Adaptive Eating Device: Performance and Satisfaction of a Person with Parkinson's Disease

BACKGROUND.

Individuals with Parkinson's disease (PD) can experience motor impairments related to their hand-use that restrict participation in daily activities. Feeding is one activity impacted by this health condition. The use of adapted utensils can improve performance and independence in this activity.

PURPOSE.

To investigate if a locally designed and made eating-adaptive device helps a person with PD to improve their feeding performance.

METHOD.

Single-case ABC-type experimental design. Performance and satisfaction of a 60-year-old man with PD were assessed during feeding tasks in 70 sequential days in three phases. Celeration Line, Two-Standard Deviation Band, and Visual Analysis were the methods used for data analysis.

FINDINGS.

Performance and satisfaction increased significantly after the introduction of the adaptive eating device. The addition of weight also contributed to the increase in the participant's performance.

IMPLICATIONS.

Adaptive eating device with low production costs and possibility of customized adjustments improves performance of people with PD.

Effect on hand kinematics when using assistive devices during activities of daily living

Assistive devices (ADs) are products intended to overcome the difficulties produced by the reduction in mobility and grip strength entailed by ageing and different pathologies. Nevertheless, there is little information about the effect that the use of these devices produces on hand kinematics. Thus, the aim of this work is to quantify this effect through the comparison of kinematic parameters (mean posture, ROM, median velocity and peak velocity) while performing activities of daily living (ADL) using normal products and ADs. Twelve healthy right-handed subjects performed 11 ADL with normal products and with 17 ADs wearing an instrumented glove on their right hand, 16 joint angles being recorded. ADs significantly affected hand kinematics, although the joints affected differed according to the AD. Furthermore, some pattern effects were identified depending on the characteristics of the handle of the ADs, namely, handle thickening, addition of a handle to products that initially did not have one, extension of existing handles or addition of handles to apply higher torques. An overview of the effects of these design characteristics on hand kinematics is presented as a basis for the selection of the most suitable AD depending on the patient’s impairments.

Adapted Feeding Utensils for People With Parkinson's-Related or Essential Tremor

OBJECTIVE

Our objective was to evaluate the effectiveness of four adapted feeding utensils with participants with essential tremor (ET) or tremor related to Parkinson's disease (PD).

METHOD

Participants performed a simulated feeding task under five conditions: (1) standard spoon (control condition), (2) weighted spoon with standard handle, (3) weighted spoon with built-up handle, (4) swivel spoon, and (5) Liftware Steady™ spoon, a product using active tremor cancellation technology. Participants rated each adapted utensil in comparison with the standard spoon regarding performance, ease of use, speed, neatness, and aesthetics.

RESULTS

Participants preferred the Liftware Steady spoon and weighted spoon with standard handle. Friedman's test did not reveal statistically significant differences in ratings between the two preferred utensils.

CONCLUSION

Participants had varied reactions to the different adaptive utensils and gave different reasons for preferences. These findings support the need for people with tremor related to ET or PD to have access to trial use of all four devices assessed in this study.

Effect of assistive devices on hand and arm posture during activities of daily living

Assistive devices (ADs) are products designed to overcome the grip strength and mobility difficulties produced by ageing and different pathologies. Nevertheless, little is known about the postural effect of such devices. This work aims to quantify this effect on the entire upper limb. Ten healthy right-handed subjects performed 13 activities of daily living (ADL) with normal products and 22 ADs and both arm (shoulder, elbow and wrist) and hand (grasp types and contacts) postures were analysed. ADs were found to affect upper limb postures in ADL, reducing the use of precision grasps in the right hand by 31.9% and increasing palm contact by 26% and 29.1% in right and left hands, respectively. Nevertheless, they were also found to increase shoulder flexion, elbow pronation and wrist deviation, which may be a drawback in some pathologies. Results may help in the selection of a suitable AD for enhancing ADL performance depending on the patient's limitations due to a particular pathology.

Effects of Wrist Weights on Kinematic and Myographic Movement Characteristics During a Reaching Task in Individuals With Parkinson Disease

OBJECTIVE

To investigate the kinematic and myographic effects of weighted wrist cuffs on individuals with Parkinson disease (PD) during a reaching task.

DESIGN

Cross-sectional study.

SETTING

Biomechanics research laboratory.

PARTICIPANTS

Individuals (N=39) with PD (n=19) and healthy age-matched control subjects (n=20).

INTERVENTIONS

Participants were instructed to reach and grasp a can at a distance of 80% of their arm length without a wrist cuff, while wearing separate 0.5- and 1.0-kg wrist cuffs, and subsequently without a wrist cuff.

MAIN OUTCOME MEASURES

Movement time, kinematic, and electromyographic data were recorded during all reach and grasp movements. Four end point coordinate strategy variables, 3 joint recruitment variables, and 2 co-contraction indices were derived from the raw data for analysis.

RESULTS

Significant interaction effects were found in the trunk and index finger movement time as the weight of the cuff increased from 0.5 to 1.0kg. The group of individuals with PD showed decreased movement times in both instances, whereas the control group showed increased movement times as the weight of the wrist cuff increased from baseline to 0.5 and 1.0kg. No group difference was observed in the co-contraction index of the upper arm and forearm.

CONCLUSIONS

Adoption of weighted wrist cuffs in the clinic should be cautiously undertaken because compensatory movements may be induced in the trunk of individuals with PD.

Fundamental Principles of Tremor Propagation in the Upper Limb

Although tremor is the most common movement disorder, there exist few effective tremor-suppressing devices, in part because the characteristics of tremor throughout the upper limb are unknown. To clarify, optimally suppressing tremor requires a knowledge of the mechanical origin, propagation, and distribution of tremor throughout the upper limb. Here we present the first systematic investigation of how tremor propagates between the shoulder, elbow, forearm, and wrist. We simulated tremor propagation using a linear, time-invariant, lumped-parameter model relating joint torques and the resulting joint displacements. The model focused on the seven main degrees of freedom from the shoulder to the wrist and included coupled joint inertia, damping, and stiffness. We deliberately implemented a simple model to focus first on the most basic effects. Simulating tremorogenic joint torque as a sinusoidal input, we used the model to establish fundamental principles describing how input parameters (torque location and frequency) and joint impedance (inertia, damping, and stiffness) affect tremor propagation. We expect that the methods and principles presented here will serve as the groundwork for future refining studies to understand the origin, propagation, and distribution of tremor throughout the upper limb in order to enable the future development of optimal tremor-suppressing devices.

Comparison of virtual reality versus physical reality on movement characteristics of persons with Parkinson's disease: effects of moving targets

OBJECTIVE

To compare the performance of reaching for stationary and moving targets in virtual reality (VR) and physical reality in persons with Parkinson's disease (PD).

DESIGN

A repeated-measures design in which all participants reached in physical reality and VR under 5 conditions: 1 stationary ball condition and 4 conditions with the ball moving at different speeds.

SETTING

University research laboratory.

PARTICIPANTS

Persons with idiopathic PD (n=29) and age-matched controls (n=25).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Success rates and kinematics of arm movement (movement time, amplitude of peak velocity, and percentage of movement time for acceleration phase).

RESULTS

In both VR and physical reality, the PD group had longer movement time (P<.001) and lower peak velocity (P<.001) than the controls when reaching for stationary balls. When moving targets were provided, the PD group improved more than the controls did in movement time (P<.001) and peak velocity (P<.001), and reached a performance level similar to that of the controls. Except for the fastest moving ball condition (0.5-s target viewing time), which elicited worse performance in VR than in physical reality, most cueing conditions in VR elicited performance generally similar to those in physical reality.

CONCLUSIONS

Although slower than the controls when reaching for stationary balls, persons with PD increased movement speed in response to fast moving balls in both VR and physical reality. This suggests that with an appropriate choice of cueing speed, VR is a promising tool for providing visual motion stimuli to improve movement speed in persons with PD. More research on the long-term effect of this type of VR training program is needed.

Effects of virtual reality training on functional reaching movements in people with Parkinson’s disease: a randomized controlled pilot trial

Objective: To investigate whether practising reaching for virtual moving targets would improve motor performance in people with Parkinson’s disease.

Design: Randomized pretest–posttest control group design.

Setting: A virtual reality laboratory in a university setting.

Participants: Thirty-three adults with Parkinson’s disease.

Interventions: The virtual reality training required 60 trials of reaching for fast-moving virtual balls with the dominant hand. The control group had 60 practice trials turning pegs with their non-dominant hand.

Main outcome measures: Pretest and posttest required reaching with the dominant hand to grasp real stationary balls and balls moving at different speeds down a ramp. Success rates and kinematic data (movement time, peak velocity and percentage of movement time for acceleration phase) from pretest and posttest were recorded to determine the immediate transfer effects.

Results: Compared with the control group, the virtual reality training group became faster ( F = 9.08, P = 0.005) and more forceful ( F = 9.36, P = 0.005) when reaching for real stationary balls. However, there was no significant difference in success rate or movement kinematics between the two groups when reaching for real moving balls.

Conclusion: A short virtual reality training programme improved the movement speed of discrete aiming tasks when participants reached for real stationary objects. However, the transfer effect was minimal when reaching for real moving objects.