Diet, Physical Activity, and Stress Among Wheelchair Users With Multiple Sclerosis: Examining Individual and Co-Occurring Behavioral Risk Factors

OBJECTIVE: This study examined individual and co-occurring behavioral risk factors (diet, exercise, and stress) in wheelchair users with multiple sclerosis (MS) and potential association with MS symptoms (ie, fatigue, depression, anxiety, pain, sleep, and health-related quality of life [HRQOL]). DESIGN: Survey. SETTING: General Community. PARTICIPANTS: One hundred twenty-three wheelchair users with MS completed this study (N=123). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants were mailed instructions for accessing online questionnaires (demographic and clinical characteristics, Godin Leisure-Time Exercise Questionnaire, Perceived Stress Scale, Automated Self-Administered 24-Hour Dietary Assessment Tool, and MS symptoms). RESULTS: Standard cut-points were used to categorize behavioral risk factors and then identify the extent and distribution of these behaviors both individually and co-occurring. We then analyzed the associations between behavioral risk factors and MS symptoms using bivariate correlation analyses and Mann-Whitney U tests. The mean age of participants was 60.6±10.0 years, 76% identified as women, 82% had a progressive disease course, and the mean MS duration was 23.0±9.7 years. Seven participants were classified as having 0 negative health behaviors, 41 participants had 1 negative health behavior, 49 participants had 2 negative health behaviors, and 26 participants had 3 negative health behaviors. The number of negative health behaviors was significantly correlated with HRQOL (physical, r=.30; psychological, r=.47), sleep (r=.25), depressive symptoms (r=.36), and anxiety (r=.43). Mann-Whitney U tests indicated greater fatigue, depression, and anxiety as well as lower sleep quality and HRQOL among participants who reported 2 or 3 behavioral risk factors compared with 0 or 1 behavioral risk factor. CONCLUSIONS: Future research should examine the design and implementation of multiple health behavior change interventions targeting co-occurring behavioral risk factors among wheelchair users with MS

Perceptions of Physical Activity Guidelines Among Wheelchair Users With Multiple Sclerosis

BACKGROUND: Physical activity guidelines provide prescriptive resources for population-level promotion of behavior change to improve health outcomes. The National Multiple Sclerosis Society (NMSS) recently created and disseminated physical activity guidelines for persons with multiple sclerosis (MS) across the disease spectrum. OBJECTIVE: This study aimed to assess perceptions of the updated NMSS Physical Activity Guidelines among wheelchair users with MS. METHODS: One hundred thirty-four wheelchair users with MS participated in a cross-sectional study examining health behaviors. Outcomes were measured using an online questionnaire that included items related to demographic and clinical characteristics and a battery of questions regarding perceptions of the NMSS Physical Activity Guidelines based on Expanded Disability Status Scale groups 7.0-7.5 & 8.0-8.5. RESULTS: Among the 134 participants, 77 participants (58%) did not meet the general recommendations, 43 participants sometimes meet the general recommendations (32%), and 14 participants (10%) reported meeting the general recommendations. Participants reported positive perceptions across modalities (i.e. Breathing, Flexibility, Upper Extremity, Lower Extremity, and Core Exercises); however Upper and Lower Extremity Exercises were rated as the most challenging based on inability to complete independently. CONCLUSION: Wheelchair users with MS in this study generally rated the NMSS Guidelines for Physical Activity as appropriate

Restless legs syndrome and health‐related quality of life in adults with multiple sclerosis

Restless legs syndrome (RLS) is a sleep disorder that may exacerbate many of the symptoms and consequences of multiple sclerosis (MS), and may have further implications for health‐related quality of life (HRQOL). The present study examined the relationships among RLS, symptoms and HRQOL in people with MS. Participants with MS (n = 275) completed the Cambridge‐Hopkins Restless Legs Syndrome Questionnaire, the International Restless Legs Syndrome Study Group Scale, the Multiple Sclerosis Impact Scale, the Pittsburgh Sleep Quality Index, the Fatigue Severity Scale, the Hospital Anxiety and Depression Scale and the Patient Determined Disease Steps. There were 74 (26.9%) persons with MS who had RLS (MS + RLS). The MS + RLS group reported worse physical and psychological HRQOL (p = 0.020 and p = 0.017, respectively) and greater perceived fatigue (p = 0.006) and anxiety symptoms (p = 0.042) than the MS‐only group. Within the MS + RLS group, RLS severity was associated with physical (r = 0.43) and psychological (r = 0.46) HRQOL, sleep quality (r = 0.38), perceived fatigue (r = 0.28), depression (r = 0.38) and anxiety (r = 0.28). The relationships between RLS severity and the domains of HRQOL were attenuated when accounting for fatigue, depression and/or anxiety. Worse RLS severity was associated with reduced HRQOL, which was accounted for by fatigue, depression and anxiety.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155491/1/jsr12880.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155491/2/jsr12880_am.pd

Accuracy and Precision of Actigraphy and SMARTwheels for Measuring Push Counts Across a Series of Wheelchair Propulsion Trials in Non-disabled Young Adults

Background: There has been a growing interest in “Lifestyle Physical Activity” (LPA) among wheelchair users. LPA can be quantified via “pushes” as an outcome metric. This study examined the accuracy and precision of research-grade devices for counting pushes across a series of wheelchair propulsion trials. Methods: Eleven non-disabled, young adults completed 19, 1-minute wheelchair propulsion trials at self-selected speeds with a wheelchair equipped with a SMARTwheel (SW) device while being video recorded. Participants also wore 2 ActiGraph accelerometers, one on the wrist and one on the upper arm. Video footage enabled manual counting of the number of pushes (gold standard). Total pushes were averaged across 16 workloads (3 trials of repeated workloads were excluded) for each device and compared to manually counted pushes. Results: Compared to manually counted pushes, SW demonstrated the greatest accuracy (mean difference [MD] compared to video of 2.3 pushes [4.5% error]) and precision (standard deviation of the mean difference [SDMD]) compared to video of 4 pushes, (Coefficient of Variation [CV] =.04), followed by the upper arm-worn accelerometer (MD of 4.4 pushes [10.4% error] and SDMD of 10, [CV= .06]) and the wrist-worn accelerometer (MD of 12.6 pushes [27.8% error] and SDMD of 13 [CV=.15]). Conclusions: SW demonstrated greater accuracy and precision than ActiGraph accelerometers placed on the upper arm and wrist. The accelerometer placed on the upper arm was more accurate and precise than the accelerometer placed on the wrist. Future investigations should be conducted to identify the source(s) of inaccuracy among wearable push counters

Comparing Risk Factor Profiles between Intracerebral Hemorrhage and Ischemic Stroke in Chinese and White Populations:Systematic Review and Meta-Analysis

<div><p>Background</p><p>Chinese populations have a higher proportion of intracerebral hemorrhage (ICH) in total strokes. However, the reasons are not fully understood.</p><p>Methods</p><p>To assess the differences in frequency of major risk factors between ICH and ischemic stroke (IS) in Chinese versus white populations of European descent, we systematically sought studies conducted since 1990 that compared frequency of risk factors between ICH and IS in Chinese or white populations. For each risk factor, in Chinese and Whites separately, we calculated study-specific and random effects pooled prevalence and odds ratios (ORs) for ICH versus IS.</p><p>Results</p><p>Six studies among 36190 Chinese, and seven among 52100 white stroke patients studied hypertension, diabetes, atrial fibrillation (AF), ischemic heart disease (IHD), hypercholesterolemia, smoking and alcohol. Pooled prevalence of AF was significantly lower in Chinese. Pooled ORs for ICH versus IS were mostly similar in Chinese and Whites. However, in Chinese–but not Whites–mean age was lower (62 versus 69 years), while hypertension and alcohol were significantly more frequent in ICH than IS (ORs 1.38, 95% CI 1.18–1.62, and 1.46, 1.12–1.91). Hypercholesterolemia and smoking were significantly less frequent in ICH in Whites, but not Chinese, while IHD, AF and diabetes were less frequent in ICH in both.</p><p>Conclusions</p><p>Different risk factor distributions in ICH and IS raise interesting possibilities about variation in mechanisms underlying the different distributions of pathological types of stroke between Chinese and Whites. Further analyses in large, prospective studies, including adjustment for potential confounders, are needed to consolidate and extend these findings.</p></div

Feasibility, Acceptability, and Preliminary Validity of Self-Report Dietary Assessment in Adults with Multiple Sclerosis: Comparison with Doubly Labeled Water Measured Total Energy Expenditure

Background: Diet is a modifiable behavior of interest in multiple sclerosis (MS); however, measures of diet in persons with MS have not been vetted for feasibility, acceptability, and validity. Methods: This cross-sectional study examined the Automated Self-Administered 24-H (ASA24) Dietary Assessment Tool in 30 persons with MS and 15 healthy control (HC) participants. Participants were prompted to complete six ASA24 recalls and undergo a standard doubly labeled water (DLW) protocol. Acceptability of ASA24 was assessed using an online questionnaire. Total energy expenditure (TEE) from DLW was compared with ASA24-reported energy intake for assessing validity. Results: All participants completed four or more ASA24 recalls, indicating feasibility of ASA24. Regarding acceptability, the hardest part of completing the ASA24 was remembering everything eaten the previous day. Pearson correlation coefficients between DLW TEE and ASA24 kcal/day were not significant among HC (r = 0.40; p = 0.14) or MS (r = 0.26; p = 0.16) participants. The absolute mean error between DLW TEE and ASA24 among HC participants was 694.96 ± 506.25 mean kcal/day and among MS participants was 585.37 ± 529.02 mean kcal/day; this represents a mean difference of 30 and 25%, respectively. Conclusion: This study established the feasibility and acceptability of ASA24 in persons with MS and provides a foundation regarding the need for further validation research examining appropriate outcomes for supporting dietary interventions

Exponential modeling of human frequency-following responses to voice pitch

Objective: Recent studies have shown that the frequency-following response (FFR) to voice pitch can be a useful method to evaluate the signal-processing mechanisms and neural plasticity in the human brainstem. The purpose of this study was to examine the quantitative properties of the FFR trends with an exponential curve-fitting model. Design: FFR trends obtained with increasing number of sweeps (up to 8000 sweeps) at three stimulus intensities (30, 45, and 60 dB nHL) were fit to an exponential model that consisted of estimates of background noise amplitude, asymptotic response amplitude, and a time constant. Five objective indices (Frequency Error, Slope Error, Tracking Accuracy, Pitch Strength and RMS Ratio) were used to represent different perspectives of pitch processing in the human brainstem. Study Sample: Twenty-three native speakers (16 males; age = 24.7 ± 2.1 years) of Mandarin Chinese were recruited. Results: The results demonstrated that the exponential model provided a good fit (r = 0.89 ± 0.10) to the FFR trends with increasing number of sweeps for the five objective indices. Conclusions: The exponential model, combined with the five objective indices, can be used for difficult-to-test patients and may prove to be useful as an assessment and diagnostic method in both clinical and basic research efforts. © 2011 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society.

Cross-linguistic comparison of frequency-following responses to voice pitch in american and chinese neonates and adults

OBJECTIVES: Cross-language studies, as reflected by the scalp-recorded frequency-following response (FFR) to voice pitch, have shown the influence of dominant linguistic environments on the encoding of voice pitch at the brainstem level in normal-hearing adults. Research questions that remained unanswered included the characteristics of the FFR to voice pitch in neonates during their immediate postnatal period and the relative contributions of the biological capacities present at birth versus the influence of the listener\u27s postnatal linguistic experience. The purpose of this study was to investigate the characteristics of FFR to voice pitch in neonates during their first few days of life and to examine the relative contributions of the biological capacity versus linguistic experience influences on pitch processing in the human brainstem. DESIGN: Twelve American neonates (five males, 1-3 days old) and 12 Chinese neonates (seven males, 1-3 days old) were recruited to examine the characteristics of the FFRs during their immediate postnatal days of life. Twelve American adults (three males; age: mean ± SD = 24.6 ± 3.0 yr) and 12 Chinese adults (six males; age: mean ± SD = 25.3 ± 2.6 yr) were also recruited to determine the relative contributions of biological and linguistic influences. A Chinese monosyllable that mimics the English vowel /i/ with a rising pitch (117-166 Hz) was used to elicit the FFR to voice pitch in all participants. RESULTS: Two-way analysis of variance (i.e., the language [English versus Chinese] and age [neonate versus adult] factors) showed a significant difference in Pitch Strength for language (p = 0.035, F = 4.716). A post hoc Tukey-Kramer analysis further demonstrated that Chinese adults had significantly larger Pitch Strength values than Chinese neonates (p = 0.024). This finding, coupled with the fact that American neonates and American adults had comparable Pitch Strength values, supported the linguistic experience model. On the other hand, Pitch Strength obtained from the American neonates, American adults, and Chinese neonates were not significantly different from each other, supporting the biological capacity model. CONCLUSIONS: This study demonstrated an early maturation of voice-pitch processing in neonates starting from 1 to 3 days after birth and a significant effect of linguistic experience on the neural processing of voice pitch at the brainstem level. These findings provide a significant conceptual advancement and a basis for further examination of developmental maturation of subcortical representation of speech features, such as pitch, timing, and harmonics. These findings can also be used to help identify neonates at risk for delays in voice-pitch perception and provide new directions for preventive and therapeutic interventions for patients with central auditory processing deficits, hearing loss, and other types of communication disorders. Copyright © 2011 by Lippincott Williams & Wilkins