Using the Timed Up & Go test in a clinical setting to predict falling in Parkinson's disease

Improvements in clinical signs and symptoms of Parkinson's disease using photobiomodulation: a five-year follow-up

BACKGROUND

Parkinson's disease is a progressive neurodegenerative disease characterized by clinical motor signs and non-motor symptoms that severely impact quality of life. There is an urgent need for therapies that might slow, halt or even reverse the progression of existing symptoms or delay the onset of new symptoms. Photobiomodulation is a therapy that has shown potential to alleviate some symptoms of Parkinson's disease in animal studies and in small clinical trials.

OBJECTIVE

To assess long-term effectiveness of photobiomodulation therapy in a cohort of Parkinson's disease individuals after five years of continuing therapy.

METHODS

Eight participants of the initial 12 in a previously published study agreed to be reassessed after five years. Seven of these participants had continued home-based, self-applied photobiomodulation therapy three times per week for five years. One participant had discontinued treatment after one year. Participants were assessed for a range of clinical motor signs, including MDS-UPDRS-III, measures of mobility and balance. Cognition was assessed objectively, and quality of life and sleep quality were assessed using self-reported questionnaires. A Wilcoxon Signed Ranks test was used to evaluate change in outcome measures between baseline (before treatment) and after five years, with the alpha value set to 0.05.

RESULTS

Of the seven participants who had continued photobiomodulation therapy, one had a preliminary diagnosis of multisystem atrophy and was excluded from the group analysis. For the remaining six participants, there was a significant improvement in walk speed, stride length, timed up-and-go tests, tests of dynamic balance, and cognition compared to baseline and nonsignificant improvements in all other measures, apart from MDS-UPDRS-III, which was unchanged and one measure of static balance (single leg stance, standing on the unaffected leg with eyes open) which declined. Five of six participants either improved or showed no decline in MDS-UPDRS-III score and most participants showed improvement or no decline in all other outcome measures. No adverse effects of the photobiomodulation therapy were reported.

CONCLUSIONS

This study provides a signal that photobiomodulation therapy might safely reduce important clinical motor signs and non-motor symptoms in some Parkinson's disease patients, with improvements maintained over several years. Home-based photobiomodulation therapy has the potential to complement standard therapies to manage symptoms and potentially delay Parkinson's symptom progression.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, registration number ACTRN12618000038291p, registered on 12/01/2018.

The IntegraPark Study: An Opportunity to Facilitate High-Intensity Exercise with Immersive Virtual Reality in Parkinson's Disease Patients

BACKGROUND

high-intensity exercise is a feasible and effective modality in the early stages of Parkinson's disease (PD). However, there are only a few studies that have carried out this type of intervention in customizable immersive virtual reality (IVR) environments. We explore the feasibility and effects of IVR-based high-intensity training through rowing and cycling exercises on the functional capacity, quality of life, and progression of PD.

METHODS

a total of 12 participants (61.50 ± 10.49 years old; 41.7% female, 58.3% male; stages I-III) were part of the study, which consisted of interventions of rowing and cycling in an IVR commercial exergame (25 min; twice per week for 14 weeks). The main variables measured were functional capacity, handgrip strength, functional mobility (TUG), functional lower-limb strength (FTSST), aerobic capacity (2-min step test), quality of life (PDQ-39), and Parkinson's disease progression (MDS-UPDRS).

RESULTS

the results showed a general improvement in handgrip strength in both hands (p = 0.008; d = 0.28), FTSST (p = 0.029; d = 0.96), and TUG times (p = 0.152; d = 0.22). Aerobic capacity, assessed by a 2-min step test, showed enhanced scores (p = 0.031; d = 0.78). Related to the PDQ-39, all dimensions of the scale were enhanced, highlighting activities of daily living (p = 0.047; d = 0.29) and bodily discomfort (p = 0.041; d = 0.37). Finally, the main symptoms of the disease were reduced, with an improvement in the parameters that show a better incidence of disease progression, such as Part IA and IB (p = 0.013; d = 0.29 and p = 0.021; d = 0.25, respectively), Part II (p = 0.021; d = 0.23), Part III (p = 0.040; d = 0.39), and Part IV (p = 0.013; d = 0.39).

CONCLUSIONS

the therapeutic exercise (rowing and cycling), when carried out at a high intensity and in a personalized IVR scenario, appear to be a feasible and safe modality for patients with stages I-III of PD, improving their functional capacity, quality of life, and disease progression.

Study Protocol for Mindfulness-Based Yoga Versus Physical Exercise on the Psychological Well-Being in Students With Early Visual Impairment: A Three-Armed, Multi-Centered, Randomized Controlled Trial

Background People with visual impairment (VI) tend to face more psychological distress than normally sighted individuals due to mobility restrictions, fear of falling, and sleep disturbances. However, research to address these problems is rare. This study aims to investigate the effect of mindfulness-based yoga versus physical exercise on the psychological well-being of individuals with VI. Methods This study will be a single-blinded, three-armed, multicentered, randomized controlled trial (RCT). A total of 132 participants with VI (ages 15-25) will be recruited in the study and will be randomly assigned to either group 1 (mindfulness-based yoga), group 2 (physical exercise), or group 3 (wait-list control). Groups 1 and 2 will receive intervention for 40 hours (eight weeks, weekly five days, one hour/day), whereas group 3 will continue their daily activities as usual. The intervention will take place in the afternoon from Monday to Friday. The timing varies between 4-5 pm according to the different time schedules of the institutions of the blind. Three times, assessments will be conducted at T0 (baseline), T1 (eighth week at the completion of the intervention), and T2 (sixth month following the completion of the intervention). ANOVA will be used to find out the differences between groups; repeated measures ANOVA will be used to check within-group changes. Trial status The study was first screened in December 2021. The recruitment of participants has been completed in two centers covering 62 individuals with VI, and intervention started in August 2022. The data collection is still ongoing due to the nature of the study design, a specific demographic, complex logistics, and administrative bottlenecks. The study incorporates three different groups and a substantial sample size (n=132). The specific demographic, people with visual impairments, are rare and difficult to locate. In addition, a six-month follow-up assessment contributes to complex procedures while coordinating between various institutions and securing necessary authorizations. Discussion This study will be the first comprehensive RCT to investigate the psychological well-being of the VI population with various psychophysiological and hormonal parameters in multiple centers. The presence of physical exercise and a wait-list control group will further elucidate the potential mechanism of Mindfulness-based yoga. Mindfulness-based yoga can be integrated into educational and rehabilitation systems to enhance the well-being of individuals with VI.

Effects of motor and cognitive complex training on obstacle walking and brain activity in people with Parkinson's disease: a randomized controlled trial

BACKGROUND

The difficulties in obstacle walking are significant in people with Parkinson's disease (PD) leading to an increased fall risk. Effective interventions to improve obstacle walking with possible training-related neuroplasticity changes are needed. We developed two different exercise programs, complex walking training and motor-cognitive training, both challenging motor and cognitive function for people with PD to improve obstacle walking.

AIM

To investigate the effects of these two novel training programs on obstacle walking and brain activities in PD.

DESIGN

A single-center randomized, single-blind controlled study.

SETTING

University laboratory; outpatient.

POPULATION

Individuals with idiopathic PD.

METHODS

Thirty-two participants were randomly assigned to the complex walking training group (N.=11), motor-cognitive training group (N.=11) or control group (N.=10). Participants in training groups received exercises for 40 minutes/session, with a total of 12-session over 6 weeks. Control group did not receive additional training. Primary outcomes included obstacle walking, and brain activities (prefrontal cortex (PFC), premotor cortex (PMC), and supplementary motor area (SMA)) during obstacle walking by using functional near-infrared spectroscopy. Secondary outcomes included obstacle crossing, timed up and go test (TUG), cognitive function in different domains, and fall efficacy scale (FES-I).

RESULTS

The motor-cognitive training group demonstrated greater improvements in obstacle walking speed and stride length, SMA activity, obstacle crossing velocity and stride length, digit span test, and TUG than the control group. The complex walking training did not show significant improvement in obstacle walking or change in brain activation compared with control group. However, the complex walking training resulted in greater improvements in Rey-Osterrieth Complex Figure test, TUG and FES-I compared with the control group.

CONCLUSIONS

Our 12-session of the cognitive-motor training improved obstacle walking performance with increased SMA activities in people with PD. However, the complex walking training did not lead such beneficial effects as the cognitive-motor training.

CLINICAL REHABILITATION IMPACT

The cognitive-motor training is suggested as an effective rehabilitation program to improve obstacle walking ability in individuals with PD.

EFFECTS OF TREADMILL GAIT TRAINING ON BALANCE IN PARKINSON'S PATIENTS AFTER DEEP BRAIN STIMULATION

Objective

After deep brain stimulation (DBS), patients with Parkinson's disease (PD) typically still present significant gait and postural stability problems, and thus additional interventions are needed. In this way, our purpose was evaluate the comparative effectiveness of treadmill training, with and without body weight support, on balance outcomes among patients with PD after DBS.

Methods

Eleven patients with PD that were using bilateral subthalamic nucleus DBS were evaluated using Time Up and Go test (TUG); Berg Balance Scale (BBS) and Static Posturography. In phase 1, all subjects participated in 8-weeks of treadmill training in conjunction with conventional physiotherapy. After six weeks (wash-out), each patient then participated in a subsequent 8-weeks of treadmill training with partial body weight support.

Results

After the phase 1, there were improvements on the cognitive TUG performance (Before: 15.7 ± 1,8 sec; After: 13.7 ± 3.1 sec; p < 0.01) and an increase of anteroposterior and medio-lateral body oscillation with eyes closed. After the phase 2, there were improvements in conventional (Before: 12.3 ± 2.0 sec; After: 10.7 ± 1.7 sec; p < 0.01) and cognitive (Before: 14.6 ± 3.5 sec; After: 12.5 ± 1.6 sec; p < 0.05) TUG performances. There were no significant changes in the Berg Balance Scale following either training protocol.

Conclusion

Both trainings improved static and dynamic balance and had similar results; however, supported treadmill training seemed to be a potentially superior option, as patients tended to feel safer. Level of Evidence II, therapeutic studies - investigation of treatment outcomes.

Reimagining Day Rehabilitation For Frailty and Neurodegenerative Conditions through the integrated Rehabilitation and EnAblement Program (iREAP)

Background

integrated Rehabilitation and EnAblement Program (iREAP) is an innovative redesign of the traditional day rehabilitation model, providing an anticipatory, early assessment and intervention program that manages care of community-dwelling older people with complex needs. It coordinates access to disciplines across medical, allied health and nursing, with a self-management focus, partnering with primary health in an integrated approach.

Objective

This observational study reviews the effectiveness of iREAP on frailty, patient activation, quality of life and physical outcome measures on older people at risk of, or experiencing falls and frailty, or with neurodegenerative conditions, including Parkinson's Disease.

Methods

99 participants completed the eight-week multidisciplinary program. Patient outcome measures included Rockwood Clinical Frailty Scale, quality of life measures, Patient Activation Measure, Timed Up and Go, 6 Minute Walk Test and Berg Balance Scale.

Results

On completion of iREAP, participants displayed improvements in their Rockwood Clinical Frailty Scores (mildly frail to vulnerable), 'patient activation' (55.08 to 60.61), quality of life (Parkinson's Disease Questionnaire-39, 49.93 to 47.16; WHO Quality of Life - Bref physical domain, 21 to 22.7) and physical measures including balance (44 to 49/56 Berg Balance scale) and mobility (294 m to 336 m, 6-minute walk test). Falls were not reduced at twelve months post-program (3.40 to 2.01).

Conclusion

iREAP is an interdisciplinary, early assessment and intervention program with the potential to reverse frailty and improve quality of life for complex older patients. This paper offers a platform for future research, given the paucity of evidence reviewing the efficacy of integrated anticipatory models of care in older adults with complex needs.

A Retrospective Analysis of Group-Based Boxing Exercise on Measures of Physical Mobility in Patients With Parkinson Disease

OBJECTIVES

The purpose of this retrospective study is to further the limited body of evidence regarding the effects of a group-based boxing intervention for those with Parkinson's disease (PD).

DESIGN

A retrospective cohort study was performed analyzing data collected on outcome measures at 6-month intervals up to 2 years. Individuals participated in the standardized "Rock Steady Boxing" (RSB) program for up to 24 months. Every 6 months, measures were taken of balance (Fullerton Advanced Balance [FAB] Scale), functional mobility (Timed-Up and Go [TUG]), lower extremity strength (30-second Chair Stand [30CST]), and gait speed (10 Meter Walk Test [10MWT]).

METHODS

Statistical significance (P < .05) was determined by a two-tailed t test. Data were collected from RSB-affiliated programs at 4 locations across the southeastern United States. Current and/or past participants in RSB with baseline and at least one subsequent outcome measure were included, resulting in 68 participants (54 male, 14 female, and mean age of 71.2 years ± 8.56 standard deviation).

RESULTS

Statistically significant improvements in FAB scale, TUG, and 30CST over time were found at both 6- and 12-month time points. Significant changes continued through 18 months for FAB and 30CST. No significant changes in 10MWT were observed; however, a moderate effect size was observed at the 1-year point.

CONCLUSIONS

Participants with PD were able to achieve statistically significant improvements in standard measures of functional mobility, balance, and strength within the timeline of this study. Limitations include the retrospective nature, an inability to monitor adherence, and lack of control over pharmaceutical or other interventions.

Optimal dosage ranges of various exercise types for enhancing timed up and go performance in Parkinson's disease patients: a systematic review and Bayesian network meta-analysis

Objective

To examine the dose-response relationship between specific types of exercise for alleviating Timed up and Go (TUG) in Parkinson's disease PD.

Design

Systematic review and Bayesian network meta-analysis.

Data sources

PubMed, Medline, Embase, PsycINFO, Cochrane Library, and Web of Science were searched from inception until February 5th, 2024.

Study analysis

Data analysis was conducted using R software with the MBNMA package. Effect sizes of outcome indicators were expressed as mean deviation (MD) and 95% confidence intervals (95% CrI). The risk of bias in the network was evaluated independently by two reviewers using ROB2.

Results

A total of 73 studies involving 3,354 PD patients. The text discusses dose-response relationships in improving TUG performance among PD patients across various exercise types. Notably, Aquatic (AQE), Mix Exercise (Mul_C), Sensory Exercise (SE), and Resistance Training (RT) demonstrate effective dose ranges, with AQE optimal at 1500 METs-min/week (MD: -8.359, 95% CI: -1.398 to -2.648), Mul_C at 1000 METs-min/week (MD: -4.551, 95% CI: -8.083 to -0.946), SE at 1200 METs-min/week (MD: -5.145, 95% CI: -9.643 to -0.472), and RT at 610 METs-min/week (MD: -2.187, 95% CI: -3.161 to -1.278), respectively. However, no effective doses are found for Aerobic Exercise (AE), Balance Gait Training (BGT), Dance, and Treadmill Training (TT). Mind-body exercise (MBE) shows promise with an effective range of 130 to 750 METs-min/week and an optimal dose of 750 METs-min/week (MD: -2.822, 95% CI: -4.604 to -0.996). According to the GRADE system, the included studies' overall quality of the evidence was identified moderate level.

Conclusion

This study identifies specific exercise modalities and dosages that significantly enhance TUG performance in PD patients. AQE emerges as the most effective modality, with an optimal dosage of 1,500 METs-min/week. MBE shows significant benefits at lower dosages, catering to patients with varying exercise capacities. RT exhibits a nuanced "U-shaped" dose-response relationship, suggesting an optimal range balancing efficacy and the risk of overtraining. These findings advocate for tailored exercise programs in PD management, emphasizing personalized prescriptions to maximize outcomes.Systematic Review Registration: International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024506968).

Correlation between motor function and health-related quality of life in early to mid-stage patients with Parkinson disease: a cross-sectional observational study

Aim

To investigate the correlation between motor function and health-related quality of life (HrQOL) in early to mid-stage patients with Parkinson disease (PwP).

Methods

This cross-sectional study recruited PwP from April 2020 to December 2023 at the outpatient clinic of Peking Union Medical College Hospital in Beijing, China. The motor symptoms were assessed using Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part 3. Balance function was evaluated using the Berg Balance Scale (BBS), and the risk of fall using Timed Up-and-Go test (TUG), and Five Times Sit-to-Stand test (FTSST). Freezing of gait questionnaire (FOGQ) was used to evaluate the severity of gait. The Intelligent Device for Energy Expenditure and Physical Activity (IDEEA) recorded gait cycle parameters, and the isokinetic dynamometer measured muscle strength. The Parkinson's Disease Questionnaire-39 (PDQ-39) was used to measure HrQOL. All assessments were tested during the on state. Spearman correlation was conducted to evaluate the correlation between motor function and HrQOL.

Results

243 patients with mean age of 69.33 years were enrolled. The PDQ-39 score was strongly correlated with FOG in H&Y stage III (r = 0.653, p < 0.001) and moderately correlated in H&Y stage I (r = 0.471, p < 0.001) and H&Y stage II (r = 0.386, p < 0.001). Furthermore, the FOG was strongly correlated with mobility domain at H&Y stage III (r = 0.694, p < 0.001) and moderately correlated at H&Y stage I (r = 0.431, p < 0.001) and H&Y stage II (r = 0.434, p < 0.001). All motor function scores were correlated with PDQ-39 scores at H&Y stage III (p < 0.05).

Conclusion

Motor function correlated with HrQOL in early to mid-stage PwP, and FOG was the main factor, especially affecting mobility, activities of daily life and communication. HrQOL in patients at different disease stages were variously affected by motor function, and HrQOL and multiple dimensions was significantly associated with motor function in patients at H&Y stage III.

Trans-Spinal Theta Burst Magnetic Stimulation in Parkinson's Disease and Gait Disorders

BACKGROUND

Gait disorders in patients with Parkinson's disease (PD) can become disabling with disease progression without effective treatment.

OBJECTIVES

To investigate the efficacy of intermittent θ burst trans-spinal magnetic stimulation (TsMS) in PD patients with gait and balance disorders.

METHODS

This was a randomized, parallel, double-blind, controlled trial. Active or sham TsMS was applied at third thoracic vertebra with 100% of the trans-spinal motor threshold, during 5 consecutive days. Participants were evaluated at baseline, immediately after last session, 1 and 4 weeks after last session. Primary outcome was Total Timed Up and Go (TUG) values comparing active versus sham phases 1 week after intervention. The secondary outcome measurements consisted of motor, gait and balance scales, and questionnaires for quality of life and cognition.

RESULTS

Thirty-three patients were included, average age 68.5 (6.4) years in active group and 70.3 (6.3) years in sham group. In active group, Total TUG mean baseline was 107.18 (95% CI, 52.1-116.1), and 1 week after stimulation was 93.0 (95% CI, 50.7-135.3); sham group, Total TUG mean baseline was 101.2 (95% CI, 47.1-155.3) and 1 week after stimulation 75.2 (95% CI 34.0-116.4), P = 0.54. Similarly, intervention had no significant effects on secondary outcome measurements. During stimulation period, five patients presented with mild side effects (three in active group and two in sham group).

DISCUSSION

TsMS did not significantly improve gait or balance analysis in patients with PD and gait disorders. The protocol was safe and well tolerated. © 2024 International Parkinson and Movement Disorder Society.

Impaired performance of rapid grip in people with Parkinson's disease and motor segmentation

Bradykinesia, or slow movement, is a defining symptom of Parkinson's disease (PD), but the underlying neuromechanical deficits that lead to this slowness remain unclear. People with PD often have impaired rates of motor output accompanied by disruptions in neuromuscular excitation, causing abnormal, segmented, force-time curves. Previous investigations using single-joint models indicate that agonist electromyogram (EMG) silent periods cause motor segmentation. It is unknown whether motor segmentation is evident in more anatomically complex and ecologically important tasks, such as handgrip tasks. Aim 1 was to determine how handgrip rates of force change compare between people with PD and healthy young and older adults. Aim 2 was to determine whether motor segmentation is present in handgrip force and EMG measures in people with PD. Subjects performed rapid isometric handgrip pulses to 20-60% of their maximal voluntary contraction force while EMG was collected from the grip flexors and extensors. Dependent variables included the time to 90% peak force, the peak rate of force development, the duration above 90% of peak force, the number of segments in the force-time curve, the number of EMG bursts, time to relaxation from 90% of peak force, and the peak rate of force relaxation. People with PD had longer durations and lower rates of force change than young and older adults. Six of 22 people with PD had motor segmentation. People with PD had more EMG bursts compared to healthy adults and the number of EMG bursts covaried with the number of segments. Thus, control of rapid movement in Parkinson's disease can be studied using isometric handgrip. People with PD have impaired rate control compared to healthy adults and motor segmentation can be studied in handgrip.

A randomized feasibility trial of medium chain triglyceride-supplemented ketogenic diet in people with Parkinson's disease

BACKGROUND

A ketogenic diet (KD) may benefit people with neurodegenerative disorders marked by mitochondrial depolarization/insufficiency, including Parkinson's disease (PD).

OBJECTIVE

Evaluate whether a KD supplemented by medium chain triglyceride (MCT-KD) oil is feasible and acceptable for PD patients. Furthermore, we explored the effects of MCT-KD on blood ketone levels, metabolic parameters, levodopa absorption, mobility, nonmotor symptoms, simple motor and cognitive tests, autonomic function, and resting-state electroencephalography (rsEEG).

METHODS

A one-week in-hospital, double-blind, randomized, placebo-controlled diet (MCT-KD vs. standard diet (SD)), followed by an at-home two-week open-label extension. The primary outcome was KD feasibility and acceptability. The secondary outcome was the change in Timed Up & Go (TUG) on day 7 of the diet intervention. Additional exploratory outcomes included the N-Back task, Unified Parkinson's Disease Rating Scale, Non-Motor Symptom Scale, and rsEEG connectivity.

RESULTS

A total of 15/16 subjects completed the study. The mean acceptability was 2.3/3, indicating willingness to continue the KD. Day 7 TUG time was not significantly different between the SD and KD groups. The nonmotor symptom severity score was reduced at the week 3 visit and to a greater extent in the KD group. UPDRS, 3-back, and rsEEG measures were not significantly different between groups. Blood ketosis was attained by day 4 in the KD group and to a greater extent at week 3 than in the SD group. The plasma levodopa metabolites DOPAC and dopamine both showed nonsignificant increasing trends over 3 days in the KD vs. SD groups.

CONCLUSIONS

An MCT-supplemented KD is feasible and acceptable to PD patients but requires further study to understand its effects on symptoms and disease.

TRIAL REGISTRATION

Trial Registration Number NCT04584346, registration dates were Oct 14, 2020 - Sept 13, 2022.

A Novel, Robust, and Portable Platform for Magnetoencephalography using Optically Pumped Magnetometers

Magnetoencephalography (MEG) measures brain function via assessment of magnetic fields generated by neural currents. Conventional MEG uses superconducting sensors, which place significant limitations on performance, practicality, and deployment; however, the field has been revolutionised in recent years by the introduction of optically-pumped-magnetometers (OPMs). OPMs enable measurement of the MEG signal without cryogenics, and consequently the conception of 'OPM-MEG' systems which ostensibly allow increased sensitivity and resolution, lifespan compliance, free subject movement, and lower cost. However, OPM-MEG remains in its infancy with limitations on both sensor and system design. Here, we report a new OPM-MEG design with miniaturised and integrated electronic control, a high level of portability, and improved sensor dynamic range (arguably the biggest limitation of existing instrumentation). We show that this system produces equivalent measures when compared to an established instrument; specifically, when measuring task-induced beta-band, gamma-band and evoked neuro-electrical responses, source localisations from the two systems were highly comparable and temporal correlation was >0.7 at the individual level and >0.9 for groups. Using an electromagnetic phantom, we demonstrate improved dynamic range by running the system in background fields up to 8 nT. We show that the system is effective in gathering data during free movement (including a sitting-to-standing paradigm) and that it is compatible with simultaneous electroencephalography (EEG - the clinical standard). Finally, we demonstrate portability by moving the system between two laboratories. Overall, our new system is shown to be a significant step forward for OPM-MEG technology and offers an attractive platform for next generation functional medical imaging.

Association between timed up-and-go test and subsequent pneumonia: A cohort study

BACKGROUND

Sarcopenia is a risk factor for pneumonia in the elderly, and the timed up-and-go test (TUG) can be used as a screening tool for sarcopenia in this population. This study aimed to evaluate the association between TUG test results and future pneumonia or ventilator care.

MATERIALS AND METHODS

From the National Health Insurance Service-Senior Cohort database, we identified 19,804 people without neurological diseases who underwent the TUG test in the National Screening Program for Transitional Ages at the age of 66 years during 2007-2008. Gait abnormality was defined as taking 10 s or longer to perform the TUG test. Pneumonia occurrence was defined using the International Classification of Diseases 10th Revision (ICD-10) code for pneumonia (J12-J18, J69), and ventilator care was defined by procedure codes (M5830, M5850, M5867, M5858, M5860, M5859) according to the Healthcare Common Procedure Coding system codes from 2007 to 2015.

RESULTS

The mean follow-up period was 7.4 years (standard error, SE 0.02). The incidence rates of pneumonia in the normal and slow TUG groups were 38 and 39.5/1000 person-years, respectively. The slow TUG group did not show a higher risk of pneumonia (adjusted hazard ratio [aHR], 1.042; 95% confidence interval [95% CI], 0.988-1.107]). Regarding ventilator care, the incidence was 4.7 and 5.2 cases per 1,000 person-years in the normal and slow TUG groups, respectively. Slow TUG groups also did not show an increased risk of ventilator occurrence (aHR, 1.136, [95% CI = 0.947-1.363]).

CONCLUSION

The TUG test result was not associated with future pneumonia or ventilator care and may not be useful for predicting pneumonia in community-dwelling elderly individuals. Further studies are needed to identify additional functional tools for sarcopenia associated with future pneumonia occurrences.

The C-Brace® microprocessor controlled stance and swing orthosis improves safety, mobility, and quality of life at one year: Interim results from a prospective registry

Introduction

The C-Brace microprocessor-controlled stance and swing control orthosis has been shown to improve function, mobility, and quality of life. A systematic registry to gather long-term, real-world safety and effectiveness data in patients fit with a C-Brace has not been performed.

Methods

International multicenter registry. Patients undergoing routine C-Brace fittings were assessed at baseline and 1 year after fitting. Primary outcomes were fast walking speed (FWS) measured by 25-foot or 10-meter walk test, Timed Up and Go (TUG) and the Activity-specific Balance Confidence (ABC) Scale. Secondary and exploratory outcomes included the Patient-specific Functional Scale (PSFS), falls, pain, PROMIS Pain Interference (PI), and quality of life.

Results

48 subjects with 1-year baseline and follow up data were analyzed. With the C-Brace, FWS improved by + 0.26 ± 0.33 m/s (p < .0001), TUG by -8.1 ± 14.6 sec (p < .0001), and ABC by + 24.9 ± 25.8% (p < .0001). Mean falls reduced from 33 ± 77 to 3.0 ± 5.6 (p = .0005). PSFS increased by 3.60 ± 2.34 points (p < .0001). Outcomes for pain, PI and quality of life showed significant improvements with the C-Brace.

Conclusion

The C-Brace is an effective option to improve safety, mobility, and quality of life for patients needing a KAFO for ambulation.

Differences in the Timed Up and Go Test under different measurement conditions in young healthy adults

[Purpose] The purpose of this study was to verify whether Timed Up and Go (TUG) test measurements differed according to the seat height of the chair, presence or absence of armrests, and measurement location in young healthy adults, and to clarify the flexibility of the TUG settings. [Participants and Methods] Fifty-nine young healthy males and females participated in this study. The TUG test was performed under several conditions. Eight measurements were obtained at both the usual walking speed and the individual's fastest walking speed. [Results] There were no significant differences in TUG test measurements according to variation in seat height, different measurement locations, with and without the use of armrests, or at the usual walking speed or the fastest walking speed. [Conclusion] In young healthy adults, TUG test measurements were unaffected by differences in chair height, use of armrests, or the location of the measurement. If TUG measurements are found to differ according to these variables, it is necessary to consider the influence of the individual's ability rather than the measurement method.

Association of Plasma Phosphorylated Tau With the Response to Neflamapimod Treatment in Patients With Dementia With Lewy Bodies

BACKGROUND AND OBJECTIVES

In a proportion of patients, dementia with Lewy bodies (DLB) is associated with Alzheimer disease (AD) copathology, which is linked to accelerated cognitive decline and more extensive cortical atrophy. The objective was to evaluate the relationship between a biomarker of AD copathology, plasma tau phosphorylated at residue 181 (ptau181), and the treatment effects of the p38α kinase inhibitor neflamapimod, which targets the cholinergic degenerative process in DLB.

METHODS

The AscenD-LB study was a phase 2a, randomized (1:1), 16-week, placebo-controlled clinical trial of neflamapimod in DLB, the main results of which have been published. After the study was completed (i.e., post hoc), pretreatment plasma ptau181 levels were determined and participants were grouped based on a cutoff for AD pathology of 2.2 pg/mL (established in a separate cohort to identify AD from healthy controls). Clinical outcomes for the comparison of placebo with neflamapimod 40 mg three times daily (TID; the higher and more clinically active of 2 doses studied) were analyzed using mixed models for repeated measures within each subgroup (baseline plasma ptau181 < and ≥2.2 pg/mL).

RESULTS

Pretreatment plasma ptau181 levels were determined in eighty-five participants with mild-to-moderate DLB receiving cholinesterase inhibitors, with 45 participants below and 40 above the 2.2 pg/mL cutoff at baseline. In the 16-week treatment period, in the comparison of placebo with neflamapimod 40 mg TID, for all end points evaluated, improvements with neflamapimod treatment were greater in participants below the cutoff, compared with those above the cutoff. In addition, participants below the ptau181 cutoff at baseline showed significant improvement over placebo in an attention composite measure (+0.42, 95% CI 0.07-0.78, p = 0.023, d = 0.78), the Clinical Dementia Rating Scale Sum of Boxes (-0.60, 95% CI -1.04 to -0.06, p = 0.031, d = 0.70), the Timed Up and Go test (-3.1 seconds, 95% CI -4.7 to -1.6, p < 0.001, d = 0.74), and International Shopping List Test-Recognition (+1.4, 95% CI 0.2-2.5, p = 0.024, d = 1.00).

DISCUSSION

Exclusion of patients with elevated plasma ptau181, potentially through excluding patients with extensive cortical neurodegeneration, enriches for a patient with DLB population that is more responsive to neflamapimod. More generally, plasma biomarkers of AD copathology at study entry should be considered as stratification variables in DLB clinical trials.

TRIAL REGISTRATION INFORMATION

NCT04001517 at ClinicalTrials.gov.

Classifying Tremor Dominant and Postural Instability and Gait Difficulty Subtypes of Parkinson's Disease from Full-Body Kinematics

Characterizing motor subtypes of Parkinson's disease (PD) is an important aspect of clinical care that is useful for prognosis and medical management. Although all PD cases involve the loss of dopaminergic neurons in the brain, individual cases may present with different combinations of motor signs, which may indicate differences in underlying pathology and potential response to treatment. However, the conventional method for distinguishing PD motor subtypes involves resource-intensive physical examination by a movement disorders specialist. Moreover, the standardized rating scales for PD rely on subjective observation, which requires specialized training and unavoidable inter-rater variability. In this work, we propose a system that uses machine learning models to automatically and objectively identify some PD motor subtypes, specifically Tremor-Dominant (TD) and Postural Instability and Gait Difficulty (PIGD), from 3D kinematic data recorded during walking tasks for patients with PD (MDS-UPDRS-III Score, 34.7 ± 10.5, average disease duration 7.5 ± 4.5 years). This study demonstrates a machine learning model utilizing kinematic data that identifies PD motor subtypes with a 79.6% F1 score (N = 55 patients with parkinsonism). This significantly outperformed a comparison model using classification based on gait features (19.8% F1 score). Variants of our model trained to individual patients achieved a 95.4% F1 score. This analysis revealed that both temporal, spectral, and statistical features from lower body movements are helpful in distinguishing motor subtypes. Automatically assessing PD motor subtypes simply from walking may reduce the time and resources required from specialists, thereby improving patient care for PD treatments. Furthermore, this system can provide objective assessments to track the changes in PD motor subtypes over time to implement and modify appropriate treatment plans for individual patients as needed.

A Comparison of Walking Behavior during the Instrumented TUG and Habitual Gait

The timed up and go test (TUG) is a common clinical functional balance test often used to complement findings on sensorimotor changes due to aging or sensory/motor dysfunction. The instrumented TUG can be used to obtain objective postural and gait measures that are more sensitive to mobility changes. We investigated whether gait and body coordination during TUG is representative of walking. We examined the walking phase of the TUG and compared gait metrics (stride duration and length, walking speed, and step frequency) and head/trunk accelerations to normal walking. The latter is a key aspect of postural control and can also reveal changes in sensory and motor function. Forty participants were recruited into three groups: young adults, older adults, and older adults with visual impairment. All performed the TUG and a short walking task wearing ultra-lightweight wireless IMUs on the head, chest, and right ankle. Gait and head/trunk acceleration metrics were comparable across tasks. Further, stride length and walking speed were correlated with the participants' age. Those with visual impairment walked significantly slower than sighted older adults. We suggest that the TUG can be a valuable tool for examining gait and stability during walking without the added time or space constraints.

Mild Traumatic Brain Injury and Functional Outcome in Older Adults: Pain Interference But Not Cognition Mediates the Relationship Between Traumatic Injury and Functional Difficulties

OBJECTIVE

To examine functional status of older people 3 months after mild traumatic brain injury (mTBI) and identify whether pain interference or cognition mediates any relationship found between injury status and functional outcomes.

SETTING

Patients admitted to a Melbourne-based emergency department.

PARTICIPANTS

Older adults 65 years and older: 40 with mTBI, 66 with orthopedic injury without mTBI (TC), and 47 healthy controls (CC) without injury.

DESIGN

Observational cohort study.

MAIN MEASURES

Functional outcome was measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and single- and dual-task conditions of the Timed-Up-and-Go task. Pain interference and cognitive performance at 3 months post-injury were examined as mediators of the relationship between injury status (injured vs noninjured) and functional outcome.

RESULTS

Patients with mTBI and/or orthopedic injury reported greater difficulties in overall functioning, including community participation, compared with noninjured older people (CC group). Both trauma groups walked slower than the CC group on the mobility task, but all groups were similar on the dual-task condition. Pain interference mediated the relationship between injury status and overall functioning [ b = 0.284; 95% CI = 0.057, 0.536), community participation ( b = 0.259; 95% CI = 0.051, 0.485), and mobility ( b = 0.116; 95% CI = 0.019, 0.247). However, cognition did not mediate the relationship between injury status and functional outcomes.

CONCLUSIONS

Three months after mild traumatic injury (with and without mTBI), patients 65 years and older had greater functional difficulties compared with noninjured peers. Pain interference, but not cognition, partially explained the impact of traumatic injury on functional outcomes. This highlights the importance of reducing pain interference for older patients after injury (including mTBI) to support better functional recovery.

Effect of 12-Week BMI-Based Vitamin D3 Supplementation in Parkinson's Disease with Deep Brain Stimulation on Physical Performance, Inflammation, and Vitamin D Metabolites

Parkinson's disease (PD) is the second most common neurodegenerative disease. To manage motor symptoms not controlled adequately with medication, deep brain stimulation (DBS) is used. PD patients often manifest vitamin D deficiency, which may be connected with a higher risk of falls. We administered a 12-week vitamin D₃ supplementation based on BMI (with higher doses given to patients with higher BMI) to investigate its effects on physical performance and inflammation status in PD patients with DBS. Patients were randomly divided into two groups: treated with vitamin D₃ (VitD, n = 13), and supplemented with vegetable oil as the placebo group (PL, n = 16). Patients underwent functional tests to assess their physical performance three times during this study. The serum 25(OH)D₃ concentration increased to the recommended level of 30 ng/mL in the VitD group, and a significant elevation in vitamin D metabolites in this group was found. We observed significant improvement in the Up and Go and the 6 MWT in the VitD group. In inflammation status, we noticed a trend toward a decrease in the VitD group. To conclude, achieving the optimal serum 25(OH)D₃ concentration is associated with better functional test performance and consequently may have a positive impact on reducing falling risk in PD.

Non-Immersive Virtual Reality Telerehabilitation System Improves Postural Balance in People with Chronic Neurological Diseases

BACKGROUND

People with chronic neurological diseases, such as Parkinson's Disease (PD) and Multiple Sclerosis (MS), often present postural disorders and a high risk of falling. When difficulties in achieving outpatient rehabilitation services occur, a solution to guarantee the continuity of care may be telerehabilitation. This study intends to expand the scope of our previously published research on the impact of telerehabilitation on quality of life in an MS sample, testing the impact of this type of intervention in a larger sample of neurological patients also including PD individuals on postural balance.

METHODS

We included 60 participants with MS and 72 with PD. All enrolled subjects were randomized into two groups: 65 in the intervention group and 67 in the control group. Both treatments lasted 30-40 sessions (5 days/week, 6-8 weeks). Motor, cognitive, and participation outcomes were registered before and after the treatments.

RESULTS

All participants improved the outcomes at the end of the treatments. The study's primary outcome (Mini-BESTest) registered a greater significant improvement in the telerehabilitation group than in the control group.

CONCLUSIONS

Our results demonstrated that non-immersive virtual reality telerehabilitation is well tolerated and positively affects static and dynamic balance and gait in people with PD and MS.

Imagined Timed Up and Go test (iTUG) in people with Parkinson's Disease: test-retest reliability and validity

PURPOSE

To determine the test-retest reliability and validity of the Imagined Timed Up and Go Test (iTUG) as a Motor Imagery measure of temporal accuracy in people with Parkinson's Disease (PD).

MATERIALS AND METHODS

A descriptive study was conducted following the GRRAS recommendations. Thirty-two people with idiopathic, mild to moderate PD (Hoehn and Yahr I-III), without cognitive impairment (MMSE ≥ 24), were assessed twice (7-15 days apart) with the iTUG. The absolute unadjusted difference in seconds, and the absolute adjusted difference as percentage of estimation error, between real and imagined TUG times, were calculated as outcome measures. Test-retest reliability was assessed using a two-way mixed-effects model of the ICC. Construct validity was tested with the Imagined Box and Blocks Test (iBBT) and convergent validity with clinical characteristics of PD, using the Spearman's rank correlation coefficient.

RESULTS

The ICC for the unadjusted and adjusted measures of the iTUG was ICC = 0.61 and ICC = 0.55, respectively. Correlations between iTUG and iBBT were not statistically significant. The iTUG was partially correlated to clinical characteristics of PD.

CONCLUSIONS

Test-retest reliability of the iTUG was moderate. Construct validity between iTUG and iBBT was poor, so caution should be taken when using them concurrently to assess imagery's temporal accuracy.

Are movement-based mindful exercises (QIGONG, TAI CHI, AND YOGA) beneficial for stroke and Parkinson's disease? A scoping review

OBJECTIVE

To synthesize evidence from systematic reviews on the effects of qigong, tai chi, and yoga in people with neurological diseases.

METHODS

A systematic search was conducted in PubMed, PsycINFO, Embase, CINAHL and Cochrane Library until September 2022. Methodological quality was assessed using the AMSTAR 2 tool. A qualitative synthesis of included reviews and meta-analyses was performed. Citation matrices and the corrected covered area were used to explore the overlap of randomized controlled trials among reviews.

RESULTS

Nineteen systematic reviews (containing 74 trials and 80 meta-analyses) in people with Parkinson's disease (PD) or stroke were included. The critical domains of the AMSTAR 2 were not satisfied in more than half of the reviews, and only 4 evaluated the certainty of the evidence. The overlap was very high (21.7%) and high (11%) for tai chi studies in PD and stroke, respectively. In people with PD, qigong, yoga, and tai chi can improve balance, with tai chi being beneficial to increase functional mobility. For stroke patients, tai chi was better than controls to enhance motor function and independence, but not for health-related quality of life and quality of sleep. Findings on balance, walking ability and depression were inconclusive in stroke population.

CONCLUSIONS

Qigong, tai chi, and yoga appear to be effective to improve balance performance in people with PD. Tai chi practice enhances motor function and independency in stroke patients.

Association of caregiver strain with the trajectory of quality of life in Parkinson's disease

We aimed to identify caregiver characteristics associated with the trajectory of quality of life (QoL) in Parkinson's disease (PD). We fit a growth mixture model to longitudinal data from the Parkinson Foundation Parkinson's Outcomes Project (POP) to identify the heterogeneity of QOL trajectories in PD. We then used multinomial logistic regression to model baseline factors that predicted class membership. Baseline growth models were fit to QOL scores measured over 4 disease duration time points. A random intercept and slope model was determined to best fit the data. Next, growth mixture models (1, 2, 3, 4, and 5-class) were fit with covariates (Hoehn & Yahr, sex, and depression) and a three-class model was found to provide the best fit. Class 1 (problematic class (10.0%)) represented individuals with poor QOL at baseline and minor improvement over time. Class 2 (moderate class (32.6%)) represented individuals with moderate QOL at baseline with slight worsening over time. Class 3 (favorable class (56.9%)) represented individuals with good QOL at baseline and slight worsening over time. Multinomial regression revealed that lower caregiver strain, better mobility, and better verbal fluency at baseline predicted membership in the favorable compared to the moderate class. Worse mobility and younger age predicted membership in the problematic compared to the moderate class. While previous studies have reported on the association between mobility and cognition, the novel finding of an association between caregiver strain and PD QOL trajectory suggests caregiver strain is important to measure and address in future research and practice.

An Explainable Spatial-Temporal Graphical Convolutional Network to Score Freezing of Gait in Parkinsonian Patients

Freezing of gait (FOG) is a poorly understood heterogeneous gait disorder seen in patients with parkinsonism which contributes to significant morbidity and social isolation. FOG is currently measured with scales that are typically performed by movement disorders specialists (i.e., MDS-UPDRS), or through patient completed questionnaires (N-FOG-Q) both of which are inadequate in addressing the heterogeneous nature of the disorder and are unsuitable for use in clinical trials The purpose of this study was to devise a method to measure FOG objectively, hence improving our ability to identify it and accurately evaluate new therapies. A major innovation of our study is that it is the first study of its kind that uses the largest sample size (>30 h, N = 57) in order to apply explainable, multi-task deep learning models for quantifying FOG over the course of the medication cycle and at varying levels of parkinsonism severity. We trained interpretable deep learning models with multi-task learning to simultaneously score FOG (cross-validated F1 score 97.6%), identify medication state (OFF vs. ON levodopa; cross-validated F1 score 96.8%), and measure total PD severity (MDS-UPDRS-III score prediction error ≤ 2.7 points) using kinematic data of a well-characterized sample of N = 57 patients during levodopa challenge tests. The proposed model was able to explain how kinematic movements are associated with each FOG severity level that were highly consistent with the features, in which movement disorders specialists are trained to identify as characteristics of freezing. Overall, we demonstrate that deep learning models' capability to capture complex movement patterns in kinematic data can automatically and objectively score FOG with high accuracy. These models have the potential to discover novel kinematic biomarkers for FOG that can be used for hypothesis generation and potentially as clinical trial outcome measures.

An explainable spatial-temporal graphical convolutional network to score freezing of gait in parkinsonian patients

Freezing of gait (FOG) is a poorly understood heterogeneous gait disorder seen in patients with parkinsonism which contributes to significant morbidity and social isolation. FOG is currently measured with scales that are typically performed by movement disorders specialists (ie. MDS-UPDRS), or through patient completed questionnaires (N-FOG-Q) both of which are inadequate in addressing the heterogeneous nature of the disorder and are unsuitable for use in clinical trials The purpose of this study was to devise a method to measure FOG objectively, hence improving our ability to identify it and accurately evaluate new therapies. We trained interpretable deep learning models with multi-task learning to simultaneously score FOG (cross-validated F1 score 97.6%), identify medication state (OFF vs. ON levodopa; cross-validated F1 score 96.8%), and measure total PD severity (MDS-UPDRS-III score prediction error ≤ 2.7 points) using kinematic data of a well-characterized sample of N=57 patients during levodopa challenge tests. The proposed model was able to identify kinematic features associated with each FOG severity level that were highly consistent with the features that movement disorders specialists are trained to identify as characteristic of freezing. In this work, we demonstrate that deep learning models' capability to capture complex movement patterns in kinematic data can automatically and objectively score FOG with high accuracy. These models have the potential to discover novel kinematic biomarkers for FOG that can be used for hypothesis generation and potentially as clinical trial outcome measures.

The psychometric properties of the figure-of-eight walk test in people with Parkinson's disease

PURPOSE

To investigate: (1) the interrater, and test-retest reliability of the figure-of-eight walk test (F8WT) in people with Parkinson's disease (PwPD); (2) the minimum detectable change in the F8WT times; (3) the concurrent and known-groups validity of the F8WT times; and (4) the cut-off times that best discriminate PwPD from healthy people and fallers from non-fallers with PD.

METHODS

This was a cross-sectional study. Forty-three PwPD and 34 healthy people were recruited. The F8WT was performed along with the timed up and go test, 10 m walk test, Berg Balance Scale, Activities-Specific Balance Confidence Scale, Unified Parkinson's disease Rating Scale, and Hoehn and Yahr Scale.

RESULTS

The F8WT showed good interrater and test-retest reliability (ICC = 0.964-0.978 and ICC = 0.905-0.920, respectively). The MDC was 2.77 s. The F8WT was correlated with other outcome measures. Significant differences in the F8WT times were found between PwPD and healthy people and between fallers and non-fallers with PD (p < 0.001 and p < 0.001, respectively). The cut-off times of 8.43 s best discriminated PwPD from healthy people, while 11.19 s best discriminated fallers from non-fallers with PD.

CONCLUSIONS

The F8WT is a reliable, valid, and easy-to-administer tool in assessing the walking skill of PwPD.Implications for rehabilitationThe figure-of-eight walk test (F8WT) is a reliable, valid, and clinically available tool for assessing walking skill in Parkinson's disease (PD).The minimal detectable change of the F8WT is 2.77 s, which may help to determine any real change in walking skill after any intervention.The F8WT correlated with functional mobility, gait speed, balance, balance confidence, and severity and stage of PD.The F8WT times may detect impaired walking skill between people with PD and healthy people, and between fallers and non-fallers with PD.

A non-expensive bidimensional assessment can detect subtle alterations in gait performance in people in the early stages of Parkinson's disease

Background

Gait is one of the activities most affected by the symptoms of Parkinson's disease and may show a linear decline as the disease progresses. Early assessment of its performance through clinically relevant tests is a key factor in designing efficient therapeutic plans and procedures, which can be enhanced using simple and low-cost technological instruments.

Objective

To investigate the effectiveness of a two-dimensional gait assessment to identify the decline in gait performance associated with Parkinson's disease progression.

Methods

One hundred and seventeen people with Parkinson's disease, classified between early and intermediate stages, performed three clinical gait tests (Timed Up and Go, Dynamic Gait Index, and item 29 of the Unified Parkinson's Disease Rating Scale), in addition to a six-meter gait test recorded by a two-dimensional movement analysis software. Based on variables generated by the software, a gait performance index was created, allowing a comparison between its results with the results obtained by clinical tests.

Results

There were differences between sociodemographic variables directly related to the evolution of Parkinson's disease. Compared to clinical tests, the index proposed to analyze gait showed greater sensitivity and was able to differentiate the first three stages of disease evolution (Hoehn and Yahr I and II: p = 0.03; Hoehn and Yahr I and III: p = 0.00001; Hoehn and Yahr II and III: p = 0.02).

Conclusion

Based on the index provided by a two-dimensional movement analysis software that uses kinematic gait variables, it was possible to differentiate the gait performance decline among the three first stages of Parkinson's disease evolution. This study offers a promising possibility of early identification of subtle changes in an essential function of people with Parkinson's disease.

Impact of LSVT-BIG ® on functional mobility, walking, dexterity, and quality of life in Parkinson's disease

Purpose: The aim of this study was to evaluate the impact of the LSVT-BIG ® (Lee Silverman Voice Treatment Big) technique on functional mobility, dexterity, and quality of life in Parkinson's disease (PD). Materials and Methods: Fifteen patients with Parkinson's disease (9 males, and 6 females, aged 40-75 years; Hoehn & Yahr Stages I-III) completed a 4-week LSVT-BIG training program for 1 hour/session, 4 sessions per week. Parkinson's Disease Quality of Life Questionnaire-39 (PDQ-39) was used in measuring patients' quality of life at the beginning (t0) and at the end (t1) of the rehabilitation program. Nine-Hole Peg Test (NHPT) was used for dexterity. 10 Meter Walking Test (10MWT), Timed-Up-and-Go Test (TUG), and Five-Times Sit-to-Stand Test (5XSST) were used for assessing functional mobility. After 4 weeks, all participants were retested. Results: After 4 weeks of LSVT-BIG therapy, a statistically significant improvement was found in PDQ-39 mobility, activities of daily living, emotional state, stigma, cognition, communication, physical discomfort, and general scores after exercise compared to before. There was no statistically significant change in the PDQ-39 social support score after exercise compared to before. In addition, functional mobility improved as indicated by the TUG test, 5XSST, 10MWT (and dexterity by NHPT on the left. Conclusion: LSVT-BIG training may be a new therapeutic option for better walking, functional mobility, and manual capability performance and for enhancing the quality of life in PD. Randomized controlled trials with bigger sizes are needed to evaluate the effect of the LSVT-BIG rehabilitation program on reducing motor and non-motor impairments in patients with PD.

Effect of therapeutic exercise on the balance of patients with progressive supranuclear palsy: A pilot study

Background

Progressive supranuclear palsy (PSP) is a parkinsonian-like progressive neurodegenerative syndrome. Key clinical features include ocular motor dysfunction, postural instability, and cognitive dysfunction. Maintaining and improving balance function and gait function are very important for patients with PSP with severe postural dysfunction and repeated falls. In addition, patients with PSP have a poor response to pharmacological treatment; hence, rehabilitation is a key approach in dealing with this syndrome. However, no conclusion on the beneficial effects of rehabilitation for patients with PSP have been established in the literature.

Objectives

The effectiveness of multiple therapeutic exercise program with probable or possible PSP according to the Movement Disorder Society criteria for the clinical diagnosis of PSP was validated.

Methods

Participants underwent multiple therapeutic exercise program customized for each participant, including resistance training, balance training, and walking exercises that were performed for 60–80 minutes a day, 5 days a week for 4 weeks. The outcomes measured were as follows: pull test, Berg Balance Scale (BBS), timed up and go test (TUG), and gait speed test.

Results

A total of 117 patients with PSP were enrolled and the analysis was performed on 20 patients with probable PSP. Four-week rehabilitation significantly improved pull test (p = 0.034) and BBS scores (p = 0.001). There were no significant differences both TUG (p = 0.502) and gait speed (p = 0.813).

Conclusion

The multiple therapeutic exercise program had beneficial effects on balance performance in patients with PSP in 4 weeks and could be an essential element in their rehabilitation. Although this pilot study was conducted without a control group, it provided valuable information for future prospective randomized controlled trials.

Clinical evaluation and resting state fMRI analysis of virtual reality based training in Parkinson’s disease through a randomized controlled trial

There are few studies investigating the short-term effects of Virtual Reality based Exergaming (EG) on motor and cognition simultaneously and pursue the brain functional activity changes after these interventions in patients with Parkinson’s Disease (PD). The purpose of this study was to investigate the synergistic therapeutic effects of Virtual Reality based EG on motor and cognitive symptoms in PD and its possible effects on neuroplasticity. Eligible patients with the diagnosis of PD were randomly assigned to one of the two study groups: (1) an experimental EG group, (2) an active control Exercise Therapy (ET) group. All patients participated in a 4-week exercise program consisting of 12 treatment sessions. Every session lasted 60 min. Participants underwent a motor evaluation, extensive neuropsychological assessment battery and rs-fMRI before and after the interventions. Thirty patients fulfilled the inclusion criteria and were randomly assigned to the EG and ET groups. After the dropouts, 23 patients completed the assessments and interventions (11 in EG, 13 in ET). Within group analysis showed significant improvements in both groups. Between group comparisons considering the interaction of group × time effect, showed superiority of EG in terms of general cognition, delayed visual recall memory and Boston Naming Test. These results were consistent in the within-group and between-group analysis. Finally, rs-fMRI analysis showed increased activity in the precuneus region in the time × group interaction in the favor of EG group. EG can be an effective alternative in terms of motor and cognitive outcomes in patients with PD. Compared to ET, EG may affect brain functional connectivity and can have beneficial effects on patients’ cognitive functions and motor symptoms. Whenever possible, using EG and ET in combination, may have the better effects on patients daily living and patients can benefit from the advantages of both interventions.

Home-Based Walking Meditation Decreases Disease Severity in Parkinson's Disease: A Randomized Controlled Trial

Objective: To determine the effects of walking meditation (WM) on functional performance, disease severity, and anxiety in Parkinson's disease (PD). Design: This was a randomized controlled trial. Settings: The study was conducted at a regional hospital. Subjects/Interventions: Thirty-three participants with PD were randomly allocated to the control (CON) group (n = 16) or the WM group (n = 17). Participants in the WM group were asked to perform WM monthly under supervision and encouraged to practice at home at least 3 days/week for 12 weeks. Outcome measurements: Gait velocity, Timed Up and Go, five times sit to stand (FTSTS) test, Unified Parkinson's Disease Rating Scale (UPDRS), and the percentage of participants with anxiety (Hospital Anxiety and Depression Scale-part anxiety [HADS-A] ≥8). Results: Both groups showed reduced gait velocity (p < 0.05), although impairment of the FTSTS (p < 0.05) score was observed only in the CON group. A significant enhancement within and between groups in the total UPDRS and UPDRS part II scores was observed only in the WM group. The percentage of participants with anxiety (HADS-A ≥ 8) decreased significantly only in the WM group (p < 0.05), compared with the baseline and after 12 weeks. There was no loss to follow-up in the WM group, and the participation rate of training was 3.2 days/week. Conclusions: Home-based WM can encourage high rates of exercise adherence, reduce disease severity, lower the percentage of participants with anxiety, and might be suitable during disease endemic and/or pandemic in PD. The protocol was registered on Thaiclinicaltrials.org (Identifier: TCTR20201009001).

Assessing mobility in primary brain tumor patients: A descriptive feasibility study using two established mobility tests

Background

Patients with primary brain tumors (PBT) face significant mobility issues related to their disease and/or treatment. Here, the authors describe the preliminary utility and feasibility of two established mobility measures, the Timed-Up-and-Go (TUG) and Five-Times Sit-to-Stand (TSS) tests, in quickly and objectively assessing the mobility status of PBT patients at a single institution's neuro-oncology clinic.

Methods

Adult patients undergoing routine PBT care completed the TUG/TSS tests and MD Anderson Symptom Inventory-Brain Tumor module (MDASI-BT), which assessed symptom burden and interference with daily life, during clinic visits over a 6-month period. Research staff assessed feasibility metrics, including test completion times/rates, and collected demographic, clinical, and treatment data. Mann-Whitney tests, Kruskal-Wallis tests, and Spearman's rho correlations were used to interrogate relationships between TUG/TSS test completion times and patient characteristics.

Results

The study cohort included 66 PBT patients, 59% male, with a median age of 47 years (range: 20-77). TUG/TSS tests were completed by 62 (94%) patients. Older patients (P < .001) and those who were newly diagnosed (P = .024), on corticosteroids (P = .025), or had poor (≤80) KPS (P < .01) took longer to complete the TUG/TSS tests. Worse activity-related (work, activity, and walking) interference was associated with longer TUG/TSS test completion times (P < .001).

Conclusions

The TUG/TSS tests are feasible for use among PBT patients and may aid in clinical care. Older age, being newly diagnosed, using corticosteroids, poor (≤80) KPS, and high activity-related interference were associated with significant mobility impairment, highlighting the tests' potential clinical utility. Future investigations are warranted to longitudinally explore feasibility and utility in other practice and disease settings.

Effect of Intensive Rehabilitation Program in Thermal Water on a Group of People with Parkinson's Disease: A Retrospective Longitudinal Study

The main objective of this study is to test the effect of thermal aquatic exercise on motor symptoms and quality of life in people with Parkinson's Disease (PD). Fourteen participants with diagnosis of idiopathic PD completed the whole rehabilitation session and evaluation protocol (Hoehn and Yahr in OFF state: 2-3; Mini Mental State Examination >24; stable pharmacological treatment in the 3 months prior participating in the study). Cognitive and motor status, functional abilities and quality of life were assessed at baseline and after an intensive rehabilitation program in thermal water (12 sessions of 45 min in a 1.4 m depth pool at 32-36 ∘C). The Mini Balance Evaluation System Test (Mini-BESTest) and the PD Quality of Life Questionnaire (PDQ-39) were considered as main outcomes. Secondary assessment measures evaluated motor symptoms and quality of life and psychological well-being. Participants kept good cognitive and functional status after treatment. Balance of all the participants significantly improved (Mini-BESTest: p<0.01). The PDQ-39 significantly improved after rehabilitation (p=0.038), with significance being driven by dimensions strongly related to motor status. Thermal aquatic exercise may represent a promising rehabilitation tool to prevent the impact of motor symptoms on daily-life activities of people with PD. PDQ-39 improvement foreshows good effects of the intervention on quality of life and psychological well-being.

Translation, Cultural Adaptation, and Reliability and Validity Testing of a Chinese Version of the Freezing of Gait Questionnaire (FOGQ-CH)

Freezing of gait is a disabling symptom with a complex episodic nature that is frequently experienced by people with Parkinson's disease (PD). Although China has the largest population with PD in the world, no Chinese version of the freezing of gait questionnaire (FOGQ), the instrument that has been most widely used to assess FOG, has yet been developed. This study aimed to translate and adapt the original version of FOGQ to create a Chinese version, the FOGQ-CH, then assess its reliability, calculate the Minimal Detectable Change (MDC) and investigate its validity. The forward-backwards translation model was adopted, and cultural adaptation included expert review and pretesting. For the reliability study, 31 Chinese native speaking patients with PD were assessed two times in a 7–10 days interval. Internal consistency and test-retest reliability of the FOGQ-CH were measured by Cronbach's alpha (Cα) and the Intraclass Correlation Coefficient (ICC). For the validity study, 34 native speakers of Chinese with PD were included. To explore the convergent validity, relationships between the FOGQ-CH and the Unified Parkinson's Disease Rating Scale Part II (UPDRS II) and Part III (UPDRS III), Timed Up and Go Test (TUGT), Timed Up and Go Test in cognitive task (TUGT-Cog), walking speed (10 MWT speed), and step length (10 MWT step length) in a 10-m Walk Test were tested. To explore predictive validity, the number of falls followed up for 6 months were assessed. The area under the ROC curve (AUC) was employed to test the capacity of FOGQ-CH to discriminate those with falls. From the reliability study, Cα = 0.823, ICC = 0.786. The MDC_0.90 = 4.538. From the validity study, the FOGQ-CH showed moderate correlations with UPDRS II (rho = 0.560, p = 0.001), UPDRS III (rho = 0.451, p = 0.007), TUGT (rho = 0.556, p = 0.007), TUGT-Cog (rho = 0.557, p = 0.001), 10MWT-speed (rho = −0.478, p = 0.004), 10MWT-step length (rho = −0.419, p = 0.014), and the number of falls followed up for 6 months (rho = 0.356, p = 0.045). The AUC = 0.777 (p = 0.036) for predicting whether the participants will have multiple falls (two or more) in the following 6 months. The FOGQ-CH showed good reliability and validity for assessing Chinese native speaking patients with PD. In addition, the FOGQ-CH showed good efficacy for predicting multiple falls in the following 6 months.

Patterns of balance loss with systematic perturbations in Parkinson's disease and multiple sclerosis

BACKGROUND:

Multiple sclerosis (MS) and Parkinson’s disease (PD) may affect balance differently. However, no studies have compared loss of balance (LOB) patterns following multi-directional perturbations.

OBJECTIVE:

1) determine reliability of LOB ratings following standardized manual perturbations; 2) compare LOB ratings in MS, PD, and healthy control (HC) groups following perturbations at upper/lower torso, in anterior/posterior, right/left, and rotational directions.

METHODS:

1) reviewers rated videotaped LOB following perturbations applied by 4 clinicians in 6–10 HCs. 2) three groups (64 MS, 42 PD and 32 HC) received perturbations. LOB ratings following perturbations were analyzed using two-factor mixed ANOVAs for magnitude and prevalence.

RESULTS:

1) LOB ratings showed moderate to good ICC and good to excellent agreement. 2) MS group showed greater magnitude and prevalence of LOB than PD or HC groups (p < .001). All groups showed greater LOB from right/left versus anterior/posterior perturbations (p < .01). PD showed greater LOB from perturbations at upper versus lower torso; MS and HC showed greater LOB from posterior versus anterior perturbations.

CONCLUSIONS:

Our reliable rating scale showed differences in patterns of LOB following manual perturbations in MS, PD, and HC. Clinically accessible and reliable assessment of LOB could facilitate targeted perturbation-based interventions and reduce falls in vulnerable populations.

Validation of quantitative gait analysis systems for Parkinson's disease for use in supervised and unsupervised environments

BACKGROUND

Gait impairments are among the most common and impactful symptoms of Parkinson's disease (PD). Recent technological advances aim to quantify these impairments using low-cost wearable systems for use in either supervised clinical consultations or long-term unsupervised monitoring of gait in ecological environments. However, very few of these wearable systems have been validated comparatively to a criterion of established validity.

OBJECTIVE

We developed two movement analysis solutions (3D full-body kinematics based on inertial sensors, and a smartphone application) in which validity was assessed versus the optoelectronic criterion in a population of PD patients.

METHODS

Nineteen subjects with PD (7 female) participated in the study (age: 62 ± 12.27 years; disease duration: 6.39 ± 3.70 years; HY: 2 ± 0.23). Each participant underwent a gait analysis whilst barefoot, at a self-selected speed, for a distance of 3 times 10 m in a straight line, assessed simultaneously with all three systems.

RESULTS

Our results show excellent agreement between either solution and the optoelectronic criterion. Both systems differentiate between PD patients and healthy controls, and between PD patients in ON or OFF medication states (normal difference distributions pooled from published research in PD patients in ON and OFF states that included an age-matched healthy control group). Fair to high waveform similarity and mean absolute errors below the mean relative orientation accuracy of the equipment were found when comparing the angular kinematics between the full-body inertial sensor-based system and the optoelectronic criterion.

CONCLUSIONS

We conclude that the presented solutions produce accurate results and can capture clinically relevant parameters using commodity wearable sensors or a simple smartphone. This validation will hopefully enable the adoption of these systems for supervised and unsupervised gait analysis in clinical practice and clinical trials.

[Short-term effect of neuromuscular bandaging on balance and gait in Parkinson's disease: Pilot study]

INTRODUCTION

Parkinson's disease is a progressive and irreversible neurodegenerative process characterized by tremor at rest, bradykinesia, stiffness, disorders in postural control, balance and gait. Kinesiology tape has a somatosensory stimulating effect, with benefits in postural control.

METHOD

A pilot study with a Physiotherapy Intervention Group and an Experimental Group (kinesiology tape was added) in gastrocnemius and lumbar spinal erectors. Outcome assessments were Berg scale, Tinetti scale (walking subscale), 10m test, TUG test, PDQ-39 and gastrocnemius electromyographic record. Three measurements were made: T0 (baseline), T1 (two days post-intervention) and T2 (one week post-intervention); PDQ-39 was administered at T0 and one month after the intervention.

RESULTS

Thirteen participants (stage III Hoehn and Yahr) were selected after applying the inclusion criteria (nine women and four men). N=7 Experimental Group and N=6 Physiotherapy Group. The intra-group contrast showed significant improvements in favor of the Experimental Group in Berg scale (T1 and T2), 10m test (T2) and in lower mean gastrocnemius muscle activity (T1). The inter-group contrast only evidenced differences in electromyographic recording of the muscle contraction of the right lower limb, after the application of kinesiology tape, in T1.

CONCLUSIONS

The application of kinesiology tape in the lumbar spinal erectors and gastrocnemius bilaterally could improve gait and balance, in subjects with Parkinson's disease in Hoehn and Yahr stage III, but its effect is not superior to conventional physiotherapy treatment.

Test-Retest Reliability of the Timed Up and Go Test in Subjects with Parkinson's Disease: Implications for Longitudinal Assessments

BACKGROUND

Despite the frequent use of the Timed Up and Go (TUG) test in clinical trials, evaluation of longitudinal test-retest reliability is generally lacking and still inconclusive for patients with Parkinson's disease (PD).

OBJECTIVE

We aimed to further investigate long-term reliability and sensitivity of the TUG test among this population. Furthermore, we explored alternative assessment strategies of the test aimed at elucidating whether the inclusion or combination of timed trials may have potential implications on outcome measure.

METHODS

Relative and absolute reliability of the TUG performance were obtained in forty-three subjects with PD over three timed trials in two different testing sessions separated by a two-months period.

RESULTS

Our results reported excellent intra-session and moderate inter-session reliability coefficients. The use of different assessment strategies of the TUG was found to have an important impact on outcome measure, highlighting the averaging of several timed trials in each testing session as a recommended alternative to minimize measurement error and increase reliability in longitudinal assessments. Nevertheless, beyond acceptable reliability, poor trial-to-trial stability of the measure appears to exist, since the ranges of expected variability upon retesting were wide and the incidence of spurious statistical effects was not negligible, especially in longitudinal repeated testing.

CONCLUSION

Limitations may exist in the interpretation of the TUG outputs as part of longitudinal assessments aimed at evaluating treatment effectiveness in PD population. Researchers and practitioners should be aware of these concerns to prevent possible misrepresentations of functional ability in patients for a particular intervention.

Periodized Resistance Training With and Without Functional Training Improves Functional Capacity, Balance, and Strength in Parkinson's Disease

ABSTRACT

Strand, KL, Cherup, NP, Totillo, MC, Castillo, DC, Gabor, NJ, and Signorile, JF. Periodized resistance training with and without functional training improves functional capacity, balance, and strength in Parkinson's disease. J Strength Cond Res 35(6): 1611-1619, 2021-Periodized progressive resistance training (PRT) is a common method used to improve strength in persons with Parkinson's disease (PD). Many researchers advocate the addition of functional training to optimize translation to activities of daily living; however, machine-based PRT, using both force and velocity training components, may elicit similar benefits. Thirty-five persons with PD (Hoehn and Yahr I-III) were randomized into a strength, power, and hypertrophy (SPH; n = 17) or strength, power, and functional (SP + Func; n = 18) group, training 3 times weekly for 12 weeks. Both groups performed machine-based strength and power training on days 1 and 2 each week, respectively; whereas, on day 3, SPH group performed machine-based hypertrophy training and SP + Func group performed functional training. Functional performance was tested using the timed up and go, 30-second sit-to-stand (30-s STS), gallon-jug shelf-transfer, and seated medicine ball throw (SMBT) tests. Balance (Mini-BESTest), strength, motor symptoms (UPDRS-III), quality of life, and freezing of gait (FOG) were also assessed. Repeated measures analysis of variance revealed a main effect for time (p ≤ 0.05) with significant improvements for the sample in the 30-s STS (p = 0.002), SMBT (p = 0.003), Mini-BESTest (p < 0.001), upper-body strength (p = 0.002) and lower-body strength (p < 0.001). A significant group × time interaction was seen for FOG, with SP + Func alone showing improvement (p = 0.04). Furthermore, the SPH group produced a clinically important difference for the UPDRS-III (mean difference = 4.39, p = 0.18). We conclude that both exercise strategies can be equally effective at improving functional capacity, balance, and muscular strength in individuals with PD. In addition, FOG and motor symptoms may be targeted through SP + Func and SPH, respectively. The results provide options for individualized exercise prescriptions.

Functional evaluation of patients with mastectomy lymphedema

Objectives

In this study, we aimed to investigate the availability of the Timed Up and Go (TUG) test in daily practice instead of the Tampa Scale for Kinesiophobia (TSK) test for the evaluation of fear of movement and to assess the functionality of the upper extremity in postmastectomy lymphedema patients.

Patients and methods

Between March 2018 and July 2018, a total of 30 female patients (mean age 53.8±12.3 years; range, 35 to 80 years) with postmastectomy lymphedema were included in this study. The severity of lymphedema of the patients was measured circumferentially at 5-cm intervals. All patients were evaluated for upper extremity functionality using the Timed Functional Arm and Shoulder Test, hand grip strength using a hand dynamometer, and pinch strength using a pinchmeter. The TSK test was used for the evaluation of fear of movement and TUG test was used for the evaluation of functional status of lower extremity.

Results

There was a significant difference in functionality between the affected and unaffected side of upper extremity (p<0.05). According to the TSK results, all patients described themselves as kinesiophobic, and advanced fear of movement was found in 66.67% of the patients. However, according to the TUG scores, lower extremity functionality of all patients was normal.

Conclusion

Our study results showed that, independently of the severity of lymphedema, fear of movement was seen in every patient and functionality of upper extremity decreased on the affected side. On the other hand, the TUG test may not be useful to asses fear of movement in daily practice regarding to functional scores of these patients.

Electroencephalographic neurofeedback training can decrease conscious motor control and increase single and dual-task psychomotor performance

The control of human movements is thought to automize with repetition, promoting consistent execution and reduced dual-task costs. However, contingencies such as illness or constraints to regular movement patterns can promote conscious motor control, which can reduce movement proficiency and make dual-task situations more difficult. This experiment evaluated whether electroencephalographic neurofeedback training can reduce the adverse effects of conscious motor control. Twenty-five participants completed the timed-up-and-go task while wearing a leg brace to de-automize their regular movement, under both single and dual-task (walking + serial sevens) conditions, both before and after 30-min of neurofeedback training. Three different types of neurofeedback were prescribed across three laboratory visits. We hypothesised that training to decrease central EEG alpha-power at scalp sites above the supplementary motor area would facilitate performance compared to opposite (increase central EEG alpha-power) or sham neurofeedback training. Results revealed a pre-test to post-test improvement in performance on the single-task and on both aspects of the dual-task when participants were trained to decrease central EEG alpha-power. There were no benefits of opposite or sham neurofeedback training. Mediation analyses revealed that the improvement in dual-task motor performance was mediated by the improvement in cognitive performance. This suggests that the neurofeedback protocol was beneficial because it helped to reduce conscious control of the motor task. The findings could have important implications for rehabilitation and high-performance (e.g., elite sport) domains; neurofeedback could be prescribed to help alleviate the problems that can arise when individuals exert conscious motor control.

Quantitative falls risk assessment in elderly people: results from a clinical study with distance based timed up-and-go test recordings

OBJECTIVE

A third of people over 65 years experiences at least one fall a year. The Timed Up-and-Go (TUG) test is commonly used to assess gait and balance and to evaluate an individual's risk of falling.

APPROACH

We conducted a clinical study with 46 older participants for evaluating the fall risk assessment capabilities of an ultra-sound based TUG test device. The fall protocols over a period of one year were used to classify participants as fallers and non-fallers. For frailty evaluation, state-of-the-art questionnaires were used. Fall recordings were compared to six TUG test measurements that were recorded in fallers and non-fallers.

MAIN RESULTS

TUG test data were available for 39 participants (36 f, age 84.2 ± 8.2, BMI 26.0 ± 5.1). Twenty-three participants did fall at least once within the fall screening period. We fitted two different regression and probability models into a region of interest of the distance over time curve as derived from the TUG device. We found that the coefficient of determination for Gaussian bell-shaped curves (p < 0.05, AUC = 0.71) and linear regression lines (p < 0.02, AUC = 0.74) significantly separated fallers from non-fallers. Subtasks of the TUG test like the sit-up time showed near significance (p < 0.07, AUC = 0.67).

SIGNIFICANCE

We found that specific features calculated from the TUG distance over time curve were significantly different between fallers and non-fallers in our study population. Automatic recording and analysis of TUG measurements could, therefore, reduce time of measurements and improve precision as compared to other methods currently being used in the assessments of fall risk.

Predicting Cognitive Decline in Parkinson's Disease with Mild Cognitive Impairment: A One-Year Observational Study

We conducted an observational study to investigate clinical predictors of cognitive decline in patients with mild cognitive impairment (MCI), with a focus on patients with Parkinson's disease (PD) and Alzheimer's disease (AD). The study was performed with detailed neuropsychological testing, a portable device for gait analysis, and a comprehensive geriatric assessment for patients with MCI. Cognitive decline was defined as subjective cognitive impairment with an objective decline in the Mini-Mental State Examination (MMSE) ≥2 points at the one-year follow-up. Participants (n = 74) had a median age of 70 (interquartile range 60–79) years, and 45.9% of them were women. At the end of the study, 17.6% of the patients with MCI had a cognitive decline. Although no differences were observed between groups at the baseline cognitive study, patients with PD-MCI demonstrated more cognitive decline than patients with AD-MCI (28.6% vs. 7.7% p = 0.03). Patients with PD-MCI had more physical disabilities, including scores of instrumental activities of daily living (IADL), Tinetti balance, and gait scores, and some Timed Up and Go components. Initial Clinical Dementia Rating—Sum of Boxes score was a better predictor of future cognitive decline than MMSE in PD-MCI. For predicting the occurrence of cognitive decline in PD-MCI, the prediction accuracy increased from the reduced model (AUC = 0.822, p < 0.001) to the full model (a total of five independent variables, AUC = 0.974, p < 0.001). Given the potentially modifiable predictor, our findings also highlight the importance of identifying sleep quality and the ability to perform IADL.

Functional improvement related to enrolment in a Parkinson's disease rehabilitation program

BACKGROUND

Parkinson's disease (PD) is a progressive neurodegenerative disorder with manifestations such as tremors, rigidity and bradykinesia.

OBJECTIVE

The objective of this study was to evaluate the efficacy of outpatient multidisciplinary rehabilitation.

METHODS

179 patients participated in the six-week program. The following outcomes were measured: Timed Up and Go (TUG), sit to stand five times (STSx5) and in 30 seconds (STS30), six minute walk distance (6MWD) and gait velocity (6MWV), MOCA, bilateral grip strength, 360-degree turn (360 R, 360 L) and bilateral nine hole peg test. Pre- and post- data was analyzed via paired t-tests. Multiple regression was used to determine age- or gender-affected outcomes.

RESULTS

Patients showed a statistically significant improvement (p < 0.05) in all outcomes. Mean TUG improved by 1.63 seconds (s), STSx5 by 4.19s, STS30 by 2.37 repetitions, 6MWD by 66.8 metres, 6MWV by 0.15 m/s, MOCA by 1.50 points, 360 R by 1.17s, 360 L by 1.60s, Grip R by 0.78 kg, Grip L by 0.95 kg, 9HP R by 1.71s and 9HP L by 1.58s. Gender had no influence. Age was a statistically significant predictor in STSx5 and 6MW.

CONCLUSIONS

An outpatient multidisciplinary program successfully decreased motor impairment and increased overall functional independence in PD.

Effects of contemporary dance and physiotherapy intervention on balance and postural control in Parkinson's disease

PURPOSE

To describe the effects of a contemporary dance program, combined with conventional physiotherapy, on postural control, satisfaction and adherence in mild-moderate Parkinson's disease (PD) patients.

METHODS

A withdrawal/reversion test with three intervention periods. Each period lasts for two months: physiotherapy, physiotherapy + dance and withdrawing dance and continuing with the physiotherapy sessions. Berg Balance Scale (BBS), Timed Up & Go test (TUG), Sensory Organization Test (SOT), Motor Control Test (MCT) and Rhythmic Weigh Shift (RWS) were assessed at T1 (baseline), T2 (post-physiotherapy treatment), T3 (post-physiotherapy and dance) and T4 (post-physiotherapy). A satisfaction questionnaire and adherence were registered.

RESULTS

27 patients (67.32 ± 6.14 yrs) completed the study. Statistical analysis revealed differences between T2-T3 (p = 0.027), T2-T4 (p = 0.029), T1-T3 (p = 0.010) and T1-T4 (p = 0.008) for BBS; and between T1-T2 (p = 0.037), T1-T3 (p = 0.005), T1-T4 (p = 0.004), T2-T3 (p = 0.022) and T2-T4 (p = 0.041) for TUG. Significant differences for CES (p < 0.001), VEST (p = 0.024) and strategy (p = 0.011) were observed, but not for MCT. Lateromedial velocity (p = 0.003) and anteroposterior velocity (p < 0.001) were significant for RWT. Patients showed a high level of satisfaction and adherence.

CONCLUSIONS

A short 8-weeks contemporary dance program plus combined physiotherapy shows benefits in functional mobility and balance, with a high degree of satisfaction and adherence in PD.IMPLICATIONS FOR REHABILITATIONContemporary dance, combined with physiotherapy, is a useful therapeutic tool to treat balance disorders and postural control in people with PD.A short 8-weeks contemporary dance program plus combined physiotherapy shows high satisfaction in people with PD.Contemporary dance, combined with physiotherapy, shows high adherence in people with mild-moderate PD to treat postural control.

Coexistent Osteoarthritis and Parkinson's Disease: Data from the Parkinson's Foundation Outcomes Project

BACKGROUND

The impact of concurrent osteoarthritis on mobility and mortality in individuals with Parkinson's disease is unknown.

OBJECTIVE

We sought to understand to what extent osteoarthritis severity influenced mobility across time and how osteoarthritis severity could affect mortality in individuals with Parkinson's disease.

METHODS

In a retrospective observational longitudinal study, data from the Parkinson's Foundation Quality Improvement Initiative was analyzed. We included 2,274 persons with Parkinson's disease. The main outcomes were the effects of osteoarthritis severity on functional mobility and mortality. The Timed Up and Go test measured functional mobility performance. Mortality was measured as the osteoarthritis group effect on survival time in years.

RESULTS

More individuals with symptomatic osteoarthritis reported at least monthly falls compared to the other groups (14.5% vs. 7.2% without reported osteoarthritis and 8.4% asymptomatic/minimal osteoarthritis, p = 0.0004). The symptomatic group contained significantly more individuals with low functional mobility (TUG≥12 seconds) at baseline (51.5% vs. 29.0% and 36.1%, p < 0.0001). The odds of having low functional mobility for individuals with symptomatic osteoarthritis was 1.63 times compared to those without reported osteoarthritis (p < 0.0004); and was 1.57 times compared to those with asymptomatic/minimal osteoarthritis (p = 0.0026) after controlling pre-specified covariates. Similar results hold at the time of follow-up while changes in functional mobility were not significant across groups, suggesting that osteoarthritis likely does not accelerate the changes in functional mobility across time. Coexisting symptomatic osteoarthritis and Parkinson's disease seem to additively increase the risk of mortality (p = 0.007).

CONCLUSION

Our results highlight the impact and potential additive effects of symptomatic osteoarthritis in persons with Parkinson's disease.