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Kamari M, Siqueira V, Bakare J, Sebastião E. Virtual Reality Technology for Physical and Cognitive Function Rehabilitation in People With Multiple Sclerosis. Rehabil Res Pract 2024; 2024:2020263. [PMID: 39355707 PMCID: PMC11444799 DOI: 10.1155/2024/2020263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 08/14/2024] [Accepted: 08/27/2024] [Indexed: 10/03/2024] Open
Abstract
Virtual reality (VR) has significantly expanded the possibilities of medical treatment, particularly in the realm of rehabilitation. VR utilizes advanced technologies to create simulated environments that users perceive as analogous to the real world. Researchers have demonstrated that VR can effectively train motor, sensory, and cognitive functions. This manuscript offers a concise review of recent evidence concerning the effects of VR training on key clinical symptoms in people with multiple sclerosis (pwMS), with the aim of highlighting VR's potential as a complementary rehabilitative tool for improving ubiquitous symptoms of multiple sclerosis (MS)-a neurodegenerative, often disabling, disease. In addition to presenting a brief overview of recent literature on VR for pwMS, this narrative review seeks to provide health professionals with a foundational understanding of VR as a rehabilitative tool in MS. Furthermore, it may aid in identifying gaps in the literature and stimulate the development of new hypotheses and theories regarding the use of VR in patients with a neurodegenerative disease.
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Affiliation(s)
- MahgolZahra Kamari
- Graduate School of Comprehensive Human SciencesUniversity of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
- Department of Kinesiology and Physical EducationNorthern Illinois University, 1425 Lincoln Highway, DeKalb, Illinois, USA
| | - Vitor Siqueira
- Department of Health and KinesiologyUniversity of Illinois Urbana-Champaign, 906 South Goodwin Avenue, Urbana, Illinois 61801, USA
| | - Jemimah Bakare
- Department of Health and KinesiologyUniversity of Illinois Urbana-Champaign, 906 South Goodwin Avenue, Urbana, Illinois 61801, USA
| | - Emerson Sebastião
- Department of Health and KinesiologyUniversity of Illinois Urbana-Champaign, 906 South Goodwin Avenue, Urbana, Illinois 61801, USA
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Tiedemann A, Sturnieks DL, Burton E, Thom JM, Lord SR, Scott S, Sherrington C. Exercise and Sports Science Australia updated position statement on exercise for preventing falls in older people living in the community. J Sci Med Sport 2024:S1440-2440(24)00518-8. [PMID: 39341781 DOI: 10.1016/j.jsams.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/28/2024] [Accepted: 09/13/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUNDS Falls affect a significant number of older Australians and present a major challenge to health care providers and health systems with over 380 older Australians hospitalised for a fall each day. OBJECTIVES This statement seeks to inform and guide exercise practitioners and health professionals in safe and effective prescription of exercise to prevent falls amongst community-dwelling older people. EXERCISE PRESCRIPTION TO PREVENT FALLS Exercise is crucial for preventing falls in older age. Research evidence has identified that programmes which include functional balance and muscle strength training are the most effective in preventing falls. It is also important for exercise to be progressively challenging, ongoing and of sufficient dose to maximise its benefits in reducing falls. Additional (non-exercise) interventions are necessary for people with complex medical conditions, recent hospitalisation and/or particular risk factors not improved by exercise. People at a higher risk of falls may need greater support to undertake safe and effective fall prevention exercise. SUMMARY Global guidelines for fall prevention and management recommend that all older adults should receive advice about exercise to prevent falls. Qualified exercise professionals are well placed to prescribe and supervise functional balance and muscle strength training to older people with varied functional abilities, including those with co-morbidities.
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Affiliation(s)
- Anne Tiedemann
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Australia.
| | - Daina L Sturnieks
- Neuroscience Research Australia, University of New South Wales, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Australia; enAble Institute, Faculty of Health Sciences, Curtin University, Australia
| | - Jeannette M Thom
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, Australia
| | - Stacey Scott
- School of Medical and Health Sciences, Edith Cowan University, Australia
| | - Catherine Sherrington
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Australia
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Peters J, Lauinger A, Mayr M, Ginell K, Abou L. Dual-Task Assessments for Predicting Future Falls in Neurologic Conditions: A Systematic Review. Am J Phys Med Rehabil 2024; 103:554-560. [PMID: 38466165 DOI: 10.1097/phm.0000000000002452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
ABSTRACT This review investigated the ability of dual-task tests to predict falls in people with neurological disorders. Databases were searched to identify prospective cohort studies that analyzed dual-task testing and falls in people with neurological disorders. Reviewers screened studies for eligibility and extracted key information like participant characteristics, intervention details, outcome measures, and significant outcomes. Reviewers assessed methodological quality of eligible studies using the Standard Quality Assessment Criteria. Eighteen studies of strong methodological qualified with 1750 participants were included in the review. Dual-task performances were predictive of future falls in people with Huntington's disease, spinal cord injury, and moderate cognitive impairment, although only one independent study was included for each disability type. In people with stroke, 37% of eligible studies showed dual-task assessments to be predictive of future falls. No dual-task tests predicted prospective falling in people with Alzheimer's or Parkinson's disease. Complex dual tasks seemed to be more predictive of fall risk than simpler dual tasks. Results suggest that disability type, severity of disability, and task complexity play a role in the predictive ability of dual-task assessments and future falling in neurological disorders. Future studies may benefit from using this review to guide the design of effective dual-task assessments and fall interventions.
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Affiliation(s)
- Joseph Peters
- From the Kansas City University College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri (JP, MM); Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (AL); and Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan (KG, LA)
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Park C, Lee BC. A Systematic Review of the Effects of Interactive Telerehabilitation with Remote Monitoring and Guidance on Balance and Gait Performance in Older Adults and Individuals with Neurological Conditions. Bioengineering (Basel) 2024; 11:460. [PMID: 38790328 PMCID: PMC11117498 DOI: 10.3390/bioengineering11050460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Recognizing the growing interests and benefits of technology-assisted interactive telerehabilitation in various populations, the aim of this review is to systematically review the effects of interactive telerehabilitation with remote monitoring and guidance for improving balance and gait performance in older adults and individuals with neurological conditions. The study protocol for this systematic review was registered with the international prospective register of systematic reviews (PROSPERO) with the unique identifier CRD42024509646. Studies written in English published from January 2014 to February 2024 in Web of Science, Pubmed, Scopus, and Google Scholar were examined. Of the 247 identified, 17 were selected after initial and eligibility screening, and their methodological quality was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. All 17 studies demonstrated balance and gait performance improvement in older adults and in individuals with stroke, Parkinson's disease, and multiple sclerosis following 4 or more weeks of interactive telerehabilitation via virtual reality, smartphone or tablet apps, or videoconferencing. The findings of this systematic review can inform the future design and implementation of interactive telerehabilitation technology and improve balance and gait training exercise regimens for older adults and individuals with neurological conditions.
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Affiliation(s)
- Catherine Park
- Division of Digital Healthcare, Yonsei University, Wonju 26493, Republic of Korea
| | - Beom-Chan Lee
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA
- Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX 77204, USA
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Abou L, Peters J, Freire B, Sosnoff JJ. Fear of falling and common symptoms of multiple sclerosis: Physical function, cognition, fatigue, depression, and sleep - A systematic review. Mult Scler Relat Disord 2024; 84:105506. [PMID: 38422635 DOI: 10.1016/j.msard.2024.105506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/03/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Fear of falling (FOF) is a common concern among persons with multiple sclerosis (MS) and affects the performance of their daily living activities. Falls may result in FOF, leading to worsening of symptoms of MS, physical deconditioning, and exposure to future falls. This may trigger a vicious cycle between FOF and falls. A better understanding of the relationship between FOF and symptoms of MS may be helpful to develop a conceptual model to guide fall prevention interventions. OBJECTIVE To synthesize the correlational and predictive relationships between FOF and common symptoms of MS. METHODS Databases including PubMed, Embase, Web of Science, Scopus, CINHAL, PsycINFO, and SPORTDiscuss were searched from inception to October 2023. Studies examining correlations and/or predictions between FOF and common MS symptoms that include measures of gait, postural control, fatigue, cognition, pain, sleep, depression, and anxiety were identified by two independent reviewers. Both reviewers also conducted the methodological quality assessment of the included studies. RESULTS Twenty-three studies with a total of 2819 participants were included in the review. Correlational findings indicated that increased FOF was significantly associated with greater walking deficits (lower gait speed, smaller steps), reduced mobility, and poorer balance. Increased FOF was also significantly correlated with higher cognitive impairments, more fatigue, sleep disturbances, and depression. Decreased gait parameters, reduced balance, lower physical functions, cognitive impairments, and sleep deficits were found as significant predictors of increased FOF. CONCLUSION Evidence indicates significant correlational and bidirectional predictive relationships exist between FOF and common MS symptoms. A comprehensive conceptual framework accounting for the interaction between FOF and MS symptoms is needed to develop effective falls prevention strategies.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Joseph Peters
- Kansas City University College of Osteopathic Medicine, Kansas City University of Medicine and Bioscience, Kansas City, MO, USA
| | - Bruno Freire
- Health and Sports Sciences Center, Santa Catarina State University, Florianópolis, SC, Brazil
| | - Jacob J Sosnoff
- Department of Physical Therapy, Rehabilitation Science, & Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
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Abou L, Rice LA. The differences in demographics, fear of falling, transfer quality and participation enfranchisement between manual and power wheelchair users with multiple sclerosis and spinal cord injury. Disabil Rehabil Assist Technol 2024; 19:1003-1008. [PMID: 36301722 DOI: 10.1080/17483107.2022.2138998] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/31/2022] [Accepted: 10/17/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE To examine the differences in demographics, fear of falling (FOF), transfer quality and participation enfranchisement between manual and power wheelchair users with multiple sclerosis (MS) and spinal cord injury (SCI). MATERIALS AND METHODS Secondary data analysis including 126 manual or power wheelchair users with MS and SCI (median age, 53.00 years, IQR = 24.00). Demographic information including age, gender, height, weight and disability duration was collected. Body mass index (BMI) was calculated for all participants. Participation enfranchisement was examined using both subscales (Importance and Control) of the enfranchisement scale of the Community Participation Indicator (CPI). FOF was assessed using the Spinal Cord Injury-Falls Concern Scale (SCI-FCS) and transfer quality was assessed using the Transfer Assessment Instrument (TAI) 3.0 and 4.0. Mann-Whitney's U-tests or independent samples t-tests and chi-square were used to analyse the differences between continuous variables and categorical variables, respectively. RESULTS Fifty-seven percent of participants were manual wheelchair users. There were significant differences in most demographic information except for weight and disability duration. Significant differences were also found for BMI (t = 1.06, p = 0.04), CPI-Importance (U = 1282.50, p < 0.01), CPI-Control (U = 1165.50, p < 0.01) and SCI-FCS (t = 4.08, p < 0.01). Manual wheelchair users outperformed power wheelchair users in all outcomes analysed except the TAI (p = 0.18). CONCLUSIONS Power wheelchairs users presented with a higher BMI, reported lower participation enfranchisement, and reported higher levels of FOF compared to manual wheelchair users. The findings may help clinicians to develop targeted rehabilitation goals specific for power and manual wheelchair users with MS and SCI.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Abou L, McCloskey C, Wernimont C, Fritz NE, Kratz AL. Examination of Risk Factors Associated With Falls and Injurious Falls in People With Multiple Sclerosis: An Updated Nationwide Study. Arch Phys Med Rehabil 2024; 105:717-724. [PMID: 38043675 DOI: 10.1016/j.apmr.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To provide an update on risk factors associated with falls and injurious falls among people with multiple sclerosis (PwMS) in the United States. DESIGN Nationwide cross-sectional web-based survey. SETTING Community setting. PARTICIPANTS Adult PwMS (n=965). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants completed self-report surveys of demographics, clinical data, concerns about falling, occurrence of falls, factors associated with falls, and injurious falls in the past 6 months. Participants also completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures of depression, pain interference, and physical function, and the Fatigue Severity Scale. RESULTS The most common self-reported factors associated with falls included personal factors such as poor balance (75%), muscle weakness (54%), and/or fatigue (35%), environmental factors such as general surface conditions (37%) and/or distraction (15%), and activities-related factors such as urgency to complete a task (35%) and/or multitasking (27%). Logistic regression analyses indicated that higher fatigue severity (OR=1.19, P<.01) and higher pain interference (OR=1.02, P<.01) were associated with higher odds of experiencing at least 1 fall. Any level of concern, even minimal concern about falling was also significantly associated with a higher odd of experiencing at least 1 fall (ORs range 2.78 - 3.95, all P<.01). Fair to very high concerns about falling compared with no concern about falling (ORs range=5.17 - 10.26, all P<.05) was significantly associated with higher odds of sustaining an injurious fall. CONCLUSIONS Findings suggest falls prevention approaches in PwMS should be multifactorial and include personal, environmental, and activities-related factors. Particular attention on fatigue, pain, and concern about falling may be needed to reduce incidence of falls and injurious falls in this population.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI.
| | - Chloe McCloskey
- Department of Physical Medicine and Rehabilitation, Kaiser Permanente Health System, Redwood City, CA
| | - Cory Wernimont
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Nora E Fritz
- Departments of Health Care Sciences & Neurology, Wayne State University, Detroit, MI
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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Zarotti N, Deane KHO, Ford CEL, Simpson J. Psychosocial interventions affecting global perceptions of control in people with Parkinson's disease: a scoping review. Disabil Rehabil 2024; 46:443-452. [PMID: 36688404 DOI: 10.1080/09638288.2023.2169376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 01/12/2023] [Indexed: 01/24/2023]
Abstract
PURPOSE Perceived control is an important construct for the psychological well-being of people affected by chronic conditions, and higher perceived control is associated with better outcomes. Psychosocial interventions have been trialled in these populations to improve both global and specific perceptions of control. However, most interventions involving people with Parkinson's have focused on single-domain forms of control, while those addressing global perceived control are yet to be reviewed. This study aimed to identify and map the types of psychosocial interventions in individuals with Parkinson's which have included forms of global perceived control as an outcome. MATERIALS AND METHODS Scoping review based on a search across MEDLINE, PsycINFO, CINAHL, Academic Search Ultimate. RESULTS From an initial return of 4388 citations, 12 citations were eventually included. These consisted of 8 quantitative and 4 qualitative studies, and covered 4 overarching categories of psychosocial interventions. Mixed results were found for cognitive, educational, and physical interventions, while a randomised controlled trial on mindfulness-based lifestyle programme showed more preliminary positive evidence. CONCLUSIONS Further rigorous research is required on the topic to build on these preliminary findings. In the meantime, clinicians may need to consider programmes which proved effective with populations similar to people with Parkinson's.IMPLICATIONS FOR REHABILITATIONPerceived control is a psychological construct important for people with chronic illnesses, which can be targeted by psychosocial interventions.This article reviewed psychosocial interventions targeting global forms of perceived control in Parkinson's.Mixed results were reported for the cognitive, educational, and physical interventions identified, while a randomised controlled trial on a mindfulness-based lifestyle programme showed more promising evidence.In the meantime, clinicians may need to consider programmes found to be effective with people with similar conditions to Parkinson's.
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Affiliation(s)
- Nicolò Zarotti
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Catherine Elaine Longworth Ford
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Pin TW, Winser SJ, Chan WLS, Chau B, Ng S, Wong T, Mak M, Pang M. Association between fear of falling and falls following acute and chronic stroke: a systematic review with meta-analysis. J Rehabil Med 2024; 56:jrm18650. [PMID: 38226564 PMCID: PMC10802787 DOI: 10.2340/jrm.v56.18650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/14/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVES To examine the association between falls and fear of falling in people with stroke and to evaluate the differences between patients with acute stroke and those with chronic stroke with regard to any such association. METHODS Articles were searched in Medline, CINAHL, AMED, Embase, PsycINFO, Cochrane Library of Reviews and PEDro from inception until March 2023. Experimental, observational or explorative studies investigating the association between fear of falling and falls in people with stroke were included. Articles were screened by 2 independent reviewers. Data were extracted by an independent reviewer. RESULTS A total of 26 reports were included in this review (n = 2863). Fear of falling, assessed by a single-question survey, was significantly associated with falls (relative risk = 1.44; 95% confidence interval (95% CI) = 1.22, 1.70; I2 = 0%) in people with acute stroke. Significant mean differences in fear of falling, based on the Falls Efficacy Scale (mean difference = 12.80; 95% CI = 1.81, 23.78; I² = 28%) and Activities-specific Balance Confidence Scale (mean difference = -9.99; 95% CI = -15.36, -4.62; I² = 57%), were also reported between fallers and non-fallers in people with chronic stroke. CONCLUSION A small, but significant, association exists between falls and fear of falling in both acute and chronic stroke patients.
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Affiliation(s)
- Tamis W Pin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Stanley J Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Wayne L S Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Bolton Chau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Shamay Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Thomson Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Margaret Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Marco Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Peters J, Abou L, Wong E, Dossou MS, Sosnoff JJ, Rice LA. Smartphone-based gait and balance assessment in survivors of stroke: a systematic review. Disabil Rehabil Assist Technol 2024; 19:177-187. [PMID: 35584288 DOI: 10.1080/17483107.2022.2072527] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/21/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Gait and balance impairments are associated with falls and reduced quality of life among survivors of stroke (SS). Effective methods to assess these impairments at-home and in-clinic can help reduce fall risks and improve functional outcomes. Smartphone technology may be able to evaluate these impairments. This review aims to summarize the validity, reliability, sensitivity, and specificity of smartphone applications for determining gait and balance disorders in SS. METHOD Database search through PubMed, Web of Science, Scopus, CINAHL, and SportDiscuss was conducted to retrieve studies that explored the use of smartphone-based applications for assessing gait and balance disorders in SS. Two independent reviewers screened potential articles to determine eligibility for inclusion. Eligible studies were summarized for participant and study characteristics, validity, reliability, sensitivity, and specificity of smartphone assessments. Methodological quality assessment of studies was performed using the NIH Quality Assessment Tool. RESULTS Seven cross-sectional studies were included in the review. Quality assessment revealed all studies had low risk of bias. Three of the included studies examined the validity, four examined the reliability, and two examined the specificity and sensitivity of smartphone-based application assessments of gait and balance in SS. Studies revealed that smartphones were valid, reliable, specific, and sensitive. Six of the seven included studies intended their use for SS and one study for clinicians. CONCLUSION Preliminary evidence supports that smartphone-based gait and balance assessments are valid, reliable, sensitive, and specific in SS in laboratory settings. Future research is needed to test smartphone-based gait and balance assessments in home settings and determine optimal wear sites for assessments.IMPLICATIONS FOR REHABILITATIONSmartphone-based gait and balance assessments are feasible, valid and reliable for survivors of strokeThe findings may guide future research to standardize the use of smartphone to assess gait and balance in this population.The remote use of smartphone-based assessments to predict fall risk in survivors of stroke needs to be explored.
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Affiliation(s)
- Joseph Peters
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ellyce Wong
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Jacob J Sosnoff
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
- Illinois Multiple Sclerosis Research Collaborative, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Illinois Multiple Sclerosis Research Collaborative, University of Illinois at Urbana Champaign, Urbana, IL, USA
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Padilha C, Souza R, Grossl FS, Gauer APM, de Sá CA, Rodrigues-Junior SA. Physical exercise and its effects on people with Parkinson's disease: Umbrella review. PLoS One 2023; 18:e0293826. [PMID: 37917715 PMCID: PMC10621990 DOI: 10.1371/journal.pone.0293826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Parkinson's disease is neurodegenerative, complex and progressive, manifesting in a slow and irreversible way. Physical exercise has been proposed as therapeutic alternative to people with Parkinson´s disease. OBJECTIVE To synthesize knowledge about the effects of physical exercise on people with Parkinson´s Disease as presented by published systematic reviews. METHODS Nine electronic databases and two grey literature databases were searched for systematic reviews reporting the effects of physical exercises on people with Parkinson´s Disease. Searches involved a two-phase process, by, at least, two independent reviewers. Methodological quality of the included systematic reviews was assessed using AMSTAR-2. RESULTS From 2,122 systematic reviews, 139 were included. Motor outcomes were assessed in 91% of the studies, with balance being the most studied. Non-motor outcomes were assessed in 68% of the studies, with emphasis on quality of life. Physical exercises were classified into five categories: aerobic exercises, strength, combined, sensorimotor activities and other activity protocols. Findings of the systematic reviews suggest that all exercise categories can be prescribed to improve balance and mobility, while combined exercises, strength, and specific activities improve both motor and non-motor outcomes, and aerobic exercise and sensorimotor activities improve motor outcomes. CONCLUSION Current evidence from systematic reviews suggests that physical exercises impacts both motor and non-motor outcomes in people with Parkinson´s Disease. Limits in evidence provided by the systematic reviews were related to methodological issues and to the description of the interventions and must be considered to improve decision-making and clinical application.
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Affiliation(s)
- Cristiano Padilha
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Renan Souza
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Fernando Schorr Grossl
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Ana Paula Maihack Gauer
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Clodoaldo Antônio de Sá
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
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Abou L, Fliflet A, Presti P, Sosnoff JJ, Mahajan HP, Frechette ML, Rice LA. Fall detection from a manual wheelchair: preliminary findings based on accelerometers using machine learning techniques. Assist Technol 2023; 35:523-531. [PMID: 36749900 DOI: 10.1080/10400435.2023.2177775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Automated fall detection devices for individuals who use wheelchairs to minimize the consequences of falls are lacking. This study aimed to develop and train a fall detection algorithm to differentiate falls from wheelchair mobility activities using machine learning techniques. Thirty, healthy, ambulatory, young adults simulated falls from a wheelchair and performed other wheelchair-related mobility activities in a laboratory. Neural Network classifiers were used to train the algorithm developed based on data retrieved from accelerometers mounted at the participant's wrist, chest, and head. Results indicate excellent accuracy to differentiate between falls and wheelchair mobility activities. The sensors mounted at the wrist, chest, and head presented with an accuracy of 100%, 96.9%, and 94.8%, respectively, using data from 258 falls and 220 wheelchair mobility activities. This pilot study indicates that a fall detection algorithm developed in a laboratory setting based on fall accelerometer patterns can accurately differentiate wheelchair-related falls and wheelchair mobility activities. This algorithm should be integrated into a wrist-worn devices and tested among individuals who use a wheelchair in the community.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexander Fliflet
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Peter Presti
- Interactive Media Technology Center, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Jacob J Sosnoff
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, Kansas USA
| | - Harshal P Mahajan
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Center for Health, Aging and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Mikaela L Frechette
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Center for Health, Aging and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Lee C, Ahn J, Lee BC. A Systematic Review of the Long-Term Effects of Using Smartphone- and Tablet-Based Rehabilitation Technology for Balance and Gait Training and Exercise Programs. Bioengineering (Basel) 2023; 10:1142. [PMID: 37892872 PMCID: PMC10604191 DOI: 10.3390/bioengineering10101142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Recent advances in wearable motion sensors, mobile devices, the Internet of Things, and telecommunications have created new potential for telerehabilitation. Recognizing that there is no systematic review of smartphone- or tablet-based balance and gait telerehabilitation technology for long-term use (i.e., four weeks or more), this systematic review summarizes the effects of smartphone- or tablet-based rehabilitation technology on balance and gait exercise and training in balance and gait disorders. The review examined studies written in English published from 2013 to 2023 in Web of Science, Pubmed, Scopus, and Google Scholar. Of the 806 studies identified, 14 were selected, and the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was applied to evaluate methodological quality. The systematic review concluded that all 14 studies found balance and gait performance improvement after four weeks or more of balance and gait telerehabilitation. Ten of the 14 studies found that carry-over effects (improved functional movements, muscle strength, motor capacity, cognition, and reduced fear of falling and anxiety levels) were maintained for weeks to months. The results of the systematic review have positive technical and clinical implications for the next-generation design of rehabilitation technology in balance and gait training and exercise programs.
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Affiliation(s)
- Chihyeong Lee
- Department of Physical Education, Seoul National University, Seoul 08826, Republic of Korea;
| | - Jooeun Ahn
- Department of Physical Education, Seoul National University, Seoul 08826, Republic of Korea;
- Institute of Sport Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Beom-Chan Lee
- Institute of Sport Science, Seoul National University, Seoul 08826, Republic of Korea
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA
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14
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Abou L, Rice LA. Frequency and characteristics of falls, fall-related injuries, and fear of falling among wheelchair users with spinal cord injury. J Spinal Cord Med 2023; 46:560-568. [PMID: 35943367 PMCID: PMC10274528 DOI: 10.1080/10790268.2022.2097995] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
CONTEXT/OBJECTIVE To investigate the frequency and characteristics of falls, fall-related injuries, and fear of falling (FOF) among non-ambulatory individuals with spinal cord injury (SCI). METHODS This is a cross-sectional study design that included 59 non-ambulatory individuals with SCI. Participants completed a survey on demographics, SCI characteristics (type of injury, level of injury, and time since injury), FOF, activities curtailment due to FOF, and frequency of falls and fall-related injuries in the past 6 months. Characteristics of the most recent falls and fall-related injuries were also collected. A directed content analysis was used to analyze qualitative data. RESULTS Overall, 63% of the study participants reported falling at least once, 46.7% reported injuries after falls, and 73% reported FOF during the previous 6 months. Participants commonly reported falling inside of the house (74.6%), during transfers (43.2%), and associated with obstacles on the way (54.5%) or surface conditions (36.4%). Almost half of the participants (42.3%) reported never received education on fall prevention from a healthcare professional. CONCLUSIONS The results confirm that falls, fall-related injuries, and FOF are a common concern in this population. These findings contribute to the knowledge base for the future development of fall prevention programs specific for non-ambulatory individuals with SCI.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Laura A. Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Trovato B, Godos J, Varrasi S, Roggio F, Castellano S, Musumeci G. Physical Activity, Sun Exposure, Vitamin D Intake and Perceived Stress in Italian Adults. Nutrients 2023; 15:nu15102301. [PMID: 37242183 DOI: 10.3390/nu15102301] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
The last decades of global development have, due to rapid urbanization, pressuring entire populations to changes in lifestyle and dietary habits, led to an increase in the prevalence of mental disorders, including stress. This study explored how lifestyle and dietary factors, such as physical activity, sun exposure, and vitamin D intake are related to perceived stress in a Mediterranean-based population. Physical activity level was evaluated using the international physical activity questionnaires (IPAQ), sun exposure was evaluated using the sunlight exposure measurement questionnaire (SEM-Q), and validated food frequency questionnaires (FFQs) were used to assess dietary intakes. The perceived stress of the study participants was evaluated using the perceived stress scale (PSS). Multivariate logistic regression models were used to test for potential associations. In the most adjusted model, an inverse association between physical activity level, sunlight exposure, vitamin D intake, and high perceived stress was found (OR = 0.72, 95% CI: 0.51, 1.00, OR = 0.72, 95% CI: 0.52, 0.99, OR = 0.69, 95% CI: 0.53, 0.89, respectively). However, when stratifying the population by level of physical activity, the retrieved associations with sunlight exposure and dietary vitamin D intake were significant only among those individuals reporting being moderately to highly physically active (OR = 0.16, 95% CI: 0.08, 0.33 and OR = 0.46, 95% CI: 0.28, 0.76, respectively), while results on low physically active participants were null. In conclusion, this study demonstrated that higher dietary intake of vitamin D and sunlight exposure are associated with a lower likelihood of having high perceived stress among physically active individuals.
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Affiliation(s)
- Bruno Trovato
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia 97, 95123 Catania, Italy
| | - Justyna Godos
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Simone Varrasi
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy
| | - Federico Roggio
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia 97, 95123 Catania, Italy
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy
| | - Sabrina Castellano
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia 97, 95123 Catania, Italy
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16
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Bishnoi A, Shankar M, Lee R, Hu Y, Hernandez ME. Effects of Therapeutic Intervention on Spatiotemporal Gait Parameters in Adults With Neurologic Disorder: Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2023; 104:451-474. [PMID: 35787837 DOI: 10.1016/j.apmr.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 05/31/2022] [Accepted: 06/05/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to review and quantify the changes in gait parameters after therapeutic intervention in adults with neurologic disorders. DATA SOURCES A keyword search was performed in 4 databases: PubMed, CINAHL, Scopus, and Web of Science (01/2000-12/2021). We performed the search algorithm including all possible combinations of keywords. Full-text articles were examined further using forward/backward search methods. STUDY SELECTION Studies were thoroughly screened using the following inclusion criteria: Study design: randomized controlled trial; adults ≥55 years old with a neurologic disorder; therapeutic intervention; spatiotemporal gait characteristics; and language: English. DATA EXTRACTION A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, and spatiotemporal gait parameters such as cadence, step length, step width, or double limb support. A meta-analysis was performed among trials presenting with similar characteristics, including study population and outcome measure. If heterogeneity was >50%, a random plot analysis was used; otherwise, a fixed plot analysis was done. DATA SYNTHESIS We included 25 out of 34 studies in our meta-analysis that examined gait in adults with neurologic disorders. All analyses used effect sizes and standard error and a P<.05(denoted by *) threshold was considered statistically significant. Overall, we found that sensory (SS) and electrical stimulation (ES) had the most significant effect on step length (SS: z=5.44*, ES: z=2.42*) and gait speed (SS: z=6.19*, ES: z=7.38*) in adults with Parkinson disease (PD). Although balance or physical activity interventions were not found to be effective in modifying step length in adults with PD, they showed a significant effect on gait speed. Further, physical activity had the most significant effect on cadence in adults with PD (z=2.84*) relative to sensory stimulation effect on cadence (z=2.59*). For stroke, conventional physical therapy had the most significant effect on step length (z=3.12*) and cadence (z=3.57*). CONCLUSION Sensory stimulation such as auditory and somatosensory stimulation while walking had the most significant effect on step length in adults with PD. We also found that conventional physical therapy did improve spatial gait parameters relative to other physical activity interventions in adults with PD and stroke.
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Affiliation(s)
- Alka Bishnoi
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL; School of Physical Therapy, Kean University, Union, NJ.
| | - Meghna Shankar
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Rachel Lee
- University of Chicago Medical Center, Department of Solid Organ Transplant, Chicago, IL
| | - Yang Hu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL; Department of Kinesiology, San Jose State University, San Jose, CA
| | - Manuel E Hernandez
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL
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Chiu CY, Ng MYH, Lam SC, Hui KY, Keung CH, Ouyang H, Li X, Pang MYC. Effect of physical exercise on fear of falling in patients with stroke: A systematic review and meta-analysis. Clin Rehabil 2023; 37:294-311. [PMID: 36444416 DOI: 10.1177/02692155221135028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To consolidate the evidence on the effect of physical exercise on fear of falling in individuals with stroke. DATA SOURCES PubMed, CINAHL, Cochrane Database and MEDLINE. METHODS An extensive database search was conducted to identify the randomised controlled trials that examined the effect of physical exercise on fear of falling post-stroke. Grading of Recommendation, Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence for each meta-analysis. RESULTS Fourteen trials totalling 1211 participants were included in this review. Thirteen of these (1180 participants) were included in the meta-analyses. In the primary analysis, very low-quality evidence suggested that exercise reduced fear of falling post-stroke (standardized mean difference (SMD) 0.48; 95% confidence interval (CI) 0.23 to 0.72). The effect was diminished at three- to six-month follow-up after exercise training ended (SMD -0.09; 95% CI -0.27 to 0.10; high-quality evidence). In the sensitivity analyses, the treatment effect was more pronounced in individuals with a lower baseline Berg balance score (BBS ≤45; SMD 0.53; 95%CI 0.17 to 0.88) and for those trials with exercise frequency of ≥3 sessions per week (SMD 0.70; 95%CI 0.39 to 1.01). Compared with circuit-based training consisting of a combination of walking, balance and strengthening exercises (SMD 0.27; 95% CI -0.09 to 0.63), walking programmes seemed to generate a larger effect on fear of falling (SMD 1.06; 95%CI 0.43 to 1.70). CONCLUSION Physical exercise was beneficial for reducing fear of falling in individuals with stroke, particularly those with poorer balance ability.
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Affiliation(s)
- Chi Yat Chiu
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Michael Yu-Hin Ng
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Sum Chung Lam
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Ka Yan Hui
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Chun Ho Keung
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Huixi Ouyang
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Xun Li
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
| | - Marco Yiu-Chung Pang
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong, China
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18
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Foong YC, Bridge F, Merlo D, Gresle M, Zhu C, Buzzard K, Butzkueven H, van der Walt A. Smartphone monitoring of cognition in people with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2023; 73:104674. [DOI: 10.1016/j.msard.2023.104674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/30/2023] [Accepted: 03/26/2023] [Indexed: 03/29/2023]
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19
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Khubetova I. Complex Rehabilitation of Patients with Parkinson’s Disease. ACTA BALNEOLOGICA 2023. [DOI: 10.36740/abal202301102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Aim: To assess the clinical effectiveness of a comprehensive rehabilitation program for patients with Parkinson’s disease Materials and Methods: The study was conducted in the regional center for movement disorders (Odesa, Ukraine). 90 patients with 1-2.5 Hoehn-Yahr stage were examined. Patients were randomly assigned to three groups (I (n=30) – standard drug therapy, II (n=30) – standard drug therapy +physical therapy, III (n=30) – standard drug therapy +physical therapy+ art therapy). The effectiveness of the therapy was assessed using the UPDRS questionnaires, Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MoCA), and Pegboard Test. The follow-up period was 12 months.
Results: Patients of the II and III groups noted an improvement in mood after physical exertion. They observed a decrease in daytime sleepiness, a decrease in tremors, and a decrease in the intensity of anxiety and fear. During the observation period, signs of disease progression were observed only in 4 (13.3%) patients of group II, in 2 (6.7%) patients of group III and in 12 (40.0%) ) patients of the control group (respectively, χ2 = 4.18 p = 0.04 and χ2 = 7.55 p = 0.006)
Conclusions: 1. The use of complex rehabilitation allows to reduce the severity of motor and non-motor manifestations of Parkinson's disease.
2. The inclusion of art therapy in the complex rehabilitation program allows to halve the number of cases of disease progression. 3. The positive effect of the use of comprehensive rehabilitation is maintained throughout the observation period.
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20
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Sessford JD, Chan K, Kaiser A, Singh H, Munce S, Alavinia M, Musselman KE. Protocol for a single group, mixed methods study investigating the efficacy of photovoice to improve self-efficacy related to balance and falls for spinal cord injury. BMJ Open 2022; 12:e065684. [PMID: 36600385 PMCID: PMC9743364 DOI: 10.1136/bmjopen-2022-065684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Many individuals living with spinal cord injury (SCI) experience falls and a fear of falling, both of which can impact participation in daily activities and quality of life. A single group, convergent mixed methods study will be conducted to examine the effects of a photovoice intervention on falls self-efficacy among individuals living with chronic SCI. Secondary objectives include examining the effects of photovoice on fear of falling, participation and quality of life and exploring participants' experiences and perceptions of the photovoice intervention through qualitative interviews. METHODS AND ANALYSIS Adults with SCI (n=40) will be divided into groups according to their mobility status (ie, those who ambulate and those who primarily use a wheelchair). The study will be conducted virtually over three consecutive phases, totalling 30 weeks. Each group will self-report falls for 12 weeks prior to and following the intervention (phases 1 and 3, respectively). The 6-week photovoice intervention (phase 2) will be comprised of two photo assignments, two individual interviews with a researcher and a peer mentor, and four group meetings. Participants will discuss these photos at the interviews and group meetings. Standardised questionnaires of falls self-efficacy, fear of falling, participation and life satisfaction will be administered at four time points (ie, beginning of each phase and the end of phase 3). Questionnaire scores will be examined over time using repeated-measures analysis of variance. A semistructured interview will be completed at the end of phase 3 to gain feedback on the photovoice intervention. Qualitative data will be analysed using reflexive thematic analysis. ETHICS AND DISSEMINATION Ethics approval was obtained prior to study enrolment. Findings will be shared through peer-reviewed scientific publications and participant-directed knowledge translation activities. TRIAL REGISTRATION NUMBER NCT04864262.
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Affiliation(s)
- James D Sessford
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Katherine Chan
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Anita Kaiser
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Hardeep Singh
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Munce
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad Alavinia
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Kristin E Musselman
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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21
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Abou L, Peters J, Fritz NE, Sosnoff JJ, Kratz AL. Motor Cognitive Dual-Task Testing to Predict Future Falls in Multiple Sclerosis: A Systematic Review. Neurorehabil Neural Repair 2022; 36:757-769. [PMID: 36320121 DOI: 10.1177/15459683221131791] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Mobility and cognitive impairments are often associated with increased fall risk among people with multiple sclerosis (PwMS). However, evidence on the concurrent assessment of gait or balance and cognitive tasks (dual-task) to predict falls appears to be inconsistent. OBJECTIVE To summarize the ability of gait or balance dual-task testing to predict future falls among PwMS. METHODS Seven databases including PubMed, Embase, Web of Science, Scopus, CINHAL, SPORTDiscuss, and PsycINFO were searched from inception to May 2022. Two independent reviewers identified studies that performed a dual-task testing among adults with multiple sclerosis and monitored falls prospectively for at least 3 months. Both reviewers also evaluated the quality assessment of the included studies. RESULTS Eight studies with 484 participants were included in the review. Most studies (75%) indicated that dual-task testing and dual-task cost did not discriminate prospective fallers (⩾1 fall) and non-fallers (0 fall) and were not found as predictors of future falls. However, dual-task cost of walking velocity (OR = 1.23, 95% CI 0.98-4.45, P = .05) and dual-task of correct response rate of serial 7 subtraction (OR = 1.34, 95% CI 1.04-3.74, P = .02) were significantly associated with increased risk of recurrent falls (≥2 falls). Pattern of cognitive-motor interference was also associated with an increased risk of falling. All studies presented with strong quality. CONCLUSION The scarce evidence indicates that dual-task testing is not able to predict future falls among PwMS. Further research with more complex motor and cognitive tasks and longer-term fall monitoring is required before dual-task testing can be recommended as a predictor of future falls in this population.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joseph Peters
- Department of Kinesiology & Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Nora E Fritz
- Departments of Health Care Sciences & Neurology, Wayne State University, Detroit, MI, USA
| | - Jacob J Sosnoff
- Department of Physical Therapy, Rehabilitation Science, & Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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22
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Thwaites C, Nayyar R, Blennerhassett J, Egerton T, Tan J, Bower K. Is telehealth an effective and feasible option for improving falls-related outcomes in community-dwelling adults with neurological conditions? A systematic review and meta-analysis. Clin Rehabil 2022; 37:17-46. [PMID: 36263524 DOI: 10.1177/02692155221133468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the effectiveness of telehealth interventions in reducing community falls risk or rates compared to equivalent in-person interventions in adults with neurological conditions. DATA SOURCES Eight electronic databases, trial registries and search engines were searched for the concepts 'falls', 'neurological conditions', and 'telehealth', limited to English language, from inception until August 2022. REVIEW METHODS Search for original research where the intervention was delivered via synchronous videoconferencing with the aim of reducing falls and falls-related outcomes. Screening and risk of bias assessment were completed by two independent researchers. Outcome data included falls rates, falls-related outcomes, safety, feasibility, and acceptability. Risk of bias was assessed using the ROB-2 and ROBINS-I tools. Quality of evidence was rated with the grading of recommendations, assessment, development and evaluation (GRADE) approach. RESULTS Seventeen studies with 581 participants were included; six were randomised controlled trials. Risk of bias ranged from low to high. Only one study (n = 76) reported falls and did not find differences between telehealth and in-person physiotherapy. There was low-quality evidence that telehealth interventions improve balance outcomes more than face-to-face interventions (pooled between-group mean difference 2.48 Berg Balance Scale units, 95%CI 0.77 to 4.20). Fear of falling was not different between intervention delivery modes. CONCLUSION Findings suggest that telehealth delivered falls prevention interventions are safe, feasible and acceptable in community-dwelling adults with neurological conditions, however, data related to effectiveness in reducing falls is limited. Low-quality evidence suggests that telehealth may deliver similar or better outcomes for standing balance in this population.PROSPERO Registration: (CRD42021240167).
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Affiliation(s)
- Claire Thwaites
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, Australia.,The Victorian Rehabilitation Centre, Healthscope, Melbourne, Australia
| | - Rohini Nayyar
- Faculty of Medicine, Dentistry and Health Sciences, Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Australia
| | - Jannette Blennerhassett
- Physiotherapy Department and Health Independence Program, 3805Austin Health, Heidelberg, Australia
| | - Thorlene Egerton
- Faculty of Medicine, Dentistry and Health Sciences, Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Australia
| | - Jasmine Tan
- Faculty of Medicine, Dentistry and Health Sciences, Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Australia
| | - Kelly Bower
- Faculty of Medicine, Dentistry and Health Sciences, Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Australia
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Rice LA, Yarnot R, Sung J, Sosnoff JJ, Backus D, Abou L, Shen S, Peterson EW. Pilot Study of a Fall Prevention and Management Intervention Program for People With Multiple Sclerosis Who Use a Wheelchair or Scooter Full-Time. Arch Rehabil Res Clin Transl 2022; 4:100225. [PMID: 36545518 PMCID: PMC9761259 DOI: 10.1016/j.arrct.2022.100225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To examine the efficacy of a fall prevention/management intervention among persons with multiple sclerosis (PwMS) who use a wheelchair (WC) or scooter full-time. Design Pre-post/follow-up trial. Setting Community and research laboratory. Participants Twenty-one PwMS who used a WC or scooter full-time, self-reported at least 1 fall/12 months, and could transfer independently or with minimal/moderate assistance (N=21). Intervention Six-week, group and community-based fall prevention and management intervention. The intervention included six 2-hour in-person weekly sessions led by a physical or occupational therapist featuring interactive group discussions, skill practice, and action planning opportunities. Main Outcome Measures Fall frequency tracked 12 weeks pre- and 24 weeks post intervention. Outcomes were assessed pre- and post intervention and 12 weeks post intervention. Measures included surveys to examine fear of falling (FOF), fall prevention/management, quality of life, community participation, and assessment of functional mobility skills. Semistructured interviews were administered post intervention to ascertain overall experiences with the program and effect on daily life. A Friedman test with signed-rank post hoc analysis was run to determine differences across the 3 study visits. Results After the intervention, fall incidence did not significantly change, but fall management strategies (P=.01-0.05), importance of community participation (P=.01), and transfer quality (P=.02) significantly improved. Moderate effect sizes were noted among concerns about falling, activity curtailment because of to FOF, and WC skills. Qualitative results indicate that participants found the intervention beneficial and applied intervention content in their daily lives. Conclusions This study is the first to describe the effect of a multicomponent fall prevention/management intervention designed specifically for PwMS who use a WC or scooter full-time. Results indicate the program has potential to reduce fall risk; however, further testing is needed to fully examine the effect of the program.
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Affiliation(s)
- Laura A. Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL,College of Applied Health Sciences, Center on Health, Aging, and Disability, Champaign, IL,Corresponding author Laura A. Rice, PhD, MPT, ATP, 219 Freer Hall, 906 S. Goodwin Ave, Urbana, IL 61801
| | - Rebecca Yarnot
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - JongHun Sung
- Department of Kinesiology, Inha University, Incheon, Korea
| | - Jacob J. Sosnoff
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS
| | - Deborah Backus
- Virginia Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL,Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Sa Shen
- College of Applied Health Sciences, Center on Health, Aging, and Disability, Champaign, IL
| | - Elizabeth W. Peterson
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL
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Abou L, Sosnoff JJ, Peterson EW, Backus D, Willingham TB, Rice LA. Prediction of future falls among full-time wheelchair and scooter users with multiple sclerosis: A prospective study. Mult Scler Relat Disord 2022; 64:103962. [PMID: 35716478 DOI: 10.1016/j.msard.2022.103962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/23/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Seventy-five percent (75%) of full-time wheelchair or scooter users with multiple sclerosis (MS) experience at least one fall in a period of 6 months. Falls are detrimental for the independence, quality of life, and community participation. No previous prospective study has evaluated fall risk factors in this segment of MS community. OBJECTIVE To develop a multivariable falls risk prediction model for people with MS (PwMS) who use a wheelchair or scooter full-time. METHODS This prospective cohort study is a secondary data analysis that recruited PwMS from the community across the US. Forty-eight adults with MS who use a wheelchair or scooter as their main form of mobility were included. Dependent variable was fall incidence over 3-month recorded through diaries. Dependent variable was categorized as fallers (≥ 1 fall) and non-fallers (0 fall). Predictors were demographics, history of falls in the past 6 months, measures of fear of falling, Spinal Cord Injury- Falls Concern Scale, California Verbal Learning Test II, and Multiple Sclerosis Quality of Life- mental health. Multivariable logistic regression analyses were conducted to identity predictors of future falls. RESULTS In total, 63 falls (range 0 - 8) were reported over the 3-month period from a total of 26 fallers (54%). Multivariate logistic regression analyses indicated that the risk factor with the best predictive ability of future falls included history of falls in the past 6 months (sensitivity 77%, specificity 54%, and area under the receiving operating curve statistic = 0.76, 95% CI 0.62 to 0.89). CONCLUSION Findings highlight the importance of asking full-time wheelchair and scooter users with MS if they have fallen in the past 6 months to quickly identify those who are at increased fall risk and in need of follow up assessment and intervention to identify and address modifiable risk factors. More attention to fall risks among full-time wheelchair or scooter users with MS is suggested to increase the understanding among clinicians and researchers of modifiable risk factors.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 219 Freer Hall, 906 S. Goodwin Ave., Urbana, IL 61801, USA. https://twitter.com/https://twitter.com/libak9
| | - Jacob J Sosnoff
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Elizabeth W Peterson
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Deborah Backus
- Virginia Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| | | | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 219 Freer Hall, 906 S. Goodwin Ave., Urbana, IL 61801, USA; Center on Health, Aging, and Disability, College of Applied Health Sciences, Champaign, IL, USA.
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Chan K, Habib Perez O, Singh H, Marinho-Buzelli AR, Hitzig SL, Musselman KE. Impact of Falls and Fear of Falling on Participation, Autonomy and Life Satisfaction in the First Year After Spinal Cord Injury. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:903097. [PMID: 36188963 PMCID: PMC9397684 DOI: 10.3389/fresc.2022.903097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022]
Abstract
IntroductionIndividuals with spinal cord injury (SCI) experience reduced participation in meaningful activities, leading to reduced social engagement and negative psychological impact. Two factors that may affect participation post-SCI are fall status (e.g., having experienced a fall) and having a fear of falling. Our objective was to examine if and how fall status and fear of falling impact participation, autonomy and life satisfaction in the first year post-injury.MethodsAdult inpatients of a SCI rehabilitation hospital were recruited. Following discharge, falls were tracked for 6 months and participants who fell at least once were categorized as “fallers”. At the end of the 6-month period, the Impact on Participation and Autonomy Questionnaire and Life Satisfaction Questionnaire 9 were administered, and participants were asked if they had a fear of falling (i.e., an ongoing concern about falling leading to the avoidance of activities they are capable of doing). Falls were reported using descriptive statistics. Ordinary least squares regression was used to evaluate the relationships between the independent variables (i.e., fall status and fear of falling) and each dependent variable (i.e., questionnaire scores).ResultsSeventy-one individuals were enrolled in the study; however, 11 participants were lost to follow-up. The included participants (n = 60) were 58.4 ± 14.6 years old and 99 ± 60.3 days post-injury. Over one third (38.3%) of participants fell over the 6-month tracking period. Twenty-seven participants (45%) reported a fear of falling and 14 (51.9%) of these participants were fallers. Fear of falling significantly predicted scores of autonomy indoors (β = 3.38, p = 0.04), autonomy outdoors (β = 2.62, p = 0.04) and family role (β = 3.52, p = 0.05).ConclusionIndividuals with subacute SCI and a fear of falling experienced reduced participation and autonomy, but with no differences in life satisfaction compared to those without a fear of falling. In contrast, having experienced a fall did not impact participation, autonomy or life satisfaction. In the first year after SCI, rehabilitation programs should place specific attention on the presence of fear of falling to help individuals with SCI prepare for everyday mobility challenges.
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Affiliation(s)
- Katherine Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Olinda Habib Perez
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Hardeep Singh
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andresa R. Marinho-Buzelli
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sander L. Hitzig
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kristin E. Musselman
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- *Correspondence: Kristin E. Musselman
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Brogårdh C, Lexell J, Westergren A. Measurement properties of the Falls Efficacy Scale-International (FES-I) in persons with late effects of polio: a cross-sectional study. PM R 2022. [PMID: 35666019 DOI: 10.1002/pmrj.12861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Fear of falling (FoF) is very common in persons with late effects of polio (LEoP). An internationally recognized rating scale to assess FoF is the Falls Efficacy Scale-International (FES-I). Yet, there is limited knowledge about its measurement properties in persons with LEoP. OBJECTIVE To investigate the measurement properties of FES-I (16-item version) and short FES-I (7-item version) in persons with LEoP. DESIGN Explorative factor analysis and Rasch model analysis of cross-sectional data. SETTING University Hospital. PARTICIPANTS A total of 321 persons with LEoP (mean age 70 ± 10 years, 173 women). MAIN OUTCOME MEASUREMENT The FES-I and short FES-I, comprising four response options about concerns of falling ranging from 1 (not at all concerned) to 4 (very concerned). METHODS Data were collected by a postal survey. First, a factor analysis was performed to investigate unidimensionality of the scale. Thereafter, a Rasch model analysis was used to further analyze the measurement properties of FES-I and short FES-I, such as local dependency, targeting, hierarchical order of items, Differential Item Functioning (DIF), response category functioning and reliability (Person Separation Index, PSI). Raw score transformation to interval measurements was also performed. RESULTS The factor analysis revealed that FES-I was unidimensional, even though the Rasch analysis showed some misfit to the Rasch model and local dependency. Targeting for FES-I and short FES-I was somewhat suboptimal as the participants on average reported less FoF than expected. A negligible gender DIF was found for two items in FES-I and for one item in short FES-I. Reliability was high (PSI >0.86), and the response category thresholds worked as intended for both FES-I, and short FES-I. CONCLUSION The FES-I and the short FES-I have sufficient measurement properties in persons with LEoP. Both versions can be used to assess fear of falling in this population. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Christina Brogårdh
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden
| | - Albert Westergren
- Department of Health Sciences, Lund University, Lund, Sweden.,The Research Platform for Collaboration for Health, and The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
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Evans NH, Suri C, Field-Fote EC. Walking and Balance Outcomes Are Improved Following Brief Intensive Locomotor Skill Training but Are Not Augmented by Transcranial Direct Current Stimulation in Persons With Chronic Spinal Cord Injury. Front Hum Neurosci 2022; 16:849297. [PMID: 35634208 PMCID: PMC9130633 DOI: 10.3389/fnhum.2022.849297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022] Open
Abstract
Motor training to improve walking and balance function is a common aspect of rehabilitation following motor-incomplete spinal cord injury (MISCI). Evidence suggests that moderate- to high-intensity exercise facilitates neuroplastic mechanisms that support motor skill acquisition and learning. Furthermore, enhancing corticospinal drive via transcranial direct current stimulation (tDCS) may augment the effects of motor training. In this pilot study, we investigated whether a brief moderate-intensity locomotor-related motor skill training (MST) circuit, with and without tDCS, improved walking and balance outcomes in persons with MISCI. In addition, we examined potential differences between within-day (online) and between-day (offline) effects of MST. Twenty-six adults with chronic MISCI, who had some walking ability, were enrolled in a 5-day double-blind, randomized study with a 3-day intervention period. Participants were assigned to an intensive locomotor MST circuit and concurrent application of either sham tDCS (MST+tDCSsham) or active tDCS (MST+tDCS). The primary outcome was overground walking speed measured during the 10-meter walk test. Secondary outcomes included spatiotemporal gait characteristics (cadence and stride length), peak trailing limb angle (TLA), intralimb coordination (ACC), the Berg Balance Scale (BBS), and the Falls Efficacy Scale-International (FES-I) questionnaire. Analyses revealed a significant effect of the MST circuit, with improvements in walking speed, cadence, bilateral stride length, stronger limb TLA, weaker limb ACC, BBS, and FES-I observed in both the MST+tDCSsham and MST+tDCS groups. No differences in outcomes were observed between groups. Between-day change accounted for a greater percentage of the overall change in walking outcomes. In persons with MISCI, brief intensive MST involving a circuit of ballistic, cyclic locomotor-related skill activities improved walking outcomes, and selected strength and balance outcomes; however, concurrent application of tDCS did not further enhance the effects of MST.
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Affiliation(s)
- Nicholas H. Evans
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
- Department of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, United States
| | - Cazmon Suri
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
| | - Edelle C. Field-Fote
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
- Department of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, United States
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
- *Correspondence: Edelle C. Field-Fote,
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THE EFFECT OF VIRTUAL REALITY-BASED THERAPY ON FEAR OF FALLING IN MULTIPLE SCLEROSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Mult Scler Relat Disord 2022; 63:103791. [DOI: 10.1016/j.msard.2022.103791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/25/2022] [Accepted: 04/01/2022] [Indexed: 11/19/2022]
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Abou L, Rice LA. Risk factors associated with falls and fall-related injuries among wheelchair users with spinal cord injury. Arch Rehabil Res Clin Transl 2022; 4:100195. [PMID: 35756987 PMCID: PMC9214309 DOI: 10.1016/j.arrct.2022.100195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Shorter time since injury and higher mobility levels as well as poor physical health are associated with higher risk of falls and fall-related injuries, respectively in wheelchair users with spinal cord injury. The findings indicate good discriminant ability and clinical utility of the factors presented to identify wheelchair users who are at risk of falls and fall-related injuries.
Objective To identify risk factors for falls and fall-related injuries for wheelchair users with spinal cord injury (SCI). Design Cross-sectional study. Setting Community setting. Participants Fifty-nine community dwelling wheelchair users (N=59), 47.5% male, median age of 52.5 years (IQR, 21 years) with chronic SCI, median time since injury of 16.6 years (IQR, 27.3 years). Interventions No intervention. Main Outcome Measures Outcomes were incidence of falls and fall-related injuries. Participants reported on falls and fall-related injuries experienced in the previous 6 months. Independent variables were self-reported and performance-based measures. Self-reported measures included demographics, characteristics of SCI, fear of falling, psychological measures, functional independence, wheelchair skills, environmental barriers, quality of life, and community participation. Performance-based measures included transfer quality and sitting balance assessments. Logistic regression analyses were conducted to identify factors influencing falls and fall-related injuries. Results In total, 152 falls and 30 fall-related injuries were reported from a total of 37 fallers. After logistic regression analysis, the model with the greatest levels of clinical utility and discriminative ability for falls (sensitivity 81%; specificity 55%; area under the receiving operating characteristic curve [AUC] statistics=0.73; 95% CI, 0.60-0.86) included the variables of shorter time since SCI, high mobility level, and having received education on fall prevention. The model for fall-related injuries (sensitivity 79%; specificity 75%; AUC statistics=0.77; 95% CI, 0.59-0.96) included the variables of older male individual, lower physical health score, and having received education on fall prevention. Conclusions The regression models presented may be used to identify wheelchair users with SCI at greater risk of falls and fall-related injuries. The findings may help to refer those in need to tailored fall and fall-related injury prevention programs. The findings presented in this study were based on a relatively small sample convenience; therefore, further prospective studies with a larger sample size are warranted.
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Fukata K, Amimoto K, Inoue M, Sekine D, Fujino Y, Makita S, Takahashi H. Immediate effect of standing and sit-to-stand training on postural vertical for backward disequilibrium following stroke: a case report. Physiother Theory Pract 2022:1-9. [DOI: 10.1080/09593985.2022.2037031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kazuhiro Fukata
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Masahide Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Daisuke Sekine
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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31
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Abou L, Qin K, Alluri A, Du Y, Rice LA. The effectiveness of physical therapy interventions in reducing falls among people with multiple sclerosis: A systematic review and meta-analysis. J Bodyw Mov Ther 2022; 29:74-85. [DOI: 10.1016/j.jbmt.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/16/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
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Block VJ, Pitsch EA, Gopal A, Zhao C, Pletcher MJ, Marcus GM, Olgin JE, Hollenbach J, Bove R, Cree BAC, Gelfand JM. Identifying falls remotely in people with multiple sclerosis. J Neurol 2022; 269:1889-1898. [PMID: 34405267 PMCID: PMC8370664 DOI: 10.1007/s00415-021-10743-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND Falling is common in people with multiple sclerosis (MS) but tends to be under-ascertained and under-treated. OBJECTIVE To evaluate fall risk in people with MS. METHODS Ninety-four people with MS, able to walk > 2 min with or without an assistive device (Expanded Disability Status Scale (EDSS ≤ 6.5) were recruited. Clinic-based measures were recorded at baseline and 1 year. Patient-reported outcomes (PROs), including a fall survey and the MS Walking Scale (MSWS-12), were completed at baseline, 1.5, 3, 6, 9, and 12 months. Average daily step counts (STEPS) were recorded using a wrist-worn accelerometer. RESULTS 50/94 participants (53.2%) reported falling at least once. Only 56% of participants who reported a fall on research questionnaires had medical-record documented falls. Fallers had greater disability [median EDSS 5.5 (IQR 4.0-6.0) versus 2.5 (IQR 1.5-4.0), p < 0.001], were more likely to have progressive MS (p = 0.003), and took fewer STEPS (mean difference - 1,979, p = 0.007) than Non-Fallers. Stepwise regression revealed MSWS-12 as a major predictor of future falls. CONCLUSIONS Falling is common in people with MS, under-reported, and under-ascertained by neurologists in clinic. Multimodal fall screening in clinic and remotely may help improve patient care by identifying those at greatest risk, allowing for timely intervention and referral to specialized physical rehabilitation.
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Affiliation(s)
- Valerie J. Block
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Erica A. Pitsch
- grid.266102.10000 0001 2297 6811Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Arpita Gopal
- grid.266102.10000 0001 2297 6811Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Chao Zhao
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Mark J. Pletcher
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA ,grid.266102.10000 0001 2297 6811Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Gregory M. Marcus
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Jeffrey E. Olgin
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Jill Hollenbach
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Riley Bove
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Bruce A. C. Cree
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Jeffrey M. Gelfand
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
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Atrsaei A, Hansen C, Elshehabi M, Solbrig S, Berg D, Liepelt-Scarfone I, Maetzler W, Aminian K. Effect of Fear of Falling on Mobility Measured During Lab and Daily Activity Assessments in Parkinson's Disease. Front Aging Neurosci 2021; 13:722830. [PMID: 34916920 PMCID: PMC8669821 DOI: 10.3389/fnagi.2021.722830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/21/2021] [Indexed: 12/24/2022] Open
Abstract
In chronic disorders such as Parkinson’s disease (PD), fear of falling (FOF) is associated with falls and reduced quality of life. With inertial measurement units (IMUs) and dedicated algorithms, different aspects of mobility can be obtained during supervised tests in the lab and also during daily activities. To our best knowledge, the effect of FOF on mobility has not been investigated in both of these settings simultaneously. Our goal was to evaluate the effect of FOF on the mobility of 26 patients with PD during clinical assessments and 14 days of daily activity monitoring. Parameters related to gait, sit-to-stand transitions, and turns were extracted from IMU signals on the lower back. Fear of falling was assessed using the Falls Efficacy Scale-International (FES-I) and the patients were grouped as with (PD-FOF+) and without FOF (PD-FOF−). Mobility parameters between groups were compared using logistic regression as well as the effect size values obtained using the Wilcoxon rank-sum test. The peak angular velocity of the turn-to-sit transition of the timed-up-and-go (TUG) test had the highest discriminative power between PD-FOF+ and PD-FOF− (r-value of effect size = 0.61). Moreover, PD-FOF+ had a tendency toward lower gait speed at home and a lower amount of walking bouts, especially for shorter walking bouts. The combination of lab and daily activity parameters reached a higher discriminative power [area under the curve (AUC) = 0.75] than each setting alone (AUC = 0.68 in the lab, AUC = 0.54 at home). Comparing the gait speed between the two assessments, the PD-FOF+ showed higher gait speeds in the capacity area compared with their TUG test in the lab. The mobility parameters extracted from both lab and home-based assessments contribute to the detection of FOF in PD. This study adds further evidence to the usefulness of mobility assessments that include different environments and assessment strategies. Although this study was limited in the sample size, it still provides a helpful method to consider the daily activity measurement of the patients with PD into clinical evaluation. The obtained results can help the clinicians with a more accurate prevention and treatment strategy.
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Affiliation(s)
- Arash Atrsaei
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Clint Hansen
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Morad Elshehabi
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Susanne Solbrig
- Department of Neurodegeneration, Center for Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany.,Department of Neurodegeneration, Center for Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Center for Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany.,IB-Hochschule, Stuttgart, Germany
| | - Walter Maetzler
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Kossi O, Agbetou M, Noukpo SI, Triccas LT, Dossou-Yovo DE, Amanzonwe ER, Adoukonou T. Factors associated with balance impairments amongst stroke survivors in northern Benin: A cross-sectional study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1559. [PMID: 34693069 PMCID: PMC8517725 DOI: 10.4102/sajp.v77i1.1559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/28/2021] [Indexed: 11/04/2022] Open
Abstract
Background Balance impairment is the predominant risk factor for falls in stroke survivors. A fear of falling after stroke can contribute to sedentary lifestyles, increased disability and risk of recurrence, leading to poor quality of life. Objective To determine the frequency and factors associated with balance impairments amongst stroke survivors at the University Hospital of Parakou. Method This cross-sectional study included adult stroke survivors. Stroke survivors after discharge were enrolled at the University Hospital of Parakou between 01 January 2020 and 30 September 2020. Balance impairments were measured by using the Berg Balance Scale (BBS), the Timed Up and Go (TUG) and the Get Up and Go (GUG) tests. Results A total of 54 stroke survivors were included, with a mean age of 58.37 ± 12.42 years and a male predominance of 68.52%. The mean BBS score was 36.87 ± 14.34 with a minimum and a maximum of 10 and 56, respectively. Thirteen (24.07%) had balance impairments (BBS score ≤ 20), 34 (62.96%) had a TUG score ≥ 14 s (abnormal), 9 (16.67%) presented a moderate risk of falling and 6 (11.11%) presented high risk of fall with the GUG test. Post-stroke duration (odds ratio [OR] = 0.04; 95% CI: 0.04–0.30; p < 0.01), severity of disability (OR = 8.33; 95% CI: 1.03–67.14; p = 0.03) and the number of physiotherapy sessions (OR = 0.18; 95% CI: 0.03–0.93; p = 0.02) were significantly associated with balance impairments. Conclusion Our results showed that almost one quarter of stroke survivors after discharge at the University Hospital of Parakou had balance impairments. Post-stroke duration, severity of disability and the number of physiotherapy sessions were significantly associated with balance impairments. Clinical implications [AQ1] Balance should be regularly assessed in people post-stroke. Further studies should document the content of rehabilitation and any rehabilitative efforts to improve balance in people post-stroke in Benin.
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Affiliation(s)
- Oyéné Kossi
- National School of Public Health and Epidemiological Surveillance (ENATSE), University of Parakou, Parakou, Benin.,Unit of Neuro Rehabilitation, Department of Neurology, University Hospital of Parakou, Parakou, Benin.,REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Mendinatou Agbetou
- Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Sènadé I Noukpo
- Unit of Neuro Rehabilitation, Department of Neurology, University Hospital of Parakou, Parakou, Benin
| | - Lisa T Triccas
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Daniel-Eude Dossou-Yovo
- National School of Public Health and Epidemiological Surveillance (ENATSE), University of Parakou, Parakou, Benin
| | - Elogni R Amanzonwe
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Thierry Adoukonou
- National School of Public Health and Epidemiological Surveillance (ENATSE), University of Parakou, Parakou, Benin.,Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
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Abou L, Peters J, Wong E, Akers R, Dossou MS, Sosnoff JJ, Rice LA. Gait and Balance Assessments using Smartphone Applications in Parkinson's Disease: A Systematic Review. J Med Syst 2021; 45:87. [PMID: 34392429 PMCID: PMC8364438 DOI: 10.1007/s10916-021-01760-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/04/2021] [Indexed: 01/21/2023]
Abstract
Gait dysfunctions and balance impairments are key fall risk factors and associated with reduced quality of life in individuals with Parkinson's Disease (PD). Smartphone-based assessments show potential to increase remote monitoring of the disease. This review aimed to summarize the validity, reliability, and discriminative abilities of smartphone applications to assess gait, balance, and falls in PD. Two independent reviewers screened articles systematically identified through PubMed, Web of Science, Scopus, CINAHL, and SportDiscuss. Studies that used smartphone-based gait, balance, or fall applications in PD were retrieved. The validity, reliability, and discriminative abilities of the smartphone applications were summarized and qualitatively discussed. Methodological quality appraisal of the studies was performed using the quality assessment tool for observational cohort and cross-sectional studies. Thirty-one articles were included in this review. The studies present mostly with low risk of bias. In total, 52% of the studies reported validity, 22% reported reliability, and 55% reported discriminative abilities of smartphone applications to evaluate gait, balance, and falls in PD. Those studies reported strong validity, good to excellent reliability, and good discriminative properties of smartphone applications. Only 19% of the studies formally evaluated the usability of their smartphone applications. The current evidence supports the use of smartphone to assess gait and balance, and detect freezing of gait in PD. More studies are needed to explore the use of smartphone to predict falls in this population. Further studies are also warranted to evaluate the usability of smartphone applications to improve remote monitoring in this population.Registration: PROSPERO CRD 42020198510.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Joseph Peters
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ellyce Wong
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Rebecca Akers
- Department of Rehabilitation Science, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mauricette Sènan Dossou
- Centre National Hospitalier et Universitaire de Pneumo-Phtisiologie, Cotonou, Littoral, Benin
| | - Jacob J Sosnoff
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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Abou L, Fliflet A, Hawari L, Presti P, Sosnoff JJ, Mahajan HP, Frechette ML, Rice LA. Sensitivity of Apple Watch fall detection feature among wheelchair users. Assist Technol 2021; 34:619-625. [PMID: 33900885 DOI: 10.1080/10400435.2021.1923087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
A reliable fall detection device is crucial to minimize long-term consequences of falls among wheelchair users. This study examines the sensitivity of Apple Watch to detect intentional falls from a wheelchair. Twenty-five able bodied (age: 21.9 ± 2.5 years) participated in a protocol in which they intentionally fell out of a wheelchair in a laboratory setting. Each participant wore an Apple Watch Series 5 and performed 3 falls in the forward, right and left sideways, and backward directions onto a crash pad totaling 12 falls each. The Apple Watch was manually checked after each fall to determine if the device registered a fall. From 300 fall trials captured, the Apple Watch detected 14 falls showing a sensitivity of 4.7%, a false negative rate of 95.3%. Logistic regression showed that participant's height, impact force, lower limb functioning, and fall direction are parameters that may influence the ability of the Apple Watch to detect falls from a wheelchair. The Apple Watch fall detection feature presented with a very poor sensitivity to detect intentional falls from a wheelchair among able bodied young adults. Due to the high incidence and consequences of falls, a reliable fall detection device specific for wheelchair users is warranted.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Alexander Fliflet
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Lina Hawari
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Peter Presti
- Interactive Media Technology Center, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Jacob J Sosnoff
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Center for Health, Aging and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Harshal P Mahajan
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Center for Health, Aging and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Mikaela L Frechette
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Abou L, Wong E, Peters J, Dossou MS, Sosnoff JJ, Rice LA. Smartphone applications to assess gait and postural control in people with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2021; 51:102943. [PMID: 33873026 DOI: 10.1016/j.msard.2021.102943] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/04/2021] [Accepted: 04/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Methods to effectively assess gait and balance impairments are necessary to guide interventions among people with Multiple Sclerosis (PwMS). Smartphone-based evaluations are becoming popular due to the ubiquitous use of smartphones in society. OBJECTIVE To determine the current state of smartphone applications that assess gait and balance among PwMS. METHODS Two independent reviewers screened articles retrieved from PubMed, Web of Science, Scopus, CINAHL, and SportDiscuss. Articles meeting eligibility criteria were summarized and qualitatively discussed. Participant characteristics, validity, reliability, sensitivity and specificity measures, and main results of smartphone-based gait and balance evaluations were summarized. Methodological quality appraisal of the studies was performed using the quality assessment tool for observational cohort and cross-sectional studies. RESULTS Eight articles were included in this review. The studies present mostly with low risk of bias. All studies successfully tested the use of smartphone applications in assessing gait and balance among PwMS. In total, 75% of the studies evaluated the validity; 38% evaluated the reliability, sensitivity, and specificity of smartphone applications to assess gait and balance. Of those, all studies except one found smartphone applications to be appropriately valid, reliable, sensitive, and specific in assessing gait and balance. Most studies (88%) reported PwMS and clinicians as their intended users. CONCLUSION There is evidence supporting the use of smartphone applications to assess gait and balance among PwMS. Future studies should further examine the psychometric properties of smartphone-based gait and postural control assessments as well as the sensitivity and specificity to improve the interpretation of the results.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Ellyce Wong
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Joseph Peters
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Mauricette S Dossou
- Centre National Hospitalier et Universitaire de Pneumo-Phtisiologie, Cotonou, BENIN
| | - Jacob J Sosnoff
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA; Illinois Multiple Sclerosis Research Collaborative, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA; Illinois Multiple Sclerosis Research Collaborative, University of Illinois at Urbana Champaign, Urbana, IL, USA.
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Smith MD, Brazier DE, Henderson EJ. Current Perspectives on the Assessment and Management of Gait Disorders in Parkinson's Disease. Neuropsychiatr Dis Treat 2021; 17:2965-2985. [PMID: 34584414 PMCID: PMC8464370 DOI: 10.2147/ndt.s304567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/25/2021] [Indexed: 12/31/2022] Open
Abstract
Gait dysfunction is a key defining feature of Parkinson's disease (PD), and is associated with symptoms of freezing and an increased risk of falls. In this narrative review, we cover the putative mechanisms of gait dysfunction in PD, the assessment of gait abnormalities, and the management of symptoms caused by the inherent difficulty in walking. Our understanding of the causes of gait problems in PD has progressed in recent times, moving from neurocognitive theory to correlates of affected neuronal pathways. In particular, this can be shown to correspond with abnormalities in responses to dual-task paradigms and dysfunction in cholinergic signaling. Great progress has been made in the sophistication and precision of gait assessment; however, it has firmly remained in the research domain. There is significant momentum behind wearable technologies that can be used by patients in their own environment, acting as digital biomarkers that can not only reflect progression but also independently discriminate PD from non-PD individuals. The treatment of gait dysfunction has historically relied on physical therapies and training combined with a view to mitigating the impact of such consequences as falls. Pharmacological therapies that are the mainstay of treatment in PD have tended to address symptoms like bradykinesia; however, optimization of dopaminergic therapies likely has a positive effect on quality of gait. Other targets have been assessed with the goal of improving gait, of which medications that improve cholinergic signaling appear most promising. Neuromodulation techniques are increasingly used in the form of deep-brain stimulation; however, standard targets, such as the globus pallidus interna, have a modest effect on gait. Considerable benefit has been seen through targeting the pedunculopontine nucleus, and a dual-target approach may be warranted. Stimulation of the spinal cord and brain through direct or magnetic approaches has been assessed, but requires further evidence.
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Affiliation(s)
- Matthew D Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
| | - Danielle E Brazier
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
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