Occupational Therapy in Patients With Multiple Sclerosis
Condition: Multiple Sclerosis; Apraxia
MeSH terms: Multiple Sclerosis; Apraxias; Sclerosis
Study type: Interventional

Summary: 
      Limb apraxia is defined as the inability to correctly perform skilled and/or learned limb
      movements, which cannot be explained by elementary motor and sensory deficits or cognitive
      problems. Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous
      system and the leading cause of disability in young adults. Apraxia and impaired manual
      dexterity are common problems in patients with MS leading to impaired activities of daily
      living. However, a specific training program to improve apraxia as well as manual dexterity
      in MS is lacking.

      In this study, the investigators want to evaluate the impact of a targeted occupational
      therapy program on apraxia and manual dexterity in patients with MS that have dexterity
      problems.

      Patients routinely seen in the investigators MS consulting hour, fulfilling all inclusion and
      exclusion criteria and willing to participate in the study will be evaluated for Apraxia and
      manual dexterity. In case of Apraxia and/or impaired manual dexterity, patients will be
      randomized 1:1 using sealed envelopes to receive occupational home therapy (experimental
      group) or general physical exercises (control group) for 4 weeks.

      At study entry and study end after 4 weeks, apraxia and manual dexterity will be tested in
      all patients.
    

Detailed description: 
      Background

      Limb apraxia is defined as the inability to correctly perform skilled and/or learned limb
      movements, which cannot be explained by elementary motor and sensory deficits or cognitive
      problems. It impairs real object/tool use as well as pantomime and imitation of gestures
      affecting both sides of the body and can be a major source of disability independent of other
      neurological deficits. It significantly affects activities of daily living (ADL) and is
      associated with poorer outcome for independent living or return to work.

      Apraxia is largely based on left parieto-frontal damage due to focal injury or more
      widespread neurodegeneration of cortical areas and/or their connections. However, apraxia has
      been described in damage of the right hemisphere, although less frequent and severe.

      Apraxia is increasingly recognized as a clinical problem in restorative neurology and various
      approaches were described how to treat the disorder.

      Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system and
      the leading cause of disability in young adults. It is characterized by focal demyelination
      as well as axonal damage. MS has been classically thought of as a typical white matter
      disorder. However, early pathology studies and recent magnetic resonance tomography (MRI)
      studies show demyelination in the cortex and deep gray matter nuclei. Grey matter damage
      starts early in the disease and substantially affects cognitive functioning.

      Apraxia and impaired manual dexterity are common problems in MS leading to impaired
      activities of daily living. However, a specific training program to improve apraxia and
      manual dexterity in MS is lacking. In this study, we want to evaluate the impact of a
      targeted occupational therapy program on apraxia and manual dexterity in patients with MS
      that have dexterity problems.

      It is a rater-blind, randomized, controlled trial. Patients routinely seen in our MS
      consulting hour, fulfilling all inclusion and exclusion criteria and willing to participate
      in the study will be evaluated for Apraxia using the AST (Apraxia Screen of TULIA). In case
      of Apraxia patients will be randomized 1:1 using sealed envelopes to receive occupational
      home therapy (experimental group) or general physical exercises (control group) for 4 weeks
      (4 times 5 days in a row).

      At study entry and study end after 4 weeks, apraxia will be tested in all patients using the
      extended version of the AST, the TULIA. Furthermore, a questionnaire on "activities of daily
      living" and "quality of life" will be evaluated, and test regarding cognition, spasticity,
      ataxia, fatigue as well as the EDSS will be performed.

      Objective

      To evaluate the impact of a targeted occupational therapy program on apraxia and manual
      dexterity in patients with MS.

      Methods

      see above.
    

Intervention name(s): Occupational Therapy; Physical therapy
Intervention type(s): Other; Other
Intervention description(s): Occupational therapy using a special arm function training.; Physical therapy for arm force training.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: apraxia; occupational therapy; multiple sclerosis; manual dexterity