Kinematic assessment of upper limb function in progressive multiple sclerosis

Upper limb dysfunction is common in multiple sclerosis (MS) with current evaluation methods relying on capacity assessments and a subjective evaluation of impairment. Kinematic techniques allow the quantification of upper limb dysfunction and may provide a useful marker in the prognosis of those affected. The aim of this thesis was to develop and use kinematic assessment techniques to characterise the extent and progression of upper limb dysfunction in people with MS (pwMS). Forty-two patients with progressive MS and 15 healthy controls reached-and-grasped objects while movement trajectories were captured with a kinematic assessment system. Clinical measures including the nine hole peg test (9HPT), Expanded Disability Status Scale (EDSS), and patient reported outcomes were administered at baseline and six months. PwMS had longer reaction and reach times, took longer to pick-up objects and move them between pre-defined positions, and spent more time placing objects, compared to controls. PwMS had lower peak wrist velocities when reaching towards and moving objects. Kinematic assessment demonstrated consistent differences between the mildly and severely affected patients, driven by object grasp dimensions, which weren’t captured by 9HPT. There was no correlation between upper limb performance and EDSS, with wide variation in upper limb performance as measured by the kinematic assessment across a narrow EDSS range. There was moderate correlation between kinematic assessment and 9HPT. There was a significant change in some kinematic parameters at 6 months follow-up capturing predicted change in function. This study developed and evaluated a novel upper limb function assessment tool and found better sensitivity and behaviour capture than the EDSS and 9HPT. For the first time, we have quantified the spatiotemporal patterns of hand function impairment in people with progressive MS.