Reliability and Validity of Nonradiologic Measures of Forward Flexed Posture in Parkinson Disease

The benefits of Shuai Shou Gong (SSG) demonstrated in a Randomised Control Trial (RCT) study of older adults in two communities in Thailand

INTRODUCTION

Shuai Shou Gong (SSG) is a type of Arm Swing Exercise (ASE) developed and practiced especially by older people in China for over one thousand years to maintain physical health and well-being. Until now the potential benefits of SSG have not been investigated in a Randomised Control Trial (RCT).

MATERIALS AND METHODS

Fifty six older women were recruited from each of two urban communities in Khon Kaen, Thailand. One community was randomly assigned as the Exercise Group (mean age 68.3 years, standard deviation 5.6 years) and the other as the Control Group (69.4 years, 4.4 years). The Exercise Group performed SSG for 40 minutes, three days per week for two months, whereas the Control Group maintained their usual daily life. Measurements of Posture (C7 to Wall Distance (C7WD), Standing Height (SH), Flexibility (Back Scratch of Left and Right arms (BSL and BSR) and Chair Sit and Reach of Left and Right legs (CSRL and CSRR), Gait (Timed Up and Go (TUG)), and Cognition (Barthel Activities of Daily Living Index (BADL) and Rosenberg Self Esteem Scale (RSES) questionnaires) were recorded for each group prior to, on day 1, week 4, and week 8 of the SSG training.

RESULTS

The 8 week SSG training course produced a significant interaction between group and time for the combined set of all outcome measures (C7WD, SH, BSL, BSR, CSRL, CSRR, TUG, BADL, and BSES) (Modified ANOVA-Type Statistic (MATS) p-value < 0.001) and for the four categories of Posture, Flexibility, Gait, and Cognition (all Wald-Type Statistic (WTS) p-values < 0.05) and in all cases the changes in the Exercise Group were in the direction predicted to be beneficial. No significant interaction effect between time and group was found after either one session or four weeks of SSG training for any of the categories (all WTS p > 0.05) with significant effects only arising after eight weeks (all WTS p < 0.05). Thus although alterations were shown to be increasingly beneficial over time the minimum period required to produce a statistically significant benefit from performing SSG training was 8 weeks. For the Control Group no significant changes were identified for Posture, Flexibility and Cognition however a significant deterioration was observed in TUG (WTS p = 0.003).

CONCLUSIONS

SSG is a holistic, gentle, rhythmic, whole body sequence of movements that may be readily learned and enjoyed in a group setting and has been confirmed in an RCT study of older adult females to produce significant benefits in Posture, Flexibility, Gait and Cognition.

Camera- and Viewpoint-Agnostic Evaluation of Axial Postural Abnormalities in People with Parkinson's Disease through Augmented Human Pose Estimation

Axial postural abnormalities (aPA) are common features of Parkinson's disease (PD) and manifest in over 20% of patients during the course of the disease. aPA form a spectrum of functional trunk misalignment, ranging from a typical Parkinsonian stooped posture to progressively greater degrees of spine deviation. Current research has not yet led to a sufficient understanding of pathophysiology and management of aPA in PD, partially due to lack of agreement on validated, user-friendly, automatic tools for measuring and analysing the differences in the degree of aPA, according to patients' therapeutic conditions and tasks. In this context, human pose estimation (HPE) software based on deep learning could be a valid support as it automatically extrapolates spatial coordinates of the human skeleton keypoints from images or videos. Nevertheless, standard HPE platforms have two limitations that prevent their adoption in such a clinical practice. First, standard HPE keypoints are inconsistent with the keypoints needed to assess aPA (degrees and fulcrum). Second, aPA assessment either requires advanced RGB-D sensors or, when based on the processing of RGB images, they are most likely sensitive to the adopted camera and to the scene (e.g., sensor-subject distance, lighting, background-subject clothing contrast). This article presents a software that augments the human skeleton extrapolated by state-of-the-art HPE software from RGB pictures with exact bone points for posture evaluation through computer vision post-processing primitives. This article shows the software robustness and accuracy on the processing of 76 RGB images with different resolutions and sensor-subject distances from 55 PD patients with different degrees of anterior and lateral trunk flexion.

Staying UpRight in Parkinson's disease: A pilot study of a novel wearable postural intervention

OBJECTIVES

This interventional pilot study aimed to 1) examine whether a novel wearable vibro-tactile feedback device ('UpRight Go') is effective and feasible to improve postural alignment in Parkinson's disease (PD); 2) explore relationships between postural alignment and attention in PD; 3) explore effect of vibro-tactile device on balance and gait; and 4) gain initial feedback on the use of the vibro-tactile device in the laboratory and at home.

METHODS

25 people with PD sat, stood and walked for two-minutes without and with the UpRight device attached to their upper backs to provide feedback on postural alignment in the laboratory. A sub-group (n = 12) wore the UpRight device at home for 60 min. per day for 7-days of postural feedback. Subjective feedback on use of the device was obtained in the laboratory and at the end of the 7-day period. The primary outcome for this study was posture measured by verticality of inertial measurement units (IMUs) at the neck, trunk and low back, which was done with and without the UpRight device. Secondary outcomes included clinical measures of posture, subjective feedback on the device, computerized attention measures, gait and balance.

RESULTS

Neck postural alignment in PD was significantly improved (reduced neck flexion) with the UpRight during sitting and standing in both clinical measures (p = 0.005) and IMU outcomes (p = 0.046), but trunk and low back posture did not change. There was no change in postural alignment during walking with the UpRight. Postural alignment response was related to attentional capabilities. Many subjects (68 %) reported that they felt a benefit from the UpRight and most participants reported that the device was acceptable (Lab use; 72 %, Home use; 75 %).

CONCLUSION

The UpRight Go feedback device may improve neck/upper-back posture in PD during sitting and standing, but not during walking. Postural alignment response to the device may depend on attentional mechanisms.

Forward flexed posture: reliability and determinants of tragus-to-wall measurement

INTRODUCTION

Forward flexed posture is an impairment in body structure commonly seen among older adults and those with pathologies such as ankylosing spondylitis and osteoporosis. Accurate measurement of forward flexed posture is important as it is related to pain, mobility limitations, and falls. Our purpose was to examine the reliability and determinants of forward flexed posture as indicated by tragus-to-wall (TTW) distance.

METHODS

Twenty healthy younger and 20 healthy older adults were included in this secondary analysis of data from a neck strength study. Measurements included the linear distance of TTW standing naturally and with neck retraction, age, gender, body mass index (BMI), and neck retraction strength. Measurements were performed initially by 2 investigators and by the primary investigator 1 week later. Intraclass correlation coefficients (ICCs) (model 3,1) described relative reliability and Bland-Altman plots characterized absolute reliability. A mixed general linear model examined the determinants for TTW distance.

RESULTS

Good inter-rater (ICC = 0.811-0.878) and test-retest reliability (ICC = 0.853-0.862) were found in both positions. Bland-Altman plots showed that absolute limits of agreement ranged from - 1.9 to +3.8 cm for inter-rater reliability and -2.4 to +2.6 cm for test-retest reliability. Analysis of TTW determinants demonstrated significant differences between neck positions, dichotomous age groups, and BMI groups (p ≤ 0.001). There was no significant difference based on neck strength.

CONCLUSIONS

Our results indicate that TTW distance, measured using a standardized procedure, is a reliable method of quantifying forward flexed posture. TTW distance is greater in relaxed standing, older individuals, and those with greater BMI.

Effects of Corrective Exercise for Thoracic Hyperkyphosis on Posture, Balance, and Well-Being in Older Women: A Double-Blind, Group-Matched Design

BACKGROUND AND PURPOSE

The purpose of this study was to identify the effects of a corrective exercise for thoracic hyperkyphosis on posture, balance, and well-being in Korean community-dwelling older women.

METHODS

Fifty women 65 years of age and older, recruited from 2 senior centers, participated in this study. Participants were assigned to either the experimental group (EG) or the control group (CG) on the basis of convenience of location, and 22 in each were analyzed. Participants in the EG underwent a thoracic corrective exercise program 1 hour each session, twice per week for 8 weeks (a total of 16 sessions), which consisted of specific exercises to enhance breathing, thoracic mobility and stability, and awareness of thoracic alignment. The CG received education on the same thoracic corrective exercise program and a booklet of the exercises. Outcome measures included the extent of postural abnormality (angle of thoracic kyphosis, kyphosis index calculated both in relaxed- and best posture using flexicurve, the ratio of the kyphosis index calculated best posture/relaxed posture, craniovertebral angle, and tragus-to-wall distance), balance (Short Physical Performance Battery and limit of stability), and well-being (Geriatric Depression Scale Short Form and the 36-Item Short Form Health Survey [SF-36]). All data were collected by 6 blinded assessors at baseline, at 8 weeks after the completion of intervention, and at 16 weeks for follow-up.

RESULTS AND DISCUSSION

For participants of the EG, means of all parameters showed significant improvements over time (P < .05), with improved values both in comparison of baseline to postintervention and baseline to follow-up. Means of CG parameters were significantly improved in only the angle of thoracic kyphosis and the tragus-to-wall distance (P < .05). Furthermore, in all parameters, percent change between baseline and postintervention data was significantly (P < .05) higher for the EG than that for the CG, except for the limit of stability and SF-36 which improved but not significantly. All parameters between baseline and follow-up data were significantly (P < .05) higher for the EG than those for the CG, except for the limit of stability.

CONCLUSIONS

The findings of this study suggest that a well-designed exercise program may be beneficial to improve spinal posture, balance, and well-being in older women with thoracic hyperkyphosis. We recommend the use of the therapeutic strategies utilized in this study to enhance thoracic posture, balance, and well-being of older women with thoracic hyperkyphosis. Future research is needed to apply this exercise protocol on a larger and more diverse population.

Flexed Posture in Parkinson Disease: Associations With Nonmotor Impairments and Activity Limitations

BACKGROUND

People with Parkinson disease (PD) are twice as likely to develop flexed truncal posture as the general older population. Little is known about the mechanisms responsible beyond associations with age, axial motor impairments, and disease severity.

OBJECTIVE

The objective was to explore: (1) the associations of the nonmotor impairments of PD with flexed posture, and (2) the relationships of flexed posture with activity limitations.

DESIGN

This was a cross-sectional study.

METHODS

Seventy people with PD participated. Posture was measured in standing as the distance between the seventh cervical vertebra and a wall. Nonmotor impairments (cognition, depression, pain, fatigue, and proprioception) and activity performance (upper limb activity, bed transfers, respiratory function, and speech volume) were variously assessed using objective measures and self-report questionnaires. Univariate and multivariate regression analyses were performed to ascertain relationships between nonmotor impairments and truncal posture, and between truncal posture and activities.

RESULTS

Greater disease severity, greater axial impairment, poorer spinal proprioception, greater postural fatigue, and male sex were significantly associated with flexed truncal posture. The multivariate model containing these factors in addition to age explained 30% of the variability in flexed truncal posture, with male sex and axial motor impairment continuing to make independent contributions. A significant association was found between greater flexed truncal posture and poorer upper limb activity performance and respiratory function.

LIMITATIONS

A limitation to this study was that participants had mild-to-moderate disease severity.

CONCLUSIONS

Spinal proprioception and postural fatigue were the only nonmotor impairments to make significant contributions to flexed posture. Given the negative influence of flexed posture on upper limb activity and respiratory function, interventions targeting spinal proprioception and postural awareness should be considered for people with PD who might develop flexed posture.

Tragus-to-wall: A systematic review of procedures, measurements obtained, and clinimetric properties

OBJECTIVE

Our purpose was to summarize the literature on the applicability, procedures for performing, and clinimetric findings related to the measurement of tragus-to-wall (TTW) distance.

METHOD

Pubmed, Scopus, and CINAHL databases were systematically searched using the key words "tragus" AND "wall". Articles were examined for information on the participants whose TTW distance was measured, the procedures used for measuring TTW, and findings regarding TTW distances measured and the clinimetric properties of the measurements.

RESULTS

Thirty-nine articles were identified that described use of the TTW test. Most used the test with patients with ankylosing spondylitis. We found evidence for the convergent and known groups validity and reliability of the TTW measurements. Limited support for the responsiveness of TTW measurements was found. Two studies provided normative reference values.

CONCLUSIONS

The TTW test is a simple objective indicator of forward flexed posture supported by research on its validity and reliability. More specific information on responsiveness and age-specific norms would increase the value of this nonspecific postural indicator.

Feasibility and informativeness of the Patient-Specific Functional Scale with patients with Parkinson's disease

Introduction: The primary purpose of this study was to examine the feasibility and informativeness of the Patient-Specific Functional Scale (PSFS) for identifying activities that persons with Parkinson disease (PD) self-identified as difficult.Method: Informativeness was investigated by cross-referencing the identified activities with the International Classification of Functioning, Disability, and Health (ICF), the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and Parkinson's Disease Questionnaire (PDQ-39). Twenty-eight individuals with PD (Hoehn & Yahr stage 1-4) completed the PSFS. Activities identified by the participants were classified according to the ICF and then cross-referenced across the MDS-UPDRS and PDQ-39.Results: Participants identified 98 specific (60 different) activities that they were unable to do or were having difficulty with as a result of PD. Activities most frequently listed as difficult included some aspect of fine hand use, dressing, eating, or changing position (e.g. transferring). All activities could be classified using the ICF, but many were not addressed specifically by the MDS-UPDRS or PDQ-39.Conclusion: We conclude that the PSFS can be used for identifying activities that persons with PD personally find difficult and may be useful as a compliment to the MDS-UPDRS and PDQ-39.