The Feldenkrais Method improves functioning and body balance in people with intellectual disability in supported employment: A randomized clinical trial

Effects of the Feldenkrais Method as a Physiotherapy Tool: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The Feldenkrais Method (FM) is based on the learning of alternative movement patterns, carried out in an active and conscious way, which may have therapeutic effects. The objective of this systematic review is to identify the populations and conditions for which the FM can be used in physiotherapy and to determine the intervention modalities. Research in PubMed, Cochrane and PEDro databases was performed. The PEDro scale was employed to assess the methodological quality. Meta-analyses (MA) were performed whenever populations and outcome measures were comparable in at least two studies. Sixteen studies were included. In elderly people, in three of the four selected trials, the FM group significantly improved gait, balance, mobility and quality of life. The MA showed significant differences between interventions in the Timed-Up-and-Go test [Cohen's d = -1.14, 95% CI (-1.78, -0.49), p = 0.0006]. FM significantly improved pain, functional balance, and perceived exertion in three trials performed on subjects with cervical, dorsal, or shoulder pain. FM demonstrated improvements in pain, disability, quality of life and interoceptive awareness in the three trials performed in subjects with chronic low back pain. In multiple sclerosis, an improvement in functional capacity was observed in the two selected studies. The MA showed no significant differences between groups in the Function (p = 0.97) and Control (p = 0.82) dimensions of the Multiple Sclerosis Self-Efficacy Scale. In Parkinson's disease, two studies showed significant effects on quality of life and functional tests. In conclusion, evidence shows that FM has therapeutic effects comparable to other physiotherapy techniques in patients with spine pain. In addition, improvements in mobility and balance were seen in the elderly and people with neurodegenerative diseases.

Factors associated with non-completion of and scores on physical capability tests in health surveys: The North Health in Intellectual Disability Study

BACKGROUND

This study investigated the completion rates, scores and factors associated with non-completion and low scores on physical capability tests in a health survey administered to adults with intellectual disabilities.

METHOD

Assessment comprised body mass index (BMI), the Short Physical Performance Battery (SPPB), the timed up-and-go (TUG) test, the one-legged stance (OLS) test; and gross motor, communication and behavioural functioning tests.

RESULTS

The completion rates among 93 participants (aged 17-78) were 46% for the SPPB, 42% for the TUG, and 31% for the OLS. More severe intellectual disability (OR = 3.12, p < .001) and lower BMI (OR = 0.859, p = .001) were related to test non-completion. The SPPB scores were below the reference values from the general population. Lower scores were associated with older age, motor disabilities and intellectual disability severity.

CONCLUSIONS

Including physical capability tests in health surveys among adults with intellectual disabilities is important to monitor functional status and guide prevention strategies.

Movement-Based Therapies in Rehabilitation

Movement therapy refers to a broad range of Eastern and Western mindful movement-based practices used to treat the mind, body, and spirit concurrently. Forms of movement practice are universal across human culture and exist in ancient history. Research demonstrates forms of movement therapy, such as dance, existed in the common ancestor shared by humans and chimpanzees, approximately 6 million years ago. Movement-based therapies innately promote health and wellness by encouraging proactive participation in one's own health, creating community support and accountability, and so building a foundation for successful, permanent, positive change.

Is Physical Activity Associated With Physical Performance in Adults With Intellectual Disability?

Physical activity (PA) and sedentary behavior may contribute to physical function in adults with intellectual disability (ID). This study examined whether objectively measured PA and sedentary behavior levels are associated with physical performance in adults with ID. Fifty-eight adults with ID (29 women and 29 men, age 44 ± 14 years) underwent a measurement of physical performance with the Short Physical Performance Battery (SPPB) and PA and sedentary time using a hip-worn accelerometer (wGT3X-BT; ActiGraph, Pensacola, FL). Moderate PA and age were significantly associated with the SPPB score (r = .39 and .34, respectively; p < .01). A hierarchical-regression model with moderate PA and age as independent variables indicated that moderate PA was a significant predictor of SPPB (p < .001; R2 = .153), but age was not (p = .123; R2 change = .036). Overall, moderate PA was significantly associated with the SPPB score, even after accounting for age, in adults with ID.

Physical Activity With Tailored mHealth Support for Individuals With Intellectual Disabilities: Protocol for a Randomized Controlled Trial

Background

Individuals with intellectual disabilities (IDs) have lower levels of physical activity (PA) and greater barriers for participation in fitness activities compared with members of the general population. As increased PA has positive effects on cardiovascular and psychosocial health, it is exceedingly important to identify effective interventions for use in everyday settings. Mobile health (mHealth) methods such as motion sensor games (exergames) and smartphone reminders for PA have been explored and found to be promising in individuals with IDs.

Objective

The purpose of this study is to examine the effectiveness of an individually tailored PA program with motivational mHealth support on daily levels of PA in youth and adults with IDs.

Methods

The trial uses a randomized controlled design comprising 30 intervention participants and 30 control group participants, aged 16 to 60 years, with sedentary lifestyles or low PA levels. While the controls will receive standard care, the intervention aims to increase the level of PA, measured as steps per day, as the primary outcome. Secondary outcome variables are body mass index, blood pressure, physical performance, social support for PA, self-efficacy in a PA setting, behavior problems, and goal attainment. The intervention involves the delivery of tailored mHealth support, using smartphones or tablets to create structure with focus on the communicative abilities of individual participants. Rewards and feedback are provided in order to motivate individuals to increase participation in PA. Participants in the intervention group, their close relatives, and care staff will be invited to participate in a preintervention goal-setting meeting, where goal attainment scaling will be used to select the participants’ PA goals for the intervention period. All participants will be assessed at baseline, at 3 months, and at 6 months.

Results

Enrollment was planned to start in April 2020 but will be delayed due to the pandemic situation. The main contribution of this paper is a detailed plan to run our study, which will produce new knowledge about tailored mHealth to support PA in individuals with intellectual disabilities.

Conclusions

We expect the new intervention to perform better than standard care in terms of improved PA, improved self-efficacy, and social support for activities. Technology offers new opportunities to promote healthy behaviors. The results of the study will determine the effectiveness and sustainability of a tailored mHealth support intervention to increase PA in youth and adults with IDs.

Trial Registration

ClinicalTrials.gov NCT04079439; https://clinicaltrials.gov/ct2/show/NCT04079439

International Registered Report Identifier (IRRID)

PRR1-10.2196/19213

[Effects of a physical exercise programme on the risk of falls, balance, and walking speed in older people with intellectual disabilities]

INTRODUCTION

People with intellectual disabilities (ID) have balance disturbances and risk of falls, which are aggravated with ageing. This study aimed to provide information on the effects of an exercise programme on fall risk, balance, and walking speed in a group of older people with ID.

MATERIALS AND METHODS

Eight people with mild to moderate ID (mean age: 56.37±7.08 years) participated in a 12-week programme based on a weekly session that included exercises aimed at strengthening stabilising muscles, stimulating proprioception, and enhancing reflexes in unstable situations. The effects of the programme on the risk of falling and on balance and walking speed were assessed using the Tinetti scale and the Timed Up and Go test, respectively.

RESULTS

The programme was feasible and no adverse effects were registered. At the end of the programme, the risk of falls remained unchanged, while balance and gait speed improved significantly.

CONCLUSIONS

A three-month weekly programme based on muscle strengthening and proprioceptive re-education exercises was feasible and had a positive impact on balance and walking speed in a group of older people with ID. These results lay the foundation for future randomised clinical trials aiming to confirm the effects of such programmes on the risk of falls in this population.

Feldenkrais 'Functional Integration' Increases Body Contact Surface in the Supine Position: A Randomized-Controlled Experimental Study

Feldenkrais ‘Functional Integration’ (FI) is a widely used type of body work with a focus on the continuous integration of body sensations and awareness with movement. The method is, amongst others, known for improving balance in aging populations, but also for its ability to relax muscles. With participants treated in the supine position FI is potentially changing the surface area of the body in contact with the surface on which a participant is lying. So far, no prior study has assessed this claim. We evaluated objectively and subjectively if a treatment with FI would induce changes in pressure and contact surface of the body on the mat. Thirty volunteers received an individual treatment with FI, in a randomized order on both sides of the body. Pressure and contact surface was documented with the Xsensor-Measurement-System. Subjective sensations were assessed with a self-report scale. Due to two parallel assessments alpha-level was adjusted to α = 0.025. We found that pressure and contact surface of the body on the mat significantly changed after the treatment (factor time: p < 0.0001, ηp2 = 0.90). We also found that pressure and contact surface increased significantly on the left side for the group that started with the left side first (time × group p = 0.016; ηp2 = 0.62), but less so on the right side for the group that started with the right side first (time × group: p = 0.056) although there was still a substantial effect size (ηp2 = 0.54). The subjective reports confirmed the physical measurements. In conclusion our results demonstrate for the first time that the treatment with the Feldenkrais method changes muscle tone leading to a more relaxed supine position with respect to pressure and contact surface on the mat.

A systematic review of the methodological and practical challenges of undertaking randomised-controlled trials with cognitive disability populations

Approximately 10% of the world's population have a cognitive disability. Cognitive disabilities can have a profound impact on a person's social, cognitive or mental functioning, requiring high levels of costly health and social support. Therefore, it is imperative that interventions and services received are based upon a sound evidence-base. For many interventions for this population, this evidence-base does not yet exist and there is a need for more Randomised Controlled Trials (RCTs). The process of conducting RCTs with disabled populations is fraught with methodological challenges. We need a better understanding of these methodological barriers if the evidence-bases are to be developed. The purpose of this study was to explore the methodological and practical barriers to conducting trials with adults with cognitive disabilities. As a case example, the literature regarding RCTs for people with intellectual disabilities (ID) was used to highlight these pertinent issues. A systematic literature review was conducted of RCTs with adults with ID, published from 2000 to 2017. A total of 53 papers met the inclusion criteria and were reviewed. Some of the barriers reported were specific to the RCT methodology and others specific to people with disabilities. Notable barriers included; difficulties recruiting; obtaining consent; resistance to the use of control groups; engaging with carers, staff and stakeholders; the need to adapt interventions and resources to be disability-accessible; and staff turnover. Conducting RCTs with people with cognitive disabilities can be challenging, however with reasonable adjustments, many of these barriers can be overcome. Researchers are not maximising the sharing of their experience-base. As a result, the development of evidence-bases remains slow and the health inequities of people with disabilities will continue to grow. The importance of the MRC guidelines on process evaluations, together with implications for the dissemination of 'evidence-base' and 'experience-base' are discussed.