Research Article
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Neck Muscle Endurance, Trunk Control, Upper Extremity Function and Manual Dexterity in Patients with Multiple Sclerosis

Year 2025, Volume: 9 Issue: 3, 485 - 493, 30.09.2025
https://doi.org/10.30621/jbachs.1659237

Abstract

References

  • McDonald I, Compston A. The symptoms and signs of multiple sclerosis. McAlpine's multiple sclerosis. 2006:287-346.
  • Lamers I, Kelchtermans S, Baert I, Feys P. Upper limb assessment in multiple sclerosis: a systematic review of outcome measures and their psychometric properties. Archives of physical medicine and rehabilitation. 2014;95(6):1184-200.
  • Feys P, Lamers I, Francis G, Benedict R, Phillips G, LaRocca N, et al. The Nine-Hole Peg Test as a manual dexterity performance measure for multiple sclerosis. Multiple Sclerosis Journal. 2017;23(5):711-20.
  • Yozbatıran N, Baskurt F, Baskurt Z, Ozakbas S, Idiman E. Motor assessment of upper extremity function and its relation with fatigue, cognitive function and quality of life in multiple sclerosis patients. Journal of the neurological sciences. 2006;246(1-2):117-22.
  • Bertoni R, Lamers I, Chen CC, Feys P, Cattaneo D. Unilateral and bilateral upper limb dysfunction at body functions, activity and participation levels in people with multiple sclerosis. Multiple Sclerosis Journal. 2015;21(12):1566-74.
  • Heldner MR, Vanbellingen T, Bohlhalter S, Mattle HP, Müri RM, Kamm CP. Coin rotation task: a valid test for manual dexterity in multiple sclerosis. Physical therapy. 2014;94(11):1644-51.
  • Einarsson U, Gottberg K, Fredrikson S, Von Koch L, Holmqvist LW. Activities of daily living and social activities in people with multiple sclerosis in Stockholm County. Clinical rehabilitation. 2006;20(6):543-51.
  • Kierkegaard M, Einarsson U, Gottberg K, von Koch L, Holmqvist LW. The relationship between walking, manual dexterity, cognition and activity/participation in persons with multiple sclerosis. Multiple Sclerosis Journal. 2012;18(5):639-46.
  • Özkan T, Ünlüer NÖ, Yaşa MEK, Buse, Vural G. The relationship between trunk control, spinal posture, and spinal mobility in patients with multiple sclerosis: a cross-sectional study. Turkish Journal of Medical Sciences. 2024;54(1):175-84.
  • Wee SK, Hughes A-M, Warner MB, Brown S, Cranny A, Mazomenos EB, et al. Effect of trunk support on upper extremity function in people with chronic stroke and people who are healthy. Physical therapy. 2015;95(8):1163-71.
  • Raats J, Arntzen EC, Lamers I, Feys P, Normann B. What is the distribution of trunk impairments and its relationship with disability level in individuals with multiple sclerosis? Multiple Sclerosis and Related Disorders. 2022;57:103325.
  • Miyake Y, Kobayashi R, Kelepecz D, Nakajima M. Core exercises elevate trunk stability to facilitate skilled motor behavior of the upper extremities. Journal of bodywork and movement therapies. 2013;17(2):259-65.
  • Lehman GJ, Story S, Mabee R. Influence of static lumbar flexion on the trunk muscles' response to sudden arm movements. Chiropractic & osteopathy. 2005;13:1-5.
  • Jull G, Sterling M, Falla D, Treleaven J, O'Leary S. Whiplash, headache, and neck pain: research-based directions for physical therapies: Elsevier Health Sciences; 2008.
  • Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual therapy. 2008;13(1):2-11.
  • Mayoux-Benhamou M, Revel M, Vallee C. Selective electromyography of dorsal neck muscles in humans. Experimental Brain Research. 1997;113:353-60.
  • Karanfil E, Salci Y, Fil Balkan A, Tuncer A, Karabudak R. The acute effect of cervical mobilization on balance in patients with multiple sclerosis: a single-blind, randomized, controlled trial. Neurological Research. 2024;46(1):65-71.
  • Jørgensen M-LK, Dalgas U, Wens I, Hvid L. Muscle strength and power in persons with multiple sclerosis–a systematic review and meta-analysis. Journal of the neurological sciences. 2017;376:225-41.
  • Verheyden G, Nuyens G, Nieuwboer A, Van Asch P, Ketelaer P, De Weerdt W. Reliability and validity of trunk assessment for people with multiple sclerosis. Physical therapy. 2006;86(1):66-76.
  • Harris KD, Heer DM, Roy TC, Santos DM, Whitman JM, Wainner RS. Reliability of a measurement of neck flexor muscle endurance. Physical therapy. 2005;85(12):1349-55.
  • Biering-Sørensen F. Physical measurements as risk indicators for low-back trouble over a one-year period. Spine. 1984;9(2):106-19.
  • Ljungquist T, Harms‐Ringdahl K, Nygren Å, Jensen I. Intra‐and inter‐rater reliability of an 11‐test package for assessing dysfunction due to back or neck pain. Physiotherapy Research International. 1999;4(3):214-32.
  • Düger T, ÜNAL E, Öksüz Ç, Yörükan S, AKEL B, Ayhan Ç, et al. Kol Omuz ve El Sorunları Disabilities of the Arm Shoulder and Hand DASH Anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Turkish Journal Of Physiotherapy Rehablilitation. 2006;17(3).
  • Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods. 2007;39(2):175-91.
  • Ingram LA, Butler AA, Brodie MA, Hoang P, Gandevia SC, Lord SR. Quantifying upper-limb motor impairment in people with multiple sclerosis: A physiological profiling approach. Annals of physical and rehabilitation medicine. 2022;65(5):101625.
  • Guclu-Gunduz A, Citaker S, Nazliel B, Irkec C. Upper extremity function and its relation with hand sensation and upper extremity strength in patients with multiple sclerosis. NeuroRehabilitation. 2012;30(4):369-74.
  • Holper L, Coenen M, Weise A, Stucki G, Cieza A, Kesselring J. Characterization of functioning in multiple sclerosis using the ICF. Journal of neurology. 2010;257:103-13.
  • Johansson S, Ytterberg C, Claesson IM, Lindberg J, Hillert J, Andersson M, et al. High concurrent presence of disability in multiple sclerosis: associations with perceived health. Journal of neurology. 2007;254:767-73.
  • Özkan T, Ünlüer NÖ, Yaşa ME, Korkmaz B, Vural G. The relationship between trunk control, spinal posture, and spinal mobility in patients with multiple sclerosis: a cross-sectional study. Turkish Journal of Medical Sciences. 2024;54(1):175-84.
  • Korkmaz NC, Akman TC, Oren GK, Bir LS. Trunk control: The essence for upper limb functionality in patients with multiple sclerosis. Multiple sclerosis and related disorders. 2018;24:101-6.
  • Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports medicine. 2006;36:189-98.
  • Özkul Ç, Gündüz AG, Esmer M, Yıldırım MŞ, Eldemir K, Irkec C. Mutual Relationship Between Upper Extremity Function and Core Muscle Endurance in Patients with Multiple Sclerosis. Clinical and Experimental Health Sciences. 2021;11(1):42-6.
  • Arslan SA, Uğurlu K, Demirci C, Keskin D. Investigating the relation between upper extremity function and trunk control, balance and functional mobility in individuals with stroke. Journal of Health Sciences and Medicine. 2021;4(2):127-31.
  • Iso F, Mitsunaga W, Yamaguchi R, Shimizu N, Ito S, Honda Y, et al. Relationship among trunk control, activities of daily living, and upper extremity function during the first week after stroke in patients with acute cerebral infarction. Journal of Physical Therapy Science. 2022;34(4):315-9.
  • Kim DH, An D-H, Yoo W-G. The relationship between trunk control and upper limb function in children with cerebral palsy. Technology and Health Care. 2018;26(3):421-7.

Neck Muscle Endurance, Trunk Control, Upper Extremity Function and Manual Dexterity in Patients with Multiple Sclerosis

Year 2025, Volume: 9 Issue: 3, 485 - 493, 30.09.2025
https://doi.org/10.30621/jbachs.1659237

Abstract

Purpose: One of the most impacted regions is upper limb function, which lowers quality of life and involvement in daily living activities in patients with Multiple Sclerosis (PwMS). This study aimed to examine the relationship between function of upper extremity and manual dexterity with trunk control and neck muscle endurance in PwMS.
Materials and Methods: Thirty-one PwMS and 30 healthy controls with matched ages and genders participated in the study.Trunk control was evaluated with Trunk Impairment Scale (TIS); neck muscle endurance with Extensor Endurance Test (EET) and Flexor Endurance Test (FET); upper extremity function and manual dexterity with 9-Hole Peg Test (9-HPT) bilaterally, Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, and Coin Rotation Test (CRT) bilaterally.
Results: TIS, and EET scores was lower and dominant-nondominant 9-HPT, DASH Questionnaire, and dominant-non-dominant CRT scores was higher in PwMS compared to healthy controls (p<0.05). Between the groups, there was no significance difference for FET (p>0.05). In PwMS, FET was only related with DASH and EET was related DASH Questionarre, nondominant NHPT and CRT(r between -0.404 and -0.481; p<0.05). Except for some sub-parameters, TIS was related with 9-HPT, DASH Questionnaire, and CRT (r between -0.401 and -0.767; p<0.05 for all).
Conclusion: These results of study suggest that rehabilitation approaches to improve neck muscle endurance, especially extensor muscle endurance, as well as trunk control can be included in the treatment protocols to improve upper extremity function and dexterity in PwMS.

Ethical Statement

The ethics committee of Ankara Yıldırım Beyazıt University gave its approval (2023/06-271).

Supporting Institution

None.

Thanks

The authors thank all participants who participated in this study.

References

  • McDonald I, Compston A. The symptoms and signs of multiple sclerosis. McAlpine's multiple sclerosis. 2006:287-346.
  • Lamers I, Kelchtermans S, Baert I, Feys P. Upper limb assessment in multiple sclerosis: a systematic review of outcome measures and their psychometric properties. Archives of physical medicine and rehabilitation. 2014;95(6):1184-200.
  • Feys P, Lamers I, Francis G, Benedict R, Phillips G, LaRocca N, et al. The Nine-Hole Peg Test as a manual dexterity performance measure for multiple sclerosis. Multiple Sclerosis Journal. 2017;23(5):711-20.
  • Yozbatıran N, Baskurt F, Baskurt Z, Ozakbas S, Idiman E. Motor assessment of upper extremity function and its relation with fatigue, cognitive function and quality of life in multiple sclerosis patients. Journal of the neurological sciences. 2006;246(1-2):117-22.
  • Bertoni R, Lamers I, Chen CC, Feys P, Cattaneo D. Unilateral and bilateral upper limb dysfunction at body functions, activity and participation levels in people with multiple sclerosis. Multiple Sclerosis Journal. 2015;21(12):1566-74.
  • Heldner MR, Vanbellingen T, Bohlhalter S, Mattle HP, Müri RM, Kamm CP. Coin rotation task: a valid test for manual dexterity in multiple sclerosis. Physical therapy. 2014;94(11):1644-51.
  • Einarsson U, Gottberg K, Fredrikson S, Von Koch L, Holmqvist LW. Activities of daily living and social activities in people with multiple sclerosis in Stockholm County. Clinical rehabilitation. 2006;20(6):543-51.
  • Kierkegaard M, Einarsson U, Gottberg K, von Koch L, Holmqvist LW. The relationship between walking, manual dexterity, cognition and activity/participation in persons with multiple sclerosis. Multiple Sclerosis Journal. 2012;18(5):639-46.
  • Özkan T, Ünlüer NÖ, Yaşa MEK, Buse, Vural G. The relationship between trunk control, spinal posture, and spinal mobility in patients with multiple sclerosis: a cross-sectional study. Turkish Journal of Medical Sciences. 2024;54(1):175-84.
  • Wee SK, Hughes A-M, Warner MB, Brown S, Cranny A, Mazomenos EB, et al. Effect of trunk support on upper extremity function in people with chronic stroke and people who are healthy. Physical therapy. 2015;95(8):1163-71.
  • Raats J, Arntzen EC, Lamers I, Feys P, Normann B. What is the distribution of trunk impairments and its relationship with disability level in individuals with multiple sclerosis? Multiple Sclerosis and Related Disorders. 2022;57:103325.
  • Miyake Y, Kobayashi R, Kelepecz D, Nakajima M. Core exercises elevate trunk stability to facilitate skilled motor behavior of the upper extremities. Journal of bodywork and movement therapies. 2013;17(2):259-65.
  • Lehman GJ, Story S, Mabee R. Influence of static lumbar flexion on the trunk muscles' response to sudden arm movements. Chiropractic & osteopathy. 2005;13:1-5.
  • Jull G, Sterling M, Falla D, Treleaven J, O'Leary S. Whiplash, headache, and neck pain: research-based directions for physical therapies: Elsevier Health Sciences; 2008.
  • Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual therapy. 2008;13(1):2-11.
  • Mayoux-Benhamou M, Revel M, Vallee C. Selective electromyography of dorsal neck muscles in humans. Experimental Brain Research. 1997;113:353-60.
  • Karanfil E, Salci Y, Fil Balkan A, Tuncer A, Karabudak R. The acute effect of cervical mobilization on balance in patients with multiple sclerosis: a single-blind, randomized, controlled trial. Neurological Research. 2024;46(1):65-71.
  • Jørgensen M-LK, Dalgas U, Wens I, Hvid L. Muscle strength and power in persons with multiple sclerosis–a systematic review and meta-analysis. Journal of the neurological sciences. 2017;376:225-41.
  • Verheyden G, Nuyens G, Nieuwboer A, Van Asch P, Ketelaer P, De Weerdt W. Reliability and validity of trunk assessment for people with multiple sclerosis. Physical therapy. 2006;86(1):66-76.
  • Harris KD, Heer DM, Roy TC, Santos DM, Whitman JM, Wainner RS. Reliability of a measurement of neck flexor muscle endurance. Physical therapy. 2005;85(12):1349-55.
  • Biering-Sørensen F. Physical measurements as risk indicators for low-back trouble over a one-year period. Spine. 1984;9(2):106-19.
  • Ljungquist T, Harms‐Ringdahl K, Nygren Å, Jensen I. Intra‐and inter‐rater reliability of an 11‐test package for assessing dysfunction due to back or neck pain. Physiotherapy Research International. 1999;4(3):214-32.
  • Düger T, ÜNAL E, Öksüz Ç, Yörükan S, AKEL B, Ayhan Ç, et al. Kol Omuz ve El Sorunları Disabilities of the Arm Shoulder and Hand DASH Anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Turkish Journal Of Physiotherapy Rehablilitation. 2006;17(3).
  • Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods. 2007;39(2):175-91.
  • Ingram LA, Butler AA, Brodie MA, Hoang P, Gandevia SC, Lord SR. Quantifying upper-limb motor impairment in people with multiple sclerosis: A physiological profiling approach. Annals of physical and rehabilitation medicine. 2022;65(5):101625.
  • Guclu-Gunduz A, Citaker S, Nazliel B, Irkec C. Upper extremity function and its relation with hand sensation and upper extremity strength in patients with multiple sclerosis. NeuroRehabilitation. 2012;30(4):369-74.
  • Holper L, Coenen M, Weise A, Stucki G, Cieza A, Kesselring J. Characterization of functioning in multiple sclerosis using the ICF. Journal of neurology. 2010;257:103-13.
  • Johansson S, Ytterberg C, Claesson IM, Lindberg J, Hillert J, Andersson M, et al. High concurrent presence of disability in multiple sclerosis: associations with perceived health. Journal of neurology. 2007;254:767-73.
  • Özkan T, Ünlüer NÖ, Yaşa ME, Korkmaz B, Vural G. The relationship between trunk control, spinal posture, and spinal mobility in patients with multiple sclerosis: a cross-sectional study. Turkish Journal of Medical Sciences. 2024;54(1):175-84.
  • Korkmaz NC, Akman TC, Oren GK, Bir LS. Trunk control: The essence for upper limb functionality in patients with multiple sclerosis. Multiple sclerosis and related disorders. 2018;24:101-6.
  • Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports medicine. 2006;36:189-98.
  • Özkul Ç, Gündüz AG, Esmer M, Yıldırım MŞ, Eldemir K, Irkec C. Mutual Relationship Between Upper Extremity Function and Core Muscle Endurance in Patients with Multiple Sclerosis. Clinical and Experimental Health Sciences. 2021;11(1):42-6.
  • Arslan SA, Uğurlu K, Demirci C, Keskin D. Investigating the relation between upper extremity function and trunk control, balance and functional mobility in individuals with stroke. Journal of Health Sciences and Medicine. 2021;4(2):127-31.
  • Iso F, Mitsunaga W, Yamaguchi R, Shimizu N, Ito S, Honda Y, et al. Relationship among trunk control, activities of daily living, and upper extremity function during the first week after stroke in patients with acute cerebral infarction. Journal of Physical Therapy Science. 2022;34(4):315-9.
  • Kim DH, An D-H, Yoo W-G. The relationship between trunk control and upper limb function in children with cerebral palsy. Technology and Health Care. 2018;26(3):421-7.
There are 35 citations in total.

Details

Primary Language English
Subjects Health Services and Systems (Other)
Journal Section Research Article
Authors

Taşkın Özkan 0000-0001-9448-0516

Nezehat Özgül Ünlüer 0000-0003-2314-0738

Yasemin Ateş Sarı 0000-0001-7046-5477

Aybike Erkoç 0009-0006-4090-1817

Gönül Vural 0000-0002-1245-7273

Publication Date September 30, 2025
Submission Date March 16, 2025
Acceptance Date June 5, 2025
Published in Issue Year 2025 Volume: 9 Issue: 3

Cite

APA Özkan, T., Ünlüer, N. Ö., Ateş Sarı, Y., … Erkoç, A. (2025). Neck Muscle Endurance, Trunk Control, Upper Extremity Function and Manual Dexterity in Patients with Multiple Sclerosis. Journal of Basic and Clinical Health Sciences, 9(3), 485-493. https://doi.org/10.30621/jbachs.1659237
AMA Özkan T, Ünlüer NÖ, Ateş Sarı Y, Erkoç A, Vural G. Neck Muscle Endurance, Trunk Control, Upper Extremity Function and Manual Dexterity in Patients with Multiple Sclerosis. JBACHS. September 2025;9(3):485-493. doi:10.30621/jbachs.1659237
Chicago Özkan, Taşkın, Nezehat Özgül Ünlüer, Yasemin Ateş Sarı, Aybike Erkoç, and Gönül Vural. “Neck Muscle Endurance, Trunk Control, Upper Extremity Function and Manual Dexterity in Patients With Multiple Sclerosis”. Journal of Basic and Clinical Health Sciences 9, no. 3 (September 2025): 485-93. https://doi.org/10.30621/jbachs.1659237.
EndNote Özkan T, Ünlüer NÖ, Ateş Sarı Y, Erkoç A, Vural G (September 1, 2025) Neck Muscle Endurance, Trunk Control, Upper Extremity Function and Manual Dexterity in Patients with Multiple Sclerosis. Journal of Basic and Clinical Health Sciences 9 3 485–493.
IEEE T. Özkan, N. Ö. Ünlüer, Y. Ateş Sarı, A. Erkoç, and G. Vural, “Neck Muscle Endurance, Trunk Control, Upper Extremity Function and Manual Dexterity in Patients with Multiple Sclerosis”, JBACHS, vol. 9, no. 3, pp. 485–493, 2025, doi: 10.30621/jbachs.1659237.
ISNAD Özkan, Taşkın et al. “Neck Muscle Endurance, Trunk Control, Upper Extremity Function and Manual Dexterity in Patients With Multiple Sclerosis”. Journal of Basic and Clinical Health Sciences 9/3 (September2025), 485-493. https://doi.org/10.30621/jbachs.1659237.
JAMA Özkan T, Ünlüer NÖ, Ateş Sarı Y, Erkoç A, Vural G. Neck Muscle Endurance, Trunk Control, Upper Extremity Function and Manual Dexterity in Patients with Multiple Sclerosis. JBACHS. 2025;9:485–493.
MLA Özkan, Taşkın et al. “Neck Muscle Endurance, Trunk Control, Upper Extremity Function and Manual Dexterity in Patients With Multiple Sclerosis”. Journal of Basic and Clinical Health Sciences, vol. 9, no. 3, 2025, pp. 485-93, doi:10.30621/jbachs.1659237.
Vancouver Özkan T, Ünlüer NÖ, Ateş Sarı Y, Erkoç A, Vural G. Neck Muscle Endurance, Trunk Control, Upper Extremity Function and Manual Dexterity in Patients with Multiple Sclerosis. JBACHS. 2025;9(3):485-93.