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Rafferty MR, Foster ER, Roberts AC, Smaller KA, Johnson LL, Lawson RA. Stemming the Tide: The Proactive Role of Allied Health Therapy in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024:JPD230267. [PMID: 38848194 DOI: 10.3233/jpd-230267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Motor and nonmotor symptoms occur in early Parkinson's disease (PD), or even in the prodromal stage. Many of these symptoms can be addressed by allied health therapies, including physical therapy, occupational therapy, speech therapy, and psychological therapies. However, referrals to these services early in the disease are low. We provide a review summarizing the efficacy of proactive allied health interventions on motor and nonmotor symptoms and daily function in prodromal and early disease. We also highlight areas for additional research and provide recommendations to improve care for individuals with early PD within each discipline. We recognize the overlapping roles of the allied health disciplines and support integrated or transdisciplinary care beginning soon after diagnosis to help stem the tide in the progression of PD symptoms and disability.
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Affiliation(s)
- Miriam R Rafferty
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Erin R Foster
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Angela C Roberts
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
- Department of Computer Sciences, Western University, London, ON, Canada
- Canadian Centre for Activity and Aging, London, ON, Canada
| | | | | | - Rachael A Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Moulaee Conradsson D, Leavy B, Hagströmer M, Franzén E. Predictors of Sustained Physical Activity During the COVID-19 Pandemic in People With Parkinson Disease in Sweden. J Neurol Phys Ther 2024; 48:75-82. [PMID: 37436217 DOI: 10.1097/npt.0000000000000455] [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: 07/13/2023]
Abstract
BACKGROUND AND PURPOSE During the first wave of the COVID-19 pandemic, people with Parkinson disease (PwPD) reported deterioration in health and physical activity. The aim of this study was to describe 1-year changes in physical activity and perceived health in PwPD during the COVID-19 pandemic and to identify predictors of sustained physical activity. METHODS This study compared perceived health and sensor-derived physical activity (Actigraph GT3x) in PwPD between the first (June to July 2020) and third waves (June to July 2021) of the pandemic. Multiple logistic regression analyses were used to predict sustained physical activity across the study period using personal factors, disease severity, and functioning as independent variables. RESULTS Sixty-three PwPD (mean age 71.0 years, 41% females) completed both baseline and 1-year follow-up (26 lost to follow-up). PwPD showed a decrease in average number of steps per day (Δ415 steps, P = 0.048), moderate-to-vigorous-physical activity (Δ7 minutes, P = 0.007) and increase in sedentary time (Δ36 minutes, P <.001) between baseline and 1-year follow-up. While self-perceived walking impairments and depressive symptoms increased significantly, balance confidence decreased between baseline and 1-year follow-up, no significant changes occurred for self-rated health, quality of life, or anxiety. Significant predictors of sustained physical activity levels were 15 years or more of education (odds ratio [OR] = 7.38, P = 0.013) and higher perceived walking ability (OR = 0.18, P = 0.041). DISCUSSION AND CONCLUSION Among PwPD with mild to moderate disease severity living in Sweden, factors associated with reduced physical activity levels during the COVID-19 pandemic included older age, lower education levels, and greater perceived walking difficulties.
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Affiliation(s)
- David Moulaee Conradsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden (D.M.C., B.L., M.H., E.F.); Medical Unit Occupational Therapy & Physiotherapy, Theme Women's Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden (D.M.C., E.F.); Research and Development Department, Stockholm Sjukhem's Foundation, Stockholm, Sweden (B.L, E.F); and Academic Primary Care Centre, Region Stockholm, Stockholm, Sweden (M.H)
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3
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Brauer SG, Lamont RM, O'Sullivan JD. A physiotherapy group exercise and self-management approach to improve physical activity in people with mild-moderate Parkinson's disease: a randomized controlled trial. Trials 2024; 25:76. [PMID: 38254229 PMCID: PMC10801959 DOI: 10.1186/s13063-023-07870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Physical activity levels are low in people with Parkinson's disease (PD) and have proved difficult to increase with exercise programs alone. Intervention approaches that address both the capacity to engage in physical activity and self-management strategies to change and maintain exercise behaviours are needed to address this intractable issue. METHODS This will be an assessor-blinded, randomized controlled trial performed in Brisbane, Australia. Ninety-two people with mild-moderate PD will be randomly allocated to two groups: usual care, and a physiotherapy-led group exercise program combined with self-management strategies. In the intervention group, twelve, 80-min sessions will be conducted over 4 weeks in groups of up to 4 participants. The intervention will consist of circuit training including treadmill walking to target aerobic fitness, and activities targeting strength, balance, and gait performance. In addition, each session will also incorporate strategies focusing on self-management and behaviour change, augmented by the provision of a fitness activity tracker. Outcome measures will be collected at baseline (T1), immediately post intervention (T2) and at 6 months follow-up (T3). The primary outcome measure is free-living physical activity (average daily step count over 7 days) at pre (T1) and post (T2) intervention measured using an activPAL™ device. Secondary outcome measures captured at all time points include time spent walking, sedentary and in moderate intensity exercise over 7 days; spatiotemporal gait performance (step length, gait speed, endurance); health-related quality of life; and outcome expectations and self-efficacy for exercise. DISCUSSION Sustainability of gains in physical activity following exercise interventions is a challenge for most populations. Our incorporation of a chronic disease self-management approach into the exercise program including fitness tracking extends previous trials and has potential to significantly improve free-living physical activity in people with PD. TRIAL REGISTRATION This study has been prospectively registered in Australian and New Zealand Clinical Trial Registry (ACTRN12617001057370), registered on 19/07/2017. Available from www.anzctr.org.au/ACTRN12617001057370.aspx .
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Affiliation(s)
- Sandra G Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, Qld, St Lucia, Australia.
| | - Robyn M Lamont
- School of Health and Rehabilitation Sciences, The University of Queensland, Qld, St Lucia, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
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Clarkin CM, Ward-Ritacco CL, Mahler L. Exercise-Induced Functional Changes in People with Parkinson's Disease following External Cueing and Task-Based Intervention. Rehabil Res Pract 2024; 2024:6188546. [PMID: 38283384 PMCID: PMC10817815 DOI: 10.1155/2024/6188546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 08/09/2023] [Accepted: 12/23/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction The purpose of this study was to evaluate change in motor function, gait speed, dynamic balance, balance confidence, and quality of life (QoL) in nine participants with Parkinson's disease (PwPD) completing Lee Silverman Voice Treatment BIG (LSVT-BIG), an external cueing and task-based intervention. Although supported as an efficacious treatment in PwPD, there is limited research examining clinically meaningful change in outcome measures related to external cueing and task-based interventions. Materials and Methods This was a case series of nine PwPD (age range 64-76 years, 55% male) who completed the LSVT-BIG protocol. Disease duration ranged from 1 to 17 years and was classified as moderate in all participants (Hoehn and Yahr = 2 or 3). Outcome measures included motor function (MDS-UPDRS Part III Motor), gait speed, dynamic balance (MiniBEST), Activities-specific Balance Confidence (ABC), and Summary Index for PD Quality of Life 39 (PDQ-SI). Assessments were completed at baseline (BASE), end of treatment (EOT), and 4 weeks after EOT (EOT+4). Results Minimal detectable change (MDC) or minimal clinical important difference (MCID) was observed in one or more outcome measures in 8 of 9 participants at EOT and EOT+4 across domains of motor function (67%, 78%), gait speed (78%, 67%), balance confidence (44%, 33%), quality of life (44%, 78%), and dynamic balance (22%, 22%). Discussion. In this case series, 8 of 9 participants showed MDC or MCID changes across multiple functional domains. Improvements were observed immediately post (EOT) and 4-week post-treatment (EOT+4) suggesting a temporal component of the LSVT-BIG impact on functional change. Future research should include clinical trials to examine additional external cueing and task-based intervention efficacy with consideration of intensity, frequency, and mode of delivery across disease severity.
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Affiliation(s)
- Christine M. Clarkin
- Physical Therapy Department, University of Rhode Island, Kingston, Rhode Island, USA
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA
| | - Christie L. Ward-Ritacco
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Kinesiology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Leslie Mahler
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Communicative Disorders, University of Rhode Island, Kingston, Rhode Island, USA
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Salaorni F, Bonardi G, Schena F, Tinazzi M, Gandolfi M. Wearable devices for gait and posture monitoring via telemedicine in people with movement disorders and multiple sclerosis: a systematic review. Expert Rev Med Devices 2024; 21:121-140. [PMID: 38124300 DOI: 10.1080/17434440.2023.2298342] [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: 03/15/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Wearable devices and telemedicine are increasingly used to track health-related parameters across patient populations. Since gait and postural control deficits contribute to mobility deficits in persons with movement disorders and multiple sclerosis, we thought it interesting to evaluate devices in telemedicine for gait and posture monitoring in such patients. METHODS For this systematic review, we searched the electronic databases MEDLINE (PubMed), SCOPUS, Cochrane Library, and SPORTDiscus. Of the 452 records retrieved, 12 met the inclusion/exclusion criteria. Data about (1) study characteristics and clinical aspects, (2) technical, and (3) telemonitoring and teleconsulting were retrieved, The studies were quality assessed. RESULTS All studies involved patients with Parkinson's disease; most used triaxial accelerometers for general assessment (n = 4), assessment of motor fluctuation (n = 3), falls (n = 2), and turning (n = 3). Sensor placement and count varied widely across studies. Nine used lab-validated algorithms for data analysis. Only one discussed synchronous patient feedback and asynchronous teleconsultation. CONCLUSIONS Wearable devices enable real-world patient monitoring and suggest biomarkers for symptoms and behaviors related to underlying gait disorders. thus enriching clinical assessment and personalized treatment plans. As digital healthcare evolves, further research is needed to enhance device accuracy, assess user acceptability, and integrate these tools into telemedicine infrastructure. PROSPERO REGISTRATION CRD42022355460.
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Affiliation(s)
- Francesca Salaorni
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giulia Bonardi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Verona, Italy
- Neurorehabilitation Unit - Azienda Ospedaliera Universitaria Integrata, Verona
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Burtscher J, Moraud EM, Malatesta D, Millet GP, Bally JF, Patoz A. Exercise and gait/movement analyses in treatment and diagnosis of Parkinson's Disease. Ageing Res Rev 2024; 93:102147. [PMID: 38036102 DOI: 10.1016/j.arr.2023.102147] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
Cardinal motor symptoms in Parkinson's disease (PD) include bradykinesia, rest tremor and/or rigidity. This symptomatology can additionally encompass abnormal gait, balance and postural patterns at advanced stages of the disease. Besides pharmacological and surgical therapies, physical exercise represents an important strategy for the management of these advanced impairments. Traditionally, diagnosis and classification of such abnormalities have relied on partially subjective evaluations performed by neurologists during short and temporally scattered hospital appointments. Emerging sports medical methods, including wearable sensor-based movement assessment and computational-statistical analysis, are paving the way for more objective and systematic diagnoses in everyday life conditions. These approaches hold promise to facilitate customizing clinical trials to specific PD groups, as well as personalizing neuromodulation therapies and exercise prescriptions for each individual, remotely and regularly, according to disease progression or specific motor symptoms. We aim to summarize exercise benefits for PD with a specific emphasis on gait and balance deficits, and to provide an overview of recent advances in movement analysis approaches, notably from the sports science community, with value for diagnosis and prognosis. Although such techniques are becoming increasingly available, their standardization and optimization for clinical purposes is critically missing, especially in their translation to complex neurodegenerative disorders such as PD. We highlight the importance of integrating state-of-the-art gait and movement analysis approaches, in combination with other motor, electrophysiological or neural biomarkers, to improve the understanding of the diversity of PD phenotypes, their response to therapies and the dynamics of their disease progression.
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Affiliation(s)
- Johannes Burtscher
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.
| | - Eduardo Martin Moraud
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland; Defitech Centre for Interventional Neurotherapies (NeuroRestore), UNIL-CHUV and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Julien F Bally
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Aurélien Patoz
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland; Research and Development Department, Volodalen Swiss Sport Lab, Aigle, Switzerland
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Holleran CL, Bland MD, Lang CE. Comprehensive Assessment of the Activity Level of the ICF Using Both Capacity and Performance Measures: A Case Report. Arch Rehabil Res Clin Transl 2023; 5:100277. [PMID: 37744190 PMCID: PMC10517369 DOI: 10.1016/j.arrct.2023.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Individuals with neurologic conditions seek physical therapy services to improve mobility in their daily lives. While clinicians commonly track activity capacity, measurement of activity performance in daily life is an emerging yet unstandardized practice within routine clinical physical therapy. The purpose of this case report is to (1) provide an example of the structure, clinical reasoning, and implementation of both activity capacity and activity performance level assessments across an episode of outpatient physical therapy and (2) to describe how objective activity performance in daily life tracking supported the physical therapy intervention and education plan. A 42-year-old woman presented to outpatient neurologic physical therapy with a rare autoimmune-mediated disorder with primary goals of independently caring for her youngest child and grandchild, walking without limitations in the home and community, participating in exercise, and returning to work due to deconditioning and dizziness. The patient participated in 12 visits across a span of 4.5 months targeting performance in daily life (steps per day), aerobic conditioning, and vestibular habituation. Activity capacity measurement served as a standardized assessment of what the patient was able to do in the clinic, and activity performance in daily life tracking via a Samsung wrist worn consumer-grade device provided a quantitative assessment of real-world daily stepping activity. Tracking of activity performance in daily life was an essential component of physical therapy management that provided an objective quantification of daily stepping activity to identify barriers and facilitators to increasing daily performance in an individual with a medical diagnosis of Susac syndrome.
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Affiliation(s)
- Carey L. Holleran
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Marghuretta D. Bland
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Catherine E. Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
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Kowahl N, Shin S, Barman P, Rainaldi E, Popham S, Kapur R. Accuracy and Reliability of a Suite of Digital Measures of Walking Generated Using a Wrist-Worn Sensor in Healthy Individuals: Performance Characterization Study. JMIR Hum Factors 2023; 10:e48270. [PMID: 37535417 PMCID: PMC10436116 DOI: 10.2196/48270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/22/2023] [Accepted: 06/21/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Mobility is a meaningful aspect of an individual's health whose quantification can provide clinical insights. Wearable sensor technology can quantify walking behaviors (a key aspect of mobility) through continuous passive monitoring. OBJECTIVE Our objective was to characterize the analytical performance (accuracy and reliability) of a suite of digital measures of walking behaviors as critical aspects in the practical implementation of digital measures into clinical studies. METHODS We collected data from a wrist-worn device (the Verily Study Watch) worn for multiple days by a cohort of volunteer participants without a history of gait or walking impairment in a real-world setting. On the basis of step measurements computed in 10-second epochs from sensor data, we generated individual daily aggregates (participant-days) to derive a suite of measures of walking: step count, walking bout duration, number of total walking bouts, number of long walking bouts, number of short walking bouts, peak 30-minute walking cadence, and peak 30-minute walking pace. To characterize the accuracy of the measures, we examined agreement with truth labels generated by a concurrent, ankle-worn, reference device (Modus StepWatch 4) with known low error, calculating the following metrics: intraclass correlation coefficient (ICC), Pearson r coefficient, mean error, and mean absolute error. To characterize the reliability, we developed a novel approach to identify the time to reach a reliable readout (time to reliability) for each measure. This was accomplished by computing mean values over aggregation scopes ranging from 1 to 30 days and analyzing test-retest reliability based on ICCs between adjacent (nonoverlapping) time windows for each measure. RESULTS In the accuracy characterization, we collected data for a total of 162 participant-days from a testing cohort (n=35 participants; median observation time 5 days). Agreement with the reference device-based readouts in the testing subcohort (n=35) for the 8 measurements under evaluation, as reflected by ICCs, ranged between 0.7 and 0.9; Pearson r values were all greater than 0.75, and all reached statistical significance (P<.001). For the time-to-reliability characterization, we collected data for a total of 15,120 participant-days (overall cohort N=234; median observation time 119 days). All digital measures achieved an ICC between adjacent readouts of >0.75 by 16 days of wear time. CONCLUSIONS We characterized the accuracy and reliability of a suite of digital measures that provides comprehensive information about walking behaviors in real-world settings. These results, which report the level of agreement with high-accuracy reference labels and the time duration required to establish reliable measure readouts, can guide the practical implementation of these measures into clinical studies. Well-characterized tools to quantify walking behaviors in research contexts can provide valuable clinical information about general population cohorts and patients with specific conditions.
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Affiliation(s)
- Nathan Kowahl
- Verily Life Sciences, South San Francisco, CA, United States
| | - Sooyoon Shin
- Verily Life Sciences, South San Francisco, CA, United States
| | - Poulami Barman
- Verily Life Sciences, South San Francisco, CA, United States
| | - Erin Rainaldi
- Verily Life Sciences, South San Francisco, CA, United States
| | - Sara Popham
- Verily Life Sciences, South San Francisco, CA, United States
| | - Ritu Kapur
- Verily Life Sciences, South San Francisco, CA, United States
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Girnis JL, Cavanaugh JT, Baker TC, Duncan RP, Fulford D, LaValley MP, Lawrence M, Nordahl T, Porciuncula F, Rawson KS, Saint-Hilaire M, Thomas CA, Zajac JA, Earhart GM, Ellis TD. Natural Walking Intensity in Persons With Parkinson Disease. J Neurol Phys Ther 2023; 47:146-154. [PMID: 37016469 PMCID: PMC10330027 DOI: 10.1097/npt.0000000000000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND AND PURPOSE Few persons with Parkinson disease (PD) appear to engage in moderate-intensity walking associated with disease-modifying health benefits. How much time is spent walking at lower, yet still potentially beneficial, intensities is poorly understood. The purpose of this exploratory, observational study was to describe natural walking intensity in ambulatory persons with PD. METHODS Accelerometer-derived real-world walking data were collected for more than 7 days at baseline from 82 participants enrolled in a PD clinical trial. Walking intensity was defined according to the number of steps in each active minute (1-19, 20-39, 40-59, 60-79, 80-99, or ≥100 steps). Daily minutes of walking and duration of the longest sustained walking bout were calculated at each intensity. Number of sustained 10 to 19, 20 to 29, and 30-minute bouts and greater at any intensity also were calculated. Values were analyzed in the context of physical activity guidelines. RESULTS Most daily walking occurred at lower intensities (157.3 ± 58.1 min of 1-19 steps; 81.3 ± 32.6 min of 20-39 steps; 38.2 ± 21.3 min of 40-59 steps; 15.1 ± 11.5 min of 60-79 steps; 7.4 ± 7.0 min of 80-99 steps; 7.3 ± 9.6 min of ≥100 steps). The longest daily sustained walking bout occurred at the lowest intensity level (15.9 ± 5.2 min of 1-19 steps). Few bouts lasting 20 minutes and greater occurred at any intensity. DISCUSSION AND CONCLUSIONS Despite relatively high daily step counts, participants tended to walk at remarkably low intensity, in bouts of generally short duration, with relatively few instances of sustained walking. The findings reinforced the need for health promotion interventions designed specifically to increase walking intensity.Video Abstract available for more insight from authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A426 ).
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Affiliation(s)
- Jaimie L. Girnis
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | - James T. Cavanaugh
- Department of Physical Therapy, University of New England, Portland, Maine
| | - Teresa C. Baker
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | - Ryan P. Duncan
- Program in Physical Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Daniel Fulford
- Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | | | - Michael Lawrence
- Department of Physical Therapy, University of New England, Portland, Maine
| | - Timothy Nordahl
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | - Franchino Porciuncula
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | - Kerri S. Rawson
- Program in Physical Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Marie Saint-Hilaire
- Department of Neurology, Parkinson’s Disease and Movement Disorders Center, Boston University, Boston Massachusetts
| | - Cathi A. Thomas
- Department of Neurology, Parkinson’s Disease and Movement Disorders Center, Boston University, Boston Massachusetts
| | - Jenna A. Zajac
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | - Gammon M. Earhart
- Program in Physical Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Neuroscience, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Terry D. Ellis
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
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10
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Zajac JA, Porciuncula F, Cavanaugh JT, McGregor C, Harris BA, Smayda KE, Awad LN, Pantelyat A, Ellis TD. Feasibility and Proof-of-Concept of Delivering an Autonomous Music-Based Digital Walking Intervention to Persons with Parkinson's Disease in a Naturalistic Setting. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1253-1265. [PMID: 37840504 PMCID: PMC10657706 DOI: 10.3233/jpd-230169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Reduced motor automaticity in Parkinson's disease (PD) negatively impacts the quality, intensity, and amount of daily walking. Rhythmic auditory stimulation (RAS), a clinical intervention shown to improve walking outcomes, has been limited by barriers associated with the need for ongoing clinician input. OBJECTIVE To assess the feasibility, proof-of-concept, and preliminary clinical outcomes associated with delivering an autonomous music-based digital walking intervention based on RAS principles to persons with PD in a naturalistic setting. METHODS Twenty-three persons with PD used the digital intervention independently for four weeks to complete five weekly 30-minute sessions of unsupervised, overground walking with music-based cues. The intervention progressed autonomously according to real-time gait sensing. Feasibility of independent use was assessed by examining participant adherence, safety, and experience. Intervention proof-of-concept was assessed by examining spatiotemporal metrics of gait quality, daily minutes of moderate intensity walking, and daily steps. Preliminary clinical outcomes were assessed following intervention completion. RESULTS Participants completed 86.4% of sessions and 131.1% of the prescribed session duration. No adverse events were reported. Gait speed, stride length, and cadence increased within sessions, and gait variability decreased (p < 0.05). Compared to baseline, increased daily moderate intensity walking (mean Δ= +21.44 minutes) and steps (mean Δ= +3,484 steps) occurred on designated intervention days (p < 0.05). Quality of life, disease severity, walking endurance, and functional mobility were improved after four weeks (p < 0.05). CONCLUSIONS Study findings supported the feasibility and potential clinical utility of delivering an autonomous digital walking intervention to persons with PD in a naturalistic setting.
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Affiliation(s)
- Jenna A. Zajac
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Franchino Porciuncula
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - James T. Cavanaugh
- Department of Physical Therapy, University of New England, Portland, ME, USA
| | - Colin McGregor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Louis N. Awad
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Alexander Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Terry D. Ellis
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
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Lang CE, Holleran CL, Strube MJ, Ellis TD, Newman CA, Fahey M, DeAngelis TR, Nordahl TJ, Reisman DS, Earhart GM, Lohse KR, Bland MD. Improvement in the Capacity for Activity Versus Improvement in Performance of Activity in Daily Life During Outpatient Rehabilitation. J Neurol Phys Ther 2023; 47:16-25. [PMID: 35930404 PMCID: PMC9750113 DOI: 10.1097/npt.0000000000000413] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We addressed questions about the potential discrepancy between improvements in activity capacity and improvements in activity performance in daily life. We asked whether this discrepancy is: Common in routine, outpatient care, or an artifact of intervention studies? Unique to upper limb (UL) rehabilitation, or is it seen in walking rehabilitation too? Only seen in persons with stroke, or a broader neurorehabilitation problem?
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Affiliation(s)
- Catherine E. Lang
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Carey L. Holleran
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Michael J Strube
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Terry D. Ellis
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Caitlin A. Newman
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Meghan Fahey
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Tamara R. DeAngelis
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Timothy J. Nordahl
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Darcy S. Reisman
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Gammon M. Earhart
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Keith R. Lohse
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Marghuretta D. Bland
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
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Bianchini E, Caliò B, Alborghetti M, Rinaldi D, Hansen C, Vuillerme N, Maetzler W, Pontieri FE. Step-Counting Accuracy of a Commercial Smartwatch in Mild-to-Moderate PD Patients and Effect of Spatiotemporal Gait Parameters, Laterality of Symptoms, Pharmacological State, and Clinical Variables. SENSORS (BASEL, SWITZERLAND) 2022; 23:214. [PMID: 36616812 PMCID: PMC9823757 DOI: 10.3390/s23010214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Commercial smartwatches could be useful for step counting and monitoring ambulatory activity. However, in Parkinson's disease (PD) patients, an altered gait, pharmacological condition, and symptoms lateralization may affect their accuracy and potential usefulness in research and clinical routine. Steps were counted during a 6 min walk in 47 patients with PD and 47 healthy subjects (HS) wearing a Garmin Vivosmart 4 (GV4) on each wrist. Manual step counting was used as a reference. An inertial sensor (BTS G-Walk), placed on the lower back, was used to compute spatial-temporal gait parameters. Intraclass correlation coefficient (ICC) and mean absolute percentage error (MAPE) were used for accuracy evaluation and the Spearman test was used to assess the correlations between variables. The GV4 overestimated steps in PD patients with only a poor-to-moderate agreement. The OFF pharmacological state and wearing the device on the most-affected body side led to an unacceptable accuracy. The GV4 showed an excellent agreement and MAPE in HS at a self-selected speed, but an unacceptable performance at a slow speed. In PD patients, MAPE was not associated with gait parameters and clinical variables. The accuracy of commercial smartwatches for monitoring step counting might be reduced in PD patients and further influenced by the pharmacological condition and placement of the device.
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Affiliation(s)
- Edoardo Bianchini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
| | - Bianca Caliò
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
| | - Marika Alborghetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
| | - Domiziana Rinaldi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Santa Lucia Foundation, IRCCS, 00179 Rome, Italy
| | - Clint Hansen
- Department of Neurology, Kiel University, 24105 Kiel, Germany
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Institut Universitaire de France, 75005 Paris, France
| | - Walter Maetzler
- Department of Neurology, Kiel University, 24105 Kiel, Germany
| | - Francesco E. Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Santa Lucia Foundation, IRCCS, 00179 Rome, Italy
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Zajac JA, Cavanaugh JT, Baker T, Duncan RP, Fulford D, Girnis J, LaValley M, Nordahl T, Porciuncula F, Rawson KS, Saint-Hilaire M, Thomas CA, Earhart GM, Ellis TD. Does clinically measured walking capacity contribute to real-world walking performance in Parkinson's disease? Parkinsonism Relat Disord 2022; 105:123-127. [PMID: 36423521 PMCID: PMC9722599 DOI: 10.1016/j.parkreldis.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/05/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The study examined how clinically measured walking capacity contributes to real-world walking performance in persons with Parkinson's disease (PD). METHODS Cross-sectional baseline data (n = 82) from a PD clinical trial were analyzed. The 6-Minute Walk Test (6MWT) and 10-Meter Walk Test (10MWT) were used to generate capacity metrics of walking endurance and fast gait speed, respectively. An activity monitor worn for seven days was used to generate performance metrics of mean daily steps and weekly moderate intensity walking minutes. Univariate linear regression analyses were used to examine associations between each capacity and performance measure in the full sample and less and more active subgroups. RESULTS Walking capacity significantly contributed to daily steps in the full sample (endurance: R2=.13, p < .001; fast gait speed: R2=.07, p = .017) and in the less active subgroup (endurance: R2 =.09, p = .045). Similarly, walking capacity significantly contributed to weekly moderate intensity minutes in the full sample (endurance: R2=.13, p < .001; fast gait speed: R2=.09, p = .007) and less active subgroup (endurance: R2 = .25, p < .001; fast gait speed: R2 =.21, p = .007). Walking capacity did not significantly contribute to daily steps or moderate intensity minutes in the more active subgroup. CONCLUSIONS Walking capacity contributed to, but explained a relatively small portion of the variance in, real-world walking performance. The contribution was somewhat greater in less active individuals. The study adds support to the idea that clinically measured walking capacity may have limited benefit for understanding real-world walking performance in PD. Factors beyond walking capacity may better account for actual walking behavior.
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Affiliation(s)
- Jenna A Zajac
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA.
| | - James T Cavanaugh
- Department of Physical Therapy, University of New England, Portland, ME, USA
| | - Teresa Baker
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Ryan P Duncan
- Program in Physical Therapy, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Neurology, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Daniel Fulford
- Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Jaimie Girnis
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | | | - Timothy Nordahl
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Franchino Porciuncula
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Kerri S Rawson
- Program in Physical Therapy, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Marie Saint-Hilaire
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University, Boston, MA, USA
| | - Cathi A Thomas
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University, Boston, MA, USA
| | - Gammon M Earhart
- Program in Physical Therapy, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Neurology, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Neuroscience, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Terry D Ellis
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
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Harro CC, Shoemaker MJ, Coatney CM, Lentine VE, Lieffers LR, Quigley JJ, Rollins SG, Stewart JD, Hall J, Khoo SK. Effects of nordic walking exercise on gait, motor/non-motor symptoms, and serum brain-derived neurotrophic factor in individuals with Parkinson's disease. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1010097. [PMID: 36311206 PMCID: PMC9614339 DOI: 10.3389/fresc.2022.1010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
Objective The primary purpose of this study was to investigate the immediate and long-term effects of Nordic Walking (NW) exercise on walking function, motor/non-motor Parkinson's Disease (PD) symptoms, and serum brain-derived neurotrophic factor (BDNF) in persons with idiopathic PD. Methods Twelve community-dwelling participants with mild to moderate idiopathic PD and varied degrees of gait dysfunction were recruited for this prospective, repeated measures design that examined clinical measures and BDNF levels at baseline (T0), post-intervention (T1) and 3-month follow-up (T2). Participants engaged in 6 weeks of supervised NW exercise training with individualized instruction, followed by 14 weeks of independent NW exercise with remote coaching. Outcome measurements included daily step counts, 6-Minute Walk Test (6-MinWT), 10-Meter Walk Test (10MWT), spatiotemporalparameters, Timed Up and Go Test (TUG), dual-task TUG, Revised-Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Revised-Freezing of Gait Questionnaire, MDS-Nonmotor Symptom scale (NMS), Parkinson's Fatigue Scale, and serum BDNF levels. The Friedman test with post hoc Wilcoxon sign-ranked pairwise comparisons were used to compare baseline to T1, baseline to T2, and T1 to T2 timepoints with a Benjamini-Hockberg correction applied. Results Statistically significant improvements found post-training and retained at 3-month follow-up included 6-MinWT, daily step count, 10mWT, MDS-UPDRS, and TUG with effect sizes of 0.57 to 1.03. Serum BDNF at T2 was significantly greater than T0 and T1. Although no statistically significant improvements were observed in the MDS-NMS, 9 of 12 participants had improved non-motor symptoms. There was good adherence, sustained independent exercise engagement, and no adverse events over the 5-month study duration. Conclusions This study demonstrated that NW exercise was a safe, feasible, and sustainable mode of aerobic exercise for this sample of participants with varied Parkinson's disease duration and severity. Following an individualized and progressive NW training intervention, significant improvements in walking function, daily activity level, and motor function were observed. Following the supervised NW training phase, independent three-month engagement in NW exercise was sustained with long-term retention of these clinical improvements and an increase in serum BDNF levels over this five-month NW exercise trial. Impact Nordic walking exercise may be a safe, feasible and sustainable mode of independent exercise for improving daily ambulatory activity, gait and motor function, and serum BDNF in individuals with mild to moderate PD with varied gait abilities. Clinical Trials Registry ID 20-101-H.
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Affiliation(s)
- Cathy C. Harro
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States,Correspondence: Cathy Harro
| | - Michael J Shoemaker
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Cassandra M. Coatney
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Valerie E. Lentine
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Lillian R. Lieffers
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Jessica J. Quigley
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Shannon G. Rollins
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Jonathan D. Stewart
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Julie Hall
- Department of Medical Laboratory Science, Grand Valley State University, Grand Rapids, MI, United States
| | - Sok Kean Khoo
- Department of Cell and Molecular Biology, Grand Valley State University, Grand Rapids, MI, United States
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Translation, Cross-Cultural Adaptation, and Validation of the Physical Activity Scale for Individuals With Physical Disabilities for Brazilian Individuals With Parkinson's Disease. J Aging Phys Act 2022; 31:223-229. [PMID: 36084930 DOI: 10.1123/japa.2021-0261] [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: 07/07/2021] [Revised: 05/30/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) is not available to Portuguese-Brazil. This study translates, cross-culturally adapts, and validates the PASIPD for Brazilian individuals with Parkinson's disease. The translation process followed guidelines: initial translation, synthesis, back translation, expert committee, and pretest. The validation and reliability processes were conducted with 40 individuals (15 men and 25 women) with Parkinson's disease. Concurrent validity was evaluated between PASIPD to Brazilian Portuguese, International Physical Activity Questionnaire, and Human Activity Profile. PASIPD to Brazilian Portuguese was found to be moderately correlated with International Physical Activity Questionnaire (r = .474, p < .05); however, there was no correlation with Human Activity Profile (r = .271, p < .05). We used the intrarater reliability with intraclass correlation coefficient and test-retest. Intrarater reliability was high (intraclass correlation coefficient = .80). Internal consistency was considered adequate by Cronbach's alpha (α = .70). PASIPD to Brazilian Portuguese is a valid and reliable instrument for evaluating physical activity levels in Brazilian individuals with Parkinson's disease.
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Correno MB, Hansen C, Carlin T, Vuillerme N. Objective Measurement of Walking Activity Using Wearable Technologies in People with Parkinson Disease: A Systematic Review. SENSORS 2022; 22:s22124551. [PMID: 35746329 PMCID: PMC9229799 DOI: 10.3390/s22124551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 12/10/2022]
Abstract
Parkinson’s disease (PD) is a complex neurodegenerative disease with a multitude of disease variations including motor and non-motor symptoms. Quality of life and symptom management may be improved with physical activity. Due to technological advancement, development of small new wearable devices recently emerged and allowed objective measurement of walking activity in daily life. This review was specifically designed to synthesize literature on objective walking activity measurements using wearable devices of patients with PD. Inclusion criteria included patients with a diagnosis of PD and exclusion criteria included studies using animal models or mixed syndromes. Participants were not required to undergo any type of intervention and the studies must have reported at least one output that quantifies daily walking activity. Three databases were systematically searched with no limitation on publication date. Twenty-six studies were eligible and included in the systematic review. The most frequently used device was the ActiGraph GT3X which was used in 10 studies. Duration of monitoring presented a range from 8 h to one year. Nevertheless, 11 studies measured walking activity during a 7-day period. On-body sensor wearing location differed throughout the included studies showing eight positions, with the waist, ankle, and wrist being the most frequently used locations. The main procedures consisted of measurement of walking hours during a 2-day period or more, equipped with a triaxial accelerometer at the dominant hip or ankle. It is also important for further research to take care of different factors such as the population, their pathology, the period, and the environment.
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Affiliation(s)
- Mathias Baptiste Correno
- Laboratory AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (M.B.C.); (T.C.); (N.V.)
- LabCom Telecom4Health, Orange Labs, Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, 24105 Kiel, Germany
| | - Clint Hansen
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, 24105 Kiel, Germany
- Correspondence:
| | - Thomas Carlin
- Laboratory AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (M.B.C.); (T.C.); (N.V.)
- LabCom Telecom4Health, Orange Labs, Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
| | - Nicolas Vuillerme
- Laboratory AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (M.B.C.); (T.C.); (N.V.)
- LabCom Telecom4Health, Orange Labs, Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Institut Universitaire de France, 75231 Paris, France
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Karni L, Jusufi I, Nyholm D, Klein GO, Memedi M. Toward Improved Treatment and Empowerment of Individuals With Parkinson Disease: Design and Evaluation of an Internet of Things System. JMIR Form Res 2022; 6:e31485. [PMID: 35679097 PMCID: PMC9227793 DOI: 10.2196/31485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Parkinson disease (PD) is a chronic degenerative disorder that causes progressive neurological deterioration with profound effects on the affected individual’s quality of life. Therefore, there is an urgent need to improve patient empowerment and clinical decision support in PD care. Home-based disease monitoring is an emerging information technology with the potential to transform the care of patients with chronic illnesses. Its acceptance and role in PD care need to be elucidated both among patients and caregivers.
Objective
Our main objective was to develop a novel home-based monitoring system (named EMPARK) with patient and clinician interface to improve patient empowerment and clinical care in PD.
Methods
We used elements of design science research and user-centered design for requirement elicitation and subsequent information and communications technology (ICT) development. Functionalities of the interfaces were the subject of user-centric multistep evaluation complemented by semantic analysis of the recorded end-user reactions. The ICT structure of EMPARK was evaluated using the ICT for patient empowerment model.
Results
Software and hardware system architecture for the collection and calculation of relevant parameters of disease management via home monitoring were established. Here, we describe the patient interface and the functional characteristics and evaluation of a novel clinician interface. In accordance with our previous findings with regard to the patient interface, our current results indicate an overall high utility and user acceptance of the clinician interface. Special characteristics of EMPARK in key areas of interest emerged from end-user evaluations, with clear potential for future system development and deployment in daily clinical practice. Evaluation through the principles of ICT for patient empowerment model, along with prior findings from patient interface evaluation, suggests that EMPARK has the potential to empower patients with PD.
Conclusions
The EMPARK system is a novel home monitoring system for providing patients with PD and the care team with feedback on longitudinal disease activities. User-centric development and evaluation of the system indicated high user acceptance and usability. The EMPARK infrastructure would empower patients and could be used for future applications in daily care and research.
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Affiliation(s)
- Liran Karni
- Centre for Empirical Research on Information Systems, Örebro University School of Business, Örebro, Sweden
| | - Ilir Jusufi
- Department of Computer Science and Media Technology, Linnaeus University, Växjö, Sweden
| | - Dag Nyholm
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Gunnar Oskar Klein
- Centre for Empirical Research on Information Systems, Örebro University School of Business, Örebro, Sweden
| | - Mevludin Memedi
- Centre for Empirical Research on Information Systems, Örebro University School of Business, Örebro, Sweden
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18
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Nagaki K, Fujioka S, Sasai H, Yamaguchi Y, Tsuboi Y. Physical Activity and Its Diurnal Fluctuations Vary by Non-Motor Symptoms in Patients with Parkinson's Disease: An Exploratory Study. Healthcare (Basel) 2022; 10:healthcare10040749. [PMID: 35455926 PMCID: PMC9029803 DOI: 10.3390/healthcare10040749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background: This exploratory study investigated the association between non-motor symptoms (NMS) and both physical activity and diurnal activity patterns in patients with Parkinson’s disease (PwPD). Methods: Participants included PwPD with modified Hoehn and Yahr stages 1−3. The presence of NMS was assessed with Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part I. Physical activity was measured using a waist-mounted triaxial accelerometer. Logistic regression analyses evaluated associations between NMS and physical activity; furthermore, diurnal fluctuation in physical activity due to NMS was examined by ANCOVA. Results: Forty-five PwPD were included in the study. Among the domains of NMS, pain and other sensations (OR, 8.36; 95% CI, 1.59−43.94) and fatigue (OR, 14.26; 95% CI, 1.85−109.90) were associated with low daily step count (<4200 steps/day). Analysis by time of day showed no characteristic variability in physical activity but had constant effect sizes for pain and other sensations (p = 0.20, ES = 0.36) and fatigue (p = 0.08, ES = 0.38). Conclusion: Our exploratory study suggested that PwPD with pain and other sensations and fatigue recorded lower step counts than their asymptomatic counterparts. Therefore, PwPD with pain and fatigue may need more support in promoting physical activity.
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Affiliation(s)
- Koichi Nagaki
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (K.N.); (S.F.); (Y.Y.)
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (K.N.); (S.F.); (Y.Y.)
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan;
| | - Yumiko Yamaguchi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (K.N.); (S.F.); (Y.Y.)
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (K.N.); (S.F.); (Y.Y.)
- Correspondence: ; Tel.: +81-92-801-1011
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Chandrabhatla AS, Pomeraniec IJ, Ksendzovsky A. Co-evolution of machine learning and digital technologies to improve monitoring of Parkinson's disease motor symptoms. NPJ Digit Med 2022; 5:32. [PMID: 35304579 PMCID: PMC8933519 DOI: 10.1038/s41746-022-00568-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/21/2022] [Indexed: 11/09/2022] Open
Abstract
Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor impairments such as tremor, bradykinesia, dyskinesia, and gait abnormalities. Current protocols assess PD symptoms during clinic visits and can be subjective. Patient diaries can help clinicians evaluate at-home symptoms, but can be incomplete or inaccurate. Therefore, researchers have developed in-home automated methods to monitor PD symptoms to enable data-driven PD diagnosis and management. We queried the US National Library of Medicine PubMed database to analyze the progression of the technologies and computational/machine learning methods used to monitor common motor PD symptoms. A sub-set of roughly 12,000 papers was reviewed that best characterized the machine learning and technology timelines that manifested from reviewing the literature. The technology used to monitor PD motor symptoms has advanced significantly in the past five decades. Early monitoring began with in-lab devices such as needle-based EMG, transitioned to in-lab accelerometers/gyroscopes, then to wearable accelerometers/gyroscopes, and finally to phone and mobile & web application-based in-home monitoring. Significant progress has also been made with respect to the use of machine learning algorithms to classify PD patients. Using data from different devices (e.g., video cameras, phone-based accelerometers), researchers have designed neural network and non-neural network-based machine learning algorithms to categorize PD patients across tremor, gait, bradykinesia, and dyskinesia. The five-decade co-evolution of technology and computational techniques used to monitor PD motor symptoms has driven significant progress that is enabling the shift from in-lab/clinic to in-home monitoring of PD symptoms.
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Affiliation(s)
- Anirudha S Chandrabhatla
- School of Medicine, University of Virginia Health Sciences Center, Charlottesville, VA, 22903, USA
| | - I Jonathan Pomeraniec
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA. .,Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville, VA, 22903, USA.
| | - Alexander Ksendzovsky
- Department of Neurosurgery, University of Maryland Medical System, Baltimore, MD, 21201, USA
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Page A, Yung N, Auinger P, Venuto C, Glidden A, Macklin E, Omberg L, Schwarzschild MA, Dorsey ER. A Smartphone Application as an Exploratory Endpoint in a Phase 3 Parkinson's Disease Clinical Trial: A Pilot Study. Digit Biomark 2022; 6:1-8. [PMID: 35224425 PMCID: PMC8832247 DOI: 10.1159/000521232] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Smartphones can generate objective measures of Parkinson's disease (PD) and supplement traditional in-person rating scales. However, smartphone use in clinical trials has been limited. OBJECTIVE This study aimed to determine the feasibility of introducing a smartphone research application into a PD clinical trial and to evaluate the resulting measures. METHODS A smartphone application was introduced part-way into a phase 3 randomized clinical trial of inosine. The application included finger tapping, gait, and cognition tests, and participants were asked to complete an assessment battery at home and in clinic alongside the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS Of 236 eligible participants in the parent study, 88 (37%) consented to participate, and 59 (27 randomized to inosine and 32 to placebo) completed a baseline smartphone assessment. These 59 participants collectively completed 1,292 batteries of assessments. The proportion of participants who completed at least one smartphone assessment was 61% at 3, 54% at 6, and 35% at 12 months. Finger tapping speed correlated weakly with the part III motor portion (r = -0.16, left hand; r = -0.04, right hand) and total (r = -0.14) MDS-UPDRS. Gait speed correlated better with the same measures (r = -0.25, part III motor; r = -0.34, total). Over 6 months, finger tapping speed, gait speed, and memory scores did not differ between those randomized to active drug or placebo. CONCLUSIONS Introducing a smartphone application midway into a phase 3 clinical trial was challenging. Measures of bradykinesia and gait speed correlated modestly with traditional outcomes and were consistent with the study's overall findings, which found no benefit of the active drug.
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Affiliation(s)
- Alex Page
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Norman Yung
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Peggy Auinger
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Charles Venuto
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Alistair Glidden
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric Macklin
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - E. Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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21
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Adams JL, Dinesh K, Snyder CW, Xiong M, Tarolli CG, Sharma S, Dorsey ER, Sharma G. A real-world study of wearable sensors in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:106. [PMID: 34845224 PMCID: PMC8629990 DOI: 10.1038/s41531-021-00248-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 10/27/2021] [Indexed: 12/17/2022] Open
Abstract
Most wearable sensor studies in Parkinson's disease have been conducted in the clinic and thus may not be a true representation of everyday symptoms and symptom variation. Our goal was to measure activity, gait, and tremor using wearable sensors inside and outside the clinic. In this observational study, we assessed motor features using wearable sensors developed by MC10, Inc. Participants wore five sensors, one on each limb and on the trunk, during an in-person clinic visit and for two days thereafter. Using the accelerometer data from the sensors, activity states (lying, sitting, standing, walking) were determined and steps per day were also computed by aggregating over 2 s walking intervals. For non-walking periods, tremor durations were identified that had a characteristic frequency between 3 and 10 Hz. We analyzed data from 17 individuals with Parkinson's disease and 17 age-matched controls over an average 45.4 h of sensor wear. Individuals with Parkinson's walked significantly less (median [inter-quartile range]: 4980 [2835-7163] steps/day) than controls (7367 [5106-8928] steps/day; P = 0.04). Tremor was present for 1.6 [0.4-5.9] hours (median [range]) per day in most-affected hands (MDS-UPDRS 3.17a or 3.17b = 1-4) of individuals with Parkinson's, which was significantly higher than the 0.5 [0.3-2.3] hours per day in less-affected hands (MDS-UPDRS 3.17a or 3.17b = 0). These results, which require replication in larger cohorts, advance our understanding of the manifestations of Parkinson's in real-world settings.
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Affiliation(s)
- Jamie L Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA.
| | - Karthik Dinesh
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | | | - Mulin Xiong
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Saloni Sharma
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Gaurav Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
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22
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Godi M, Arcolin I, Giardini M, Corna S, Schieppati M. A pathophysiological model of gait captures the details of the impairment of pace/rhythm, variability and asymmetry in Parkinsonian patients at distinct stages of the disease. Sci Rep 2021; 11:21143. [PMID: 34707168 PMCID: PMC8551236 DOI: 10.1038/s41598-021-00543-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/05/2021] [Indexed: 01/15/2023] Open
Abstract
Locomotion in people with Parkinson' disease (pwPD) worsens with the progression of disease, affecting independence and quality of life. At present, clinical practice guidelines recommend a basic evaluation of gait, even though the variables (gait speed, cadence, step length) may not be satisfactory for assessing the evolution of locomotion over the course of the disease. Collecting variables into factors of a conceptual model enhances the clinical assessment of disease severity. Our aim is to evaluate if factors highlight gait differences between pwPD and healthy subjects (HS) and do it at earlier stages of disease compared to single variables. Gait characteristics of 298 pwPD and 84 HS able to walk without assistance were assessed using a baropodometric walkway (GAITRite®). According to the structure of a model previously validated in pwPD, eight spatiotemporal variables were grouped in three factors: pace/rhythm, variability and asymmetry. The model, created from the combination of three factor scores, proved to outperform the single variables or the factors in discriminating pwPD from HS. When considering the pwPD split into the different Hoehn and Yahr (H&Y) stages, the spatiotemporal variables, factor scores and the model showed that multiple impairments of gait appear at H&Y stage 2.5, with the greatest difference from HS at stage 4. A contrasting behavior was found for the asymmetry variables and factor, which showed differences from the HS already in the early stages of PD. Our findings support the use of factor scores and of the model with respect to the single variables in gait staging in PD.
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Affiliation(s)
- Marco Godi
- Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, 28010, Gattico-Veruno, NO, Italy
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, 28010, Gattico-Veruno, NO, Italy.
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, 28010, Gattico-Veruno, NO, Italy
| | - Stefano Corna
- Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, 28010, Gattico-Veruno, NO, Italy
| | - Marco Schieppati
- Scientific Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
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Zajac JA, Cavanaugh JT, Baker T, Colón-Semenza C, DeAngelis TR, Duncan RP, Fulford D, LaValley M, Nordahl T, Rawson KS, Saint-Hilaire M, Thomas CA, Earhart GM, Ellis TD. Are Mobile Persons With Parkinson Disease Necessarily More Active? J Neurol Phys Ther 2021; 45:259-265. [PMID: 34091569 PMCID: PMC8460597 DOI: 10.1097/npt.0000000000000362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Walking activity in persons with Parkinson disease (PD) is important for preventing functional decline. The contribution of walking activity to home and community mobility in PD is poorly understood. METHODS Cross-sectional baseline data (N = 69) were analyzed from a randomized controlled PD trial. The Life-Space Assessment (LSA) quantified the extent, frequency, and independence across 5 expanding levels of home and community mobility, producing individual subscores and a total score. Two additional summed scores were used to represent mobility within (Levels 1-3) and beyond (Levels 4-5) neighborhood limits. An accelerometer measured walking activity for 7 days. Regression and correlation analyses evaluated relationships between daily steps and mobility scores. Mann-Whitney U tests secondarily compared differences in mobility scores between the active and sedentary groups. RESULTS Walking activity contributed significantly to the summed Level 1-3 score (β = 0.001, P = 0.004) but not to the summed Level 4-5 (β = 0.001, P = 0.33) or total (β = 0.002, P = 0.07) scores. Walking activity was significantly related to Level 1 (ρ = 0.336, P = 0.005), Level 2 (ρ = 0.307, P = 0.010), and Level 3 (ρ = 0.314, P = 0.009) subscores. Only the summed Level 1-3 score (P = 0.030) was significantly different between the active and sedentary groups. DISCUSSION AND CONCLUSIONS Persons with PD who demonstrated greater mobility beyond the neighborhood were not necessarily more active; walking activity contributed more so to home and neighborhood mobility. Compared with LSA total score, the Level 1-3 summed score may be a more useful participation-level measure for assessing the impact of changes in walking activity.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A349).
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Affiliation(s)
- Jenna A Zajac
- Departments of Physical Therapy and Athletic Training (J.A.Z., T.B., T.R.D., T.N., T.D.E) and Occupational Therapy (D.F.), Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts; Department of Physical Therapy (J.T.C.), University of New England, Portland, Maine; Department of Kinesiology (C.C.-S.), College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, Connecticut; Program in Physical Therapy (R.P.D., K.S.R., G.M.E), Department of Neuroscience (G.M.E), and Department of Neurology (R.P.D., G.M.E), Washington University in St Louis School of Medicine, St Louis, Missouri; School of Public Health (M.L.), Boston University, Boston, Massachusetts; and Department of Neurology (M.S.-H., C.A.T.), Parkinson's Disease and Movement Disorders Center, Boston University, Boston, Massachusetts
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Carlin T, Hansen C, Vuillerme N. Objective Measurement of Walking Activity Using Wearable Technologies in People with Parkinson Disease: A Systematic Review Protocol. Biomed Hub 2021; 6:64-68. [PMID: 34616747 PMCID: PMC8460917 DOI: 10.1159/000516819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/23/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Parkinson's disease (PD) is a complex neurodegenerative disease with motor and nonmotor symptoms with a multitude of disease variations and severity. Physical activity can improve the management of disease symptoms and increase patients' quality of life. Technological development of small wearable devices allows objective activity measurement such as daily step count. OBJECTIVE To synthesize ongoing and past research on objective walking activity measurements using wearable devices in patients with PD. METHODS PubMed, Cochrane, Web of Science, and PEDro database are systematically searched with no limitation on publication date. Keywords are relative to (1) the population, (2) the measurement tool, and (3) the measured outcomes. Only full-text English articles published in a peer-reviewed journal will be included. Participants do not have to undergo any type of intervention. Included studies must report an objective measurement of walking activity using wearable devices in PD patients. After an independent screening process done by 2 reviewers, data will be extracted from the articles according to the following 5 set of data: (1) the study metrics, (2) the population characteristics, (3) the measurement tools, (4) the experimental procedure, and (5) the reported outcomes. RESULTS The results will contain inter alia summaries of the wearables' specifications, wearing location, and recommendations for feasible methodologies to capture daily walking activity. DISCUSSION This review aims to synthesize the evidence of objective walking activity assessment with wearable devices in patients with PD. It will also provide recommendations with regard to device selection and suggest key points when monitoring walking activity in this specific population.
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Affiliation(s)
- Thomas Carlin
- Laboratory AGEIS, Universitaire Grenoble Alpes, Grenoble, France
- LabCom Telecom4Health, Universitaire Grenoble Alpes, Grenoble, France
| | - Clint Hansen
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Nicolas Vuillerme
- Laboratory AGEIS, Universitaire Grenoble Alpes, Grenoble, France
- LabCom Telecom4Health, Universitaire Grenoble Alpes, Grenoble, France
- Institut Universitaire de France, Paris, France
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25
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Day-to-Day Variability of Walking Performance Measures in Individuals Poststroke and Individuals With Parkinson Disease. J Neurol Phys Ther 2021; 44:241-247. [PMID: 32769671 DOI: 10.1097/npt.0000000000000327] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Improvement of walking performance is a primary goal for individuals poststroke or with Parkinson disease (PD) who receive physical therapy. More data about day-to-day variability of walking performance are critical for determining if changes in performance have occurred. METHODS Baseline assessments were utilized from an ongoing, observational, prospective cohort study including 84 individuals poststroke (n = 37) or with PD (n = 47) receiving outpatient physical therapy services to improve mobility. Participants wore step activity monitors for up to 7 days to measure walking performance (steps per day, walking duration, maximum 30-minute output, and peak activity index) in daily life. Correlation analyses evaluated relationships between both capacity and performance measures as well as the relationships between mean performance variables and day-to-day variability. Regression analyses explored factors that contribute to variability in day-to-day performance variables. RESULTS Mean steps per day for participants poststroke (5376 ± 2804) and with PD (8149 ± 4490) were consistent with previously reported cohorts. Greater amounts of walking were related to more day-to-day variability, with moderate correlations found between the mean and day-to-day variability of each performance measure, regardless of medical diagnosis or walking speed. Day-to-day variability is large (upwards of 50% of the mean), with the amount of walking performance serving as the primary predictor of day-to-day variability in walking performance. DISCUSSION AND CONCLUSIONS The results of this study elucidate the factors that are related to and predict day-to-day variability of performance. Walking performance metrics should be evaluated over multiple days and greater variability should be anticipated with greater amounts of performance.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A319).
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Ellis TD, Colón-Semenza C, DeAngelis TR, Thomas CA, Hilaire MHS, Earhart GM, Dibble LE. Evidence for Early and Regular Physical Therapy and Exercise in Parkinson's Disease. Semin Neurol 2021; 41:189-205. [PMID: 33742432 DOI: 10.1055/s-0041-1725133] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Advances in medical management of Parkinson's disease (PD) have resulted in living longer with disability. Although disability worsens over the course of the disease, there are signs of disability even in the early stages. Several studies reveal an early decline in gait and balance and a high prevalence of nonmotor signs in the prodromal period that contribute to early disability. There is a growing body of evidence revealing the benefits of physical therapy and exercise to mitigate motor and nonmotor signs while improving physical function and reducing disability. The presence of early disability coupled with the benefits of exercise suggests that physical therapy should be initiated earlier in the disease. In this review, we present the evidence revealing early disability in PD and the effectiveness of physical therapy and exercise, followed by a discussion of a secondary prevention model of rehabilitation to reduce early disability and optimize long-term outcomes.
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Affiliation(s)
- Terry D Ellis
- Department of Physical Therapy and Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Cristina Colón-Semenza
- Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Tamara R DeAngelis
- Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Cathi A Thomas
- Parkinson's Disease and Movement Disorders Center, Boston University Medical Campus, Boston, Massachusetts.,American Parkinson Disease Association Information and Referral Center at Boston University Medical Center, Boston, Massachusetts
| | - Marie-Hélène Saint Hilaire
- Parkinson's Disease and Movement Disorders Center, Boston University Medical Campus, Boston, Massachusetts.,Department of Neurology at Boston University School of Medicine, Boston, Massachusetts.,American Parkinson Disease Association Center for Advanced Research at Boston University Medical Center, Boston, Massachusetts
| | - Gammon M Earhart
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City, Utah.,Health-Kinesiology-Recreation, The University of Utah, Salt Lake City, Utah
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27
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Wilson J, Yarnall AJ, Craig CE, Galna B, Lord S, Morris R, Lawson RA, Alcock L, Duncan GW, Khoo TK, O'Brien JT, Burn DJ, Taylor J, Ray NJ, Rochester L. Cholinergic Basal Forebrain Volumes Predict Gait Decline in Parkinson's Disease. Mov Disord 2021; 36:611-621. [PMID: 33382126 PMCID: PMC8048433 DOI: 10.1002/mds.28453] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/28/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Gait disturbance is an early, disabling feature of Parkinson's disease (PD) that is typically refractory to dopaminergic medication. The cortical cholinergic system, originating in the nucleus basalis of Meynert of the basal forebrain, has been implicated. However, it is not known if degeneration in this region relates to a worsening of disease-specific gait impairment. OBJECTIVE To evaluate associations between sub-regional cholinergic basal forebrain volumes and longitudinal progression of gait impairment in PD. METHODS 99 PD participants and 47 control participants completed gait assessments via an instrumented walkway during 2 minutes of continuous walking, at baseline and for up to 3 years, from which 16 spatiotemporal characteristics were derived. Sub-regional cholinergic basal forebrain volumes were measured at baseline via MRI and a regional map derived from post-mortem histology. Univariate analyses evaluated cross-sectional associations between sub-regional volumes and gait. Linear mixed-effects models assessed whether volumes predicted longitudinal gait changes. RESULTS There were no cross-sectional, age-independent relationships between sub-regional volumes and gait. However, nucleus basalis of Meynert volumes predicted longitudinal gait changes unique to PD. Specifically, smaller nucleus basalis of Meynert volume predicted increasing step time variability (P = 0.019) and shortening swing time (P = 0.015); smaller posterior nucleus portions predicted shortening step length (P = 0.007) and increasing step time variability (P = 0.041). CONCLUSIONS This is the first study to demonstrate that degeneration of the cortical cholinergic system predicts longitudinal progression of gait impairments in PD. Measures of this degeneration may therefore provide a novel biomarker for identifying future mobility loss and falls. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Joanna Wilson
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Alison J. Yarnall
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
- The Newcastle upon Tyne NHS Foundation TrustNewcastle upon TyneUnited Kingdom
| | - Chesney E. Craig
- Health, Psychology and Communities Research Centre, Department of PsychologyManchester Metropolitan UniversityManchesterUnited Kingdom
| | - Brook Galna
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
- School of Biomedical, Nutritional and Sport SciencesNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Sue Lord
- Auckland University of TechnologyAucklandNew Zealand
| | - Rosie Morris
- Department of Sport, Exercise, and RehabilitationNorthumbria UniversityNewcastle upon TyneUnited Kingdom
| | - Rachael A. Lawson
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Lisa Alcock
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Gordon W. Duncan
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUnited Kingdom
- NHS LothianEdinburghUnited Kingdom
| | - Tien K. Khoo
- School of Medicine & Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
- School of Medicine, University of WollongongAustralia
| | - John T. O'Brien
- Department of PsychiatryUniversity of CambridgeCambridgeUnited Kingdom
| | - David J. Burn
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - John‐Paul Taylor
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Nicola J. Ray
- Health, Psychology and Communities Research Centre, Department of PsychologyManchester Metropolitan UniversityManchesterUnited Kingdom
| | - Lynn Rochester
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
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von Rosen P, Hagströmer M, Franzén E, Leavy B. Physical activity profiles in Parkinson's disease. BMC Neurol 2021; 21:71. [PMID: 33581724 PMCID: PMC7881685 DOI: 10.1186/s12883-021-02101-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/31/2021] [Indexed: 12/25/2022] Open
Abstract
Background Identifying physical activity (PA) profiles of people with Parkinson’s Disease (PD) could provide clinically meaningful knowledge concerning how to tailor PA interventions. Our objectives were therefore to i) identify distinct PA profiles in people with PD based on accelerometer data, ii) explore differences between the profiles regarding personal characteristics and physical function. Methods Accelerometer data from 301 participants (43% women, mean age: 71 years) was analysed using latent profile analyses of 15 derived PA variables. Physical function measurements included balance performance, comfortable gait speed and single and dual-task functional mobility. Results Three distinct profiles were identified; “Sedentary” (N = 68), “Light Movers” (N = 115), “Steady Movers” (N = 118). “Sedentary” included people with PD with high absolute and relative time spent in Sedentary behaviour (SB), little time light intensity physical activity (LIPA) and negligible moderate-to-vigorous physical activity (MVPA). “Light Movers” were people with PD with values close to the mean for all activity variables. “Steady Movers” spent less time in SB during midday, and more time in LIPA and MVPA throughout the day, compared to the other profiles. “Sedentary” people had poorer balance (P = 0.006), poorer functional mobility (P = 0.027) and were more likely to have fallen previously (P = 0.027), compared to “Light Movers. The Timed Up and Go test, an easily performed clinical test of functional mobility, was the only test that could distinguish between all three profiles. Conclusion Distinct PA profiles, with clear differences in how the time awake is spent exist among people with mild-moderate PD.
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Affiliation(s)
- Philip von Rosen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Academic Primary Care Center, Region Stockholm, Stockholm, Sweden.,Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Karolinska University Hospital, Medical unit Occupational Therapy & Physiotherapy, Theme Women's Health and Allied Health Professionals, Stockholm, Sweden.,Stockholms Sjukhem Foundation, Reseach and Development Department, Stockholm, Sweden
| | - Breiffni Leavy
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Stockholms Sjukhem Foundation, Reseach and Development Department, Stockholm, Sweden
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Colón-Semenza C, Fulford D, Ellis T. Effort-Based Decision-Making for Exercise in People with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:725-735. [PMID: 33459665 DOI: 10.3233/jpd-202353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with Parkinson's disease (PwPD) are less active than their age-matched peers. Non-motor symptoms, specifically, deficient motivation, may influence decision-making for exercise due to the impaired mesolimbic dopaminergic pathway. OBJECTIVE The purpose of this study was to determine if effort-based decision-making for physical effort was different in PwPD compared to healthy controls. We sought to determine the relationship between effort-based decision making for exercise and a discrete motor task as well as the impact of components of motivation on decision-making for physical effort in PwPD. METHODS An effort-based decision-making paradigm using a discrete motor task (button pressing) and a continuous exercise task (cycling) was implemented in 32 PwPD and 23 healthy controls. Components of motivation were measured using the Apathy Scale and the Temporal Experience of Pleasure Scale- Anticipatory Pleasure scale. RESULTS The presence of Parkinson's disease (PD) did not moderate decisions for either physical effort task. There was a moderate correlation between decisions for both tasks, within each group. The anticipation of pleasure and apathy were predictors of decisions for both physical effort tasks in PwPD, but not in healthy controls. CONCLUSION PwPD responded similarly to effort and reward valuations compared to those without PD. Individuals were consistent in their decisions, regardless of the physical effort task. The anticipation of pleasure and apathy were significant predictors of decisions for exercise in PwPD only. Increased anticipation of pleasure, reduction of apathy, and the use of rewards may enhance engagement in high effort exercise among PwPD.
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Affiliation(s)
| | - Daniel Fulford
- Departments of Occupational Therapy and Psychology & Brain Sciences, Boston University, Boston, MA, USA
| | - Terry Ellis
- Center for Neurorehabilitation, Department of Physical Therapy & Athletic Training, Boston University, Boston, MA, USA
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Katzan I, Schuster A, Kinzy T. Physical Activity Monitoring Using a Fitbit Device in Ischemic Stroke Patients: Prospective Cohort Feasibility Study. JMIR Mhealth Uhealth 2021; 9:e14494. [PMID: 33464213 PMCID: PMC7854036 DOI: 10.2196/14494] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/01/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background Continuous tracking of ambulatory activity in real-world settings using step activity monitors has many potential uses. However, feasibility, accuracy, and correlation with performance measures in stroke patients have not been well-established. Objective The primary study objective was to determine adherence with wearing a consumer-grade step activity monitor, the Fitbit Charge HR, in home-going ischemic stroke patients during the first 90 days after hospital discharge. Secondary objectives were to (1) determine accuracy of step counts of the Fitbit Charge HR compared with a manual tally; (2) calculate correlations between the Fitbit step counts and the mobility performance scores at discharge and 30 days after stroke; (3) determine variability and change in weekly step counts over 90 days; and (4) evaluate patient experience with using the Fitbit Charge HR poststroke. Methods A total of 15 participants with recent mild ischemic stroke wore a Fitbit Charge HR for 90 days after discharge and completed 3 mobility performance tests from the National Institutes of Health Toolbox at discharge and Day 30: (1) Standing Balance Test, (2) 2-Minute Walk Endurance Test, and (3) 4-Meter Walk Gait Speed Test. Accuracy of step activity monitors was assessed by calculating differences in steps recorded on the step activity monitor and a manual tally during 2-minute walk tests. Results Participants had a mean age of 54 years and a median modified Rankin scale score of 1. Mean daily adherence with step activity monitor use was 83.6%. Mean daily step count in the first week after discharge was 4376. Daily step counts increased slightly during the first 30 days after discharge (average increase of 52.5 steps/day; 95% CI 32.2-71.8) and remained stable during the 30-90 day period after discharge. Mean step count difference between step activity monitor and manual tally was –4.8 steps (–1.8%). Intraclass correlation coefficients for step counts and 2-minute walk, standing balance, and 4-meter gait speed at discharge were 0.41 (95% CI –0.14 to 0.75), –0.12 (95% CI –0.67 to 0.64), and 0.17 (95% CI –0.46 to 0.66), respectively. Values were similarly poor at 30 days. Conclusions The use of consumer-grade Fitbit Charge HR in patients with recent mild stroke is feasible with reasonable adherence and accuracy. There was poor correlation between step counts and gait speed, balance, and endurance. Further research is needed to evaluate the association between step counts and other outcomes relevant to patients, including patient-reported outcomes and measures of physical function.
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Affiliation(s)
- Irene Katzan
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH, United States.,Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, United States
| | - Andrew Schuster
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH, United States
| | - Tyler Kinzy
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH, United States
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31
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Paul SS, Canning CG, Löfgren N, Sherrington C, Lee DC, Bampton J, Howard K. People with Parkinson's disease are more willing to do additional exercise if the exercise program has specific attributes: a discrete choice experiment. J Physiother 2021; 67:49-55. [PMID: 33358546 DOI: 10.1016/j.jphys.2020.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 11/12/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
QUESTION What specific attributes of exercise programs influence the preferences of people with Parkinson's disease for additional exercise compared with their current practice? What trade-offs are participants willing to make between exercise program attributes? DESIGN Discrete choice experiment. PARTICIPANTS Five hundred and forty people with Parkinson's disease. INTERVENTION Participants decided whether they would adopt a hypothetical program in addition to their current exercise routine. OUTCOME MEASURES Exercise program attributes included: type, number of sessions/week, location, travel time/session, delivery mode, supervisor's expertise, extent of supervision, benefits for physical and psychological function and out-of-pocket cost/session. RESULTS Participants preferred additional exercise when programs: provided physical (OR 1.85, 95% CI 1.61 to 2.13) or psychological (OR 1.45, 95% CI 1.26 to 1.67) benefit, involved less travel time (ORs 1.50 to 2.02) and were supervised by qualified professionals with Parkinson's disease expertise (ORs 1.51 to 1.91). Participants were most willing to add multimodal exercise to their exercise routine (ORs 2.01 to 2.19). Participants were less likely to prefer higher cost programs (OR 0.65, 95% CI 0.60 to 0.71, per AU$10 cost increase) or group sessions compared to individual sessions (OR 0.72, 95% CI 0.54 to 0.96). Men preferred adding strengthening exercises (OR 2.00, 95% CI 1.23 to 3.26) and women had a preference against adding aerobic exercise (OR 0.33, 95% CI 0.15 to 0.73). Participants not currently exercising were more likely to prefer adding exercise compared with those already exercising 300 minutes weekly (OR 1.74, 95% CI 1.15 to 2.63). CONCLUSION People with Parkinson's disease were more willing to participate in exercise programs that cost less, involve less travel, provide physical or psychological benefits and are supervised by qualified professionals. To enable more people with Parkinson's disease to exercise, health services should provide programs addressing these factors and account for sex differences.
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Affiliation(s)
- Serene S Paul
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Niklas Löfgren
- Function Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Cathie Sherrington
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Deborah C Lee
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julie Bampton
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Morris R, Mancin M. Lab-on-a-chip: wearables as a one stop shop for free-living assessments. Digit Health 2021. [DOI: 10.1016/b978-0-12-818914-6.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Shah VV, McNames J, Mancini M, Carlson-Kuhta P, Spain RI, Nutt JG, El-Gohary M, Curtze C, Horak FB. Laboratory versus daily life gait characteristics in patients with multiple sclerosis, Parkinson's disease, and matched controls. J Neuroeng Rehabil 2020; 17:159. [PMID: 33261625 PMCID: PMC7708140 DOI: 10.1186/s12984-020-00781-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/25/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND AND PURPOSE Recent findings suggest that a gait assessment at a discrete moment in a clinic or laboratory setting may not reflect functional, everyday mobility. As a step towards better understanding gait during daily life in neurological populations, we compared gait measures that best discriminated people with multiple sclerosis (MS) and people with Parkinson's Disease (PD) from their respective, age-matched, healthy control subjects (MS-Ctl, PD-Ctl) in laboratory tests versus a week of daily life monitoring. METHODS We recruited 15 people with MS (age mean ± SD: 49 ± 10 years), 16 MS-Ctl (45 ± 11 years), 16 people with idiopathic PD (71 ± 5 years), and 15 PD-Ctl (69 ± 7 years). Subjects wore 3 inertial sensors (one each foot and lower back) in the laboratory followed by 7 days during daily life. Mann-Whitney U test and area under the curve (AUC) compared differences between PD and PD-Ctl, and between MS and MS-Ctl in the laboratory and in daily life. RESULTS Participants wore sensors for 60-68 h in daily life. Measures that best discriminated gait characteristics in people with MS and PD from their respective control groups were different between the laboratory gait test and a week of daily life. Specifically, the toe-off angle best discriminated MS versus MS-Ctl in the laboratory (AUC [95% CI] = 0.80 [0.63-0.96]) whereas gait speed in daily life (AUC = 0.84 [0.69-1.00]). In contrast, the lumbar coronal range of motion best discriminated PD versus PD-Ctl in the laboratory (AUC = 0.78 [0.59-0.96]) whereas foot-strike angle in daily life (AUC = 0.84 [0.70-0.98]). AUCs were larger in daily life compared to the laboratory. CONCLUSIONS Larger AUC for daily life gait measures compared to the laboratory gait measures suggest that daily life monitoring may be more sensitive to impairments from neurological disease, but each neurological disease may require different gait outcome measures.
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Affiliation(s)
- Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA.
| | - James McNames
- Department of Electrical and Computer Engineering, Portland State University, Portland, OR, USA
- APDM Wearable Technologies, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA
| | - Patricia Carlson-Kuhta
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA
| | - Rebecca I Spain
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA
- Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - John G Nutt
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA
| | | | - Carolin Curtze
- Department of Biomechanics, University of Nebraska At Omaha, Omaha, NE, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA
- APDM Wearable Technologies, Portland, OR, USA
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Wilson J, Alcock L, Yarnall AJ, Lord S, Lawson RA, Morris R, Taylor JP, Burn DJ, Rochester L, Galna B. Gait Progression Over 6 Years in Parkinson's Disease: Effects of Age, Medication, and Pathology. Front Aging Neurosci 2020; 12:577435. [PMID: 33192470 PMCID: PMC7593770 DOI: 10.3389/fnagi.2020.577435] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/09/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Gait disturbance is an early, cardinal feature of Parkinson's disease (PD) associated with falls and reduced physical activity. Progression of gait impairment in Parkinson's disease is not well characterized and a better understanding is imperative to mitigate impairment. Subtle gait impairments progress in early disease despite optimal dopaminergic medication. Evaluating gait disturbances over longer periods, accounting for typical aging and dopaminergic medication changes, will enable a better understanding of gait changes and inform targeted therapies for early disease. This study aimed to describe gait progression over the first 6 years of PD by delineating changes associated with aging, medication, and pathology. Methods: One-hundred and nine newly diagnosed PD participants and 130 controls completed at least two gait assessments. Gait was assessed at 18-month intervals for up to 6 years using an instrumented walkway to measure sixteen spatiotemporal gait characteristics. Linear mixed-effects models assessed progression. Results: Ten gait characteristics significantly progressed in PD, with changes in four of these characteristics attributable to disease progression. Age-related changes also contributed to gait progression; changes in another two characteristics reflected both aging and disease progression. Gait impairment progressed irrespective of dopaminergic medication change for all characteristics except step width variability. Conclusions: Discrete gait impairments continue to progress in PD over 6 years, reflecting a combination of, and potential interaction between, disease-specific progression and age-related change. Gait changes were mostly unrelated to dopaminergic medication adjustments, highlighting limitations of current dopaminergic therapy and the need to improve interventions targeting gait decline.
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Affiliation(s)
- Joanna Wilson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sue Lord
- Auckland University of Technology, Auckland, New Zealand
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rosie Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Brook Galna
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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35
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Shah VV, McNames J, Harker G, Mancini M, Carlson-Kuhta P, Nutt JG, El-Gohary M, Curtze C, Horak FB. Effect of Bout Length on Gait Measures in People with and without Parkinson's Disease during Daily Life. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5769. [PMID: 33053703 PMCID: PMC7601493 DOI: 10.3390/s20205769] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 01/06/2023]
Abstract
Although the use of wearable technology to characterize gait disorders in daily life is increasing, there is no consensus on which specific gait bout length should be used to characterize gait. Clinical trialists using daily life gait quality as study outcomes need to understand how gait bout length affects the sensitivity and specificity of measures to discriminate pathological gait as well as the reliability of gait measures across gait bout lengths. We investigated whether Parkinson's disease (PD) affects how gait characteristics change as bout length changes, and how gait bout length affects the reliability and discriminative ability of gait measures to identify gait impairments in people with PD compared to neurotypical Old Adults (OA). We recruited 29 people with PD and 20 neurotypical OA of similar age for this study. Subjects wore 3 inertial sensors, one on each foot and one over the lumbar spine all day, for 7 days. To investigate which gait bout lengths should be included to extract gait measures, we determined the range of gait bout lengths available across all subjects. To investigate if the effect of bout length on each gait measure is similar or not between subjects with PD and OA, we used a growth curve analysis. For reliability and discriminative ability of each gait measure as a function of gait bout length, we used the intraclass correlation coefficient (ICC) and area under the curve (AUC), respectively. Ninety percent of subjects walked with a bout length of less than 53 strides during the week, and the majority (>50%) of gait bouts consisted of less than 12 strides. Although bout length affected all gait measures, the effects depended on the specific measure and sometimes differed for PD versus OA. Specifically, people with PD did not increase/decrease cadence and swing duration with bout length in the same way as OA. ICC and AUC characteristics tended to be larger for shorter than longer gait bouts. Our findings suggest that PD interferes with the scaling of cadence and swing duration with gait bout length. Whereas control subjects gradually increased cadence and decreased swing duration as bout length increased, participants with PD started with higher than normal cadence and shorter than normal stride duration for the smallest bouts, and cadence and stride duration changed little as bout length increased, so differences between PD and OA disappeared for the longer bout lengths. Gait measures extracted from shorter bouts are more common, more reliable, and more discriminative, suggesting that shorter gait bouts should be used to extract potential digital biomarkers for people with PD.
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Affiliation(s)
- Vrutangkumar V. Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (G.H.); (M.M.); (P.C.-K.); (J.G.N.); (F.B.H.)
| | - James McNames
- Department of Electrical and Computer Engineering, Portland State University, Portland, OR 97207, USA;
| | - Graham Harker
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (G.H.); (M.M.); (P.C.-K.); (J.G.N.); (F.B.H.)
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (G.H.); (M.M.); (P.C.-K.); (J.G.N.); (F.B.H.)
| | - Patricia Carlson-Kuhta
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (G.H.); (M.M.); (P.C.-K.); (J.G.N.); (F.B.H.)
| | - John G. Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (G.H.); (M.M.); (P.C.-K.); (J.G.N.); (F.B.H.)
| | | | - Carolin Curtze
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA;
| | - Fay B. Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (G.H.); (M.M.); (P.C.-K.); (J.G.N.); (F.B.H.)
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36
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Lang CE, Barth J, Holleran CL, Konrad JD, Bland MD. Implementation of Wearable Sensing Technology for Movement: Pushing Forward into the Routine Physical Rehabilitation Care Field. SENSORS 2020; 20:s20205744. [PMID: 33050368 PMCID: PMC7601835 DOI: 10.3390/s20205744] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 01/01/2023]
Abstract
While the promise of wearable sensor technology to transform physical rehabilitation has been around for a number of years, the reality is that wearable sensor technology for the measurement of human movement has remained largely confined to rehabilitation research labs with limited ventures into clinical practice. The purposes of this paper are to: (1) discuss the major barriers in clinical practice and available wearable sensing technology; (2) propose benchmarks for wearable device systems that would make it feasible to implement them in clinical practice across the world and (3) evaluate a current wearable device system against the benchmarks as an example. If we can overcome the barriers and achieve the benchmarks collectively, the field of rehabilitation will move forward towards better movement interventions that produce improved function not just in the clinic or lab, but out in peoples' homes and communities.
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Affiliation(s)
- Catherine E. Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
- Correspondence:
| | - Jessica Barth
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
| | - Carey L. Holleran
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
| | - Jeff D. Konrad
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
| | - Marghuretta D. Bland
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
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37
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Rawson KS, Cavanaugh JT, Colon-Semenza C, DeAngelis T, Duncan RP, Fulford D, LaValley MP, Mazzoni P, Nordahl T, Quintiliani LM, Saint-Hilaire M, Thomas CA, Earhart GM, Ellis TD. Design of the WHIP-PD study: a phase II, twelve-month, dual-site, randomized controlled trial evaluating the effects of a cognitive-behavioral approach for promoting enhanced walking activity using mobile health technology in people with Parkinson-disease. BMC Neurol 2020; 20:146. [PMID: 32312243 PMCID: PMC7171812 DOI: 10.1186/s12883-020-01718-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/05/2020] [Indexed: 12/15/2022] Open
Abstract
Background Parkinson disease (PD) is a debilitating and chronic neurodegenerative disease resulting in ambulation difficulties. Natural walking activity often declines early in disease progression despite the relative stability of motor impairments. In this study, we propose a paradigm shift with a “connected behavioral approach” that targets real-world walking using cognitive-behavioral training and mobile health (mHealth) technology. Methods/design The Walking and mHealth to Increase Participation in Parkinson Disease (WHIP-PD) study is a twelve-month, dual site, two-arm, randomized controlled trial recruiting 148 participants with early to mid-stage PD. Participants will be randomly assigned to connected behavioral or active control conditions. Both conditions will include a customized program of goal-oriented walking, walking-enhancing strengthening exercises, and eight in-person visits with a physical therapist. Participants in the connected behavioral condition also will (1) receive cognitive-behavioral training to promote self-efficacy for routine walking behavior and (2) use a mHealth software application to manage their program and communicate remotely with their physical therapist. Active control participants will receive no cognitive-behavioral training and manage their program on paper. Evaluations will occur at baseline, three-, six-, and twelve-months and include walking assessments, self-efficacy questionnaires, and seven days of activity monitoring. Primary outcomes will include the change between baseline and twelve months in overall amount of walking activity (mean number of steps per day) and amount of moderate intensity walking activity (mean number of minutes per day in which > 100 steps were accumulated). Secondary outcomes will include change in walking capacity as measured by the six-minute walk test and ten-meter walk test. We also will examine if self-efficacy mediates change in amount of walking activity and if change in amount of walking activity mediates change in walking capacity. Discussion We expect this study to show the connected behavioral approach will be more effective than the active control condition in increasing the amount and intensity of real-world walking activity and improving walking capacity. Determining effective physical activity interventions for persons with PD is important for preserving mobility and essential for maintaining quality of life. Clinical trials registration NCT03517371, May 7, 2018. Trial registration ClinicalTrials.gov: NCT03517371. Date of registration: May 7, 2018. Protocol version: Original.
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Affiliation(s)
- Kerri S Rawson
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - James T Cavanaugh
- Department of Physical Therapy, University of New England, Portland, ME, USA
| | - Cristina Colon-Semenza
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Tami DeAngelis
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Ryan P Duncan
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Daniel Fulford
- Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | | | - Pietro Mazzoni
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Timothy Nordahl
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Lisa M Quintiliani
- Department of Medicine, Section of General Internal Medicine, Boston University, Boston, MA, USA
| | - Marie Saint-Hilaire
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University, Boston, MA, USA
| | - Cathi A Thomas
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University, Boston, MA, USA
| | - Gammon M Earhart
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.,Department of Neuroscience, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Terry D Ellis
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA.
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Shah VV, McNames J, Mancini M, Carlson-Kuhta P, Spain RI, Nutt JG, El-Gohary M, Curtze C, Horak FB. Quantity and quality of gait and turning in people with multiple sclerosis, Parkinson's disease and matched controls during daily living. J Neurol 2020; 267:1188-1196. [PMID: 31927614 PMCID: PMC7294824 DOI: 10.1007/s00415-020-09696-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/12/2022]
Abstract
Clinical trials need to specify which specific gait characteristics to monitor as mobility measures for each neurological disorder. As a first step, this study aimed to investigate a set of measures from daily-life monitoring that best discriminate mobility between people with multiple sclerosis (MS) and age-matched healthy control subjects (MS-Ctl) and between people with Parkinson's disease (PD) and age-matched healthy control subjects (PD-Ctl). Further, we investigated how these discriminative measures relate to the disease severity of MS or PD. We recruited 13 people with MS, 21 MS-Ctl, 29 people with idiopathic PD, and 20 PD-Ctl. Subjects wore 3 inertial sensors on their feet and the lumbar back for a week. The Area Under Curves (AUC) from the receiver operator characteristic (ROC) plot was calculated for each measure to determine the objective measures that best separated the MS and PD groups from their respective control cohorts. Adherence wearing the sensors was similar among groups for 58-66 h of recording (p = 0.14). Quantity of mobility (activity measures, such as a median number of strides per gait bout, AUC = 0.93) best discriminated mobility impairments in MS from MS-Ctl. In contrast, quality of mobility (such as turn angle, AUC = 0.90) best discriminated mobility impairments in PD from PD-Ctl. Mobility measures with AUC > 0.80 were correlated with MS and PD clinical scores of disease severity. Thus, measures characterizing mobility impairments differ for MS versus PD during daily life suggesting that mobility measures for clinical trials and clinical practice need to be specific to each neurological disorder.
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Affiliation(s)
- Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA.
| | - James McNames
- Department of Electrical and Computer Engineering, Portland State University, Portland, OR, USA
- APDM, Inc., Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA
| | - Patricia Carlson-Kuhta
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA
| | - Rebecca I Spain
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA
- Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - John G Nutt
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA
| | | | - Carolin Curtze
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA
- APDM, Inc., Portland, OR, USA
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39
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Does the postural stability of patients with Parkinson’s disease affect the physical activity? Int J Rehabil Res 2020; 43:41-47. [DOI: 10.1097/mrr.0000000000000382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morgan C, Rolinski M, McNaney R, Jones B, Rochester L, Maetzler W, Craddock I, Whone AL. Systematic Review Looking at the Use of Technology to Measure Free-Living Symptom and Activity Outcomes in Parkinson's Disease in the Home or a Home-like Environment. JOURNAL OF PARKINSON'S DISEASE 2020; 10:429-454. [PMID: 32250314 PMCID: PMC7242826 DOI: 10.3233/jpd-191781] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/31/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The emergence of new technologies measuring outcomes in Parkinson's disease (PD) to complement the existing clinical rating scales has introduced the possibility of measurement occurring in patients' own homes whilst they freely live and carry out normal day-to-day activities. OBJECTIVE This systematic review seeks to provide an overview of what technology is being used to test which outcomes in PD from free-living participant activity in the setting of the home environment. Additionally, this review seeks to form an impression of the nature of validation and clinimetric testing carried out on the technological device(s) being used. METHODS Five databases (Medline, Embase, PsycInfo, Cochrane and Web of Science) were systematically searched for papers dating from 2000. Study eligibility criteria included: adults with a PD diagnosis; the use of technology; the setting of a home or home-like environment; outcomes measuring any motor and non-motor aspect relevant to PD, as well as activities of daily living; unrestricted/unscripted activities undertaken by participants. RESULTS 65 studies were selected for data extraction. There were wide varieties of participant sample sizes (<10 up to hundreds) and study durations (<2 weeks up to a year). The metrics evaluated by technology, largely using inertial measurement units in wearable devices, included gait, tremor, physical activity, bradykinesia, dyskinesia and motor fluctuations, posture, falls, typing, sleep and activities of daily living. CONCLUSIONS Home-based free-living testing in PD is being conducted by multiple groups with diverse approaches, focussing mainly on motor symptoms and sleep.
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Affiliation(s)
- Catherine Morgan
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- School of Computer Science, Electrical and Electronic Engineering, and Engineering Mathematics, Faculty of Engineering, University of Bristol, Bristol, UK
- Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
| | - Michal Rolinski
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
| | - Roisin McNaney
- School of Computer Science, Electrical and Electronic Engineering, and Engineering Mathematics, Faculty of Engineering, University of Bristol, Bristol, UK
| | - Bennet Jones
- Library and Knowledge Service, Learning and Research, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
- Newcastle Upon Tyne Hospitals National Health Service Foundation Trust, Newcastle Upon Tyne, UK
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - Ian Craddock
- School of Computer Science, Electrical and Electronic Engineering, and Engineering Mathematics, Faculty of Engineering, University of Bristol, Bristol, UK
| | - Alan L. Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
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Rafferty MR, MacDonald J, Byskosh A, Sloan L, Toledo S, Marciniak C, Simuni T. Using Implementation Frameworks to Provide Proactive Physical Therapy for People With Parkinson Disease: Case Report. Phys Ther 2019; 99:1644-1655. [PMID: 31508801 PMCID: PMC7372734 DOI: 10.1093/ptj/pzz129] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/15/2019] [Accepted: 04/12/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND PURPOSE European clinical practice guidelines recommend physical therapy for people with Parkinson disease (PD) soon after diagnosis to provide education, physical activity advice, and individualized interventions when needed. However, therapy is frequently not used until after gait and balance problems occur. The purpose of this administrative case study is to present the application of a proactive physical therapy (PAPT) approach at 1 rehabilitation center using implementation frameworks to support the (1) implementation process, (2) determinants of implementation success, and (3) implementation evaluation. CASE DESCRIPTION The PAPT program targeted people with PD before the onset of significant mobility dysfunction. It was initiated in 1 outpatient neurological rehabilitation center. The program used shared decision-making to promote long-term maintenance of independent exercise. The Knowledge-to-Action Framework was used by champions to plan implementation processes. Implementation barriers were addressed using the Consolidated Framework for Implementation Research. The program was evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework with mixed methods. OUTCOMES In the program's first year, 38 people were referred, 28 were evaluated, and 20 participated in the 6-month program evaluation. Following PAPT, the number of participants reporting regular participation in aerobic, strengthening, and flexibility exercise approximately doubled, while those engaging in balance activities increased from 1 to 8. They reported a median of 140 minutes of aerobic exercise per week. Implementation barriers included location, insurance coverage, and difficulty scheduling long-term follow-up visits. Participants reported physical and emotional benefits of the program. DISCUSSION Implementation frameworks assisted with the implementation and evaluation of a PAPT delivery model that helped people with PD to increase and maintain independent exercise participation.
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Affiliation(s)
- Miriam R Rafferty
- Shirley Ryan AbilityLab Illinois; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 E Erie St, 19th Floor Strength and Endurance Lab, Chicago, IL 60611 (USA); and Department of Psychiatry and Behavioral Science, Feinberg School of Medicine, Northwestern University
| | - Jillian MacDonald
- Shirley Ryan AbilityLab. Dr MacDonald is a board-certified clinical specialist in neurologic physical therapy
| | | | | | - Santiago Toledo
- Shirley Ryan AbilityLab; and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
| | - Christina Marciniak
- AbilityLab; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University; and Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - Tanya Simuni
- Department of Neurology, Feinberg School of Medicine, Northwestern University
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Mantri S, Fullard ME, Duda JE, Morley JF. Physical Activity in Early Parkinson Disease. JOURNAL OF PARKINSONS DISEASE 2019; 8:107-111. [PMID: 29480222 PMCID: PMC5836409 DOI: 10.3233/jpd-171218] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background: Physical activity and exercise improve outcomes in Parkinson disease (PD), however little is known about activity levels in early PD patients. Objective and Methods: We examined self-reported activity scores and examined associations with clinical characteristics in 383 PD subjects and 175 healthy controls from the Parkinson Progression Markers Initiative (PPMI). Results: Activity scores were 8% lower for PD subjects than HC (162.6±86.2 vs 175.0±78.5, p = 0.10). Higher scores were associated with younger age and male sex. Only 47% of PD subjects and 44% of HC reported activity consistent with standard recommendations for adults. Conclusions: Our findings highlight the need to encourage exercise even in early PD.
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Affiliation(s)
- Sneha Mantri
- Parkinson's Disease Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Michelle E Fullard
- Parkinson's Disease Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - John E Duda
- Parkinson's Disease Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - James F Morley
- Parkinson's Disease Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania Health System, Philadelphia, PA, USA
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Pradhan S, Kelly VE. Quantifying physical activity in early Parkinson disease using a commercial activity monitor. Parkinsonism Relat Disord 2019; 66:171-175. [PMID: 31420310 DOI: 10.1016/j.parkreldis.2019.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 07/08/2019] [Accepted: 08/02/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Physical inactivity in Parkinson disease (PD) has an impact on motor and non-motor symptoms of the disease. It is unclear whether this decline in physical activity occurs early in the disease, in addition to any decline due to aging, and whether commercial activity monitors can be used to self-monitor physical activity levels in this population. OBJECTIVE To compare the quantity and intensity of physical activity (PA), as measured by commercial activity monitors, in people with mild PD and healthy older adults (HOA). A secondary objective was to assess adherence and user experience with wearing the activity monitoring device. METHODS An observational descriptive study design examined PA levels over a 14-day period using commercially-available activity monitors (Fitbit Charge HR). RESULTS Individuals with PD (n = 30) and HOA (n = 30) both demonstrated high adherence with wear time (PD = 13.8 [0.5] days, HOA = 13.9 [0.4] days, p = 0.55). People with PD took fewer steps per day than HOA (PD = 6416.9 (2795.5), HOA = 11441.3 (3932.1), p < 0.001). Compared to HOA, individuals with PD spent fewer minutes per day engaged in moderate to vigorous intensity activity (PD = 33.0 (22.5), HOA = 72.0(37.3), p < 0.001) and more minutes per day sedentary (PD = 803.74 (154.9), HOA = 578.26 (103.7), p < 0.001). Both groups reported that ease of use and satisfaction with the activity monitor were high. CONCLUSIONS People with mild PD demonstrated reduced quantity and intensity of PA compared to HOA. Both the PD and the HOA groups had good adherence wearing a commercial activity monitor that provided feedback regarding activity levels.
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Affiliation(s)
- Sujata Pradhan
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, United states.
| | - Valerie E Kelly
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, United states
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Amara AW, Chahine L, Seedorff N, Caspell-Garcia CJ, Coffey C, Simuni T. Self-reported physical activity levels and clinical progression in early Parkinson's disease. Parkinsonism Relat Disord 2019; 61:118-125. [DOI: 10.1016/j.parkreldis.2018.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 01/16/2023]
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Yeung J, Catolico D, Fullmer N, Daniel R, Lovell R, Tang R, Pearson EM, Rosenberg SS. Evaluating the Sensoria Smart Socks Gait Monitoring System for Rehabilitation Outcomes. PM R 2019; 11:512-521. [PMID: 30861329 DOI: 10.1002/pmrj.12003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 10/13/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Gait monitoring is important for rehabilitation but clinic-based measurements provide a brief snapshot of gait patterns. Many consumer-based activity monitors facilitate continuous gait monitoring in daily life but may be subject to measurement errors. This study examines a novel consumer-based activity monitor that is worn on the feet, and therefore not susceptible to inaccurately detecting upper body movements as gait. OBJECTIVE To evaluate the clinical validity of Sensoria smart socks, a commercially available wireless gait monitoring technology. DESIGN A method comparison study between the GAITRite, a criterion standard for clinical gait monitoring, and Sensoria smart socks. SETTING Outpatient rehabilitation clinic. PARTICIPANTS Thirty individuals capable of supervised ambulation, with or without assistive devices, were recruited through the use of flyers and emails. Data were analyzed for 29 participants. Fifteen participants had no neurologic diagnosis. Fourteen participants had a neurologic diagnosis that could result in gait impairments. Diagnoses included Parkinson disease, stroke, brain injury, developmental delay, and acoustic neuroma. METHODS Participants completed three gait trials with simultaneous measurements by the smart socks and the GAITRite. MAIN OUTCOME MEASURES Measurements of step count, cadence, and velocity were compared between the two gait monitoring systems. RESULTS There was no significant difference in step count measurements between the two systems. Although there was a significant difference in cadence measurements for the total sample group, the mean difference fell within the GAITRite Standard Error of Measurement. There was no significant difference in velocity measurements for the total sample group and the mean difference fell within the GAITRite Standard Error of Measurement. CONCLUSION These results support the clinical validity of the smart socks for measuring step number and velocity. Further investigation is warranted to determine the efficacy and clinical value of the smart socks system for measuring cadence and for monitoring gait over longer distances outside the clinic. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Julia Yeung
- Research Institute, Casa Colina Hospital and Centers for Healthcare, San Diego, CA
| | - Davis Catolico
- Research Institute, Casa Colina Hospital and Centers for Healthcare, San Diego, CA
| | - Niko Fullmer
- Research Institute, Casa Colina Hospital and Centers for Healthcare, San Diego, CA
| | - Russell Daniel
- Research Institute, Casa Colina Hospital and Centers for Healthcare, San Diego, CA
| | - Ryan Lovell
- Research Institute, Casa Colina Hospital and Centers for Healthcare, San Diego, CA
| | - Ruiqi Tang
- Research Institute, Casa Colina Hospital and Centers for Healthcare, San Diego, CA
| | - Elise M Pearson
- Research Institute, Casa Colina Hospital and Centers for Healthcare, San Diego, CA
| | - Sheila S Rosenberg
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Kaiser Permanente, Pasadena, CA 91101
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Ellis TD, Cavanaugh JT, DeAngelis T, Hendron K, Thomas CA, Saint-Hilaire M, Pencina K, Latham NK. Comparative Effectiveness of mHealth-Supported Exercise Compared With Exercise Alone for People With Parkinson Disease: Randomized Controlled Pilot Study. Phys Ther 2019; 99:203-216. [PMID: 30715489 DOI: 10.1093/ptj/pzy131] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/04/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Declining physical activity commonly occurs in people with Parkinson disease (PD) and contributes to reduced functional capacity and quality of life. OBJECTIVE The purpose of this study was to explore the preliminary effectiveness, safety, and acceptability of a mobile health (mHealth)-mediated exercise program designed to promote sustained physical activity in people with PD. DESIGN This was a 12-month single-blind (assessor), pilot, comparative-effectiveness, randomized controlled study. METHODS An mHealth-mediated exercise program (walking with a pedometer plus engagement in planned exercise supported by a mobile health application) was compared over 1 year with an active control condition (walking with a pedometer and exercise only). There were 51 participants in a community setting with mild-to-moderately severe (Hoehn and Yahr stages 1-3) idiopathic PD. Daily steps and moderate-intensity minutes were measured using a step activity monitor for 1 week at baseline and again at 12 months. Secondary outcomes included the 6-Minute Walk Test, Parkinson Disease Questionnaire 39 mobility domain, safety, acceptability, and adherence. RESULTS Both groups increased daily steps, moderate-intensity minutes, and 6-Minute Walk Test, with no statistically significant between-group differences observed. In the less active subgroup, changes in daily steps and moderate-intensity minutes were clinically meaningful. An improvement in the Parkinson Disease Questionnaire 39 mobility score favored mHealth in the overall comparison and was statistically and clinically meaningful in the less active subgroup. LIMITATIONS The limitation of the current study was the small sample size. CONCLUSIONS Both groups improved physical activity compared with expected activity decline over 1 year. The addition of the mHealth app to the exercise intervention appeared to differentially benefit the more sedentary participants. Further study in a larger group of people with low activity at baseline is needed.
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Affiliation(s)
- Terry D Ellis
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Ave, Boston, MA 02215 (USA); and Center for Neurorehabilitation, Boston University
| | - James T Cavanaugh
- Department of Physical Therapy, University of New England, Portland, Maine
| | - Tamara DeAngelis
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University
| | - Kathryn Hendron
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University
| | - Cathi A Thomas
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University
| | - Marie Saint-Hilaire
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University
| | - Karol Pencina
- Research Program in Men's Health, Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy K Latham
- Research Program in Men's Health, Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School
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Thorp JE, Adamczyk PG, Ploeg HL, Pickett KA. Monitoring Motor Symptoms During Activities of Daily Living in Individuals With Parkinson's Disease. Front Neurol 2018; 9:1036. [PMID: 30619024 PMCID: PMC6299017 DOI: 10.3389/fneur.2018.01036] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/16/2018] [Indexed: 01/23/2023] Open
Abstract
This literature review addressed wearable sensor systems to monitor motor symptoms in individuals with Parkinson's disease (PD) during activities of daily living (ADLs). Specifically, progress in monitoring tremor, freezing of gait, dyskinesia, bradykinesia, and hypokinesia was reviewed. Twenty-seven studies were found that met the criteria of measuring symptoms in a home or home-like setting, with some studies examining multiple motor disorders. Accelerometers, gyroscopes, and electromyography sensors were included, with some studies using more than one type of sensor. Five studies measured tremor, five studies examined bradykinesia or hypokinesia, thirteen studies included devices to measure dyskinesia or motor fluctuations, and ten studies measured akinesia or freezing of gait. Current sensor technology can detect the presence and severity of each of these symptoms; however, most systems require sensors on multiple body parts, which is challenging for remote or ecologically valid observation. Different symptoms are detected by different sensor placement, suggesting that the goal of detecting all symptoms with a reduced set of sensors may not be achievable. For the goal of monitoring motor symptoms during ADLs in a home setting, the measurement system should be simple to use, unobtrusive to the wearer and easy for an individual with PD to put on and take off. Machine learning algorithms such as neural networks appear to be the most promising way to detect symptoms using a small number of sensors. More work should be done validating the systems during unscripted and unconstrained ADLs rather than in scripted motions.
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Affiliation(s)
- Jenna E. Thorp
- Department of Mechanical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Peter Gabriel Adamczyk
- Department of Mechanical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Heidi-Lynn Ploeg
- Department of Mechanical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Kristen A. Pickett
- Department of Biomedical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States
- Occupational Therapy Program, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
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Mantri S, Wood S, Duda JE, Morley JF. Understanding physical activity in Veterans with Parkinson disease: A mixed-methods approach. Parkinsonism Relat Disord 2018; 61:156-160. [PMID: 31036158 DOI: 10.1016/j.parkreldis.2018.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/12/2018] [Accepted: 10/22/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Physical activity is critical in Parkinson disease (PD) management, but barriers and motivators of activity in Veterans with PD may be unique. We examined activity habits, including barriers and motivators, in this population. METHODS Participants completed the Physical Activity Scale in the Elderly (PASE). Compliance with American Heart Association (AHA) recommendations was assessed. Veterans also completed the Exercise Perceptions Questionnaire (EPQ), assessing knowledge, barriers, and motivators of activity. Free-text barriers/motivators were analyzed by the overlapping clusters method. RESULTS Seventy-five Veterans were recruited; mean age (standard deviation [SD]) was 70.5 (8.2) years and mean disease duration (SD) was 5.4 (5.2) years. Raw median PASE was 120.4 (interquartile range [IQR] 68.8-165.7); age-adjusted median PASE was 135.3. Only 9 Veterans (14.3%) were AHA-compliant. There were trends toward negative association between PASE and UPDRS-3 (r = -0.24, p = 0.06) and between PASE and PDQ-8 (r = -0.23, p = 0.08). Sixty-three subjects (84%) completed the EPQ; 27 (42.9%) preferred scheduled exercise, and only 33 (53.2%) reported that they preferred to exercise with others. Common themes of 46 free-text responses included desire to improve PD symptoms (n = 15, 32.6%) and social engagement (n = 12, 26.1%). CONCLUSIONS Self-reported activity in Veterans with PD is low, with less than 15% of subjects meeting recommended activity targets. Qualitative analysis of barriers and motivators revealed that although many Veterans enjoy the social aspects of group exercise, they may not feel comfortable in general exercise classes aimed at younger participants without chronic illnesses. These data will be useful in designing Veteran- and/or PD-specific interventions to increase activity levels.
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Affiliation(s)
- Sneha Mantri
- Parkinson Disease Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Mailstop 127, Philadelphia PA 19104, USA; Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, 2nd Floor SPE, Philadelphia PA 19104, USA; Department of Neurology, Duke University Medical Center, DUMC 3333, 932 Morreene Road, Durham NC 27705, USA.
| | - Stephanie Wood
- Parkinson Disease Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Mailstop 127, Philadelphia PA 19104, USA
| | - John E Duda
- Parkinson Disease Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Mailstop 127, Philadelphia PA 19104, USA; Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, 2nd Floor SPE, Philadelphia PA 19104, USA
| | - James F Morley
- Parkinson Disease Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Mailstop 127, Philadelphia PA 19104, USA; Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, 2nd Floor SPE, Philadelphia PA 19104, USA
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Association between Objectively Measured Physical Activity and Gait Patterns in People with Parkinson's Disease: Results from a 3-Month Monitoring. PARKINSONS DISEASE 2018; 2018:7806574. [PMID: 30416704 PMCID: PMC6207897 DOI: 10.1155/2018/7806574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/15/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022]
Abstract
Background Although physical activity (PA) is known to be beneficial in improving motor symptoms of people with Parkinson's disease (pwPD), little is known about the relationship between gait patterns and features of PA performed during daily life. Objective To verify the existence of possible relationships between spatiotemporal and kinematic parameters of gait and amount/intensity of PA, both instrumentally assessed. Methods Eighteen individuals affected by PD (10F and 8M, age 68.0 ± 10.8 years, 1.5 ≤ Hoehn and Yahr (H&Y) < 3) were required to wear a triaxial accelerometer 24 h/day for 3 consecutive months. They also underwent a 3D computerized gait analysis at the beginning and end of the PA assessment period. The number of daily steps and PA intensity were calculated on the whole day, and the period from 6:00 to 24:00 was grouped into 3 time slots, using 3 different cut-point sets previously validated in the case of both pwPD and healthy older adults. 3D gait analysis provided spatiotemporal and kinematic parameters of gait, including summary indexes of quality (Gait Profile Score (GPS) and Gait Variable Score (GVS)). Results The analysis of hourly trends of PA revealed the existence of two peaks located in the morning (approximately at 10) and in the early evening (between 18 and 19). However, during the morning time slot (06:00–12:00), pwPD performed significantly higher amounts of steps (4313 vs. 3437 in the 12:00–18:00 time slot, p < 0.001, and vs. 2889 in the 18:00–24:00 time slot, p=0.021) and of moderate-to-vigorous PA (43.2% vs. 36.3% in the 12:00–18:00 time slot, p=0.002, and vs. 31.4% in the 18:00–24:00 time slot, p=0.049). The correlation analysis shows that several PA intensity parameters are significantly associated with swing-phase duration (rho = −0.675 for sedentary intensity, rho = 0.717 for moderate-to-vigorous intensity, p < 0.001), cadence (rho = 0.509 for sedentary intensity, rho = −0.575 for moderate-to-vigorous intensity, p < 0.05), and overall gait pattern quality as expressed by GPS (rho = −0.498 to −0.606 for moderate intensity, p < 0.05) and GVS of knee flexion-extension (rho = −0.536 for moderate intensity, p < 0.05). Conclusions Long-term monitoring of PA integrated by the quantitative assessment of spatiotemporal and kinematic parameters of gait may represent a useful tool in supporting a better-targeted prescription of PA and rehabilitative treatments in pwPD.
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Son H, Park WS, Kim H. Mobility monitoring using smart technologies for Parkinson’s disease in free-living environment. Collegian 2018. [DOI: 10.1016/j.colegn.2017.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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