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Bladder dysfunction is the most common autonomic disturbance in people with MS (PwMS). Only a few studies have examined the relationship between bladder dysfunction and falls in PwMS. Bladder dysfunction has been deemed only a secondary outcome measure, and classified by a gross measure providing a limited perspective of this disturbing symptom. Furthermore, no study to date has focused on the relationship between bladder dysfunction and balance performance in PwMS. Determine the relationship between bladder dysfunction with balance, falls and fear of falling in women with MS. The study was observational, including 44 women with MS, mean age 46.3 (SD = 5.7), all with at least a mild bladder dysfunction. Outcome measures included the Urinary Incontinence Quality of Life Scale (I-QoL), Bladder Control Scale (BLCS), Timed Up and Go Test (TUG), Four Square Step Test (FSST), Falls Efficacy Scale International (FES-I), Falls status, and posturography. Participants performed the TUG in 14.1 s (S.D. = 11.1), and the FSST in 20.5 s (S.D. = 22.4). A relatively large proportion (68.2 %) of women was classified as fallers. However, no differences were found between those classified as fallers (n = 30) or non-fallers (n = 14) in terms of the I-QoL and the BLCS, controlling for age, EDSS and number of vaginal deliveries. Significant correlations scores were found between the I-QoL, BLCS and FES-I (rho ∼0.47), while controlling for age, EDSS and number of vaginal deliveries. No associations were demonstrated between the bladder dysfunction outcome scores and either the TUG and/or FSST. Women afflicted with MS and suffering from bladder dysfunction tend to fall and present with more balance difficulties compared with disability-matched PwMS. Nevertheless, once bladder dysfunction is detected, the perceived severity of the condition is not associated with balance and prevalence of falling, but rather on fear of falling.
Rotem Soll; Temima Greenberg; Mark Dolev; Alon Kalron. The association between bladder dysfunction, balance and falls in women with multiple sclerosis: the specific contribution of fear of falling. Gait & Posture 2021, 88, 252 -257.
AMA StyleRotem Soll, Temima Greenberg, Mark Dolev, Alon Kalron. The association between bladder dysfunction, balance and falls in women with multiple sclerosis: the specific contribution of fear of falling. Gait & Posture. 2021; 88 ():252-257.
Chicago/Turabian StyleRotem Soll; Temima Greenberg; Mark Dolev; Alon Kalron. 2021. "The association between bladder dysfunction, balance and falls in women with multiple sclerosis: the specific contribution of fear of falling." Gait & Posture 88, no. : 252-257.
Objective To evaluate the test-retest reproducibility and convergent validity of the Sitting-Rising Test (SRT) in people with multiple sclerosis (PwMS). Design Observational study comprising a test-retest design. Setting Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. Participants 50 PwMS (32 women, 18 men), mean age 44.8 (SD=7.6) and mean disease duration of 13.8 (SD=8.5) years since diagnosis, were enrolled in the study. The median Expanded Disability Status Scale (EDSS) score was 4.5 indicating a mild-moderate neurological disability. Interventions Not applicable. ‘ Main Outcome Measures Sitting-Rising Test (SRT), posturography measures, 10-repetion Sit-to-Stand test (10STS), Timed Up and Go test (TUG), hand grip strength, strength of hip flexion/extension/ abduction, knee flexion/extension, and Fall Status Questionnaire. Results The intraclass correlation coefficient value for the intra-rater test-retest reproducibility (7-10 day interval between tests) of the SRT test, was 0.931 (95%CI, 0.796, 0.977). Strong correlations were found between the SRT, TUG (Rho=-0.709) and 10STS (Rho=-0.719) and moderate correlations were found between the SRT and postural control measures (Rho∼0.4). Moderate correlations were found between the SRT and the hip and knee strength (combined) of the weaker limb (Rho=0.344). No differences were found in the SRT score between fallers and non-fallers. Conclusions The current study supports the convergent validity and test-retest reproducibility of the SRT in PwMS.
Temima Greenberg; Rotem Soll; Mark Dolev; Alon Kalron. Reproducibility and Convergent Validity of the Sitting-Rising Test in People With Multiple Sclerosis. Archives of Physical Medicine and Rehabilitation 2021, 1 .
AMA StyleTemima Greenberg, Rotem Soll, Mark Dolev, Alon Kalron. Reproducibility and Convergent Validity of the Sitting-Rising Test in People With Multiple Sclerosis. Archives of Physical Medicine and Rehabilitation. 2021; ():1.
Chicago/Turabian StyleTemima Greenberg; Rotem Soll; Mark Dolev; Alon Kalron. 2021. "Reproducibility and Convergent Validity of the Sitting-Rising Test in People With Multiple Sclerosis." Archives of Physical Medicine and Rehabilitation , no. : 1.
Background: Cognitive–motor interference (CMI) has been well recognized in persons with multiple sclerosis (pwMS); however, there are limited data on effects of task difficulty. Objective: Examine (1) the effects of motor and cognitive tasks varying in difficulty on the magnitude of CMI and (2) the discriminative validity of CMI between pwMS and healthy controls (HC). Methods: Nine cognitive–motor dual-task (DT) conditions (combinations of three cognitive and three walking tasks) were examined. Outcome measures were DT-performance and dual-task cost (DTC) of gait parameters and correct answers. Task differences and overall group-effects were analysed by mixed model analysis, plus the Wilcoxon signed-rank tests or multivariate analysis of variances (MANOVAs), respectively. Results: Task effects were examined in 82 pwMS (Expanded Disability Status Scale (EDSS): 3.3 ± 1.0) and discriminative validity in a subsample (35 pwMS and 33 HC). Motor-DTC and DT-performance were affected by difficulty of both the cognitive task ( p < 0.001) and the walking condition ( p ⩽ 0.002), while cognitive-DTC only varied between cognitive tasks with a large difference in difficulty ( p ⩽ 0.005) and not between walking conditions ( p ⩾ 0.125). None of the DTCs differed between groups. Conclusion: CMI, and especially motor performance, is affected by difficulty of the DT. Although pwMS performed worse on the tasks than HC, none of the DT-conditions showed a discriminative DTC.
Renee Veldkamp; Alon Kalron; Ilse Baert; Paivi Hämäläinen; Andrea Tacchino; Mieke D’Hooge; Xavier Giffroy; Fanny Van Geel; Joke Raats; Karin Coninx; Bart Van Wijmeersch; Peter Feys. Differential effects and discriminative validity of motor and cognitive tasks varying in difficulty on cognitive–motor interference in persons with multiple sclerosis. Multiple Sclerosis Journal 2021, 1 .
AMA StyleRenee Veldkamp, Alon Kalron, Ilse Baert, Paivi Hämäläinen, Andrea Tacchino, Mieke D’Hooge, Xavier Giffroy, Fanny Van Geel, Joke Raats, Karin Coninx, Bart Van Wijmeersch, Peter Feys. Differential effects and discriminative validity of motor and cognitive tasks varying in difficulty on cognitive–motor interference in persons with multiple sclerosis. Multiple Sclerosis Journal. 2021; ():1.
Chicago/Turabian StyleRenee Veldkamp; Alon Kalron; Ilse Baert; Paivi Hämäläinen; Andrea Tacchino; Mieke D’Hooge; Xavier Giffroy; Fanny Van Geel; Joke Raats; Karin Coninx; Bart Van Wijmeersch; Peter Feys. 2021. "Differential effects and discriminative validity of motor and cognitive tasks varying in difficulty on cognitive–motor interference in persons with multiple sclerosis." Multiple Sclerosis Journal , no. : 1.
Alon Kalron; Ibtisam Mahameed; Israela Weiss; Dror Rosengarten; Gingy Ronen Balmor; Moshe Heching; Mordechai Reuven Kramer. Effects of a 12-week combined aerobic and strength training program in ambulatory patients with amyotrophic lateral sclerosis: a randomized controlled trial. Journal of Neurology 2021, 268, 1857 -1866.
AMA StyleAlon Kalron, Ibtisam Mahameed, Israela Weiss, Dror Rosengarten, Gingy Ronen Balmor, Moshe Heching, Mordechai Reuven Kramer. Effects of a 12-week combined aerobic and strength training program in ambulatory patients with amyotrophic lateral sclerosis: a randomized controlled trial. Journal of Neurology. 2021; 268 (5):1857-1866.
Chicago/Turabian StyleAlon Kalron; Ibtisam Mahameed; Israela Weiss; Dror Rosengarten; Gingy Ronen Balmor; Moshe Heching; Mordechai Reuven Kramer. 2021. "Effects of a 12-week combined aerobic and strength training program in ambulatory patients with amyotrophic lateral sclerosis: a randomized controlled trial." Journal of Neurology 268, no. 5: 1857-1866.
Multiple sclerosis (MS) itself and first-line disease modifying therapies do not increase the risk of contracting COVID-19. However, home isolation is likely to result in a significant decrease in participation in leisure time physical activities and an increase in sedentary behavior. Therefore, using an online cross-sectional survey we examined the impact of the COVID-19 epidemic on physical activity (PA) behavior and fitness level in an Israeli cohort of people with multiple sclerosis (PwMS). The survey PA questionnaire included 10 questions. Specifically, participants reported on whether, and to what extent, the pandemic conditions had altered their PA behavior. One hundred and twenty PwMS filled out the online survey, 78 were females with a mean age of 43.0 (S.D.=12.9) years. PA behavior during the pandemic demonstrated that 17.5% who were engaged in PA before the COVID-19 pandemic, ceased PA, 33.3% reduced their PA, 20.0% continued their PA as before, 18.3% increased their PA during the pandemic, and 10.8% did not perform any PA in the past and did not so during the pandemic. As for the patient's self-reported fitness level, 31.7% reported that their fitness level had decreased during the pandemic, 60.0% felt no change, and 8.3% reported an improvement. Our findings serve as a call of action for all professionals involved in MS management to address physical activity behavior in PwMS during the COVID-19 epidemic.
Alon Kalron; Mark Dolev; Michal Greenberg-Abrahami; Shay Menascu; Lior Frid; Sharon Avrech-Shezifi; Gil Harari; David Magalashvili; Anat Achiron. Physical activity behavior in people with multiple sclerosis during the COVID-19 pandemic in Israel: Results of an online survey. Multiple Sclerosis and Related Disorders 2020, 47, 102603 -102603.
AMA StyleAlon Kalron, Mark Dolev, Michal Greenberg-Abrahami, Shay Menascu, Lior Frid, Sharon Avrech-Shezifi, Gil Harari, David Magalashvili, Anat Achiron. Physical activity behavior in people with multiple sclerosis during the COVID-19 pandemic in Israel: Results of an online survey. Multiple Sclerosis and Related Disorders. 2020; 47 ():102603-102603.
Chicago/Turabian StyleAlon Kalron; Mark Dolev; Michal Greenberg-Abrahami; Shay Menascu; Lior Frid; Sharon Avrech-Shezifi; Gil Harari; David Magalashvili; Anat Achiron. 2020. "Physical activity behavior in people with multiple sclerosis during the COVID-19 pandemic in Israel: Results of an online survey." Multiple Sclerosis and Related Disorders 47, no. : 102603-102603.
Alon Kalron. Specific dietary interventions to tackle obesity should be a routine part of recommended MS care – No. Multiple Sclerosis Journal 2020, 26, 1629 -1631.
AMA StyleAlon Kalron. Specific dietary interventions to tackle obesity should be a routine part of recommended MS care – No. Multiple Sclerosis Journal. 2020; 26 (13):1629-1631.
Chicago/Turabian StyleAlon Kalron. 2020. "Specific dietary interventions to tackle obesity should be a routine part of recommended MS care – No." Multiple Sclerosis Journal 26, no. 13: 1629-1631.
Background The 12-item Multiple Sclerosis Walking Scale (MSWS-12) is currently the most widely validated, patient-reported outcome measure assessing patients' perception of the impact of multiple sclerosis (MS) on walking ability. To date, the majority of previous studies investigating the MSWS-12 have focused on the total score despite individual items being potentially informative. Therefore, our objective was to examine the associations between the individual items of the MSWS-12 and mobility and whether these associations depend on disability level. Methods Participants completed the MSWS-12, Two-Minute Walk Test (2MWT), Timed 25-Foot Walk (T25FW), Timed Up and Go Test (TUG) and the Four Square Step Test (FSST). Subsequently, they were divided into two groups according to their disability level, classified as either "mildly" or "moderately-severely" disabled. The correlation between individual items of the MSWS-12 and clinical measures of mobility were separately examined by Spearman's correlation coefficients; linear regression analyses were performed for each disability group, with/without adjusting for cognition, age and gender. Results 242 people with MS (PwMS), 108 mildly and 134 moderately-severely disabled, were included. Stronger correlations between the MSWS-12 items and mobility tests were found in the mildly disabled compared to the moderately-severely disabled group. The linear regression analysis showed that in the mildly disabled, item 9 (use of support outdoors) explained 35.4%, 30.8%, and 23.7% of the variance related to the 2MWT, T25FW and TUG, respectively. As for the moderately-severely disabled, the linear regression analysis presented a model which included item 8 (use of support indoors), explaining 31.6%, 18.0%, 20.2% and 9.5% of the variance related to the 2MWT, T25FWT, TUG and FSST, respectively. Conclusions Items 8 and 9 of the MSWS-12 focusing on the patient's use of walking support in and outdoors, provide a robust indicator of mobility capabilities for mildly and moderately-severely disabled PwMS.
Alon Kalron; Rainer Ehling; Ilse Baert; Tori Smedal; Kamila Rasova; Adnan Heric-Mansrud; Iratxe Elorriage; Una Nedeljkovic; Andrea Tachino; Leszek Gargul; Klaus Gusowski; Davide Cattaneo; Sophie Borgers; Jeffrey Hebert; Ulrik Dalgas; Peter Feys. Improving our understanding of the most important items of the Multiple Sclerosis Walking Scale-12 indicating mobility dysfunction: Secondary results from a RIMS multicenter study. Multiple Sclerosis and Related Disorders 2020, 46, 1 .
AMA StyleAlon Kalron, Rainer Ehling, Ilse Baert, Tori Smedal, Kamila Rasova, Adnan Heric-Mansrud, Iratxe Elorriage, Una Nedeljkovic, Andrea Tachino, Leszek Gargul, Klaus Gusowski, Davide Cattaneo, Sophie Borgers, Jeffrey Hebert, Ulrik Dalgas, Peter Feys. Improving our understanding of the most important items of the Multiple Sclerosis Walking Scale-12 indicating mobility dysfunction: Secondary results from a RIMS multicenter study. Multiple Sclerosis and Related Disorders. 2020; 46 ():1.
Chicago/Turabian StyleAlon Kalron; Rainer Ehling; Ilse Baert; Tori Smedal; Kamila Rasova; Adnan Heric-Mansrud; Iratxe Elorriage; Una Nedeljkovic; Andrea Tachino; Leszek Gargul; Klaus Gusowski; Davide Cattaneo; Sophie Borgers; Jeffrey Hebert; Ulrik Dalgas; Peter Feys. 2020. "Improving our understanding of the most important items of the Multiple Sclerosis Walking Scale-12 indicating mobility dysfunction: Secondary results from a RIMS multicenter study." Multiple Sclerosis and Related Disorders 46, no. : 1.
Approximately 60% of people with multiple sclerosis (PwMS) suffer from upper limb dysfunction. Our primary goal is to implement a single-blind, randomized control trial (RCT) designed to compare the effectiveness of an 8-week home-based telerehab virtual reality (VR) program with conventional therapy in PwMS with manual dexterity difficulties. Secondary aims include (a) evaluating the impact of the programs on quality of life after the intervention and a follow-up 1 month later and (b) evaluating the impact of the programs on adherence and satisfaction. Twenty-four PwMS will be recruited to the study which will be conducted at two established MS centers: (1) The Regional Center for Diagnosis and Treatment of Multiple Sclerosis, Binaghi Hospital, Cagliari, Italy, and (2) The Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. Participants will complete a total of three assessments focusing on upper limb functions. Both groups will receive 16 training sessions focusing on functional upper limb activities. The home-based telerehab VR intervention will comprise a custom-made software program running on a private computer or laptop. PwMS will perform several activities of daily living (ADL) functions associated with self-care, dressing, and meal preparation. Conventional therapy will focus on task-related upper-limb treatments while in a sitting position, indicative of the standard care in MS. Following 8 weeks of training, participants will complete a further outcome assessment. The same tests will be conducted 1 month (as a follow-up) after completion of the intervention. The outcomes of this study have tremendous potential to improve the quality of evidence and informed decisions of functional upper limb activities in PwMS. If comparable results are found between the treatments in improving upper limb outcomes, this would suggest that PwMS can choose the program that best meets their personal needs, e.g., financial concerns, transportation, or accessibility issues. Secondly, this information can be used by healthcare providers and medical professionals in developing upper limb exercise programs that will most likely succeed in PwMS. ClinicalTrials.gov NCT04032431. Registered on 19 July 2019.
Alon Kalron; Anat Achiron; Massimiliano Pau; Eleonora Cocco. The effect of a telerehabilitation virtual reality intervention on functional upper limb activities in people with multiple sclerosis: a study protocol for the TEAMS pilot randomized controlled trial. Trials 2020, 21, 1 -9.
AMA StyleAlon Kalron, Anat Achiron, Massimiliano Pau, Eleonora Cocco. The effect of a telerehabilitation virtual reality intervention on functional upper limb activities in people with multiple sclerosis: a study protocol for the TEAMS pilot randomized controlled trial. Trials. 2020; 21 (1):1-9.
Chicago/Turabian StyleAlon Kalron; Anat Achiron; Massimiliano Pau; Eleonora Cocco. 2020. "The effect of a telerehabilitation virtual reality intervention on functional upper limb activities in people with multiple sclerosis: a study protocol for the TEAMS pilot randomized controlled trial." Trials 21, no. 1: 1-9.
There is scarce data as to the association between physical activity and the volumes of subcortical brain regions in people with multiple sclerosis (PwMS). To compare the volumetric measures of subcortical brain structures in physically active and insufficiently active PwMS. This cross‐sectional study comprised 153 PwMS (39.3 ± 12.0 years, 68.0% female) who had undergone a complete neurological examination, computerized cognitive evaluation and brain MRI (using a high‐resolution scanner). MRI volumetric analysis was based on the FreeSurfer image analysis suite. Regions of interest included the hippocampus, amygdala, brain stem, basal ganglia, thalamus, accumbens nucleus, putamen, caudate and pallidum. Two MRI metrics, total volume (mm3) and estimated percentile of the subcortical region according to adjusted normative population, were calculated for each individual and brain region. Based on scores obtained from the Godin Leisure-Time Exercise Questionnaire, the cohort was subsequently divided into two groups, physically active (n = 77) and insufficiently active (n = 76). The left hippocampus estimated percentile point significantly differentiated between active and insufficiently active PwMS (48.5 (S.D. = 32.2) vs. 36.4 (S.D. = 29.8); p = 0.004), even after controlling for disability (p = 0.011) and cognition (p = 0.021). The right hippocampal estimated percentile point was also significantly different between groups (46.7 (S.D. = 30.6) vs. 34.6 (S.D. = 30.8); p = 0.004). Subcortical volume of the right hippocampus explained 19.4% of the variance between the groups (p = 0.008), even after controlling for disability (p = 0.013) and cognition (p = 0.020). Our results provide evidence that PwMS who regularly participate in leisure-time physical activities maintain their hippocampal volume, regardless of their disability and cognitive capabilities.
Alon Kalron; Shay Menascu; Chen Hoffmann; Anat Achiron. The importance of physical activity to preserve hippocampal volume in people with multiple sclerosis: a structural MRI study. Journal of Neurology 2020, 267, 3723 -3730.
AMA StyleAlon Kalron, Shay Menascu, Chen Hoffmann, Anat Achiron. The importance of physical activity to preserve hippocampal volume in people with multiple sclerosis: a structural MRI study. Journal of Neurology. 2020; 267 (12):3723-3730.
Chicago/Turabian StyleAlon Kalron; Shay Menascu; Chen Hoffmann; Anat Achiron. 2020. "The importance of physical activity to preserve hippocampal volume in people with multiple sclerosis: a structural MRI study." Journal of Neurology 267, no. 12: 3723-3730.
Background: Approximately 60% of people with multiple sclerosis (PwMS) suffer from upper limb dysfunction. Our primary goal is to implement a single-blind, randomized control trial (RCT) designed to compare the effectiveness of an 8-week home-based telerehab virtual reality (VR) program with conventional therapy in PwMS with manual dexterity difficulties. Secondary aims include: a) evaluating the impact of the programs on quality of life after the intervention and a follow up 1 month later; and b) evaluating the impact of the programs on adherence and satisfaction. Methods: Twenty-four PwMS will be recruited to the study which will be conducted at two established MS centers: (1) The Regional Center for Diagnosis and Treatment of Multiple Sclerosis, Binaghi Hospital, Cagliari, Italy; (2) The Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. Participants will complete a total of three assessments focusing on upper limb functions. Both groups will receive 16 training sessions focusing on functional upper limb activities. The home-based telerehab VR intervention will comprise a custom-made software program running on a private computer or laptop. PwMS will perform several activities of daily living (ADL) functions associated with self-care, dressing and meal preparation. Conventional therapy will focus on task-related upper-limb treatments while in a sitting position, indicative of the standard care in MS. Following 8-weeks of training, participants will complete a further outcome assessment. The same tests will be conducted 1 month (as a follow-up) after completion of the intervention. Discussion: The outcomes of this study have tremendous potential to improve the quality of evidence and informed decisions of functional upper limb activities in PwMS. If comparable results are found between the treatments in improving upper limb outcomes, this would suggest that PwMS can choose the program that best meets their personal needs, e.g., financial concerns, transportation or accessibility issues. Secondly, this information can be used by healthcare providers and medical professionals in developing upper limb exercise programs that will most likely succeed in PwMS. Trial registration: ClinicalTrials.gov NCT04032431. Registered on 19 July 2019.
Alon Kalron; Anat Achiron; Massimiliano Pau; Eleonora Cocco. STUDY PROTOCOL The effect of a telerehabilitation virtual reality intervention on functional upper limb activities in people with multiple sclerosis: A study protocol for the TEAMS pilot randomized controlled trial. 2020, 1 .
AMA StyleAlon Kalron, Anat Achiron, Massimiliano Pau, Eleonora Cocco. STUDY PROTOCOL The effect of a telerehabilitation virtual reality intervention on functional upper limb activities in people with multiple sclerosis: A study protocol for the TEAMS pilot randomized controlled trial. . 2020; ():1.
Chicago/Turabian StyleAlon Kalron; Anat Achiron; Massimiliano Pau; Eleonora Cocco. 2020. "STUDY PROTOCOL The effect of a telerehabilitation virtual reality intervention on functional upper limb activities in people with multiple sclerosis: A study protocol for the TEAMS pilot randomized controlled trial." , no. : 1.
Background Interest toward dual-task training (DTT) is increasing as traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These usually involve simultaneous cognitive and motor tasks, and they often show a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but limited evidence is present for people with multiple sclerosis (MS). The use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols and easier implementation of multicenter and multilanguage studies. Objective To describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based app, and to present the preliminary results of a multicenter pilot study involving people with MS performed in several European centers for evaluating the feasibility of and adherence to a rehabilitation program based on CMI-APP. Methods CMI-APP includes user-friendly interfaces for personal data input and management, assessment of CMI, and DTT. A dedicated team developed CMI-APP for Android tablets above API level 14 (version 4.0), using C# as the programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, and sustained attention and four motor assessment tests for walking at different difficulty levels were implemented. Dual cognitive-motor tasks were performed by combining single cognitive and motor tasks. CMI-APP implements exercises for DTT involving the following 12 cognitive functions: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, and visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen people with MS (mean age 52.6, SD 8.6 years; mean disease duration 9.4, SD 8.4 years; mean Expanded Disability Status Scale score 3.6, SD 1.1) underwent DTT (20 sessions). Adherence to the rehabilitation program was evaluated according to the percentage of performed sessions, perceived exertion during the training (Borg 15-point Ratings of Perceived Exertion [RPE] Scale), and subjective experience of the training (Intrinsic Motivation Inventory [IMI]). Results The adherence rate was 91%. DTT was perceived as “somewhat difficult” (mean RPE Scale score 12.6, SD 1.9). IMI revealed that participants enjoyed the training and felt that it was valuable and, to some extent, important, without feelings of pressure. They felt competent, although they did not always feel they could choose the exercises, probably because the therapist chose the exercises and many exercises had few difficulty levels. Conclusions CMI-APP is safe, highly usable, motivating, and well accepted for DTT by people with MS. The findings are fundamental for the preparation of future large-sample studies examining CMI and the effectiveness of DTT interventions with CMI-APP in people with MS.
Andrea Tacchino; Renee Veldkamp; Karin Coninx; Jens Brulmans; Steven Palmaers; Päivi Hämäläinen; Mieke D'Hooge; Ellen Vanzeir; Alon Kalron; Giampaolo Brichetto; Peter Feys; Ilse Baert. Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study. JMIR mHealth and uHealth 2020, 8, e15344 .
AMA StyleAndrea Tacchino, Renee Veldkamp, Karin Coninx, Jens Brulmans, Steven Palmaers, Päivi Hämäläinen, Mieke D'Hooge, Ellen Vanzeir, Alon Kalron, Giampaolo Brichetto, Peter Feys, Ilse Baert. Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study. JMIR mHealth and uHealth. 2020; 8 (4):e15344.
Chicago/Turabian StyleAndrea Tacchino; Renee Veldkamp; Karin Coninx; Jens Brulmans; Steven Palmaers; Päivi Hämäläinen; Mieke D'Hooge; Ellen Vanzeir; Alon Kalron; Giampaolo Brichetto; Peter Feys; Ilse Baert. 2020. "Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study." JMIR mHealth and uHealth 8, no. 4: e15344.
Stroboscopic visual training (SVT) is a form of training aimed at improving visual and perceptual performance by having individuals perform activities under conditions of intermittent vision. The efficacy of SVT has never been examined in people with multiple sclerosis (PwMS), therefore, our aim was to examine the immediate effect of SVT on cognitive function, gait and static balance performance in PwMS. This assessor-blinded, randomized crossover study included 26 PwMS, 16 females, mean age 47.9 and median EDSS score 4.5. Participants attended two sessions: SVT and control training. Exercises for both the SVT and control sessions were based on ball-catching tasks. Training sessions were identical in length (40–50 min) and type of exercise drills. The difference between the two practice regimes was that the SVT session was performed wearing stroboscopic glasses and the control training was performed with similar glasses without lenses. Cognition was evaluated by a computerized software (Mindstreams®, NeuroTrax Corp., NY). Gait and balance were evaluated via wearable accelerometers (APDM, Oregon, USA). Outcome measures were collected twice during a single session, prior to training and immediately afterward. Information processing speed (p = 0.003) increased at the post-evaluation compared with baseline, solely in the SVT session. No differences between pre–post evaluations were observed for other cognitive scores following the SVT session. No differences between pre–post measurements were noted for gait and balance following the SVT session. The present study’s results justify performing future RCT studies to examine the effects of a longer SVT program on cognition in PwMS.
Nov Shalmoni; Alon Kalron. The immediate effect of stroboscopic visual training on information-processing time in people with multiple sclerosis: an exploratory study. Journal of Neural Transmission 2020, 127, 1125 -1131.
AMA StyleNov Shalmoni, Alon Kalron. The immediate effect of stroboscopic visual training on information-processing time in people with multiple sclerosis: an exploratory study. Journal of Neural Transmission. 2020; 127 (8):1125-1131.
Chicago/Turabian StyleNov Shalmoni; Alon Kalron. 2020. "The immediate effect of stroboscopic visual training on information-processing time in people with multiple sclerosis: an exploratory study." Journal of Neural Transmission 127, no. 8: 1125-1131.
Background: Approximately 60% of people with multiple sclerosis (PwMS) suffer from upper limb dysfunction. Our primary goal is to implement a single-blind, randomized control trial (RCT) designed to compare the effectiveness of an 8-week home-based telerehab virtual reality (VR) program with conventional therapy in PwMS with manual dexterity difficulties. Secondary aims include: a) evaluating the impact of the programs on quality of life after the intervention and a follow up 1 month later; and b) evaluating the impact of the programs on adherence and satisfaction. Methods: Twenty-four PwMS will be recruited to the study which will be conducted at two established MS centers: (1) The Regional Center for Diagnosis and Treatment of Multiple Sclerosis, Binaghi Hospital, Cagliari, Italy; (2) The Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. Participants will complete a total of three assessments focusing on upper limb functions. Both groups will receive 16 training sessions focusing on functional upper limb activities. The home-based telerehab VR intervention will comprise a custom-made software program running on a private computer or laptop. PwMS will perform several ADL functions associated with self-care, dressing and meal preparation. Conventional therapy will focus on task-related upper-limb treatments while in a sitting or prone position, indicative of the standard care in MS. Following 8-weeks of training, participants will complete a further outcome assessment. The same tests will be conducted 1 month (as a follow-up) after completion of the intervention. Discussion: The outcomes of this study have tremendous potential to improve the quality of evidence and informed decisions of functional upper limb activities in PwMS. If comparable results are found between the treatments in improving upper limb outcomes, this would suggest that PwMS can choose the program that best meets their personal needs, e.g., financial concerns, transportation or accessibility issues. Secondly, this information can be used by healthcare providers and medical professionals in developing upper limb exercise programs that will most likely succeed in PwMS.Trial registration: ClinicalTrials.gov NCT04032431. Registered on 19 July 2019.
Alon Kalron; Anat Achiron; Massimiliano Pau; Eleonora Cocco. The Effect of a Telerehabilitation Virtual Reality Intervention on Functional Upper Limb Activities in People with Multiple Sclerosis: A Study Protocol for the TEAMS Pilot Randomized Controlled Trial. 2020, 1 .
AMA StyleAlon Kalron, Anat Achiron, Massimiliano Pau, Eleonora Cocco. The Effect of a Telerehabilitation Virtual Reality Intervention on Functional Upper Limb Activities in People with Multiple Sclerosis: A Study Protocol for the TEAMS Pilot Randomized Controlled Trial. . 2020; ():1.
Chicago/Turabian StyleAlon Kalron; Anat Achiron; Massimiliano Pau; Eleonora Cocco. 2020. "The Effect of a Telerehabilitation Virtual Reality Intervention on Functional Upper Limb Activities in People with Multiple Sclerosis: A Study Protocol for the TEAMS Pilot Randomized Controlled Trial." , no. : 1.
(1) Purpose: Conflicting information exists regarding the relationship between obesity, leisure-time physical activity (PA), and disability in people with multiple sclerosis (PwMS). We aimed to investigate the association between leisure-time PA and weight status in a relatively large cohort of PwMS. Furthermore, we examined this relationship according to the level of neurological disability. (2) Methods: The study included 238 PwMS (138 women) with a mean Expanded Disability Status Scale (EDSS) score of 2.5 (standard deviation [SD] = 1.7), mean disease duration of 6.4 (SD = 8.2) years, and mean age of 40.5 (SD = 12.9) years. Obesity was defined using two different metrics, each based on body mass index (BMI). Leisure-time PA was determined by the Godin–Shephard leisure-time PA questionnaire. Statistical analyses included multivariate logistic regression, the chi-square test, and Pearson coefficient correlations. (3) Results: The unadjusted odds ratio (OR) between leisure-time PA and BMI based on the World Health Organization’s (WHO) definition was 1.070 (p = 0.844) for overweight and 1.648 (p = 0.254) for obesity. The adjusted OR was 1.126 (p = 0.763) for overweight and 1.093 (p = 0.847) for obesity after adjustment for age, gender, and disability status. Chi-square analysis revealed no significant correlation between leisure-time PA and obesity (p = 0.564) according to the BMI threshold for PwMS. The unadjusted OR (95% confidence interval [CI]) between disability level and BMI based on the WHO definition was 1.674 (p = 0.220) for overweight and 0.618 (p = 0.460) for obesity. The adjusted OR was 1.130 (p = 0.787) for overweight and 0.447 (p = 0.234) for obesity after adjustment for age, gender, and leisure-time PA. Similarly, chi-square analysis revealed no significant correlation between disability level and obesity (p = 0.701) per the BMI threshold for PwMS. (4) Conclusions: No association was found between leisure-time PA and BMI in PwMS. An additional finding was the absence of any association between obesity and neurological disability level in the multiple sclerosis cohort.
Wi-Young So; Alon Kalron. The Association between Body Mass Index and Leisure-Time Physical Activity in Adults with Multiple Sclerosis. International Journal of Environmental Research and Public Health 2020, 17, 920 .
AMA StyleWi-Young So, Alon Kalron. The Association between Body Mass Index and Leisure-Time Physical Activity in Adults with Multiple Sclerosis. International Journal of Environmental Research and Public Health. 2020; 17 (3):920.
Chicago/Turabian StyleWi-Young So; Alon Kalron. 2020. "The Association between Body Mass Index and Leisure-Time Physical Activity in Adults with Multiple Sclerosis." International Journal of Environmental Research and Public Health 17, no. 3: 920.
The aim was to compare the effectiveness of dual-task training (DTT) compared to single mobility training (SMT) on dual-task walking, mobility and cognition, in persons with Multiple Sclerosis (pwMS). Forty pwMS were randomly assigned to the DTT or SMT groups. The DTT-group performed dual-task exercises using an interactive tablet-based application, while the SMT-group received conventional walking and balance exercises. Both interventions were supervised and identical in weeks (8) and sessions (20). Nine cognitive-motor dual-task conditions were assessed at baseline, after intervention and at 4-weeks follow-up (FU). The dual-task cost (DTC), percentage change of dual-task performance compared to single-task performance, was the primary outcome. Mobility and cognition were secondarily assessed. Mixed model analyses were done with group, time and the interaction between group and time as fixed factors and participants as random factors. Significant time by group interactions were found for the digit-span walk and subtraction walk dual-task conditions, with a reduction in DTC (gait speed) for the DTT maintained at FU. Further, absolute dual-task gait speed during walking over obstacles only improved after the DTT. Significant improvements were found for both groups in various motor and cognitive measures. However, the DTT led to better dual-task walking compared to the SMT.
Renee Veldkamp; Ilse Baert; Alon Kalron; Andrea Tacchino; Mieke D’Hooge; Ellen Vanzeir; Fanny Van Geel; Joke Raats; Mieke Goetschalckx; Giampaolo Brichetto; Nov Shalmoni; Peter Hellinckx; Natasja De Weerdt; Dorien De Wilde; Peter Feys. Structured Cognitive-Motor Dual Task Training Compared to Single Mobility Training in Persons with Multiple Sclerosis, a Multicenter RCT. Journal of Clinical Medicine 2019, 8, 2177 .
AMA StyleRenee Veldkamp, Ilse Baert, Alon Kalron, Andrea Tacchino, Mieke D’Hooge, Ellen Vanzeir, Fanny Van Geel, Joke Raats, Mieke Goetschalckx, Giampaolo Brichetto, Nov Shalmoni, Peter Hellinckx, Natasja De Weerdt, Dorien De Wilde, Peter Feys. Structured Cognitive-Motor Dual Task Training Compared to Single Mobility Training in Persons with Multiple Sclerosis, a Multicenter RCT. Journal of Clinical Medicine. 2019; 8 (12):2177.
Chicago/Turabian StyleRenee Veldkamp; Ilse Baert; Alon Kalron; Andrea Tacchino; Mieke D’Hooge; Ellen Vanzeir; Fanny Van Geel; Joke Raats; Mieke Goetschalckx; Giampaolo Brichetto; Nov Shalmoni; Peter Hellinckx; Natasja De Weerdt; Dorien De Wilde; Peter Feys. 2019. "Structured Cognitive-Motor Dual Task Training Compared to Single Mobility Training in Persons with Multiple Sclerosis, a Multicenter RCT." Journal of Clinical Medicine 8, no. 12: 2177.
The objective of the study was to examine the differences in physical activity participation with the pyramidal, cerebellar, and sensory functional systems in people with multiple sclerosis (PwMS). This cross-sectional study included 289 PwMS with a median EDSS of 2.0 (range 0–6.5) and a mean disease duration of 6.8 (SD = 8.4) years. The Godin leisure-time exercise questionnaire (GLTEQ) assessed physical activity participation. The sample was divided into seven groups according to the pyramidal, cerebellar, and sensory functional system scores derived from the EDSS data. Additionally, PwMS were divided into three physical activity subgroups (active, moderately active, and insufficiently active). Furthermore, PwMS were categorized into four levels of disability based on their global Expanded Disability Status Scale (EDSS) score [very mild (0–1.5), mild (2.0–3.5), moderate (4.0–5.5), and severe (6.0–6.5)]. In the physical activity subgroups, 159 (55.0%) were classified as insufficiently active, 59 (20.4%) as moderately active, and 71 (24.6%) as active. Pyramidal, cerebellar, and sensory impairments were demonstrated in 134 (46.4%), 73 (25.3%), and 85 (29.4%) patients, respectively. No differences were found for the GLTEQ scores for all seven functional system groups (P value = 0.168). As for the EDSS disability subgroups, the percentage of active patients (moderately at least) were 60%, 45.8%, 36.5%, and 15.4%, for the very mild, mild, moderate, and severe subgroups, respectively. This study found that participation in leisure-time physical activity is independent from the pyramidal, cerebellar, and sensory functional systems in PwMS.
Alon Kalron; Lior Frid; Roy Aloni; Shay Menascu; Uri Givon. Physical activity participation according to the pyramidal, sensory, and cerebellar functional systems in multiple sclerosis. Journal of Neural Transmission 2019, 126, 1609 -1616.
AMA StyleAlon Kalron, Lior Frid, Roy Aloni, Shay Menascu, Uri Givon. Physical activity participation according to the pyramidal, sensory, and cerebellar functional systems in multiple sclerosis. Journal of Neural Transmission. 2019; 126 (12):1609-1616.
Chicago/Turabian StyleAlon Kalron; Lior Frid; Roy Aloni; Shay Menascu; Uri Givon. 2019. "Physical activity participation according to the pyramidal, sensory, and cerebellar functional systems in multiple sclerosis." Journal of Neural Transmission 126, no. 12: 1609-1616.
Existing research studies have demonstrated a relationship between magnetic resonance imaging (MRI) neuroimaging measures and walking speed in people with multiple sclerosis (PwMS). However, to date there are no data as to the brain structures involved in gait coordination and control in PwMS. Therefore, the aim of our study was to investigate the association between walk ratio, an indicator of gait coordination, and related brain structures in PwMS. A brain MRI was performed by a 3.0-T MR scanner in conjunction with a volumetric analysis based on three-dimensional T1-weighted images. Regions of interest were volumes of the hippocampus, amygdala, putamen, caudate, pallidum, thalamus, cerebellum and the corpus callosum regions. Walking speed and walk ratio, defined as step length divided by step rate, was measured whilst walking on an electronic walkway. In all, 343 PwMS (41.1 ± 13.4 years, 69.1% female, median Expanded Disability Status Scale 2.5) were included in the study. A significant association was found between the left cerebellum volume and walk ratio after controlling for age, gender, total cranial volume and disability; R2 = 0.379, P = 0.002. A similar association was found between the right cerebellum volume and walk ratio, R2 = 0.364, P = 0.002. No correlations were observed between walk ratio and the thalamus, basal ganglia, hippocampus, amygdala and the corpus callosum volumes. No association was found between walking speed and all brain measures. The walk ratio should be considered when evaluating and assessing PwMS presenting with ataxia. Furthermore, it is also hypothesized that a low walk ratio indicates a lower cerebellum volume in the MS population.
Alon Kalron; Shay Menascu; Uri Givon; Mark Dolev; Anat Achiron. Is the walk ratio a window to the cerebellum in multiple sclerosis? A structural magnetic resonance imaging study. European Journal of Neurology 2019, 27, 454 -460.
AMA StyleAlon Kalron, Shay Menascu, Uri Givon, Mark Dolev, Anat Achiron. Is the walk ratio a window to the cerebellum in multiple sclerosis? A structural magnetic resonance imaging study. European Journal of Neurology. 2019; 27 (3):454-460.
Chicago/Turabian StyleAlon Kalron; Shay Menascu; Uri Givon; Mark Dolev; Anat Achiron. 2019. "Is the walk ratio a window to the cerebellum in multiple sclerosis? A structural magnetic resonance imaging study." European Journal of Neurology 27, no. 3: 454-460.
Falls, gait variability and increased energy cost of walking are common in people with multiple sclerosis (PwMS). However, no studies have as yet examined this triple association in PwMS or in other neurological populations. Does a relationship exist between gait variability, falls and the energy cost of gait in PwMS? This cross sectional study included 88 PwMS (50 women), mean age 39.8 (S.D = 13.0) and mean disease duration of 6.2 (SD = 8.2) years since diagnosis. Energy expenditure during walking was collected via a portable metabolic device (COSMED K5, COSMED Srl, Roma, Italy). Gait variability was measured by an electronic walkway (GAITRite™). Participants were divided into groups based on fall history (fallers and non-fallers). Differences between groups in terms of energy expenditure measures and gait variability metrics were determined by the analysis of variance test. The relationship between gait variability and energy cost of walking was examined by the Pearson's correlation coefficient test. Thirty-three PwMS were classified as fallers and 55 as non-fallers. Non-significant differences between groups were observed in the energy expenditure measures, including cost of walking. Fallers demonstrated higher step length variability compared with non-fallers (4.58 (S.D. = 2.42 vs. 3.40 (S.D. = 1.40); p-value = 0.005). According to the Pearson's correlation coefficient analysis, a significant relationship was found between step length variability and energy cost of walking in the non-fallers group (Rho = 0.372, P-value = 0.006) and the total group (Rho = 0.296, p-value = 0.005), but not in those PwMS with a history of falls. We demonstrated a significant relationship between increased gait variability and energy expenditure while walking only in MS patients without a history of falls. This is important as there is evidence of the clinical relevance of increased gait variability, poor fitness level and high risk of falling in the MS population.
Alon Kalron; Lior Frid; Shay Menascu; Uri Givon. The association between gait variability with the energy cost of walking depends on the fall status in people with multiple sclerosis without mobility aids. Gait & Posture 2019, 74, 231 -235.
AMA StyleAlon Kalron, Lior Frid, Shay Menascu, Uri Givon. The association between gait variability with the energy cost of walking depends on the fall status in people with multiple sclerosis without mobility aids. Gait & Posture. 2019; 74 ():231-235.
Chicago/Turabian StyleAlon Kalron; Lior Frid; Shay Menascu; Uri Givon. 2019. "The association between gait variability with the energy cost of walking depends on the fall status in people with multiple sclerosis without mobility aids." Gait & Posture 74, no. : 231-235.
Multiple sclerosis (MS) may lead to cognitive decline over-time. Characterize cognitive performance in MS patients with long disease duration treated with disease modifying drugs (DMD) in relation to disability and determine the prevalence of cognitive resilience. Cognitive and functional outcomes were assessed in 1010 DMD-treated MS patients at least 10 years from onset. Cognitive performance was categorized as high, moderate or low, and neurological disability was classified according to the Expanded Disability Status Scale (EDSS) as mild, moderate or severe. Relationship between cognitive performance and disability was examined. After a mean disease duration of 19.6 (SD = 7.7) years, low cognitive performance was observed in 23.7% (N = 239), moderate performance in 42.7% (N = 431), and 33.7% (N = 340) had high cognitive performance, meeting the definition of cognitively resilient patients. Within the group of patients with low cognitive performance, severe disability was observed in 50.6% (121/239), while in the group of patients with high cognitive performance, mild disability was observed in 64.4% (219/340). Differences between the group of patients with high cognitive performance and severe disability (4.5%) and the group of patients with low cognitive performance and mild disability (5.0%) were not accounted for by DMD treatment duration. The majority of DMD treated MS patients did not have cognitive decline that could impair their quality of life after disease of extended duration.
Yermi Harel; Alon Kalron; Shay Menascu; David Magalashvili; Mark Dolev; Glen Doniger; Ely Simon; Anat Achiron. Cognitive function in multiple sclerosis: A long-term look on the bright side. PLOS ONE 2019, 14, e0221784 .
AMA StyleYermi Harel, Alon Kalron, Shay Menascu, David Magalashvili, Mark Dolev, Glen Doniger, Ely Simon, Anat Achiron. Cognitive function in multiple sclerosis: A long-term look on the bright side. PLOS ONE. 2019; 14 (8):e0221784.
Chicago/Turabian StyleYermi Harel; Alon Kalron; Shay Menascu; David Magalashvili; Mark Dolev; Glen Doniger; Ely Simon; Anat Achiron. 2019. "Cognitive function in multiple sclerosis: A long-term look on the bright side." PLOS ONE 14, no. 8: e0221784.
BACKGROUND Interest toward dual-task training (DTT) is increasing as traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These usually involve simultaneous cognitive and motor tasks, and they often show a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but limited evidence is present for people with multiple sclerosis (MS). The use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols and easier implementation of multicenter and multilanguage studies. OBJECTIVE To describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based app, and to present the preliminary results of a multicenter pilot study involving people with MS performed in several European centers for evaluating the feasibility of and adherence to a rehabilitation program based on CMI-APP. METHODS CMI-APP includes user-friendly interfaces for personal data input and management, assessment of CMI, and DTT. A dedicated team developed CMI-APP for Android tablets above API level 14 (version 4.0), using C# as the programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, and sustained attention and four motor assessment tests for walking at different difficulty levels were implemented. Dual cognitive-motor tasks were performed by combining single cognitive and motor tasks. CMI-APP implements exercises for DTT involving the following 12 cognitive functions: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, and visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen people with MS (mean age 52.6, SD 8.6 years; mean disease duration 9.4, SD 8.4 years; mean Expanded Disability Status Scale score 3.6, SD 1.1) underwent DTT (20 sessions). Adherence to the rehabilitation program was evaluated according to the percentage of performed sessions, perceived exertion during the training (Borg 15-point Ratings of Perceived Exertion [RPE] Scale), and subjective experience of the training (Intrinsic Motivation Inventory [IMI]). RESULTS The adherence rate was 91%. DTT was perceived as “somewhat difficult” (mean RPE Scale score 12.6, SD 1.9). IMI revealed that participants enjoyed the training and felt that it was valuable and, to some extent, important, without feelings of pressure. They felt competent, although they did not always feel they could choose the exercises, probably because the therapist chose the exercises and many exercises had few difficulty levels. CONCLUSIONS CMI-APP is safe, highly usable, motivating, and well accepted for DTT by people with MS. The findings are fundamental for the preparation of future large-sample studies examining CMI and the effectiveness of DTT interventions with CMI-APP in people with MS.
Andrea Tacchino; Renee Veldkamp; Karin Coninx; Jens Brulmans; Steven Palmaers; Päivi Hämäläinen; Mieke D'hooge; Ellen Vanzeir; Alon Kalron; Giampaolo Brichetto; Peter Feys; Ilse Baert. Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study (Preprint). 2019, 1 .
AMA StyleAndrea Tacchino, Renee Veldkamp, Karin Coninx, Jens Brulmans, Steven Palmaers, Päivi Hämäläinen, Mieke D'hooge, Ellen Vanzeir, Alon Kalron, Giampaolo Brichetto, Peter Feys, Ilse Baert. Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study (Preprint). . 2019; ():1.
Chicago/Turabian StyleAndrea Tacchino; Renee Veldkamp; Karin Coninx; Jens Brulmans; Steven Palmaers; Päivi Hämäläinen; Mieke D'hooge; Ellen Vanzeir; Alon Kalron; Giampaolo Brichetto; Peter Feys; Ilse Baert. 2019. "Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study (Preprint)." , no. : 1.