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Monaghan AS, Hooyman A, Dibble LE, Mehta SH, Peterson DS. Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease. J Neurol Phys Ther 2024; 48:165-173. [PMID: 38489661 DOI: 10.1097/npt.0000000000000471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND AND PURPOSE Reactive balance training improves reactive postural control in people with Parkinson disease (PwPD). However, the extent to which reactive balance training generalizes to a novel, unpracticed reactive balance task is unknown. This study aimed to determine whether reactive training stepping through support surface translations can be generalized to an unpracticed, instrumented tether-release task. METHODS Twenty-five PwPD (70.52 years ± 7.15; Hoehn and Yahr range 1-3) completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Stepping was trained through a 2-week (6-session) intervention with repeated support surface translations. Performance on an untrained tether-release task (generalization task) was measured at 2 baseline assessments (B1 and B2, 2 weeks apart), immediately after the intervention (P1), and 2 months after training (P2). The tether-release task outcomes were the anterior-posterior margin of stability (MOS), step length, and step latency during backward and forward steps. RESULTS After support surface translation practice, tether-release stepping performance improved in MOS, step length, and step latency for both backward and forward steps compared to baseline ( P < 0.05). Improvements in MOS and step length during backward and forward steps in the tether-release task, respectively, were related to stepping changes in the practiced task. However, the improvements in the generalization task were not retained for 2 months. DISCUSSION AND CONCLUSIONS These findings support short-term generalization from trained balance tasks to novel, untrained tasks. These findings contribute to our understanding of the effects and generalization of reactive step training in PwPD. VIDEO ABSTRACT AVAILABLE for more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A465 ).
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Affiliation(s)
- Andrew S Monaghan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, Georgia (A.S.M.); School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona (A.H.); Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah (L.E.D.); Department of Neurology, Mayo Clinic, Scottsdale, Arizona (S.H.M.); College of Health Solutions, Arizona State University, Tempe, Arizona (D.S.P.); and Phoenix VA Health Care Center, Phoenix, Arizona (D.S.P.)
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Monaghan AS, Ofori E, Fling BW, Peterson DS. Associating white matter microstructural integrity and improvements in reactive stepping in people with Parkinson's Disease. Brain Imaging Behav 2024:10.1007/s11682-024-00867-w. [PMID: 38530517 DOI: 10.1007/s11682-024-00867-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/28/2024]
Abstract
Reactive steps are rapid responses after balance challenges. People with Parkinson's Disease (PwPD) demonstrate impaired reactive stepping, increasing fall-risk. Although PwPD can improve steps through practice, the neural mechanisms contributing to improved reactive stepping are poorly understood. This study investigated white-matter correlates of responsiveness to reactive step training in PwPD. In an eighteen-week multiple-baseline study, participants (n = 22) underwent baseline assessments (B1 and B2 two-weeks apart), a two-week training protocol, and post-training assessments immediately (P1) and two-months (P2) post-training. Assessments involved three backward reactive step trials, measuring anterior-posterior margin of stability (AP MOS), step length, and step latency. Tract-Based Spatial Statistics correlated white-matter integrity (fractional anisotropy (FA) and radial diffusivity (RD)) with retained (P2-B2) and immediate improvements (P1-B2) in stepping. Significant and sustained improvements in step length and AP MOS were observed. Greater retention of step length improvement correlated with increased FA in the left anterior thalamic radiation (ATR), left posterior thalamic radiation (PTR), left superior longitudinal fasciculus (SLF), and right inferior longitudinal fasciculus (ILF). Step latency retention was associated with lower RD in the left posterior corona radiata and left PTR. Immediate improvements in AP MOS correlated with increased FA of the right ILF, right SLF, and right corticospinal tract. Immediate step length improvements were associated with increased FA in right and left ATR and right SLF. These findings highlight the importance of white-matter microstructural integrity in motor learning and retention processes in PD and could aid in identifying individuals with PD who would benefit most from balance rehabilitation.
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Affiliation(s)
- Andrew S Monaghan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Edward Ofori
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
- Molecular, Cellular and Integrative Neurosciences Program, Colorado State University, Fort Collins, USA
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
- Phoenix VA Health Care Center, Phoenix, AZ, USA.
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Savoie FA, Benoit S, Riesco E, Tanguay A. Long-term impact of a community-based adapted boxing program on physical functioning and quality of life of individuals with Parkinson's disease. NeuroRehabilitation 2024; 54:473-484. [PMID: 38640181 DOI: 10.3233/nre-230382] [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] [Indexed: 04/21/2024]
Abstract
BACKGROUND Adapted boxing can help improve the physical functioning and health-related quality of life (HRQoL) of individuals with Parkinson's disease (PD). Whether these benefits persist longitudinally is unclear. OBJECTIVE The purpose of this retrospective study was to evaluate the impact of a community-based adapted boxing program on the physical functioning and HRQoL of individuals with PD over 1-1.5 years. METHODS Twenty-six individuals with PD agreed to share their results on tests administered upon enrollment in the program (PRE) and ∼431 days later (POST). The tests included the Fullerton Advanced Balance scale, (FAB), the Timed Up-and-Go test (TUG), the 30-second Sit-to-Stand test (30-STS), and the PD questionnaire-39 (PDQ-39). RESULTS From PRE to POST, performance significantly improved on the TUG and 30-STS tests (both p < 0.001), but not on the FAB (p = 0.79). Over the same period, PDQ-39 scores significantly increased (p = 0.05). No PRE to POST changes surpassed the minimal detectable change threshold. CONCLUSION The results of this study suggest that adapted boxing is at worst non-detrimental and at best potentially beneficial for muscle strength, endurance, and functional mobility in individuals with PD. However, adapted boxing probably cannot fully counteract the HRQoL decrements that accompany PD progression.
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Affiliation(s)
- Félix-Antoine Savoie
- Departement des Sciences de la Santé, Université du Québec à Rimouski, Rimouski, QC, Canada
- Centre de Recherche sur le Vieillissement, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Simon Benoit
- Faculté des Sciences de l'Activité Physique, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Eléonor Riesco
- Centre de Recherche sur le Vieillissement, Université de Sherbrooke, Sherbrooke, QC, Canada
- Faculté des Sciences de l'Activité Physique, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Andréanne Tanguay
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
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Monaghan AS, Hooyman A, Dibble LE, Mehta SH, Peterson DS. Stability Changes in Fall-Prone Individuals With Parkinson Disease Following Reactive Step Training. J Neurol Phys Ther 2024; 48:46-53. [PMID: 37259190 DOI: 10.1097/npt.0000000000000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND PURPOSE Poor reactive steps may lead to falls in people with Parkinson disease (PwPD). However, whether reactive steps can be improved in PwPD at risk for falls or whether step training reduces falls remains unclear. This study aimed to determine whether 2 weeks of reactive step training result in (1) immediate and retained improvements in stepping and (2) fewer prospective falls in PwPD at fall risk. METHODS Twenty-five PwPD (70.52 years ± 7.15; Hoehn & Yahr range 1-3) at risk for falls completed a multiple baseline, open-label, uncontrolled pre-/postintervention study. Stepping performance was assessed at 2 baseline assessments (B1 and B2) followed by a 2-week, 6-session training protocol. Stepping was assessed immediately (P1) and 2 months after training (P2). Primary outcomes were anterior-posterior margin of stability (MOS), step length, and step latency during backward stepping. Fall frequency was measured for 2 months before and after training. RESULTS MOS during backward steps was significantly larger (better) after training ( P < 0.001, d = 0.83), and improvements were retained for 2 months ( P = 0.04, d = 0.66). Step length was not statistically significant different after training ( P = 0.13, d = 0.46) or at follow-up ( P = 0.08, d = 0.62), although effect sizes were medium and large, respectively. Step latency improved after initial exposure ( P = 0.01, d = 0.60) but not following training ( P = 0.43, d = 0.35). Twelve participants experienced fewer falls after training than before (10 = no change, 5 = increase; P = 0.12). Greater improvements in MOS were related to fewer falls ( P = 0.04). DISCUSSION AND CONCLUSIONS Two weeks of reactive step training resulted in immediate and retained improvements in some reactive stepping outcomes in PwPD at risk for falls and may reduce fall risk. Reactive step training may be a viable approach to reduce falls in PwPD.
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Affiliation(s)
- Andrew S Monaghan
- College of Health Solutions, Arizona State University, Phoenix (A.S.M., D.S.P.); School of Biological and Health Systems Engineering, Arizona State University, Tempe (A.H.); Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City (L.E.D.); Mayo Clinic, Scottsdale, Arizona (S.H.M.); and Phoenix VA Health Care Center, Phoenix, Arizona (D.S.P.)
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Kocer B, Soke F, Ataoglu NEE, Ersoy N, Gulsen C, Gulsen EO, Yasa ME, Uysal I, Comoglu SS, Bora HAT. The reliability and validity of the 3-m backward walk test in people with Parkinson's disease. Ir J Med Sci 2023; 192:3063-3071. [PMID: 37160569 DOI: 10.1007/s11845-023-03384-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND People with Parkinson's disease (PwPD) lose the ability in backward walking which is an important part of mobility in daily life. The 3-m backward walk test (3MBWT) evaluates backward walking; however, its reliability and validity have not been examined in PwPD yet. AIMS To examine (1) the test-retest reliability of the 3MBWT in PwPD; (2) the minimum detectable change in the 3MBWT times; (3) the concurrent and known-groups validity of the 3MBWT; and (4) the optimum cutoff time which best discriminates fallers from non-fallers with Parkinson's disease (PD). METHODS This cross-sectional study included 36 PwPD and 33 healthy people. The 3MBWT was conducted with the 10-m walk test, timed up and go test, Berg Balance Scale, four square step test, activity-specific balance confidence scale, Movement Disorders Society Sponsored Unified Parkinson's Disease Rating Scale, and Hoehn and Yahr Scale. RESULTS The 3MBWT demonstrated excellent test-retest reliability (ICC = 0.965). The MDC of 2.13 s was determined. The 3MBWT had moderate to high correlations with the other outcome measures (correlation coefficient ranged from -0.592 to 0.858). On the 3MBWT times, there were significant differences between PwPD and healthy people, and between fallers and non-fallers with PD (p < 0.001 and p < 0.001, respectively). A 3MBWT time of 10.31 s was found to best discriminate fallers from non-fallers with PD. CONCLUSIONS The 3MBWT is a reliable, valid, and easy to administer outcome measure to assess backward walking performance in PwPD, indicating it to be used in practice and research.
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Affiliation(s)
- Bilge Kocer
- Ankara Etlik City Hospital, Department of Neurology, University of Health Sciences, Varlik Neighborhood, Halil Sezai Erkut Street, Yenimahalle, Ankara, Turkey.
| | - Fatih Soke
- Gulhane Faculty of Physiotherapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | | | - Nursena Ersoy
- Faculty of Health Sciences, Department of Nutrition and Dietetic, Ankara University, Ankara, Turkey
| | - Cagri Gulsen
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Ankara, Turkey
| | - Elvan Ozcan Gulsen
- Vocational School of Health Services, Elderly Care Program, Anadolu University, Eskisehir, Turkey
| | - Mustafa Ertugrul Yasa
- Gulhane Faculty of Physiotherapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Ismail Uysal
- Fethiye Vocational School of Health Services, Department of Health Care Services, Mugla Sitki Kocman University, Ankara, Turkey
| | - Selim Selcuk Comoglu
- Ankara Etlik City Hospital, Department of Neurology, University of Health Sciences, Varlik Neighborhood, Halil Sezai Erkut Street, Yenimahalle, Ankara, Turkey
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Monaghan AS, Hooyman A, Dibble LE, Mehta SH, Peterson DS. Cognitive Predictors of Responsiveness to Reactive Step Training in People with Parkinson's Disease at Fall-Risk. Neurosci Lett 2023; 817:137517. [PMID: 37832815 DOI: 10.1016/j.neulet.2023.137517] [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: 09/06/2023] [Revised: 10/03/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
Reactive stepping can be improved in people with Parkinson's Disease (PwPD). However, there is variability in the responsiveness to such training. This study examined if cognition could predict the responsiveness of PwPD to a two-week reactive step training intervention. 25 PwPD (70.52 years ± 7.15; Hoehn & Yahr range 1-3) at risk for falls completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Reactive stepping was trained through a two-week (six-session) intervention with repeated support surface translations. Stepping performance was measured at two baseline assessments (B1 and B2), immediately after the intervention (P1), and two months after training (P2). Primary stepping outcomes were anterior-posterior margin of stability (MOS), step length, and step latency during backward steps. The primary aim assessed whether global cognition (Scales for Outcomes in Parkinson's Disease-Cognition - SCOPA-COG, & Montreal Cognitive Assessment - MoCA) was related to two-month retention of improvements in reactive stepping after practice. The secondary aim explored whether specific cognitive domains predicted retained stepping improvements, including attention/working memory, executive function, language, memory, and visuospatial function. Greater baseline global cognition was related to better two-month retention of step length improvements (SCOPA-COG: p = 0.002, f2 = 0.31; MoCA: p = 0.002, f2 = 0.38). However, only SCOPA-COG retained statistical significance after p-value adjustment for multiple comparisons (p = 0.04). Optimal cut-point analysis revealed that a SCOPA-COG threshold of 31 or higher was optimal for identifying individuals likely to retain improvement. Specific cognitive domains did not predict changes in reactive stepping outcomes. Participants with greater baseline global cognition, particularly as measured by SCOPA-COG, demonstrated greater retention of improvements in reactive stepping. In this cohort, a SCOPA-COG threshold of 31 could predict individuals likely to benefit from the intervention. These findings highlight the potential of cognitive screening to identify people more or less likely to benefit from reactive balance training.
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Affiliation(s)
- Andrew S Monaghan
- College of Health Solutions, Arizona State University, 550 N 3(rd) St, Phoenix, AZ 85004, USA
| | - Andrew Hooyman
- School of Biological and Health Systems Engineering, Arizona State University, 501 E Tyler Mall Wing, Tempe, AZ 85281, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA
| | | | - Daniel S Peterson
- College of Health Solutions, Arizona State University, 550 N 3(rd) St, Phoenix, AZ 85004, USA; Phoenix VA Health Care Center, 1500 E Thomas Rd, Phoenix, AZ 85014, USA.
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A Low-Cost System Using a Big-Data Deep-Learning Framework for Assessing Physical Telerehabilitation: A Proof-of-Concept. Healthcare (Basel) 2023; 11:healthcare11040507. [PMID: 36833041 PMCID: PMC9957301 DOI: 10.3390/healthcare11040507] [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: 12/19/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
The consolidation of telerehabilitation for the treatment of many diseases over the last decades is a consequence of its cost-effective results and its ability to offer access to rehabilitation in remote areas. Telerehabilitation operates over a distance, so vulnerable patients are never exposed to unnecessary risks. Despite its low cost, the need for a professional to assess therapeutic exercises and proper corporal movements online should also be mentioned. The focus of this paper is on a telerehabilitation system for patients suffering from Parkinson's disease in remote villages and other less accessible locations. A full-stack is presented using big data frameworks that facilitate communication between the patient and the occupational therapist, the recording of each session, and real-time skeleton identification using artificial intelligence techniques. Big data technologies are used to process the numerous videos that are generated during the course of treating simultaneous patients. Moreover, the skeleton of each patient can be estimated using deep neural networks for automated evaluation of corporal exercises, which is of immense help to the therapists in charge of the treatment programs.
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Pongmala C, Roytman S, van Emde Boas M, Dickinson O, Kanel P, Bohnen NI. Composite measures of motor performance and self-efficacy are better determinants of postural instability and gait difficulties than individual clinical measures in Parkinson's disease. Parkinsonism Relat Disord 2023; 107:105251. [PMID: 36566525 PMCID: PMC10028594 DOI: 10.1016/j.parkreldis.2022.105251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postural instability and gait difficulties (PIGD) are a significant cause of disability and loss of quality of life (QoL) in Parkinson's Disease. Most research on clinical predictors of PIGD measures have focused on individual clinical often motor performance variables, However, PIGD motor features often result in fear of falling (FoF) lowering a patient's mobility self-efficacy. The purpose of this study was to assess composite measures of motor and self-efficacy determinants PIGD motor features in PD and compare these to analysis of individual clinical metrics. METHODS 75 PD participants underwent detailed motor and non-motor test batteries. Principal component analysis (PCA) was used to identify clusters of covarying correlates of slow walking, imbalance, falls, freezing of gait, FoG and compare these to traditional univariate analyses. RESULTS A single PCA-derived composite measure of motor performance and self-efficacy of mobility was the most robust determinant of all PIGD motor features except for falls. In contrast, analysis of the individual clinical variables showed more limited and diverging findings, including evidence of better cognitive performance but more severe motor parkinsonian ratings in the fall group. CONCLUSION There are robust associations between composite measures of motor performance and self-efficacy of mobility and all PIGD motor features except for falls. Univariate analysis of individual clinical measures showed limited correlates of PIGD motor features. Patient's own perception of motor performance, FoF, and QoL deserve more attention as PIGD therapeutic targets in PD.
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Affiliation(s)
- Chatkaew Pongmala
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA.
| | - Stiven Roytman
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Miriam van Emde Boas
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Olivia Dickinson
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA; Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, USA
| | - Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA; Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, USA; Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Feng H, Jiang Y, Lin J, Qin W, Jin L, Shen X. Cortical activation and functional connectivity during locomotion tasks in Parkinson's disease with freezing of gait. Front Aging Neurosci 2023; 15:1068943. [PMID: 36967824 PMCID: PMC10032375 DOI: 10.3389/fnagi.2023.1068943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
Background Freezing of gait (FoG) is a severely disabling symptom in Parkinson's disease (PD). The cortical mechanisms underlying FoG during locomotion tasks have rarely been investigated. Objectives We aimed to compare the cerebral haemodynamic response during FoG-prone locomotion tasks in patients with PD and FoG (PD-FoG), patients with PD but without FoG (PD-nFoG), and healthy controls (HCs). Methods Twelve PD-FoG patients, 10 PD-nFoG patients, and 12 HCs were included in the study. Locomotion tasks included normal stepping, normal turning and fast turning ranked as three difficulty levels based on kinematic requirements and probability of provoking FoG. During each task, we used functional near-infrared spectroscopy to capture concentration changes of oxygenated haemoglobin (ΔHBO2) and deoxygenated haemoglobin (ΔHHB) that reflected cortical activation, and recorded task performance time. The cortical regions of interest (ROIs) were prefrontal cortex (PFC), supplementary motor area (SMA), premotor cortex (PMC), and sensorimotor cortex (SMC). Intra-cortical functional connectivity during each task was estimated based on correlation of ΔHBO2 between ROIs. Two-way multivariate ANOVA with task performance time as a covariate was conducted to investigate task and group effects on cerebral haemodynamic responses of ROIs. Z statistics of z-scored connectivity between ROIs were used to determine task and group effects on functional connectivity. Results PD-FoG patients spent a nearly significant longer time completing locomotion tasks than PD-nFoG patients. Compared with PD-nFoG patients, they showed weaker activation (less ΔHBO2) in the PFC and PMC. Compared with HCs, they had comparable ΔHBO2 in all ROIs but more negative ΔHHB in the SMC, whereas PD-nFoG showed SMA and PMC hyperactivity but more negative ΔHHB in the SMC. With increased task difficulty, ΔHBO2 increased in each ROI except in the PFC. Regarding functional connectivity during normal stepping, PD-FoG patients showed positive and strong PFC-PMC connectivity, in contrast to the negative PFC-PMC connectivity observed in HCs. They also had greater PFC-SMC connectivity than the other groups. However, they exhibited decreased SMA-SMC connectivity when task difficulty increased and had lower SMA-PMC connectivity than HCs during fast turning. Conclusion Insufficient compensatory cortical activation and depletion of functional connectivity during complex locomotion in PD-FoG patients could be potential mechanisms underlying FoG. Clinical trial registration Chinese clinical trial registry (URL: http://www.chictr.org.cn, registration number: ChiCTR2100042813).
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Affiliation(s)
- HongSheng Feng
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - YanNa Jiang
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - JinPeng Lin
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - WenTing Qin
- Department of Neurology and Neurological Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - LingJing Jin
- Department of Neurology and Neurological Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Xia Shen
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Rehabilitation Medicine Research Center, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Xia Shen,
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Huang T, Li M, Huang J. Recent trends in wearable device used to detect freezing of gait and falls in people with Parkinson's disease: A systematic review. Front Aging Neurosci 2023; 15:1119956. [PMID: 36875701 PMCID: PMC9975590 DOI: 10.3389/fnagi.2023.1119956] [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: 12/09/2022] [Accepted: 01/23/2023] [Indexed: 02/17/2023] Open
Abstract
Background The occurrence of freezing of gait (FOG) is often observed in moderate to last-stage Parkinson's disease (PD), leading to a high risk of falls. The emergence of the wearable device has offered the possibility of FOG detection and falls of patients with PD allowing high validation in a low-cost way. Objective This systematic review seeks to provide a comprehensive overview of existing literature to establish the forefront of sensors type, placement and algorithm to detect FOG and falls among patients with PD. Methods Two electronic databases were screened by title and abstract to summarize the state of art on FOG and fall detection with any wearable technology among patients with PD. To be eligible for inclusion, papers were required to be full-text articles published in English, and the last search was completed on September 26, 2022. Studies were excluded if they; (i) only examined cueing function for FOG, (ii) only used non-wearable devices to detect or predict FOG or falls, and (iii) did not provide sufficient details about the study design and results. A total of 1,748 articles were retrieved from two databases. However, only 75 articles were deemed to meet the inclusion criteria according to the title, abstract and full-text reviewed. Variable was extracted from chosen research, including authorship, details of the experimental object, type of sensor, device location, activities, year of publication, evaluation in real-time, the algorithm and detection performance. Results A total of 72 on FOG detection and 3 on fall detection were selected for data extraction. There were wide varieties of the studied population (from 1 to 131), type of sensor, placement and algorithm. The thigh and ankle were the most popular device location, and the combination of accelerometer and gyroscope was the most frequently used inertial measurement unit (IMU). Furthermore, 41.3% of the studies used the dataset as a resource to examine the validity of their algorithm. The results also showed that increasingly complex machine-learning algorithms had become the trend in FOG and fall detection. Conclusion These data support the application of the wearable device to access FOG and falls among patients with PD and controls. Machine learning algorithms and multiple types of sensors have become the recent trend in this field. Future work should consider an adequate sample size, and the experiment should be performed in a free-living environment. Moreover, a consensus on provoking FOG/fall, methods of assessing validity and algorithm are necessary.Systematic Review Registration: PROSPERO, identifier CRD42022370911.
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Affiliation(s)
- Tinghuai Huang
- Laboratory of Laser Sports Medicine, South China Normal University, Guangzhou, Guangdong, China
| | - Meng Li
- Laboratory of Laser Sports Medicine, South China Normal University, Guangzhou, Guangdong, China
| | - Jianwei Huang
- Department of Gastroenterology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
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Thwaites C, Nayyar R, Blennerhassett J, Egerton T, Tan J, Bower K. Is telehealth an effective and feasible option for improving falls-related outcomes in community-dwelling adults with neurological conditions? A systematic review and meta-analysis. Clin Rehabil 2022; 37:17-46. [PMID: 36263524 DOI: 10.1177/02692155221133468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the effectiveness of telehealth interventions in reducing community falls risk or rates compared to equivalent in-person interventions in adults with neurological conditions. DATA SOURCES Eight electronic databases, trial registries and search engines were searched for the concepts 'falls', 'neurological conditions', and 'telehealth', limited to English language, from inception until August 2022. REVIEW METHODS Search for original research where the intervention was delivered via synchronous videoconferencing with the aim of reducing falls and falls-related outcomes. Screening and risk of bias assessment were completed by two independent researchers. Outcome data included falls rates, falls-related outcomes, safety, feasibility, and acceptability. Risk of bias was assessed using the ROB-2 and ROBINS-I tools. Quality of evidence was rated with the grading of recommendations, assessment, development and evaluation (GRADE) approach. RESULTS Seventeen studies with 581 participants were included; six were randomised controlled trials. Risk of bias ranged from low to high. Only one study (n = 76) reported falls and did not find differences between telehealth and in-person physiotherapy. There was low-quality evidence that telehealth interventions improve balance outcomes more than face-to-face interventions (pooled between-group mean difference 2.48 Berg Balance Scale units, 95%CI 0.77 to 4.20). Fear of falling was not different between intervention delivery modes. CONCLUSION Findings suggest that telehealth delivered falls prevention interventions are safe, feasible and acceptable in community-dwelling adults with neurological conditions, however, data related to effectiveness in reducing falls is limited. Low-quality evidence suggests that telehealth may deliver similar or better outcomes for standing balance in this population.PROSPERO Registration: (CRD42021240167).
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Affiliation(s)
- Claire Thwaites
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, Australia.,The Victorian Rehabilitation Centre, Healthscope, Melbourne, Australia
| | - Rohini Nayyar
- Faculty of Medicine, Dentistry and Health Sciences, Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Australia
| | - Jannette Blennerhassett
- Physiotherapy Department and Health Independence Program, 3805Austin Health, Heidelberg, Australia
| | - Thorlene Egerton
- Faculty of Medicine, Dentistry and Health Sciences, Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Australia
| | - Jasmine Tan
- Faculty of Medicine, Dentistry and Health Sciences, Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Australia
| | - Kelly Bower
- Faculty of Medicine, Dentistry and Health Sciences, Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Australia
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12
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Ünlüer NÖ, Ozkan T, Sari YA, Karadağ YS. Investigation of the relationship between trunk position sense and balance, functional mobility, fear of falling, and disease stage in Parkinson's disease. Ir J Med Sci 2022:10.1007/s11845-022-03192-7. [PMID: 36251108 DOI: 10.1007/s11845-022-03192-7] [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: 08/24/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Parameters related to trunk control such as balance disorders, mobility problems, and falling are frequently observed in patients with Parkinson's disease (PD). However, to provide a stable foundation for movement, trunk stability requires appropriate adequate position sense. The aim of the study was to examine the relationship between trunk position sense, balance, functional mobility, fear of falling, and disease stage in patients with PD. METHODS The study was conducted in 41 patients with PD (16 female and 25 male). Trunk position sense was assessed with a digital inclinometer, balance with functional reach test, Berg balance scale and one-leg stand test, functional mobility with timed up and go test, fear of falling with activity-specific balance confidence scale, and disease stage with Modified Hoehn and Yahr Scale (MHYS). All patients were tested during the "on" phase following drug therapy. RESULTS Repositioning error degree was related with MHYS, Berg balance scale, right and left one-leg stand test, forward functional reach test, timed up and go test, timed up and go test-cognitive and activity-specific balance confidence scale results in patients with PD (r = - 0.363/ - 0.609, p < 0.05 for all). CONCLUSION It was shown in the study that trunk position sense was associated with disease stage, balance level, functional mobility, and fear of falling in patients with PD. These results suggest that trunk position sense is more important to plan effective rehabilitation program for development and protection of disease stage, balance level, functional mobility, and fear of falling in patients with PD.
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Affiliation(s)
- Nezehat Özgül Ünlüer
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University, 06760, Ankara, Turkey.
| | - Taskin Ozkan
- Physiotherapy Program, Vocational School of Health Services, Giresun University, Giresun, Turkey
| | - Yasemin Ateş Sari
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University, 06760, Ankara, Turkey
| | - Yesim Sücüllü Karadağ
- Department of Neurology, Health Science University, Ankara City Hospital, Ankara, Turkey
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13
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Da Silva KG, Nuvolini RA, Bacha JMR, De Freitas TB, Doná F, Torriani-Pasin C, Pompeu JE. Comparison of the Effects of an Exergame-Based Program with Conventional Physiotherapy Protocol Based on Core Areas of the European Guideline on Postural Control, Functional Mobility, and Quality of Life in Patients with Parkinson's Disease: Randomized Clinical Trial. Games Health J 2022; 12:228-241. [PMID: 36206023 DOI: 10.1089/g4h.2022.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Impairment of postural control and functional mobility are debilitating symptoms of Parkinson's disease (PD). In addition to limiting performance in activities of daily living, it is associated with a higher prevalence of falls in this population. Particularly, dysfunction in postural control does not respond to dopaminergic replacement therapy, but physiotherapy can improve this outcome in patients with PD. Objective: The aim of this study was to analyze the effects of training based on Kinect Adventures games compared with a conventional physiotherapy protocol based on the core areas of the European physiotherapy guideline in patients with PD on postural control, functional mobility, self-perception of confidence in the balance, quality of life (QoL), lower limb muscle strength, transfer skill and motor function, as well as to observe adherence and safety interventions. Methods: Thirty-eight patients diagnosed with idiopathic PD were randomized into two groups, and performed 14 training sessions, twice a week for 60 minutes. The primary outcome assessed postural control using the Mini-Balance Evaluation Systems Test (Mini-BESTest). The following were evaluated as secondary outcomes: limit of stability; balance functional reserve and center of pressure area by computerized posturography; functional mobility by the Timed Up and Go test; self-confidence in balance through the Activities-specific Balance Confidence scale; QoL through the Parkinson's Disease Questionnaire; lower limb muscle strength by the Five Times Sit-To-Stand test; and motor function by the Unified Parkinson's Disease Rating Scale. Results: Patients completed training sessions with high rates of safety and adherence. After training, there was a significant improvement in postural control, motor function, and QoL. Conclusion: Both interventions proved to be safe, applicable, and effective to improve postural control, QoL, and motor function in patients with PD. However, there was no difference between the effects of Kinect Adventures games and conventional physiotherapeutic protocol in patients with PD. Brazilian Registry of Clinical Trials (RBR-27kqv5).
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Affiliation(s)
- Keyte Guedes Da Silva
- Department of Physiotherapy, Speech and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Rosemeyre Alcarde Nuvolini
- Department of Physiotherapy, Speech and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jéssica Maria Ribeiro Bacha
- Department of Physiotherapy, Speech and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Tatiana Beline De Freitas
- Motor Behavior Laboratory, Department of Biodynamics of Human Body Movement, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Flávia Doná
- Department of Sciences of the Human Movement and Rehabilitation, Federal University of São Paulo, São Paulo, Brazil
| | - Camila Torriani-Pasin
- Motor Behavior Laboratory, Department of Biodynamics of Human Body Movement, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - José Eduardo Pompeu
- Department of Physiotherapy, Speech and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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14
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Liu WY, Tung TH, Zhang C, Shi L. Systematic review for the prevention and management of falls and fear of falling in patients with Parkinson's disease. Brain Behav 2022; 12:e2690. [PMID: 35837986 PMCID: PMC9392538 DOI: 10.1002/brb3.2690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/17/2022] [Accepted: 04/24/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To synthesize recent empirical evidence for the prevention and management of falls and fear of falling in patients with Parkinson's disease (PD). DATA SOURCE Database from PubMed, Cochrane Library, and EMBASE. STUDY DESIGN Systematic review. DATA COLLECTION We searched the PubMed, Cochrane Library, and EMBASE databases for studies published from inception to February 27, 2021. Inclusion criteria were nonreview articles on prevention and management measures related to falls and fall prevention in Parkinson's disease patients. PRINCIPAL FINDINGS We selected 45 articles and conducted in-depth research and discussion. According to the causes of falls in PD patients, they were divided into five directions, namely physical status, pre-existing conditions, environment, medical care, and cognition. In the cognitive domain, we focused on the fear of falling. On the above basis, we constructed a fall prevention model, which is a tertiary prevention health care network, based on The Johns Hopkins Fall Risk Assessment Tool to provide ideas for the prevention and management of falling and fear of falling in PD patients in clinical practice CONCLUSIONS: Falls and fear of falls in patients with Parkinson's disease can be reduced by effective clinical prevention and management. Future studies are needed to explore the efficacy of treatment and prevention of falls and fear of falls.
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Affiliation(s)
- Wen-Yi Liu
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Shanghai Bluecross Medical Science Institute, Shanghai, China.,Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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15
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Dutra ACL, Soares NM, Artigas NR, Pereira GM, Krimberg JS, Ovando AC, Schuh AFS, de Mello Rieder CR. Life-space mobility, balance and self-efficacy in Parkinson's disease: a cross-sectional study. PM R 2022. [PMID: 35706393 DOI: 10.1002/pmrj.12865] [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: 04/23/2021] [Revised: 04/29/2022] [Accepted: 05/27/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Life-space mobility (LSM) is a mobility measure that assesses the physical and social environments through which people move during their daily lives. To characterize LSM among individuals with Parkinson's disease and explore the relationship between LSM, self-efficacy, and balance. DESIGN A cross-sectional study. SETTINGS Movement disorder clinic at a teaching hospital. PARTICIPANTS Eighty-eight participants with Parkinson's disease. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The dependent variable (LSM) was assessed using the Life-Space Assessment (LSA) instrument. Balance evaluation and balance self-efficacy were assessed using the Mini Balance Evaluation Systems Test (Mini-BESTest) and the Activities-Specific Balance Confidence Scale, respectively. Other variables, such as age, disease staging (Hoehn-Yahr staging system), cognition (Montreal Cognitive Assessment), and depressive symptoms (Beck Depression Inventory-II), were also measured. RESULTS The mean LSA score was 65.22 (SD [SD]: 22.75) and mean age was 66.99 years (SD: 9.35 years). Among the 88 patients, 35 (39.7%) were classified as restricted SM. Age (P = 0.03), disease severity (P = 0.02), cognition (P = 0.02), and motor subtype (P = 0.006) were associated with more restricted LSM among participants. A multiple linear regression model demonstrated that LSM can be predicted by balance performance (R2 = 0.377; P < 0.001). CONCLUSIONS Age, disease severity, cognition, motor subtype, balance self-efficacy, and balance performance are associated with LSM. Understanding and improving balance and self-efficacy in people with Parkinson's disease could facilitate community mobility and promote functional independence and health maintenance. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ana Carolina Leonardi Dutra
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Nayron Medeiros Soares
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Nathalie Ribeiro Artigas
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabriela Magalhães Pereira
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Julia Schneider Krimberg
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Artur Francisco Schumacher Schuh
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carlos Roberto de Mello Rieder
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Departamento de Clínica Médica, Faculdade de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
- Serviço de Neurologia, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
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16
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Masaki M, Kasahara M, Takeuchi M, Minakawa K, Inagaki Y, Ogawa Y, Sato Y, Yokota M, Maruyama S, Usuki R, Azuma S, Obinata S. Comparison of the mass and amount of intramuscular non-contractile tissue of the trunk and lower extremity muscles between patients with Parkinson’s disease and community-dwelling older adults. Neurol Sci 2022; 43:3629-3640. [DOI: 10.1007/s10072-021-05828-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
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17
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Effects on intermittent postural control in people with Parkinson's due to a dual task. Hum Mov Sci 2022; 83:102947. [DOI: 10.1016/j.humov.2022.102947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 12/05/2021] [Accepted: 03/17/2022] [Indexed: 11/20/2022]
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18
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Torriani-Pasin C, Domingues VL, de Freitas TB, Silva TAD, Caldeira MF, Júnior RPA, Lara ARF, Antonio BDA, Palma GCDS, Makhoul MP, Mochizuki L. Adherence rate, barriers to attend, safety and overall experience of a physical exercise program via telemonitoring during COVID-19 pandemic for individuals with Parkinson's disease: A feasibility study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1959. [PMID: 35633094 PMCID: PMC9348085 DOI: 10.1002/pri.1959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/30/2022] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
Background Telemonitoring can maintain daily exercise routine during the COVID‐19 pandemic of individuals with Parkinson's disease (PD). However, there are barriers to adherence and attendance with remote physical rehabilitation. The main objective of this study was to evaluate adherence rate, barriers to attendance, and safety of a telemonitoring program for individuals with PD; and secondarily to evaluate the individual and their family members perceived overall experience when performing the telemonitoring physical exercise program. Methods This was a phase 1 of a clinical trial, engaging 19 individuals with idiopathic PD of an in‐person community rehabilitation program. For 24 weeks an asynchronous telemonitoring physical exercise program delivered two sessions per week by video including warm‐up, balance, aerobic and resistance exercises, and cool‐down. During the remote program were verified: adherence rate at entrance, attendance rate, barriers to attend, safety, and overall experience of the program. Results and conclusion Only one participant did not perform any session and 18 participants completed between 2 and 34 sessions. Participants with a caregiver showed higher attendance rates. The most frequently cited barriers to attend the program were: pain; lack of motor skills; and reduced physical fitness. In relation to safety of the program, the most frequently reported was fear of falling. Although participants reported the telemonitoring program induced health benefits and they had positive experiences for themselves and for their families, most of participants prefer an in‐person program. In this sense, the asynchronous telemonitoring physical exercise program was safe, showed moderate adherence, with attendance rate depending on the presence of a companion.
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Affiliation(s)
- Camila Torriani-Pasin
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Vitoria Leite Domingues
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Tatiana Beline de Freitas
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | - Marina Portugal Makhoul
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Luis Mochizuki
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
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19
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Balance Ability and Occupational Performance in Patients With Parkinson’s Disease and On-Medication-State Freezing of Gait. Rehabil Nurs 2022; 47:138-146. [DOI: 10.1097/rnj.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Landers MR, Nilsson MH. A theoretical framework for addressing fear of falling avoidance behavior in Parkinson's disease. Physiother Theory Pract 2022; 39:895-911. [PMID: 35180834 DOI: 10.1080/09593985.2022.2029655] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Postural instability in Parkinson's disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent downstream consequences is fear of falling (FOF), which is both common and problematic in PD. It can lead to a vicious cycle of FOF avoidance behavior that results in more sedentary behavior, physical deconditioning, and weakening of already impaired balance systems. This, in turn, may make the person with PD more susceptible to a future fall even with benign daily tasks. While FOF activity avoidance can be adaptive (appropriate), it can also be maladaptive (inappropriate or exaggerated). When this adaptive and maladaptive FOF avoidance behavior is contextualized to gait/balance performance, it provides a theoretical framework that can be used by clinicians to match patterns of behavior to a concordant treatment approach. In the theoretical framework proposed in this perspective, four different patterns related to FOF avoidance behavior and gait/balance performance are suggested: appropriate avoiders, appropriate non-avoiders, inappropriate avoiders, and inappropriate non-avoiders. For each of the four FOF avoidance behavior patterns, this paper also provides suggested treatment focuses, approaches and recommendations.
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Affiliation(s)
- Merrill R Landers
- Department of Physical Therapy, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Maria H Nilsson
- Department of Health Sciences, Lund University, Lund, Sweden.,Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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21
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Cubo E, Garcia-Bustillo A, Arnaiz-Gonzalez A, Ramirez-Sanz JM, Garrido-Labrador JL, Valiñas F, Allende M, Gonzalez-Bernal JJ, Gonzalez-Santos J, Diez-Pastor JF, Jahouh M, Arribas J, Trejo J. Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson's disease. Protocol for a longitudinal, randomized clinical trial. PLoS One 2021; 16:e0260889. [PMID: 34932580 PMCID: PMC8691608 DOI: 10.1371/journal.pone.0260889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022] Open
Abstract
Background Approximately 40–70% of people with Parkinson’s disease (PD) fall each year, causing decreased activity levels and quality of life. Current fall-prevention strategies include the use of pharmacological and non-pharmacological therapies. To increase the accessibility of this vulnerable population, we developed a multidisciplinary telemedicine program using an Information and Communication Technology (ICT) platform. We hypothesized that the risk for falling in PD would decrease among participants receiving a multidisciplinary telemedicine intervention program added to standard office-based neurological care. Objective To determine the feasibility and cost-effectiveness of a multidisciplinary telemedicine intervention to decrease the incidence of falls in patients with PD. Methods Ongoing, longitudinal, randomized, single-blinded, case-control, clinical trial. We will include 76 non-demented patients with idiopathic PD with a high risk of falling and limited access to multidisciplinary care. The intervention group (n = 38) will receive multidisciplinary remote care in addition to standard medical care, and the control group (n = 38) standard medical care only. Nutrition, sarcopenia and frailty status, motor, non-motor symptoms, health-related quality of life, caregiver burden, falls, balance and gait disturbances, direct and non-medical costs will be assessed using validated rating scales. Results This study will provide a cost-effectiveness assessment of multidisciplinary telemedicine intervention for fall reduction in PD, in addition to standard neurological medical care. Conclusion In this challenging initiative, we will determine whether a multidisciplinary telemedicine intervention program can reduce falls, as an alternative intervention option for PD patients with restricted access to multidisciplinary care. Trial registration ClinicalTrials.gov Identifier: NCT04694443.
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Affiliation(s)
- Esther Cubo
- Hospital Universitario Burgos, Burgos, Spain
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
- * E-mail:
| | - Alvaro Garcia-Bustillo
- Hospital Universitario Burgos, Burgos, Spain
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | | | | | | | | | | | | | | | - Maha Jahouh
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | - Jose Trejo
- Hospital Universitario Burgos, Burgos, Spain
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22
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Longhurst JK, Rider JV, Eckard K, Hammar R, Vukojevic F, Campbell PJ, Landers MR. Factors predicting fear of falling avoidance behavior in parkinsonisms. NeuroRehabilitation 2021; 50:65-73. [PMID: 34957961 DOI: 10.3233/nre-210267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fear of falling avoidance behavior (FFAB) is common in parkinsonisms and results in potentially mitigable downstream consequences. OBJECTIVE Determine the characteristics of individuals with parkinsonisms most associated with FFAB. METHODS A retrospective, cross-sectional study was conducted from medical records data of 142 patients with parkinsonisms. These data included: demographics (age, sex), disease severity (Movement Disorders Society -Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III), years since diagnosis), fall history (number of fall injuries in previous year), and gait and balance function (five times sit to stand, MiniBESTest, Timed Up and Go (TUG), dual-task TUG, ten-meter walk test (10MWT), observed freezing of gait (FOG) (MDS-UPDRS III item 11)). RESULTS 10MWT (p < .001) and MDS-UPDRS III item 11 (p < .014) were significantly associated with FFAB above and beyond disease severity, which also contributed significantly to the overall model (ps < .046). Fall history was not associated with FFAB. CONCLUSION Our findings suggest that the largest portion of variability in FFAB is explained by gait velocity and FOG; however, disease severity also explains a significant portion of the variability of FFAB. Further investigation into factors predictive of FFAB and mitigation of downstream consequences, using more robust designs, is warranted.
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Affiliation(s)
- Jason K Longhurst
- Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO, USA.,Department of Neurorehabilitation, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.,Department of Physical Therapy, University of Nevada - Las Vegas, Las Vegas, NV, USA
| | - John V Rider
- Department of Physical Therapy, University of Nevada - Las Vegas, Las Vegas, NV, USA.,School of Occupational Therapy, Touro University Nevada, Henderson, NV, USA
| | - Kameron Eckard
- Department of Physical Therapy, University of Nevada - Las Vegas, Las Vegas, NV, USA
| | - Ryan Hammar
- Department of Physical Therapy, University of Nevada - Las Vegas, Las Vegas, NV, USA
| | - Franjo Vukojevic
- Department of Physical Therapy, University of Nevada - Las Vegas, Las Vegas, NV, USA
| | | | - Merrill R Landers
- Department of Physical Therapy, University of Nevada - Las Vegas, Las Vegas, NV, USA
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23
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Tao G, Miller WC, Eng JJ, Esfandiari E, Imam B, Lindstrom H, Payne MW. Group-based telerehabilitation intervention using Wii Fit to improve walking in older adults with lower limb amputation (WiiNWalk): A randomized control trial. Clin Rehabil 2021; 36:331-341. [PMID: 34841917 DOI: 10.1177/02692155211061222] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Determine efficacy of the novel WiiNWalk intervention on walking-related outcomes in older adults with lower limb amputation. DESIGN Multi-site, parallel, evaluator-masked randomized controlled trial. SETTING Home-setting in three Canadian cities. PARTICIPANTS Community-dwelling lower limb prosthesis users over 50 years of age. INTERVENTIONS The WiiNWalk group (n = 38) used modified Wii Fit activities for prosthetic rehabilitation. The attention control group (n = 33) used Big Brain Academy: Wii Degree, comprising of cognitive activities. Both groups completed a 4-week supervised phase with three 1-h sessions/week in groups of three overseen by a clinician via videoconferencing and a 4-week unstructured and unsupervised phase. MAIN MEASURES Primary outcome was walking capacity (2 min walk test); secondary outcomes were balance confidence (activities-specific balance confidence scale), dynamic balance (four-step square test), and lower limb functioning (short physical performance battery). Outcomes were compared across time points with repeated measures analysis of covariance, adjusting for baseline and age. RESULTS Mean age was 65.0 (8.4) years, with 179.5 (223.5) months post-amputation and 80% transtibial amputation. No group difference in a 2 min walk test with an effect size: 1.53 95% CI [-3.17, 6.23] m. Activities balance confidence was greater in the WiiNWalk group by 5.53 [2.53, 8.52]%. No group difference in the four-step square test -0.16 [-1.25, 0.92] s, nor short physical performance battery 0.48 [-0.65, 1.61]. A post-hoc analysis showed the greatest difference in balance confidence immediately after an unsupervised phase. CONCLUSIONS The WiiNWalk intervention improved balance confidence, but not walking-related physical function in older adult lower limb prosthesis users. Future rehabilitation games should be specific to the amputation context.Clinical Trial Registration number, NCT01942798.
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Affiliation(s)
- Gordon Tao
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, 8166The University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - William C Miller
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, 8166The University of British Columbia, Vancouver, BC, Canada
| | - Janice J Eng
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Department of Physical Therapy, 8166The University of British Columbia, Vancouver, BC, Canada
| | - Elham Esfandiari
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, 8166The University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Bita Imam
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, 8166The University of British Columbia, Vancouver, BC, Canada
| | - Heather Lindstrom
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, 3158University of Alberta, Edmonton, AB, Canada
| | - Michael W Payne
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
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Sarasso E, Gardoni A, Tettamanti A, Agosta F, Filippi M, Corbetta D. Virtual reality balance training to improve balance and mobility in Parkinson's disease: a systematic review and meta-analysis. J Neurol 2021; 269:1873-1888. [PMID: 34713324 DOI: 10.1007/s00415-021-10857-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND In the last few years, virtual reality (VR) has been increasingly used to strengthen the effect of balance training (BT) in Parkinson's disease (PD). OBJECTIVE We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the effects of VR-BT relative to BT alone for improving balance and mobility PD subjects with balance/mobility difficulties. METHODS Four electronic databases were searched: two reviewers independently selected RCTs, extracted data, and applied the Cochrane risk-of-bias tool for randomized trials (version 2) and the GRADE framework for assessing the certainty of evidence. Primary outcomes were balanced (Berg Balance Scale-BBS), mobility (Timed Up and Go-TUG) and walking speed. Secondary outcomes were falls, walking distance and stability, spatial gait parameters, balance confidence, sensory integration ability, motor signs and quality of life. RESULTS We included 22 studies (901 patients). Meta-analysis on fourteen trials (430 patients) showed a mean difference (MD) of 2.09 points (95% confidence interval [CI] 0.86-3.33) on BBS favoring VR-BT compared to BT (low certainty evidence). Subgroup analyses showed higher balance improvement in most affected subjects (moderate certainty evidence) and using VR rehabilitation-specific systems vs. VR non-specific systems. Eight trials (236 patients) assessing mobility showed a MD of 1.55 s (95% CI 0.04-3.06) on TUG favoring VR-BT (very low certainty evidence). No differences were observed in walking speed. Estimated effects were not maintained for any outcome at follow-up. CONCLUSIONS This review suggests that VR-BT is more effective than BT to improve balance in PD subjects immediately after training, particularly in individuals with higher postural instability at baseline.
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Affiliation(s)
- Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Gardoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Tettamanti
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy. .,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy. .,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
| | - Davide Corbetta
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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25
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Are weight shifting and dynamic control strategies different in postmenopausal women with and without type-I osteoporosis? Exp Gerontol 2021; 154:111529. [PMID: 34450234 DOI: 10.1016/j.exger.2021.111529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/06/2021] [Accepted: 08/18/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Tracking postural control processes at dynamic conditions might help develop an appropriate rehabilitation program in osteoporotic women. This study aimed to investigate the differences in center of pressure (COP) control at weight shifting and dynamic tasks between postmenopausal women with and without type-I osteoporosis. Also, we investigated the correlations between bone mineral density (BMD), the activity-specific balance confidence questionnaire (ABC-Q) score, and postural control parameters. METHOD A total of 62 volunteer postmenopausal women participated in this study. The participants were classified into non-osteoporotic (NOP, T-score >1, n = 35, age = 60.04± 5.33 years) and osteoporotic (OP, T-score < -2.5, n = 27, age = 61.88 ± 5.34 years) groups. The COP sway was recorded using a Kistler force plate during performance-based Limits of Stability (LOS), Curve Tracking (CT), Sit to Stand (STS), and Turn tasks. In addition, the level of balance confidence in daily activities was evaluated by ABC-Q. RESULTS In the LOS task, COP sway velocity in the anterior direction (P = 0.02) and COP maximum excursion in the side-to-side direction (right-side P = 0.027 and left-side P = 0.044) were significantly lower in the OP than the NOP group. In the CT task, all the quantified parameters, including errors and area, showed significantly lower values in the OP group than the NOP group (P < 0.05). In the STS task, the rising index score was significantly higher in the OP group than the NOP group (P = 0.014). The two groups had an equal ABC-Q score (P = 0.175). The COP sway variables correlated significantly with the lumbar and femoral neck T-score (P < 0.05). CONCLUSION BMD decline can change weight shifting and dynamic postural control in postmenopausal women.
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26
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Daines KJF, Baddour N, Burger H, Bavec A, Lemaire ED. Fall risk classification for people with lower extremity amputations using random forests and smartphone sensor features from a 6-minute walk test. PLoS One 2021; 16:e0247574. [PMID: 33901209 PMCID: PMC8075234 DOI: 10.1371/journal.pone.0247574] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/09/2021] [Indexed: 11/23/2022] Open
Abstract
Fall-risk classification is a challenging but necessary task to enable the recommendation of preventative programs for individuals identified at risk for falling. Existing research has primarily focused on older adults, with no predictive fall-risk models for lower limb amputees, despite their greater likelihood of fall-risk than older adults. In this study, 89 amputees with varying degrees of lower limb amputation were asked if they had fallen in the past 6 months. Those who reported at least one fall were considered a fall risk. Each participant performed a 6 minute walk test (6MWT) with an Android smartphone placed in a holder located on the back of the pelvis. A fall-risk classification method was developed using data from sensors within the smartphone. The Ottawa Hospital Rehabilitation Center Walk Test app captured accelerometer and gyroscope data during the 6MWT. From this data, foot strikes were identified, and 248 features were extracted from the collection of steps. Steps were segmented into turn and straight walking, and four different data sets were created: turn steps, straightaway steps, straightaway and turn steps, and all steps. From these, three feature selection techniques (correlation-based feature selection, relief F, and extra trees classifier ensemble) were used to eliminate redundant or ineffective features. Each feature subset was tested with a random forest classifier and optimized for the best number of trees. The best model used turn data, with three features selected by Correlation-based feature selection (CFS), and used 500 trees in a random forest classifier. The resulting metrics were 81.3% accuracy, 57.2% sensitivity, 94.9% specificity, a Matthews correlation coefficient of 0.587, and an F1 score of 0.83. Since the outcomes are comparable to metrics achieved by existing clinical tests, the classifier may be viable for use in clinical practice.
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Affiliation(s)
- Kyle J. F. Daines
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
| | - Natalie Baddour
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada
| | - Helena Burger
- University Rehabilitation Institute, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Bavec
- University Rehabilitation Institute, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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27
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Chew S, Burke KM, Collins E, Church R, Paganoni S, Nicholson K, Babu S, Scalia JB, De Marchi F, Ellrodt AL, Moura LMVR, Chan J, Berry JD. Patient reported outcomes in ALS: characteristics of the self-entry ALS Functional Rating Scale-revised and the Activities-specific Balance Confidence Scale. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:467-477. [PMID: 33771057 DOI: 10.1080/21678421.2021.1900259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: This study characterized two patient-reported outcome measures (PROMs): a patient-facing adaptation of the revised amyotrophic lateral sclerosis (ALS) Functional Rating Scale ("self-entry ALSFRS-R") and the Activities-specific Balance Confidence (ABC) Scale. Methods: ALS patients presenting to clinic completed PROMs that included (1) the self-entry ALSFRS-R, (2) the Activities-specific Balance Confidence Scale (ABC Scale), and (3) a question about falls. PROM data were compared to one another and to the traditional ALSFRS-R collected by trained evaluators in clinic ("standard ALSFRS-R"). Results: Over the data collection period, 449 ALS patients completed at least one of the three PROMs. Self-entry vs. standard ALSFRS-R total scores (n = 183) had high agreement (intraclass correlation (ICC)=0.81, 95% CI = 0.67, 0.88). Self-entry ALSFRS-R total scores were significantly higher than standard ALSFRS-R total scores (2.3 points, p < 0.001). In a subset of participants who contributed data at two timepoints, the average ALSFRS-R decline was not significantly different between methods (n = 49). ABC scores correlated highly with self-entry and standard ALSFRS-R Gross Motor subdomain scores (Pearson's r = 0.72, p < 0.001 and Pearson's r = 0.76, p < 0.001, respectively; n = 130). ABC score was negatively correlated with the number of reported falls within the last month (Spearman's r=-0.40; p < 0.001; n = 130). A 10-point decrease in ABC score increased odds of a reported fall by 16%. Conclusions: In a multidisciplinary clinic setting, self-entry and standard ALSFRS-R scores were similar, but not interchangeable. Self-entry scores were higher than standard ALSFRS-R scores but declined at a similar rate to the standard ALSFRS-R. ABC scores correlated with self-reported fall history and thus may provide useful data for clinical care.
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Affiliation(s)
- Sheena Chew
- Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Biogen, Cambridge, MA, USA
| | - Katherine M Burke
- Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ella Collins
- Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Reagan Church
- Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sabrina Paganoni
- Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA and
| | - Katharine Nicholson
- Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Suma Babu
- Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer B Scalia
- Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Fabiola De Marchi
- Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy L Ellrodt
- Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lidia M V R Moura
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James Chan
- Massachusetts General Hospital, Biostatistics Center, Harvard Medical School, Boston, MA, USA
| | - James D Berry
- Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Sangarapillai K, Norman BM, Almeida QJ. Rehabilitation of Falls in Parkinson's Disease: Self-Perception vs. Objective Measures of Fall Risk. Brain Sci 2021; 11:brainsci11030320. [PMID: 33802431 PMCID: PMC7999150 DOI: 10.3390/brainsci11030320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023] Open
Abstract
Falls are an important cause of injury and increased hospital/long-term care facility stays and has been reported in 70% of people with Parkinson’s disease (PD), yet there is limited effectiveness of medications for reducing falls. As an adjunct, many exercise therapies succeed in objectively reducing the number of falls, but this may not translate to improved quality of life (QOL). Importantly, self-perceived fall risk has a greater influence on activities of daily living and QOL, making it important to evaluate in the rehabilitation of PD. The purpose of this study was to examine the influence of a 10-week exercise intervention (PD SAFE × TM) on self-perceived (according to balance confidence measures) and objective measures of gait that are commonly linked to fall risk in PD. Participants (N = 44) with PD completed PD SAFE × TM. Pre-/post-assessment involved the Activities-specific Balance Confidence Scale (perception), objective falls characteristics (stride time, stride width, stride length, and stride variability), and symptom severity (Unified Parkinson’s Disease Rating Scale motor subsection III (UPDRS-III)) after participants were stratified into a mild (no-balance impairment) vs. severe (balance impairment) groups. Overall disease severity (F (1, 43) = 8.75, p < 0.003) and all objective fall parameters improved (p < 0.05) in both groups, yet self-perceived fall risk improved in only the severe PD group F (1, 43) = 9.86, p < 0.022. Given that self-perceived fall risk and objective fall risk both play a role in the quality of life, identifying strategies to improve both aspects may be important in improving the overall quality of life.
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29
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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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30
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Landers MR, Jacobson KM, Matsunami NE, McCarl HE, Regis MT, Longhurst JK. A vicious cycle of fear of falling avoidance behavior in Parkinson's disease: A path analysis. Clin Park Relat Disord 2021; 4:100089. [PMID: 34316667 PMCID: PMC8299987 DOI: 10.1016/j.prdoa.2021.100089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/12/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Postural instability (PI) in Parkinson's disease (PD) is associated with several negative downstream consequences. OBJECTIVE The purpose was to explore the validity of a theoretical model of these downstream consequences arranged in a vicious cycle wherein PI leads to decreased balance confidence, which in turn leads to increased fear of falling (FOF) avoidance behavior, which in turn leads to decreased physical conditioning, which then feeds back and negatively affects PI. METHODS A path analysis of cross-sectional data from 55 participants with PD was conducted. The four constructs in the model connected in succession were: 1. PI (principal components analysis (PCA) composite of the Unified Parkinson's Disease Rating Scale PI and Gait Difficulty score, Timed Up and Go test, and Berg Balance Scale); 2. balance confidence (Activities-Specific Balance Confidence Scale); 3. FOF avoidance behavior (PCA composite of the FOF Avoidance Behavior Questionnaire and average number of steps per day); and, 4. physical conditioning (2-Minute Step Test). RESULTS The path model was an excellent fit to the data, χ2 (7) = 7.910, p = .341, CFI = 0.985, TLI = 0.968, RMSEA = 0.049 (90% CI: 0.000 to 0.179). The moderate to strong and uniformly significant parameter estimates were -0.519, -0.651, -0.653, and -0.570, respectively (ps < 0.01). CONCLUSIONS PI directly and inversely predicted balance confidence, which in turn directly and inversely predicted FOF avoidance behavior. Furthermore, FOF avoidance behavior directly and inversely predicted physical conditioning, which directly and inversely predicted PI, thereby closing the cycle. These findings highlight the downstream consequences of PI in PD and support the notion of a vicious cycle of FOF avoidance behavior.
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Affiliation(s)
| | | | | | | | | | - Jason K. Longhurst
- University of Nevada, Las Vegas, United States
- Cleveland Clinic Lou Ruvo Center for Brain Health
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31
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Halperin O, Karni R, Israeli-Korn S, Hassin-Baer S, Zaidel A. Overconfidence in visual perception in parkinson's disease. Eur J Neurosci 2021; 53:2027-2039. [PMID: 33368717 DOI: 10.1111/ejn.15093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/04/2020] [Accepted: 12/18/2020] [Indexed: 01/23/2023]
Abstract
Increased dependence on visual cues in Parkinson's disease (PD) can unbalance the perception-action loop, impair multisensory integration, and affect everyday function of PD patients. It is currently unknown why PD patients seem to be more reliant on their visual cues. We hypothesized that PD patients may be overconfident in the reliability (precision) of their visual cues. In this study we tested coherent visual motion perception in PD, and probed subjective (self-reported) confidence in their visual motion perception. Twenty patients with idiopathic PD, 21 healthy aged-matched controls and 20 healthy young adult participants were presented with visual stimuli of moving dots (random dot kinematograms). They were asked to report: (1) whether the aggregate motion of dots was to the left or to the right, and (2) how confident they were that their perceptual discrimination was correct. Visual motion discrimination thresholds were similar (unimpaired) in PD compared to the other groups. By contrast, PD patients were significantly overconfident in their visual perceptual decisions (p = .002 and p < .001 vs. the age-matched and young adult groups, respectively). These results suggest intact visual motion perception, but overestimation of visual cue reliability, in PD. Overconfidence in visual (vs. other, e.g., somatosensory) cues could underlie increased visual dependence and impaired multisensory/sensorimotor integration in PD. It could thereby contribute to gait and balance impairments, and affect everyday activities, such as driving. Future work should investigate and compare PD confidence in somatosensory function. A better understanding of altered sensory reliance might open up new avenues to treat debilitating PD symptoms.
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Affiliation(s)
- Orly Halperin
- Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Roie Karni
- Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Simon Israeli-Korn
- Movement Disorders Institute and the Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Hassin-Baer
- Movement Disorders Institute and the Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adam Zaidel
- Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
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Wang Y, Gangwani R, Kannan L, Schenone A, Wang E, Bhatt T. Can Smartphone-Derived Step Data Predict Laboratory-Induced Real-Life Like Fall-Risk in Community- Dwelling Older Adults? Front Sports Act Living 2020; 2:73. [PMID: 33345064 PMCID: PMC7739785 DOI: 10.3389/fspor.2020.00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background: As age progresses, decline in physical function predisposes older adults to high fall-risk, especially on exposure to environmental perturbations such as slips and trips. However, there is limited evidence of association between daily community ambulation, an easily modifiable factor of physical activity (PA), and fall-risk. Smartphones, equipped with accelerometers, can quantify, and display daily ambulation-related PA simplistically in terms of number of steps. If any association between daily steps and fall-risks is established, smartphones due to its convenience and prevalence could provide health professionals with a meaningful outcome measure, in addition to existing clinical measurements, to identify older adults at high fall-risk. Objective: This study aimed to explore whether smartphone-derived step data during older adults' community ambulation alone or together with commonly used clinical fall-risk measurements could predict falls following laboratory-induced real-life like slips and trips. Relationship between step data and PA questionnaire and clinical fall-risk assessments were examined as well. Methods: Forty-nine community-dwelling older adults (age 60-90 years) completed Berg Balance Scale (BBS), Activities-specific Balance Confidence scale (ABC), Timed Up-and-Go (TUG), and Physical Activity Scale for the Elderly (PASE). One-week and 1-month smartphone steps data were retrieved. Participants' 1-year fall history was noted. All participants' fall outcomes to laboratory-induced slip-and-trip perturbations were recorded. Logistic regression was performed to identify a model that best predicts laboratory falls. Pearson correlations examined relationships between study variables. Results: A model including age, TUG, and fall history significantly predicted laboratory falls with a sensitivity of 94.3%, specificity of 58.3%, and an overall accuracy of 85.1%. Neither 1-week nor 1-month steps data could predict laboratory falls. One-month steps data significantly positively correlated with BBS (r = 0.386, p = 0.006) and ABC (r = 0.369, p = 0.012), and negatively correlated with fall history (r p = -0.293, p = 0.041). Conclusion: Older participants with fall history and higher TUG scores were more likely to fall in the laboratory. No association between smartphone steps data and laboratory fall-risk was established in our study population of healthy community-dwelling older adults which calls for further studies on varied populations. Although modest, results do reveal a relationship between steps data and functional balance deficits and fear of falls.
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Affiliation(s)
- Yiru Wang
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Rachana Gangwani
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States.,MS Program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Lakshmi Kannan
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States.,Ph.D. Program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Alison Schenone
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Edward Wang
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
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33
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Teljigovic S, Søgaard K, Sandal LF, Dalager T, Nielsen NO, Sjøgaard G, Holm L. Individualised physical exercise training and enhanced protein intake in older citizens during municipality-based rehabilitation: protocol for a randomised controlled trial. BMJ Open 2020; 10:e041605. [PMID: 33243811 PMCID: PMC7692977 DOI: 10.1136/bmjopen-2020-041605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Successful rehabilitation of the growing number of older citizens receiving healthcare services can lead to preservation of functional independence and improvement in quality of life. Adequate intake of dietary protein and physical training are key factors in counteracting the age-related decline in strength performance and physical function. However, during rehabilitation, many older people/persons have insufficient protein intake, and difficulties in performing exercise training with sufficient intensity and volume. The primary aim of this trial is to investigate if individualised physical exercise training programmes combined with increased protein intake (IPET+P) can improve measures on all International Classification of Functioning, Disability and Health levels, such as strength, gait speed and health-related quality of life, when compared with care as usual in municipality-based rehabilitation alone (usual care, UC) or care as usual in combination with increased protein intake (UC+P). Further, the trial investigates whether UC+P will potentiate more significant improvements in outcome measures than UC. METHODS AND ANALYSIS The trial is a three-armed multicentre, block-randomised controlled trial consisting of a 12-week intervention period with a 1-year follow-up. Citizens above 65 years referred to rehabilitation in the municipality without restricting comorbidities are eligible. Participants are randomised to either a UC group, a UC group with protein supplementation receiving 27.5 g protein/day (UC+P), or an IPET+P supplementation of 27.5 g protein/day. The Short Musculoskeletal Function Assessment questionnaire is the primary outcome. ETHICS AND DISSEMINATION Approvals from The Ethics Committee in Region Zealand, Denmark (SJ-758), and the General Data Protection Regulation at the University of Southern Denmark, Odense (10.330) have been obtained. TRIAL REGISTRATION NUMBER NCT04091308.
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Affiliation(s)
- Sanel Teljigovic
- Department of Physiotherapy, University College Absalon, Naestved, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Louise Fleng Sandal
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Tina Dalager
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Gisela Sjøgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars Holm
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Ünlüer NÖ, Ateş Y, Balbaba A, Sücüllü Karadağ Y. Investigation of non-motor symptoms, balance, muscle strength, and functional mobility in patients with parkinson's disease. Somatosens Mot Res 2020; 38:20-26. [PMID: 33131377 DOI: 10.1080/08990220.2020.1834377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Although both motor symptoms and non-motor symptoms (NMSs) occur in patients with Parkinson's disease (PD), clinical practice focuses more on motor symptoms. The aim of this study was to examine balance, muscle strength, and mobility in relation with NMSs in patients with PD. The other aim of this study was to investigate the relationship between NMSs and muscle strength, balance, and functional mobility in PD. MATERIALS AND METHODS The study included 24 patients with PD (between Hoehn & Yahr Stage 1 and 3) and 20 healthy individuals of similar age and sex. The participants' balance was assessed with the Biodex Balance System (Biodex Medical Systems, Shirley, NY, USA), muscle strength assessments were conducted with a Biodex® System 4 Dynamometer device, and functional mobility was assessed with the Timed Up and Go test (TUG). The non-motor symptoms scale was used for NMSs. RESULTS We found that lower extremity strength scores were lower and NMSs, balance, and mobility scores were greater in patients with PD in comparison to healthy controls (p < 0.05). The correlation analysis revealed that higher NMSs were related to reduced knee extension strength and cognitive dual task performance. CONCLUSION Although no relationship between NMSs and balance was observed, the relationship between the TUG + cognitive task and muscle strength suggests that NMSs should be carefully evaluated along with the motor symptoms, which deteriorate beginning with the early period.
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Affiliation(s)
- Nezehat Özgül Ünlüer
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Yasemin Ateş
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Ayşe Balbaba
- Department of Physiotherapy and Rehabilitation, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Yeşim Sücüllü Karadağ
- Department of Neurology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Ashburn A, Pickering R, McIntosh E, Hulbert S, Rochester L, Roberts HC, Nieuwboer A, Kunkel D, Goodwin VA, Lamb SE, Ballinger C, Seymour KC. Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson's: the PDSAFE RCT. Health Technol Assess 2020; 23:1-150. [PMID: 31339100 DOI: 10.3310/hta23360] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND People with Parkinson's disease are twice as likely to experience a fall as a healthy older person, often leading to debilitating effects on confidence, activity levels and quality of life. OBJECTIVE To estimate the effect of a physiotherapy programme for fall prevention among people with Parkinson's disease. DESIGN A multicentre, pragmatic, investigator-masked, individually randomised controlled trial (RCT) with prespecified subgroup analyses. SETTING Recruitment from NHS hospitals and clinics and community and social services in eight English regions with home-based interventions. PARTICIPANTS A total of 474 people with Parkinson's disease (i.e. Hoehn and Yahr scale stages 1-4) were recruited: 238 were assigned to a physiotherapy programme and 236 were assigned to usual care. Random allocation was 50 : 50. INTERVENTIONS All participants received routine care; the usual-care group received an information digital versatile disc (DVD) and a single advice session at trial completion. The intervention group had an individually tailored, progressive, home-based fall avoidance strategy training programme with balance and strengthening exercises: PDSAFE. MAIN OUTCOME MEASURES The primary outcome was the risk of repeat falling, collected by self-report monthly diaries between 0 and 6 months after randomisation. Secondary outcomes included near-falls, falls efficacy, freezing of gait (FoG), health-related quality of life, and measurements taken using the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Chair Stand Test (CST), the Geriatric Depression Scale, the Physical Activity Scale for the Elderly and the Parkinson's Disease Questionnaire. RESULTS PDSAFE is the largest RCT of falls management among people with Parkinson's disease: 541 patients were screened for eligibility. The average age was 72 years, and 266 out of 474 (56%) participants were men. Of the 474 randomised participants, 238 were randomised to the intervention group and 236 were randomised to the control group. No difference in repeat falling within 6 months of randomisation was found [PDSAFE group to control group odds ratio (OR) 1.21, 95% confidence interval (CI) 0.74 to 1.98; p = 0.447]. An analysis of secondary outcomes demonstrated better balance (Mini-BESTest: mean difference 0.95, 95% CI 0.24 to 1.67; p = 0.009), functional strength (CST: p = 0.041) and falls efficacy (Falls Efficacy Scale - International: mean difference 1.6, 95% CI -3.0 to -0.19; p = 0.026) with near-falling significantly reduced with PDSAFE (OR 0.67, 95% CI 0.53 to 0.86; p = 0.001) at 6 months. Prespecified subgroup analysis (i.e. disease severity and FoG) revealed a PDSAFE differing effect; the intervention may be of benefit for people with moderate disease but may increase falling for those in the more severe category, especially those with FoG. LIMITATIONS All participants were assessed at primary outcome; only 73% were assessed at 12 months owing to restricted funding. CONCLUSIONS PDSAFE was not effective in reducing repeat falling across the range of people with Parkinson's disease in the trial. Secondary analysis demonstrated that other functional tasks and self-efficacy improved and demonstrated differential patterns of intervention impact in accordance with disease severity and FoG, which supports previous secondary research findings and merits further primary evaluation. FUTURE WORK Further trials of falls prevention on targeted groups of people with Parkinson's disease are recommended. TRIAL REGISTRATION Current Controlled Trials ISRCTN48152791. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 36. See the NIHR Journals Library website for further project information. Sarah E Lamb is funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) at Oxford Health NHS Foundation Trust, the NIHR Oxford Biomedical Research Centre at the Oxford University Hospitals NHS Foundation Trust and CLAHRC Oxford. Victoria A Goodwin is supported by the NIHR Collaborations for Leadership in Applied Health Research and Care in the South West Peninsula (PenCLAHRC). Lynn Rochester is supported by the NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. The research was also supported by the NIHR Newcastle Clinical Research Facility Infrastructure funding. Helen C Roberts is supported by CLAHRC Wessex and the NIHR Southampton Biomedical Research Centre.
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Affiliation(s)
- Ann Ashburn
- Faculty of Health Science, University of Southampton, Southampton, UK
| | - Ruth Pickering
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Sophia Hulbert
- Faculty of Health Science, University of Southampton, Southampton, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Helen C Roberts
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Dorit Kunkel
- Faculty of Health Science, University of Southampton, Southampton, UK
| | | | - Sarah E Lamb
- Oxford Clinical Trials Research Unit, University of Oxford Medical Sciences Division, Oxford, UK
| | - Claire Ballinger
- Wessex Public Involvement Network (PIN), University of Southampton, Southampton General Hospital, Southampton, UK
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Swink LA, Fling BW, Sharp JL, Fruhauf CA, Atler KE, Schmid AA. Merging Yoga and Occupational Therapy for Parkinson's Disease: A Feasibility and Pilot Program. Occup Ther Health Care 2020; 34:351-372. [PMID: 32965143 DOI: 10.1080/07380577.2020.1824302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to assess feasibility and changes in outcome measures following the Merging Yoga and Occupational Therapy for Parkinson's Disease (MY-OT for PD) program: a 14-session program which combined community-based yoga for PD, and fall-risk focused group occupational therapy sessions. Seventeen participants completed an 8-week control period consisting of their normal participation, and an 8-week intervention period (14 MY-OT for PD sessions). There were fewer self-reported falls in the intervention (6) vs. control periods (10). One fall risk factor management scale (the Fall Prevention and Management Questionnaire, p=.02), and balance (p<.01) showed significant improvement between the control and intervention. The MY-OT for PD program is an encouraging occupational therapist-led program, which may improve balance and reduce self-reported falls.
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Affiliation(s)
- Laura A Swink
- Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA.,Department of Physical Therapy, University of Colorado Anschutz Campus, Aurora, CO, USA
| | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA.,Molecular, Cellular, and Integrative Neuroscience Graduate Program, Colorado State University, Fort Collins, CO, USA
| | - Julia L Sharp
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - Christine A Fruhauf
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Karen E Atler
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
| | - Arlene A Schmid
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
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Aktar B, Balci B, Donmez Colakoglu B. Physical activity in patients with Parkinson's disease: A holistic approach based on the ICF model. Clin Neurol Neurosurg 2020; 198:106132. [PMID: 32781376 DOI: 10.1016/j.clineuro.2020.106132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The International Classification of Functioning, Disability and Health (ICF) is a framework providing information on disability and health. Physical activity's behavior is complex and affected by various factors. We aimed to examine the ICF domains in Parkinson's disease (PD) patients; to compare them in sedentary and non-sedentary PD patients and their association with activity level. PATIENTS AND METHODS Sixty PD patients (25 sedentary PD group, 35 non-sedentary PD group) were included in this retrospective study. Functional disability was evaluated using the Movement Disorder Society Unified Parkinson's Disease Rating Scale. The physical activity level was measured by the SenseWear Arm Band activity monitor. Patients' cognitive function, severity of depression and anxiety, the functional impact of fatigue, balance performance (NeuroCom Balance Master System), functional mobility (Timed Up and Go Test, TUG), walking capacity (Six-Minute Walk Test, 6MWT), fear of falling, health-related quality of life are also analyzed. RESULTS Sedentary PD patients had worse scores in NeuroCom Balance Master System parameters, TUG score, and 6MWT distance in activities domains of the ICF model as a guide than non-sedentary group (p < 0.05). No statistically significant differences were found in the body structures and function, participation, personal and environmental domains of the ICF model between sedentary and non-sedentary PD groups (p > 0.05). There was no correlation between steps taken per day and NeuroCom Balance Master System parameters, TUG score, and 6MWT distance in both groups (p > 0.05). CONCLUSION Patients with sedentary lifestyle had worse scores in postural control/balance, sit-to-stand and walking performance. However, deteriorated dynamic balance may not lead to sedentary lifestyle. Physiotherapy programs should be including the behavior change interventions and motivational strategies to promote activity level in PD.
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Affiliation(s)
- Burcin Aktar
- Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey; School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.
| | - Birgul Balci
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
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Lebel S, Mutsaers B, Tomei C, Leclair CS, Jones G, Petricone-Westwood D, Rutkowski N, Ta V, Trudel G, Laflamme SZ, Lavigne AA, Dinkel A. Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates. PLoS One 2020; 15:e0234124. [PMID: 32716932 PMCID: PMC7384626 DOI: 10.1371/journal.pone.0234124] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective (e.g., fear of cancer recurrence), a generic illness perspective (e.g., fear of progression), and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder). The broader concept of health anxiety (HA) can also be applied to patients with a chronic disease. This review was conducted to investigate the conceptual, theoretical, measurement-overlap, and differences between these distinct perspectives. We also aimed to summarize prevalence, course, and correlates of these fears in different chronic illnesses. METHODS We used PsycINFO, PubMED, CINAHL, Web of Science, SCOPUS, and PSYNDEX to conduct a systematic review of studies pertaining to these fears in chronic illness published from January 1996 to October 2017. A total of 401 articles were retained. RESULTS There were commonalities across different conceptualizations and diseases: a high prevalence of clinical levels of fears (>20%), a stable course over time, and a deleterious impact on quality of life. Reviewed studies used definitions, models, and measures that were illness-specific, with only a minority employing a psychiatric perspective, limiting cross-disease generalizability. There appears to be some applicability of DSM-5 disorders to the experience of fear of illness/symptoms in patients with a chronic illness. While conceptualizing HA on a continuum ranging from mild and transient to severe may be appropriate, there is a lack of agreement about when the level of fear becomes 'excessive.' The definitions, models, and measures of HA across chronic illnesses involve affective, cognitive, behavioral, and perceptual features. CONCLUSIONS The concept of HA may offer a unifying conceptual perspective on the fears of illness/symptoms worsening or returning commonly experienced by those with chronic disease.
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Affiliation(s)
- Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christina Tomei
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Georden Jones
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Nicole Rutkowski
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Viviane Ta
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Geneviève Trudel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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Cabrera-Martos I, Jiménez-Martín AT, López-López L, Rodríguez-Torres J, Ortiz-Rubio A, Valenza MC. Effects of a core stabilization training program on balance ability in persons with Parkinson's disease: a randomized controlled trial. Clin Rehabil 2020; 34:764-772. [PMID: 32349543 DOI: 10.1177/0269215520918631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the effects of an eight-week core stability program on balance ability in persons with Parkinson's disease. DESIGN Randomized controlled trial. SETTING A local Parkinson's association. SUBJECTS A total of 44 participants with a clinical diagnosis of Parkinson's disease were randomly assigned to an experimental (n = 22) or control group (n = 22). INTERVENTION The experimental group received 24 sessions of core training, while the control group received an intervention including active joint mobilization, muscle stretching, and motor coordination exercises. MAIN MEASURES The primary outcome measure was dynamic balance evaluated using the Mini-Balance Evaluation Systems Test. Secondary outcomes included the balance confidence assessed with the Activities-specific Balance Confidence Scale and standing balance assessed by the maximal excursion of center of pressure during the Modified Clinical Test of Sensory Interaction on Balance and the Limits of Stability test. RESULTS After treatment, a significant between-group improvement in dynamic balance was observed in the experimental group compared to the control group (change, 2.75 ± 1.80 vs 0.38 ± 2.15, P = 0.002). The experimental group also showed a significant improvement in confidence (change, 16.48 ± 16.21 vs 3.05 ± 13.53, P = 0.047) and maximal excursion of center of pressure in forward (change, 0.86 ± 1.89 cm vs 0.17 ± 0.26 cm, P = 0.048), left (change, 0.88 ± 2.63 cm vs 0.07 ± 0.48 cm, P = 0.010), and right (change, 1.63 ± 2.82 cm vs 0.05 ± 0.17 cm, P = 0.046) directions of limits of stability compared to the control group. CONCLUSION A program based on core stability in comparison with non-specific exercise benefits dynamic balance and confidence and increases center of mass excursion in patients with Parkinson's disease.
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Affiliation(s)
- Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | - Laura López-López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Janet Rodríguez-Torres
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Chung YC, Lewthwaite R, Winstein CJ, Monterosso JR, Fisher BE. Expectancy and affective response to challenging balance practice conditions in individuals with Parkinson's disease. Eur J Neurosci 2020; 52:3652-3662. [PMID: 32176392 DOI: 10.1111/ejn.14723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 02/10/2020] [Accepted: 03/03/2020] [Indexed: 11/27/2022]
Abstract
Psychological states can influence motor performance and learning. In Parkinson's disease (PD), placebo effects or expectancies for pharmacological treatment benefits are not uncommon, but little is known about whether self-efficacy, beliefs about personal performance capabilities, may play a role in this population. To address this question, we investigated whether experimental manipulations designed to enhance self-efficacy would benefit motor performance and learning in PD. A motor learning paradigm was utilized to determine the short-term (i.e., practice) and longer-term (i.e., retention) impact of self-efficacy enhancement when 44 individuals with PD (Hoehn and Yahr stage I-III) acquired a challenging balance skill. Using stratified randomization by Hoehn and Yahr stage, participants were assigned to a control group or one of two investigational groups: (a) an expectancy-relevant statement that encouraged an incremental mindset in which the balance skill, though initially challenging, was acquirable with practice (incremental theory group, IT), and (b) the expectancy-relevant statement in combination with a criterion for successful performance (incremental theory plus success criteria group, IT + SC). All groups improved their balance performance, but contrary to expectations, investigational groups did not outperform the control group at practice or retention. Unexpectedly, the IT + SC group reported greater nervousness than the control and IT groups, suggesting that the employed success criteria may have induced performance-related anxiety. Regression analyses revealed that self-efficacy increase from initial practice predicted performance at the end of practice and at retention. These findings highlight the potential contribution of psychological factors on motor function and rehabilitation in individuals with PD.
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Affiliation(s)
- Yu-Chen Chung
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Rebecca Lewthwaite
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.,Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.,Department of Neurology, University of Southern California, Los Angeles, CA, USA
| | - John R Monterosso
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Beth E Fisher
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.,Department of Neurology, University of Southern California, Los Angeles, CA, USA
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Balance and Dizziness Disorders in the Elderly: a Review. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Carvalho DV, Santos RMS, Magalhães HCD, Souza MSD, Christo PP, Almeida-Leite CMD, Scalzo PL. Can fatigue predict walking capacity of patients with Parkinson's disease? ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:70-75. [PMID: 32159720 DOI: 10.1590/0004-282x20190136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/09/2019] [Indexed: 11/22/2022]
Abstract
Although fatigue is an expressive symptom of Parkinson's disease (PD), few studies have investigated the association between fatigue, mobility and walking capacity of these patients. OBJECTIVE To investigate whether fatigue is an independent factor associated with mobility and the walking capacity in patients with PD. METHODS Forty-eight patients with PD (22 with fatigue) were tested for mobility and their walking capacity: Timed Up and Go (TUG), 10-Meter Walk Test (10MWT) at usual and fastest speed, and 6-Minute Walk Test (6MWT). Fatigue was measured with Parkinson's Fatigue Scale (PFS-16). Linear regression analysis was used to investigate if fatigue is an independent factor contributing to variance in mobility and walking capacity. RESULTS There was a positive correlation between PFS-16 and TUG (rs=0.385; p=0.007). There was a negative correlation between PFS-16 and 10MWT at comfortable (r=-0.385; p=0.007) and fast speeds (r=-0.396; p=0.005), and 6MWT (r=-0.472; p=0.001). Linear regression analysis revealed that fatigue did not explain the variance of TUG and 10MWT. PFS-16, age and section III of UPDRS explained 49.6% (adjusted R2; p<0.001) variance in the 6MWT, and fatigue was the most significant predictor (F=-32.1; p=0.022). CONCLUSIONS Fatigue is an independent factor contributing to the distance covered during 6MWT in patients with PD. Our results highlight the importance of recognition and management of this symptom.
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Affiliation(s)
- Davi Vilela Carvalho
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
| | - Renata Maria Silva Santos
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Patologia, Belo Horizonte MG, Brazil
| | | | | | - Paulo Pereira Christo
- Santa Casa de Belo Horizonte, Centro de Especialidades Médicas, Belo Horizonte MG, Brazil
| | | | - Paula Luciana Scalzo
- Instituto de Ciências Biológicas, Departamento de Morfologia, Belo Horizonte MG, Brazil
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Alghwiri AA, Khalil H, Al-Sharman A, El-Salem K. Psychometric properties of the Arabic Activities-specific Balance Confidence scale in people with multiple sclerosis: Reliability, validity, and minimal detectable change. NeuroRehabilitation 2020; 46:119-125. [DOI: 10.3233/nre-192900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alia A. Alghwiri
- The University of Jordan, School of Rehabilitation Sciences, Department of Physical Therapy, Amman, Jordan
| | - Hanan Khalil
- Jordan University of Science and Technology, Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Irbid, Jordan
| | - Alham Al-Sharman
- Jordan University of Science and Technology, Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Irbid, Jordan
| | - Khalid El-Salem
- Jordan University of Science and Technology, Faculty of Medicine, Department of Neurosciences, Irbid, Jordan
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Godi M, Giardini M, Arcolin I, Ferrante S, Nardone A, Corna S, Colombo R. Is the Brief-BESTest Brief Enough? Suggested Modifications Based on Structural Validity and Internal Consistency. Phys Ther 2019; 99:1562-1573. [PMID: 31348513 DOI: 10.1093/ptj/pzz103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Brief Balance Evaluation Systems Test (Brief-BESTest) could be a useful tool for balance assessment. Although some psychometric characteristics have been examined, others still need to be clarified. OBJECTIVE The objective was to assess the structural validity, convergent validity, discriminant validity, and internal consistency of the Brief-BESTest in neurological patients. DESIGN This was a cross-sectional study. METHODS Data were from 416 patients with neurological disease and related balance disorders. Patients were assessed with the 5-levels Activities-Specific Balance Confidence Scale (ABC 5-levels), Brief-BESTest, and some simple balance tests (ie, 1-leg stance, Timed "Up & Go" test, functional reach, and a fall history questionnaire). Three Brief-BESTest models were examined through confirmatory factor analysis, and the following indexes were calculated: Comparative Fit Index, Tucker-Lewis Index, and root-mean-square error of approximation. Convergent validity was assessed by calculating the correlation between Brief-BESTest and ABC 5-levels total scores. Receiver operating characteristics assessed the ability of each model to differentiate between people with falls and those without falls. Internal consistency was measured with Cronbach α and coefficient ω. RESULTS Confirmatory factor analysis showed model 3 (Comparative Fit Index = 0.97; Tucker-Lewis Index = 0.95; root-mean-square error of approximation = 0.05), with item 1 removed and error covariance between items 3 and 4 and between items 5 and 6, to have a significantly better structure than models 1 and 2. The correlation between Brief-BESTest and ABC 5-levels was 0.61 (Spearman ρ) for all 3 models. The area under the curve of the receiver operating characteristics showed an acceptable accuracy (0.72) in distinguishing patients with a history of falls from those without a history of falls (95% confidence interval = 0.66-0.78) for all models and was superior to the areas under the curve of other simple balance tests (1-leg stance, Timed "Up & Go" test, functional reach). Cronbach α was good for Brief-BESTest models 1 (0.92) and 3 (0.92), but ω was greater than 0.80 only for model 3. LIMITATIONS The sample was heterogeneous. CONCLUSIONS The Brief-BESTest, after some changes, shows good validity and internal consistency in patients affected by different balance disorders.
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Affiliation(s)
- Marco Godi
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Simona Ferrante
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
| | - Antonio Nardone
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Stefano Corna
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Roberto Colombo
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
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Urell C, Zetterberg L, Hellström K, Anens E. Factors explaining physical activity level in Parkinson´s disease: A gender focus. Physiother Theory Pract 2019; 37:507-516. [PMID: 31387476 DOI: 10.1080/09593985.2019.1630875] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: To analyze the multivariate associations between self-rated level of physical activity and demographic characteristics, self-efficacy for physical activity, fall-related self-efficacy, fear of falling, enjoyment from participation in physical activity, social support, fatigue, and health-related quality of life in persons with PD with a focus on gender.Method: Participants were persons with PD (n = 285, mean age 69.1 ± 7 years). Self-reported scales measuring level of physical activity (Physical Activity Disability Survey-Revised), enjoyment of physical activity (study- specific questions), self-efficacy for physical activity (Exercise Self-Efficacy Scale), fall-related self-efficacy (Falls Efficacy Scale), social support (Social Influences on Physical Activity), fatigue (Fatigue Severity Scale) and health-related quality of life (Parkinson's Disease Questionnaire-39) were used. The response rate was 58.2%.Results: Multiple regression analyses showed that 54.5% of the level of physical activity was explained by low-degree limitations in mobility and activities of daily life (ADL), being younger, higher self-efficacy for physical activity, communication limitations, bodily discomfort, social support and shorter time since diagnosis. Enjoyment of physical activity explained the level of physical activity for women, whereas self-efficacy for physical activity explained the level of physical activity for men.Conclusion: Implementing strategies to increase functional mobility, self-efficacy for physical activity, social support, and enjoyment of physical activity might facilitate persons with PD beginning and/or maintain different physical activities.
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Affiliation(s)
- Charlotte Urell
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Lena Zetterberg
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Karin Hellström
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Elisabeth Anens
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
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Landers MR, Johnson KN, Johnson S, Ormsby T, Salgo DC, Zorn JB, Lyle J, Murtishaw AS, Salazar AM, Kinney JW. Pre-diagnosis physical activity habits are associated with age of diagnosis in Parkinson's disease. Clin Park Relat Disord 2019; 1:25-30. [PMID: 34316595 PMCID: PMC8288698 DOI: 10.1016/j.prdoa.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Studies suggest that exercise may be neuroprotective when implemented before the clinical presentation of Parkinson's disease (PD). Levels of brain-derived neurotrophic factor (BDNF), theorized to play a role in neuroprotection, are affected by its genotype and exercise. Here we explore this previously unstudied interaction on age at diagnosis and severity of symptoms. METHODS 76 participants with PD submitted buccal cells to determine BDNF genotype, completed the modified Lifetime Physical Activity Questionnaire to determine exercise habits, and were assessed using the Movement Disorder Society - Unified Parkinson's Disease Rating Scale III (MDS-UPDRS-III) and the Mini-Balance Evaluations Test (MBT). For aim 1 (age at diagnosis), 60 participants (age = 69.6 ± 7.4; males = 45, females = 15) were analyzed. For aim 2 (severity of symptoms), 54 participants (age = 70.0 ± 7.6; males = 41, females = 13) were analyzed. RESULTS The final hierarchical regression model for age at diagnosis produced an R2 = 0.146, p = .033; however, the only significant variable in the final model was average moderate physical activity from ages 20s to 40s (p = .009). The regression for MDS-UPDRS III was not significant; however, the regression for MBT was, p = .0499. In the final model, 23.1% of the variance was explained. Years since diagnosis (p = .014) and average vigorous physical activity from ages 20s to 40s (p = .047) were the only predictors in the final model. CONCLUSIONS While a strong interaction between BDNF genotype and lifetime physical activity was not observed, our results suggest that lifetime exercise may be neuroprotective in PD. Specifically, higher amounts of moderate PA were associated with an older age at diagnosis.
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Affiliation(s)
- Merrill R. Landers
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 Maryland Parkway, Box 453029, Las Vegas, NV 89154, USA
| | - Kyle N. Johnson
- Encompass Health Rehabilitation Hospital of Las Vegas, 1250 South Valley View Blvd, Las Vegas, NV 89102, USA
| | - Samantha Johnson
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 Maryland Parkway, Box 453029, Las Vegas, NV 89154, USA
| | - Tyler Ormsby
- Encompass Health Rehabilitation Hospital of Henderson, Henderson, NV 89052, USA
| | - Danielle C. Salgo
- Custom Physical Therapy, 1450 E Prater Way Unit 103, Sparks, NV 89434, USA
| | - Jessica B. Zorn
- Benchmark Human Services, 11350 Random Hills Road, Suite 885, Fairfax, VA 22030, USA
| | - James Lyle
- 11257 Mile 2 E., Mercedes, TX 78570, USA
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Abstract
Parkinson's disease is the second most common neurodegenerative disease with a prevalence rate of 1-2 per 1000 of the population worldwide. Pharmacological management is the mainstay of treatment. Despite optimal medication, motor impairment particularly balance and gait impairment persist leading to various degree of disability and reduced quality-of-life. The present review describes motor impairment including postural impairment, gait dysfunction, reduced muscle strength and aerobic capacity and falls. Physical therapy and complementary exercises have been proven to improve motor performance and functional mobility. Evidence on the efficacy of physical therapy and complementary exercises is presented in this review. These exercises include gait training with cues, gait training with treadmill, Nordic walking, brisk walking, balance training, virtual reality interventions, Tai Chi and dance. All these treatment interventions produce short-term beneficial effects and some interventions demonstrate long-term benefit. Gait training with treadmill enhance walking performance and the effects sustain for 3-6 months. Balance training improves balance, function and reduces fall rate, and these effects carry over to at least 12 months after training ended. Sustained Tai Chi for 6 months, dance therapy for 12 months, progressive resistive training for 24 months alleviates the PD motor symptoms, suggesting that they could slow down PD progression. Based on this evidence, individuals with PD are encouraged to sustain their training in order to improve/maintain their physical ability and to combat the progression of PD.
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Affiliation(s)
- Margaret K Y Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Irene S K Wong-Yu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Borm CDJM, Werkmann M, Visser F, Peball M, Putz D, Seppi K, Poewe W, Notting IC, Vlaar A, Theelen T, Hoyng C, Bloem BR, de Vries NM. Towards seeing the visual impairments in Parkinson's disease: protocol for a multicentre observational, cross-sectional study. BMC Neurol 2019; 19:141. [PMID: 31238904 PMCID: PMC6591947 DOI: 10.1186/s12883-019-1365-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/13/2019] [Indexed: 01/21/2023] Open
Abstract
Background Visual disorders are common in Parkinson’s disease (PD) but their exact frequency and severity are unknown. Good visual functioning is crucial for patients with PD, because of their need to compensate for loss of automated motor control and their postural instability, forcing patients to guide their movements visually. Here, we describe the study design of a cross-sectional, multi-centre study aiming to: (1) validate the Visual Impairment screening questionnaire (VIPD-Q, which aims to identify PD patients who should be referred to an ophthalmologist for further assessment); (2) study the prevalence of visual disorders in PD; (3) study the severity and clinical impact of different types of visual disorders in PD; and (4) explore treatment options for ophthalmologic disorders in PD, as a basis for future guideline development. Methods This study consists of two phases. In phase one, 750 PD patients and 250 healthy controls will be recruited to complete the VIPD-Q. In phase two, a subgroup of responders (n = 100) (with the highest and lowest scores on the VIPD-Q) will be invited for an extensive neurological and ophthalmological assessment. The in-depth ophthalmologic examination will serve as the “gold standard” for validating the VIPD-Q. Moreover, these assessments will be used to study associations between visual disorders and clinical presentation, in order to gain more insight in their clinical impact. Discussion Our study will heighten the awareness of visual problems in PD and offers a robust starting point to systematically approach this subject. In current daily practice, the association between visual problems and PD is far from obvious to both patients and clinicians. Consequently, patients may not adequately report visual problems themselves, while clinicians miss potentially treatable visual disorders. Routinely asking patients to complete a simple screening questionnaire could be an easy solution leading to timely identification of visual problems, tailored treatment, restored mobility, greater independence and improved quality of life. Trial registration Dutch Trial Registration, NL7421, Registered on 4 December 2018 – Retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12883-019-1365-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlijn D J M Borm
- Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, Donders institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Mario Werkmann
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Femke Visser
- Department of Neurology, Onze Lieve Vrouw Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Marina Peball
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Diana Putz
- Department of ophthalmology, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Irene C Notting
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Annemarie Vlaar
- Department of Neurology, Onze Lieve Vrouw Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Thomas Theelen
- Radboud University Medical Centre, Department of Ophthalmology, Nijmegen, The Netherlands
| | - Carel Hoyng
- Radboud University Medical Centre, Department of Ophthalmology, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, Donders institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Nienke M de Vries
- Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, Donders institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
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Major MJ. Fall Prevalence and Contributors to the Likelihood of Falling in Persons With Upper Limb Loss. Phys Ther 2019; 99:377-387. [PMID: 30561742 PMCID: PMC6684228 DOI: 10.1093/ptj/pzy156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 10/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Arms are important for locomotor stability and preventing falls by controlling whole-body angular momentum, redirecting the body's center of mass, and providing support to arrest descent. Hence, upper limb loss (ULL) can increase fall risk. However, the prevalence of falls and factors that influence fall risk have not previously been reported for people with ULL. OBJECTIVE This study quantified fall prevalence in persons with ULL at or proximal to the wrist and identified clinical factors that contributed to the likelihood of falling. DESIGN This was a cross-sectional study. METHODS Factors including body and health characteristics, activity level, fall history, prosthesis use, and balance confidence were determined for persons with ULL proximal to the wrist using an online survey. Logistic regression analyses assessed the contribution of these factors to the classification of fallers (≥2 falls in previous year) and nonfallers. RESULTS A percentage (28.6%) of participants (n = 105) reported experiencing 2 or more falls in the past year. The regression model (R2 = 0.473) correctly classified 84.5% of cases and indicated that increased likelihood of falling was significantly influenced by reduced balance confidence, use of upper limb prostheses, and reduced physical capabilities. LIMITATIONS Data were collected online from a convenience sample, and fall classification was based on retrospective data. CONCLUSIONS Falls in persons with ULL are prevalent, suggesting that clinicians should use screening methods to identify at-risk individuals. Balance confidence, use of upper limb prostheses, and perceived physical capabilities could be useful screening metrics. Research is warranted to better understand the factors that underlie fall risk in persons with ULL and the efficacy of therapeutic interventions capable of mitigating fall risk.
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Affiliation(s)
- Matthew J Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, 680 N Lake Shore Dr, Suite 1100, Chicago, IL 60611 (USA); and Jesse Brown VA Medical Center, Chicago, Illinois
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Harro CC, Kelch A, Hargis C, DeWitt A. Comparing Balance Performance on Force Platform Measures in Individuals with Parkinson's Disease and Healthy Adults. PARKINSON'S DISEASE 2018; 2018:6142579. [PMID: 30687494 PMCID: PMC6304814 DOI: 10.1155/2018/6142579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/23/2018] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Postural instability is a known contributing factor to balance dysfunction and increased fall risk in those with Parkinson's disease (PD). Computerized posturography employing a force platform system provides objective, quantitative assessments of postural control impairments. This study examines balance performance as measured by force platform (FP) tests in persons with PD compared to age-matched healthy adults. Secondarily, we examine if these FP measures provide diagnostic and clinically meaningful information about the underlying balance impairments in the PD population. METHODS Participants-42 individuals with PD (Hoehn and Yahr stage = 2.33 ± 0.77) and 55 age-matched healthy adults-were assessed on three standardized balance measures on a computerized force platform system. Between groups, comparisons of FP performance were analyzed using independent t-test. Within the group, comparisons for the PD cohort were analyzed using ANOVA for comparing disease stage and Mann-Whitney U test for PD subtypes. RESULTS The PD cohort demonstrated significantly greater postural instability on the sensory organization test (SOT) measures (P=0.013, CI-95% = 1.286 to 10.37) and slower movement velocity on the limits of stability (LOS) test (P=0.001, CI-95% = 0.597 to 1.595) than the healthy cohort, suggesting that these tests were sensitive to detect sensory integration and voluntary postural control deficits in the PD cohort. Within the PD group, the SOT differentiated between H&Y stages 1-3. The motor control test (MCT) detected changes in reactive postural control mainly in later disease stages. All three FP tests distinguished between PD subtypes, with the Posture Gait Instability subtype demonstrating poorer balance performance than Tremor Dominant subtype. CONCLUSION These findings suggest FP measures provide clinically meaningful, diagnostic information in the examination of balance impairments in individuals with PD. FP measures may inform clinicians regarding intrinsic balance deficits and guide them in designing targeted balance interventions to reduce fall risk in persons with PD.
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Affiliation(s)
- Cathy C. Harro
- Assistance Professor, Physical Therapy, College of Health Professions, Grand Valley State University, Cook DeVos Center for Health Sciences, 301 Michigan Street NE, Suite 268, Grand Rapids, MI 49503, USA
| | - Amanda Kelch
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy Street SE, Grand Rapids, MI 49503, USA
| | - Cora Hargis
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy Street SE, Grand Rapids, MI 49503, USA
| | - Abigail DeWitt
- PT Solutions, 1321 Tusculum Blvd., Greeneville, TN 37743, USA
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