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Davies SJ, Gullo HL, Doig E. Efficacy and Feasibility of the CO-OP Approach in Parkinson's Disease: RCT Study Protocol. Can J Occup Ther 2023; 90:363-373. [PMID: 36785891 PMCID: PMC10647899 DOI: 10.1177/00084174231156287] [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: 02/15/2023]
Abstract
Background. Parkinson's disease (PD) leads to cognitive dysfunction which limits participation and occupational performance. Cognitive Orientation to Daily Occupational Performance (CO-OP) approach is effective in other adult neurological populations and warrants investigation in PD. Purpose. To describe a study protocol evaluating the preliminary efficacy and feasibility of CO-OP approach in PD. Method. A randomised controlled trial (RCT) with adults with PD was assigned to either: CO-OP training-intensive (CO-OP-I, 20 sessions) or waitlist control (WLC) followed by CO-OP-standard (CO-OP-S, 10 sessions). Outcomes. Occupational performance and satisfaction of adults with PD in chosen goals. Measures will be obtained at baseline, post-intervention, and 3-month follow-up. Implications. As the first RCT focused on CO-OP in PD, this trial will provide evidence for the potential of this approach in PD and lay the groundwork for future large-scale trials. Trial Registration. Australian New Zealand Clinical Trials registry, ACTRN12621001483842. Registered November 1, 2021; retrospectively registered 3 months after commencement.
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Affiliation(s)
- Sarah J. Davies
- Sarah J. Davies, School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia.
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2
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Lelos MJ. Investigating cell therapies in animal models of Parkinson's and Huntington's disease: Current challenges and considerations. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 166:159-189. [PMID: 36424091 DOI: 10.1016/bs.irn.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cell therapeutics have entered into an exciting era, with first-in-person clinical trials underway for Parkinson's disease and novel cell therapies in development for other neurodegenerative diseases. In the hope of ensuring successful translation of these novel cell products to the clinic, a significant amount of preclinical work continues to be undertaken. Rodent models of neural transplantation are required to thoroughly assess the survival, safety and efficacy of novel therapeutics. It is critical to produce robust and reliable preclinical data, in order to increase the likelihood of clinical success. As a result, significant effort has been driven into generating ever more relevant model systems, from genetically modified disease models to mice with humanized immune systems. Despite this, several challenges remain in the quest to assess human cells in the rodent brain long-term. Here, with a focus on models of Parkinson's and Huntington's disease, we discuss key considerations for choosing an appropriate rodent model for neural transplantation. We also consider the challenges associated with long-term survival and assessment of functional efficacy in these models, as well as the need to consider the clinical relevance of the model. While the choice of model will be dependent on the scientific question, by considering the caveats associated with each model, we identify opportunities to optimize the preclinical assessment and generate reliable data on our novel cell therapeutics.
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Affiliation(s)
- Mariah J Lelos
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, United Kingdom.
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Zhou Y, Box D, Hardy KG, Jenkins ME, Garland J, Naish MD, Trejos AL. Survey-based identification of design requirements and constraints for a wearable tremor suppression device. J Rehabil Assist Technol Eng 2022; 9:20556683221094480. [PMID: 35548101 PMCID: PMC9083043 DOI: 10.1177/20556683221094480] [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: 09/20/2021] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Parkinsonian tremor has severely impacted the lives of 65% of individuals with Parkinson’s disease, and nearly 25% do not respond to traditional treatments. Although wearable tremor suppression devices (WTSDs) have become a promising alternative approach, this technology is still in the early stages of development, and no studies have reported the stakeholders’ opinions on this technology and their desired design requirements. Methods An online survey was distributed to affected Canadians and Canadian movement disorder specialists (MDS) to acquire information on demographics, the current state of treatments, opinions on the WTSDs, and the desired design requirements of future WTSDs. Results A total of 101 affected individuals and 24 MDS completed the survey. It was found that both groups are generally open to using WTSDs to manage tremor. The most important design requirement to end users is the adaptability to lifestyle, followed by weight and size, accurate motion, comfort, safety, quick response, and cost. Lastly, most of the participants (65%) think that the device should cost under $500. Conclusions The findings from this study can be used as guidelines for the development of future WTSDs, such that the future generations could be evaluated and accepted by the end users.
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Affiliation(s)
- Yue Zhou
- School of Biomedical Engineering, Western University, London, ON, Canada
| | - Devin Box
- School of Kinesiology, Western University, London, ON, Canada
| | - Kenneth G Hardy
- Ivey Business School, Western University, London, ON, Canada
| | - Mary E Jenkins
- Movement Disorders Program, Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Jayne Garland
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Michael D Naish
- School of Biomedical Engineering, Western University, London, ON, Canada
- Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Ana Luisa Trejos
- School of Biomedical Engineering, Western University, London, ON, Canada
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
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4
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Soukup T, Davis RE, Baldellou Lopez M, Healey A, Estevao C, Fancourt D, Dazzan P, Pariante C, Dye H, Osborn T, Bind R, Sawyer K, Rebecchini L, Hazelgrove K, Burton A, Manoharan M, Perkins R, Podlewska A, Chaudhuri R, Derbyshire-Fox F, Hartley A, Woods A, Crane N, Bakolis I, Sevdalis N. Study protocol: randomised controlled hybrid type 2 trial evaluating the scale-up of two arts interventions for postnatal depression and Parkinson's disease. BMJ Open 2022; 12:e055691. [PMID: 35105591 PMCID: PMC8808453 DOI: 10.1136/bmjopen-2021-055691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Research on the benefits of 'arts' interventions to improve individuals' physical, social and psychological well-being is growing, but evidence on implementation and scale-up into health and social care systems is lacking. This protocol reports the SHAPER-Implement programme (Scale-up of Health-Arts Programmes Effectiveness-Implementation Research), aimed at studying the impact, implementation and scale-up of: Melodies for Mums (M4M), a singing intervention for postnatal depression; and Dance for Parkinson's (PD-Ballet) a dance intervention for Parkinson's disease. We examine how they could be embedded in clinical pathways to ensure their longer-term sustainability. METHODS AND ANALYSIS A randomised two-arm effectiveness-implementation hybrid type 2 trial design will be used across M4M/PD-Ballet. We will assess the implementation in both study arms (intervention vs control), and the cost-effectiveness of implementation. The design and measures, informed by literature and previous research by the study team, were refined through stakeholder engagement. Participants (400 in M4M; 160 in PD-Ballet) will be recruited to the intervention or control group (2:1 ratio). Further implementation data will be collected from stakeholders involved in referring to, delivering or supporting M4M/PD-Ballet (N=25-30 for each intervention).A mixed-methods approach (surveys and semi-structured interviews) will be employed. 'Acceptability' (measured by the 'Acceptability Intervention Measure') is the primary implementation endpoint for M4M/PD-Ballet. Relationships between clinical and implementation outcomes, implementation strategies (eg, training) and outcomes will be explored using generalised linear mixed models. Qualitative data will assess factors affecting the acceptability, feasibility and appropriateness of M4M/PD-Ballet, implementation strategies and longer-term sustainability. Costs associated with implementation and future scale-up will be estimated. ETHICS AND DISSEMINATION SHAPER-PND (the M4M trial) and SHAPER-PD (the PD trial) are approved by the West London and GTAC (20/PR/0813) and the HRA and Health and Care Research Wales (REC Reference: 20/WA/0261) Research Ethics Committees. Study findings will be disseminated through scientific peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBERS Both trials are registered with NIH US National Library of Medicine, ClinicalTrials.gov. The trial registration numbers, URLs of registry records, and dates of registration are: (1) PD-Ballet: URL: NCT04719468 (https://eur03.safelinks.protection. OUTLOOK com/?url=https%3A%2F%2Fwww.clinicaltrials.gov%2Fct2%2Fshow%2FNCT04719468%3Fterm%3DNCT04719468%26draw%3D2%26rank%3D1&data=04%7C01%7Crachel.davis%40kcl.ac.uk%7C11a7c5142782437919f808d903111449%7C8370cf1416f34c16b83c724071654356%7C0%7C0%7C6375441942616) (date of registration: 22 Jan 2021). (2) Melodies for Mums: NCT04834622 (https://clinicaltrials.gov/ct2/show/NCT04834622?term=shaper-pnd&draw=2&rank=1) (date of registration: 8 Apr 2021).
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Affiliation(s)
- Tayana Soukup
- Centre Implementation Science, King's College London, London, UK
| | - Rachel E Davis
- Centre Implementation Science, King's College London, London, UK
| | | | - Andy Healey
- Centre Implementation Science, King's College London, London, UK
| | - Carolina Estevao
- Department of Psychological Medicine, King's College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, King's College London, London, UK
| | - Carmine Pariante
- Department of Psychological Medicine, King's College London, London, UK
| | - Hannah Dye
- Breathe Arts Health Research, London, UK
| | - Tim Osborn
- Breathe Arts Health Research, London, UK
| | - Rebecca Bind
- Department of Psychological Medicine, King's College London, London, UK
| | - Kristi Sawyer
- Department of Psychological Medicine, King's College London, London, UK
| | | | - Katie Hazelgrove
- Department of Psychological Medicine, King's College London, London, UK
| | - Alexandra Burton
- Department of Behavioural Science and Health, University College London, London, UK
| | | | - Rosie Perkins
- Faculty of Medicine, Imperial College London, London, UK
- Centre for Performance Science, Royal College of Music, London, UK
| | - Aleksandra Podlewska
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | | | | | - Anthony Woods
- Department of Psychological Medicine, King's College London, London, UK
| | - Nikki Crane
- Department of Psychological Medicine, King's College London, London, UK
| | - Ioannis Bakolis
- Centre Implementation Science, King's College London, London, UK
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Nick Sevdalis
- Centre Implementation Science, King's College London, London, UK
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New approaches to treatments for sleep, pain and autonomic failure in Parkinson's disease - Pharmacological therapies. Neuropharmacology 2022; 208:108959. [PMID: 35051446 DOI: 10.1016/j.neuropharm.2022.108959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 01/08/2022] [Accepted: 01/13/2022] [Indexed: 01/07/2023]
Abstract
Non-motor symptoms (NMSs) are highly prevalent throughout the course of Parkinson's disease (PD). Pain, autonomic dysfunction and sleep disturbances remain at the forefront of the most common NMSs; their treatment is challenging and their effect on the quality of life of both patients and caregivers detrimental. Yet, the landscape of clinical trials in PD is still dominated by therapeutic strategies seeking to ameliorate motor symptoms; subsequently, effective strategies to successfully treat NMSs remain a huge unmet need. Wider awareness among industry and researchers is thus essential to give rise to development and delivery of high-quality, large-scale clinical trials in enriched populations of patients with PD-related pain, autonomic dysfunction and sleep. In this review, we discuss recent developments in the field of pharmacological treatment strategies designed or re-purposed to target three key NMSs: pain, autonomic dysfunction and sleep disturbances. We focus on emerging evidence from recent clinical trials and outline some exciting and intriguing findings that call for further investigations.
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Mathur S, Stamford J. Bringing Advanced Therapies for Parkinson's Disease to the Clinic: The Patient's Perspective. JOURNAL OF PARKINSONS DISEASE 2021; 11:S141-S145. [PMID: 33967058 PMCID: PMC8543244 DOI: 10.3233/jpd-212650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is an urgent unmet need in the Parkinson’s disease community—advanced therapies to modify the inevitable decline that occurs in those affected by this progressive neurodegenerative disease for which there is no cure. This will require collaboration from all stakeholders and central to those partnerships are patients themselves. But participation in clinical trials and clinical use of advanced therapies have their own risk profile above and beyond standard therapeutics as evidenced by past invasive procedures. Therefore, it is of utmost importance that clear, evidence-based information about these potential treatments be clearly communicated by those exploring their use to ensure safe and informed participation from the patient community. Likewise, patients must weigh the benefits of these treatments their limitations and risks in order to truly give informed consent to participate in bringing these treatments to the clinic. Here we explore these issues from the patient perspective.
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Affiliation(s)
| | - Jon Stamford
- Gentleman Neuroscientist and Independent Parkinson's Advocate
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Assessment of real life eating difficulties in Parkinson's disease patients by measuring plate to mouth movement elongation with inertial sensors. Sci Rep 2021; 11:1632. [PMID: 33452324 PMCID: PMC7810687 DOI: 10.1038/s41598-020-80394-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
Parkinson’s disease (PD) is a neurodegenerative disorder with both motor and non-motor symptoms. Despite the progressive nature of PD, early diagnosis, tracking the disease’s natural history and measuring the drug response are factors that play a major role in determining the quality of life of the affected individual. Apart from the common motor symptoms, i.e., tremor at rest, rigidity and bradykinesia, studies suggest that PD is associated with disturbances in eating behavior and energy intake. Specifically, PD is associated with drug-induced impulsive eating disorders such as binge eating, appetite-related non-motor issues such as weight loss and/or gain as well as dysphagia—factors that correlate with difficulties in completing day-to-day eating-related tasks. In this work we introduce Plate-to-Mouth (PtM), an indicator that relates with the time spent for the hand operating the utensil to transfer a quantity of food from the plate into the mouth during the course of a meal. We propose a two-step approach towards the objective calculation of PtM. Initially, we use the 3D acceleration and orientation velocity signals from an off-the-shelf smartwatch to detect the bite moments and upwards wrist micromovements that occur during a meal session. Afterwards, we process the upwards hand micromovements that appear prior to every detected bite during the meal in order to estimate the bite’s PtM duration. Finally, we use a density-based scheme to estimate the PtM durations distribution and form the in-meal eating behavior profile of the subject. In the results section, we provide validation for every step of the process independently, as well as showcase our findings using a total of three datasets, one collected in a controlled clinical setting using standardized meals (with a total of 28 meal sessions from 7 Healthy Controls (HC) and 21 PD patients) and two collected in-the-wild under free living conditions (37 meals from 4 HC/10 PD patients and 629 meals from 3 HC/3 PD patients, respectively). Experimental results reveal an Area Under the Curve (AUC) of 0.748 for the clinical dataset and 0.775/1.000 for the in-the-wild datasets towards the classification of in-meal eating behavior profiles to the PD or HC group. This is the first work that attempts to use wearable Inertial Measurement Unit (IMU) sensor data, collected both in clinical and in-the-wild settings, towards the extraction of an objective eating behavior indicator for PD.
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Ahmad Zubaidi ZS, Ariffin F, Oun CTC, Katiman D. Caregiver burden among informal caregivers in the largest specialized palliative care unit in Malaysia: a cross sectional study. BMC Palliat Care 2020; 19:186. [PMID: 33292214 PMCID: PMC7722979 DOI: 10.1186/s12904-020-00691-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informal caregivers (IC) are often overshadowed by the attention required by the terminally ill. This study aims to reveal the estimated proportion of caregiver burden, psychological manifestations and factors associated with caregiver burden among IC in the largest specialized Palliative Care Unit (PCU) in Malaysia. METHODS This was a cross-sectional study involving IC attending a PCU. Caregiver burden and psychological manifestations were measured using previously translated and validated Zarit Burden Interview and DASS-21 questionnaires respectively. Two hundred forty-nine samples were selected for analysis. RESULT The mean ZBI score was 23.33 ± 13.7. About half of the population 118(47.4%) was found to experienced caregiver burden whereby majority have mild to moderate burden 90(36.1%). The most common psychological manifestation among IC is anxiety 74(29.7%) followed by depression 51(20.4%) and stress 46(18.5%). Multiple logistic regression demonstrated that women who are IC to patients with non-malignancy were less likely to experience caregiver burden. IC who were highly educated and spent more than 14 h per day caregiving were at least twice likely to experience caregiver burden. Finally, those with symptoms of depression and anxiety were three times more likely to suffer from caregiver burden. CONCLUSION Caregiver burden among IC to palliative patients is prevalent in this population. IC who are men, educated, caregiving for patients with malignancy, long hours of caregiving and have symptoms of depression and anxiety are at risk of developing caregiver burden. Targeted screening should be implemented and IC well-being should be given more emphasis in local policies.
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Affiliation(s)
- Zati Sabrina Ahmad Zubaidi
- Clinical lecturer and Family Medicine Specialist, Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM) Selayang campus, Jalan Prima 7, 68100, Batu Caves, Selangor, Malaysia.
| | - Farnaza Ariffin
- Clinical lecturer and Family Medicine Specialist, Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM) Selayang campus, Jalan Prima 7, 68100, Batu Caves, Selangor, Malaysia
| | - Cindy Teoh Cy Oun
- Palliative Medicine Physician, Palliative Care Unit, Selayang Hospital, 68100, Batu Caves, Selangor, Malaysia
| | - Diana Katiman
- Clinical lecturer and Palliative Medicine Physician, Department of Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM) Sg Buloh campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
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Screening of Parkinsonian subtle fine-motor impairment from touchscreen typing via deep learning. Sci Rep 2020; 10:12623. [PMID: 32724210 PMCID: PMC7387517 DOI: 10.1038/s41598-020-69369-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/30/2020] [Indexed: 11/22/2022] Open
Abstract
Fine-motor impairment (FMI) is progressively expressed in early Parkinson’s Disease (PD) patients and is now known to be evident in the immediate prodromal stage of the condition. The clinical techniques for detecting FMI may not be robust enough and here, we show that the subtle FMI of early PD patients can be effectively estimated from the analysis of natural smartphone touchscreen typing via deep learning networks, trained in stages of initialization and fine-tuning. In a validation dataset of 36,000 typing sessions from 39 subjects (17 healthy/22 PD patients with medically validated UPDRS Part III single-item scores), the proposed approach achieved values of area under the receiver operating characteristic curve (AUC) of 0.89 (95% confidence interval: 0.80–0.96) with sensitivity/specificity: 0.90/0.83. The derived estimations result in statistically significant (\documentclass[12pt]{minimal}
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\begin{document}$$p<0.05$$\end{document}p<0.05) correlation of 0.66/0.73/0.58 with the clinical standard UPDRS Part III items 22/23/31, respectively. Further validation analysis on 9 de novo PD patients vs. 17 healthy controls classification resulted in AUC of 0.97 (0.93–1.00) with 0.93/0.90. For 253 remote study participants, with self-reported health status providing 252.000 typing sessions via a touchscreen typing data acquisition mobile app (iPrognosis), the proposed approach predicted 0.79 AUC (0.66–0.91) with 0.76/0.71. Remote and unobtrusive screening of subtle FMI via natural smartphone usage, may assist in consolidating early and accurate diagnosis of PD.
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Falup-Pecurariu C, Titova N, Ray Chaudhuri K. Editorial: Movement Disorders and Sleep - Underlying Mechanisms, Clinical Aspects and Treatment. Front Neurol 2019; 10:1034. [PMID: 31681136 PMCID: PMC6812678 DOI: 10.3389/fneur.2019.01034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/11/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cristian Falup-Pecurariu
- Department of Neurology, Faculty of Medicine, County Emergency Clinic Hospital, Transilvania University Braşov, Braşov, Romania
| | - Nataliya Titova
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - K Ray Chaudhuri
- Parkinson Foundation Centre of Excellence, King's College London, King's College Hospital, London, United Kingdom
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