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      Can hand dexterity predict the disability status of patients with multiple sclerosis?

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          Abstract

          Background: Multiple Sclerosis (MS) is the most common disabling neurological disease. Hand dysfunction is one of the main complaints of patients with MS. The present study aimed to compare hand dexterity of MS patients with low Expanded Disability Status Scale (EDSS) scores and healthy adults. It also sought to identify the predictors of disability status of patients with MS based on their manual dexterity and demographic characteristics.

          Methods: In this cross-sectional study, 60 (16 male/44 female) patients with MS and 60 (19 male/41 female) healthy people, who matched in terms of age and sex, were recruited. Their hand dexterity was evaluated by the Purdue Pegboard Test. The disability status of the MS group was determined by the Expanded Disability Status Scale. The data were analyzed using SPSS15.

          Results: The hand dexterity in MS group even with low EDSS score (1.5 ± 1.07) was weaker than control group. Moreover, the dexterity of dominant hand and alternating two hands coordination subtests of the PPT was a good discriminator between two groups (p<0.001). The results of linear regression analysis suggested dominant hand dexterity and disease duration as predictors of disability status that predict 60.5 per cent of the variation in EDSS scores in patients with MS (p<0.001).

          Conclusion: Reduced dominant hand dexterity in patients with MS is a disabling factor. Further research is recommended to determine if early hand rehabilitation can reduce the severity of disability in Patients with MS.

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          Most cited references 31

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          Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study.

          To establish: (1) inter-rater and test-retest reliability of standardized guidelines for the Fugl-Meyer upper limb section, Action Research Arm Test and Box and Block Test in patients with paresis secondary to stroke, multiple sclerosis or traumatic brain injury and (2) correlation between these arm motor scales and more general measures of impairment and activity limitation. Multicentre cohort study. Three European referral centres for neurorehabilitation. Thirty-seven stroke, 14 multiple sclerosis and five traumatic brain injury patients. Scores of the Fugl-Meyer Test (arm section), Action Research Arm Test, and Box and Block Test derived from video information. All three motor tests showed very high inter-rater and test-retest reliability (ICC and rho for main variables > 0.95). Correlation between the motor scales was very high (rho > 0.92). Motor scales correlated moderately highly with the Hemispheric Stroke Scale, a measure of impairment (rho = 0.660-0.689), but not with the Modified Barthel Index, a measure of the ability to cope with basic activities of daily living (rho = 0.044-0.086). The standardized guidelines assured comparability of test administration and scoring across clinical facilities. The arm motor scales provided information that was not identical to information from the Hemispheric Stroke Scale or the Modified Barthel Index.
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            High concurrent presence of disability in multiple sclerosis. Associations with perceived health.

            (1) To explore functioning and concurrent presence of disabilities - concerning cognition, manual dexterity, walking, energy, mood, activities of daily living (ADL), and social/lifestyle activities - in persons with multiple sclerosis (PwMS) cared for at an outpatient MS clinic. 2) To describe the PwMS' perceived physical and psychological impact and associations with the same disabilities. A descriptive cross-sectional study was carried out in 219 PwMS at the MS Centre, Karolinska University Hospital. Logistic regression employing proportional odds models was used to identify the associations of the disabilities with the perceived physical and psychological impact. In this sample the distribution with regard to disease severity as per Expanded Disability Status Scale was; mild 59.5%, moderate 17% and severe 23.5%. Despite the high proportion with mild disease severity disability regarding cognition was found in 49%, manual dexterity 76%, walking 43%, energy 67%, mood 29%, ADL 44% and social/lifestyle activities in 48%. Two or more disabilities were found in 80%, 24 % had six or seven disabilities. Disability regarding energy, mood, walking, manual dexterity and ADL was significantly associated with increase in the perceived physical impact, whereas disability in energy and mood was significantly associated with increase in the perceived psychological impact. The presence of several concurrent disabilities, some significantly associated with high perceived physical and psychological impact, in the majority of PwMS in outpatient clinics highlights the importance to identify disabilities, in particular fatigue and depressed mood, in order to supply health care interventions aiming to improve the life situation of PwMS.
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              Two hands, one brain: cognitive neuroscience of bimanual skill.

              Bimanual coordination, a prototype of a complex motor skill, has recently become the subject of intensive investigation. Whereas past research focused mainly on the identification of the elementary coordination constraints that limit performance, the focus is now shifting towards overcoming these coordination constraints by means of task symbolization or perceptual transformation rules that promote the integration of the task components into a meaningful "gestalt". The study of these cognitive penetrations into action will narrow the brain-mind gap and will facilitate the development of a cognitive neuroscience perspective on bimanual movement control.
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                Author and article information

                Journal
                Med J Islam Repub Iran
                Med J Islam Repub Iran
                MJIRI
                Med J Islam Repub Iran
                Medical Journal of the Islamic Republic of Iran
                Iran University of Medical Sciences
                1016-1430
                2251-6840
                2015
                30 August 2015
                : 29
                : 255
                Affiliations
                1 MSc of occupational therapy, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. Maghandi1388@ 123456gmail.com
                2 Assistant professor, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. Akbarfahimi.m@ 123456iums.ac.ir
                3 Associate Professor, Department of Neurology, School of Medicine, Shahed Medical University, Tehran, Iran. seyedmassoodnabavi@ 123456gmail.com
                4 Associate Professor, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. Mehraban.a@ 123456iums.ac.ir
                5 Professor, Department of Optometry, Iran University of Medical Sciences, Tehran, Iran. Ejafarzadehpure@ 123456iums.ac.ir
                Author notes
                (Corresponding author) Assistant professor, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. Akbarfahimi.m@ 123456iums.ac.ir
                Article
                4715381
                © 2015 Iran University of Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0), which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                Page count
                Figures: 1, Tables: 2, References: 37, Pages: 8
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                Original Article

                multiple sclerosis, hand, disability

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