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Malwanage KT, Dissanayaka TD, Allen NE, Paul SS. Effect of Proprioceptive Training Compared With Other Interventions for Upper Limb Deficits in People With Parkinson Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2024; 105:1364-1374. [PMID: 37951376 DOI: 10.1016/j.apmr.2023.10.016] [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: 06/19/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to determine the efficacy of proprioceptive training on hand dexterity, upper limb function, and quality of life (QoL) in people with Parkinson disease (PD) compared with no or other active interventions. DATA SOURCES Medline PubMed, Cochrane Library, CINAHL, PEDro, and Web of Science databases were searched to identify published studies until February 2023. STUDY SELECTION Peer-reviewed English publications of randomized controlled trials (RCTs) of proprioceptive training conducted among people with PD. DATA EXTRACTION Study characteristics, exercise program type and dosage, outcome of interest, and between-group comparisons of post-test results of intervention and comparison groups. DATA SYNTHESIS Eight RCTs were included, involving 344 people with PD. Six RCTs contributed to meta-analyses. There was very low certainty of evidence that proprioceptive training may improve dominant hand (standard mean difference [SMD] 0.34, 95% CI 0.08-0.60, P=.01) and non-dominant hand (SMD 0.36, 95% CI 0.10-0.63, P<.01) fine motor dexterity, and dominant hand gross manual dexterity (SMD 1.73, 95% CI 0.30-3.16, P=.02), following 2-8 weeks of proprioceptive training. There was no evidence of effects on non-dominant hand gross manual dexterity, upper limb function, and QoL after proprioceptive training. CONCLUSIONS Findings regarding the effect of proprioceptive training on hand dexterity in the short-term are inconclusive. The small sample size likely limited effect detection. Future large RCTs should compare proprioceptive training with no intervention and perform comprehensive biomechanical analysis to gain a clearer idea of its effects. Incorporating longer-duration proprioceptive training programs is also recommended to investigate long-lasting effects.
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Affiliation(s)
- Kavinda T Malwanage
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka.
| | | | - Natalie E Allen
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Serene S Paul
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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Proud E, Morris ME, Bilney B, Miller KJ, Nijkrake MJ, Munneke MM, McGinley JL. Effects of dual-task interference on dexterity performance in people with mild to moderately severe Parkinson's disease: An observational analysis. J Hand Ther 2024:S0894-1130(24)00031-0. [PMID: 38942655 DOI: 10.1016/j.jht.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 03/07/2024] [Accepted: 04/02/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Debilitating problems with hand function experienced by people with Parkinson's disease (PD) can worsen during multitasking. PURPOSE To investigate the effects of dual-task interference on a pegboard task in people with mild to moderately severe PD. STUDY DESIGN Descriptive analysis. METHODS A secondary analysis of baseline data from the ParkinsonNet physiotherapy study conducted in 2006 in the Netherlands. The 9-hole peg test was performed with the more affected hand under single- and dual-task conditions. In dual-task trials, a cognitive task was added. The patient specific index-Parkinson's disease identified two functional priority groups-those reporting arm and hand problems as a priority for allied health management ("upper extremity priority") and those prioritizing other issues ("other priority"). We investigated differences in single- and dual-task performance at different levels of disease severity (Hoehn and Yahr stage) and for the two priority groups, and calculated the dual-task effect. RESULTS Participants were 566 people with PD (Hoehn and Yahr stages I-IV). Dual-task interference occurred at each disease stage. Significant interactions existed between the task condition and disease severity (F (3, 559) = 4.28, p = 0.005) and task condition and priority group (F (1, 561) = 4.44, p = 0.036). Dual-task interference was greater in participants with more advanced disease or those prioritizing upper extremity problems. CONCLUSION We described the effects of dual-task interference on more affected hand performance of a standardized dexterity test in a broad sample of people with PD. Dual-task interference may impact the daily lives of people with PD, especially those with more severe disease or who report arm and hand problems. It is important for clinicians to consider dual-task interference during upper extremity assessment and treatment.
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Affiliation(s)
- Elizabeth Proud
- Department of Physiotherapy, Level 7, Alan Gilbert Building, The University of Melbourne, Parkville, Victoria, Australia.
| | - Meg E Morris
- Academic and Research Collaborative in Health and CERI, La Trobe University, Bundoora, Victoria, Australia; Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Victoria, Australia.
| | - Belinda Bilney
- Physiotherapy, School of Allied Health, Australian Catholic University, Ballarat, Victoria, Australia.
| | - Kimberly J Miller
- Department of Physiotherapy, Level 7, Alan Gilbert Building, The University of Melbourne, Parkville, Victoria, Australia; Department of Physical Therapy, The University of British Colombia, Vancouver, British Columbia, Canada.
| | - Maarten J Nijkrake
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Marten M Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Jennifer L McGinley
- Department of Physiotherapy, Level 7, Alan Gilbert Building, The University of Melbourne, Parkville, Victoria, Australia.
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Miri A, Araújo H, Gil A, de Oliveira M, Volpe R, Angelo E, Mahmoud Smaili S. Analysis of handgrip strength, pulling force using the upper limbs, and ground reaction forces in the task of boarding a bus between healthy elderly individuals and those with Parkinson's disease. Physiother Theory Pract 2024; 40:909-918. [PMID: 36377318 DOI: 10.1080/09593985.2022.2144781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Elderly individuals with neurodegenerative diseases, such as Parkinson's disease (PD), may experience difficulties when performing functional tasks. OBJECTIVE To analyze the handgrip strength, pulling force, and ground reaction forces (GRF) of individuals with and without PD when boarding a bus while performing both simple (ST) and dual tasks (DT). METHOD This case-control study addressed 31 individuals with PD (GPD) and 30 healthy individuals (GHI). Assessments were performed in ST and DT situations using a bus model (prototype). Handgrip strength and pulling force were measured in both upper limbs using a dynamometer, and GRF was measured using a force platform. The GPD's and GHI's performances were compared in both ST and DT, and the individuals were classified as fallers according to the Falls Efficacy Scale. RESULTS In the inter-group comparison, the GPD presented significantly lower maximum force using their right hand, in handgrip strength (30.43 vs. 36.62, P = .022), and pulling force (10.77 vs 12.81, P = .037). The left hand's pulling force proved to be the most demanding for the GPD, during ST (6.35 vs. 4.76, P = .006) and DT (6.32 vs 4.74, P = .008). The GPD also took longer to perform ST (6.14 vs. 4.67, P < .001) and DT (6.08 vs. 4.81, P = .002). Additionally, the GPD was more afraid of falling compared to the GHI (34.74 vs. 24.77, P < .001). CONCLUSION Boarding a bus is a complex task for individuals with PD because they present lower maximum strength in the upper limbs and more significant functional expenditure than their healthy counterparts.
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Affiliation(s)
- Andressa Miri
- Post-Graduation Program in Rehabilitation Sciences, State University of Londrina (UEL), Avenida Robert Koch, n 60, Vila Operária, Londrina, Brazil
| | - Hayslenne Araújo
- Post-Graduation Program in Rehabilitation Sciences, State University of Londrina (UEL), Avenida Robert Koch, n 60, Vila Operária, Londrina, Brazil
| | - André Gil
- Post-Graduation Program in Rehabilitation Sciences, Northern Paraná University (UNOPAR), Londrina, Brazil
| | - Marcio de Oliveira
- Post-Graduation Program in Rehabilitation Sciences, Northern Paraná University (UNOPAR), Londrina, Brazil
| | - Renata Volpe
- Post-Graduation Program in Rehabilitation Sciences, State University of Londrina (UEL), Avenida Robert Koch, n 60, Vila Operária, Londrina, Brazil
| | - Edylaine Angelo
- Undergraduate Student at the Physiotherapy Program, State University of Londrina (UEL), Londrina, Brazil
| | - Suhaila Mahmoud Smaili
- Post-Graduation Program in Rehabilitation Sciences, Physiotherapy Department, State University of Londrina (UEL), Londrina, Brazil
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DeGutis J, Aul C, Barthelemy OJ, Davis BL, Alshuaib S, Marin A, Kinger SB, Ellis TD, Cronin-Golomb A. Side of motor symptom onset predicts sustained attention deficits and motor improvements after attention training in Parkinson's disease. Neuropsychologia 2023; 190:108698. [PMID: 37806442 DOI: 10.1016/j.neuropsychologia.2023.108698] [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: 03/08/2023] [Revised: 08/28/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Parkinson's disease (PD) side of motor symptom onset has been associated with distinct cognitive deficits; individuals with left-side onset (LPD) show more visuospatial impairments, whereas those with right-side onset (RPD) show more verbal impairments. Non-spatial attention is a critical cognitive ability associated with motor functioning that is right hemisphere lateralized but has not been characterized with regard to PD side of onset. We compared individuals with LPD and RPD on non-spatial attention tasks and examined differential responses to a 4-week sustained attention training program. METHOD Participants included 9 with LPD and 12 with RPD, who performed both brief and extended go/no-go continuous performance tasks and an attentional blink task. Participants also engaged in an at-home sustained attention training program, Tonic and Phasic Alertness Training (TAPAT), 5 days/week for 4 weeks. We assessed cognitive and motor symptoms before and after training, and after a 4-week no-contact period. RESULTS At baseline, participants with LPD exhibited worse performance than those with RPD on the extended continuous performance task, indicating specific deficits in sustaining attention. Poorer attention was associated with worse clinical motor scores. Notably, side of onset had a significant effect on clinical motor changes after sustained attention training, with only LPD participants improving after training, and 4/9 showing clinically meaningful improvements. CONCLUSIONS Compared to RPD, participants with LPD had poorer sustained attention pre-training and were more likely to improve on clinical motor functioning after sustained attention training. These findings support mechanistic differences between LPD and RPD and suggest potential differential treatment approaches.
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Affiliation(s)
- Joseph DeGutis
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA; Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Courtney Aul
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA; Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, USA
| | - Olivier J Barthelemy
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Breanna L Davis
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Shaikhah Alshuaib
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Anna Marin
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Shraddha B Kinger
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Terry D Ellis
- Department of Physical Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
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Soke F, Ozcan Gulsen E, Erkoc Ataoglu NE, Kocer B, Gulsen C, Turker D, Comoglu SS, Bora Tokcaer A. The coin rotation test: a reliable and valid test in people with Parkinson's disease. Disabil Rehabil 2023; 45:879-888. [PMID: 35263197 DOI: 10.1080/09638288.2022.2044925] [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: 11/03/2022]
Abstract
PURPOSE To investigate: (1) the interrater, and test-retest reliability of the coin rotation test (CRT) in people with Parkinson's Disease (PwPD); (2) the minimum detectable change in the CRT; (3) the concurrent and known-groups validity of the CRT; and (4) the cut-off times that best discriminate PwPD from healthy people and functionally dependent PwPD from functionally independent PwPD. METHOD Forty-eight PwPD and 33 healthy people were included. The CRT was administered with the nine-hole peg test, Movement Disorders Society Sponsored Unified Parkinson's Disease Rating Scale, Hoehn and Yahr Scale, Parkinson's Disease Questionnaire-8, and Schwab and England Scale. RESULTS The CRT had excellent interrater and test-retest reliability. Minimal detectable changes were 5.96 and 8.23 s for the dominant and non-dominant hand, respectively. The CRT correlated with other outcome measures. Significant differences in the CRT times were found between PwPD and healthy people, and between functionally dependent PwPD and functionally independent PwPD. The cut-off times of 12.66 s on the dominant hand and 15.76 s on the non-dominant best discriminated PwPD from healthy people, while 22.99 s on the dominant hand and 23.48 s on the non-dominant best discriminated functionally dependent PwPD from functionally independent PwPD. CONCLUSIONS The CRT is a reliable, and clinically available tool for assessing manual dexterity in PwPD.Implications for rehabilitationThe coin rotation test is a reliable, valid, and clinically available tool for assessing manual dexterity in Parkinson's Disease.The minimal detectable changes of the coin rotation test are 5.96 s for dominant hand and 8.23 s for the non-dominant hand, which may useful for clinicians and researchers to detect in any true change in manual dexterity after any intervention.The coin rotation test correlated with Parkinson's Disease-specific measurement tools.The coin rotation test times may detect impaired manual dexterity between people with Parkinson's Disease and healthy people, and between functionally dependent and functionally independent in Parkinson's Disease population.
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Affiliation(s)
- Fatih Soke
- Department of Physiotherapy and Rehabilitation, Gulhane Faculty of Physiotherapy and Rehabilitation, Fatih Soke, University of Health Sciences, Ankara, Turkey
| | - Elvan Ozcan Gulsen
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Elvan Ozcan Gulsen, Yuksek Ihtisas University, Ankara, Turkey
| | - Nigar Esra Erkoc Ataoglu
- Department of Neurology, Faculty of Medicine, Nigar Esra Erkoc Ataoglu, Gazi University, Ankara, Turkey
| | - Bilge Kocer
- Department of Neurology, Bilge Kocer, Diskapi Yildirim Beyazit Teaching and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Cagri Gulsen
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Cagri Gulsen, Gazi University, Ankara, Turkey
| | - Duygu Turker
- Department of Physiotherapy and Rehabilitation, Gulhane Faculty of Physiotherapy and Rehabilitation, Fatih Soke, University of Health Sciences, Ankara, Turkey
| | - Selim Selcuk Comoglu
- Department of Neurology, Bilge Kocer, Diskapi Yildirim Beyazit Teaching and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ayse Bora Tokcaer
- Department of Neurology, Faculty of Medicine, Nigar Esra Erkoc Ataoglu, Gazi University, Ankara, Turkey
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Schwalbe M, Satz S, Miceli R, Hu H, Manelis A. Hand Dexterity Is Associated with the Ability to Resolve Perceptual and Cognitive Interference in Older Adults: Pilot Study. Geriatrics (Basel) 2023; 8:31. [PMID: 36960986 PMCID: PMC10037645 DOI: 10.3390/geriatrics8020031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
The relationship between hand dexterity and inhibitory control across the lifespan is underexplored. In this pilot study, we examined inhibitory control using a modified Simon task. During the task, participants were presented with right- and left-pointing arrows located either on the right or the left parts of the screen. In the congruent trials, the arrow location and direction matched. In the incongruent trials, they mismatched, thus creating cognitive interference. In 50% of trials, the arrow presentation was accompanied by a task-irrelevant but environmentally meaningful sound that created perceptual interference. Hand dexterity was measured with the 9-hole peg test. Significantly faster reaction time (RT) on the modified Simon task (p < 0.001) was observed in younger adults, trials with concurrent sound stimuli, and congruent trials. Older adults who reported recent falls had greater difficulty resolving cognitive interference than older adults without recent falls. Hand dexterity significantly moderated the effect of sound on RT, but only in the group of older individuals. Interestingly, older individuals with reduced hand dexterity benefited from concurrent sounds more than those with better hand dexterity. Our findings suggest that task-irrelevant but environmentally meaningful sounds may increase alertness and enhance stimulus perception and recognition, thus improving motor performance in older individuals.
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Affiliation(s)
- Marie Schwalbe
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Skye Satz
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Rachel Miceli
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Hang Hu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Anna Manelis
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Gülşen Ç, Koçer B, Çomoğlu SS, Gündüz AG. The effect of subthalamic nucleus deep brain stimulation and dopaminergic treatment on dual-task manual dexterity in Parkinson's disease. Neurol Sci 2023; 44:1633-1641. [PMID: 36598618 DOI: 10.1007/s10072-022-06589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Dual-task manual dexterity is required to perform activities of daily living and is affected by cognitive functions. This study aimed to investigate the effects of two main treatment options, subthalamic nucleus deep brain stimulation (STN-DBS) and dopaminergic treatment (DT), on dual-task manual dexterity and cognitive functions of people with Parkinson's disease (PwPD). METHODS Twenty-one PwPD were assessed in four different conditions as medication "on-off" and STN-DBS "on-off" in random order. Motor symptoms were measured with the Movement Disorder Society-Unified Parkinson Disease Rating Scale, motor section (MDS-UPDRS-III). Single and dual-task manual dexterity was assessed with the Nine-Hole Peg Test (NHPT) and cognitive functions were assessed with the Stroop Test (ST) and the Trail Making Test (TMT). RESULTS Both DT and STN-DBS enhanced MDS-UPDRS-III, and the combination of DT and STN-DBS provided further improvement. Only STN-DBS enhanced dominant hand single-task NHPT scores. Non-dominant single-task NHPT scores and dual-task NHPT scores improved with both treatments alone; however, STN-DBS resulted in more improvement than DT. Dual-task interference, ST, and TMT scores improved with both treatments alone; however, combining DT and STN-DBS did not provide more improvement. CONCLUSION DT, STN-DBS, and combining both treatments have different effects on motor symptoms, single and dual-task manual dexterity, dual-task interference, and cognitive functions. These results indicate that DT and STN-DBS may affect motor and cognitive functions via different mechanisms. Effects of DT and STN-DBS on manual dexterity may depend on the degree of cognitive involvement in manual dexterity tasks.
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Affiliation(s)
- Çağrı Gülşen
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Emek, 6. Street, No: 2, Çankaya, 06490, Ankara, Turkey. .,Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Osmangazi University, Eskişehir, Turkey.
| | - Bilge Koçer
- Neurology Clinic, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Selim Selçuk Çomoğlu
- Neurology Clinic, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Arzu Güçlü Gündüz
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Emek, 6. Street, No: 2, Çankaya, 06490, Ankara, Turkey
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Amprimo G, Masi G, Priano L, Azzaro C, Galli F, Pettiti G, Mauro A, Ferraris C. Assessment Tasks and Virtual Exergames for Remote Monitoring of Parkinson's Disease: An Integrated Approach Based on Azure Kinect. SENSORS (BASEL, SWITZERLAND) 2022; 22:8173. [PMID: 36365870 PMCID: PMC9654712 DOI: 10.3390/s22218173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/17/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
Motor impairments are among the most relevant, evident, and disabling symptoms of Parkinson’s disease that adversely affect quality of life, resulting in limited autonomy, independence, and safety. Recent studies have demonstrated the benefits of physiotherapy and rehabilitation programs specifically targeted to the needs of Parkinsonian patients in supporting drug treatments and improving motor control and coordination. However, due to the expected increase in patients in the coming years, traditional rehabilitation pathways in healthcare facilities could become unsustainable. Consequently, new strategies are needed, in which technologies play a key role in enabling more frequent, comprehensive, and out-of-hospital follow-up. The paper proposes a vision-based solution using the new Azure Kinect DK sensor to implement an integrated approach for remote assessment, monitoring, and rehabilitation of Parkinsonian patients, exploiting non-invasive 3D tracking of body movements to objectively and automatically characterize both standard evaluative motor tasks and virtual exergames. An experimental test involving 20 parkinsonian subjects and 15 healthy controls was organized. Preliminary results show the system’s ability to quantify specific and statistically significant (p < 0.05) features of motor performance, easily monitor changes as the disease progresses over time, and at the same time permit the use of exergames in virtual reality both for training and as a support for motor condition assessment (for example, detecting an average reduction in arm swing asymmetry of about 14% after arm training). The main innovation relies precisely on the integration of evaluative and rehabilitative aspects, which could be used as a closed loop to design new protocols for remote management of patients tailored to their actual conditions.
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Affiliation(s)
- Gianluca Amprimo
- Institute of Electronics, Computer and Telecommunication Engineering, National Research Council, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
- Department of Control and Computer Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
| | - Giulia Masi
- Department of Neurosciences, University of Turin, Via Cherasco 15, 10100 Torino, Italy
| | - Lorenzo Priano
- Department of Neurosciences, University of Turin, Via Cherasco 15, 10100 Torino, Italy
- Istituto Auxologico Italiano, IRCCS, S. Giuseppe Hospital, Strada Luigi Cadorna 90, 28824 Piancavallo, Italy
| | - Corrado Azzaro
- Istituto Auxologico Italiano, IRCCS, S. Giuseppe Hospital, Strada Luigi Cadorna 90, 28824 Piancavallo, Italy
| | - Federica Galli
- Istituto Auxologico Italiano, IRCCS, S. Giuseppe Hospital, Strada Luigi Cadorna 90, 28824 Piancavallo, Italy
| | - Giuseppe Pettiti
- Institute of Electronics, Computer and Telecommunication Engineering, National Research Council, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
| | - Alessandro Mauro
- Department of Neurosciences, University of Turin, Via Cherasco 15, 10100 Torino, Italy
- Istituto Auxologico Italiano, IRCCS, S. Giuseppe Hospital, Strada Luigi Cadorna 90, 28824 Piancavallo, Italy
| | - Claudia Ferraris
- Institute of Electronics, Computer and Telecommunication Engineering, National Research Council, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
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Awasthi P, Lin TH, Bae J, Miller LE, Danziger ZC. Validation of a non-invasive, real-time, human-in-the-loop model of intracortical brain-computer interfaces. J Neural Eng 2022; 19:056038. [PMID: 36198278 PMCID: PMC9855658 DOI: 10.1088/1741-2552/ac97c3] [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: 03/21/2022] [Accepted: 10/05/2022] [Indexed: 01/26/2023]
Abstract
Objective. Despite the tremendous promise of invasive brain-computer interfaces (iBCIs), the associated study costs, risks, and ethical considerations limit the opportunity to develop and test the algorithms that decode neural activity into a user's intentions. Our goal was to address this challenge by designing an iBCI model capable of testing many human subjects in closed-loop.Approach. We developed an iBCI model that uses artificial neural networks (ANNs) to translate human finger movements into realistic motor cortex firing patterns, which can then be decoded in real time. We call the model the joint angle BCI, or jaBCI. jaBCI allows readily recruited, healthy subjects to perform closed-loop iBCI tasks using any neural decoder, preserving subjects' control-relevant short-latency error correction and learning dynamics.Main results. We validated jaBCI offline through emulated neuron firing statistics, confirming that emulated neural signals have firing rates, low-dimensional PCA geometry, and rotational jPCA dynamics that are quite similar to the actual neurons (recorded in monkey M1) on which we trained the ANN. We also tested jaBCI in closed-loop experiments, our single study examining roughly as many subjects as have been tested world-wide with iBCIs (n= 25). Performance was consistent with that of the paralyzed, human iBCI users with implanted intracortical electrodes. jaBCI allowed us to imitate the experimental protocols (e.g. the same velocity Kalman filter decoder and center-out task) and compute the same seven behavioral measures used in three critical studies.Significance. These encouraging results suggest the jaBCI's real-time firing rate emulation is a useful means to provide statistically robust sample sizes for rapid prototyping and optimization of decoding algorithms, the study of bi-directional learning in iBCIs, and improving iBCI control.
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Affiliation(s)
- Peeyush Awasthi
- Department of Biomedical Engineering, Florida International University, Miami, FL, United States of Amercia
| | - Tzu-Hsiang Lin
- Department of Biomedical Engineering, Florida International University, Miami, FL, United States of Amercia
| | - Jihye Bae
- Department of Electrical and Computer Engineering, University of Kentucky, Lexington, KY, United States
| | - Lee E Miller
- Department of Neuroscience, Physical Medicine, and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Zachary C Danziger
- Department of Biomedical Engineering, Florida International University, Miami, FL, United States of Amercia,Author to whom any correspondence should be addressed
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Wong-Yu ISK, Ren L, Mak MKY. Impaired Hand Function and Its Association With Self-Perceived Hand Functional Ability and Quality of Life in Parkinson Disease. Am J Phys Med Rehabil 2022; 101:843-849. [PMID: 35978454 DOI: 10.1097/phm.0000000000001923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Comprehensive hand function in people with Parkinson disease (PD) has been underevaluated. The objectives were to compare self-perceived and objective hand functions of PD and controls, compare outcomes between more and less affected hand subgroups, and evaluate relationship between self-perceived and objective outcomes in subgroups. DESIGN A total of 165 PD and 82 healthy participants completed the Jebsen-Taylor Hand Function Test, Purdue Pegboard Test, grip strength test, and Manual Ability Measure-16 in a cross-sectional study. PD participants completed the Parkinson Disease Questionnaire-39. Associations between objective and self-perceived/quality of life outcomes in PD groups were analyzed, and nondominant and dominant more affected subgroups performance was compared. RESULTS PD participants had significantly worse performance in most Jebsen-Taylor Hand Function Test and all Purdue Pegboard Test items, lower Manual Ability Measure-16 scores, and poorer handgrip strength. Weak associations were found between dexterity, but not grip strength, and self-perceived functional hand ability and Parkinson Disease Questionnaire-39 scores in PD subgroups. For nondominant more affected subgroup, poorer dexterity was associated with better Parkinson Disease Questionnaire-39 Activity of Daily Living domain scores. CONCLUSION People with mild to moderate PD were shown to have poorer manual dexterity, reduced grip strength, and lower self-perceived functional hand ability than controls. Associations between dexterity and self-perceived outcomes highlight the importance of unimanual and bimanual training.
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Affiliation(s)
- Irene S K Wong-Yu
- From the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
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11
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Dual task effect on upper and lower extremity skills in different stages of Parkinson's disease. Acta Neurol Belg 2022:10.1007/s13760-022-02007-x. [PMID: 35776407 DOI: 10.1007/s13760-022-02007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/09/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND PURPOSE Loss of automaticity and deteriorated executive function give rise to dual task deficits in Parkinson's disease (PD). This study aimed to compare single task and dual task upper and lower extremity skills in people with PD (PwPD) at different stages of PD and to examine the dual task effect (DTE) on upper and lower extremity skills in PwPD at different stages of PD. The second aim was to investigate the relationship between the DTE and the quality of life in PwPD. METHODS 30 patients divided into 2 groups as mild PD group and moderate PD group according to the Modified Hoehn & Yahr Scale. 15 age matched healthy adults were recruited as the control group. The Unified Parkinson's Disease Rating Scale (UPDRS), the Purdue Pegboard Test (PPT), the Timed Up and Go Test (TUG), the 10 Meter Walk Test (10MWT), and the Parkinson's Disease Questionnaire (PDQ-8) were used for assessments. RESULTS Single task and dual task scores of all assessments of all groups were significantly different. The DTE on PPT was greater in mild and moderate PD groups than control group and significantly lower in mild PD group than moderate PD group. However, DTE on the TUG and 10MWT was not different in mild PD group than control group and DTE significantly lower in both groups than moderate PD group. Significant correlations between the DTE on PPT, TUG and 10MWT and the PDQ-8 in PwPD were observed. CONCLUSION Dual task has a worsening effect on upper and lower extremity skills in PwPD. This effect can be observed earlier in upper extremity skills than lower extremity skills. Also, the DTE and the QoL in PwPD are related.
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12
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Rabah A, Le Boterff Q, Carment L, Bendjemaa N, Térémetz M, Dupin L, Cuenca M, Mas JL, Krebs MO, Maier MA, Lindberg PG. A novel tablet-based application for assessment of manual dexterity and its components: a reliability and validity study in healthy subjects. J Neuroeng Rehabil 2022; 19:35. [PMID: 35331273 PMCID: PMC8953393 DOI: 10.1186/s12984-022-01011-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We developed five tablet-based tasks (applications) to measure multiple components of manual dexterity. AIM to test reliability and validity of tablet-based dexterity measures in healthy participants. METHODS Tasks included: (1) Finger recognition to assess mental rotation capacity. The subject taps with the finger indicated on a virtual hand in three orientations (reaction time, correct trials). (2) Rhythm tapping to evaluate timing of finger movements performed with, and subsequently without, an auditory cue (inter-stimulus interval). (3) Multi-finger tapping to assess independent finger movements (reaction time, correct trials, unwanted finger movements). (4) Sequence tapping to assess production and memorization of visually cued finger sequences (successful taps). (5) Line-tracking to assess movement speed and accuracy while tracking an unpredictably moving line on the screen with the fingertip (duration, error). To study inter-rater reliability, 34 healthy subjects (mean age 35 years) performed the tablet tasks twice with two raters. Relative reliability (Intra-class correlation, ICC) and absolute reliability (Standard error of measurement, SEM) were established. Task validity was evaluated in 54 healthy subjects (mean age 49 years, range: 20-78 years) by correlating tablet measures with age, clinical dexterity assessments (time taken to pick-up objects in Box and Block Test, BBT and Moberg Pick Up Test, MPUT) and with measures obtained using a finger force-sensor device. RESULTS Most timing measures showed excellent reliability. Poor to excellent reliability was found for correct trials across tasks, and reliability was poor for unwanted movements. Inter-session learning occurred in some measures. Age correlated with slower and more variable reaction times in finger recognition, less correct trials in multi-finger tapping, and slower line-tracking. Reaction times correlated with those obtained using a finger force-sensor device. No significant correlations between tablet measures and BBT or MPUT were found. Inter-task correlation among tablet-derived measures was weak. CONCLUSIONS Most tablet-based dexterity measures showed good-to-excellent reliability (ICC ≥ 0.60) except for unwanted movements during multi-finger tapping. Age-related decline in performance and association with finger force-sensor measures support validity of tablet measures. Tablet-based components of dexterity complement conventional clinical dexterity assessments. Future work is required to establish measurement properties in patients with neurological and psychiatric disorders.
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Affiliation(s)
- Ayah Rabah
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université Paris Cité, 75014, Paris, France
| | - Quentin Le Boterff
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université Paris Cité, 75014, Paris, France
| | - Loïc Carment
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université Paris Cité, 75014, Paris, France
| | - Narjes Bendjemaa
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université Paris Cité, 75014, Paris, France.,Centre de Recherche Clinique, GHU, GHU Paris Psychiatrie & Neurosciences, 75014, Paris, France.,Evaluation Centre for Young Adults (Pépite), GHU Paris Psychiatrie & Neurosciences, Université de Paris, Paris, France
| | - Maxime Térémetz
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université Paris Cité, 75014, Paris, France
| | - Lucile Dupin
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université Paris Cité, 75014, Paris, France
| | - Macarena Cuenca
- Centre de Recherche Clinique, GHU, GHU Paris Psychiatrie & Neurosciences, 75014, Paris, France
| | - Jean-Louis Mas
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université Paris Cité, 75014, Paris, France.,Department of Neurology, GHU Paris Psychiatrie & Neurosciences, Université de Paris, Paris, France
| | - Marie-Odile Krebs
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université Paris Cité, 75014, Paris, France.,Evaluation Centre for Young Adults (Pépite), GHU Paris Psychiatrie & Neurosciences, Université de Paris, Paris, France.,Institut de Psychiatrie (Centre, National de la Recherche Scientifique [CNRS] 3557), Paris, France
| | - Marc A Maier
- Université Paris Cité, INCC UMR 8002, CNRS, 75006, Paris, France
| | - Påvel G Lindberg
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université Paris Cité, 75014, Paris, France.
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13
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Cousineau J, Plateau V, Baufreton J, Le Bon-Jégo M. Dopaminergic modulation of primary motor cortex: From cellular and synaptic mechanisms underlying motor learning to cognitive symptoms in Parkinson's disease. Neurobiol Dis 2022; 167:105674. [PMID: 35245676 DOI: 10.1016/j.nbd.2022.105674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
The primary motor cortex (M1) is crucial for movement execution, especially dexterous ones, but also for cognitive functions like motor learning. The acquisition of motor skills to execute dexterous movements requires dopamine-dependent and -independent plasticity mechanisms within M1. In addition to the basal ganglia, M1 is disturbed in Parkinson's disease (PD). However, little is known about how the lack of dopamine (DA), characteristic of PD, directly or indirectly impacts M1 circuitry. Here we review data from studies of PD patients and the substantial research in non-human primate and rodent models of DA depletion. These models enable us to understand the importance of DA in M1 physiology at the behavioral, network, cellular, and synaptic levels. We first summarize M1 functions and neuronal populations in mammals. We then look at the origin of M1 DA and the cellular location of its receptors and explore the impact of DA loss on M1 physiology, motor, and executive functions. Finally, we discuss how PD treatments impact M1 functions.
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Cheng B, Zhu T, Zhao W, Sun L, Shen Y, Xiao W, Zhang S. Effect of Theta Burst Stimulation-Patterned rTMS on Motor and Nonmotor Dysfunction of Parkinson's Disease: A Systematic Review and Metaanalysis. Front Neurol 2022; 12:762100. [PMID: 35095722 PMCID: PMC8790062 DOI: 10.3389/fneur.2021.762100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/10/2021] [Indexed: 01/27/2023] Open
Abstract
Background: Theta burst stimulation (TBS), a type of patterned repetitive transcranial magnetic stimulation (rTMS), has several advantages, such as short time of single treatment and low stimulation intensity compared with traditional rTMS. Since the efficacy of TBS on the symptoms of Parkinson's disease (PD) was inconsistent among different studies, we systematically searched these studies and quantitatively analyzed the therapeutic effect of TBS for patients with PD. Methods: We followed the recommended PRISMA guidelines for systematic reviews. Studies from PubMed, EMBASE, CENTRAL, and ClinicalTrials.gov from January 1, 2005 of each database to September 30, 2021 were analyzed. We also manually retrieved studies of reference. Results: Eight eligible studies with 189 participants (received real TBS and/or sham TBS) were included. This metaanalysis found that TBS did not significantly improve Unified Parkinson's Disease Rating Scale part III (UPDRS-III) score in the “on” medicine state (SMD = −0.06; 95% CI, −0.37 to 0.25; p = 0.69; I2 = 0%), while, it brought significant improvement of UPDRS-III scores in the “off” medicine state (SMD = −0.37; 95% CI, −0.65 to −0.09; p < 0.01; I2 = 19%). Subgroup analysis found that merely continuous TBS (cTBS) over the supplementary motor area (SMA) brought significant improvement of UPDRS-III score (SMD = −0.63; 95% CI, −1.02 to −0.25; p < 0.01). TBS had insignificant effectiveness for upper limb movement disorder both in the “on” and “off” medicine status (SMD = −0.07; 95% CI, −0.36 to 0.22; p = 0.64; I2 = 0%; SMD = −0.21; 95% CI, −0.57 to 0.15; p = 0.26; I2 = 0%; respectively). TBS significantly improved slowing of gait in the “off” medicine status (SMD = −0.37; 95% CI, −0.71 to −0.03; p = 0.03; I2 = 0%). Subgroup analysis suggested that only intermittent TBS (iTBS) over the primary motor cortex (M1) + dorsolateral prefrontal cortex (DLPFC) had significant difference (SMD = −0.57; 95% CI, −1.13 to −0.01; p = 0.04). Additionally, iTBS over the M1+ DLPFC had a short-term (within 2 weeks) therapeutic effect on PD depression (MD = −2.93; 95% CI, −5.52 to −0.33; p = 0.03). Conclusion: Our study demonstrated that cTBS over the SMA could significantly improve the UPDRS-III score for PD patients in the “off,” not in the “on,” medicine state. TBS could not bring significant improvement of upper limb movement dysfunction. ITBS over the M1+DLPFC could significantly improve the slowing of gait in the “off” medicine status. Additionally, iTBS over the M1+DLPFC has a short-term (within 2 weeks) therapeutic effect on PD depression. Further RCTs of a large sample, and excellent design are needed to confirm our conclusions.
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Affiliation(s)
- Bo Cheng
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Tao Zhu
- Department of Preventive Medicine, North Sichuan Medical College (University), Nanchong, China
| | - Wenhao Zhao
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Ling Sun
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Yao Shen
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Wei Xiao
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Shushan Zhang
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
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15
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Martins NIM, Aguiar MMD, Correa CL. Freezing of Upper Limbs in Parkinson’s Disease: A Systematic Review. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2021.1929658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Núbia Isabela Macêdo Martins
- Graduate Program in Physical Education, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Medicine School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Clynton Lourenço Correa
- Graduate Program in Physical Education, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Faculty of Physical Therapy, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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16
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Carroll LM, Morris ME, O'Connor WT, Clifford AM. Is Aquatic Therapy Optimally Prescribed for Parkinson's Disease? A Systematic Review and Meta-Analysis. JOURNAL OF PARKINSONS DISEASE 2021; 10:59-76. [PMID: 31815701 DOI: 10.3233/jpd-191784] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aquatic therapy offers an alternative physiotherapy approach to managing the motor and non-motor symptoms associated with Parkinson's disease (PD). OBJECTIVE This review examined exercise prescription for aquatic therapy in PD and evaluated if aquatic therapy is as effective as land-based physiotherapy for improving movement, disability and wellbeing in people living with PD. METHODS A systematic search of eight databases was conducted to identify suitable randomized controlled trials from inception until August 2019. Aquatic therapy prescription data and outcomes of interest included gait, balance, motor disability, mobility, falls, mood, cognitive function and health related quality of life data was extracted and synthesised. A meta-analysis was performed where appropriate. RESULTS Fourteen studies involving 472 participants (Hoehn & Yahr scale I-IV) met the inclusion criteria. Eight were of modest quality, scoring 70-80% on the PEDro scale. Seven studies were included in the meta-analysis. Exercise prescription was highly variable and often insufficiently dosed. Similar gains were shown for aquatic therapy and land exercises for balance, motor disability or quality of life. A statistically significant difference was found for mobility as measured using the TUG (-1.5 s, 95 % CI -2.68 to -0.32; p = 0.01, I2 = 13%), in favor of aquatic therapy. CONCLUSION Aquatic therapy had positive outcomes for gait, balance and mobility that were comparable to land-based physiotherapy in the early stages of PD. The optimal dosage, content and duration of aquatic interventions for PD could not be confirmed in this meta-analysis. Many trials appeared to be under-dosed and therapy duration was low, ranging from 3-11 weeks.
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Affiliation(s)
- Louise M Carroll
- School of Allied Health, Faculty of Education and Health Sciences, Health Sciences Building, University of Limerick, Limerick, Ireland
| | - Meg E Morris
- Healthscope & La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - William T O'Connor
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Amanda M Clifford
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Ageing Research Centre, University of Limerick, Limerick, Ireland
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17
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Ingram LA, Carroll VK, Butler AA, Brodie MA, Gandevia SC, Lord SR. Quantifying upper limb motor impairment in people with Parkinson's disease: a physiological profiling approach. PeerJ 2021; 9:e10735. [PMID: 33604177 PMCID: PMC7869669 DOI: 10.7717/peerj.10735] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 12/17/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Upper limb motor impairments, such as slowness of movement and difficulties executing sequential tasks, are common in people with Parkinson's disease (PD). OBJECTIVE To evaluate the validity of the upper limb Physiological Profile Assessment (PPA) as a standard clinical assessment battery in people with PD, by determining whether the tests, which encompass muscle strength, dexterity, arm stability, position sense, skin sensation and bimanual coordination can (a) distinguish people with PD from healthy controls, (b) detect differences in upper limb test domains between "off" and "on" anti-Parkinson medication states and (c) correlate with a validated measure of upper limb function. METHODS Thirty-four participants with PD and 68 healthy controls completed the upper limb PPA tests within a single session. RESULTS People with PD exhibited impaired performance across most test domains. Based on validity, reliability and feasibility, six tests (handgrip strength, finger-press reaction time, 9-hole peg test, bimanual pole test, arm stability, and shirt buttoning) were identified as key tests for the assessment of upper limb function in people with PD. CONCLUSIONS The upper limb PPA provides a valid, quick and simple means of quantifying specific upper limb impairments in people with PD. These findings indicate clinical assessments should prioritise tests of muscle strength, unilateral movement and dexterity, bimanual coordination, arm stability and functional tasks in people with PD as these domains are the most commonly and significantly impaired.
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Affiliation(s)
- Lewis A. Ingram
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Vincent K. Carroll
- NSW Health, Mid North Coast Local Health District, Coffs Harbour, New South Wales, Australia
- Parkinson’s NSW, Sydney, New South Wales, Australia
| | - Annie A. Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew A. Brodie
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Simon C. Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R. Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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18
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Progressive muscle-strength protocol for the functionality of upper limbs and quality of life in individuals with Parkinson's disease: Pilot study. Complement Ther Med 2020; 52:102432. [PMID: 32951706 DOI: 10.1016/j.ctim.2020.102432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/06/2020] [Accepted: 05/06/2020] [Indexed: 11/22/2022] Open
Abstract
The effects of physical-therapy intervention on the motor function of upper limbs and the quality of life in patients with Parkinson's disease (PD) are not fully understood. We evaluated the effects of a progressive muscle-strengthening protocol for upper limbs on the functionality and quality of life. Patients were divided into two groups: Intervention (n = 6) and Control (n = 7). Assessment tools used were: Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Questionnaire, Nine-Hole Peg Test (9HPT), Test d'Évaluation des Membres Supérieurs de Personnes Âgées (TEMPA), 10-Repetition Maximum (10-RM) and handgrip dynamometer, which were applied pre- and post-intervention, with follow-up for one month after the last training session. Only, the Intervention group (post-intervention) showed significant statistical differences, with the following outcomes: UPDRS III (p = 0.042); 9HPT, right (p = 0.028) and left side (p = 0.028); TEMPA for total right side (p = 0.028), left side (p = 0.028) and total bilateral tasks (p = 0.028); TEMPA task 2 - open a jar and take a spoonful of coffee (p = 0.028), task 3 - pick up a pitcher and pour water into a glass for right (p = 0.046) and left side (p = 0.028), task 5 - write on an envelope and stick on a stamp (p = 0.028), and task 6 - shuffle and deal playing cards (p = 0.028). We observed significant statistical differences between groups (post-intervention) for TEMPA task 6 (p = 0.032), total right side (p = 0.032), and total bilateral tasks (p = 0.032). An increase in the maximum load in the post-intervention stage, based on the 10-RM test, was observed on the right (p = 0.003) and left (p = 0.007) sides. Our results showed an improvement in upper-limb functionality in PD patients submitted to progressive muscle-strength training, although not in quality of life.
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19
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Kanmogne GD, Fonsah JY, Umlauf A, Moul J, Doh RF, Kengne AM, Tang B, Tagny CT, Nchindap E, Kenmogne L, Franklin D, Njamnshi DM, Kuate CT, Mbanya D, Njamnshi AK, Heaton RK. Effects of HIV infection, antiretroviral therapy, and immune status on the speed of information processing and complex motor functions in adult Cameroonians. Sci Rep 2020; 10:14016. [PMID: 32820234 PMCID: PMC7441321 DOI: 10.1038/s41598-020-70981-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022] Open
Abstract
HIV-associated neurocognitive deficits include impaired speed-of-information processing (SIP) and motor functions. There is lack of Cameroonian adult norms for assessing SIP or motor functions. This study of 683 Cameroonians (320 HIV+, 363 HIV-) establishes demographically-adjusted norms for six SIP [Wechsler-Adult-Intelligence-Scale (WAIS)-III Digit Symbol (WAIS-IIIDS) and Symbol Search (WAIS-IIISS), Stroop Color-Naming, Stroop Word-Reading, Trail-Making Test-A (TMT-A), Color Trails-1 (CTT1)], and two motor function [Grooved Pegboard-dominant (GP-DH) and non-dominant (GP-NDH) hands] tests. We assessed viral effects on SIP and motor functions. HIV-infected persons had significantly lower (worse) T scores on GP-DH, WAIS-IIIDS, Stroop Word-Reading, TMT-A; lower motor and SIP summary T scores. Significantly higher proportion of cases (20.7%) than controls (10.3%) had impaired SIP. Male cases had better T scores than female cases on GP-NDH, WAIS-IIIDS, WAIS-IIISS, TMT-A, CTT1; better SIP summary T scores. Antiretroviral therapy (ART) was associated with significantly better T scores on GP-NDH, WAIS-IIIDS, Stroop Color-Naming; better motor and SIP summary T scores. Cases with higher CD4 had better T scores on WAIS-IIIDS, TMT-A, CTT1; better SIP summary T scores. Overall, we demonstrate that HIV infection in Cameroon is associated with deficits in SIP and motor functions; ART and higher CD4 are associated with better cognitive performance. We provide SIP and psychomotor functions normative standards, which will be useful for neurobehavioral studies in Cameroon of diseases affecting the brain.
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Affiliation(s)
- Georgette D Kanmogne
- Vice-Chair for Resource Allocation and Faculty Development, Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-5800, USA.
| | - Julius Y Fonsah
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Jacob Moul
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Roland F Doh
- Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Anne M Kengne
- Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Bin Tang
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Claude T Tagny
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | | | | | - Donald Franklin
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Dora M Njamnshi
- HIV-Day Care Service, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Callixte T Kuate
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Laquintinie Hospital, Douala, Cameroon
| | - Dora Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | - Alfred K Njamnshi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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Proud EL, Miller KJ, Bilney B, Morris ME, McGinley JL. Construct validity of the 9-Hole Peg Test and Purdue Pegboard Test in people with mild to moderately severe Parkinson's disease. Physiotherapy 2019; 107:202-208. [PMID: 32026821 DOI: 10.1016/j.physio.2019.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/13/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the construct validity of two dexterity measures, the 9-Hole Peg Test (9HPT) and Purdue Pegboard Test (PPT) in people with Parkinson's disease (PD). DESIGN Cross-sectional observational study. SETTING Testing was conducted at the university or in participants' homes. PARTICIPANTS Thirty community dwelling people with mild to moderately severe PD and no major upper limb comorbidities or cognitive impairments. INTERVENTIONS Pegboard tests were administered in the 'on' and 'end-of-dose' phases of participants' PD medication cycles. Participants rated hand function with two self-report questionnaires - the Manual Ability Measure-36 (MAM-36) and a subset of upper limb items from the MDS-UPDRS. To explore construct validity, we compared 'on' phase pegboard scores with normative values for unimpaired men and women and investigated relationships between pegboard scores and hand function questionnaires. RESULTS In the 'on' phase, pegboard scores were poorer than normative values. Differences in individual subtest scores ranged between 10 and 41%. Correlations between self-reported hand function and pegboard scores were weak to moderately strong in the 'on' phase (r=0.21-0.51), and weak at 'end-of-dose' (r=0.13-0.22). Higher correlation coefficients were observed between hand function and PPT subtest scores than with hand function and 9HPT scores. Most participants reported difficulty with daily hand tasks. CONCLUSIONS We found evidence for construct validity supporting the use of the 9HPT and PPT to evaluate people with mild to moderately severe PD when 'on', but not at the 'end-of-dose'. Results also suggest that the PPT may be more sensitive to PD-related changes in dexterity than the 9HPT.
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Affiliation(s)
- Elizabeth L Proud
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia.
| | - Kimberly J Miller
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia; Sunny Hill Health Centre for Children, Vancouver, Canada
| | - Belinda Bilney
- School of Allied Health, Australian Catholic University, Ballarat, Australia
| | - Meg E Morris
- Healthscope and La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Australia
| | - Jennifer L McGinley
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia
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21
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Bryant MS, Workman CD, Jamal F, Meng H, Jackson GR. Feasibility study: Effect of hand resistance exercise on handwriting in Parkinson's disease and essential tremor. J Hand Ther 2019; 31:29-34. [PMID: 28389133 DOI: 10.1016/j.jht.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 12/23/2016] [Accepted: 01/04/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A single group, repeated measures design was used. INTRODUCTION Tremor can lead to impaired hand function in patients with Parkinson's disease (PD) and essential tremor (ET). Difficulty with handwriting is a common complaint in these patients suffering from hand tremors. The effect of hand resistance exercise on handwriting is unknown. PURPOSE OF THE STUDY To explore the influence of 6 weeks of home-based hand resistance exercise on handwriting in individuals with PD and ET. METHODS Nine individuals with PD and 9 with ET participated in the study. The average age was 65.3 (6.0) years with an average disease duration of 7.8 years. Participants were instructed to perform a home-based, hand and arm resistance exercise program 3 times a week for 6 weeks. Samples of the area of handwriting and maximal grip strength were measured at baseline and after 6 weeks of exercise. The area of the handwriting sample and maximal grip strength measured before and after 6 weeks were compared. RESULTS Mean grip strength of the participants with PD improved after 6 weeks of hand resistance exercise (P = .031), but grip strength did not change in ET (P = .091). The size of the handwriting samples (words and sentences) did not change after exercise in either participants with PD or ET. DISCUSSION Micrographia in patients with PD and macrographia in patients with ET represent complex fine motor skills. More research is needed to understand what therapies could be effective in modifying the size and quality of handwriting. CONCLUSIONS The purpose of this feasibility study was to explore the influence of home-based wrist resistance exercise on handwriting in individuals with PD and ET. Despite small gains in grip strength, the size of the handwriting samples (words and sentences) did not change for patients with PD or ET following a 6-week home-based hand resistance exercise program.
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Affiliation(s)
- Mon S Bryant
- Research Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA; Department of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA.
| | - Craig D Workman
- Research Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Fariha Jamal
- Parkinson's Disease Research Education and Clinical Center, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Hao Meng
- Research Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - George R Jackson
- Parkinson's Disease Research Education and Clinical Center, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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22
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Occupational Therapy for Parkinsonian Patients: A Retrospective Study. PARKINSON'S DISEASE 2019; 2019:4561830. [PMID: 31781364 PMCID: PMC6875269 DOI: 10.1155/2019/4561830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/24/2019] [Accepted: 07/04/2019] [Indexed: 11/20/2022]
Abstract
Background Hand functionality and finger dexterity are impaired in patients with Parkinson's disease (PD). These disturbances lead to a dependency in activities of daily living (ADL) and poor quality of life (QoL). Objective We aimed to evaluate whether a specific occupational therapy (OT) program is effective in improving finger and hand dexterity and its impact on ADL in PD patients. Methods We retrospectively studied PD patients, hospitalized for a 4-week multidisciplinary intensive rehabilitation treatment (MIRT) between January 2015 and June 2018. All patients underwent 1 h/day OT treatment, 5 days a week. The primary outcome measure was the O'Connor finger dexterity test; secondary outcome measures were the Minnesota dexterity test, UPDRS II, and Self-Assessment Parkinson's Disease Disability Scale (SPDDS). These measures were assessed at admission (T0) and discharge (T1). Results Based on the Hoehn and Yahr scale (H&Y), patients were divided into two groups: 262 subjects in H&Y stage <3 (early-stage PD patients) and 220 in H&Y stage ≥3 (medium-advanced stage PD patients). As expected, at baseline, all measures were worse in higher H&Y stages. After treatment, both groups experienced significant improvements in all outcomes. Significant differences between early-stage and medium-advanced stage PD patients were observed only for the changes in UPDRS II, with a better improvement in patients in H&Y stage ≥3. Conclusions We showed that PD patients who underwent a rehabilitation protocol including OT experienced improvements in finger dexterity and hand functionality. Our results underline the relevance of OT in improving autonomy and QoL in PD patients.
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Dan X, Liu J, Doyon J, Zhou Y, Ma J, Chan P. Impaired Fine Motor Function of the Asymptomatic Hand in Unilateral Parkinson's Disease. Front Aging Neurosci 2019; 11:266. [PMID: 31636557 PMCID: PMC6787142 DOI: 10.3389/fnagi.2019.00266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/13/2019] [Indexed: 01/05/2023] Open
Abstract
The early detection of Parkinson's disease (PD) still remains a challenge to date. Although studies have previously reported subtle motor function abnormalities in early PD patients, it is unclear whether such clinical signs can be better detected while patients are concurrently performing a cognitive task, and whether they can be useful in predicting patients' clinical conversion state. Seventy-two right-handed participants (40 drug-naive patients with idiopathic unilateral PD and 32 age-matched healthy controls) were enrolled in this study. All participants were asked to perform the Purdue Pegboard test (PPT) either alone (single-task condition) or during a concurrent mental subtraction-by-3 task (dual-task condition). A 4-year telephone follow-up was later conducted to determine whether PD patients converted to bilateral signs. We found that PD patients showed a significant reduction in dexterity on the PPT compared to the controls in both single- and dual-task conditions. Yet patients' performance in the dual-task condition revealed a greater interference effect when patients performed the task with their right hand than with their left hand. PPT also revealed reasonable discriminative ability for prediagnosing PD. However, dual-tasking did not have added value in differentiating early patients and controls. At follow-up, the baseline PPT performance of the asymptomatic hands was positively correlated with time to convert from unilaterally to bilaterally affected states (r = 0.62, P = 0.031). Together, these findings suggest that PPT can serve as a useful auxiliary tool in evaluating early PD, and shed light on the neuroplasticity mechanism of fine motor deficit at this very early stage.
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Affiliation(s)
- Xiaojuan Dan
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Key Laboratory on Parkinson's Disease of Beijing, Beijing, China
| | - Jia Liu
- Department of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Julien Doyon
- McConnell Brain Imaging Center, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Yongtao Zhou
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Key Laboratory on Parkinson's Disease of Beijing, Beijing, China
| | - Jinghong Ma
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Key Laboratory on Parkinson's Disease of Beijing, Beijing, China
| | - Piu Chan
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Key Laboratory on Parkinson's Disease of Beijing, Beijing, China.,Department of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China.,Beijing Institute for Brain Disorders Parkinson's Disease Center, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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24
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Reliability, validity and responsiveness of the squares test for manual dexterity in people with Parkinson's disease. Clin Neurol Neurosurg 2019; 186:105542. [PMID: 31605895 DOI: 10.1016/j.clineuro.2019.105542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 09/26/2019] [Accepted: 09/28/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Impaired manual dexterity is one of the major disorder in people with Parkinson's Disease (PwPD). However, there is limited research examining the measurement properties, especially the validity and responsiveness of the tools used to assess manual dexterity. The aim of this study was to examine reliability, validity, and responsiveness of the Squares Test (ST) in PwPD. PATIENTS AND METHODS Fifty-seven PwPD and 50 healthy people, all of whom were right-handed, were recruited. The ST, Nine-Hole Peg Test, Unified Parkinson's Disease Rating Scale (UPDRS), and Hoehn and Yahr scale were performed in ON state. For responsiveness analysis, the ST and UPDRS motor score (UPDRS-III) were also performed in OFF state. RESULTS The ST showed excellent test-retest reliability. The ST was found to correlate significantly with other outcome measures, which indicated good concurrent validity. PwPD demonstrated significantly lower scores of the ST than healthy people, which demonstrated satisfactory known-groups validity. The ST had excellent discriminant validity. The ST scores of 52 for more affected hand and 62 for less affected hand were shown to best discriminate between PwPD and healthy people. The ST is high internal responsiveness based on standardized effect size and standardized response mean (0.79 and 1.88, respectively for more affected hand and 0.85 and 1.83, respectively for less affected hand), and also PwPD had better performance based on the ST in ON state than in OFF state (p < 0.001 for both hands). Moderate correlations were found between the change scores of the ST and UPDRS-III, which reflected adequate external responsiveness. CONCLUSIONS The ST is a reliable, valid and responsive measurement tool for assessing manual dexterity in PwPD.
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25
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Acaröz Candan S, Özcan TŞ. Dual-task interference during hand dexterity is a predictor for activities of daily living performance in Parkinson's disease. Parkinsonism Relat Disord 2019; 66:100-104. [DOI: 10.1016/j.parkreldis.2019.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 07/10/2019] [Accepted: 07/13/2019] [Indexed: 12/11/2022]
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26
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Uzochukwu JC, Stegemöller EL. Repetitive Finger Movement and Dexterity Tasks in People With Parkinson’s Disease. Am J Occup Ther 2019; 73:7303205090p1-7303205090p8. [DOI: 10.5014/ajot.2019.028738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
BACKGROUND. Little is known regarding how repetitive finger movement performance, an assessment of bradykinesia (slowness of movement), is related to fine-motor dexterity tasks in people with Parkinson’s disease (PD).
OBJECTIVE. This pilot study examined the relationship between the performance of fine-motor dexterity tasks and repetitive finger movement in people with PD.
METHOD. Forty-six participants with PD completed an acoustically cued repetitive finger movement task (1–3 Hz). Movement amplitude, movement rate difference, and coefficient of variation were obtained for each tone rate. Participants also completed a buttoning and Purdue pegboard assembly task. Buttoning time and number of assemblies were recorded.
RESULTS. A significant association was found between movement rate difference and movement rate difference coefficient of variation and buttoning performance in which higher movement rate and higher variability were associated with slower buttoning times. No significant associations between any of the repetitive finger movement outcome measures and Purdue pegboard assembly performance were revealed.
CONCLUSION. Changes in movement amplitude and movement rate may influence fine-motor dexterity tasks differently. Thus, it is important to consider the quantitative assessment of both movement rate and movement amplitude because they may indicate differential clinical applications in the treatment of people with PD.
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Affiliation(s)
- Jennifer C. Uzochukwu
- Jennifer C. Uzochukwu, MS, is Graduate Student, Department of Kinesiology, Iowa State University, Ames
| | - Elizabeth L. Stegemöller
- Elizabeth L. Stegemöller, PhD, is Assistant Professor, Department of Kinesiology, Iowa State University, Ames;
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27
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Cabrera-Martos I, Ortiz-Rubio A, Torres-Sánchez I, López-López L, Rodríguez-Torres J, Carmen Valenza M. Agreement Between Face-to-Face and Tele-assessment of Upper Limb Functioning in Patients with Parkinson Disease. PM R 2019; 11:590-596. [PMID: 30840363 DOI: 10.1002/pmrj.12001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/13/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Upper limb disturbances are prevalent in patients with Parkinson disease (PD) and can limit their participation in activities of daily living. Tele-assessment of upper limb motor symptoms using an Internet application may be an alternative for addressing the growing demand for monitoring of disease progression. OBJECTIVE To evaluate the level of agreement between face-to-face and tele-assessment of patients with PD. DESIGN Reliability study. SETTING Parkinson's Disease Association. PARTICIPANTS Twenty-one patients with PD from a local association participated in the study. METHODS Patients attended a session for clinical face-to-face and real-time online tele-assessment. MAIN OUTCOME MEASUREMENTS Upper limb measures of function (assessed with the Manual Ability Measure 16), dexterity (evaluated using the coin rotation task), motor speed (assessed by the finger tapping test), tremor (evaluated with the Fahn-Tolosa-Marin Tremor Rating Scale), and range of motion (using the Kinovea software) were recorded by two independent researchers. RESULTS All the outcome measures evaluated showed a good interrater, intraclass correlation coefficient (ρ > 0.75). In addition, most confidence intervals were narrow and excluded 0.8. The lowest reliability was obtained for elbow flexion of the most affected upper limb (ρ = 0.75; confidence interval 0.49-0.89) and the highest reliability for finger tapping tests (ρ = 1; 1, 1). CONCLUSIONS This study demonstrates high interrater reliability of upper limb tele-assessment in patients with PD compared to a face-to-face assessment. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, 60 Ilustración Av., 18016 Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Torres-Sánchez
- 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
| | - M Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Alwardat M, Schirinzi T, Di Lazzaro G, Franco D, Imbriani P, Sinibaldi Salimei P, Mercuri NB, Pisani A. The influence of postural deformities on neck function and pain in patients with Parkinson’s disease. NeuroRehabilitation 2019; 44:79-84. [DOI: 10.3233/nre-182505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mohammad Alwardat
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Department of Neurosciences, Bambino Gesu Children Hospital, Rome, Italy
| | - Giulia Di Lazzaro
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
| | - Donatella Franco
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Paola Imbriani
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
- Fondazione Santa Lucia (IRCSS), Rome, Italy
| | - Antonio Pisani
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
- Fondazione Santa Lucia (IRCSS), Rome, Italy
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29
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Lee SH, Lee MJ, Lyoo CH, Cho H, Lee MS. Impaired finger dexterity and nigrostriatal dopamine loss in Parkinson's disease. J Neural Transm (Vienna) 2018; 125:1333-1339. [PMID: 29971496 DOI: 10.1007/s00702-018-1901-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/29/2018] [Indexed: 11/28/2022]
Abstract
Impaired finger dexterity occurs in Parkinson's disease (PD) and has been considered a limb-kinetic apraxia associated with primary sensory cortical dysfunction. To study the role of nigrostriatal dopamine loss and elementary parkinsonian motor deficits in impaired finger dexterity of PD. Thirty-two right-handed untreated PD patients and 30 right-handed healthy controls were included. All patients underwent [18F] FP-CIT positron emission tomography studies. We examined the associations among unilateral coin rotation (CR) score, Unified Parkinson's Disease Rating Scale (UPDRS) subscores for bradykinesia and rigidity of the corresponding arm, and contralateral regional striatal dopamine transporter (DAT) uptake. We also measured the effect of oral levodopa dose on CR scores and UPDRS subscores. PD patients performed worse than controls on the CR task. Unilateral arm UPDRS bradykinesia scores were associated with DAT uptake in the contralateral putamen. The left CR score was associated with left arm bradykinesia and rigidity scores and DAT uptake in the right posterior putamen, whereas no such associations were found for the right CR score. There was a significant effect of handedness on the association of putamen DAT uptake with CR scores, but not with UPDRS subscores. An oral levodopa challenge improved CR scores and UPDRS subscores on both sides. Impaired finger dexterity in PD is related to elementary parkinsonian motor deficits and nigrostriatal dopamine loss. Impaired dominant hand dexterity associated with nigrostriatal dopamine loss seems to be compensated to some extent by the dominant cerebral cortex specialized for controlling precise finger movements.
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Affiliation(s)
- S H Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea
| | - M J Lee
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
| | - C H Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea
| | - H Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea
| | - M S Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea.
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30
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Almuklass AM, Feeney DF, Mani D, Hamilton LD, Enoka RM. Peg-manipulation capabilities of middle-aged adults have a greater influence on pegboard times than those of young and old adults. Exp Brain Res 2018; 236:2165-2172. [PMID: 29785485 DOI: 10.1007/s00221-018-5294-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022]
Abstract
Declines in manual dexterity are frequently quantified as the time it takes to complete the grooved pegboard test. The test requires individuals to manipulate 25 pegs, one at a time, by removing them from a well and inserting them into a prescribed hole. The manipulation of each peg involves four phases: selection, transport, insertion, and return. The purpose of our study was to compare the times to complete the four phases of peg manipulation and the forces applied to the pegboard during peg insertion as young, middle-aged, and old adults performed the grooved pegboard test. The relative significance of the peg-manipulation attributes for 30 young (24.0 ± 4.4 years), 15 middle-aged (46.5 ± 6.5 years), and 15 old (70.4 ± 4.0 years) adults was assessed with a multiple-regression analysis. The grooved pegboard test was performed on a force plate. Pegboard times for the old adults (81 ± 17 s) were longer than those for young (56 ± 7 s) and middle-aged (58 ± 11 s) adults. Regression analysis indicated that the explanatory variables for the pegboard times of young (R2 = 0.33) and middle-aged (R2 = 0.78) adults were the times for the peg insertion and return phases, whereas the predictors for old adults (R2 = 0.49) were the times for the peg selection and transport phases. The relative influence of peg-manipulation capabilities on a pegboard test of manual dexterity was greater for middle-aged adults than for young and old adults.
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Affiliation(s)
- Awad M Almuklass
- Department of Integrative Physiology, University of Colorado, Boulder, CO, 80309, USA. .,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Daniel F Feeney
- Department of Integrative Physiology, University of Colorado, Boulder, CO, 80309, USA
| | - Diba Mani
- Department of Integrative Physiology, University of Colorado, Boulder, CO, 80309, USA
| | - Landon D Hamilton
- Department of Integrative Physiology, University of Colorado, Boulder, CO, 80309, USA
| | - Roger M Enoka
- Department of Integrative Physiology, University of Colorado, Boulder, CO, 80309, USA
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31
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Kübel S, Stegmayer K, Vanbellingen T, Walther S, Bohlhalter S. Deficient supplementary motor area at rest: Neural basis of limb kinetic deficits in Parkinson's disease. Hum Brain Mapp 2018; 39:3691-3700. [PMID: 29722099 DOI: 10.1002/hbm.24204] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/16/2018] [Accepted: 04/23/2018] [Indexed: 12/14/2022] Open
Abstract
Parkinson's disease (PD) patients frequently suffer from limb kinetic apraxia (LKA) affecting quality of life. LKA denotes an impairment of precise and independent finger movements beyond bradykinesia, which is reliably assessed by coin rotation (CR) task. BOLD fMRI detected activation of a left inferior parietal-premotor praxis network in PD during CR. Here, we explored which network site is most critical for LKA using arterial spin labeling (ASL). Based on a hierarchical model, we hypothesized that LKA would predominantly affect the functional integrity of premotor areas including supplementary motor areas (SMA). Furthermore, we suspected that for praxis function with higher demand on temporal-spatial processing such as gesturing, inferior parietal lobule (IPL) upstream to premotor areas would be essential. A total of 21 PD patients and 20 healthy controls underwent ASL acquisition during rest. Behavioral assessment outside the scanner involved the CR, finger tapping task, and the test of upper limb apraxia (TULIA). Whole-brain analysis of activity at rest showed a significant reduction of CR-related perfusion in the left SMA of PD. Furthermore, the positive correlation between SMA perfusion and CR, seen in controls, was lost in patients. By contrast, TULIA was significantly associated with the perfusion of left IPL in both patients and controls. In conclusion, the findings suggest that LKA in PD are linked to an intrinsic disruption of the left SMA function, which may only be overcome by compensatory network activation. In addition, gestural performance relies on IPL which remains available for functional recruitment in early PD.
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Affiliation(s)
- Stefanie Kübel
- Neurocenter, Luzerner Kantonsspital, Spitalstrasse 31, Luzern 16, 6000, Switzerland
| | - Katharina Stegmayer
- University Hospital of Psychiatry, Bolligenstrasse 111, Bern 60, 3000, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, Spitalstrasse 31, Luzern 16, 6000, Switzerland.,Gerontechnology and Rehabilitation Group, University of Bern, Murtenstrasse 50, Bern, 3008, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry, Bolligenstrasse 111, Bern 60, 3000, Switzerland
| | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Spitalstrasse 31, Luzern 16, 6000, Switzerland.,Department of Clinical Research, University of Bern, Bern, 3000, Switzerland
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32
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Alwardat M, Di Lazzaro G, Schirinzi T, Sinibaldi Salime P, Mercuri NB, Pisani A. Does Pisa syndrome affect upper limb function in patients with Parkinson’s disease? An observational cross-sectional study. NeuroRehabilitation 2018; 42:143-148. [DOI: 10.3233/nre-172274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mohammad Alwardat
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
| | - Giulia Di Lazzaro
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Department of Neurosciences, Bambino Gesú Children Hospital, Rome, Italy
| | | | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
- IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Antonio Pisani
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
- IRCSS Fondazione Santa Lucia, Rome, Italy
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Yoshitake Y, Ikeda A, Shinohara M. Robotic finger perturbation training improves finger postural steadiness and hand dexterity. J Electromyogr Kinesiol 2017; 38:208-214. [PMID: 29199081 DOI: 10.1016/j.jelekin.2017.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/25/2017] [Accepted: 11/16/2017] [Indexed: 11/28/2022] Open
Abstract
The purpose of the study was to understand the effect of robotic finger perturbation training on steadiness in finger posture and hand dexterity in healthy young adults. A mobile robotic finger training system was designed to have the functions of high-speed mechanical response, two degrees of freedom, and adjustable loading amplitude and direction. Healthy young adults were assigned to one of the three groups: random perturbation training (RPT), constant force training (CFT), and control. Subjects in RPT and CFT performed steady posture training with their index finger using the robot in different modes: random force in RPT and constant force in CFT. After the 2-week intervention period, fluctuations of the index finger posture decreased only in RPT during steady position-matching tasks with an inertial load. Purdue pegboard test score improved also in RPT only. The relative change in finger postural fluctuations was negatively correlated with the relative change in the number of completed pegs in the pegboard test in RPT. The results indicate that finger posture training with random mechanical perturbations of varying amplitudes and directions of force is effective in improving finger postural steadiness and hand dexterity in healthy young adults.
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Affiliation(s)
- Yasuhide Yoshitake
- Department of Sports and Life Sciences, National Institute of Fitness and Sports in Kanoya, Kagoshima, Japan
| | - Atsutoshi Ikeda
- Department of Mechanical Engineering, Kindai University, Osaka, Japan; Graduate School of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Minoru Shinohara
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA; Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan.
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Altered praxis network underlying limb kinetic apraxia in Parkinson's disease - an fMRI study. NEUROIMAGE-CLINICAL 2017; 16:88-97. [PMID: 28765808 PMCID: PMC5527158 DOI: 10.1016/j.nicl.2017.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/19/2017] [Accepted: 07/12/2017] [Indexed: 11/20/2022]
Abstract
Parkinson's disease (PD) patients frequently suffer from dexterous deficits impeding activities of daily living. There is controversy whether impaired fine motor skill may stem from limb kinetic apraxia (LKA) rather than bradykinesia. Based on classical models of limb praxis LKA is thought to result when premotor transmission of time-space information of skilled movements to primary motor representations is interrupted. Therefore, using functional magnetic resonance imaging (fMRI) we tested the hypothesis that dexterous deficits in PD are associated with altered activity and connectivity in left parieto-premotor praxis network. Whole-brain analysis of fMRI activity during a task for LKA (coin rotation) showed increased activation of superior and inferior parietal lobule (SPL, IPL) and ventral premotor cortex (vPM) in PD patients compared to controls. For bradykinesia (assessed by finger tapping) a decreased fMRI activity could be detected in patients. Additionally, psychophysical interaction analysis showed increased functional connectivity between IPL and the posterior hippocampi in patients with PD. By contrast, functional connectivity to the right dorsolateral prefrontal cortex was decreased in patients with PD compared to controls. In conclusion, our data demonstrates that dexterous deficits in PD were associated with enhanced fMRI activation of the left praxis network upstream to primary motor areas, mirroring a neural correlate for the behavioral dissociation of LKA and bradykinesia. Furthermore, the findings suggest that patients recruit temporal areas of motor memory as an attempt to compensate for impaired motor skills. Finally, dysexecutive function may contribute to the deficit. Impaired dexterity is related to a defective praxis network in PD. The findings support the concept of an underlying limb kinetic apraxia. Recruitment of temporal areas may reflect compensatory recall of motor engrams. Dysexecutive control in PD may contribute to impaired motor skill.
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Nackaerts E, Heremans E, Smits-Engelsman BCM, Broeder S, Vandenberghe W, Bergmans B, Nieuwboer A. Validity and reliability of a new tool to evaluate handwriting difficulties in Parkinson's disease. PLoS One 2017; 12:e0173157. [PMID: 28253374 PMCID: PMC5333892 DOI: 10.1371/journal.pone.0173157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/15/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Handwriting in Parkinson's disease (PD) features specific abnormalities which are difficult to assess in clinical practice since no specific tool for evaluation of spontaneous movement is currently available. OBJECTIVE This study aims to validate the 'Systematic Screening of Handwriting Difficulties' (SOS-test) in patients with PD. METHODS Handwriting performance of 87 patients and 26 healthy age-matched controls was examined using the SOS-test. Sixty-seven patients were tested a second time within a period of one month. Participants were asked to copy as much as possible of a text within 5 minutes with the instruction to write as neatly and quickly as in daily life. Writing speed (letters in 5 minutes), size (mm) and quality of handwriting were compared. Correlation analysis was performed between SOS outcomes and other fine motor skill measurements and disease characteristics. Intrarater, interrater and test-retest reliability were assessed using the intraclass correlation coefficient (ICC) and Spearman correlation coefficient. RESULTS Patients with PD had a smaller (p = 0.043) and slower (p<0.001) handwriting and showed worse writing quality (p = 0.031) compared to controls. The outcomes of the SOS-test significantly correlated with fine motor skill performance and disease duration and severity. Furthermore, the test showed excellent intrarater, interrater and test-retest reliability (ICC > 0.769 for both groups). CONCLUSION The SOS-test is a short and effective tool to detect handwriting problems in PD with excellent reliability. It can therefore be recommended as a clinical instrument for standardized screening of handwriting deficits in PD.
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Affiliation(s)
| | - Elke Heremans
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Sanne Broeder
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Wim Vandenberghe
- Department of Neurosciences, KU Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Bruno Bergmans
- Department of Neurology, A.Z. Sint-Jan Brugge-Oostende, Bruges, Belgium
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Hwang S, Song CS. Relationship between manual dexterity and the unified parkinson's disease rating scale-motor exam. J Phys Ther Sci 2017; 28:3403-3406. [PMID: 28174461 PMCID: PMC5276770 DOI: 10.1589/jpts.28.3403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/20/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the relationships between manual
dexterity and the Unified Parkinson’s Disease Rating Scale-Motor Exam as a clinical tool
for quantifying upper extremity function in persons with Parkinson’s disease. [Subjects
and Methods] Thirty-two persons with idiopathic Parkinson’s disease participated in this
study. This study measured two clinical outcomes, the box-and-block test and the Unified
Parkinson’s Disease Rating Scale-Motor Exam, to investigate the relationships between
manual dexterity and the Unified Parkinson’s Disease Rating Scale-Motor Exam. [Results]
The box-and-block test on the more affected side was positive relationship with the
box-and-block test on the less affected side. The Unified Parkinson’s Disease Rating
Scale-motor exam score had a negative correlation with the box-and-block test results for
both sides. [Conclusion] A positive association was noted between manual dexterity and
motor function in patients with idiopathic Parkinson disease. The results of this study
suggest that the box-and-block test and the Unified Parkinson’s Disease Rating Scale-Motor
Exam are good clinical measures that quantify upper extremity function and are necessary
for the accurate evaluation of patients and to plan intervention strategies.
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Affiliation(s)
- Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Republic of Korea
| | - Chiang-Soon Song
- Department of Occupational Therapy, College of Health Science, Chosun University, Republic of Korea
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Reliability and validity of a new dexterity questionnaire (DextQ-24) in Parkinson's disease. Parkinsonism Relat Disord 2016; 33:78-83. [DOI: 10.1016/j.parkreldis.2016.09.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 12/23/2022]
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Motor performance differentiates individuals with Lewy body dementia, Parkinson's and Alzheimer's disease. Gait Posture 2016; 50:1-7. [PMID: 27544062 DOI: 10.1016/j.gaitpost.2016.08.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/08/2016] [Accepted: 08/10/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Differential diagnosis of dementia with Lewy bodies (DLB), Parkinson's disease with dementia (PDD), Parkinson's disease (PD) and Alzheimer's disease (AD) is challenging. Comparative motor profiles of these neurodegenerative disorders may aid in earlier diagnosis but have not been extensively studied. METHODS Groups were rigorously matched by age, education, and sex. DLB/PDD participants were matched by Mini-Mental State Examination Score to individuals with AD and by Unified Parkinson's Disease Rating Scale motor scores to individuals with PD. Gait, balance, dual task walking and hand dexterity measures were compared between a combined group (n=21) of individuals with Lewy body dementia (LBD) consisting of those with DLB (n=11) and PDD (n=10) to individuals with PD (n=21) or AD (n=21). RESULTS Individuals at the same disease stage with LBD walked significantly slower with shorter stride lengths (p<0.05), demonstrated poorer balance on both the Tinetti and Berg Balance Scale, and poorer performance on dual-task and figure-of-eight walking compared to PD and AD (p<0.05 for all) groups. Upper extremity coordination on the 9-hole peg test differentiated LBD from both PD and AD and was the only motor test in which individuals with AD performed worse than those with PD. Tinetti balance subscores were significantly lower in PDD compared to DLB participants (10.4±2.3 versus 12.8±2.3; p=0.027). CONCLUSIONS Motor features distinguish individuals with LBD from those with AD and PD. Measures of gait, balance and finger dexterity provide an additional means of differentiating individuals with LBD from those with AD and PD.
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On the assessment of coordination between upper extremities: towards a common language between rehabilitation engineers, clinicians and neuroscientists. J Neuroeng Rehabil 2016; 13:80. [PMID: 27608923 PMCID: PMC5017057 DOI: 10.1186/s12984-016-0186-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022] Open
Abstract
Well-developed coordination of the upper extremities is critical for function in everyday life. Interlimb coordination is an intuitive, yet subjective concept that refers to spatio-temporal relationships between kinematic, kinetic and physiological variables of two or more limbs executing a motor task with a common goal. While both the clinical and neuroscience communities agree on the relevance of assessing and quantifying interlimb coordination, rehabilitation engineers struggle to translate the knowledge and needs of clinicians and neuroscientists into technological devices for the impaired. The use of ambiguous definitions in the scientific literature, and lack of common agreement on what should be measured, present large barriers to advancements in this area. Here, we present the different definitions and approaches to assess and quantify interlimb coordination in the clinic, in motor control studies, and by state-of-the-art robotic devices. We then propose a taxonomy of interlimb activities and give recommendations for future neuroscience-based robotic- and sensor-based assessments of upper limb function that are applicable to the everyday clinical practice. We believe this is the first step towards our long-term goal of unifying different fields and help the generation of more consistent and effective tools for neurorehabilitation.
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40
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Mak MKY, Lau ETL, Tam VWK, Woo CWY, Yuen SKY. Use of Jebsen Taylor Hand Function Test in evaluating the hand dexterity in people with Parkinson's disease. J Hand Ther 2016; 28:389-94; quiz 395. [PMID: 26227308 DOI: 10.1016/j.jht.2015.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 02/13/2015] [Accepted: 05/11/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To investigate the test-retest reliability of JTT in older patients with Parkinson's disease (PD); and to compare the Jebsen Taylor Hand Function Test (JTT) scores between PD and healthy subjects. STUDY DESIGN Cross-sectional comparative study. METHODS Fifteen PD and fifteen healthy subjects performed the JTT and the time taken to complete the JTT was recorded. RESULTS Test-retest reliabilities of JTT subtests and total score of both dominant and non-dominant hand were good to excellent (ICCs = 0.77-0.97) except J5 checkers which had moderate reliability. PD subjects required significantly longer time to finish subtests and the whole JTT (p < 0.05), except the subtest J1 writing of dominant hand that showed marginal significance (p = 0.059). CONCLUSION JTT is a reliable and easily available assessment tool for assessing the hand function of PD subjects. PD subjects took a longer time to complete the JTT, suggesting that they have deficits in gross and fine functional dexterity.
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Affiliation(s)
- M K Y Mak
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - E T L Lau
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - V W K Tam
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - C W Y Woo
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - S K Y Yuen
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Chung C, Mak M. Effect of Repetitive Transcranial Magnetic Stimulation on Physical Function and Motor Signs in Parkinson's Disease: A Systematic Review and Meta-Analysis. Brain Stimul 2016; 9:475-87. [DOI: 10.1016/j.brs.2016.03.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 03/17/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022] Open
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Foki T, Vanbellingen T, Lungu C, Pirker W, Bohlhalter S, Nyffeler T, Kraemmer J, Haubenberger D, Fischmeister FPS, Auff E, Hallett M, Beisteiner R. Limb-kinetic apraxia affects activities of daily living in Parkinson's disease: a multi-center study. Eur J Neurol 2016; 23:1301-7. [PMID: 27132653 DOI: 10.1111/ene.13021] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Impaired dexterity (fine hand movements) is often present in Parkinson's disease (PD), even at early to moderate disease stages. It has a detrimental impact on activities of daily living (ADL) such as buttoning, contributing to reduced quality of life. Limb-kinetic apraxia, a loss of the ability to make precise, independent but coordinated finger and hand movements, may contribute to impaired dexterity even more than bradykinesia per se. However, the impact of limb-kinetic apraxia on ADL remains controversial. Our aim was to identify the strongest predictor of buttoning and unbuttoning in PD. It was hypothesized that coin rotation (a surrogate of limb-kinetic apraxia) represents the most important determinant. METHODS Sixty-four right-handed, early to moderate PD patients were recruited from three movement disorder centers (Hoehn andYahr stages 1-3). Buttoning, unbuttoning and coin rotation (right and left hand) represented the target tasks. Motor impairment was assessed according to the Unified Parkinson's Disease Rating Scale. RESULTS Multiple linear regression analysis showed that coin rotation with the right hand was the only significant predictor of buttoning (P < 0.001) and unbuttoning (P = 0.002). Notably, measures of bradykinesia or overall motor impairment did not represent significant predictors. CONCLUSIONS Constituting the novel key finding, limb-kinetic apraxia seems to be particularly relevant for ADL requiring dexterity skills in PD, even at early to moderate disease stages. Our results prompt research into the pathophysiological background and therapeutic options to treat limb-kinetic apraxia. The simple coin rotation test provides valuable information about ADL-related dexterity skills.
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Affiliation(s)
- T Foki
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,MR Center of Excellence, Medical University of Vienna, Vienna, Austria
| | - T Vanbellingen
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Bern, Switzerland.,Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - C Lungu
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - W Pirker
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - S Bohlhalter
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Bern, Switzerland.,Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - T Nyffeler
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Bern, Switzerland.,Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - J Kraemmer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - D Haubenberger
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - F Ph S Fischmeister
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,MR Center of Excellence, Medical University of Vienna, Vienna, Austria
| | - E Auff
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - M Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - R Beisteiner
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,MR Center of Excellence, Medical University of Vienna, Vienna, Austria
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Heremans E, Nackaerts E, Broeder S, Vervoort G, Swinnen SP, Nieuwboer A. Handwriting Impairments in People With Parkinson's Disease and Freezing of Gait. Neurorehabil Neural Repair 2016; 30:911-919. [PMID: 27094858 DOI: 10.1177/1545968316642743] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent studies show that patients with Parkinson's disease (PD) and freezing of gait (FOG) experience motor problems outside their gait freezing episodes. Because handwriting is also a sequential movement, it may be affected in PD patients with FOG relative to those without. OBJECTIVE The current study aimed to assess the quality of writing in PD patients with and without FOG in comparison to healthy controls (CTs) during various writing tasks. METHODS Handwriting was assessed by the writing of cursive loops on a touch-sensitive writing tablet and by means of the Systematic Screening of Handwriting Difficulties (SOS) test in 30 PD patients with and without freezing and 15 healthy age-matched CTs. The tablet tests were performed at 2 different sizes, either continuously or alternatingly, as indicated by visual target lines. RESULTS Patients with freezing showed decreased writing amplitudes and increased variability compared with CTs and patients without freezing on the writing tablet tests. Writing problems were present during both tests but were more pronounced during writing at alternating compared with writing at continuous size. Patients with freezing also had a higher total score on the SOS test than patients without freezing and CTs, reflecting more extensive handwriting problems, particularly with writing fluency. CONCLUSIONS Writing is more severely affected in PD patients with FOG than in those without FOG. These results indicate that deficient movement sequencing and adaptation is a generic problem in patients with FOG.
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Smits EJ, Tolonen AJ, Cluitmans L, van Gils M, Zietsma RC, Borgemeester RWK, van Laar T, Maurits NM. Graphical Tasks to Measure Upper Limb Function in Patients With Parkinson's Disease: Validity and Response to Dopaminergic Medication. IEEE J Biomed Health Inform 2015; 21:283-289. [PMID: 26625435 DOI: 10.1109/jbhi.2015.2503802] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The most widely used method to assess motor functioning in Parkinson's disease (PD) patients is the unified Parkinson's disease rating scale-III (UPDRS-III). The UPDRS-III has limited ability to detect subtle changes in motor symptoms. Alternatively, graphical tasks can be used to provide objective measures of upper limb motor dysfunction. This study investigated the validity of such graphical tasks to assess upper limb function in PD patients and their ability to detect subtle changes in performance. Fourteen PD patients performed graphical tasks before and after taking dopaminergic medication. Graphical tasks included figure tracing, writing, and a modified Fitts' task. The Purdue pegboard test was performed to validate these graphical tasks. Movement time (MT), writing size, and the presence of tremor were assessed. MT on the graphical tasks correlated significantly with performance on the Purdue pegboard test (Spearman's ρ > 0.65; p < 0.05). MT decreased significantly after the intake of dopaminergic medication. Tremor power decreased after taking dopaminergic medication in most PD patients who suffered from tremor. Writing size did not correlate with performance on the Purdue pegboard test, nor did it change after taking medication. Our set of graphical tasks is valid to assess upper limb function in PD patients. MT proved to be the most useful measure for this purpose. The response on dopaminergic medication was optimally reflected by an improved MT on the graphical tasks in combination with a decreased tremor power, whereas writing size did not respond to dopaminergic treatment.
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Effects of a Single Hand-Exercise Session on Manual Dexterity and Strength in Persons with Parkinson Disease: A Randomized Controlled Trial. PM R 2015; 8:115-22. [PMID: 26079867 DOI: 10.1016/j.pmrj.2015.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/30/2015] [Accepted: 06/06/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the effects on manual dexterity, hand grip, and pinch strength of a single intervention focused on hand exercises. DESIGN Randomized, controlled, blinded study. PATIENTS Sixty people with Parkinson disease (PD) were recruited; 30 participants were allocated to a brief exercise session and 30 to a control group. INTERVENTIONS Participants randomized to the experimental group received a 15-minute exercise session focused on hand training using therapeutic putty. Participants allocated to the control group performed active upper limb exercises. MAIN OUTCOME MEASUREMENTS Measures of manual dexterity (assessed by the Purdue Pegboard Test and the Chessington Occupational Therapy Neurologic Assessment Battery dexterity task) and strength (hand grip and pinch strength) were recorded at baseline and after the intervention. RESULTS Participants had significantly improved manual dexterity values (P < .05) after the intervention. They also had increased hand grip (P < .001) and pinch strength (P < .05). CONCLUSIONS A single hand-exercise session showed an improvement in manual dexterity and strength in persons with PD.
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46
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Lin KC, Wu YF, Chen IC, Tsai PL, Wu CY, Chen CL. Dual-Task Performance Involving Hand Dexterity and Cognitive Tasks and Daily Functioning in People With Schizophrenia: A Pilot Study. Am J Occup Ther 2015; 69:6903250020p1-7. [DOI: 10.5014/ajot.2014.014738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. This study investigated separate and concurrent performance on cognitive and hand dexterity tasks and the relationship to daily functioning in 16 people with schizophrenia and 16 healthy control participants.
METHOD. Participants performed the Purdue Pegboard Test and the Serial Seven Subtraction Test under single- and dual-task conditions and completed two daily functioning evaluations.
RESULTS. The hand dexterity of all participants declined in the dual-task condition, but the discrepancy between single-task and dual-task hand dexterity was greater in the schizophrenia group than in the control group (p < .03, d > .70, for all). The extent of discrepancy in hand dexterity was negatively correlated with daily functioning in the schizophrenia group (rs = −.3 to −.5, ps = .04–.26).
CONCLUSION. Ability to perform dual tasks may be an indicator of daily functioning in people with schizophrenia. Use of dual-task training may be considered as a therapeutic activity with these clients.
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Affiliation(s)
- Keh-chung Lin
- Keh-chung Lin, ScD, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei
| | - Yi-fang Wu
- Yi-fang Wu, MS, is Occupational Therapist, Department of Psychiatry, National Taiwan University Hospital, Taipei
| | - I-chen Chen
- I-chen Chen, MS, is Research Assistant, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei
| | - Pei-luen Tsai
- Pei-luen Tsai, PhD, is Associate Professor, Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-yi Wu
- Ching-yi Wu, ScD, is Professor and Chair, Department of Occupational Therapy, College of Medicine, Chang Gung University, Tao-Yuan County, Taiwan;
| | - Chia-ling Chen
- Chia-ling Chen, PhD, is Professor, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Tao-Yuan County, Taiwan
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Proud EL, Miller KJ, Bilney B, Balachandran S, McGinley JL, Morris ME. Evaluation of Measures of Upper Limb Functioning and Disability in People With Parkinson Disease: A Systematic Review. Arch Phys Med Rehabil 2015; 96:540-551.e1. [DOI: 10.1016/j.apmr.2014.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/01/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
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Grip force modulation characteristics as a marker for clinical disease progression in individuals with Parkinson disease: case-control study. Phys Ther 2015; 95:369-79. [PMID: 25476717 PMCID: PMC4757638 DOI: 10.2522/ptj.20130570] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Upper extremity deficits are prevalent in individuals with Parkinson disease (PD). In the early stages of PD, such deficits can be subtle and challenging to document on clinical examination. OBJECTIVE The purpose of this study was to use a novel force sensor system to characterize grip force modulation, including force, temporal, and movement quality parameters, during a fine motor control task in individuals with early stage PD. DESIGN A case-control study was conducted. METHODS Fourteen individuals with early stage PD were compared with a control group of 14 healthy older adults. The relationship of force modulation parameters with motor symptom severity and disease chronicity also was assessed in people with PD. Force was measured during both precision and power grasp tasks using an instrumented twist-cap device capable of rotating in either direction. RESULTS Compared with the control group, the PD group demonstrated more movement arrests during both precision and power grasp and longer total movement times during the power grasp. These deficits persisted when a concurrent cognitive task was added, with some evidence of force control deficits in the PD group, including lower rates of force production during the precision grasp task and higher peak forces during the power grasp task. For precision grasp, a higher number of movement arrests in single- and dual-task conditions as well as longer total movement times in the dual-task condition were associated with more severe motor symptoms. LIMITATIONS The sample was small and consisted of individuals in the early stages of PD with mild motor deficits. The group with PD was predominantly male, whereas the control group was predominantly female. CONCLUSION The results suggest that assessing grip force modulation deficits during fine motor tasks is possible with instrumented devices, and such sensitive measures may be important for detecting and tracking change early in the progression of PD.
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Roberts HC, Syddall HE, Butchart JW, Stack EL, Cooper C, Sayer AA. The Association of Grip Strength With Severity and Duration of Parkinson’s. Neurorehabil Neural Repair 2015; 29:889-96. [DOI: 10.1177/1545968315570324] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Weakness is reported in Parkinson’s but always unadjusted for recognized factors that influence muscle strength such as participants’ age, gender, and body size. This may obscure the true association of Parkinson’s with muscle strength. Objective. To evaluate the relationship between grip strength, Parkinson’s severity, and duration adjusting for these factors. Methods. Age, gender, height, weight, grip strength, Unified Parkinson’s Disease Rating Score (UPDRS) motor score, Hoehn and Yahr (H&Y) stage, disease duration, number of comorbidities and medications, Barthel score, Mini Mental State Examination (MMSE) score, and Malnutrition Universal Screening Tool (MUST) score were recorded. Results. Fifty-seven of 79 (72%) people with Parkinson’s resident in one town were recruited. Age, gender, height, and Parkinson’s severity were the most significant determinants of grip strength. Each unit increase in UPDRS motor score and H&Y stage was associated with lower grip strength in univariate linear regression analyses adjusted for gender: −0.3 kg strength (95% confidence interval = −0.51, −0.09), P = .006 for each additional UPDRS point, and −3.87 kg strength (95% confidence interval = −6.54, −1.21), P = .005 for each additional H&Y stage. Disease duration was not associated with grip strength. In multivariate regression, Parkinson’s severity remained strongly associated with grip strength (UPDRS score P = .09; H&Y stage P = .04). Conclusions. This is the first demonstration that increasing severity of Parkinson’s was associated with weaker grip after adjustment for known influences on muscle strength. Participants’ age, gender, and body size also had a significant impact on strength. Adjustment of reported values for all these factors is essential to allow accurate reporting of grip strength values in intervention trials and comparison between different groups.
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Affiliation(s)
- Helen C. Roberts
- University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Joe W. Butchart
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Avan A. Sayer
- University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Simpson J, McMillan H, Leroi I, Murray CD. Experiences of apathy in people with Parkinson's disease: a qualitative exploration. Disabil Rehabil 2014; 37:611-9. [PMID: 25070650 DOI: 10.3109/09638288.2014.939771] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Research has suggested that people with Parkinson's disease (PD) can experience apathy. This study explored the lived experiences of apathy in people with PD. METHOD Seven participants with Parkinson's disease who were also described as having apathy were interviewed and the data analysed using interpretative phenomenological analysis. RESULTS The findings were understood within three overlapping themes: (1) "The apathy creeps into jobs that I used to be able to do and no longer can do": Reduced motivation in response to the consequences of impairment; (2) "I hate at the end of the day if I've achieved nothing": The (un)acceptability of apathy; (3) "They say 'come on you lazy b*gger, get something done'": The social context of apathy. CONCLUSIONS These themes are compared to wider research on apathy, PD and chronic illness. This study offers a view that, for some, apathy may be experienced as a number of behavioural choices influenced by increasing impairment and enacted in a social context. It presents an alternative conceptualisation from one describing apathy as the sole result of an endogenous disease process. As such, a number of therapeutic options are discussed but with the caveat that "apathy" need not always be the focus for intervention. Implications for Rehabilitation Apathy is a term used to denote a decrease in motivation and, although widely used, lacks conceptual clarity. Therefore the personal meaning of the behaviour for the individual within the context of their illness must be considered on assessment. Apathy is a societal as well as personal issue and the therapist also needs to assess the meaning and implications of the behaviour in the individual's social context. Practitioners need to be aware that apathy need not always be a focus for intervention. Discussion around the meaning of the behaviour may be all which is needed. Where individuals do wish to change their behaviours, a number of behavioural and psychological approaches are available. "Third wave" psychological therapies such as compassion- and acceptance-based approaches seem useful although none currently have any evidence base specifically with people with Parkinson's disease.
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Affiliation(s)
- Jane Simpson
- Division of Health Research, Lancaster University , Lancaster , UK
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