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Objective assessment of motor fatigue in multiple sclerosis: the Fatigue index Kliniken Schmieder (FKS)

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Abstract

Fatigue is a common and frequently disabling symptom of multiple sclerosis (MS). The aim of this study was to develop the Fatigue index Kliniken Schmieder (FKS) for detecting motor fatigue in patients with MS using kinematic gait analysis. The FKS relies on the chaos theoretical term “attractor”, which, if unchanged, is a necessary and sufficient indicator of a stable dynamical system. We measured the acceleration of the feet at the beginning of and shortly before stopping a treadmill walking task in 20 healthy subjects and 40 patients with multiple sclerosis. The attractor and movement variability were calculated. In the absence of muscular exhaustion a significant difference in the attractor and movement variability between the two time points demonstrates altered motor control indicating fatigue. Subjects were classified using the FKS. All healthy subjects had normal FKS and thus no fatigue. 29 patients with MS were classified into a fatigue group and 11 patients into a non-fatigue group. This classification agreed with the physician’s observation and video analyses in up to 97 % of cases. The FKS did not correlate significantly with the overall and motor dimensions of the fatigue questionnaire scores in patients with MS and motor fatigue. The common concept of fatigue as overall subjective sensation of exhaustion can be affected by conditions including depression, sleep disorder and others. FKS constitutes a robust and objective measure of changes in motor performance. Therefore, the FKS allows correct identification of motor fatigue even in cases where common comorbidities mask motor fatigue.

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References

  1. Thickbroom GW, Sacco P, Faulkner DL, Kermode AG, Mastaglia FL (2008) Enhanced corticomotor excitability with dynamic fatiguing exercise of the lower limb in multiple sclerosis. J Neurol 255:1001–1005

    Article  PubMed  Google Scholar 

  2. Romani A, Bergamaschi R, Candeloro E, Alfonsi E, Callieco R, Cosi V (2004) Fatigue in multiple sclerosis: multidimensional assessment and response to symptomatic treatment. Mult Scler 10:462–468

    Article  PubMed  Google Scholar 

  3. Kluger BM, Krupp LB, Enoka RM (2013) Fatigue and fatigability in neurologic illnesses: proposal for a unified taxonomy. Neurology 80:409–416

    Article  PubMed Central  PubMed  Google Scholar 

  4. Liepert J, Mingers D, Heesen C, Baumer T, Weiller C (2005) Motor cortex excitability and fatigue in multiple sclerosis: a transcranial magnetic stimulation study. Mult Scler 11:316–321

    Article  CAS  PubMed  Google Scholar 

  5. Bigland-Ritchie B, Rice CL, Garland SJ, Walsh ML (1995) Task-dependent factors in fatigue of human voluntary contractions. Adv Exp Med Biol 384:361–380

    Article  CAS  PubMed  Google Scholar 

  6. Petajan JH, White AT (2000) Motor-evoked potentials in response to fatiguing grip exercise in multiple sclerosis patients. Clin Neurophysiol 111:2188–2195

    Article  CAS  PubMed  Google Scholar 

  7. McDonald WI, Compston A, Edan G et al (2001) Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127

    Article  CAS  PubMed  Google Scholar 

  8. Roelcke U, Kappos L, Lechner-Scott J et al (1997) Reduced glucose metabolism in the frontal cortex and basal ganglia of multiple sclerosis patients with fatigue: a 18F-fluorodeoxyglucose positron emission tomography study. Neurology 48:1566–1571

    Article  CAS  PubMed  Google Scholar 

  9. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46:1121–1123

    Article  CAS  PubMed  Google Scholar 

  10. Schwartz JE, Jandorf L, Krupp LB (1993) The measurement of fatigue: a new instrument. J Psychosom Res 37:753–762

    Article  CAS  PubMed  Google Scholar 

  11. Fisk JD, Pontefract A, Ritvo PG, Archibald CJ, Murray TJ (1994) The impact of fatigue on patients with multiple sclerosis. Can J Neurol Sci 21:9–14

    CAS  PubMed  Google Scholar 

  12. Guidelines MSCfCP (1998) Fatigue and multiple sclerosis. Paralyzed Veterans Association, Washington, DC

    Google Scholar 

  13. Penner IK, Raselli C, Stocklin M, Opwis K, Kappos L, Calabrese P (2009) The fatigue scale for motor and cognitive functions (FSMC): validation of a new instrument to assess multiple sclerosis-related fatigue. Mult Scler 15:1509–1517

    Article  CAS  PubMed  Google Scholar 

  14. Flachenecker P, Muller G, Konig H, Meissner H, Toyka KV, Rieckmann P (2006) “Fatigue” in multiple sclerosis. Development and validation of the “Wurzburger Fatigue Inventory for MS”. Der Nervenarzt 77:165–166 (168–170, 172–164)

    Article  CAS  PubMed  Google Scholar 

  15. Sehle A, Mündermann A, Starrost K et al (2011) Objective assessment of motor fatigue in multiple sclerosis using kinematic gait analysis: a pilot study. J Neuroeng Rehabil 8:59

    Article  PubMed Central  PubMed  Google Scholar 

  16. Harris GF, Smith PA (1996) Human motion analysis: current applications and future directions. Institute of Electrical and Electronics Engineers Press, New York

    Google Scholar 

  17. Schablowski-Trautmann M, Gerner HJ (2006) State-space analysis of joint angle kinematics in normal treadmill walking. Biomed Eng 5:294–298

    Article  Google Scholar 

  18. Rosenstein MT, Collins JJ, De Luca CJ (1993) A practical method for calculating largest Lyapunov exponents from small data sets. Phys D 65:117–134

    Article  Google Scholar 

  19. Kantz H (1994) A robust method to estimate the maximal Lyapunov exponent of a time series. Phys Lett A 185:77–87

    Article  Google Scholar 

  20. van Schooten KS, Rispens SM, Pijnappels M, Daffertshofer A, van Dieen JH (2013) Assessing gait stability: the influence of state space reconstruction on inter- and intra-day reliability of local dynamic stability during over-ground walking. J Biomech 46:137–141

    Article  PubMed  Google Scholar 

  21. Vieten MM, Sehle A, Jensen RL (2013) A novel approach to quantify time series differences of gait data using attractor attributes. PLoS ONE. doi:10.71371/journal.pone.0071824

    PubMed Central  PubMed  Google Scholar 

  22. Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381

    CAS  PubMed  Google Scholar 

  23. Vieten MM (2004) Triple F (F 3) Filtering of kinematic data. In: Proceeding: 22 International Symposium on Biomechanics in Sports, pp 446–449

  24. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452

    Article  CAS  PubMed  Google Scholar 

  25. Kuhner C, Burger C, Keller F, Hautzinger M (2007) Reliability and validity of the revised beck depression inventory (BDI-II). Results from German samples. Der Nervenarzt 78:651–656

    Article  CAS  PubMed  Google Scholar 

  26. Hautzinger M, Keller F, Kühner C (2008) Beck depressions-inventar (BDI-II), revision. Reportpsychologie 6:301–302

    Google Scholar 

  27. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117

    Article  Google Scholar 

  28. Paul L, Enright MD (2003) The six-minute walk test. Respir Care 48:783–785

    Google Scholar 

  29. Braley TJ, Chervin RD, Segal BM (2012) Fatigue, tiredness, lack of energy, and sleepiness in multiple sclerosis patients referred for clinical polysomnography. Mult Scler. doi:10.1155/2012/673936

    Google Scholar 

  30. Labuz-Roszak B, Kubicka-Baczyk K, Pierzchala K, Machowska-Majchrzak A, Skrzypek M (2012) Fatigue and its association with sleep disorders, depressive symptoms and anxiety in patients with multiple sclerosis. Neurol Neurochir Pol 46:309–317

    PubMed  Google Scholar 

  31. Kelleher KJ, Spence W, Solomonidis S, Apatsidis D (2010) The characterisation of gait patterns of people with multiple sclerosis. Disabil Rehabil 32:1242–1250

    Article  PubMed  Google Scholar 

  32. Spain RI, St George RJ, Salarian A et al (2012) Body-worn motion sensors detect balance and gait deficits in people with multiple sclerosis who have normal walking speed. Gait Posture 35:573–578

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Sosnoff JJ, Sandroff BM, Motl RW (2012) Quantifying gait abnormalities in persons with multiple sclerosis with minimal disability. Gait Posture 36:154–156

    Article  PubMed  Google Scholar 

  34. Morris ME, Cantwell C, Vowels L, Dodd K (2002) Changes in gait and fatigue from morning to afternoon in people with multiple sclerosis. J Neurol Neurosurg Psychiatry 72:361–365

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Remelius JG, Jones SL, House JD et al (2012) Gait impairments in persons with multiple sclerosis across preferred and fixed walking speeds. Arch Phys Med Rehabil 93:1637–1642

    Article  PubMed  Google Scholar 

  36. Geisler MW, Sliwinski M, Coyle PK, Masur DM, Doscher C, Krupp LB (1996) The effects of amantadine and pemoline on cognitive functioning in multiple sclerosis. Arch Neurol 53:185–188

    Article  CAS  PubMed  Google Scholar 

  37. Schwartz CE, Coulthard-Morris L, Zeng Q (1996) Psychosocial correlates of fatigue in multiple sclerosis. Arch Phys Med Rehabil 77:165–170

    Article  CAS  PubMed  Google Scholar 

  38. Krupp LB (2003) Fatigue in multiple sclerosis: definition, pathophysiology and treatment. CNS Drugs 17:225–234

    Article  CAS  PubMed  Google Scholar 

  39. Genova HM, Rajagopalan V, Deluca J et al (2013) Examination of cognitive fatigue in multiple sclerosis using functional magnetic resonance imaging and diffusion tensor imaging. PLoS ONE. doi:10.1371/journal.pone.0078811

    Google Scholar 

  40. Sharma KR, Kent-Braun J, Mynhier MA, Weiner MW, Miller RG (1995) Evidence of an abnormal intramuscular component of fatigue in multiple sclerosis. Muscle Nerve 18:1403–1411

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Acknowledgments

The study was supported by the Lurija Institute, Kliniken Schmieder, Germany.

Conflicts of interest

The authors declare no conflicts of interest with respect to the authorship and/or publication of this article.

Ethical standard

The study was approved by the local ethics committee and conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent prior to their participation.

Author information

Authors and Affiliations

  1. Division of Sport Science, University of Konstanz, 78457, Constance, Germany

    Aida Sehle, Manfred Vieten & Annegret Mündermann

  2. Kliniken Schmieder Allensbach, Zum Tafelholz 8, 78476, Allensbach, Germany

    Aida Sehle

  3. Kliniken Schmieder Konstanz, 78464, Constance, Germany

    Simon Sailer & Christian Dettmers

  4. School of Physiotherapy, University of Otago, 9016, Dunedin, New Zealand

    Annegret Mündermann

  5. Department of Orthopaedics, University Hospital Basel, 4031, Basel, Switzerland

    Annegret Mündermann

Authors
  1. Aida Sehle
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  2. Manfred Vieten
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  3. Simon Sailer
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  4. Annegret Mündermann
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  5. Christian Dettmers
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Corresponding author

Correspondence to Aida Sehle.

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Sehle, A., Vieten, M., Sailer, S. et al. Objective assessment of motor fatigue in multiple sclerosis: the Fatigue index Kliniken Schmieder (FKS). J Neurol 261, 1752–1762 (2014). https://doi.org/10.1007/s00415-014-7415-7

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  • DOI: https://doi.org/10.1007/s00415-014-7415-7

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