Balance assessment in Multiple Sclerosis and cerebellar ataxia: rationale, protocol and demographic data

A core set of standardized balance measures are required for use in rehabilitation among people with multiple sclerosis (MS) and cerebellar ataxia. An earlier systematic review and Delphi survey identified the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), Posture and Gait sub-component of the International Co-operative Ataxia Rating Scale (PG of ICARS) and the gait, sitting and stance sub-components of the Scale for the Assessment and Rating of Ataxia (SARA Bal) as suitable balance measures. This study aims to estimate the reliability, validity and interpretability of these measures. This study will recruit 60 participants with multiple sclerosis with secondary cerebellar involvement across four centres in New Zealand and the United States of America. Participants will be assessed and videotaped performing the BBS, TUG, SARA Bal and PG of ICARS by trained physiotherapists. Barthel Index, Expanded Disability Status Scale (EDSS), Disease duration, ICARS and SARA will also be assessed to determine validity. A second assessment to determine reliability will be conducted by assessors watching the video-recording. Data collection is in progress, 44 samples have been collected and the demographic data are presented. The findings of this study will recommend a core set of reliable, valid and interpretable measures that are suitable for clinical practice and research for the assessment of balance among adults with MS and cerebellar ataxia. Minimal Clinically Important Difference (MCID) and cut-off scores to predict the use of assistive walking device will be established

Pathology Case Study: Left Facial Numbness

This is a case study presented by the University of Pittsburgh Department of Pathology in which a 56-year-old woman developed left facial numbness, followed by right peripheral facial weakness, left hand weakness, and left side hearing loss and tinnitus. The patientâs medical history and detailed description of her symptoms after admittance to the hospital are included in the âPatient Historyâ section. Results from a cranial magnetic resonance (MR) scan along with a microscopic description and images of a sural nerve biopsy are provided here to help aid in understanding the diagnosis. The âFinal Diagnosisâ section contains the attending doctorâs notes on the patient with commentary, and a detailed pathology. References are also included in this section. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student knowledge of neuropathology

Adding to the Burden: Gastrointestinal Symptoms and Syndromes in Multiple Sclerosis

Background. Multiple sclerosis (MS) patients often suffer from gastrointestinal (GI) symptoms. However, the full extent and prevalence of such symptoms are not clearly established. Thus, we sought to define the prevalence of GI symptoms and syndromes in those with MS. Methods. 218 MS patients completed self-reported demographic and clinical data questionnaires as well as several standardized surveys probing MS severity and GI health. Results. Nearly two thirds (65.6%) of patients endorsed at least one persistent GI symptom. Constipation (36.6%), dysphagia (21.1%), and fecal incontinence (15.1%) were common. Surprisingly, nearly 30% (28.4%) of the patients reported dyspeptic symptoms. Using validated diagnostic algorithms, patients met criteria for functional dysphagia (14.7%), functional dyspepsia (16.5%), functional constipation (31.7%), and IBS (19.3%), among others. Functional dysphagia, functional dyspepsia, and IBS were significantly more common in those with self-identified mood disorders. Conclusions. Constipation, fecal incontinence, and dysphagia are indeed frequent symptoms seen in MS patients. We also noted a ~30% prevalence of dyspepsia in this population. The mechanisms driving this association are not clear and require further study. However, due to this high prevalence, dyspeptic symptoms should be incorporated into the routine assessment of MS patients and, if found, may warrant collaborative referral with a GI specialist

Psychometric properties of a core set of measures of balance for people with cerebellar ataxia secondary to multiple sclerosis

Objective: To examine the reliability, validity and interpretability of four clinical measures in assessing the severity of balance dysfunction among people with cerebellar ataxia (CA) secondary to multiple sclerosis (MS). Design: Cross sectional observation study. Setting: Data collected across four outpatient clinics in New Zealand and United States of America. Participants: Sixty consecutive participants with CA secondary to MS. Main outcome measures Balance was assessed and video-recorded using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, the posture and gait sub-component of the International Co-operative Ataxia Rating Scale (PG-ICARS) and gait, stance and sit sub-components of the Scale for the Assessment and Rating of Ataxia (SARABal). The videos were later used to estimate reliability. The Barthel Index, Expanded Disability Status Scale (EDSS), ICARS and SARA were assessed and disease duration recorded. Results: Reliability was good for all four measures (range between ICC 0.95 and 0.99). Internal consistency was moderate to good for all four measures (α range 0.72-0.94), moderate to good correlation between the measures of balance (ρS range 0.72-0.85) and poor to moderate correlation with disease severity (EDSS), functional independence (Barthel Index) and disease duration (ρS range -0.37 to 0.76). Minimal Detectable Change (MDC) was derived for BBS (3), PG-ICARS (2) and SARABal (2). Measures were able to discriminate between assistive walking device users and non-users. Conclusions: All four measures showed good reliability and acceptable validity; however, owing to the item repetition in scoring of the PG-ICARS and moderate construct, criterion and convergent validity of the TUG, the BBS and SARABal are recommended for balance assessment in clinical practice for people with CA secondary to MS