title: Digital biomarkers for immunotherapy in multiple sclerosis patients
title: Digitale Biomarker für Immunotherapie bei Multiple-Sklerose-Patienten
Creators: name: Ibrahim, Alzhraa A.
Publisher: name: Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)
Year: 2024

description: Multiple sclerosis (MS) is a chronic, immune‐mediated disorder that affects the central nervous system. As one of the most common neurological diseases in young adults, it often leads to a wide range of physical and cognitive impairments, with symptoms varying greatly among individuals. Two of the most prevalent and debilitating symptoms in people with MS are gait and cognitive impairments. Gait impairments can result in decreased mobility, reduced balance, and an increased risk of falls, significantly impacting the quality of life. These difficulties in walking are often associated with fatigue, a symptom reported by up to 80% of MS patients, which can exacerbate mobility issues. Cognitive impairment, on the other hand, affects approximately 40‐70% of MS patients, irrespective of their disease duration or physical disability. These cognitive issues can range from mild to severe and can impact various domains including attention, memory, information processing speed, and executive functions. In this thesis, Inertial Measurement Unit (IMU)‐based gait analysis was utilized as a tool to explore the implications of motor fatigue and cognitive functions in people with MS. The objectives of the initial two contributions were focused on the analysis and validation of IMU‐based gait parameters in assessing fatigue in people with MS, using long gait tests and subsequently shorter gait bouts, providing a feasible and accessible approach for patients with severe fatigue. The third publication delved into the exploration of longitudinal smartphone‐based gait parameters derived from the Floodlight study thus investigating the long‐term association between gait and cognitive impairment. The first research paper demonstrated the potential of using wearable inertial sensors in studying the relationship between perceived fatigue and gait disorders in MS. The results indicated that fatigue levels could be predicted using spatiotemporal gait parameters, thereby aiding therapists in monitoring fatigue levels and offering an opportunity for potential home‐based monitoring of fatigue, reducing the burden on patients and healthcare professionals. The second research paper investigated the potential of short inertial sensor‐based gait tests in assessing perceived fatigue in MS. The results underscored the possibility of substituting long gait tests with shortened gait tests, thereby lessening the burden of testing on both patients and clinicians. These findings could potentially pave the way for future research exploring the use of short bouts of real‐world walking with unobtrusive inertial sensors for fatigue assessment. The final research paper delved into the association between gait and cognition impairments in people with MS using longitudinal data from smartphone‐based measures. The findings support the evidence that gait and cognition are interconnected in MS, providing crucial insights for clinicians in tailoring treatment and intervention programs that address both gait and cognition. This thesis presents a comprehensive exploration into the potential of wearable technology and smartphone‐based measures in understanding and monitoring the symptoms of MS, particularly fatigue and cognitive impairment. It underscores the importance of such technology in developing patient‐centric interventions and monitoring strategies. Furthermore, it lays the groundwork for future research exploring the integration of these measures with other physiological and cognitive parameters, ultimately aiming for a more comprehensive, multimodal approach for managing MS.