovering a conundrum with the interpretation of activity counts from accelerometers as a measure of physical activity. It then reviews research on calibration of accelerometer output based on its association with energy expenditure in yielding a biologically based metric for studying physical activity in MS. The paper concludes with other applications and lessons learned for guiding future research on physical activity measurement using accelerometry in MS and other populations with neurological diseases and conditions. [ABSTRACT FROM AUTHOR]

Background and Aim: Multiple sclerosis is one of the most common chronic inflammatory autoimmune diseases of the central nervous system that can affect the basic sensory and motor systems. This study aimed to investigate the effect of 8 weeks of neuromuscular training on motor function, fatigue severity, and quality of life in women with Multiple Sclerosis in Isfahan City. Materials and Methods: In this quasi-experimental study, women aged 20-40 years with Multiple Sclerosis with an Expanded Disability Status Scale between 2-4 formed the study population, and 20 patients were selected using a simple random sampling method and were randomly divided into experimental (n=10) and control (n=10) groups. Initially, both groups participated in a timed up-and-go test and completed questionnaires on the fatigue severity scale and quality of life of patients with multiple sclerosis. The subjects in the experimental group performed an eight-week training program of neuromuscular that included three sessions per week and each session lasted 50 minutes. After eight weeks, the subjects in the two groups were reevaluated through previous tests. Data were analyzed by analysis of covariance (ANCOVA) at the error level of (P<0.05). Results: The results showed that post-tests of motor function, fatigue severity, and quality of life were significantly different between the experimental and control groups of women with multiple sclerosis (P=0.001). Conclusion: Considering the beneficial effects of eight weeks of neuromuscular training, it is recommended that this training be used to better perform daily activities of life, reduce the severity of fatigue, and increase the quality of life and well-being of women 20-40 years old with moderate multiple sclerosis. [ABSTRACT FROM AUTHOR]

Physical rehabilitation and physical activity are known non-pharmacological methods of treating multiple sclerosis. Both lead to an improvement in physical fitness in patients with movement deficits while improving cognitive function and coordination. These changes occur through the induction of brain plasticity. This review presents the basics of the induction of brain plasticity in response to physical rehabilitation. It also analyzes the latest literature evaluating the impact of traditional physical rehabilitation methods, as well as innovative virtual reality-based rehabilitation methods, on the induction of brain plasticity in patients with multiple sclerosis. [ABSTRACT FROM AUTHOR]

Multiple Sclerosis (MS) affects 2.1 million people world-wide. There is no cure but an expanding body of research suggests that physical activity can have a positive impact on the symptoms of MS. This case study was designed as a view into the life experiences of one woman’s journey with MS as a competitive athlete, focusing on how psychological skills aid her in conquering her challenges. The participant was a 51-year old competitive mountain bike racer who was diagnosed with MS as a teenager. A postpositivist approach using a series of in-depth, conversational interviews explored the role athletics has played in her life and specifically in helping her live with MS. The interviews focused on the psychological skills the participant used to deal with her sport and MS. Results suggest that resilience, resulting from self-efficacy, goal setting, and a positive outlook, is the key to her success, and that her participation in athletics strengthens those positive characteristics. Findings may be helpful to both sport psychology and medical professionals who work with individuals with MS. [ABSTRACT FROM AUTHOR]

Cognitive impairment is common and debilitating among persons with multiple sclerosis (MS) and might be managed with exercise training. The present pilot study adopted a single-blind randomized controlled trial (RCT) design and is the first to examine the effect of a systematically developed, progressive treadmill walking exercise training intervention on cognition among fully ambulatory persons with MS. Ten fully ambulatory females with MS were randomly assigned into exercise training intervention or waitlist control conditions. The intervention condition involved 12 weeks of supervised, progressive chronic treadmill walking exercise training. Participants underwent measures of cognition (i.e., cognitive processing speed (CPS), executive function), walking performance, and cardiorespiratory fitness before and after the 12-week period; baseline and follow-up assessments were performed by blinded assessors. Overall, there were large intervention effects on CPS (d = 0.95), walking performance (d = 0.76), and cardiorespiratory fitness (d > 1.08). The change in cardiorespiratory fitness was significantly associated with change in CPS (r = .60), but not walking performance. This small pilot RCT provides preliminary proof-of-concept data supporting progressive treadmill walking exercise training for potentially improving CPS, walking performance, and cardiorespiratory fitness in fully ambulatory persons with MS, and that improved fitness might be a possible mechanism for improved CPS. [ABSTRACT FROM PUBLISHER]

The Australian multiple sclerosis (MS) community experienced two recent major crises, widespread bushfires and the COVID 19 pandemic. We aimed to understand the needs of persons with MS during times of crisis. A consumer-directed mixed-method study. We included an online survey, semi-structured interviews, and a workshop with persons with MS, carers, healthcare professionals, and disability advocates. Data were collected via: (1) 176 people completing online surveys to identify crisis concerns and communications, (2) 29 people completing online interviews on bushfire and pandemic impact, and (3) 13 people participating in a crises-priorities workshop. Descriptive data were calculated for survey response, and a general inductive analytical approach was taken with interview and workshop responses. The most significant concerns were bushfire smoke exposure and disease-modifying-medication and susceptibility to COVID-19 (66% and 63% mean concern score, respectively). Interviews indicated crises experiences from the bushfires, and the pandemic overlapped respective of changes in mood and symptom stability. For bushfires, a need for future preparations, and for the pandemic, the benefits of social restrictions, disclosing personal health information and increased care burden were important. Multiple crises challenged the MS community but offered lessons for healthcare in future crises. Continued progress in centralised crisis information, with considered use of telehealth and rural healthcare support, is needed. The MS community showed high concerns for the effect of toxic smoke from the 2019/2020 Australian bushfires and, separately, for the disease-modifying-medication and susceptibility to COVID-19. The MS community placed priority on a crisis management plan for individuals. Reduced social activity due to restrictions was beneficial for MS symptom self-awareness and may help overall fatigue management. Healthcare system preparation must prepare to alleviate increased carer workload at times of crisis. [ABSTRACT FROM AUTHOR]

People living with neurological conditions such as multiple sclerosis, Parkinson's disease and dementia may experience physical impairment, social disengagement, cognitive issues, and emotional disturbances. While qualitative research utilising in-depth interviews can access lived experience perspectives, the use of photovoice has the potential to obtain rich insights that include images and raise community awareness. The purpose of this scoping review was to document salient themes relating to the lived experience of neurological conditions as reported in photovoice studies. Following established scoping review methods of the Joanna Briggs Institute, a comprehensive search of five electronic databases, including MEDLINE, EMBASE, PSYCHINFO, CINAHL, and SCOPUS was conducted, as well as relevant journals and reference lists of retrieved studies. References were sorted, screened, and evaluated for inclusion using Endnote and Rayyan. The search results and the study inclusion process were reported in full in the final scoping review and presented in a PRISMA-ScR flow diagram. Reflexive thematic analysis was managed through NVivo to identify and synthesise findings, as well as identify themes. Following the removal of duplicates, the search identified 109 articles for title and abstract screening. The final dataset consisted of 25 studies published between 2007 and 2021. Two themes were identified: 1) 'Losses and benefit finding' focuses on the lived experience of people with neurological conditions including being pushed aside by society, a progressive decline of self and growing as a result of losses; 2) 'Challenges of using photovoice in neurological research' covers the confusion of terminology and implementation complexities and adaption. Societal change is needed for greater inclusion of people living with neurological conditions. Future studies using photovoice need to pay attention to methodological issues and include the recommended final step of the photovoice process to hold gallery exhibits to disseminate findings to raise awareness and initiate social change. [ABSTRACT FROM AUTHOR]

Objectives: Difficulties with prospective memory (PM) are not routinely assessed in persons with multiple sclerosis (MS) even though they can impact daily functioning. This study aimed to examine the preliminary criterion and ecological validity of a highly abbreviated Memory for Intentions Test (MIST) intended to serve as an initial screening of PM in persons with MS. Methods: Participants (n = 112) were classified as impaired if they performed 1.5 standard deviations below the normative mean on the MIST. Individual MIST trials with adequate difficulty and discriminability were examined using receiver operating characteristic analyses, with their classification accuracies, sensitivities, and specificities compared to each other. Regressions were run to evaluate their ecological validity, with appointment attendance and employment as the outcomes. Results: Two trials had a classification accuracy of ≥80%: Trial 3 (79% sensitivity, 84% specificity) and Trial 4 (57% sensitivity, 91% specificity). These two trials had comparable specificity (p=.127), with Trial 3 having slightly higher sensitivity (p=.083). Only Trial 4 was significantly associated with appointment attendance (b = 1.63, p=.047) and unemployment (aOR = 11.20, p=.027). Discussion:Trial 4 of the MIST, a verbal task with a time-based cue that requires participants to complete a pre-specified response after a 15-minute delay, has the potential to be a screener for PM. [ABSTRACT FROM AUTHOR]

Introduction: Extensive human and animal research shows that exercise has beneficial effects on multiple clinical outcomes for patients suffering from multiple sclerosis (MS). This research was conducted to examine the effect of aerobic exercise with probiotic consumption on the myelination of nerve fibers in a cuprizone-induced demyelination mouse model of MS. Methods: Rats exposed to cuprizone (CPZ) for 13 weeks were subjected to motor and balance tests in week 5. They (5 people in each group) were assigned to five groups of control (C), MS, MS with exercise (MS+Exe), MS with probiotic (MS+Pro), and MS with probiotic and exercise (MS+Pro+Exe) randomly. The exercise groups conducted aerobic exercises 5 days a week for 60 days. The rats received probiotics by gavage. Performance and balance tests were repeated when the eight-week protocol of exercise and probiotic consumption was finished. One day after these interventions, they were sacrificed to undergo biochemical and molecular biology assays. Results: The results showed that Myelin basic protein (MBP) was increased in the MS+Pro+Exe, MS+Pro, and MS+Exe compared to the MS group (P<0.05). The nestin mRNA showed an increase in MS+Pro+Exe, MS+Exe, and MS+Pro groups compared to the MS group, but this increase was not significant in MS+Pro+Exe and MS+Exe groups compared to the control and MS groups (P>0.05). Conclusion: According to the results, lifestyle interventions can effectively alleviate demyelinating-inflammatory processes that happen in the brains of MS patients. [ABSTRACT FROM AUTHOR]

Background: Multiple Sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system through the destruction of sheaths (myelin), disseminated in space and time. The aim of our work is to study the neurocognitive concept and mood disorders in patients with MS. Material/Methods: The study includes in this study 75 cases of MS, collected at the Neurology (B) and Neurogenetics Department of Rabat Ibn Sina Hospital. The study was performed on MS patients using different scales that included: a self-questionnaire (so - cio-demographic, clinical), Hospital Anxiety and Depression scale (HADS), Rosenberg's Self-Esteem scale (RSE) and Expanded Disability Status Scale (EDSS). Results: The mean age for the onset of the disease was 30-years, with a sex ratio of 3.4. The main clinical signs are: 69.33% and 70.67% of patients had respectively anxious and depressive disorder, which was associated with low self-esteem in 89% of them. The distribution according to the evolutionary forms of MS is 65% Relapsing Remitting (RR), 29% secondary progressive (SP) and 5% Primary Progressive (PP). As for the assessment of disability using EDSS, we note an average 4.07±1.829. Conclusions: That results of our study concord with other studies on the same age category. It confirms the predominance of women. They are followed by the appearance of psychological disorders such as depression anxiety and cognitive disorders. Remitting MS is the most common when compared to other forms. The anxiety and depression score was strongly corre - lated with the degree of self-esteem and disability. [ABSTRACT FROM AUTHOR]

This study designed to investigate the protective effects of L-theanine on experimental Multiple sclerosis in mice. Frothy Male C57BL/6 mice were allocated into 4 experimental groups: control no treatment received a regular chew pellet, and the cuprizone (CPZ) group received a standard chew pellet containing 0.2% (w/w) CPZ. In group 3, mice were fed a regular diet and administered p.o. with L-theanine (50 mg/kg). In group 4, mice received a diet containing CPZ and were administered p.o. with L-theanine (50mg/kg). Finally, reflexive motor behavior and serum antioxidant levels were determined. Based on findings, CPZ significantly decreased ambulation score, hind-limb suspension, front limb suspension, and grip strength (P<0.05). The CPZ+Ltheanine reduced the adverse effect of the CPZ on ambulation score, hind-limb foot angle, surface righting, and negative geotaxis (P<0.05). The CPZ+L-theanine increased front and hind-limb suspension, grip strength, number of the cross, and duration of a stay on the rotarod compared to the control animal (P<0.05). CPZ administration significantly elevated serum malondialdehyde (MDA) while superoxide dismutase (SOD) and glutathione peroxidase (GPx) and total antioxidant status (TAS) levels decreased compared to control mice (P<0.05). The CPZ+L-theanine leads to the cessation of MDA production while increasing SOD, GPx, and TAS levels (P<0.05). These results suggested L-theanine has a protective effect against CPZ-induced MS in mice. [ABSTRACT FROM AUTHOR]

Over recent years, significant improvements have been made in the understanding of (epi)genetics and neuropathophysiological mechanisms driving the different forms of multiple sclerosis (MS). For example, the role and importance of the bidirectional communications between the brain and the gut—also referred to as the gut-brain axis—in the pathogenesis of MS is receiving increasing interest in recent years and is probably one of the most promising areas of research for the management of people with MS. However, despite these important advances, it must be noted that these data are not—yet—used in rehabilitation. Neurorehabilitation is a cornerstone of MS patient management, and there are many techniques available to clinicians and patients, including technology-supported rehabilitation. In this paper, we will discuss how new findings on the gut microbiome could help us to better understand how rehabilitation can improve motor and cognitive functions. We will also see how the data gathered during the rehabilitation can help to get a better diagnosis of the patients. Finally, we will discuss how these new techniques can better guide rehabilitation to lead to precision rehabilitation and ultimately increase the quality of patient care. [ABSTRACT FROM AUTHOR]

Background Multiple sclerosis (MS) patients frequently experience severe fatigue that can be as disabling as objective neurological deficits. Walking exercise has significant effect in reducing MS-related fatigue. Aim To evaluate the effect of walking exercise on fatigue among patients with MS. Design Nonequivalent control group time series quasi-experimental design was utilized. Research hypotheses H1: the fatigue mean scores of patients with MS who subjected to walking exercise would be less than the fatigue mean scores of a control group after 6 weeks. H2: the fatigue mean scores of patients with MS who subjected to walking exercise would be less than the fatigue mean scores of a control group after 12 weeks. H3: the fatigue mean scores of patients with MS who subjected to 12 weeks of walking exercise would be less than 6 weeks of walking exercise in the study group. Sample A convenient sample of 60 MS patients were recruited along 12 weeks. Tools Four tools were utilized to collect data: (a) Semi-Structured Interview Questionnaire, (b) Fatigue Severity Scale (FSS), (c) The Expanded Disability Status Scale, (d) The Beck Depression Inventory-II. Results supported the stated research hypotheses. As regards, the total mean scores of FSS, there were high statistically significant differences between the study and control groups after 6 and 12 weeks of implementing treadmill walking exercise (35.67 and 49.63 and 29.11 and 50.87, respectively). As well, total mean scores of FSS among the study group after 6 and 12 weeks of implementing treadmill walking exercise was 35.67±10.77 and 29.11±9.93, respectively. Moreover, 76.70% of the study group had no fatigue after 12 weeks of treadmill walking exercise compared with 50% of them after 6 weeks. Conclusion Treadmill walking exercise was effective in reducing fatigue severity level among patients with MS and more than three quarters of the study group had no fatigue after 12 weeks of treadmill walking exercise compared with half of the study group after 6 weeks. Recommendations: this study recommended that patients with MS should practice walking exercise regularly in order to reduce fatigue severity level. Also, further studies should be conducted to compare the effect of different types of walking exercise on MS-related fatigue. [ABSTRACT FROM AUTHOR]

Background and aim: Health-promoting lifestyle behaviors (HPLBs) have a significant impact on disease management among people with multiple sclerosis (MS). However, the coronavirus disease 2019 (COVID-19) pandemic has significantly affected lifestyle of all individuals, particularly patients with chronic diseases. The present study aimed to explore the barriers and facilitators to HPLBs among people with MS during the COVID-19 pandemic. Methods: This qualitative study was conducted in Iran. Participants were sixteen people with MS purposively selected from the central MS clinic of a referral specialty neuroscience hospital in Tehran, Iran. Data were collected via in-depth semi-structured face-to-face interviews and concurrently analyzed through conventional content analysis. Findings: The mean of participants' age was 37.93 years and most participants were female (81.25%). The major barriers to HPLBs were lack of knowledge, limited access to resources, and poor health status, while the major facilitators were attention to inner abilities and social support. Conclusion: Many different factors such as lack of knowledge, limited access to resources, poor health status, awareness, and social support can influence engagement in HPLBs among people with MS. Healthcare authorities and policymakers need to use quality educational and supportive interventions to improve knowledge, health literacy, perceived support, self-efficacy, and self-care ability among people with MS during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Resilience research in family caregiving in chronic neurological conditions is growing, but multiple sclerosis (MS) caregivers are noticeably absent from this body of work. MS caregivers represent a unique population due to the disease's early onset, prolonged life expectancy, and heterogeneity. As such, this study aimed to explore MS caregivers' conceptualizations of resilience, examine MS caregivers' experiences of resilience development, and determine which assets and resources influence resilience in this role. Twenty-four Canadian MS caregivers were recruited. Semi-structured in-depth interviews were conducted with questions derived from an ecological resilience framework. Data were analysed using reflexive thematic analysis. Themes constructed a cyclical resilience model, beginning with encounters with hardship and extending to thriving adjustment. Subthemes included reports of additive challenges, impactful individual and community resources, and multi-level adaptive pathways. Within this cycle, the achievement of healthy adjustment exerted a positive feedback function and informed future responses to lifelong challenges. Despite the salience of resilience processes within caregiver testimonies, inadequate resources at societal levels were evident. These findings afford researchers and decision-makers relevant information for designing and implementing resilience-building interventions for MS caregivers that attend to contextual factors and current systemic support deficiencies. [ABSTRACT FROM AUTHOR]

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Multiple sclerosis (MS) is a severe autoimmune illness that can be treated with a variety of medications. However, over a third of patients do not adhere to their treatment regimens. Drug compliance may be influenced by social support and demographic factors. This is a cross-sectional study that examines the association between Patient with MS socio-demographic characteristics and social support and their treatment adherence. We used the perceived social support scale and the treatment compliance scale to collect data on socio-demographic factors. We looked at the correlations between the scores on the three scales. We included 155 female, 45 male patients in our study. The mean age of the patients was 36.3±11.8 (±standard deviation). The rate of noncompliant patients was 15.5%. and 56.0% showed moderate-level compliance with their treatment. The mean multi-dimensional perceived social support score was 62.3±18.8. The only socio-demographic feature that impacts the social support and special person subscale scores was the marital status. We found that married patiens had significantly more social support and were significantly higher than divorced patient (p<0.05). This study found that PwMS compliance with their medicines is unaffected by socio-demographic characteristics or perceived social support. Larger patient groups with less perceived social support will need to be studied. On the other hand, this suggests that patient compliance is more influenced by personal factors such illness perception and beliefs than by social support. [ABSTRACT FROM AUTHOR]

This study is a secondary analysis of data from a mixed methods exploration of fatigue in people with multiple sclerosis (MS), a chronic autoimmune disease affecting the central nervous system. During initial analysis, worry emerged during discussions of the fatigue experience. The purpose of this study is to explore worry in relationship to exercise and physical activity behavior. Mixed methods were used to address the research question. 55 people with MS provided demographic and survey data (habitual physical activity, body perception, functioning). 35 participated in semi-structured interviews on the topics of fatigue, body sensations, emotions, and their effects on physical activity. Qualitative data were analyzed utilizing constructivist grounded theory. Quantitative data were analyzed utilizing multiple regression. Qualitative theory described participants' thoughts and experiences regarding the consequences of fatigue during activity, and how they appear to influence subsequent actions. Worry played a critical role in thought processes regarding physical activity. Aspects of body perception were weak quantitative predictors of physical activity behavior after control of physical functionality. The most significant finding of this study was the description and dialogue about worry as a factor that shapes perceptions of the benefits and value of exercise and physical activity. Physical activity practitioners could benefit from seeking to understand physical-activity-related worry when examining physical activity behavior and designing programming. [ABSTRACT FROM AUTHOR]

Gait and cognitive impairments are compounded when performed simultaneously in individuals with multiple sclerosis (MS), and this is termed cognitive-motor interference (CMI). The authors examined whether CMI is related to balance confidence in individuals with MS. They hypothesized that individuals with low balance confidence would exhibit greater CMI possibly indicating a behavioral modification during dual task conditions. Thirty-four individuals with MS completed Activity-specific Balance Confidence (ABC) scale and a cognitive assessment as well as single and dual task walking trials at a comfortable pace. CMI was calculated as the percent change in walking velocity and cognitive task performance from single- to dual-task conditions and termed dual-task cost (DTC). A correlation analysis was performed to determine the relationships between DTCs of gait and cognitive performance and ABC scores. The correlation analysis revealed no significant association between ABC and DTC of walking velocity (p > .05). A significant relationship between balance confidence and DTCs of cognition was observed. The observed relationships suggest individuals with MS tend to alter their cognitive performance rather than manipulating their gait when confronted with a dual task. Overall, the findings partially support a behavioral explanation of CMI in individuals with MS. [ABSTRACT FROM AUTHOR]

Persons with multiple sclerosis (MS) often demonstrate impairment in cardiorespiratory and musculoskeletal systems that may be associated with functional performance, functional limitations, and disability limitations. This study examined such relationships in persons with MS using Nagi’s disablement model and its subsequent conceptual modifications. The sample included 63 persons with MS (75% relapsing–remitting MS, median EDSS = 4.0, and mean MS duration = 13.1 years) who underwent measurements of aerobic fitness and muscular strength (i.e. impairment), functional performance, functional limitations, and disability limitations. The data were primarily examined using path analysis in Mplus7.0. Our final model provided an excellent fit for the data (χ² = 0.67, df = 3,p = 0.88, SRMR = 0.01, and CFI = 1.00). The final model indicated that aerobic fitness and muscular strength were indirectly associated with disability limitations in persons with MS through a pathway that included functional limitations (indirect path coefficients of 0.29 and 0.20, respectively), but not functional performance. Aerobic fitness and muscular strength may be the important targets of exercise training interventions for improving perceived functional limitations and disability limitations in persons with MS. [ABSTRACT FROM PUBLISHER]

Multiple sclerosis (MS) patients, in general, show reduced physical function, physical activity, and quality of life. Positive associations between physical activity and quality of life have been reported. In particular, we were interested in the relation between physical activity and mental health in MS patients without limitation of physical function, since limitations of physical function may influence both physical activity and quality of life. Assessment comprised the Baecke questionnaire on physical activity, the Short Form 36 Health Survey (SF-36), and Beck Depression Inventory (BDI). We ranked our sample according to physical activity into four groups and performed an ANOVA to analyze the relationship between levels of physical activity and health-related quality of life (HRQoL). Then we performed a subgroup analysis and included patients with unlimited walking distance and a score of less than 18 in the BDI. Most active vs. inactive patients were compared for the mental subscales of the SF-36 and depression scores. From 632 patients, 265 met inclusion criteria and hence quartiles were filled with 67 patients each. Active and inactive patients did not differ considerably in physical function. In contrast, mental subscales of the SF-36 were higher in active patients. Remarkable and significant differences were found regarding vitality, general health perception, social functioning and mental health, all in favor of physically active patients. Our study showed that higher physical activity is still associated with higher mental health scores even if limitations of physical function are accounted for. Therefore, we believe that physical activity and exercise have considerable health benefits for MS patients. [ABSTRACT FROM AUTHOR]

Depression is a prevalent and often early symptom of multiple sclerosis (MS). It occurs more frequently in people with MS than in the general population or other disease groups. The lifetime prevalence of depression in people with MS is estimated to be 50%, which is two to three times higher than the general population. Depression in MS is associated with structural and functional brain changes, and there are shared immune-based mechanisms between depression and MS. Treatment for depression in MS is different from other groups, as traditional approaches have been found to be only modestly effective. MS presents unique psychosocial challenges that contribute to a favorable environment for depression, such as long-term chronic disease, disability, and high rates of unemployment. It is suggested that depression should be recognized as a core symptom of MS and receive increased attention for suitable management options. [Extracted from the article]

Introduction: Regular exercise is strongly recommended for people with MS (pwMS), but recent studies still describe them as sedentary and insufficiently active. The purpose of this study is to identify the major barriers that prevent pwMS from exercising and underline the importance of the general practitioner (GP) in promoting an active lifestyle. Materials and methods: We performed a multicenter cross-sectional study using a self-administered questionnaire among pwMS. Data about demographics, the disease, current exercise practice, barriers, previous GP's advice to practice, and motivation were collected. Results: A total of 741 pwMS (age 55.6 ± 12.5 years, 66% females) completed the survey. Most responders (75.3%) did not practice any exercise. Fatigue was the most limiting factor to attending and/or starting an exercise program, followed by travel and/or moving issues, and the lack of time. Only 25.5% of participants received GP's advice to practice exercise, but 48.6% of them attended an exercise program. A greater likelihood of practice was evidenced for people that received the GP's advice than those who had not received it (OR 2.96; p <0.001). Finally, among those who did not practice exercise but received advice from GPs, 69 out of 99 (69.7%) were motivated to start an exercise program. Conclusion: Fatigue and physical issues are the main barriers to exercise for pwMS, but also other factors not related to the disease seem to be relevant, like travel issues and lack of time. Although few participants received advice to exercise from their general practitioner, his role proved effective in encouraging the practice. [ABSTRACT FROM AUTHOR]

The gut-brain axis (GBA) refers to the multifactorial interactions between the intestine microflora and the nervous, immune, and endocrine systems, connecting brain activity and gut functions. Alterations of the GBA have been revealed in people with multiple sclerosis (MS), suggesting a potential role in disease pathogenesis and making it a promising therapeutic target. Whilst research in this field is still in its infancy, a number of studies revealed that MS patients are more likely to exhibit modified microbiota, altered levels of short-chain fatty acids, and enhanced intestinal permeability. Both clinical and preclinical trials in patients with MS and animal models revealed that the administration of probiotic bacteria might improve cognitive, motor, and mental behaviors by modulation of GBA molecular pathways. According to the newest data, supplementation with probiotics may be associated with slower disability progression, reduced depressive symptoms, and improvements in general health in patients with MS. Herein, we give an overview of how probiotics supplementation may have a beneficial effect on the course of MS and its animal model. Hence, interference with the composition of the MS patient's intestinal microbiota may, in the future, be a grip point for the development of diagnostic tools and personalized microbiota-based adjuvant therapy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients with multiple sclerosis (MS) were vulnerable to the effects of physical inactivity during the COVID- 19 pandemic. As patients returned to in-person visits, providers reported seeing increased weakness, balance issues, falls, worsening pain, and spasticity. Social isolation also contributed to increased stress, depression, and anxiety. This study explored whether attending virtual wellness programs was associated with improvements in standard quality of life questionnaire scores for patients with MS. METHODS: The purposive convenience sample consisted of 43 patients in the treatment group and 28 in the control group. Patients in the treatment group attended 2 monthly programs for 6 months and completed a demographic questionnaire, the 36-Item Short Form Health Survey (SF-36), the Modified Fatigue Impact Scale, and the Medical Outcomes Study Pain Effects Scale (PES). Patients requested additional topics, resulting in 5 additional programs. The control group consisted of patients who chose not to attend the programs but agreed to complete the questionnaires. RESULTS: In comparing questionnaire responses (6 months minus baseline) among the participants in the treatment group, an association was found between higher meeting attendance and improvements in emotional well-being (P = .038), pain on the PES (P = .011), mindfulness on the SF-36 pain scale (P = .0472), and exercise on the PES (P = .0115). CONCLUSIONS: The results of this study suggest that a virtual wellness program may provide beneficial emotional support, physical exercise, and health promotion activities resulting in improved quality of life in people with MS. In addition, mindfulness and exercise programs may be beneficial in pain management. [ABSTRACT FROM AUTHOR]

Cognitive problems are common in people with Multiple Sclerosis (MS), and researchers and clinicians have used a vast array of measures to assess cognition. Our aim was to systematically identify cognitive measures routinely used in MS research, and outline their different uses. Previous recommendations of cognitive measures to use in MS have relied on expert consensus approaches. We believe this systematic review is a starting point for an evidence-based approach to recommend cognitive tests for use with people with MS. We systematically searched electronic databases using relevant search terms for studies that assessed cognitive functioning in MS (last search in February 2020). From 11,854 abstracts retrieved, based on title and abstract review, 2563 remained. Data were extracted from 1526 studies. Studies used 5665 measures of cognition, with 316,053 people with MS. Substitutional style tests, serial addition tests, and word list learning tests were the most commonly used individual tests, and the Brief Repeatable Battery of Neuropsychological Tests was the most commonly used battery. Some of the most frequently used measures were potentially inappropriate due to measuring irrelevant domains of cognition, and issues with sensitivity. Further research is needed to ascertain the psychometric properties, and acceptability of measures for people with MS. [ABSTRACT FROM AUTHOR]

This study examined participant characteristics, particularly disease duration, in theory-based physical activity behavior change trials in multiple sclerosis (MS) and summarized theoretical frameworks and changes in physical activity outcomes. PubMed, CINAHL, Embase, and Scopus were searched to identify potential trials. One reviewer screened titles and abstracts, and two reviewers then independently screened full-text articles based on predetermined eligibility criteria. Data were extracted by one reviewer and checked by a second reviewer. Among 33 trials reviewed, only one trial reported a mean disease duration of less than five years (i.e., 4.5 years) for the sample. The remaining trials included samples with a mean disease duration of 6.7 years or longer. The most common theories used were Social Cognitive Theory, Trans-theoretical Model, and Motivational Interviewing. The effects on physical activity were heterogeneous; device-measured outcomes increased in 41.4% of studies, self-reported outcomes improved in 72.4%. Adherence (≥80%) was reported in 34.5% of studies. There is little focus on persons with MS in the early disease course in physical activity behavior change interventions. Future research should include comprehensive theoretical approaches for more homogeneous effects across outcome measures when targeting those in the early stage and all MS populations. Theory-based physical activity behavior change interventions have not included persons with multiple sclerosis (MS) in the early disease course (<5 years since diagnosis). Disease duration has not been a criterion used to include or exclude participants in the reviewed theory-based behavior change interventions for physical activity in people with MS. The theory-based behavior change interventions in this review positively affected short-term physical activity levels in people with MS. [ABSTRACT FROM AUTHOR]

Multiple sclerosis is a chronic autoimmune disorder that greatly impacts on patients' physical and psychosocial wellbeing. The purpose of this study is to investigate the experiences of people diagnosed with multiple sclerosis in Greece (N = 30), with regard to the way they coped with the diagnosis and the symptoms, the psychological implications of the disorder and the meaning they attributed to it. Data were collected through semi-structured interviews and they were analyzed using grounded theory. The findings showed that despite the negative implications of the disorder and the difficulty in managing the diagnosis and the symptoms, half of the patients attributed positive meaning to the disorder. Taking care of oneself, re-evaluation of life and a sense of liberation were described as the positive outcomes of experiencing multiple sclerosis. [ABSTRACT FROM AUTHOR]

Background: Patients with multiple sclerosis have low levels of physical activity. This is of concern because low activity levels are related to cardiovascular disease, poor walking ability, and reduced quality of life. The aim of this study was to evaluate the impact of rehabilitation on daily physical activity and walking capacity in patients with multiple sclerosis who have moderate to severe walking disability. Methods: This exploratory, observational study of 24 patients with multiple sclerosis examined daily physical activity, walking capacity and fatigue before and after 3 weeks of inpatient rehabilitation. Inpatient rehabilitation included physiotherapy (30–60 min, 5 times/week), strength and endurance training (30–45 min, 3–5 times/week), occupational therapy (30 min, 2–3 times/week), and neuropsychological training (30 min, 2 times/week). There were no specific interventions to target daily levels of physical activity. Results: Daily physical activity did not change after rehabilitation (physical activity: effect size = –0.23, 95% confidence interval (95% CI) 0.02‒0.62). There were significant improvements in walking capacity (Two-Minute Walk Test: effect size = 0.74, 95% CI 0.31‒1.16, +17 m, 20.2%) and mobility (Timed Up and Go Test: effect size = 0.65, 95% CI 0.22‒1.07, ‒2.1 s, 14.9%). Motor and cognitive fatigue (Fatigue Scale for Motor: effect size = 0.56, 95% CI 0.14‒0.99 and Cognitive Functions: effect size = 0.44, 95% CI 0.01‒0.86) improved significantly after rehabilitation. Conclusion: Three weeks of rehabilitation improved walking capacity, but not daily physical activity, in patients with multiple sclerosis with moderate to severe walking disability. To increase physical activity, it may be necessary to add specific behavioural interventions to the rehabilitation programme. The intervention plan should include strategies to overcome personal and environmental barriers. [ABSTRACT FROM AUTHOR]

Self-concept or sense of self is often altered in the context of neurological illness. Yet, these core aspects of subjective experience are poorly understood for people with multiple sclerosis (MS). This systematic review aimed to synthesize the findings of quantitative and qualitative studies investigating self-concept in MS. PsycINFO, MEDLINE (PubMed), CINAHL, Scopus, and Web of Science were last systematically searched in May 2021, with the Mixed Methods Appraisal Tool and Consolidated Criteria for Reporting Qualiatative Research used to appraise the quality of the eligible articles. Articles were included if they measured or explored self-concept in MS populations, were published in English and peer-reviewed. A total of 30 studies (11 quantitative, 19 qualitative) were identified. Quantitative studies were synthesized using a narrative approach, with results suggesting that MS is associated with some degree of self-concept change. Qualitative studies were synthesized using thematic synthesis, with results illustrating a complex process of self-concept change that is catalyzed by MS-related events and characterized by varying degrees of resistance to, or acknowledgement of, such changes. Future prospective longitudinal studies are needed to characterize the nature of self-concept change in MS using validated tools that measure relevant aspects of self-concept for the MS population. [ABSTRACT FROM AUTHOR]

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Locomotor disorders and impairment of gait are common in patient with chronic diseases such as Parkinson's disease or Multiple Sclerosis (MS). However, the relevance of changes of these measures in free-living situations and across prolonged observation periods has not been studied. Here, we investigated the minimal detectable change (MDC) of physical activity and gait parameters assessed by accelerometry in eleven patients with MS during their daily activities over a period of one year. MDC of maximum walking speed was constant throughout all measurements, whereas variations of MDC were observed for mean walking speed, steps per day and activity level. This variation was also associated with the patients' degrees of disability. Our findings suggest that ambulatory assessment of MDC parameters of gait may help to detect and interpret subclinical changes of motor behavior in patients with MS. [ABSTRACT FROM AUTHOR]

Self-efficacy is an important predictor of health-related physical activity in multiple sclerosis (MS). While past experiences are believed to influence efficacy beliefs, the explanations individuals provide for these experiences also may be critical. Our objective was to test the hypothesis that perceived success or failure to accumulate 150 min of physical activity in the previous week would moderate the relationship between the attributional dimension of stability and self-efficacy to exercise in the future. Forty-two adults with MS participated in this cross-sectional descriptive study. Participants completed questions assessing physical activity, perceived outcome for meeting the recommended level of endurance activity, attributions for the outcome, and exercise self-efficacy. Results from hierarchical multiple regression revealed a significant main effect for perceived outcome predicting self-efficacy that was qualified by a significant interaction. The final model, which included perceived outcome, stability, and the interaction term, predicted 37% of the variance in exercise self-efficacy,F(3, 38) = 7.27,p = .001. Our findings suggest that the best prediction of self-efficacy in the MS population may include the interaction of specific attributional dimensions with success/failure at meeting the recommended physical activity dose. Attributions may be another target for interventions aimed at increasing the physical activity in MS. [ABSTRACT FROM PUBLISHER]

This study investigates the potential of passive monitoring of gait and turning in daily life in people with multiple sclerosis (PwMS) to identify those at future risk of falls. Seven days of passive monitoring of gait and turning were carried out in a pilot study of 26 PwMS in home settings using wearable inertial sensors. The retrospective fall history was collected at the baseline. After gait and turning data collection in daily life, PwMS were followed biweekly for a year and were classified as fallers if they experienced >1 fall. The ability of short-term passive monitoring of gait and turning, as well as retrospective fall history to predict future falls were compared using receiver operator curves and regression analysis. The history of retrospective falls was not identified as a significant predictor of future falls in this cohort (AUC = 0.62, p = 0.32). Among quantitative monitoring measures of gait and turning, the pitch at toe-off was the best predictor of falls (AUC = 0.86, p < 0.01). Fallers had a smaller pitch of their feet at toe-off, reflecting less plantarflexion during the push-off phase of walking, which can impact forward propulsion and swing initiation and can result in poor foot clearance and an increased metabolic cost of walking. In conclusion, our cohort of PwMS showed that objective monitoring of gait and turning in daily life can identify those at future risk of falls, and the pitch at toe-off was the single most influential predictor of future falls. Therefore, interventions aimed at improving the strength of plantarflexion muscles, range of motion, and increased proprioceptive input may benefit PwMS at future fall risk. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS), a chronic autoimmune disorder, affects the central nervous system of many young adults. More than half of MS patients develop cognition problems. Although several genomic and transcriptomic studies are currently reported in MS cognitive impairment, a comprehensive repository dealing with all the experimental data is still underdeveloped. In this study, we combined text mining, gene regulation, pathway analysis, and genome-wide association studies (GWAS) to identify miRNA biomarkers to explore the cognitive dysfunction in MS, and to understand the genomic etiology of the disease. We first identified the dysregulated miRNAs associated with MS and cognitive dysfunction using PubTator (text mining), HMDD (experimental associations), miR2Disease, and PhenomiR database (differentially expressed miRNAs). Our results suggest that miRNAs such as hsa-mir-148b-3p, hsa-mir-7b-5p, and hsa-mir-7a-5p are commonly associated with MS and cognitive dysfunction. Next, we retrieved GWAS signals from GWAS Catalog, and analyzed the enrichment analysis of association signals in genes/miRNAs and their association networks. Then, we identified susceptible genetic loci, rs17119 (chromosome 6; p = 1 × 10−10), rs1843938 (chromosome 7; p = 1 × 10−10), and rs11637611 (chromosome 15; p = 1.00 × 10−15), associated with significant genetic risk. Lastly, we conducted a pathway analysis for the susceptible genetic variants and identified novel risk pathways. The ECM receptor signaling pathway (p = 3.98 × 10−8) and PI3K/Akt signaling pathway (p = 5.98 × 10−5) were found to be associated with differentially expressed miRNA biomarkers. [ABSTRACT FROM AUTHOR]

Background Multiple sclerosis (MS) affects over 2.5 million individuals worldwide, yet much of the disease course is unknown. Hemispheric vulnerability in MS may elucidate part of this process but has not yet been studied. The current study assessed neuropsychological functioning as it relates to hemispheric vulnerability in MS. Methods Verbal IQ, as measured by verbal comprehension index (VCI), nonverbal IQ, as measured by perceptual reasoning index (PRI) and memory acquisition were compared in right-handed (dextral) and non-right-handed (non-dextral) persons with MS (PwMS). Results Linear mixed-effects modeling indicated a significant main effect of handedness, F (1, 195.35) = 3.95, p  = .048, for a composite measure of VCI, PRI, and memory acquisition, with better performance for dextral PwMS. In examining differences for specific neuropsychological measures, the largest effect size between dextral and non-dextral participants was seen in PRI (d  = 0.643), F (1,341) = 12.163, p  = .001. No significant interaction effect between handedness and IQ was found, F (3, 525.60) = 0.75, p  = .523. Conclusions Dextral PwMS perform better than non-dextral PwMS when assessing neuropsychological performance for memory and IQ combined. Results are suggestive of increased vulnerability in the left brain to the pathological process of MS. [ABSTRACT FROM AUTHOR]

Objective. There is limited information about gait patterns during prolonged walking in people with multiple sclerosis (PwMS). The aim of this review was to report on gait metrics during and immediately after the 6-Minute Walk Test (6MWT) in PwMS with different levels of disability. Methods. The systematic search was performed in 3 databases (PubMed, Web of Science, and SCOPUS) using keywords related to multiple sclerosis and 6MWT. Studies that reported on quantitative gait outcomes before and after the 6MWT or multiple time points during the 6MWT were included. The Hedges g effect size (ES) was calculated to determine the magnitude of change in each gait parameter. Results. Fourteen studies (n = 534 PwMS; n = 166 healthy controls) were eligible. Five studies investigated gait parameters prior to and immediately after the 6MWT Nine studies collected gait measures during the 6MWT. Speed (ES = -0.43 to 0.19), cadence (ES = -0.46 to 0.16), step length (ES = -0.46 to 0.14), stability (ES = -0.35 to 0.33), and regularity (ES = -0.25 to -0.15) decreased in most studies. In the majority of included studies, step time (ES = 0 to 0.35), stance period (ES = 0.12 to 0.58), double support phase (ES = 0.03 to 0.62), variability (ES = -0.19 to 1.13), and asymmetry (ES = -0.79 to 0.62) increased following the 6MWT The kinetic and kinematic (mainly in dorsiflexion angle [ES = -0.08 to -0.36]) features of gait were also negatively changed after 6 minutes of walking. Walking speed, cadence, step length, stride length, and stride time after 6MWT at a comfortable speed all increased. Changes in the majority of spatiotemporal parameters were more pronounced in PwMS with moderate-to-severe disability compared with PwMS with mild disability. Conclusion. Most quantitative gait parameters deteriorated during the 6MWT, especially in PwMS with moderate-to-severe disability. Impact. The deterioration of gait patterns should be considered when designing therapeutic interventions to increase sustained walking capacity. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the benefits of a lower-limb fast-velocity concentric resistance training on rate of force development, mobility, and quality of life in people with Multiple Sclerosis. A randomized controlled trial was conducted in 30 people with Multiple Sclerosis, who were randomly assigned to either an experimental (n=18) or a control (n=12) group. The experimental group carried out 10-weeks of fast-velocity concentric resistance training, while the control group did not perform any intervention. Early and late rate of force development during knee extension in both legs, sit-to-stand and Timed Up and Go tests and quality life questionnaire were evaluated before and after intervention. The training program evoked an increase in early rate of force development in experimental group (0–30; Rightleg : 63.9%, p<0.001; ES=-1.4; Leftleg : 52.7%, p<0.001; ES=-1.0) compared to control group (showed modest increases). Furthermore, experimental group improved mobility after training (Sit-to-stand: 22.2%, p<0.001; ES=1.0; Timed Up and Go Test: 10.1%, p<0.001; ES=1.1) and increased the perception of quality of life after training, while control showed no changes. The fast-velocity concentric resistance training has the potential to improve early rate of force development and mobility after 10-weeks of training. In addition, the increase in self-perceived quality of life following this training modality demonstrates promising results in the Multiple Sclerosis population. [ABSTRACT FROM AUTHOR]

The clinical monitoring of walking generates enormous amounts of data that contain extremely valuable information. Therefore, machine learning (ML) has rapidly entered the research arena to analyze and make predictions from large heterogeneous datasets. Such data-driven ML-based applications for various domains become increasingly applicable, and thus their software qualities are taken into focus. This work provides a proof of concept for applying state-of-the-art ML technology to predict the distance travelled of the 2-min walk test, an important neurological measurement which is an indicator of walking endurance. A transparent lean approach was emphasized to optimize the results in an explainable way and simultaneously meet the specified software requirements for a generic approach. It is a general-purpose strategy as a fractional–factorial design benchmark combined with standardized quality metrics based on a minimal technology build and a resulting optimized software prototype. Based on 400 training and 100 validation data, the achieved prediction yielded a relative error of 6.1 % distributed over multiple experiments with an optimized configuration. The Adadelta algorithm ( LR = 0.000814 , f ModelSpread = 5 , n ModelDepth = 6 , n epoch = 1000 ) performed as the best model, with 90 % of the predictions with an absolute error of <15 m. Factors such as gender, age, disease duration, or use of walking aids showed no effect on the relative error. For multiple sclerosis patients with high walking impairment (EDSS Ambulation Score ≥ 6 ), the relative difference was significant ( n = 30 ; 24.0 % ; p < 0.050 ). The results show that it is possible to create a transparently working ML prototype for a given medical use case while meeting certain software qualities. [ABSTRACT FROM AUTHOR]

Purpose: Physical activity may be effective for managing the consequences of aging with multiple sclerosis (MS), yet physical activity participation is exceedingly low among older adults with MS. This study examined variables from social cognitive theory (SCT) as correlates of physical activity in older adults with MS as an important first step for informing the design of behavior change interventions. Methods: We focused on identifying correlates of light (LPA) and moderate-to-vigorous physical activity (MVPA) based on intensity-dependent benefits of physical activity. Older adults with MS (≥ 60 years, N = 441) completed an online survey including demographic and clinical characteristics, SCT variables (self-efficacy, exercise goal setting, social support, and outcome expectations), and physical activity (LPA, MVPA). Results: Bivariate correlation analyses indicated that all SCT variables correlated with both LPA and MVPA; however, correlations were stronger in magnitude for MVPA (range r = 0.25–0.56) than for LPA (all r = 0.11–0.20). Conclusion: Our results suggest that behavior change interventions informed by SCT may be a promising approach for increasing physical activity, particularly MVPA, in older adults with MS, and this should be a focus of future research in this segment of MS. [ABSTRACT FROM AUTHOR]

BACKGROUND: Persons with MS (pwMS) in the community show reduced physical activity while studies demonstrated beneficial effects of exercise therapy in supervised settings. OBJECTIVE: This study investigated, in pwMS living in the community, the effects of a 1-day education program about exercises and sports, on physical activity behavior and related outcome measures as self-efficacy, perceived walking ability, fatigue, perceived impact of MS and quality of life. METHODS: PwMS attended an education day with theoretical and practical sessions that was organized by the Flemish MS Society and professional exercise experts. Forty-two participants immediately completed questionnaires as well as after three and six months. Overall disability and physical activity level were measured using PDSS (patient determined disease steps) and PASIPD (Physical Activity Scale for Individuals with Physical Disabilities) respectively. Other outcomes were the ESES, MSWS-12, MFIS, MSIS-29 and SF-36. Analyses of variance were performed in groups distinguished by self-reported disability level (PDDS ≤1; n = 24 and PDSS >1; n = 18). RESULTS: Groups differed significantly for perceived walking ability (PDDS,MSWS-12) and physical related-domains of MSIS-29 and SF-36, but not PASIPD. A trend towards significant group*time interaction effect was found for the PASIPD indicating, at 3 and 6 months, increased physical activity in the subgroup PDDS ≤1. For the MSIS-29, a significant time effect was found with reduced impact being largest for the more disabled group at 6 months. No changes were found in other outcome measures. CONCLUSION: An one-day education program had, depending on perceived disability level, some long-standing effects on physical activity and perceived impact of MS. [ABSTRACT FROM AUTHOR]

Background: Physical activity and self-efficacy represent behavioral and psychological factors, respectively, that are compromised in persons with multiple sclerosis (MS), but might be modifiable through intervention and result in better health-related quality of life (HRQOL). Purpose: The present study adopted a panel research design and examined the associations between individual-level changes in physical activity, self-efficacy, and HRQOL over a one-year period in persons with MS. Method: The sample consisted of 269 persons with relapsing-remitting MS who completed the Godin Leisure-Time Questionnaire (GLTEQ), Multiple Sclerosis Self-Efficacy (MSSE) Scale, and Multiple Sclerosis Quality of Life-29 (MSIS-29) Scale on two occasions that were separated by 1 year. The data were analyzed using panel analysis in M plus 3.0. Results: The initial panel analysis indicated that individual-level change in physical activity was associated with individual-level change in both physical and psychological HRQOL. The subsequent panel analysis indicated that (a) individual-level change in self-efficacy for functioning with MS was associated with individual-level change in physical HRQOL, whereas individual-level change in self-efficacy for control was associated with individual-level change in psychological HRQOL; (b) individual-level change in self-efficacy for functioning with MS, but not self-efficacy for control, mediated the association between individual-level change in physical activity and physical HRQOL; and (c) individual-level change in self-efficacy for controlling MS was the strongest predictor of individual-level change in HRQOL. Conclusion: Physical activity and self-efficacy both might be important targets of subsequent behavioral and self-management interventions for improving the HRQOL of persons with MS, although self-efficacy is seemingly more important than physical activity. [ABSTRACT FROM AUTHOR]

Background: Ambulatory disability is common in people with multiple sclerosis (MS). Remote monitoring using average daily step count (STEPS) can assess physical activity (activity) and disability in MS. STEPS correlates with conventional metrics such as the expanded disability status scale (Expanded Disability Status Scale; EDSS), Timed-25 Foot walk (T25FW) and timed up and go (TUG). However, while STEPS as a summative measure characterizes the number of steps taken over a day, it does not reflect variability and intensity of activity. Objectives: Novel analytical methods were developed to describe how individuals spends time in various activity levels (e.g., continuous low versus short bouts of high) and the proportion of time spent at each activity level. Methods: 94 people with MS spanning the range of ambulatory impairment (unaffected to requiring bilateral assistance) were recruited into FITriMS study and asked to wear a Fitbit continuously for 1-year. Parametric distributions were fit to minute-by-minute step data. Adjusted R2 values for regressions between distributional fit parameters and STEPS with EDSS, TUG, T25FW and the patient-reported 12-item MS Walking scale (MSWS-12) were calculated over the first 4-weeks, adjusting for sex, age and disease duration. Results: Distributional fits determined that the best statistically-valid model across all subjects was a 3-compartment Gaussian Mixture Model (GMM) that characterizes the step behavior within 3 levels of activity: high, moderate and low. The correlation of GMM parameters for baseline step count measures with clinical assessments was improved when compared with STEPS (adjusted R2 values GMM vs. STEPS: TUG: 0.536 vs. 0.419, T25FW: 0.489 vs. 0.402, MSWS-12: 0.383 vs. 0.378, EDSS: 0.557 vs. 0.465). The GMM correlated more strongly (Kruskal-Wallis: p = 0.0001) than STEPS and gave further information not included in STEPS. Conclusions: Individuals' step distributions follow a 3-compartment GMM that better correlates with clinic-based performance measures compared with STEPS. These data support the existence of high-moderate-low levels of activity. GMM provides an interpretable framework to better understand the association between different levels of activity and clinical metrics and allows further analysis of walking behavior that takes step distribution and proportion of time at three levels of intensity into account. [ABSTRACT FROM AUTHOR]

COVID-19 in Brazil is threatening, and it has forced the government to adopt partial lockdown as a strategy to stop the spread of the virus in the first wave of pandemic (March 2020). These preventive measures during the COVID-19 pandemic may affect the motor and non-motor symptoms in people with Parkinson's disease (PD) and Multiple sclerosis (MS). Thus, the purpose of this study was to investigate the perception during the first wave of COVID-19 pandemic lockdown on motor and non-motor symptoms, and also measure physical activity level, quality of life, and sleep quality in Brazilian people with PD and MS. One hundred and fifty-three participants (PD-97 and MS-56) answered an online survey to identify the perception of motor and non-motor symptoms, and characterize the physical activity level, and quality of life and sleep in these neurological Brazillian population. During the beginning of pandemic lockdown in Brazil, our results indicated that 69% of people with PD and 55% of people with MS reported worse on motor aspects and lower amount of physical activity performed. Also, 75.2% (PD) and 92.9% (MS) of our cohort were considered inactive or sedentary. Based on the perception and behavior of the population studied, people with PD and MS should be encouraged to perform more physical activity in order to reduce the effects of isolation in motor and non-motor aspects of the diseases. Teleinterventions, such as home-based exercise, should be included in the new routine of people with PD and MS to reduce the impacts of lockdown and to maintain quality of life at a good level. [ABSTRACT FROM AUTHOR]

Background: Fatigue is one of the most common symptoms of multiple sclerosis (MS), significantly affecting the functioning of the patients. However, the neural underpinnings of physical and mental fatigue in MS are still vague. The aim of our study was to investigate the functional architecture of resting-state networks associated with fatigue in patients with MS. Methods: The sum of 107 high-functioning patients underwent a resting-state scanning session and filled out the 9-item Fatigue Severity Scale (FSS). Based on the FSS score, we identified patients with different levels of fatigue using the cluster analysis. The low-fatigue group consisted of n = 53 subjects, while the high-fatigue group n = 48. The neuroimaging data were analyzed in terms of functional connectivity (FC) between various resting-state networks as well as amplitude of low-frequency fluctuation (ALFF) and fractional amplitude of low-frequency fluctuations (fALFF). Results: Two-sample t -test revealed between-group differences in FC of posterior salience network (SN). No differences occurred in default mode network (DMN) and sensorimotor network (SMN). Moreover, differences in fALFF were shown in the right middle frontal gyrus and right superior frontal gyrus, however, no ALFF differences took place. Conclusion: Current study revealed significant functional network (FN) architecture between-group differences associated with fatigue. Present results suggest the higher level of fatigue is related to deficits in awareness as well as higher interoceptive awareness and nociception. [ABSTRACT FROM AUTHOR]