title: Unilateral and bilateral upper limb dysfunction at body functions, activity and participation levels in people with multiple sclerosis.
abstract: BACKGROUND
  There has been limited research on upper limb dysfunction in people with multiple sclerosis (PwMS).
  
  
  OBJECTIVE
  The objective of this paper is to study unilateral and bilateral upper limb dysfunction at different International Classification of Functioning (ICF) levels according to overall disability in PwMS.
  
  
  METHODS
  A total of 105 PwMS (16 with EDSS<4 (mild); 17 with EDSS 4-5.5 (moderate); 37 with EDSS 6-6.5 (severe); 35 with EDSS>6.5 (severe non-ambulant)) were recruited from two rehabilitation centers and assessed in a cross-sectional study.
  
  
  RESULTS
  The whole sample showed a diminished sensory function (median (first/third interquartile)) score of 3 (2/3) on the Monofilament Test and a reduced strength 91 (76/100) points on the Motricity Index (Body-Function level). Sensory dysfunction did not increase with higher EDSS while strength decreased from 100 (86/100) in the mild subgroups to 91 (80/100) points in the severe subgroup. All showed diminished dexterity, scoring 0.28 peg/s (0.17/0.35) on the Nine-Hole Peg Test (NHPT) (activity level). Score was better for the mild (0.38 (0.35/0.46)) peg/s compared to the severe subgroup (0.28 (0.17/0.35)). Sixty-eight percent, 44% and 75% of PwMS showed bilateral disorders in sensation, strength and dexterity, respectively. The Community Integration Questionnaire (participation level) showed a 35% reduction in home activities, even among PwMS with EDSS<4.
  
  
  CONCLUSIONS
  This study showed uni-/bilateral upper limb abnormalities at all ICF levels increasing with the overall disability.
authors: LaRiCE lab: Gait and Balance Disorders Laboratory, Don Gnocchi Foundation, I.R.C.C.S., Italy.
authors: Rita
authors: R
authors: Bertoni
authors: REVAL - Rehabilitation Research Institute, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Belgium.
authors: Ilse
authors: I
authors: Lamers
authors: Rehabilitation Sciences (Occupational Therapy), University of Texas at El Paso, El Paso, Texas.
authors: Christine C
authors: CC
authors: Chen
authors: REVAL - Rehabilitation Research Institute, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Belgium.
authors: Peter
authors: P
authors: Feys
authors: LaRiCE lab: Gait and Balance Disorders Laboratory, Don Gnocchi Foundation, I.R.C.C.S., Italy dcattaneo@dongnocchi.it.
authors: Davide
authors: D
authors: Cattaneo
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000503:physiopathology*; D012720:Severity of Illness Index; D034941:Upper Extremity / Q000503:physiopathology*
keywords: ICF; Upper limb; bilateral involvement; dysfunction; multiple sclerosis