טכניון מכון טכנולוגי לישראל
הטכניון מכון טכנולוגי לישראל - בית הספר ללימודי מוסמכים  
M.Sc Thesis
M.Sc StudentMichal Greenberg Abrahami
SubjectInteractive Sensory Digital Platform for Upper Limb Sensory
Training in Patients with Multiple Sclerosis
DepartmentDepartment of Architecture and Town Planning
Supervisors Professor Bitterman Noemi
Full Professor Ron Achiron
Full Thesis text - in Hebrew Full thesis text - Hebrew Version


Abstract


Background: Multiple sclerosis (MS) is a progressive autoimmune disease of the central nervous system that leads to the destruction of myelin. The disease is typically diagnosed between the ages of 20 and 45 and is more common in woman. Symptoms of MS can differ greatly from person to person and depend on the location of the affected nerve fibers. Sensory impairments are very common in MS. Several studies have found prevalence rates as high as 80% with many patients identifying sensory impairments as their most distressing symptoms. When involving the hands, sensory impairments can significantly interfere with fine motor movements required for daily tasks such as writing, typing, cutting a salad and brushing teeth. In previous studies at the Multiple Sclerosis Center Sheba Medical Center we have shown that sensory re-education, which combines techniques of physical and occupational therapy, is effective in MS patients with upper limb sensory impairments. However, this intervention can have beneficial effects on manual dexterity as well as sensory training.

The aims of the current study were first, to develop an interactive sensory digital platform (ISPD) for training MS patients with upper limb sensory impairments, and second, to examine performance on the ISPD by comparing response time for identifying shapes and textures, in patients with MS and healthy individuals. Based on our previous work, we predicted that patients with MS would perform more poorly overall on textures particular, compared to healthy individuals.  

Methods: Twenty-eight patients with MS (19 females; Mean age= 37.3, SD= 10.9) and 31 (19 females; Mean age= 35.2, SD= 7.8) healthy individuals underwent sensory evaluation using the ISDP. The ISDP consists of 30 items (14 shapes and 16 textures) constructed on computer keyboard buttons. During the experiment, an image of each item was presented on a computer screen and participants were asked to identify the corresponding keyboard button within 30 seconds by using their dominant hand and without looking at the keyboard. The items were presented in the same order for all participants with all shapes presented first followed by the textures. The study was a clinical study carried out in the Multiple Sclerosis Center at Sheba Medical Center.  

Results: Patients with MS, compared to healthy individuals, had longer response times for identifying all items (p=.001) and textures only (p=.001). The group difference in response time for shapes was marginally significant (p=.055). Pairwise comparisons for each of the 30 items showed longer response times in the MS group for nine textures, and one shape. (all ps< .05). In the MS group, there was a significant positive association between response time for all items and age (p= .017) but no associations between response time and disease duration or Expanded Disability Status Scale (EDSS) scores.

Conclusions: Patients with MS had poorer performance on the ISDP despite showing no evidence for sensory impairments on neurological examinations prior to testing and having low EDSS scores. This suggests that the ISDP could be useful for detecting sensory impairments in early stages of MS before neural markers are present. In addition to assessment, the ISDP could be used for sensory training focused on each hand as well as separate fingers, and could be used in sensory training to improve performance of daily tasks. Another conclusion to this study is the clinical implication of the ISPD is an innovative sensory-assessment platform and can be used to detect sensory impairments in MS patients. Importantly, the platform can be adapted for home use to increase compliance and motivation, and the level of difficulty can be adjusted for each patient.