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Kaşlı K, Doğan M, Özal C, Doğan Y, Kılınç M, Aksu Yıldırım S. The effects of myofascial release in combined with task-oriented circuit training on balance in people with Parkinson's disease: a randomized pilot trial. Neurol Res 2024:1-11. [PMID: 38818769 DOI: 10.1080/01616412.2024.2360860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES Task-oriented circuit training (TOCT) has been used to improve balance in people with Parkinson's disease (pwPD). To investigate the effectiveness of TOCT on balance, quality of life, and disease symptoms when combined with myofascial release in pwPD. METHODS Twenty-six pwPD were randomized into two groups for this randomized controlled study. The groups received TOCT three days a week for eight weeks. At the end of each session, the myofascial release was applied to the neck, trunk, and lumbar region with three sets of 60-s foam rolling body weight (Intervention group-IG) and perceived discomfort level 0/10 (Control group-CG) using a numeric rating scale. Primary outcome measures were measured by the Berg Balance Scale (BBS), Parkinson's Disease Questionnaire (PDQ-8), and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Secondary outcome measures included posturographic assessment, timed-up and go test (TUG), Trunk Impairment Scale (TIS), and rolling time. RESULTS Data obtained from 26 pwPDs in equal numbers in both groups were analyzed. All groups reported a significant change in MDS-UPDRS, MDS-UPDRS-III, PDQ-8, TIS, and rolling time after treatment compared to pretreatment. Post-hoc analyses showed that IG significantly improved motor symptoms, TUG, and TIS dynamics compared to CG. The mediolateral limits of stability and anterioposterior limits of stability distances of IG increased (p < 0.05). DISCUSSION Myofascial release, when combined with TOCT, may help to reduce disease-related motor symptoms and improve dynamic balance in pwPD. These findings suggest that myofascial release can be a beneficial addition to TOCT programs for pwPD.Clinical Trial Number: NCT05900934 (ClinicalTrials.gov).
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Affiliation(s)
- Kutay Kaşlı
- Department of Health Care Services, Vocational School of Health Services, Çankırı Karatekin University, Çankırı, Turkey
- Institute of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Mert Doğan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Cemil Özal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yahya Doğan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Muhammed Kılınç
- Institute of Health Sciences, Hacettepe University, Ankara, Turkey
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Sibel Aksu Yıldırım
- Institute of Health Sciences, Hacettepe University, Ankara, Turkey
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Bonde-Jensen F, Dalgas U, Langeskov-Christensen M. Are physical activity levels, cardiorespiratory fitness and peak power associated with Parkinson's disease severity? J Neurol Sci 2024; 460:122996. [PMID: 38615406 DOI: 10.1016/j.jns.2024.122996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Increased physical activity (PA) may slow Parkinson's disease (PD) progression. Associations between markers of PA and PD severity could justify further studies evaluating interventions increasing PA levels in PD. The objectives of the present study were to assess associations between PA, cardiorespiratory fitness (VO2-max), and muscle peak power and measures of the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the Parkinson's disease questionnaire-39 (PDQ-39), and the four PD hallmark motor symptoms (rigidity, bradykinesia, postural instability, and tremor). METHODS Data from 105 people with PD were used. PA was measured for seven consecutive days using accelerometers. Peak power was measured with a linear encoder during a chair rise test, while VO2-max was directly assessed during a graded bicycle test. Analyses included simple and multiple linear regression and hurdle exponential regression. RESULTS PA was weakly to moderately associated with MDS-UPDRS II + III, rigidity, bradykinesia, and postural instability, as well as PDQ-39 mobility and activities of daily living sub-scores. VO2-max and peak power were weakly to moderately associated with MDS-UPDRS III, bradykinesia, and postural instability, while peak power was further weakly associated with the MDS-UPDRS II. Lastly, VO2-max was associated with PDQ-39 mobility and activities of daily living sub-scores. CONCLUSION PA, VO2-max, and peak power were associated with PD severity, thus highlighting the potential benefits of a physically active lifestyle. Furthermore, PA and VO2-max were associated with PDQ-39 sub-scores. This calls for confirmation of the potential effect of PA on quality of life in PD.
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Affiliation(s)
- Frederik Bonde-Jensen
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000 Aarhus C, Denmark.
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000 Aarhus C, Denmark
| | - Martin Langeskov-Christensen
- Department of Neurology, Viborg Regional Hospital, Heibergs Alle 2, 8800 Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200 Aarhus N, Denmark
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Seshadri S, Dini M, Corcoran J, Job A, Contento A, Norton SA, Holtrop JS, Kluger BM. Parkinson disease patients' and carepartners' perceptions of palliative care. Parkinsonism Relat Disord 2024; 119:105982. [PMID: 38160602 DOI: 10.1016/j.parkreldis.2023.105982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/26/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Outpatient palliative care offers an opportunity to improve the quality of life of Parkinson's disease (PD) patients and families. While there are efforts to improve clinicians' palliative care knowledge and skills, there is limited knowledge on patients and carepartners' knowledge and perceptions of palliative care. As part of a larger study on implementing outpatient palliative care, this study aimed to understand patients' and carepartners' knowledge and perceptions of palliative care, and their palliative care needs and preferences prior to the implementation. METHODS Using qualitative descriptive research design, we completed semi-structured interviews with 47 patients and carepartners prior to the project implementation. De-identified transcripts of interviews were coded and analyzed. RESULTS Five themes were identified that describe patients' and carepartners' palliative care knowledge, perceptions, needs and preferences: (a) Patients and carepartners have varied knowledge and perceptions of palliative care (b) Non-motor symptoms are challenging for patients and carepartners, (c) Addressing patients' grief and emotional needs is important to patients and carepartners, (d) Carepartners want a place for emotional care, well-being, and strategizing and (e) Patients and carepartners desire anticipatory guidance and care planning. Study participants desired guidance to manage non-motor symptoms, support for patients' emotional needs and for carepartners, and for anticipatory guidance to guide future planning. CONCLUSIONS Despite varied palliative care knowledge, PD patients and carepartners universally desire care that addresses their palliative care needs. Palliative care education and integration of palliative care approaches into standard care may facilitate increased acceptance of outpatient palliative care throughout the disease trajectory.
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Affiliation(s)
- Sandhya Seshadri
- Department of Neurology, University of Rochester, Rochester, NY, USA.
| | - Megan Dini
- Parkinson's Foundation, New York, NY, USA
| | - Jennifer Corcoran
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Anna Job
- University of Rochester, Rochester, NY, USA
| | | | - Sally A Norton
- University of Rochester School of Nursing, Rochester, NY, USA
| | - Jodi Summers Holtrop
- Department of Family Medicine at the University of Colorado School of Medicine, Anschutz Medical Campus, CO, USA
| | - Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, USA
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Laurent L, Koskas P, Estrada J, Sebbagh M, Lacaille S, Raynaud-Simon A, Lilamand M. Tinetti balance performance is associated with mortality in older adults with late-onset Parkinson's disease: a longitudinal study. BMC Geriatr 2023; 23:54. [PMID: 36717787 PMCID: PMC9887890 DOI: 10.1186/s12877-023-03776-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/07/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is associated with a 3-fold mortality risk, which is closely related to advancing age. Evidence is lacking regarding the factors associated with the risks of mortality or nursing-home (NH) admission, in elderly patients with PD. We aimed at identifying the clinical characteristics associated with these outcomes, in older community-dwelling patients with late-onset PD. METHODS Retrospective, observational analysis of data from geriatric day hospital patients. Motor assessment included Unified Parkinson Disease Rating Scale (UPDRS) part III score, Tinetti Performance Oriented Mobility Assessment (POMA) balance and gait tests, and gait speed. Levodopa equivalent dose, comorbidity, cognitive performance, Activities of Daily Living performance were examined. Cox proportional hazards models were performed to identify the factors associated with mortality and NH admission rate (maximum follow-up time = 5 years). RESULTS We included 98 patients, mean age 79.4 (SD = 5.3) of whom 18 (18.3%) died and 19 (19.4%) were admitted into NH, over a median follow-up of 4 years. In multivariate Cox models, poor balance on the Tinetti POMA scale (HR = 0.82 95%CI (0.66-0.96), p = .023) and older age (HR = 1.12 95%CI (1.01-1.25), p = .044) were the only variables significantly associated with increased mortality risk. A Tinetti balance score below 11/16 was associated with a 6.7 hazard for mortality (p = .006). No specific factor was associated with NH admissions. CONCLUSIONS Age and the Tinetti POMA score were the only factors independently associated with mortality. The Tinetti POMA scale should be considered for balance assessment and as a screening tool for the most at-risk individuals, in this population.
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Affiliation(s)
- Louise Laurent
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France
| | - Pierre Koskas
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France
| | - Janina Estrada
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France
| | - Mélanie Sebbagh
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France
| | - Sophie Lacaille
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France
| | - Agathe Raynaud-Simon
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France
| | - Matthieu Lilamand
- grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.7429.80000000121866389INSERM UMR-S 1144 research unit, Paris, France ,grid.50550.350000 0001 2175 4109Assistance Publique-Hôpitaux de Paris.Nord, Lariboisière-Fernand Widal, Geriatric department, 200 rue du Fbg St Denis, 75010 Paris, France
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Kanegusuku H, Peçanha T, Silva-Batista C, Miyasato RS, Silva Júnior NDD, Mello MTD, Piemonte MEP, Ugrinowitsch C, Forjaz CLDM. Effects of resistance training on metabolic and cardiovascular responses to a maximal cardiopulmonary exercise test in Parkinson`s disease. EINSTEIN-SAO PAULO 2021; 19:eAO5940. [PMID: 33886934 PMCID: PMC8051939 DOI: 10.31744/einstein_journal/2021ao5940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate the effects of resistance training on metabolic and cardiovascular responses during maximal cardiopulmonary exercise testing in patients with Parkinson’s disease. Methods: Twenty-four patients with Parkinson’s disease (modified Hoehn and Yahr stages 2 to 3) were randomly assigned to one of two groups: Control or Resistance Training. Patients in the Resistance Training Group completed an exercise program consisting of five resistance exercises (two to four sets of six to 12 repetitions maximum per set) twice a week. Patients in the Control Group maintained their usual lifestyle. Oxygen uptake, systolic blood pressure and heart rate were assessed at rest and during cycle ergometer-based maximal cardiopulmonary exercise testing at baseline and at 12 weeks. Assessments during exercise were conducted at absolute submaximal intensity (slope of the linear regression line between physiological variables and absolute workloads), at relative submaximal intensity (anaerobic threshold and respiratory compensation point) and at maximal intensity (maximal exercise). Muscle strength was also evaluated. Results: Both groups had similar increase in peak oxygen uptake after 12 weeks of training. Heart rate and systolic blood pressure measured at absolute and relative submaximal intensities and at maximal exercise intensity did not change in any of the groups. Muscle strength increased in the Resistance Training but not in the Control Group after 12 weeks. Conclusion: Resistance training increases muscle strength but does not change metabolic and cardiovascular responses during maximal cardiopulmonary exercise testing in patients with Parkinson’s disease without cardiovascular comorbidities.
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Akbar U, McQueen RB, Bemski J, Carter J, Goy ER, Kutner J, Johnson MJ, Miyasaki JM, Kluger B. Prognostic predictors relevant to end-of-life palliative care in Parkinson's disease and related disorders: a systematic review. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-323939. [PMID: 33789923 PMCID: PMC8142437 DOI: 10.1136/jnnp-2020-323939] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 11/22/2022]
Abstract
Parkinson's disease and related disorders (PDRD) are the second most common neurodegenerative disease and a leading cause of death. However, patients with PDRD receive less end-of-life palliative care (hospice) than other illnesses, including other neurologic illnesses. Identification of predictors of PDRD mortality may aid in increasing appropriate and timely referrals. To systematically review the literature for causes of death and predictors of mortality in PDRD to provide guidance regarding hospice/end-of-life palliative care referrals. We searched MEDLINE, PubMed, EMBASE and CINAHL databases (1970-2020) of original quantitative research using patient-level, provider-level or caregiver-level data from medical records, administrative data or survey responses associated with mortality, prognosis or cause of death in PDRD. Findings were reviewed by an International Working Group on PD and Palliative Care supported by the Parkinson's Foundation. Of 1183 research articles, 42 studies met our inclusion criteria. We found four main domains of factors associated with mortality in PDRD: (1) demographic and clinical markers (age, sex, body mass index and comorbid illnesses), (2) motor dysfunction and global disability, (3) falls and infections and (4) non-motor symptoms. We provide suggestions for consideration of timing of hospice/end-of-life palliative care referrals. Several clinical features of advancing disease may be useful in triggering end-of-life palliative/hospice referral. Prognostic studies focused on identifying when people with PDRD are nearing their final months of life are limited. There is further need for research in this area as well as policies that support need-based palliative care for the duration of PDRD.
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Affiliation(s)
- Umer Akbar
- Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | | | - Julienne Bemski
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Julie Carter
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Elizabeth R Goy
- Department of Neurology, Portland VA Medical Center, Portland, Oregon, USA
| | - Jean Kutner
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Miriam J Johnson
- Department of Palliative Medicine, Hull York Medical School, Hull, Kingston upon Hull, UK
| | - Janis M Miyasaki
- Department of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Benzi Kluger
- Department of Neurology, University of Rochester, Rochester, New York, USA
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Braz de Oliveira MP, Maria Dos Reis L, Pereira ND. Effect of Resistance Exercise on Body Structure and Function, Activity, and Participation in Individuals With Parkinson Disease: A Systematic Review. Arch Phys Med Rehabil 2021; 102:1998-2011. [PMID: 33587899 DOI: 10.1016/j.apmr.2021.01.081] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effects of resistance exercise (RE) on body structure and function, activity, and participation in individuals with Parkinson Disease (PD) in the mild to moderate stages. DATA SOURCES Medline, Embase, Web of Science, The Cochrane Library, Lilacs, and PEDro were searched from inception until June 2020 using the terms "Parkinson Disease," "Exercise," "Resistance Training," "Muscle Strength," "Cardiorespiratory Fitness," "Postural Balance," "Gait," and "Quality of Life." STUDY SELECTION We included studies conducted in individuals with PD involving RE compared with a control group. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. In total, 270 individuals with PD were included from 10 selected studies. DATA EXTRACTION Two reviewers independently extracted characteristics related to participants, intervention and control types, and results. The PEDro scale was used to assess the methodological quality, and the level of evidence was analyzed and synthesized using the Grading of Recommendation, Assessment, Development, and Evaluations approach. DATA SYNTHESIS The level of evidence for body structure and function was low and without effect for lower limb muscle strength; very low and with effect for upper limb muscle strength, cardiorespiratory fitness, and postural balance; and very low and without effect for flexibility after RE training. For activity, the evidence was very low and with effect for gait and very low and without effect for mobility. For participation (ie, quality of life) the evidence was very low and without effect. CONCLUSIONS Although the level of evidence was low to very low, RE was shown to promote improvements in body structure and function (upper limb muscle strength, cardiovascular function, postural balance) and activity (gait). In contrast, RE did not significantly improve participation (quality of life). However, based on the present findings, the practice of RE can be recommended for individuals with PD in the mild to moderate stages.
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Affiliation(s)
- Marcos Paulo Braz de Oliveira
- Physiotherapy Department, Healthy Aging Research Laboratory, Federal University of São Carlos, São Carlos, SP, Brazil.
| | - Luciana Maria Dos Reis
- Physiotherapy Department, Neurofunctional Physiotherapy Laboratory, Federal University of Alfenas, Alfenas, MG, Brazil
| | - Natalia Duarte Pereira
- Physiotherapy Department, Research Group in Functionality and Technological Innovation in NeuroRehabilitation, Federal University of São Carlos, São Carlos, SP, Brazil
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Borchers EE, McIsaac TL, Bazan-Wigle JK, Elkins AJ, Bay RC, Farley BG. A physical therapy decision-making tool for stratifying persons with Parkinson's disease into community exercise classes. Neurodegener Dis Manag 2019; 9:331-346. [PMID: 31686582 DOI: 10.2217/nmt-2019-0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: Physical therapy and exercise are considered essential components in the management of Parkinson's disease (PD). Using our retrospective data and years of experience in assigning persons with PD to multilevel group classes we propose a two-part physical therapy decision-making tool consisting of participant and exercise program considerations. Methods: Retrospective medical record review and therapist consensus identified evaluation considerations determined to aide clinical decision making. The ability of these variables (i.e., demographics, clinical characteristics, clinical measures cut-offs) to predict the class assignment decision of PD-specialized physical therapists was evaluated using discriminant function analysis. Results: Therapist-assigned groups differed significantly on all clinical measures (p < 0.001) which provided the categorical data required for discriminant analysis. Using all variables, the discriminant function analysis predicted class assignment of the therapists with 79% agreement. Conclusion: This proposed tool provides a framework that may guide the process for increasing access to multilevel group classes.
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Affiliation(s)
- Emily E Borchers
- NeuroFit Networks, Inc. DBA Parkinson Wellness Recovery
- PWR!, 3849 E. Broadway Blvd. STE163, Tucson, AZ 85716, USA
| | - Tara L McIsaac
- Department of Physical Therapy, Arizona School of Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 85206, USA
| | - Jennifer K Bazan-Wigle
- NeuroFit Networks, Inc. DBA Parkinson Wellness Recovery
- PWR!, 3849 E. Broadway Blvd. STE163, Tucson, AZ 85716, USA
| | - Aaron J Elkins
- NeuroFit Networks, Inc. DBA Parkinson Wellness Recovery
- PWR!, 3849 E. Broadway Blvd. STE163, Tucson, AZ 85716, USA
| | - Ralph C Bay
- Department of Interdisciplinary Sciences, Arizona School of Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 85206, USA
| | - Becky G Farley
- NeuroFit Networks, Inc. DBA Parkinson Wellness Recovery
- PWR!, 3849 E. Broadway Blvd. STE163, Tucson, AZ 85716, USA
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Effects of Alexander-Based Corrective Techniques on Forward Flexed Posture, Risk of Fall, and Fear of Falling in Idiopathic Parkinson’s Disease. ARCHIVES OF NEUROSCIENCE 2018. [DOI: 10.5812/archneurosci.61274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kanegusuku H, Silva-Batista C, Peçanha T, Nieuwboer A, Silva ND, Costa LA, de Mello MT, Piemonte ME, Ugrinowitsch C, Forjaz CL. Effects of Progressive Resistance Training on Cardiovascular Autonomic Regulation in Patients With Parkinson Disease: A Randomized Controlled Trial. Arch Phys Med Rehabil 2017; 98:2134-2141. [PMID: 28705551 DOI: 10.1016/j.apmr.2017.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/31/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the effects of a progressive resistance training (RT) on cardiac autonomic modulation and on cardiovascular responses to autonomic stress tests in patients with Parkinson disease (PD). DESIGN Randomized clinical trial. SETTING The Brazil Parkinson Association. PARTICIPANTS Patients (N=30) with PD (modified Hoehn & Yahr stages 2-3) were randomly divided into 2 groups: a progressive RT group (PD training [PDT] group) and a control group (PD control [PDC] group). In addition, a group of paired healthy control (HC) subjects without PD was evaluated. INTERVENTIONS The PDT group performed 5 resistance exercises, 2 to 4 sets, 12 to 6 repetitions maximum per set. Individuals in the PDC group maintained their usual lifestyle. MAIN OUTCOME MEASURES The PDT and PDC groups were evaluated before and after 12 weeks. The HC group was evaluated once. Autonomic function was assessed by spectral analysis of heart rate variability and cardiovascular responses to autonomic stress tests (deep breathing, Valsalva maneuver, orthostatic stress). RESULTS Compared with baseline, the normalized low-frequency component of heart rate variability decreased significantly after 12 weeks in the PDT group only (PDT: 61±17 normalized units [nu] vs 47±20nu; PDC: 60±14nu vs 63±10nu; interaction P<.05). A similar result was observed for systolic blood pressure fall during orthostatic stress that also was reduced only in the PDT group (PDT: -14±11mmHg vs -6±10mmHg; PDC: -12±10mmHg vs -11±10mmHg; interaction P<.05). In addition, after 12 weeks, these parameters in the PDT group achieved values similar to those in the HC group. CONCLUSIONS In patients with PD, progressive RT improved cardiovascular autonomic dysfunction.
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Affiliation(s)
- Hélcio Kanegusuku
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
| | - Carla Silva-Batista
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Tiago Peçanha
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Alice Nieuwboer
- Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Natan D Silva
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Luiz A Costa
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Marco T de Mello
- School of Physical Education, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Maria E Piemonte
- Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| | - Carlos Ugrinowitsch
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Cláudia L Forjaz
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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Kluger BM, Fox S, Timmons S, Katz M, Galifianakis NB, Subramanian I, Carter JH, Johnson MJ, Richfield EW, Bekelman D, Kutner JS, Miyasaki J. Palliative care and Parkinson's disease: Meeting summary and recommendations for clinical research. Parkinsonism Relat Disord 2017; 37:19-26. [DOI: 10.1016/j.parkreldis.2017.01.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 12/01/2016] [Accepted: 01/10/2017] [Indexed: 12/25/2022]
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Iki M, Fujita Y, Tamaki J, Kouda K, Yura A, Sato Y, Moon JS, Harano A, Hazaki K, Kajita E, Hamada M, Arai K, Tomioka K, Okamoto N, Kurumatani N. Incident fracture associated with increased risk of mortality even after adjusting for frailty status in elderly Japanese men: the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study. Osteoporos Int 2017; 28:871-880. [PMID: 27752744 DOI: 10.1007/s00198-016-3797-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
UNLABELLED Frail elderly individuals have elevated risks of both fracture and mortality. We found that incident fractures were associated with an increased risk of death even after adjusting for pre-fracture frailty status as represented by physical performance tests and laboratory tests for common geriatric diseases in community-dwelling elderly Japanese men. INTRODUCTION While fractures reportedly increase the risk of mortality, frailty may complicate this association, generating a false-positive result. We evaluated this association after adjusting for pre-fracture levels of frailty. METHODS We examined 1998 community-dwelling ambulatory men aged ≥65 years at baseline in the Fujiwara-kyo Osteoporosis Risk in Men Study for frailty status as represented by activities of daily living (ADL), physical performance tests (grip strength, one-foot standing balance with eyes open, timed 10-m walk), and laboratory sera tests. Participants were then followed for 5 years for incident clinical fractures and death. Effects of incident fracture on death were determined by Cox proportional hazards model with the first fracture during follow-up as a time-dependent predictor and with frailty status indices as covariates. RESULTS We identified 111 fractures in 99 men and 138 deaths during the follow-up period (median follow-up, 4.5 years). Participants with incident fractures did not have significantly worse frailty statuses, but did show a significantly higher cumulative mortality rate than those without fractures (p = 0.0047). Age-adjusted hazard ratio (HR) of death for incident fracture was 3.57 (95 % confidence interval: 2.05, 6.24). When adjusted for physical performance, this decreased to 2.77 (1.51, 5.06), but remained significant. The HR showed no significant change when adjusted for laboratory test results (3.96 (2.26, 6.94)). Exclusion of deaths within the first 24 months of follow-up did not alter these results. CONCLUSION Incident clinical fracture was associated with an elevated risk of death independently of pre-fracture levels of frailty in community-dwelling elderly men.
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Affiliation(s)
- M Iki
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Y Fujita
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - J Tamaki
- Department of Hygiene and Public Health, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - K Kouda
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - A Yura
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Y Sato
- Department of Health and Nutrition, Faculty of Human Life, Jin-ai University, 3-1-1 Ohdecho, Echizen, Fukui, 915-8586, Japan
| | - J S Moon
- Department of Nursing, Faculty of Health Science, Kio University, 4-2-2 Umami-naka, Kita-Katsuragi-gun, Koryo-cho, Nara, 635-0832, Japan
| | - A Harano
- Department of Orthopedics, Yamato-Takada Municipal Hospital, 1-1 Isonokitamachi, Yamato-Takada, Nara, 635-8501, Japan
| | - K Hazaki
- Department of Physical Therapy, Faculty of Biomedical Engineering, Osaka Electro-Communication University, 18-8 Hatsucho, Neyagawa, Osaka, 572-8530, Japan
| | - E Kajita
- Department of Public Health and Home Nursing, Graduate School of Medical Sciences, Nagoya University, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan
| | - M Hamada
- Department of Public Health and Home Nursing, Graduate School of Medical Sciences, Nagoya University, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan
| | - K Arai
- Department of Public Health and Home Nursing, Graduate School of Medical Sciences, Nagoya University, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan
| | - K Tomioka
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara, 634-8521, Japan
| | - N Okamoto
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara, 634-8521, Japan
| | - N Kurumatani
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara, 634-8521, Japan
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Observational Gait Assessments in People With Neurological Disorders: A Systematic Review. Arch Phys Med Rehabil 2015; 97:131-40. [PMID: 26254954 DOI: 10.1016/j.apmr.2015.07.018] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/06/2015] [Accepted: 07/26/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the clinical and psychometric properties of observational gait assessment scales in people with neurological disorders. DATA SOURCES The databases used for the literature search were MEDLINE, the Cochrane Central Register of Controlled Trial, Web of Science, and the Cumulative Index to Nursing and Allied Health. The search was conducted between September 15 and November 30, 2014. STUDY SELECTION Studies that investigate and validate observational gait assessment scales in people with central nervous system disorders. DATA EXTRACTION General characteristics of the studies, including number of patients and observational gait assessment scales analyzed and their psychometric properties, were extracted. DATA SYNTHESIS After the literature search, 15 articles were included in this review. Seven of the 15 articles studied the Tinetti Gait Scale (TGS), 2 studied the Rivermead Visual Gait Assessment (RVGA), 1 studied the Gait Assessment and Intervention Tool (G.A.I.T.), 3 studied the Wisconsin Gait Scale, and one of them compared the TGS and the G.A.I.T. CONCLUSIONS The scale that appears to be the most suitable for both clinical practice and research is the G.A.I.T. because it has shown to be valid, reliable, and sensitive to change, homogeneous, and comprehensive, containing a large number of items that assess most components of the gait pattern. The RVGA was studied in those with diverse neurological disorders, including multiple sclerosis. For those with Parkinson disease, the TGS showed sensitivity and the Tinetti Performance-Oriented Mobility Assessment (POMA) showed predictive capability for falls and mortality as well as intra- and interrater reliability. The Tinetti POMA was also studied in those with normal pressure hydrocephalus, showing sensitivity and in those with Huntington disease, showing reliability and validity. More research is needed to more comprehensively analyze the psychometric properties of the RVGA, Wisconsin Gait Scale, TGS, and G.A.I.T. in patients with diverse neurological disorders, other than stroke.
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Liu Y, Fan JH, Gao X, Ma L, Qiao YL, Zhang L. The Natural Progression of Parkinson's Disease in a Small Cohort with 15 Drug-naïve Patients. Chin Med J (Engl) 2015; 128:1761-4. [PMID: 26112717 PMCID: PMC4733712 DOI: 10.4103/0366-6999.159350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The studies of the natural progression of Parkinson's disease (PD) in Chinese populations have been lacking. To address this issue and obtain a preliminary data, we conducted a PD progression assessment in 15 adults with de novo PD from a nutritional intervention trial (NIT) cohort in Lin County China. METHODS Using the Copiah County screening questionnaire and United Kingdom Parkinson's Disease Society Brain Bank diagnostic criteria, we surveyed the available NIT cohort members in 2000 and diagnosed 86 patients as PD. In 2010, we resurveyed all PD patients and confirmed definite PD diagnosis in 15 cases with the rest of them being dead (54); having probable (10) PD or vascular Parkinsonism (3); refusing to participate (2); or being away (2). In both surveys, we used Hoehn and Yahr (HY) scale and assessed the disease progression. Unified Parkinson's Disease Rating Scale (UPDRS) was added to the second survey. RESULTS In 2010, the average disease duration for 15 definite PD patients was 13.6 ± 7.3 years. Over a 10-year time span, 9 out of 15 patients remained at the same HY stage while the remaining 6 progressed. Rigidity (47% vs. 100%; P = 0.002) and postural instability (7% vs. 47%; P = 0.005) worsened significantly. The mean UPDRS motor scores in 2010 were 39.4 ± 23.7. CONCLUSIONS Overall worsening of motor function in PD seems to be the rule in this untreated cohort, and their rate of progression seemed to be slower than those reported in the western populations.
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Affiliation(s)
- Ying Liu
- Department of Neurology, Dalian Municipal Friendship Hospital, Dalian, Liaoning 116001, China
| | - Jin-Hu Fan
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiang Gao
- Department of Medicine, Channing Laboratory, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02115, USA
- Department of Nutrition, Harvard University School of Public Health, Boston, MA 02115, USA
| | - Li Ma
- Department of Epidemiology, Dalian Medical University, Dalian, Liaoning 116044, China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Lin Zhang
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA 95817, USA
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Capecci M, Serpicelli C, Fiorentini L, Censi G, Ferretti M, Orni C, Renzi R, Provinciali L, Ceravolo MG. Postural rehabilitation and Kinesio taping for axial postural disorders in Parkinson's disease. Arch Phys Med Rehabil 2014; 95:1067-75. [PMID: 24508531 DOI: 10.1016/j.apmr.2014.01.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 01/02/2014] [Accepted: 01/13/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess the effects of postural rehabilitation (PR) on trunk asymmetry and balance, with and without Kinesio taping (KT) of the back muscles as additional treatment, in patients with Parkinson's disease (PD) who have postural disorders. DESIGN Single-blind, randomized controlled trial with 1-month follow-up. SETTING Ambulatory care in referral center. PARTICIPANTS Patients (N=20) with PD showing postural abnormalities of the trunk, in the sagittal and/or coronal plane. INTERVENTIONS Four weeks of patient-tailored proprioceptive and tactile stimulation, combined with stretching and postural reeducation, was provided to 13 subjects (PR group), while 7 received no treatment (control group). Six of the 13 subjects receiving PR also had KT strips applied to their trunk muscles, according to the features of their postural abnormalities. MAIN OUTCOME MEASURES Berg Balance Scale, Timed Up and Go, and degrees of trunk bending in the sagittal and coronal planes were assessed at the enrollment (t0), 1 month later (t1), and 2 months later (t2). RESULTS At t1, all treated patients showed a significant improvement in trunk posture in both the sagittal (P=.002) and coronal planes (P=.01), compared with baseline. Moreover, they showed an improvement in measures of gait and balance (P<.01). Benefits persisted at t2 for all measures, except lateral trunk bend. No differences were found when comparing the PR and KT groups. CONCLUSIONS The combination of active posture correction and trunk movements, muscle stretching, and proprioceptive stimulation may usefully impact PD axial symptoms. Repeated training is advocated to avoid waning of the effect.
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Affiliation(s)
- Marianna Capecci
- Neurorehabilitation Clinic, Department of Experimental and Clinical Medicine, Clinical Neuroscience Section, Politecnica delle Marche University, Ancona, Italy.
| | - Chiara Serpicelli
- Neurorehabilitation Clinic, Department of Experimental and Clinical Medicine, Clinical Neuroscience Section, Politecnica delle Marche University, Ancona, Italy
| | - Luca Fiorentini
- Neurorehabilitation Clinic, Department of Experimental and Clinical Medicine, Clinical Neuroscience Section, Politecnica delle Marche University, Ancona, Italy
| | - Giovanna Censi
- Neurorehabilitation Clinic, Department of Experimental and Clinical Medicine, Clinical Neuroscience Section, Politecnica delle Marche University, Ancona, Italy
| | - Matteo Ferretti
- Neurorehabilitation Clinic, Department of Experimental and Clinical Medicine, Clinical Neuroscience Section, Politecnica delle Marche University, Ancona, Italy
| | - Chiara Orni
- Neurorehabilitation Clinic, Department of Experimental and Clinical Medicine, Clinical Neuroscience Section, Politecnica delle Marche University, Ancona, Italy
| | - Rosita Renzi
- Neurorehabilitation Clinic, Department of Experimental and Clinical Medicine, Clinical Neuroscience Section, Politecnica delle Marche University, Ancona, Italy
| | - Leandro Provinciali
- Neurologic Clinic, Department of Experimental and Clinical Medicine, Clinical Neuroscience Section, Politecnica delle Marche University, Ancona, Italy
| | - Maria Gabriella Ceravolo
- Neurorehabilitation Clinic, Department of Experimental and Clinical Medicine, Clinical Neuroscience Section, Politecnica delle Marche University, Ancona, Italy
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Barbirato D, Carvalho A, Araujo NBD, Martins JV, Deslandes A. Muscle strength and executive function as complementary parameters for the assessment of impairment in Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:948-54. [PMID: 24347014 DOI: 10.1590/0004-282x20130175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 06/24/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the relationship between the quantitative results of functional and cognitive performance of patients with Parkinson's disease (PD) and disease severity; and to study the relationship between patients' functional and cognitive capacity and motor impairment (Unified Parkinson's Disease Rating Scale - UPDRS III). METHOD Twenty-nine subjects clinically diagnosed with PD were classified into three groups according to disease severity using the modified Hoehn and Yahr Scale (H&Y). They were submitted to functional (Senior Fitness Test) and neuropsychological tests. Stepwise regression analysis showed a significant association between H&Y and upper limb strength (r² =0.30; p=0.005) and executive function (r² =0.37; p=0.004). In relation to UPDRS III, there was a significant association between lower limb strength (r² =0.27; p=0.010) and global cognitive status (r² =0.24; p=0.024). CONCLUSION The implementation of simple tests of functional capacity associated with neuropsychological testing can help to assess disease severity and motor impairment, and can be used to monitor the response to treatment in PD.
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Affiliation(s)
- Dannyel Barbirato
- Laboratório de Neurociência do Exercício, Universidade Gama Filho, Brazil, Rio de JaneiroRJ
| | - Alessandro Carvalho
- Laboratório de Neurociência do Exercício, Universidade Gama Filho, Brazil, Rio de JaneiroRJ
| | | | - José Vicente Martins
- Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro, Brazil, Rio de JaneiroRJ
| | - Andrea Deslandes
- Laboratório de Neurociência do Exercício, Universidade Gama Filho, Brazil, Rio de JaneiroRJ
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Aris E, Dotchin CL, Gray WK, Walker RW. Autonomic function in a prevalent Tanzanian population with Parkinson's disease and its relationship to disease duration and 5-year mortality. BMC Res Notes 2013; 6:535. [PMID: 24341436 PMCID: PMC3878399 DOI: 10.1186/1756-0500-6-535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/10/2013] [Indexed: 11/24/2022] Open
Abstract
Background Autonomic dysfunction is common in patients with Parkinson’s disease (PD). We report autonomic function test results in a prevalent, largely untreated, Tanzanian population of PD patients, at different disease stages and investigate the relationship between autonomic dysfunction and mortality. Methods Ewing’s battery of autonomic tests was carried out on a prevalent population of PD patients living in the rural Hai district of Tanzania. Where possible, all four tests were performed in the patient’s home. The main outcome of interest was the presence of abnormalities of sympathetic or parasympathetic function. Information on medications used and other co-morbidities was recorded. Results Autonomic function tests were recorded for 29 subjects, of whom 3 were on medication at the time of assessment. Of the 26 unmedicated patients, 14 (53.8%) had at least one abnormal test result for autonomic function, of whom only 3 (21.4%) were in late stage disease (Hoehn and Yahr stage IV or V), compared to 7 (58.3%) of 12 with normal autonomic function tests in late stage disease. Ten subjects had died at 5-year follow-up, but there was no association between mortality and autonomic function test abnormalities. Conclusions In unmedicated subjects, many patients in late stage disease had relatively preserved autonomic function, compared to those in early stage disease. In people with PD who are taking medication, it may be that when autonomic dysfunction presents in late stage disease it is often due to side effects of medication rather than the disease itself.
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Affiliation(s)
- Eric Aris
- Department of Internal Medicine, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.
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Walterfang M, Chien YH, Imrie J, Rushton D, Schubiger D, Patterson MC. Dysphagia as a risk factor for mortality in Niemann-Pick disease type C: systematic literature review and evidence from studies with miglustat. Orphanet J Rare Dis 2012; 7:76. [PMID: 23039766 PMCID: PMC3552828 DOI: 10.1186/1750-1172-7-76] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 09/24/2012] [Indexed: 02/06/2023] Open
Abstract
Niemann-Pick disease type C (NP-C) is a rare neurovisceral disease characterised by progressive neurological deterioration and premature death, and has an estimated birth incidence of 1:120,000. Mutations in the NPC1 gene (in 95% of cases) and the NPC2 gene (in approximately 4% of cases) give rise to impaired intracellular lipid metabolism in a number of tissues, including the brain. Typical neurological manifestations include vertical supranuclear gaze palsy, saccadic eye movement abnormalities, cerebellar ataxia, dystonia, dysmetria, dysphagia and dysarthria. Oropharyngeal dysphagia can be particularly problematic as it can often lead to food or fluid aspiration and subsequent pneumonia. Epidemiological data suggest that bronchopneumonia subsequent to food or fluid aspiration is a major cause of mortality in NP-C and other neurodegenerative disorders. These findings indicate that a therapy capable of improving or stabilising swallowing function might reduce the risk of aspiration pneumonia, and could have a positive impact on patient survival. Miglustat, currently the only approved disease-specific therapy for NP-C in children and adults, has been shown to stabilise key neurological manifestations in NP-C, including dysphagia. In this article we present findings from a systematic literature review of published data on bronchopneumonia/aspiration pneumonia as a cause of death, and on the occurrence of dysphagia in NP-C and other neurodegenerative diseases. We then examine the potential links between dysphagia, aspiration, pneumonia and mortality with a view to assessing the possible effect of miglustat on patient lifespan.
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Affiliation(s)
- Mark Walterfang
- Royal Melbourne Hospital and Melbourne Neuropsychiatry Centre, Melbourne 3050, Australia
| | - Yin-Hsiu Chien
- Departments of Paediatrics and Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Derren Rushton
- Actelion Pharmaceuticals Pty Ltd, New South Wales, Australia
| | - Danielle Schubiger
- Royal Melbourne Hospital and Melbourne Neuropsychiatry Centre, Melbourne 3050, Australia
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Cancela J, Ayán C, Gutiérrez-Santiago A, Prieto I, Varela S. The Senior Fitness Test as a functional measure in Parkinson’s disease: A pilot study. Parkinsonism Relat Disord 2012; 18:170-3. [DOI: 10.1016/j.parkreldis.2011.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 09/10/2011] [Accepted: 09/20/2011] [Indexed: 10/17/2022]
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Hirsch MA, Iyer SS, Englert D, Sanjak M. Promoting exercise in Parkinson's disease through community-based participatory research. Neurodegener Dis Manag 2011; 1:365-377. [PMID: 22545069 PMCID: PMC3337755 DOI: 10.2217/nmt.11.44] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Parkinson's disease (PD) is a chronic, progressive, as-of-yet incurable, neurodegenerative condition affecting the nigro-striatal dopaminergic system. Emerging evidence suggests the importance of exercise in improving the trajectory of PD. Yet few people with PD are physically active. One challenge that healthcare professionals face in the 21st century is how to deliver physical activity programs to the population of individuals living with PD. A novel approach to delivering physical activity to people with PD is introduced - termed community-based participatory research (CBPR) - which engages people with PD and patient advocates as co-researchers in the development and implementation of community-based exercise programs. The authors describe the CBPR approach and provide several recent examples of community exercise programs that are steps in the direction of developing the CBPR model. This is followed by a discussion of what a more fully realized CBPR model might look like. Finally, the authors describe some obstacles to conducting CBPR and suggest strategies for overcoming them. It is argued that people with PD are an integral component of delivering the exercise intervention.
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Affiliation(s)
- Mark A Hirsch
- Carolinas Rehabilitation, Carolinas Medical Center, Department of Physical Medicine & Rehabilitation, 1100 Blythe Blvd, Charlotte, NC 28203, USA
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Mak JCS, Mason R, Klein L, Cameron ID. Improving mobility and reducing disability in older people through early high-dose vitamin d replacement following hip fracture: a protocol for a randomized controlled trial and economic evaluation. Geriatr Orthop Surg Rehabil 2011; 2:94-9. [PMID: 23569677 PMCID: PMC3597307 DOI: 10.1177/2151458511406723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Hypovitaminosis D is particularly common among older people with a proximal femoral (hip) fracture and has been linked with poorer lower extremity functioning, falls, and fractures. There is evidence that disability severity and fall rates may be reduced by adequate vitamin D replacement. However, the ideal regimen for vitamin D administration to have these benefits in older people who have been in the hospital has not been established. This randomized controlled trial will investigate the effects of an oral vitamin D loading dose with maintenance oral vitamin D and calcium on lower extremity function (gait velocity), correction of hypovitaminosis D, falls, and fractures among older people after hip fracture surgery. The cost-effectiveness of the REVITAHIP program from the health and community service provider's perspective will also be established, as will predictors of adherence with the treatment. A total of 450 older people who have recently had a hip fracture requiring surgical intervention will be screened to achieve 250 participants for the study. Participants will have no medical contraindications to vitamin D replacement. The primary outcome measure will be mobility-related disability as measured with the 2.4-m gait velocity test. Secondary measures will be 25-hydroxyvitamin D (25-OHD) levels at 2, 4, and 26 weeks, number of falls and fractures, and additional measures of mobility, disability, quality of life, health system and community-service contact, adherence to the intervention, and adverse events. After surgical fixation and being deemed medically stable, participants will be randomly allocated to an intervention or placebo-control group. Participants of the intervention group will receive initial oral 250 000 IU (5 × 50 000 IU) vitamin D3 tablets. Both groups will receive oral maintenance vitamin D3 and calcium and will follow the usual hip fracture rehabilitation pathway. The study will determine the impact of a vitamin D loading dose on mobility-related disability in older people following hip fracture and will discuss the efficacy and cost-effectiveness of a loading dose vitamin D replacement more generally. The results will have direct implications for future use of vitamin D therapy for this high-risk group.
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Affiliation(s)
- Jenson C. S. Mak
- Department of Geriatric Medicine, Northern Sydney Central Coast Area Health Service, Gosford Hospital, Gosford, NSW, Australia
- Department of General Medicine, Mater Hospital, Sydney, New South Wales, Australia
- Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Rebecca Mason
- Department of Physiology, School of Medical Sciences, The University of Sydney, New South Wales, Australia
| | - Linda Klein
- Office of Medical Education, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Ian D. Cameron
- Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, New South Wales, Australia
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Tsai PF, Kuo YF, Beck C, Richards K, Means KM, Pate BL, Keefe FJ. Non-verbal cues to osteoarthritic knee and/or hip pain in elders. Res Nurs Health 2011; 34:218-27. [PMID: 21425277 DOI: 10.1002/nur.20432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2011] [Indexed: 11/10/2022]
Abstract
Behavioral cues are believed to be useful to identify pain among elders who may be experiencing pain but unable to express it. To examine this assumption, we recruited 192 elders who could verbally express pain to determine whether regression models combining behavioral cues (motor and gait patterns) predicted verbal pain reports. In the best model, age (p < .01) and subscales that measured guarding (p < .001) and joint flexion (p < .01) motor patterns were significant predictors of verbal pain reports. The receiver operating characteristic curve indicated that the best cutoff for predictive probability was 40-44%, with a fair to good C statistic of .78 (SD = .04). With a 40% cutoff, sensitivity and specificity were 71.6% and 71.0%, respectively. The investigators concluded that the final model could serve as a building block for the development of a tool using behavioral cues to identify elders' pain.
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Affiliation(s)
- Pao-Feng Tsai
- Alice An-Loh Sun Endowed Professorship in Geriatric Nursing, College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Hirsch MA. Community-based rehabilitation for Parkinson's disease: from neurons to neighborhoods. Parkinsonism Relat Disord 2010; 15 Suppl 3:S114-7. [PMID: 20082969 DOI: 10.1016/s1353-8020(09)70795-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This paper describes a model for developing early, community-based exercise interventions for people with Parkinson's disease (PD). The model being described is novel in that it advocates collaborative development of the program by multiple stakeholders (i.e., researchers, people with Parkinson's disease, caregivers, Parkinson's associations and healthcare providers), utilizing a community-based participatory research (CBPR) approach, and peer-to-peer training by caregivers and person's with PD. Opportunities and challenges of creating community-based exercise programs are discussed.
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Affiliation(s)
- Mark A Hirsch
- Carolinas Rehabilitation, Carolinas Medical Center, Department of Physical Medicine and Rehabilitation, Charlotte, NC 28203, USA.
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