Background

The reported prevalence of walking difficulties in MS is approximately 70%. Walking impairments impact physical activity level, increase risk of falls, and reduce quality of life. Various exoskeletons are being studied as an adjunct to traditional physical exercise therapy. We present data from our study using the HAL® exoskeleton, a neurologically controlled robotic exoskeleton activated by the users' bio-electrical signals, to help rehabilitation in SPMS, NMO, and non-MS patients. The interim analysis is part of an ongoing pilot study involving 30 patients over the course of 4 years.

Objectives

To establish the safety and effectiveness of intervention using the HAL® exoskeleton in the SPMS, NMO, and non-MS populations in functional outcomes after training, 6, and 12 months.

Methods

This is an ongoing single-center prospective pilot study that takes place at the Swedish Multiple Sclerosis Center gym.

It includes 14 Patients - Progressive ((n=8; SPMS (n=7), NMO (n=1)) and non-MS patients (n=6).

Patients underwent 48-60 sessions of treadmill training over an average of 15 weeks in a body weight-supporting harness using the HAL® exoskeleton under the supervision of physical therapists. Training sessions were customized for each individual and could include stretching, vibration, strengthening, pre-gait, and training with alternate assistive devices. Training in HAL® had a goal of 30 minutes of skilled gait training integrating form, speed, balance, decreased visual reliance and dual task attention of the 2 hr session.

The main outcome measures are the 10 Meter Walk Test (10MWT), Timed Up & Go (TUG), 6 Minute Walk, and the BERG Balance Scale.

Results

Patients completed sessions of treadmill training with no serious adverse events noted. Patients were categorized into 2 groups: progressive (SPMS/NMO) and non-MS patients. Both groups demonstrated a mean improvement in all functional outcomes. Patients in both groups improved from baseline at least 20% in all functional outcomes (range, 22%-41%). Patients from the SPMS/NMO group on average tended to improve more with a 34%, 41%, 35% and 24% improvement in the TUG, BERG, 10MWT, and 6MWT, respectively. Those in the non-MS group improved 22%, 26%, 28%, and 35% in these same measures. The gains continued to remain the same or improve over the 6 and 12 month post training periods. The SPMS/NMO patients had a higher rate of improvement.

Conclusions

HAL® treadmill training improves the rehabilitation of patients with SPMS, NMO, and non- MS patient populations. This continues in follow-up testing at 6, and 12 months. The intervention is safe, and, patients demonstrated improved walking performances over the course of training and follow-up.

Background

Symptom management, an important component of multiple sclerosis (MS) care, can be achieved by using a patient app tool to manage symptoms and track/store symptom issues to share with clinicians.

Multiple Sclerosis Association of America (MSAA) and @Point of Care collaborated to develop complementary apps for use by patients and their clinicians that facilitate sharing of data: My MS Manager ^TM, a HIPAA compliant patient app, and Multiple Sclerosis @Point of Care, a clinician app. By enhancing the patient app with symptom management tools, patients can track and manage their symptoms and improve their quality of life.

Objectives

Analyze impact of patient app in assessing differences in symptom severity based on clinical phenotype and in empowering patients to track/manage their MS symptoms.

Methods

MSAA and @Point of Care added more validated measures to the app to facilitate tracking of bladder control (Bladder Control Scale; BLCS; 11/2019), depression (Patient Health Questionnaire Score for Depression; PHQ-9; 08/2019), cognitive function (PROMIS Cognitive Function-Short Form 8a; 03/2019), and fatigue (Modified Fatigue Impact Scale; MFIS; 08/2015). Patient data were analyzed to assess: 1) symptom severity by phenotype, 2) quality of life (QOL) factors most affected by symptom severity, and 3) benefits of frequent app use (>26 visits) on symptoms.

Results

Of 22,858 registered users on the My MS Manager app, 6717 patients have already identified their clinical phenotype and/or tracked their bladder control, depression, cognitive function, and/or fatigue scores:

• SPMS patients compared to RRMS patients had

–Significantly greater bladder control issues that alter their activities (35% vs 18%; P = 0.002) and severely affect their lifestyle (17% vs 8%; P = 0.033)

–Significantly worse depression symptoms for “more than half the days/nearly every day”

–Reported their depression issues more severely affect their work (>19% difference)

• PPMS compared to RRMS/SPMS patients showed no significant differences in bladder, depression, cognitive function, and fatigue symptoms

• Infrequent RRMS users (≤ 26 visits) of the My MS Manager app experienced higher depression severity as opposed to frequent RRMS users (>26 visits)

Conclusions

The My MS Manager patient app facilitates the ability of patients with MS to record their symptoms utilizing validated measures, to track and manage their MS, and to discuss their symptoms with their clinicians.

Background

Symptom management, an important component of multiple sclerosis (MS) care, can be achieved by using a patient app tool to manage symptoms and track/store symptom issues to share with clinicians.

Multiple Sclerosis Association of America (MSAA) and @Point of Care collaborated to develop complementary apps for use by patients and their clinicians that facilitate sharing of data: My MS Manager ^TM, a HIPAA compliant patient app, and Multiple Sclerosis @Point of Care, a clinician app. By enhancing the patient app with symptom management tools, patients can track and manage their symptoms and improve their quality of life.

Objectives

Analyze impact of patient app in assessing differences in symptom severity based on clinical phenotype and in empowering patients to track/manage their MS symptoms.

Methods

MSAA and @Point of Care added more validated measures to the app to facilitate tracking of bladder control (Bladder Control Scale; BLCS; 11/2019), depression (Patient Health Questionnaire Score for Depression; PHQ-9; 08/2019), cognitive function (PROMIS Cognitive Function-Short Form 8a; 03/2019), and fatigue (Modified Fatigue Impact Scale; MFIS; 08/2015). Patient data were analyzed to assess: 1) symptom severity by phenotype, 2) quality of life (QOL) factors most affected by symptom severity, and 3) benefits of frequent app use (>26 visits) on symptoms.

Results

Of 22,858 registered users on the My MS Manager app, 6717 patients have already identified their clinical phenotype and/or tracked their bladder control, depression, cognitive function, and/or fatigue scores:

• SPMS patients compared to RRMS patients had

–Significantly greater bladder control issues that alter their activities (35% vs 18%; P = 0.002) and severely affect their lifestyle (17% vs 8%; P = 0.033)

–Significantly worse depression symptoms for “more than half the days/nearly every day”

–Reported their depression issues more severely affect their work (>19% difference)

• PPMS compared to RRMS/SPMS patients showed no significant differences in bladder, depression, cognitive function, and fatigue symptoms

• Infrequent RRMS users (≤ 26 visits) of the My MS Manager app experienced higher depression severity as opposed to frequent RRMS users (>26 visits)

Conclusions

The My MS Manager patient app facilitates the ability of patients with MS to record their symptoms utilizing validated measures, to track and manage their MS, and to discuss their symptoms with their clinicians.