Cooling During Inpatient Rehabilitation in Persons With MS

The Six-Minute Walk Test (6-MWT) is used to determine the total distance in meters covered within six minutes when walking back and forth on a 20-metres hallway, as a measure of endurance walking capacity. Participants are asked to walk back and forth at maximal walking speed for the duration of six minutes. The instruction is standardized as "to walk at fastest speed, and to cover as much distance as possible". Participants are allowed to use a walking aid, if necessary to ensure safe ambulation.

The five-time sit to stand (5STS) test measures the time needed for a person to stand up from a chair and sit back down five times as fast as possible.

The Mini-Balance Evaluation Systems Test (Mini-BESTest) measures the balance capacity of an individual and differentiates between four areas of balance: anticipatory, reactive postural control, sensory orientation and dynamical walking capacities. There are 14 different tasks. Each task will be scored from 0 to 2 points (0 = severe, 1 = moderate, 2 = normal) by the examiner. A maximal total score of 28 points can be achieved. Higher scores indicate better balance.

Cognition is tested with the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), composed of the Symbol Digit Modalities Test (SDMT), the Verbal Learning and Memory Test (VLMT), and the Brief Visuospatial Memory Test (BVMT-R). The SDMT assesses processing speed. The test consists of single digits paired with abstract symbols. Rows of the nine symbols are arranged pseudo-randomly. The patient must say the number that corresponds with each symbol within 90 seconds. The VLMT assesses verbal memory. The VLMT comprises a 15-item word list. The list is read aloud five times in the same order to the patient. Patients are required to recall as many items as possible, in any order, after each reading of the list. The BVMT-R assesses visual memory. Participants inspect a 2 × 3 stimulus array of abstract geometric figures. There are three learning trials of 10s. The array is removed, and the participant is required to draw the array from memory.

Trait fatigue is assessed with the Fatigue Scale for Motor and Cognitive functions (FSMC), that allows separate rating of motor and cognitive fatigue, based on a 5-point Likert scale (range 1-5). Scores range from 20-100 for FSMC total score, and from 10-50 for each subscale (i.e. motor and cognitive). Higher scores indicate a higher level of fatigue. The instrument has defined cut-off scores to classify mildly, moderately, and severely fatigued patients. Cut-off for mild fatigue is set for the total score at 43 and for the motor and cognitive sub-scores at 22.

Muscle strength will be assessed using a five-repetition maximum (5RM) test. The test will be carried out on the seated row machine and will be measured in kilogram (kg). Firstly, the participants should warm up by completing several submaximal repetitions. Then, the 5RM will be determined within four trials with rest periods of 3 min between trials. An initial weight that is within the subject's perceived capacity (~ 50-70% of capacity) will be chosen. Thereafter, the resistance will be progressively increased by 2.5-20 kg until the subject is not able to complete the selected repetition(s). All repetitions should be performed at the same speed of movement and range of motion to ensure consistency between trials.

Muscle strength will be assessed using a five-repetition maximum (5RM) test. The test will be carried out on the leg press and will be measured in kilograms (kg). Firstly, the participants should warm up by completing several submaximal repetitions. Then, the 5RM will be determined within four trials with rest periods of 3 min between trials. An initial weight that is within the subject's perceived capacity (~ 50-70% of capacity) will be chosen. Thereafter, the resistance will be progressively increased by 2.5-20 kg until the subject is not able to complete the selected repetition(s). All repetitions should be performed at the same speed of movement and ran-ge of motion to ensure consistency between trials.

Peak oxygen consumption (VO2peak) in ml/min and in ml/min/kg will be assessed via following progressive cardiopulmonary exercise testing (CPET) on a cycle ergometer (Ergoline 800, Germany): The individual cardiorespiratory fitness level is monitored by direct and continuous measurements (breath by breath) of maximum oxygen consumption (VO2peak) by ergospirometry. The exercise ramp-type protocol consists of (a) a resting state measurement without pedalling while participants are sitting on the bicycle ergometer (2 minutes); (b) subsequent unloaded pedalling (20W) as a warm-up (3 minutes); (c) the testing phase until exhaustion, during which the workload is continuously increased by 5-10W every minute to ensure 8-12 minutes of testing; (d) followed by a cool-down of unloaded pedalling (20W, 3-5 minutes). HR and blood pressure are monitored every 2 minutes and for the last 10 seconds of the test. The rate of perceived exertion (RPE) is assessed via Borg-CR10 scale at phases (c) and (d).

Peak maximum power output will be assessed in watts via following progressive cardiopulmo-nary exercise testing (CPET) on a cycle ergometer (Ergoline 800, Germany): The individual car-diorespiratory fitness level is monitored by direct and continuous measurements (breath by breath) of maximum oxygen consumption (VO2peak) by ergospirometry. The exercise ramp-type protocol consists of (a) a resting state measurement without pedalling while participants are sitting on the bicycle ergometer (2 minutes); (b) subsequent unloaded pedalling (20W) as a warm-up (3 minutes); (c) the testing phase until exhaustion, during which the workload is con-tinuously increased by 5-10W every minute to ensure 8-12 minutes of testing; (d) followed by a cool-down of unloaded pedalling (20W, 3 - 5 minutes). HR and blood pressure are monitored every 2 minutes and for the last 10 seconds of the test. The rate of perceived exertion (RPE) is assessed via Borg-CR10 scale at phases (c) and (d).

Peak heart rate will be assessed in beats per minutes via following progressive cardiopulmonary exercise testing (CPET) on a cycle ergometer (Ergoline 800, Germany): The individual cardiore-spiratory fitness level is monitored by direct and continuous measurements (breath by breath) of maximum oxygen consumption (VO2peak) by ergospirometry. The exercise ramp-type pro-tocol consists of (a) a resting state measurement without pedalling while participants are sit-ting on the bicycle ergometer (2 minutes); (b) subsequent unloaded pedalling (20W) as a warm-up (3 minutes); (c) the testing phase until exhaustion, during which the workload is continuous-ly increased by 5-10W every minute to ensure 8-12 minutes of testing; (d) followed by a cool-down of unloaded pedalling (20W, 3 - 5 minutes). HR and blood pressure are monitored every 2 minutes and for the last 10 seconds of the test. The rate of perceived exertion (RPE) is asses-sed via Borg-CR10 scale at phases (c) and (d).