Gait rehabilitation and monitoring in multiple sclerosis; optimal rehabilitation interventions, longitudinal changes, sex differences and the protective role of cardiorespiratory fitness

Multiple sclerosis (MS) is a chronic demyelinating and autoimmune disease of the central nervous system, characterized by episodes of new or worsening neurologic symptoms, followed by partial or complete recovery. Despite an expanding body of literature on the effectiveness of exercise in MS, the optimal approaches to improve gait are lacking. Notably, people with MS often have low levels of cardiorespiratory fitness, limiting their exercise capacity. Furthermore, covert gait changes precede clinical signs, often not detectable on observation, and measurement of subtle changes in gait, such as variability, could be a potential biomarker of covert neurodegeneration. Both cognition and fitness could influence changes in gait variability over time. The purpose of my doctoral work was to systematically review the optimal interventions to improve gait speed, the intricate relationship between cardiorespiratory fitness, and gait variability—a potential longitudinal biomarker of covert gait changes. The first study critically synthesized randomized controlled trials, consolidating knowledge on optimal rehabilitation interventions to improve gait speed in individuals with MS. Lower limb resistance and treadmill training emerged as the most effective interventions. Overall, there was a positive albeit small effect of interventions on gait speed in individuals with MS. The second study focused on the early detection of covert gait changes in clinically stable people with MS and highlighted gait variability as a sensitive longitudinal biomarker. Notably, it proposed the protective role of cardiorespiratory fitness against covert worsening of gait variability over two years in individuals with MS. The third study assessed cardiorespiratory fitness and examined its association with self-reported moderate to vigorous physical activity, with an emphasis on sex-related differences. The findings showed that males and females had low levels of cardiorespiratory fitness. Furthermore, there was an agreement between self-reported physical activity and aerobic fitness only in females, indicating potential over-reporting by males. This comprehensive thesis contributes valuable insights into treatments and monitoring of gait in MS, specifically identifying optimal rehabilitation interventions, identifying gait variability as a potential longitudinal biomarker for covert neurodegeneration, the protective role of cardiorespiratory fitness and sex differences in fitness and reporting of physical activity

Translingual neurostimulation combined with physical therapy to improve walking and balance in multiple sclerosis (NeuroMSTraLS): Study protocol for a randomized controlled trial

INTRODUCTION: Physical rehabilitation restores lost function and promotes brain plasticity in people with Multiple Sclerosis (MS). Research groups worldwide are testing the therapeutic effects of combining non-invasive neuromodulation with physical therapy (PT) to further improve functional outcomes in neurological disorders but with mixed results. Whether such devices enhance function is not clear. We present the rationale and study design for a randomized controlled trial evaluating if there is additional benefit to the synergistic pairing of translingual neurostimulation (TLNS) with PT to improve walking and balance in MS. METHODS AND ANALYSIS: A parallel group [PT + TLNS or PT + Sham], quadruple-blinded, randomized controlled trial. Participants (N = 52) with gait and balance deficits due to relapsing-remitting or progressive MS, who are between 18 and 70 years of age, will be recruited through patient registries in Newfoundland & Labrador and Saskatchewan, Canada. All participants will receive 14 weeks of PT while wearing either a TLNS or sham device. Dynamic Gait Index is the primary outcome. Secondary outcomes include fast walking speed, subjective ratings of fatigue, MS impact, and quality of life. Outcomes are assessed at baseline (Pre), after 14 weeks of therapy (Post), and 26 weeks (Follow Up). We employ multiple methods to ensure treatment fidelity including activity and device use monitoring. Primary and secondary outcomes will be analyzed using linear mixed-effect models. We will control for baseline score and site to test the effects of Time (Post vs. Follow-Up), Group and the Group x Time interaction as fixed effects. A random intercept of participant will account for the repeated measures in the Time variable. Participants must complete the Post testing to be included in the analysis. ETHICS AND DISSEMINATION: The Human Research Ethics Boards in Newfoundland & Labrador (HREB#2021.085) & Saskatchewan (HREB Bio 2578) approved the protocol. Dissemination avenues include peer-reviewed journals, conferences and patient-oriented communications

Association Between Physical Activity and Post menopausal Symptoms in Saudi Women: A Cross-sectional Study

Objectives: Menopause is the termination of a woman’s menstrual cycle for a year. In this condition, women’s health status declines due to hormonal changes and aging. Physical Activity (PA) is among the best available alternatives for managing menopause-related symptoms without any adverse effects. This study aimed to assess the relationship between PA and symptoms, such as fatigue, depression, and insomnia in Saudi menopausal women. Methods: This cross-sectional study involved 60 menopausal women; they were divided into physically active and inactive groups. The group allocation was conducted based on their PA level determined by the International Physical Activity Questionnaire Short-Form (IPAQ-SF). Menopausal symptoms, such as fatigue, depression, and insomnia were assessed using the Fatigue Severity Scale (FSS), Beck Depression Inventory-II (BDI-II), and Insomnia Severity Index (ISI), respectively, in the study groups. The association between PA and fatigue, depression, and insomnia was assessed using the Pearson correlation coefficient. The significance level was set at P≤0.05. Results: Fatigue, depression, and insomnia were more prevalent in physically inactive post-menopause women than the active women. A significant difference was observed in the outcome variables between the study groups. Furthermore, a significant association was detected between PA and fatigue, depression, and insomnia in the study participants. Discussion: Half of the explored menopausal women were physically active. Physically active menopausal women presented less fatigue, depression, and insomnia, compared to their inactive counterparts. This study suggested that PA positively impacted menopausal symptoms (fatigue, insomnia, & depression). Besides, the collected results highlighted the importance of physical activity among menopausal women

Cross-Cultural Variation in BMI, Sedentary Behavior, and Physical Activity in International School Girls Residing in Saudi Arabia

Background: The current study was done to assess the cross-cultural difference in physical activity and sedentary behavior among girls from culturally, environmentally, and geographically diverse countries residing in Saudi Arabia. Methods: This was a comparative cross-sectional study conducted among expatriate girls (N = 275), aged 9–16 years. Participants were from India (n = 65), Pakistan (n = 88), Egypt (n = 50), Sudan (n = 49), and other nationals (n = 23). They were randomly selected from different schools in Riyadh and their Body Mass Index (BMI) and screen time was assessed. Physical activity (PA) and leisure-time activity was assessed using Physical Activity Questionnaire for Older Children (PAQ-C) and the Godin-Shephard Leisure-Time Exercise Questionnaire (GSLTPAQ) respectively. Results: Out of 275, 65.8% were active and 34.2% were insufficiently active as per the GSLTPAQ, and half of them were moderately active and only 22.2% were extremely active as per PAQ-C. No statistical significant differences in their BMI status, screen time, or the levels of PA among expatriate girls. Conclusions: This study shows that the expatriate female school children in Saudi Arabia demonstrated a similar pattern in their BMI, sedentary time spent, and PA levels

Effect of Therapy Ball Seating on Learning and Sitting Discomforts among Saudi Female Students

The aim of the study was to evaluate the effect of therapy ball seating as an alternative for typical chair seating in a classroom. We evaluated the effect of ball seating on the student's sitting discomfort and academic performance using Cornell Musculoskeletal Discomfort Questionnaire and problem-based learning scales, respectively. A sample of convenience was taken. Data was collected and analyzed using t-test. Subjects experienced a major discomfort at neck and a minor discomfort at knee joint. Results showed that there was a significant improvement (P≤0.05) in sitting discomfort and student's performance when seated on therapy balls compared to typical classroom chairs. This study provides evidence for the effectiveness of therapy balls as a classroom seating for students who exhibit sitting discomfort and problem-based learning

Influence of Work-Related Safety and Health Guidelines on Knowledge and Prevalence of Occupational Back Pain among Rehabilitation Nurses in Saudi Arabia: A 6-Month Follow-Up Study

Background: Nurses are frequently involved in different types of patient handling activities in different departments of the hospitals. Mishandling the patients causes accumulative stress on their spine that results in occupational back pain (OBP), substantial morbidity, and incurred cost. Objectives: This study aimed to observe the influence of work-related safety and health guidelines on knowledge and prevalence of occupational back pain among rehabilitation nurses in Saudi Arabia. Methodology: This cohort study was conducted with the inclusion of a total of 116-registered rehabilitation nurses (97-female, 19-male, mean age = 39.6-years) from different regions of Saudi Arabia. After the invitation, these nurses attended an ergonomic workshop focusing on work-related safety and patient handling guidelines, risk assessment, and control of OBP. A self-administered questionnaire was used to assess the knowledge, risk, and prevalence of OBP at baseline and 6-months follow-up. Results: The perceived knowledge score significantly improved (95% CI; t = 4.691; p < 0.001; Cohen’s d = 0.72) at 6-month follow-up (mean ± SD = 81.6 ± 18.2) from its baseline score (mean ± SD = 68.2 ± 19.2). Likewise, the prevalence score of OBP markedly reduced from 71.5% (baseline) to 65.0% (6-month follow-up). Conclusion: The level of knowledge highly improved and the prevalence of OBP markedly reduced within a span of 6-month among rehabilitation nurses in Saudi Arabia after attending an ergonomic workshop. Importantly, the nurses learned and geared up themselves for practicing the safe patient handling guidelines to avoid occupational back pain in the future. Therefore, rehabilitation nurses should update their knowledge and awareness about occupational safety and health guidelines, risk assessments, and control of OBP at a regular interval for increasing the knowledge and reducing the prevalence of OBP among them

Relationship Between Teacher’s and Therapist’s Evaluations on Handwriting Performance in First-grade Children

Objectives: Handwriting dysfunction may harm children’s wellbeing. Therapists and elementary school teachers help to identify and improve children’s handwriting performance. The present study aimed to assess the relationship between therapists’ assessment and teachers’ perception of handwriting performance in first graders. Methods: This cross-sectional study involved (n=31) first-grade students, aged 6-8 years from an international school in Riyadh City, Saudi Arabia. Teachers evaluated the handwriting proficiency using the Handwriting Proficiency Screening Questionnaire (HPSQ), and the explored students were rated as proficient and non-proficient hand writers. Furthermore, therapists assessed students’ handwriting proficiency using the Minnesota Handwriting Assessment (MHA) (manuscript & D’Nealian styles) scores. The Mann–Whitney U test was used to assess the differences in MHA scores between proficient and non-proficient hand writers. Moreover, Spearman’s correlation coefficient was used to assess the relationship between the scores of MHA and HPSQ. Results: There was a significant difference in all component scores of MHA (except the rate) and both writing styles between the proficient and non-proficient writers (P<0.05). There was also a significant relationship between the MHA and the HSPQ scores (P<0.05). However, further analysis of these scales’ components suggested no significant association between teachers’ and therapists’ evaluation of the handwriting speed domain. Discussion: There was a significant relationship between the teacher’s and therapist’s evaluation of handwriting performance using standardized measures. Thus, therapists should work in collaboration with teachers to identify and treat handwriting difficulties in school children