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Mohammadzadeh Gonabadi A, Buster TW, Cesar GM, Burnfield JM. Effect of Data and Gap Characteristics on the Nonlinear Calculation of Motion During Locomotor Activities. J Appl Biomech 2024; 40:278-286. [PMID: 38843863 DOI: 10.1123/jab.2023-0283] [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: 11/18/2023] [Revised: 03/05/2024] [Accepted: 04/03/2024] [Indexed: 07/31/2024]
Abstract
This study investigated how data series length and gaps in human kinematic data impact the accuracy of Lyapunov exponents (LyE) calculations with and without cubic spline interpolation. Kinematic time series were manipulated to create various data series lengths (28% and 100% of original) and gap durations (0.05-0.20 s). Longer gaps generally resulted in significantly higher LyE% error values in each plane in noninterpolated data. During cubic spline interpolation, only the 0.20-second gap in frontal plane data resulted in a significantly higher LyE% error. Data series length did not significantly affect LyE% error in noninterpolated data. During cubic spline interpolation, sagittal plane LyE% errors were significantly higher at shorter versus longer data series lengths. These findings suggest that not interpolating gaps in data could lead to erroneously high LyE values and mischaracterization of movement variability. When applying cubic spline, a long gap length (0.20 s) in the frontal plane or a short sagittal plane data series length (1000 data points) could also lead to erroneously high LyE values and mischaracterization of movement variability. These insights emphasize the necessity of detailed reporting on gap durations, data series lengths, and interpolation techniques when characterizing human movement variability using LyE values.
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Affiliation(s)
- Arash Mohammadzadeh Gonabadi
- Rehabilitation Engineering Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Thad W Buster
- Rehabilitation Engineering Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Guilherme M Cesar
- Department of Physical Therapy, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | - Judith M Burnfield
- Rehabilitation Engineering Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
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Sade S, Pickholz H, Melzer I, Shapiro A. Development of an Elliptical Perturbation System that provides unexpected perturbations during elliptical walking (the EPES system). J Neuroeng Rehabil 2023; 20:125. [PMID: 37749627 PMCID: PMC10521489 DOI: 10.1186/s12984-023-01251-3] [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: 05/27/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND 'Perturbation-based balance training' (PBBT) is a training method that was developed to improve balance reactive responses to unexpected balance loss. This training method is more effective in reducing fall rates than traditional balance training methods. Many PBBTs are performed during standing or treadmill walking which targeted specifically step reactive responses, we however, aimed to develop and build a mechatronic system that can provide unexpected perturbation during elliptical walking the Elliptical Perturbation System (the EPES system), with the aim of improving specifically the trunk and upper limbs balance reactive control. METHODS This paper describes the development, and building of the EPES system, using a stationary Elliptical Exercise device, which allows training of trunk and upper limbs balance reactive responses in older adults. RESULTS The EPES system provides 3-dimensional small, controlled, and unpredictable sudden perturbations during stationary elliptical walking. We developed software that can identify a trainee's trunk and arms reactive balance responses using a stereo camera. After identifying an effective trunk and arms reactive balance response, the software controls the EPES system motors to return the system to its horizontal baseline position after the perturbation. The system thus provides closed-loop feedback for a person's counterbalancing trunk and arm responses, helping to implement implicit motor learning for the trainee. The pilot results show that the EPES software can successfully identify balance reactive responses among participants who are exposed to a sudden unexpected perturbation during elliptical walking on the EPES system. CONCLUSIONS EPES trigger reactive balance responses involving counter-rotation action of body segments and simultaneously evoke arms, and trunk reactive response, thus reactive training effects should be expected.
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Affiliation(s)
- Shoval Sade
- Department of Mechanical Engineering, Faculty of Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hodaya Pickholz
- Schwartz Movement Analysis & Rehabilitation Laboratory, Physical Therapy Department, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, Israel
| | - Itshak Melzer
- Schwartz Movement Analysis & Rehabilitation Laboratory, Physical Therapy Department, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, Israel.
| | - Amir Shapiro
- Department of Mechanical Engineering, Faculty of Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Dale ML, Silva-Batista C, de Almeida FO, Horak FB. Balance and gait in progressive supranuclear palsy: a narrative review of objective metrics and exercise interventions. Front Neurol 2023; 14:1212185. [PMID: 37426438 PMCID: PMC10327556 DOI: 10.3389/fneur.2023.1212185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Background The use of objective gait and balance metrics is rapidly expanding for evaluation of atypical parkinsonism, and these measures add to clinical observations. Evidence for rehabilitation interventions to improve objective measures of balance and gait in atypical parkinsonism is needed. Aim Our aim is to review, with a narrative approach, current evidence on objective metrics for gait and balance and exercise interventions in progressive supranuclear palsy (PSP). Methods Literature searches were conducted in four computerized databases from the earliest record up to April 2023: PubMed, ISI's Web of Knowledge, Cochrane's Library, and Embase. Data were extracted for study type (cross-sectional, longitudinal, and rehabilitation interventions), study design (e.g., experimental design and case series), sample characteristics, and gait and balance measurements. Results Eighteen gait and balance (16 cross-sectional and 4 longitudinal) and 14 rehabilitation intervention studies were included. Cross-sectional studies showed that people with PSP have impairments in gait initiation and steady-state gait using wearable sensors, and in static and dynamic balance assessed by posturography when compared to Parkinson's disease (PD) and healthy controls. Two longitudinal studies observed that wearable sensors can serve as objective measures of PSP progression, using relevant variables of change in turn velocity, stride length variability, toe off angle, cadence, and cycle duration. Rehabilitation studies investigated the effect of different interventions (e.g., balance training, body-weight supported treadmill gait, sensorimotor training, and cerebellar transcranial magnetic stimulation) on gait, clinical balance, and static and dynamic balance assessed by posturography measurements. No rehabilitation study in PSP used wearable sensors to evaluate gait and balance impairments. Although clinical balance was assessed in 6 rehabilitation studies, 3 of these studies used a quasi-experimental design, 2 used a case series, only 1 study used an experimental design, and sample sizes were relatively small. Conclusion Wearable sensors to quantify balance and gait impairments are emerging as a means of documenting progression of PSP. Robust evidence for improving balance and gait in PSP was not found for rehabilitation studies. Future powered, prospective and robust clinical trials are needed to investigate the effects of rehabilitation interventions on objective gait and balance outcomes in people with PSP.
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Affiliation(s)
- Marian L. Dale
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Neurology Section, VA Portland Health Care System, Veterans Health Administration, Portland, OR, United States
| | - Carla Silva-Batista
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo, Brazil
| | | | - Fay B. Horak
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States
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Effect of gap-filling technique and gap location on linear and nonlinear calculations of motion during locomotor activities. Gait Posture 2022; 94:85-92. [PMID: 35255383 DOI: 10.1016/j.gaitpost.2022.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Marker occlusion during camera-based movement analysis is common. Different interpolation techniques are available for estimating location of missing marker trajectories. RESEARCH QUESTION What is the effect of gap location and interpolation technique on linear and nonlinear measures for a given kinematic time series? METHODS Kinematic data were recorded during motor-assisted elliptical training and treadmill walking. Gap-filling techniques (i.e., Cubic, Makima, Autoregressive, Nearest Neighbor, and No Interpolation) and gap locations experimentally applied to each cycle across initially complete time series (Gap 1: local minimum and maximum peaks; Gap 2: maximum peaks; Gap 3: maximum peaks at negative slope; Gap 4: random locations) were examined during linear (Maxima and Minima joint angles) and nonlinear [maximum Lyapunov exponent (LyE)] measures. RESULTS Gap-filling technique and gap location influenced values calculated for linear and nonlinear measures of joint motions. When referenced to the gold standard (original data series without gaps), across all joints studied the average % error of Maxima and Minima joint angles and LyE % error were lower when applying Cubic, Makima, Autoregressive, and Nearest Neighbor techniques compared to No Interpolation (p < 0.0001). The % error of Maxima joint angles was lower for Gaps 1, 3, and 4 compared to Gap 2 (p = 0.0003), while % error of Minima joint angles was lower for Gaps 2 and 3, compared to Gaps 1 and 4 (p < 0.0001). An interaction between gap-filling technique and gap location was identified for LyE % error, in which Gap 4 % error was significantly greater during No Interpolation compared to other gap-filling techniques (p < 0.0001). SIGNIFICANCE Findings can guide selection of appropriate techniques to manage missing kinematic data points in camera-based motion analysis time series. Gap-filling techniques significantly reduced error in calculating select linear and nonlinear measures of variability, with Cubic most consistently resulting in the greatest reduction in error.
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Bluett B, Pantelyat AY, Litvan I, Ali F, Apetauerova D, Bega D, Bloom L, Bower J, Boxer AL, Dale ML, Dhall R, Duquette A, Fernandez HH, Fleisher JE, Grossman M, Howell M, Kerwin DR, Leegwater-Kim J, Lepage C, Ljubenkov PA, Mancini M, McFarland NR, Moretti P, Myrick E, Patel P, Plummer LS, Rodriguez-Porcel F, Rojas J, Sidiropoulos C, Sklerov M, Sokol LL, Tuite PJ, VandeVrede L, Wilhelm J, Wills AMA, Xie T, Golbe LI. Best Practices in the Clinical Management of Progressive Supranuclear Palsy and Corticobasal Syndrome: A Consensus Statement of the CurePSP Centers of Care. Front Neurol 2021; 12:694872. [PMID: 34276544 PMCID: PMC8284317 DOI: 10.3389/fneur.2021.694872] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS; the most common phenotype of corticobasal degeneration) are tauopathies with a relentless course, usually starting in the mid-60s and leading to death after an average of 7 years. There is as yet no specific or disease-modifying treatment. Clinical deficits in PSP are numerous, involve the entire neuraxis, and present as several discrete phenotypes. They center on rigidity, bradykinesia, postural instability, gait freezing, supranuclear ocular motor impairment, dysarthria, dysphagia, incontinence, sleep disorders, frontal cognitive dysfunction, and a variety of behavioral changes. CBS presents with prominent and usually asymmetric dystonia, apraxia, myoclonus, pyramidal signs, and cortical sensory loss. The symptoms and deficits of PSP and CBS are amenable to a variety of treatment strategies but most physicians, including many neurologists, are reluctant to care for patients with these conditions because of unfamiliarity with their multiplicity of interacting symptoms and deficits. CurePSP, the organization devoted to support, research, and education for PSP and CBS, created its CurePSP Centers of Care network in North America in 2017 to improve patient access to clinical expertise and develop collaborations. The directors of the 25 centers have created this consensus document outlining best practices in the management of PSP and CBS. They formed a writing committee for each of 12 sub-topics. A 4-member Steering Committee collated and edited the contributions. The result was returned to the entire cohort of authors for further comments, which were considered for incorporation by the Steering Committee. The authors hope that this publication will serve as a convenient guide for all clinicians caring for patients with PSP and CBS and that it will improve care for patients with these devastating but manageable disorders.
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Affiliation(s)
- Brent Bluett
- Neurology, Pacific Central Coast Health Center, Dignity Health, San Luis Obispo, CA, United States
- Neurology, Stanford University, Stanford, CA, United States
| | - Alexander Y. Pantelyat
- Neurology, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Irene Litvan
- Neurology, University of California, San Diego, San Diego, CA, United States
| | - Farwa Ali
- Neurology, Mayo Clinic, Rochester, MN, United States
| | - Diana Apetauerova
- Neurology, Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Danny Bega
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lisa Bloom
- Neurology, Surgery, University of Chicago, Chicago, IL, United States
| | - James Bower
- Neurology, Mayo Clinic, Rochester, MN, United States
| | - Adam L. Boxer
- Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Marian L. Dale
- Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Rohit Dhall
- Neurology, University of Arkansas for Medical Sciences, Little Rock, AK, United States
| | - Antoine Duquette
- Service de Neurologie, Département de Médecine, Unité de Troubles du Mouvement André-Barbeau, Centre Hospitalier de l'Université de Service de Neurologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Hubert H. Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jori E. Fleisher
- Neurological Sciences, Rush Medical College, Rush University, Chicago, IL, United States
| | - Murray Grossman
- Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael Howell
- Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Diana R. Kerwin
- Geriatrics, Presbyterian Hospital of Dallas, Dallas, TX, United States
| | | | - Christiane Lepage
- Service de Neurologie, Département de Médecine, Unité de Troubles du Mouvement André-Barbeau, Centre Hospitalier de l'Université de Service de Neurologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | | | - Martina Mancini
- Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Nikolaus R. McFarland
- Neurology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Paolo Moretti
- Neurology, The University of Utah, Salt Lake City, UT, United States
| | - Erica Myrick
- Neurological Sciences, Rush Medical College, Rush University, Chicago, IL, United States
| | - Pritika Patel
- Neurology, Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Laura S. Plummer
- Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | | | - Julio Rojas
- Neurology, University of California, San Francisco, San Francisco, CA, United States
| | | | - Miriam Sklerov
- Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Leonard L. Sokol
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Paul J. Tuite
- Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Lawren VandeVrede
- Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer Wilhelm
- Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Anne-Marie A. Wills
- Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Tao Xie
- Neurology, Surgery, University of Chicago, Chicago, IL, United States
| | - Lawrence I. Golbe
- Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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Variations in plantar pressure variables across elliptical trainers in older adults. Clin Biomech (Bristol, Avon) 2020; 80:105142. [PMID: 32791378 DOI: 10.1016/j.clinbiomech.2020.105142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ellipticals are used to address walking and cardiorespiratory training goals of older adults, some of whom are at risk for foot injuries. Variations in joint kinematics and muscle demands when using different ellipticals could lead to plantar pressure differences. This study explored plantar pressure variables during gait and use of four ellipticals. METHODS Plantar pressures were recorded while 10 adults [68.1 (4.5) years] walked and used the True, Octane, Life Fitness, and SportsArt ellipticals. Repeated-measures ANOVAs (5 × 1) identified forefoot and heel differences across conditions. FINDINGS Maximum forefoot forces and peak pressures were significantly lower than walking for each elliptical condition with one exception (Life Fitness peak pressure). However, sustained elliptical pedal contact time contributed to forefoot pressure-time integrals and dosages (i.e., cumulative pressure during one minute of activity) not varying significantly amongst elliptical and walking conditions. Heel maximum forces and peak pressures were significantly lower than walking during all elliptical conditions except SportsArt. Heel contact time on SportsArt and Octane exceeded walking, and SportsArt heel contact time exceeded Life Fitness. Heel pressure-time integral was greater on SportsArt compared to walking, Life Fitness, and True. Sports Art heel dosage exceeded Life Fitness and True. INTERPRETATION While elliptical training's sustained double limb support diminished maximal forces and peak pressures under the forefoot and heel compared to walking, each ellipticals' pressure-time integral and dosage were not significantly lower than walking. These findings point to the importance of carefully initiating elliptical training programs to minimize tissue injury, particularly if sensory neuropathy is present.
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Fallahtafti F, Pfeifer CM, Buster TW, Burnfield JM. Effect of motor-assisted elliptical training speed and body weight support on center of pressure movement variability. Gait Posture 2020; 81:138-143. [PMID: 32888552 DOI: 10.1016/j.gaitpost.2020.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND A motor-assisted elliptical trainer is being used clinically to help individuals with physical disabilities regain and/or retain walking ability and cardiorespiratory fitness. Unknown is how the device's training parameters can be used to optimize movement variability and regularity. This study examined the effect of motor-assisted elliptical training speed as well as body weight support (BWS) on center of pressure (CoP) movement variability and regularity during training. METHODS CoP was recorded using in-shoe pressure insoles as participants motor-assisted elliptical trained at three speeds (20, 40 and 60 cycles per minute) each performed at four BWS levels (0 %, 20 %, 40 %, and 60 %). Separate two-way repeated measures ANOVAs (3 × 4) evaluated impact of training speed and BWS on linear variability (standard deviation) and non-linear regularity (sample entropy) of CoP excursion (anterior-posterior, medial-lateral) for 10 dominant limb strides. FINDINGS Training speed and BWS did not significantly affect the linear variability of CoP in the anterior-posterior or medial-lateral directions. However, sample entropy in both directions revealed the main effect of training speed (p < 0.0001), and a main effect of BWS was observed in the medial-lateral direction (p = 0.004). Faster training speeds and greater levels of BWS resulted in more irregular CoP patterns. INTERPRETATION The finding that speed and BWS can be used to manipulate CoP movement variability when using a motor-assisted elliptical has significant clinical implications for promoting/restoring walking capacity. Further research is required to determine the impact of motor-assisted elliptical speed and BWS manipulations on functional recovery of walking in individuals who have experienced a neurologic injury or illness.
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Affiliation(s)
- Farahnaz Fallahtafti
- Movement and Neurosciences Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506, United States; Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive, Omaha, NE 68182-0860, United States
| | - Chase M Pfeifer
- Movement and Neurosciences Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506, United States
| | - Thad W Buster
- Movement and Neurosciences Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506, United States
| | - Judith M Burnfield
- Movement and Neurosciences Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506, United States.
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Slade SC, Underwood M, McGinley JL, Morris ME. Exercise and Progressive Supranuclear Palsy: the need for explicit exercise reporting. BMC Neurol 2019; 19:305. [PMID: 31783740 PMCID: PMC6884751 DOI: 10.1186/s12883-019-1539-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Progressive Supranuclear Palsy (PSP) is the most frequent form of atypical Parkinsonism. Although there is preliminary evidence for the benefits of gait rehabilitation, balance training and oculomotor exercises in PSP, the quality of reporting of exercise therapies appears mixed. The current investigation aims to evaluate the comprehensiveness of reporting of exercise and physical activity interventions in the PSP literature. METHODS Two independent reviewers used the Consensus on Exercise Reporting Template (CERT) to extract all exercise intervention data from 11 studies included in a systematic review. CERT items covered: 'what' (materials), 'who' (instructor qualifications), 'how' (delivery), 'where' (location), 'when', 'how much' (dosage), 'tailoring' (what, how), and 'how well' (fidelity) exercise delivery complied with the protocol. Each exercise item was scored '1' (adequately reported) or '0' (not adequately reported or unclear). The CERT score was calculated, as well as the percentage of studies that reported each CERT item. RESULTS The CERT scores ranged from 3 to 12 out of 19. No PSP studies adequately described exercise elements that would allow exact replication of the interventions. Well-described items included exercise equipment, exercise settings, exercise therapy scheduling, frequency and duration. Poorly described items included decision rules for exercise progression, instructor qualifications, exercise adherence, motivation strategies, safety and adverse events associated with exercise therapies. DISCUSSION The results revealed variability in the reporting of physical therapies for people living with PSP. Future exercise trials need to more comprehensively describe equipment, instructor qualifications, exercise and physical activity type, dosage, setting, individual tailoring of exercises, supervision, adherence, motivation strategies, progression decisions, safety and adverse events. CONCLUSION Although beneficial for people living with PSP, exercise and physical therapy interventions have been inadequately reported. It is recommended that evidence-based reporting templates be utilised to comprehensively document therapeutic exercise design, delivery and evaluation.
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Affiliation(s)
- Susan C. Slade
- La Trobe Centre for Sport and Exercise Medicine Research, School Allied Health, Human Services and Sport, College Science, Health & Engineering, La Trobe University, Kingsbury Drive, Bundoora, 3086 Australia
| | - Martin Underwood
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jennifer L. McGinley
- Physiotherapy, The University of Melbourne, Level 7, Alan Gilbert Building, Barry Street, Parkville, Australia
| | - Meg E. Morris
- La Trobe Centre for Sport and Exercise Medicine Research, School Allied Health, Human Services and Sport, College Science, Health & Engineering, La Trobe University, Kingsbury Drive, Bundoora, 3086 Australia
- Healthscope, North Eastern Rehabilitation Centre, Ivanhoe, Australia
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Slade SC, Finkelstein DI, McGinley JL, Morris ME. Exercise and physical activity for people with Progressive Supranuclear Palsy: a systematic review. Clin Rehabil 2019; 34:23-33. [PMID: 31559853 PMCID: PMC6943961 DOI: 10.1177/0269215519877235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: To conduct a systematic review to evaluate exercise and structured physical activity for people living with Progressive Supranuclear Palsy. Data sources: AMED, CINAHL, Cochrane, EMBASE, Informit, MEDLINE, PEDro, PsycINFO, PubMed and SportDiscus were searched until 18 August 2019. Reference lists of included studies were hand-searched. Methods: Cochrane guidelines informed review methods. English language peer-reviewed studies of any design, in any setting, were included. Method quality was appraised with the Physiotherapy Evidence Database scale and Joanna Briggs Institute instruments. Data were extracted for study design, sample characteristics and therapy content. Effectiveness was calculated where possible. Results: Eleven studies were included. Method appraisal showed moderate to high risk of bias. Research designs included three randomized controlled trials, two quasi-experimental studies, one cohort study, four case studies and one case series. Sample sizes ranged from 1 to 24. Exercise interventions included supported and robot-assisted gait training, gaze training, balance re-education and auditory-cued motor training. Dosage ranged from two to five sessions per week over four to eight weeks. End-of-intervention effect sizes were small (6-minute walk test: –0.07; 95% confidence interval (CI): –0.87, 0.73) to moderate (balance: –0.61; 95% CI: –1.40, 0.23; Timed Up and Go: 0.42; 95% CI: –0.49, 1.33) and statistically non-significant. Function, quality of life and adverse events were inconsistently reported. Conclusions: For people with Progressive Supranuclear Palsy, robust evidence was not found for therapeutic exercises. Reported improvements in walking were derived from two clinical trials. The effects of structured physical activity for people with advanced Progressive Supranuclear Palsy are not known.
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Affiliation(s)
- Susan C Slade
- La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services and Sport, SHE College, La Trobe University, Melbourne, VIC, Australia
| | - David I Finkelstein
- Parkinson's Disease Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jennifer L McGinley
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC, Australia
| | - Meg E Morris
- La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services and Sport, SHE College, La Trobe University, Melbourne, VIC, Australia.,Healthscope, North Eastern Rehabilitation Centre, Ivanhoe, VIC, Australia
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Cesar GM, Buster TW, Burnfield JM. Cardiorespiratory fitness, balance and walking improvements in an adolescent with cerebral palsy (GMFCS II) and autism after motor-assisted elliptical training. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1536764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Guilherme M. Cesar
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Thad W. Buster
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Judith M. Burnfield
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
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Burnfield JM, Buster TW, Pfeifer CM, Irons SL, Cesar GM, Nelson CA. Adapted Motor-Assisted Elliptical for Rehabilitation of Children With Physical Disabilities. J Med Device 2018. [DOI: 10.1115/1.4041588] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Many children with physical disabilities experience difficulty using traditional exercise equipment for gait rehabilitation and fitness training, and the clinician resources required to deliver intensive overground or treadmill-based therapies are infrequently available in most clinics, hospitals, and school settings. This work describes design and testing of a comprehensive set of modifications that enabled children to use a commercially available robotic exercise device (i.e., Intelligently Controlled Assistive Rehabilitation Elliptical (ICARE)) initially developed to address walking and fitness goals of adults with physical disabilities and chronic conditions. Fifteen children (3–11 years old) concurrently enrolled in physical therapy due to varied neurologic conditions were recruited with their parent(s) to evaluate the safety, comfort, and usability of the adult ICARE and pediatric-modified ICARE. After children tried each device, feedback was recorded. To assess feasibility, each child then participated in up to ten sessions (two to five sessions per week; average session length: 38 min, range 21–66 min) using the pediatric-modified ICARE. Parents, on average, perceived that the pediatric-modified ICARE was significantly safer, more comfortable and usable than the adult ICARE. Children's perceptions of the pediatric-modified ICARE were similar, although not statistically significant. Children used the prototype device during 133 sessions for over 3800 min and more than 162,000 cycles. In conclusion, this study demonstrated the feasibility of using the pediatric-modified ICARE with children as young as 3 years old as an adjunct to ongoing therapy.
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Affiliation(s)
- Judith M. Burnfield
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Thad W. Buster
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Chase M. Pfeifer
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Sonya L. Irons
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Guilherme M. Cesar
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Carl A. Nelson
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, W316 Nebraska Hall, P.O. Box: 880526, Lincoln, NE 68588 e-mail:
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Pfeifer CM, Rowen DA, Buster TW, Cesar GM, Irons SL, Burnfield JM. Design and Validation of a Heart Rate and Speed Monitoring Device With Intelligently Controlled Assistive Rehabilitation Elliptical. J Med Device 2018. [DOI: 10.1115/1.4041337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Cardiovascular assessment and fitness training are often overlooked in physical rehabilitation. Many current rehabilitation exercise devices do not allow for the recording and exportation of variables related to cardiovascular fitness. Therefore, the purpose of this work was to design, prototype, and validate a data logger that measures, records, and exports time, heart rate (HR), and speed data with the commercially available rehabilitation device called the Intelligently Controlled Assistive Rehabilitation Elliptical (ICARE). Validation involved using the data logger device in parallel with devices currently used in research environments for measuring HR (TrueOne 2400 metabolic cart with polar HR monitoring chest strap) and speed (ICARE's console). Ten healthy individuals without known disability impacting walking or ability to use the ICARE, exercised on the ICARE while HR and ICARE speed were measured. It was found that the data logger can be used to accurately measure, record, and export HR (linear regression: P < 0.001; R2 = 0.892) and speed (linear regression: P < 0.001; R2 = 0.997) data when used with the ICARE.
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Affiliation(s)
- Chase M. Pfeifer
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Douglas A. Rowen
- Department of Biomechanics, 6160 University Drive, South Omaha, NE 68182 e-mail:
| | - Thad W. Buster
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Guilherme M. Cesar
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Sonya L. Irons
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
| | - Judith M. Burnfield
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506 e-mail:
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Walking and Fitness Improvements in a Child With Diplegic Cerebral Palsy Following Motor-Assisted Elliptical Intervention. Pediatr Phys Ther 2018; 30:E1-E7. [PMID: 30277973 DOI: 10.1097/pep.0000000000000541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To quantify effects of motor-assisted elliptical (Intelligently Controlled Assistive Rehabilitation Elliptical [ICARE]) training on walking and fitness of a child with cerebral palsy (CP). KEY POINTS A 12-year-old boy with walking limitations due to spastic diplegic CP (Gross Motor Function Classification System II) participated in 24 sessions of primarily moderate- to vigorous-intensity ICARE exercise. Fitness improvements were evidenced clinically across sessions by the child's capacity to train for longer periods, at faster speeds, and while overriding motor's assistance. Postintervention, the child walked faster with greater stability and endurance and more rapidly completed the modified Time Up and Go test. CONCLUSION The child's fitness and gait improved following engagement in a moderate- to vigorous-intensity gait-like exercise intervention. RECOMMENDATIONS FOR CLINICAL PRACTICE Integration of moderate- to vigorous-intensity motor-assisted elliptical training can promote simultaneous gains in fitness and function for children with CP.
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Burnfield JM, Cesar GM, Buster TW, Irons SL, Nelson CA. Kinematic and muscle demand similarities between motor-assisted elliptical training and walking: Implications for pediatric gait rehabilitation. Gait Posture 2017; 51:194-200. [PMID: 27810692 DOI: 10.1016/j.gaitpost.2016.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/23/2016] [Indexed: 02/02/2023]
Abstract
Many children with physical disabilities and special health care needs experience barriers to accessing effective therapeutic technologies to improve walking and fitness in healthcare and community environments. The expense of many robotic and exoskeleton technologies hinders widespread use in most clinics, school settings, and fitness facilities. A motor-assisted elliptical trainer that is being used to address walking and fitness deficits in adults was modified to enable children as young as three years of age to access the technology (Pedi-ICARE). We compared children's kinematic and muscle activation patterns during walking and training on the Pedi-ICARE. Eighteen children walked (self-selected comfortable speed), Pedi-ICARE trained with motor-assistance at self-selected comfortable speed (AAC), and trained while over-riding motor-assistance (AAC+). Coefficient of multiple correlations (CMCs) compared lower extremity kinematic profiles during AAC and AAC+ to gait. Repeated measures ANOVAs identified muscle demand differences across conditions. CMCs revealed strong similarities at the hip and knee between each motor-assisted elliptical condition and gait. Ankle CMCs were only moderate. Muscle demands were generally lowest during AAC. Over-riding the motor increased hip and knee muscle demands. The similarity of motion patterns between Pedi-ICARE conditions and walking suggest the device could be used to promote task-specific training to improve walking. The capacity to manipulate muscle demands using different motor-assistance conditions highlights Pedi-ICARE's versatility in addressing a wide range of children's abilities.
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Affiliation(s)
- Judith M Burnfield
- Movement and Neurosciences Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE, 68506-2150, United States.
| | - Guilherme M Cesar
- Movement and Neurosciences Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE, 68506-2150, United States.
| | - Thad W Buster
- Movement and Neurosciences Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE, 68506-2150, United States.
| | - Sonya L Irons
- Movement and Neurosciences Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE, 68506-2150, United States.
| | - Carl A Nelson
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, W 316 NH, Lincoln, NE, 68588-0526, United States.
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Novel Motor-Assisted Elliptical Training Intervention Improves 6-Minute Walk Test and Oxygen Cost for an Individual With Progressive Supranuclear Palsy. Cardiopulm Phys Ther J 2016. [DOI: 10.1097/cpt.0000000000000027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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