The Assessment of Motor Fatigability in Persons With Multiple Sclerosis

Obviously we have no similar research for stroke. Because we have NO stroke leadership and NO stroke strategy.
In one study, two years after their stroke 10 per cent of stroke survivors said they were always tired and 30 per cent said they were sometimes tired. In another study, at least 12 months after their stroke, 50 per cent of stroke survivors said tiredness was their main problem. 

The Assessment of Motor Fatigability in Persons With Multiple Sclerosis

A Systematic Review

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Deborah Severijns, PhD, Inge Zijdewind, PhD, Ulrik Dalgas, PhD, Ilse Lamers, PhD, Caroline Lismont, Peter Feys, PhD

First Published January 1, 2017 review-article

Abstract

Background. Persons with multiple sclerosis (PwMS) are often characterized by increased motor fatigability, which is a performance change on an objectively measured criterion after any type of voluntary muscle contractions. This review summarizes the existing literature to determine which protocols and outcome measures are best to detect or study motor fatigability and the underlying mechanisms in MS.  
Methods. Two electronic databases, PubMed and Web of Science, were searched for relevant articles published until August 2016 with a combination of multiple sclerosis, fatigability, muscle fatigue, and motor fatigue.  
Results. A total of 48 articles were retained for data extraction. A variety of fatigability protocols were reported; protocols showed differences in type (isometric vs concentric), duration (15 to 180 s), and number of contractions (fixed or until exhaustion). Also, 12 articles reported motor fatigability during functional movements, predominantly assessed by changes in walking speed; 11 studies evaluated the mechanisms underlying motor fatigability, using additional electrical nerve or transcranial magnetic stimulation. Three articles reported psychometrics of the outcomes. Conclusions. The disparity of protocols and outcome measures to study different aspects of motor fatigability in PwMS impedes direct comparison between data. Most protocols use maximal single-joint isometric contractions, with the advantage of high standardization. Because there is no head-to-head comparison of the different protocols and only limited information on psychometric properties of outcomes, there is currently no gold standard to assess motor fatigability. The disability level, disease phenotype, and studied limb may influence the assessment of motor fatigability in PwMS.