Patrick Oschmann

Mindfulness-based interventions in multiple sclerosis: beneficial effects of Tai Chi on balance, coordination, fatigue and depression

BackgroundPatients suffering from Multiple Sclerosis (MS) experience a wide array of symptoms, including balance problems, mobility impairment, fatigue and depression. Physical exercise has recently been acknowledged as a treatment option complementary to medication. However, information regarding putative effects of structured exercise programs on neurological symptoms is sparse. Tai Chi, a Chinese martial art incorporating physical exercise and mindfulness training, has been shown to yield health benefits in various neurological groups. It seems particularly suitable for patients with motoric deficits as it challenges coordination and balance. The purpose of the current study was to explore the therapeutic value of structured Tai Chi training for coordination, balance, fatigue and depression in mildly disabled MS patients.MethodsA sample of 32 MS patients (Expanded Disability Status Scale, EDSS < 5) was examined. A structured Tai Chi course was devised and a Tai Chi group participated in two weekly sessions of 90 minutes duration for six months, while a comparison group received treatment as usual (TAU). Both groups were examined prior to and following the six-months interval with regards to balance and coordination performance as well as measures of fatigue, depression and life satisfaction.ResultsFollowing the intervention, the Tai Chi group showed significant, consistent improvements in balance, coordination, and depression, relative to the TAU group (range of effect-sizes: partial η2 = 0.16 – 0.20). Additionally, life satisfaction improved (partial η2 = 0.31). Fatigue deteriorated in the comparison group, whereas it remained relatively stable in the Tai Chi group (partial η2 = 0.24).ConclusionsThe consistent pattern of results confirms that Tai Chi holds therapeutic potential for MS patients. Further research is needed to determine underlying working mechanisms, and to verify the results in a larger sample and different MS subgroups.

Normative data and long-term test-retest reliability of the triple stimulation technique (TST) in multiple sclerosis.

OBJECTIVES Transcranial magnetic stimulation is useful for the assessment of cortico-spinal tract integrity in multiple sclerosis (MS). An advanced approach is the triple stimulation technique (TST), utilizing a combination of central and peripheral stimuli, reducing individual response variability. Although TST measures have been implemented in longitudinal studies, basic methodological data on temporal properties of abnormal TST values in MS are sparse. METHODS Normative TST data were obtained from 48 healthy participants. Longitudinal measures were derived from 17 MS-patients (relapsing-remitting: N=10; clinically isolated syndrome: N=7) prior to, three and twelve months following therapy initiation. Intraclass correlations were used to examine test-retest reliability. Complementary, patient ambulation and cognition were assessed. RESULTS Patient TST parameters were abnormal, involving excellent test-retest reliability and stable mean values. Cognitive and motor performance improved. CONCLUSIONS Results are the first to show that abnormal TST values in MS, reflecting diagnostic utility, are highly reliable in a long-term follow-up. Methodological properties are adequate for a longitudinal implementation of TST. Parameters were insensitive to alterations in cognitive/motor functioning. Sensitivity may be verified in subgroups with different treatment regimes. SIGNIFICANCE Results provide new normative data, support diagnostic utility of TST measures in MS, and confirm their long-term robustness.

Measuring standing balance in multiple sclerosis: Further progress towards an automatic and reliable method in clinical practice

BACKGROUND Balance deficits in multiple sclerosis (MS) are often monitored by means of observer-rated tests. These may provide reliable data, but may also be time-consuming, subject to inter-rater variability, and potentially insensitive to mild fluctuations throughout the clinical course. On the other hand, laboratory assessments are often not available. The Nintendo Wii Balance Board (WBB) may represent a low-cost solution. The purpose of the current study was to examine the methodological quality of WBB data in MS (internal consistency, test-retest reliability), convergent validity with observer-rated tests (Berg Balance Scale, BBS; Timed-Up and Go Test, TUG), and discriminative validity concerning clinical status (Expanded Disability Status Scale, EDSS). METHODS Standing balance was assessed with the WBB for 4min in 63 MS patients at two assessment points, four months apart. Additionally, patients were examined with the BBS, TUG and the EDSS. RESULTS A period of 4min on the WBB provided data characterized by excellent internal consistency and test-retest reliability. Significant correlations between WBB data and results of the BBS and TUG were obtained after merely 2min on the board. An EDSS median-split revealed that higher EDSS values (>3) were associated with significantly increased postural sway on the WBB. CONCLUSIONS WBB measures reflecting postural sway are methodologically robust in MS, involving excellent internal consistency and test-retest reliability. They are also characterized by convergent validity with other considerably lengthier observer-rated balance measures (BBS) and sensitive to broader clinical characteristics (EDSS). The WBB may hence represent an effective, easy-to-use monitoring tool for MS patients in clinical practice.

Cognitive screening in Multiple Sclerosis: the Five-Point Test as a substitute for the PASAT in measuring executive function

Abstract Objective: The Paced Auditory Serial Addition Test (PASAT) is frequently employed to measure executive functions in patients with Multiple Sclerosis (MS). In the past, the PASAT has often been criticized because of its stressful and demanding requirements. Continuous utilization might also reduce its validity. The Five-Point Test (FPT) by Regard, Strauss, and Knapp ((1982) Children’s production on verbal and non-verbal fluency tasks. Perceptual and Motor Skills, 55, 839–844.) is a short test of figural fluency which might serve as a substitute.Method: 116 patients diagnosed with MS were tested with a short version of the Brief Repeatable Battery (BRB) by Rao and the Cognitive Function Study Group of the National Multiple Sclerosis Society including the PASAT, as well as the FPT. A factor analysis was computed and the frequency of cognitive impairment was calculated for both the original short version of the BRB and the alternative version (involving the FPT).Results: In the factor analysis, PASAT and FPT loaded highest on the same factor (two factors were extracted). The estimation of the frequency of cognitive impairment showed that replacing the PASAT with the FPT did not considerably alter the proportion of patients identified as cognitively impaired.Conclusions: The FPT proved to be a viable alternative to the PASAT in this study. It may be recommended as a possible replacement in neuropsychological screening of MS-patients with the advantage of avoiding the indicated limitations of the PASAT.