Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep-Oct;25(5):226-232.
doi: 10.7224/1537-2073.2021-069. Epub 2023 Sep 14.

Assessment of Multiple Aspects of Upper Extremity Function Independent From Ambulation in Patients With Multiple Sclerosis

Caspar E P van Munster  1 , Burggraaff Jessica  1 , Saskia Steinheimer  2 , Christian P Kamm  2   3 , Marcus D'Souza  4   5 , Manuela Diederich  4 , Jonas Dorn  6 , Lorcan Walsh  6 , Frank Dahlke  6 , Ludwig Kappos  4 , Bernard M J Uitdehaag  1
Affiliations

Assessment of Multiple Aspects of Upper Extremity Function Independent From Ambulation in Patients With Multiple Sclerosis

Caspar E P van Munster et al. Int J MS Care. 2023 Sep-Oct.

Abstract

Background: Upper extremity function (UEF) is often compromised in multiple sclerosis (MS), although its importance is regularly underrecognized relative to ambulation. We explored the concurrent presence of impairment in UEF and ambulation by examining various aspects of UEF across different levels of ambulation.

Methods: The cohort consisted of 247 patients with clinically definite MS or clinically isolated syndrome according to the revised 2010 McDonald criteria. The Nine-Hole Peg Test and the Expanded Disability Status Scale were used to stratify patients into clinically different subgroups. For UEF, cerebellar function (finger-to-nose test), pyramidal function (pronator drift test), and the ability to perform a task of activities of daily living (drinking-from-cup test) were examined. Patient-reported limitations of UEF in daily life were assessed using the Arm Function in Multiple Sclerosis Questionnaire.

Results: Patients in more severely impaired ambulation groups displayed poorer performance on all UEF measures. Although most patients had normal to mild (n = 147) or moderate (n = 46) ambulatory impairment, 87.7% exhibited some level of UEF impairment as defined using the Nine-Hole Peg Test. Most patients had mild UEF impairment (n = 174), accounting for the largest proportion in all ambulation groups (51.9%-77.8%).

Conclusions: A distinct pattern of impairment was found for ambulation and multiple aspects of UEF. Independent assessment of multiple aspects of disability may be helpful in treatment decision-making and could support the development of rehabilitation strategies that specifically target UEF impairment.

PubMed Disclaimer

Conflict of interest statement

FINANCIAL DISCLOSURES: Dr van Munster has received travel support from Novartis Pharma AG, Sanofi Genzyme, Teva Pharmaceuticals, and Merck Serono; honoraria for lecturing and consulting from Novartis Pharma AG, Biogen Idec, and Merck Serono; and compensation for serving on a scientific advisory board from Biogen Idec, Roche, Merck Serono, and Sanofi Genzyme. Dr Burggraaff has received travel support from Novartis Pharma AG. Dr Kamm has received honoraria for lectures as well as research support from Biogen, Novartis, Almirall, Bayer Schweiz AG, Teva Pharmaceuticals, Merck, Sanofi Genzyme, Roche, Celgene, and the Swiss MS Society. Dr D’Souza has received travel support from Bayer AG, Hoffmann-La Roche, Teva Pharmaceuticals, and Sanofi Genzyme and research support from the University Hospital Basel. Drs Dorn, Walsh, and Dahlke are employees of Novartis Pharma AG. Dr Uitdehaag has received consultancy fees from Biogen Idec, Genzyme, Merck Serono, Novartis, Roche, and Teva Pharmaceuticals. Dr Steinheimer and M. Diederich declare no conflicts of interest. In the past 3 years, Dr Kappos’ institution (University Hospital Basel) received and used exclusively for research support for the Department of Neurology steering committee, advisory board, and consultancy fees from Actelion, Alkermes, Almirall, Bayer, Biogen, df-mp, Excemed, GeNeuro SA, Genzyme, Merck, Minoryx, Mitsubishi Pharma, Novartis, Receptos, Roche, Sanofi Aventis, Santhera, Teva Pharmaceuticals, and Vianex and royalties from Neurostatus products. For department educational activities, the institution received honoraria from Allergan, Almirall, Bayer, Biogen, Excemed, Genzyme, Merck, Novartis, Pfizer, Sanofi Aventis, Teva Pharmaceuticals, and UCB.

Figures

FIGURE 1.
FIGURE 1.
Distribution Among the Clinically Different UEF and Ambulation Subgroups
See this image and copyright information in PMC

References

    1. Kamm CP, Uitdehaag BM, Polman CH. Multiple sclerosis: current knowledge and future outlook. Eur Neurol . 2014;72(3-4):132–141. doi: 10.1159/000360528. - DOI - PubMed
    1. Meyer-Moock S, Feng YS, Maeurer M, Dippel FW, Kohlmann T. Systematic literature review and validity evaluation of the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC) in patients with multiple sclerosis. BMC Neurol . 2014;14:58. doi: 10.1186/1471-2377-14-58. - DOI - PMC - PubMed
    1. Kraft GH, Amtmann D, Bennett SE, et al. Assessment of upper extremity function in multiple sclerosis: review and opinion. Postgrad Med . 2014;126(5):102–108. doi: 10.3810/pgm.2014.09.2803. - DOI - PubMed
    1. Yozbatiran N, Baskurt F, Baskurt Z, Ozakbas S, Idiman E. Motor assessment of upper extremity function and its relation with fatigue, cognitive function and quality of life in multiple sclerosis patients. J Neurol Sci . 2006;246(1-2):117–122. doi: 10.1016/j.jns.2006.02.018. - DOI - PubMed
    1. Koch MW, Murray TJ, Fisk J, et al. Hand dexterity and direct disease related cost in multiple sclerosis. J Neurol Sci . 2014;341(1-2):51–54. doi: 10.1016/j.jns.2014.03.047. - DOI - PubMed