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Almeida LRS, Vasconcelos L, Valenca GT, Carvalho K, Pinto EB, Oliveira-Filho J, Canning CG. Psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral Scale in people with Parkinson's disease. Disabil Rehabil 2024; 46:2684-2690. [PMID: 37403370 DOI: 10.1080/09638288.2023.2230132] [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: 12/28/2022] [Accepted: 06/23/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To verify the psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral (FaB-Brazil) Scale in Parkinson's disease (PD). MATERIAL AND METHODS Participants (n = 96) were assessed by disease-specific, self-report and functional mobility measures. Internal consistency of the FaB-Brazil scale was evaluated using Cronbach's alpha and inter-rater and test-retest reliability using intraclass correlation coefficients (ICC). The standard error of measurement (SEM), minimal detectable change (MDC), ceiling and floor effects, and convergent and discriminative validity were evaluated. RESULTS Internal consistency was moderate (α = 0.77). Excellent inter-rater (ICC = 0.90; p < 0.001) and test-retest (ICC = 0.91; p < 0.001) reliability were found. The SEM was 0.20 and MDC was 0.38. Ceiling and floor effects were not found. Convergent validity was established by the positive correlations between the FaB-Brazil scale and age, modified Hoehn and Yahr, PD duration, Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Motor Aspects of Experiences of Daily Living, Timed Up & Go and 8-item Parkinson's Disease Questionnaire, and negative correlations between the FaB-Brazil scale and community mobility, Schwab & England, and Activities-specific Balance Confidence scale. Females showed greater protective behaviors than males; recurrent fallers showed greater protective behaviors than non-recurrent fallers (p < 0.05). CONCLUSIONS The FaB-Brazil scale is reliable and valid for assessing people with PD.
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Affiliation(s)
- Lorena Rosa S Almeida
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Bahia, Brazil
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Bahia, Brazil
| | - Lara Vasconcelos
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Guilherme T Valenca
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Bahia, Brazil
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Kárin Carvalho
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Bahia, Brazil
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Elen Beatriz Pinto
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Bahia, Brazil
- Department of Life Sciences (DCV), Bahia State University, Salvador, Bahia, Brazil
| | - Jamary Oliveira-Filho
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Gomaa YS, Awad MI, Emara T, Elbokl A, Al-Yahya E, ElMeligie MM. Role of virtual reality in examining the effect of fear of falling (FOF) on postural stability in individuals without and with Parkinson's disease in Egypt: a mixed-methods feasibility study protocol. BMJ Open 2024; 14:e080592. [PMID: 38692713 PMCID: PMC11086402 DOI: 10.1136/bmjopen-2023-080592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/22/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Falls are common in older people and individuals with neurological conditions. Parkinson's disease (PD) is known for postural instability causing mobility disabilities, falls and reduced quality of life. The fear of falling (FOF), a natural response to unstable balance, can worsen postural control problems. Evaluating FOF relies largely on affected persons' subjective accounts due to limited objective assessment methods available. The aim of this mixed-methods feasibility study is to develop an assessment method for FOF while in motion and walking within virtual environments. This study will assess a range of FOF-related responses, including cognitive factors, neuromuscular response and postural stability. METHODS AND ANALYSIS This feasibility study will consist of four phases: the first two phases will include people without PD, while the other two will include people diagnosed with PD. Participants will be assessed for direct and indirect responses to real life, as well as virtual environment walking scenarios that may induce FOF. Data from questionnaires, different neurophysiological assessments, movement and gait parameters, alongside evaluations of usability and acceptability, will be collected. Semistructured interviews involving both participants and research assistants shall take place to elicit their experiences throughout different phases of the assessments undertaken. Demographic data, the scores of assessment scales, as well as feasibility, usability and acceptability of the measurement methods, will be illustrated via descriptive statistics. Movement and gait outcomes, together with neurophysiological data, will be extracted and calculated. Exploring relationships between different factors in the study will be achieved using a regression model. Thematic analysis will be the approach used to manage qualitative data. ETHICS AND DISSEMINATION This feasibility study was approved by the Ethics Committee of the Faculty of Physical Therapy, Kafr El Sheikh University, Egypt (number: P.T/NEUR/3/2023/46). The results of this study will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05931692).
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Affiliation(s)
- Yasmine S Gomaa
- Department of Physical Therapy for Neuromuscular Disorders, Faculty of Physical Therapy, Kafr Elsheikh University, Kafr El Sheikh, Egypt
- Department of Physical Therapy for Neuromuscular Disorders, Faculty of Physical Therapy, Ahram Canadian University, 6th of October, Egypt
| | - Mohammed I Awad
- Department of Mechatronics, Faculty of Engineering, Ain Shams University, Cairo, Egypt
- Human Mechatronics Lab, Ain Shams Virtual Hospital, Ain Shams University, Cairo, Egypt
| | - Tamer Emara
- Human Mechatronics Lab, Ain Shams Virtual Hospital, Ain Shams University, Cairo, Egypt
- Department of Neurology, Ain Shams University, Cairo, Egypt
| | - Ahmed Elbokl
- Human Mechatronics Lab, Ain Shams Virtual Hospital, Ain Shams University, Cairo, Egypt
- Department of Neurology, Ain Shams University, Cairo, Egypt
| | - Emad Al-Yahya
- School of Rehabilitation Sciences, University of Jordan, Amman, Jordan
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O'Malley N, Coote S, Clifford AM. Outcomes of importance to people with multiple sclerosis, Parkinson's disease and stroke following a falls prevention intervention: a qualitative study to inform a core outcome set. Disabil Rehabil 2024; 46:1580-1592. [PMID: 37092355 DOI: 10.1080/09638288.2023.2201513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/06/2023] [Indexed: 04/25/2023]
Abstract
Purpose: Falls are a major issue for people with neurological conditions, and the evaluation of falls prevention interventions is of high priority. To date, the views of patient groups regarding outcomes of importance have been largely overlooked. The purpose of this study was to explore outcomes of interest among people with Multiple Sclerosis (MS), Parkinson's disease (PD) and stroke upon completion of falls prevention interventions to inform the development of a core outcome set (COS).Materials and methods: Five online focus groups and one semi-structured interview were conducted among people with PD (n = 10), MS (n = 7), and post-stroke (n = 3), one of whom also had PD. Transcripts were analysed using reflexive thematic analysis.Results: Four themes were developed; (1) Fall events are not homogeneous, (2) Exercise-based programmes are beneficial but falls services are not meeting user needs, (3) Programme success beyond the reduction in falls, and (4) Acquisition of skills to self-manage falls beyond the life of the programme.Conclusions: This study presents new perspectives across patient groups regarding important outcomes upon completion of falls prevention interventions. Taken together with the findings of a literature review, this data will inform the development of a COS.Implications for rehabilitationPeople with multiple sclerosis, Parkinson's disease and stroke consider the success of a falls prevention intervention to be dependent on improvements across a wide range of outcomes.The design and implementation of falls prevention interventions should align with patient preferences.Clinicians and researchers should consider the use of multidomain interventions to facilitate improvements in the desired outcomes of patients.
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Affiliation(s)
- Nicola O'Malley
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Susan Coote
- School of Allied Health, University of Limerick, Limerick, Ireland
- Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
- Multiple Sclerosis Society of Ireland, Limerick, Ireland
| | - Amanda M Clifford
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Allen NE, Romaliiska O, Naisby J. Pain and the Non-Pharmacological Management of Pain in People with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024:JPD230227. [PMID: 38457146 DOI: 10.3233/jpd-230227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Pain is a distressing and universal experience, yet everyone's pain experience is influenced by a complex array of biological, psychological, and social factors. For people with Parkinson's disease (PwP), these biopsychosocial factors include neurodegeneration and the psychological and social factors that accompany living with a chronic, neurodegenerative condition in addition to the factors experienced by those in the general population (e.g., living with co-morbidities such as osteoarthritis). The way these factors influence each individual is likely to determine which pain management strategies are optimal for them. This review first describes pain and the biopsychosocial model of pain. It explores how pain is classified in Parkinson's disease (PD) and describes the three main types of pain: nociceptive, neuropathic, and nociplastic pain. This background provides context for a discussion of non-pharmacological pain management strategies that may aid in the management of pain in PwP; exercise, psychological strategies, acupuncture and massage. While there is little PD-specific research to inform the non-pharmacological management of pain, findings from current PD research are combined with that from chronic pain research to present recommendations for clinical practice. Recommendations include assessment that incorporates potential biopsychosocial contributors to pain that will then guide a holistic, multi-modal approach to management. As exercise provides overall benefits for PwP, those with chronic pain should be carefully monitored with exercise prescribed and adjusted accordingly. Research is needed to develop and evaluate multi-modal approaches to pain management that are delivered in a biopsychosocial framework.
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Affiliation(s)
- Natalie Elizabeth Allen
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Oksana Romaliiska
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jenni Naisby
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, United Kingdom
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Hong JP, Kwon H, Park E, Lee SU, Lee CN, Kim BJ, Kim JS, Park KW. The semicircular canal function is preserved with little impact on falls in patients with mild Parkinson's disease. Parkinsonism Relat Disord 2024; 118:105933. [PMID: 38007917 DOI: 10.1016/j.parkreldis.2023.105933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Postural instability is a cardinal symptom of Parkinson's disease (PD), which suggests the vestibular system may be affected in PD. This study aimed to determine whether vestibular dysfunction is associated with the risk of falls in PD. METHODS We prospectively recruited patients with de-novo PD at a tertiary medical center between December 2019 and March 2023. During initial assessment, each patient was queried about falls within the preceding year. All patients underwent evaluation of video head-impulse tests (video-HITs), motion analysis, mini-mental state examination (MMSE), and Montreal Cognitive Assessment (MOCA). We determined whether head impulse gain of the vestibulo-ocular reflex (VOR) was associated with clinical severity of PD or risk of falls. RESULTS Overall, 133 patients (mean age ± SD = 68 ± 10, 59 men) were recruited. The median Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor part (MDS-UPDRS-III) was 23 (interquartile range = 16-31), and 81 patients (61 %) scored 2 or less on the Hoehn and Yahr scale. Fallers were older (p = 0.001), had longer disease duration (p = 0.001), slower gait velocity (p = 0.009), higher MDS-UPDRS-III (p < 0.001) and H&Y scale (p < 0.001), lower MMSE (p = 0.018) and MOCA scores (p = 0.001) than non-fallers. Multiple logistic regression showed that MDS-UPDRS-III had a positive association with falling (p = 0.004). Falling was not associated with VOR gain (p = 0.405). The VOR gain for each semicircular canal showed no correlation with the MDS-UPDRS-III or disease duration. CONCLUSIONS The semicircular canal function, as determined by video-HITs, is relatively spared and has little effect on the risk of falls in patients with mild-to-moderate PD.
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Affiliation(s)
- Jun-Pyo Hong
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Hanim Kwon
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Euyhyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea; Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea; Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Chan-Nyoung Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea; BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea; Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kun-Woo Park
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
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Yang Y, Wang Y, Gao T, Reyila A, Liu J, Liu J, Han H. Effect of Physiotherapy Interventions on Motor Symptoms in People With Parkinson's Disease: A Systematic Review and Meta-Analysis. Biol Res Nurs 2023; 25:586-605. [PMID: 37070664 DOI: 10.1177/10998004231171587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of different types of physiotherapy interventions in people with Parkinson's disease (PD). DESIGN Systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS Five databases (PubMed, Embase, Cochrane Library, CINAHL and Web of Science Core Collection) were searched for relevant RCTs published from database inception to July 14, 2022. Reviewers independently screened the literature, extracted data, and assessed the literature quality according to the Cochrane Collaboration Risk of Bias Tool and PEDro Scale. This meta-analysis was conducted using RevMan 5.4.1 and reported in compliance with the PRISMA statement. RESULTS Forty-two RCTs with 2,530 participants were included. Across all types of physiotherapy, strength training, mind-body exercise, aerobic exercise, and non-invasive brain stimulation (NiBS) were effective in improving motor symptoms as measured by the (Movement Disorders Society-) Unified PD Scale, whereas balance and gait training (BGT) and acupuncture were not. The pooled results showed that the change in mind-body exercise (MD = -5.36, 95% CI [-7.97 to -2.74], p < .01, I2 = 68%) and NiBS (MD = -4.59, 95% CI [-8.59 to -0.59], p = .02, I2 = 78%) reached clinical threshold, indicating clinically meaningful improvements. Considering the effectiveness of the interventions on motor symptoms, balance, gait and functional mobility, mind-body exercise was recommended the most. CONCLUSIONS Exercise appears to be a better form of physiotherapy than NiBS and acupuncture for improving motor function. Mind-body exercise showed beneficial effects on motor symptoms, balance, gait and functional mobility in people with PD, and is worthy of being promoted.
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Affiliation(s)
- Yajie Yang
- School of Nursing, Peking University, Beijing 100191, China
| | - Yang Wang
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | - Tianzi Gao
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | | | - Jiaxin Liu
- Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - Jiajia Liu
- School of Nursing, Peking University, Beijing 100191, China
| | - Hongbin Han
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
- NMPA Key Laboratory for Evaluation of Medical Imaging Equipment and Technique, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging Technology, Beijing 100191, China
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Pham Nguyen TP, Gray SL, Newcomb CW, Liu Q, Hamedani AG, Weintraub D, Hennessy S, Willis AW. Potentially inappropriate medications in older adults with Parkinson disease before and after hospitalization for injury. Parkinsonism Relat Disord 2023; 114:105793. [PMID: 37567062 DOI: 10.1016/j.parkreldis.2023.105793] [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: 05/10/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Parkinson disease (PD) patients are at increased risk of serious injury, such as fall-related fractures. Prescription medications are a modifiable factor for injury risk. OBJECTIVES To determine the extent to which a serious injury requiring hospitalization affects prescribing of potentially inappropriate medications (PIMs) among older adults with PD. METHODS We conducted a quasi-experimental difference-in-difference (DID) study using 2013-2017 Medicare data. The cohort consisted of beneficiaries with PD hospitalized for injury versus for other reasons. PIMs were classified into PD and injury-relevant categories (CNS-active PIMs, PD motor symptom PIMs, PD non-motor symptom PIMs, PIMs that reduce bone mineral density). We estimated mean standardized daily doses (SDDs) of medications within each PIM category before and at 3, 6, and 12 months after hospitalization. We used generalized linear regression models to compare changes in mean SDDs for each PIM category between the injury and non-injury group at each timepoint, adjusting for biological, clinical and social determinants of health variables. RESULTS Both groups discontinued PIMs and/or reduced PIM doses after hospitalization. There were no between-group differences in mean SDD changes, after covariate adjustment, for any PIM category, except for the CNS-active PIMs category at 3 months (DID p-value = 0.00) and for the category of PIMs that reduce bone mineral density at all timepoints (DID p-values = 0.02, 0.04, 0.02 at 3, 6, and 12 months). CONCLUSIONS Similar patterns of PIM among persons with PD after hospitalization for serious injury versus for other reasons may represent a missed opportunity to deprescribe high-risk medications during care transitions.
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Affiliation(s)
- Thanh Phuong Pham Nguyen
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Real-world Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shelly L Gray
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Craig W Newcomb
- Center for Real-world Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Qing Liu
- Center for Real-world Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ali G Hamedani
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Real-world Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Parkinson's Disease Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Real-world Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Allison W Willis
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Real-world Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Parkinson's Disease Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
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A Low-Cost System Using a Big-Data Deep-Learning Framework for Assessing Physical Telerehabilitation: A Proof-of-Concept. Healthcare (Basel) 2023; 11:healthcare11040507. [PMID: 36833041 PMCID: PMC9957301 DOI: 10.3390/healthcare11040507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
The consolidation of telerehabilitation for the treatment of many diseases over the last decades is a consequence of its cost-effective results and its ability to offer access to rehabilitation in remote areas. Telerehabilitation operates over a distance, so vulnerable patients are never exposed to unnecessary risks. Despite its low cost, the need for a professional to assess therapeutic exercises and proper corporal movements online should also be mentioned. The focus of this paper is on a telerehabilitation system for patients suffering from Parkinson's disease in remote villages and other less accessible locations. A full-stack is presented using big data frameworks that facilitate communication between the patient and the occupational therapist, the recording of each session, and real-time skeleton identification using artificial intelligence techniques. Big data technologies are used to process the numerous videos that are generated during the course of treating simultaneous patients. Moreover, the skeleton of each patient can be estimated using deep neural networks for automated evaluation of corporal exercises, which is of immense help to the therapists in charge of the treatment programs.
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Vitorio R, Mancini M, Carlson-Kuhta P, Horak FB, Shah VV. Should we use both clinical and mobility measures to identify fallers in Parkinson's disease? Parkinsonism Relat Disord 2023; 106:105235. [PMID: 36512851 PMCID: PMC10756255 DOI: 10.1016/j.parkreldis.2022.105235] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/09/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although much is known about the multifactorial nature of falls in Parkinson's disease (PD), optimal classification of fallers remains unclear. OBJECTIVE To identify clinical (demographic, motor, cognitive and patient-reported) and objective mobility (balance and gait) measures that best discriminate fallers from non-fallers in PD. METHODS People with mild-to-moderate idiopathic PD were classified as fallers (at least one fall; n = 54) or non-fallers (n = 90) based on previous six months falls. Clinical characteristics included demographic, motor and cognitive status and patient-reported outcomes. Mobility (balance and gait) characteristics were derived from body-worn, inertial sensors while performing walking and standing tasks. To investigate the combinations of (up to four) measures that best discriminate fallers from non-fallers in each scenario (i.e., clinical-only, mobility-only and combined clinical + mobility models), we applied logistic regression employing a 'best subsets selection strategy' with a 5-fold cross validation, and calculated the area under the curve (AUC). RESULTS The highest AUCs for the clinical-only, mobility-only and clinical + mobility models were 0.89, 0.88, and 0.94, respectively. The most consistently selected measures in the top-10 ranked models were freezing of gait status (8x), the root mean square of anterior-posterior trunk acceleration while standing on a foam with eyes open (5x), gait double support duration (4x) and the postural instability and gait disorders score from the MDS UPDRS (4x). CONCLUSIONS Findings highlight the importance of considering multiple aspects of clinical as well as objective balance and gait characteristics for the classification of fallers and non-fallers in PD.
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Affiliation(s)
- Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Department of Sport, Exercise & Rehabilitation, Northumbria University, UK
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; APDM Wearable Technologies, a Clario Company, Portland, OR, USA
| | - Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; APDM Wearable Technologies, a Clario Company, Portland, OR, USA.
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10
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Jansen JA, Tosserams A, Weerdesteyn VG, Bloem BR, Nonnekes J. The 'Pants-Sign': A Predictor for Falling in People with Parkinson's Disease? JOURNAL OF PARKINSON'S DISEASE 2023; 13:1321-1327. [PMID: 38108362 PMCID: PMC10741315 DOI: 10.3233/jpd-230353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND A history of falls is the most established predictor of future falls in people with Parkinson's disease (PD). However, predicting a first fall remains challenging. OBJECTIVE To assess whether experiencing difficulties putting on pants while standing is a viable predictor of future falling, and specifically a first fall, in persons with PD. We define this 'Pants-sign' as people who resort to putting on their pants only while seated. METHODS 264 persons with PD were included. Information on the Pants-sign, history of falls, disease severity (MDS-UPDRS part III), freezing of gait (N-FOGQ > 0), cognitive function (MoCA), self-reported disability (Schwab & England scale), health-related quality of life (SF-12), Timed-Up-and-Go, and one-legged stance were determined at baseline and after one-year follow-up. The association between the Pants-sign and future falling was examined by univariate logistic regression analysis. A multivariate step-wise logistic regression with forward selection was employed to identify the strongest associations in the entire cohort and a sub-cohort of people without falls in the year prior to baseline. RESULTS The Pants-sign was univariably associated with a future fall (OR = 2.406, 95% CI [1.313-4.409], p = 0.004]), but was not an independent predictor in the multivariate logistic regression; predictors were higher MDS-UPDRS part III scores (OR = 1.088, 95% CI [1.056-1.121], p < 0.001] and history of falls (OR = 5.696, 95% CI [2.650-12.243], p≤0.001]. For the sub-cohort of people without falls in the previous year (n = 189), the Pants-sign was not associated with future falls. CONCLUSIONS The Pants-sign is simple to assess and is associated with future falling in PD but is not an independent predictor.
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Affiliation(s)
- Jamie A.F. Jansen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Anouk Tosserams
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Vivian G.M. Weerdesteyn
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Bastiaan R. Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Ubbergen, The Netherlands
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11
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Cristini J, Parwanta Z, De las Heras B, Medina-Rincon A, Paquette C, Doyon J, Dagher A, Steib S, Roig M. Motor Memory Consolidation Deficits in Parkinson's Disease: A Systematic Review with Meta-Analysis. JOURNAL OF PARKINSON'S DISEASE 2023; 13:865-892. [PMID: 37458048 PMCID: PMC10578244 DOI: 10.3233/jpd-230038] [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] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The ability to encode and consolidate motor memories is essential for persons with Parkinson's disease (PD), who usually experience a progressive loss of motor function. Deficits in memory encoding, usually expressed as poorer rates of skill improvement during motor practice, have been reported in these patients. Whether motor memory consolidation (i.e., motor skill retention) is also impaired is unknown. OBJECTIVE To determine whether motor memory consolidation is impaired in PD compared to neurologically intact individuals. METHODS We conducted a pre-registered systematic review (PROSPERO: CRD42020222433) following PRISMA guidelines that included 46 studies. RESULTS Meta-analyses revealed that persons with PD have deficits in retaining motor skills (SMD = -0.17; 95% CI = -0.32, -0.02; p = 0.0225). However, these deficits are task-specific, affecting sensory motor (SMD = -0.31; 95% CI -0.47, -0.15; p = 0.0002) and visuomotor adaptation (SMD = -1.55; 95% CI = -2.32, -0.79; p = 0.0001) tasks, but not sequential fine motor (SMD = 0.17; 95% CI = -0.05, 0.39; p = 0.1292) and gross motor tasks (SMD = 0.04; 95% CI = -0.25, 0.33; p = 0.7771). Importantly, deficits became non-significant when augmented feedback during practice was provided, and additional motor practice sessions reduced deficits in sensory motor tasks. Meta-regression analyses confirmed that deficits were independent of performance during encoding, as well as disease duration and severity. CONCLUSION Our results align with the neurodegenerative models of PD progression and motor learning frameworks and emphasize the importance of developing targeted interventions to enhance motor memory consolidation in PD.
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Affiliation(s)
- Jacopo Cristini
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Zohra Parwanta
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Bernat De las Heras
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Almudena Medina-Rincon
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
- Grupo de investigación iPhysio, San Jorge University, Zaragoza, Aragón, Spain
- Department of Physiotherapy, San Jorge University, Zaragoza, Aragón, Spain
| | - Caroline Paquette
- Department of Kinesiology & Physical Education, McGill University, Montreal, QC,Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
| | - Julien Doyon
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Alain Dagher
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Simon Steib
- Department of Human Movement, Training and Active Aging, Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Marc Roig
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
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12
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Li Y, Huang X, Ruan X, Duan D, Zhang Y, Yu S, Chen A, Wang Z, Zou Y, Xia M, Wei X. Baseline cerebral structural morphology predict freezing of gait in early drug-naïve Parkinson's disease. NPJ Parkinsons Dis 2022; 8:176. [PMID: 36581626 PMCID: PMC9800563 DOI: 10.1038/s41531-022-00442-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022] Open
Abstract
Freezing of gait (FOG) greatly impacts the daily life of patients with Parkinson's disease (PD). However, predictors of FOG in early PD are limited. Moreover, recent neuroimaging evidence of cerebral morphological alterations in PD is heterogeneous. We aimed to develop a model that could predict the occurrence of FOG using machine learning, collaborating with clinical, laboratory, and cerebral structural imaging information of early drug-naïve PD and investigate alterations in cerebral morphology in early PD. Data from 73 healthy controls (HCs) and 158 early drug-naïve PD patients at baseline were obtained from the Parkinson's Progression Markers Initiative cohort. The CIVET pipeline was used to generate structural morphological features with T1-weighted imaging (T1WI). Five machine learning algorithms were calculated to assess the predictive performance of future FOG in early PD during a 5-year follow-up period. We found that models trained with structural morphological features showed fair to good performance (accuracy range, 0.67-0.73). Performance improved when clinical and laboratory data was added (accuracy range, 0.71-0.78). For machine learning algorithms, elastic net-support vector machine models (accuracy range, 0.69-0.78) performed the best. The main features used to predict FOG based on elastic net-support vector machine models were the structural morphological features that were mainly distributed in the left cerebrum. Moreover, the bilateral olfactory cortex (OLF) showed a significantly higher surface area in PD patients than in HCs. Overall, we found that T1WI morphometric markers helped predict future FOG occurrence in patients with early drug-naïve PD at the individual level. The OLF exhibits predominantly cortical expansion in early PD.
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Affiliation(s)
- Yuting Li
- grid.79703.3a0000 0004 1764 3838Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China ,grid.284723.80000 0000 8877 7471Affiliated Dongguan Hospital, Southern Medical University (Dongguan People’s Hospital), Guangdong, China
| | - Xiaofei Huang
- grid.79703.3a0000 0004 1764 3838Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Xiuhang Ruan
- grid.79703.3a0000 0004 1764 3838Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Dingna Duan
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yihe Zhang
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Shaode Yu
- grid.443274.20000 0001 2237 1871School of Information and Communication Engineering, Communication University of China, Beijing, China
| | - Amei Chen
- grid.79703.3a0000 0004 1764 3838Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Zhaoxiu Wang
- grid.79703.3a0000 0004 1764 3838Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Yujian Zou
- grid.284723.80000 0000 8877 7471Affiliated Dongguan Hospital, Southern Medical University (Dongguan People’s Hospital), Guangdong, China
| | - Mingrui Xia
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Xinhua Wei
- grid.79703.3a0000 0004 1764 3838Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
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13
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Castro IP, Valença GT, Pinto EB, Cavalcanti HM, Oliveira‐Filho J, Almeida LRS. Predictors of Falls with Injuries in People with Parkinson's Disease. Mov Disord Clin Pract 2022; 10:258-268. [PMID: 36825046 PMCID: PMC9941941 DOI: 10.1002/mdc3.13636] [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: 12/06/2021] [Revised: 11/03/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Background Falls are frequent in Parkinson's disease (PD), but there is lack of information about predictors of injurious falls. Objectives To determine predictors of falls with injuries in people with PD; to compare circumstances and consequences of falls in single and recurrent fallers. Methods Participants (n = 225) were assessed by disease-specific, self-report, and balance measures, and followed-up for 12 months with a diary to record falls, their circumstances, and injuries. Univariate and multivariate analyses were performed. Circumstances and consequences of falls presented by single and recurrent fallers were compared. Results A total of 805 falls were analyzed, 107 (13%) were falls with injuries. Multivariate logistic regression model revealed that greater PD duration and higher balance confidence were protective factors; better balance during gait, outdoor falls, and falls related to extrinsic factors were risk factors for falls with injuries, when compared to falls with no injuries. Multivariate multinomial regression model revealed that, when compared to zero fall, past falls and daily levodopa equivalent dose were predictors of falls with injuries; these predictors together with disability were predictors of falls with no injuries. Single falls (n = 27; 3%) were more common outdoors because of extrinsic factors, whereas recurrent falls (n = 778; 97%) were more common indoors because of intrinsic factors. Single falls led to more injuries than recurrent falls (P < 0.05). Conclusions Different predictors of falls with injuries were obtained when different outcomes were compared. It should be noted that falls with injuries might be influenced by fall-related activities and environmental factors. Single and recurrent falls differed on circumstances and consequences.
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Affiliation(s)
- Isabella P.R. Castro
- Postgraduate Program in Health SciencesFederal University of Bahia School of MedicineSalvadorBahiaBrazil,Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBahiaBrazil
| | - Guilherme T. Valença
- Movement Disorders and Parkinson's Disease ClinicRoberto Santos General HospitalSalvadorBahiaBrazil
| | - Elen Beatriz Pinto
- Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBahiaBrazil,Department of Life Sciences (DCV)Bahia State UniversitySalvadorBahiaBrazil
| | - Helen M. Cavalcanti
- Postgraduate Program in Health SciencesFederal University of Bahia School of MedicineSalvadorBahiaBrazil,Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBahiaBrazil
| | - Jamary Oliveira‐Filho
- Postgraduate Program in Health SciencesFederal University of Bahia School of MedicineSalvadorBahiaBrazil
| | - Lorena Rosa S. Almeida
- Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBahiaBrazil,Movement Disorders and Parkinson's Disease ClinicRoberto Santos General HospitalSalvadorBahiaBrazil
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14
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Brognara L, Mafla-España MA, Gil-Molina I, Castillo-Verdejo Y, Cauli O. The Effects of 3D Custom Foot Orthotics with Mechanical Plantar Stimulation in Older Individuals with Cognitive Impairment: A Pilot Study. Brain Sci 2022; 12:brainsci12121669. [PMID: 36552129 PMCID: PMC9775314 DOI: 10.3390/brainsci12121669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Recent scientific evidence supports the idea that foot plantar stimulation increases the functional connectivity of brain regions involved in visuo-spatial and sensory-motor integration. In this before−after, non-randomised intervention study we assessed the change in several gait and postural parameters using inertial sensor measurements after acute plantar stimulation using custom 3D-printed insoles. The pilot study was performed on 22 institutionalised, older individuals with a high comorbidity burden who either walked autonomously or with the help of a cane. The intensity of the effects in the first mechanical plantar stimulation session (at one week) strongly predicted a change in the 180° turn duration (p < 0.05) and the standard deviation of the step duration (p < 0.05) during the timed up-and-go test. Based on these effects, researchers also predicted decreases in some postural parameters such as the root mean square of displacement on the anterior−posterior axis (p < 0.01). Thus, these preliminary findings provide a strong rationale for performing controlled clinical trials with larger samples to investigate the efficacy and mechanisms of mechanical plantar stimulation in frail elderly individuals.
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Affiliation(s)
- Lorenzo Brognara
- Department of Biomedical and Neuromotor Science, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy
- Correspondence:
| | - Mayra Alejandra Mafla-España
- Frailty and Cognitive Impairment Organized Group, University of Valencia, 46010 Valencia, Spain
- Department of Nursing, University of Valencia, Jaume Roig s/n, 46010 Valencia, Spain
| | | | | | - Omar Cauli
- Frailty and Cognitive Impairment Organized Group, University of Valencia, 46010 Valencia, Spain
- Department of Nursing, University of Valencia, Jaume Roig s/n, 46010 Valencia, Spain
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15
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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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16
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Magnuszewski L, Wojszel A, Kasiukiewicz A, Wojszel ZB. Falls at the Geriatric Hospital Ward in the Context of Risk Factors of Falling Detected in a Comprehensive Geriatric Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10789. [PMID: 36078502 PMCID: PMC9518316 DOI: 10.3390/ijerph191710789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
It is only by knowing the most common causes of falls in the hospital that appropriate and targeted fall prevention measures can be implemented. This study aimed to assess the frequency of falls in a hospital geriatrics ward and the circumstances in which they occurred and evaluate the parameters of the comprehensive geriatric assessment (CGA) correlating with falls. We considered medical, functional, and nutritional factors associated with falls and built multivariable logistic regression analysis models. A total of 416 (median age 82 (IQR 77-86) years, 77.4% women) hospitalizations in the geriatrics ward were analyzed within 8 months. We compared the results of a CGA (including health, psycho-physical abilities, nutritional status, risk of falls, frailty syndrome, etc.) in patients who fell and did not fall. Fourteen falls (3.3% of patients) were registered; the rate was 4.4 falls per 1000 patient days. They most often occurred in the patient's room while changing position. Falls happened more frequently among people who were more disabled, had multimorbidity, were taking more medications (certain classes of drugs in particular), had Parkinson's disease and diabetes, reported falls in the last year, and were diagnosed with orthostatic hypotension. Logistic regression determined the significant independent association between in-hospital falls and a history of falls in the previous 12 months, orthostatic hypotension, Parkinson's disease, and taking statins, benzodiazepines, and insulin. Analysis of the registered falls that occurred in the hospital ward allowed for an analysis of the circumstances in which they occurred and helped to identify people at high risk of falling in a hospital, which can guide appropriate intervention and act as an indicator of good hospital care.
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Affiliation(s)
- Lukasz Magnuszewski
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
- Doctoral Studies, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
| | - Aleksandra Wojszel
- Student’s Scientific Society at the Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
| | - Agnieszka Kasiukiewicz
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
| | - Zyta Beata Wojszel
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
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17
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Myra RS, Koerich MHADL, Gregório EC, Swarowsky A. Primary care for people with Parkinson's disease in Brazil: A referral flowchart based on risk of falls. Front Public Health 2022; 10:836633. [PMID: 35991031 PMCID: PMC9387551 DOI: 10.3389/fpubh.2022.836633] [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: 12/15/2021] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background People with Parkinson's disease (PD) need to exercise to have a better quality of life. The risk of falling needs to be considered when choosing and implementing exercise interventions. Flowcharts are used to facilitate referrals in Brazilian primary care network, but there is no specific one for PD. Aim To develop a referral flowchart for people with PD in Brazilian primary care based on the risk of falls and scientific evidence in the context of a multidisciplinary approach. Methods The development of the referral flowchart was accomplished in three steps; (1) relevant literature was reviewed (2) semi-structured interviews (in focus groups) were conducted with primary health care professionals to investigate the current care for people with Parkinson's disease, and (3) the information obtained from the previous steps were analyzed to inform the development of the referral flowchart. Results The fall risk-based flowchart uses the 3-step-fall-prediction tool. The primary health care professional should refer the person with a low risk of falls to activities with minimal supervision and those with a higher risk of falls to specialized neurology services. Neurology services are also the referral target for persons presenting significant mobility restrictions (i.e., restricted to a wheelchair or bed). The referral occurs according to what is available in Brazilian primary care. Conclusion This flowchart might be the first step to build a multidisciplinary approach for people with Parkinson's disease in Brazilian primary care. The next stage of this study is the validation and subsequent implementation of the flowchart through the primary care at Unified Health System in Brazil.
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Affiliation(s)
- Rafaela Simon Myra
- Brazilian Parkinson's Disease Rehabilitation Initiative (BPaRkI), Center for Health and Sports Sciences (CEFID), Santa Catarina State University (UDESC), Florianópolis, Brazil
| | | | - Elaine Cristina Gregório
- Brazilian Parkinson's Disease Rehabilitation Initiative (BPaRkI), Center for Health and Sports Sciences (CEFID), Santa Catarina State University (UDESC), Florianópolis, Brazil
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18
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Zhang J, Luximon Y, Pang MYC, Wang H. Effectiveness of exergaming-based interventions for mobility and balance performance in older adults with Parkinson's disease: systematic review and meta-analysis of randomised controlled trials. Age Ageing 2022; 51:6653486. [PMID: 35930726 DOI: 10.1093/ageing/afac175] [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: 01/24/2022] [Revised: 06/01/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND exergaming-based interventions (EbIs) have been proposed to improve older adults' mobility and balance performance. However, the effectiveness of such interventions for older adults with Parkinson's disease (OAPD) remains unclear. METHODS seven databases (Web of Science, Medline, Academic Search Premier, CINAHL Complete, PsycINFO, PsychARTICLE and PubMed) were searched up to 7 April 2022. We assessed mobility and balance performance between EbIs groups and control groups or traditional physical training interventions (TPTIs) groups by comparing the outcomes of the Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), Berg Balance Scale (BBS), gait velocity, stride length and Functional Gait Assessment (FGA). RESULTS we scanned 1,190 articles and meta-analysed 19 trials (sample size = 781). In general, the results revealed statistical differences between EbIs groups and TPTIs groups in the TUG [mean difference (MD) = -1.030 s; 95% confidence interval (CI) = -2.029 to -0.031; P = 0.043; high quality of evidence], 6MWT (MD = 63.483 m; 95% CI = 9.542 to 117.425; P = 0.021; moderate quality of evidence), BBS (MD = 2.129; 95% CI = -1.293 to 2.965; P < 0.001; high quality of evidence) and FGA (MD = 2.099 95% CI = -0.306 to 3.893; P = 0.022; moderate quality of evidence). No significant difference was discovered between EbIs groups and TPTIs groups in enhancing gait velocity and stride length. CONCLUSIONS EbIs are statistically better than TPTIs in improving OAPD's performance in TUG, 6MWT, BBS and FGA, whereas only the change between EbIs and TPTIs in 6MWT can reach the value of minimal clinically important difference. Further studies are needed to better assess the effectiveness of exergaming-based interventions.
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Affiliation(s)
- Jiaxin Zhang
- School of Design, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yan Luximon
- School of Design, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Hailiang Wang
- School of Design, The Hong Kong Polytechnic University, Hong Kong SAR, China
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19
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Liu N, Babazono A, Ishihara R, Li Y, Jamal A, Kim SA, Matsuda S. Association between care rehabilitation and the risk of fracture hospitalization in people with Parkinson's disease. Geriatr Gerontol Int 2022; 22:628-634. [PMID: 35777740 DOI: 10.1111/ggi.14428] [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: 07/24/2021] [Revised: 05/13/2022] [Accepted: 06/05/2022] [Indexed: 11/29/2022]
Abstract
AIM This study examined whether there is an association between continuous care rehabilitation (CR) and the risk of fracture hospitalization among people with Parkinson's disease (PwP) aged >75 years with mild-to-moderate care needs level. METHODS A retrospective study design based on the merging of medical claims and long-term care insurance claims data was used. Before propensity score matching, of the 2177 participants, 222 received continuous CR, whereas 1955 did not. After matching using a 1:4 ratio, we identified 222 patients in the CR group and 888 patients in the non-CR groups. We carried out a survival analysis to clarify the association between CR and the risk of fracture hospitalization. RESULTS After matching, there was a significant difference between the CR and non-CR groups in 3 years (stratified log-rank test by age P = 0.036) and in 4 years (stratified log-rank test by age P = 0.011). The CR group was significantly associated with delays of hospital admission due to fracture within 3 years (hazard ratio 0.54; 95% confidence interval 0.29-0.99; P = 0.047) and within 4 years (hazard ratio 0.52; 95% confidence interval 0.30-0.88; P = 0.010). CONCLUSIONS Our study showed that older people with Parkinson's disease who continuously received CR had a lower risk of fracture hospitalization in 3 and 4 years than those who did not receive CR or received interrupted CR. Considering our participants with a mild-to-moderate care needs level, a sustainable CR service might benefit people with Parkinson's disease from an early time when their activities of daily living are still intact and cognitive function has not deteriorated. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Ning Liu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Reiko Ishihara
- Department of Management Welfare Business, Faculty of Human Sociology, Kobe University of Future Health Sciences, Osaka, Japan
| | - Yunfei Li
- Department of Health Care Administration and Management, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.,Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Aziz Jamal
- Department of Health Care Administration and Management, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.,Health Administration Program, Faculty of Business and Management, University Teknologi MARA, Shah Alam, Malaysia
| | - Sung-A Kim
- Department of Health Care Administration and Management, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Fukuoka, Japan
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20
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Roth N, Ullrich M, Kuderle A, Gladow T, Marxreiter F, Gassner H, Kluge F, Klucken J, Eskofier BM. Real-World Stair Ambulation Characteristics Differ Between Prospective Fallers and Non-Fallers in Parkinson's Disease. IEEE J Biomed Health Inform 2022; 26:4733-4742. [PMID: 35759602 DOI: 10.1109/jbhi.2022.3186766] [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: 11/08/2022]
Abstract
Falls are among the leading causes of injuries or death for individuals from the age of 65 and the prevalence of falls is especially high for patients suffering from neurological diseases like Parkinson's disease (PD). Due to advancements in wearable sensor technology, inertial measurement units (IMUs) can be integrated unobtrusively into patients' everyday lives to monitor various mobility and gait parameters, which are related to common risk factors like reduced balance and reduced lower-limb muscle strength, or lower range of joints. Although stair ambulation is a fundamental part of our daily lives and is known for its unique challenges for the gait and balance system, long-term gait analysis studies have not investigated real-world stair ambulation parameters yet. Therefore, we applied a recently published gait analysis pipeline on real-world foot-worn IMU data of 40 PD patients over a recording period of two weeks to extract objective gait parameters from level walking but also from stair ascending and stair descending gait. In combination with fall records from a prospective three-month follow-up phase, we investigated group differences in gait parameters of future fallers compared to non-fallers for each individual gait activity. We found significant differences in stair ascending and descending parameters. Stance time was increased by up to 20% and gait speed reduced by up to 16% for fallers compared to non-fallers during stair walking. These differences were not present in level walking parameters. Hence, these results suggest that real-world stair ambulation provides sensitive parameters for mobility and fall risk due to the unique challenges stairs add to the balance and control system. Our work complements existing gait analysis studies by adding new insights into mobility and gait performance during real-world gait.
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21
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Allen NE, Canning CG, Almeida LRS, Bloem BR, Keus SH, Löfgren N, Nieuwboer A, Verheyden GS, Yamato TP, Sherrington C. Interventions for preventing falls in Parkinson's disease. Cochrane Database Syst Rev 2022; 6:CD011574. [PMID: 35665915 PMCID: PMC9169540 DOI: 10.1002/14651858.cd011574.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Most people with Parkinson's disease (PD) experience at least one fall during the course of their disease. Several interventions designed to reduce falls have been studied. An up-to-date synthesis of evidence for interventions to reduce falls in people with PD will assist with informed decisions regarding fall-prevention interventions for people with PD. OBJECTIVES To assess the effects of interventions designed to reduce falls in people with PD. SEARCH METHODS CENTRAL, MEDLINE, Embase, four other databases and two trials registers were searched on 16 July 2020, together with reference checking, citation searching and contact with study authors to identify additional studies. We also conducted a top-up search on 13 October 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) of interventions that aimed to reduce falls in people with PD and reported the effect on falls. We excluded interventions that aimed to reduce falls due to syncope. DATA COLLECTION AND ANALYSIS We used standard Cochrane Review procedures. Primary outcomes were rate of falls and number of people who fell at least once. Secondary outcomes were the number of people sustaining one or more fall-related fractures, quality of life, adverse events and economic outcomes. The certainty of the evidence was assessed using GRADE. MAIN RESULTS This review includes 32 studies with 3370 participants randomised. We included 25 studies of exercise interventions (2700 participants), three studies of medication interventions (242 participants), one study of fall-prevention education (53 participants) and three studies of exercise plus education (375 participants). Overall, participants in the exercise trials and the exercise plus education trials had mild to moderate PD, while participants in the medication trials included those with more advanced disease. All studies had a high or unclear risk of bias in one or more items. Illustrative risks demonstrating the absolute impact of each intervention are presented in the summary of findings tables. Twelve studies compared exercise (all types) with a control intervention (an intervention not thought to reduce falls, such as usual care or sham exercise) in people with mild to moderate PD. Exercise probably reduces the rate of falls by 26% (rate ratio (RaR) 0.74, 95% confidence interval (CI) 0.63 to 0.87; 1456 participants, 12 studies; moderate-certainty evidence). Exercise probably slightly reduces the number of people experiencing one or more falls by 10% (risk ratio (RR) 0.90, 95% CI 0.80 to 1.00; 932 participants, 9 studies; moderate-certainty evidence). We are uncertain whether exercise makes little or no difference to the number of people experiencing one or more fall-related fractures (RR 0.57, 95% CI 0.28 to 1.17; 989 participants, 5 studies; very low-certainty evidence). Exercise may slightly improve health-related quality of life immediately following the intervention (standardised mean difference (SMD) -0.17, 95% CI -0.36 to 0.01; 951 participants, 5 studies; low-certainty evidence). We are uncertain whether exercise has an effect on adverse events or whether exercise is a cost-effective intervention for fall prevention. Three studies trialled a cholinesterase inhibitor (rivastigmine or donepezil). Cholinesterase inhibitors may reduce the rate of falls by 50% (RaR 0.50, 95% CI 0.44 to 0.58; 229 participants, 3 studies; low-certainty evidence). However, we are uncertain if this medication makes little or no difference to the number of people experiencing one or more falls (RR 1.01, 95% CI 0.90 to 1.14230 participants, 3 studies) and to health-related quality of life (EQ5D Thermometer mean difference (MD) 3.00, 95% CI -3.06 to 9.06; very low-certainty evidence). Cholinesterase inhibitors may increase the rate of non fall-related adverse events by 60% (RaR 1.60, 95% CI 1.28 to 2.01; 175 participants, 2 studies; low-certainty evidence). Most adverse events were mild and transient in nature. No data was available regarding the cost-effectiveness of medication for fall prevention. We are uncertain of the effect of education compared to a control intervention on the number of people who fell at least once (RR 10.89, 95% CI 1.26 to 94.03; 53 participants, 1 study; very low-certainty evidence), and no data were available for the other outcomes of interest for this comparisonWe are also uncertain (very low-certainty evidence) whether exercise combined with education makes little or no difference to the number of falls (RaR 0.46, 95% CI 0.12 to 1.85; 320 participants, 2 studies), the number of people sustaining fall-related fractures (RR 1.45, 95% CI 0.40 to 5.32,320 participants, 2 studies), or health-related quality of life (PDQ39 MD 0.05, 95% CI -3.12 to 3.23, 305 participants, 2 studies). Exercise plus education may make little or no difference to the number of people experiencing one or more falls (RR 0.89, 95% CI 0.75 to 1.07; 352 participants, 3 studies; low-certainty evidence). We are uncertain whether exercise combined with education has an effect on adverse events or is a cost-effective intervention for fall prevention. AUTHORS' CONCLUSIONS: Exercise interventions probably reduce the rate of falls, and probably slightly reduce the number of people falling in people with mild to moderate PD. Cholinesterase inhibitors may reduce the rate of falls, but we are uncertain if they have an effect on the number of people falling. The decision to use these medications needs to be balanced against the risk of non fall-related adverse events, though these adverse events were predominantly mild or transient in nature. Further research in the form of large, high-quality RCTs are required to determine the relative impact of different types of exercise and different levels of supervision on falls, and how this could be influenced by disease severity. Further work is also needed to increase the certainty of the effects of medication and further explore falls prevention education interventions both delivered alone and in combination with exercise.
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Affiliation(s)
- Natalie E Allen
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Colleen G Canning
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lorena Rosa S Almeida
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital, Salvador, Brazil
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Bastiaan R Bloem
- Raboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
| | - Samyra Hj Keus
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
- Quality and Improvement, OLVG, Amsterdam, Netherlands
| | - Niklas Löfgren
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Women's and Children's Health, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Tiê P Yamato
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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22
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O'Malley N, Coote S, Clifford AM. Protocol for the development of a core outcome set for evaluating mixed-diagnosis falls prevention interventions for people with Multiple Sclerosis, Parkinson’s Disease and stroke. HRB Open Res 2022; 4:123. [PMID: 35633846 PMCID: PMC9123332 DOI: 10.12688/hrbopenres.13459.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 01/07/2023] Open
Abstract
Background: Given the high incidence of falls and their associated negative effects, the development of effective falls prevention interventions for people with Multiple Sclerosis (MS), Parkinson's Disease (PD) and stroke is a priority. Currently the implementation of condition-specific falls prevention interventions is challenging in the community due to lack of participants and resources. Given the similarities in falls risk factors across stroke, PD and MS, the design of mixed-diagnosis interventions for groups comprising of people with these three neurological conditions may solve these implementation challenges. Having a core outcome set (COS) for evaluating these interventions would enable the comparison and combination of data, thereby facilitating progress in this research area. Therefore, the aim of this research study is to develop a COS for evaluating mixed-diagnosis falls prevention interventions for people with MS, PD and stroke. Methods: This will be a mixed-methods, international, multi-perspective Delphi consensus study with five stages. Stage one will involve the identification of potential outcomes through a systematic literature search, patient focus groups, and consultation with our stakeholder group. The second stage will be the development of the Delphi survey using the outcomes elicited from stage one. Stage three will be the prioritisation of outcomes using a two-round online Delphi survey involving patients, clinicians, researchers and policy-makers/service-planners. The fourth stage will be to identify and recommend outcome measures and definitions. The final stage will be a consensus meeting with representatives from each stakeholder group to agree upon the final COS. Discussion: Adoption of this COS in future trials investigating the effectiveness of mixed-diagnosis falls prevention interventions for people with MS, PD and stroke will facilitate the comparison and combination of research findings. This should translate into improved decision-making by service-planners/policy-makers and clinicians regarding the implementation of evidence-based falls prevention interventions into practice.
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Affiliation(s)
- Nicola O'Malley
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Susan Coote
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
- Multiple Sclerosis Society of Ireland, Limerick, Ireland
| | - Amanda M Clifford
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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23
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O'Malley N, Coote S, Clifford AM. Protocol for the development of a core outcome set for evaluating mixed-diagnosis falls prevention interventions for people with Multiple Sclerosis, Parkinson's Disease and stroke. HRB Open Res 2022; 4:123. [PMID: 35633846 PMCID: PMC9123332 DOI: 10.12688/hrbopenres.13459.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/15/2023] Open
Abstract
Background: Given the high incidence of falls and their associated negative effects, the development of effective falls prevention interventions for people with Multiple Sclerosis (MS), Parkinson's Disease (PD) and stroke is a priority. Currently the implementation of condition-specific falls prevention interventions is challenging in the community due to lack of participants and resources. Given the similarities in falls risk factors across stroke, PD and MS, the design of mixed-diagnosis interventions for groups comprising of people with these three neurological conditions may solve these implementation challenges. Having a core outcome set (COS) for evaluating these interventions would enable the comparison and combination of data, thereby facilitating progress in this research area. Therefore, the aim of this research study is to develop a COS for evaluating mixed-diagnosis falls prevention interventions for people with MS, PD and stroke. Methods: This will be a mixed-methods, international, multi-perspective Delphi consensus study with five stages. Stage one will involve the identification of potential outcomes through a systematic literature search, patient focus groups, and consultation with our stakeholder group. The second stage will be the development of the Delphi survey using the outcomes elicited from stage one. Stage three will be the prioritisation of outcomes using a two-round online Delphi survey involving patients, clinicians, researchers and policy-makers/service-planners. The fourth stage will be to identify and recommend outcome measures and definitions. The final stage will be a consensus meeting with representatives from each stakeholder group to agree upon the final COS. Discussion: Adoption of this COS in future trials investigating the effectiveness of mixed-diagnosis falls prevention interventions for people with MS, PD and stroke will facilitate the comparison and combination of research findings. This should translate into improved decision-making by service-planners/policy-makers and clinicians regarding the implementation of evidence-based falls prevention interventions into practice.
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Affiliation(s)
- Nicola O'Malley
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Susan Coote
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
- Multiple Sclerosis Society of Ireland, Limerick, Ireland
| | - Amanda M Clifford
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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24
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Laic RAG, Vander Sloten J, Depreitere B. Traumatic brain injury in the elderly population: a 20-year experience in a tertiary neurosurgery center in Belgium. Acta Neurochir (Wien) 2022; 164:1407-1419. [PMID: 35267099 DOI: 10.1007/s00701-022-05159-0] [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: 01/13/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Traumatic brain injury (TBI) rates in the elderly population are rapidly increasing worldwide. However, there are no clinical guidelines for the treatment of elderly TBI to date. This study aims at describing injury patterns and severity, clinical management, and outcomes in elderly TBI patients, which may contribute to specific prognostic tools and clinical guidelines in the future. METHODS Clinical records of 2999 TBI patients ≥ 65 years old admitted in the University Hospital Leuven (Belgium) between 1999 and 2019 were manually screened and 1480 cases could be included. Records were scrutinized for relevant clinical data. RESULTS The median age in the cohort was 78.0 years (IQR = 12). Falls represented the main accident mechanism (79.7%). The median Glasgow Coma Score on admission was 15 (range 3-15). Subdural hematomas were the most common lesion (28.4%). 90.1% of all patients were hospitalized and 27.0% were admitted to intensive care. 16.4% underwent a neurosurgical intervention. 11.0% of all patients died within 30 days post-TBI. Among the 521 patients with mild TBI, 28.6% were admitted to ICU and 13.1% had a neurosurgical intervention and 30-day mortality was 6.9%. CONCLUSION Over the 20-year study period, an increase of age and comorbidities and a reduction in neurosurgical interventions and ICU admissions were observed, along with a trend to less severe injuries but a higher proportion of treatment withdrawals, while at the same time mortality rates decreased. TBI is a life-changing event, leading to severe consequences in the elderly population, especially at higher ages. Even mild TBI is associated with substantial rates of hospitalization, surgery, and mortality in elderly. The characteristics of the elderly population with TBI are subject to changes over time.
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25
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Landers MR, Nilsson MH. A theoretical framework for addressing fear of falling avoidance behavior in Parkinson's disease. Physiother Theory Pract 2022; 39:895-911. [PMID: 35180834 DOI: 10.1080/09593985.2022.2029655] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Postural instability in Parkinson's disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent downstream consequences is fear of falling (FOF), which is both common and problematic in PD. It can lead to a vicious cycle of FOF avoidance behavior that results in more sedentary behavior, physical deconditioning, and weakening of already impaired balance systems. This, in turn, may make the person with PD more susceptible to a future fall even with benign daily tasks. While FOF activity avoidance can be adaptive (appropriate), it can also be maladaptive (inappropriate or exaggerated). When this adaptive and maladaptive FOF avoidance behavior is contextualized to gait/balance performance, it provides a theoretical framework that can be used by clinicians to match patterns of behavior to a concordant treatment approach. In the theoretical framework proposed in this perspective, four different patterns related to FOF avoidance behavior and gait/balance performance are suggested: appropriate avoiders, appropriate non-avoiders, inappropriate avoiders, and inappropriate non-avoiders. For each of the four FOF avoidance behavior patterns, this paper also provides suggested treatment focuses, approaches and recommendations.
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Affiliation(s)
- Merrill R Landers
- Department of Physical Therapy, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Maria H Nilsson
- Department of Health Sciences, Lund University, Lund, Sweden.,Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Kawami Y, Nikaido Y, Nose S, Unekawa M, Marumoto K, Kawami M, Matsugashita S, Kozuki T, Akisue T. Mediolateral Postural Control during Gait in Parkinson’s Disease. Prog Rehabil Med 2022; 7:20220048. [PMID: 36160027 PMCID: PMC9470496 DOI: 10.2490/prm.20220048] [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: 03/21/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: Balance in the mediolateral direction is usually maintained in patients with
early-stage Parkinson’s disease (PD), but not in moderate-stage PD as revealed by the
Tandem Gait Test. Although mediolateral postural control in PD patients remains
controversial, previous studies have shown that the Tandem Gait Test may predict the
risk of future falls in patients with PD. This study aimed to clarify postural control
differences among PD patients with and without mediolateral balance impairments (MLBI:
mediolateral balance impairments, nMLBI: non-mediolateral balance impairments,
respectively) and healthy controls (HCs). Methods: We recruited 40 PD patients and 20 HCs. According to the Tandem Gait Test score, PD
patients were divided into MLBI and nMLBI groups. Primary outcome measures were the
ambulatory movement trajectory amplitude of the center of mass and its coefficient of
variation (CV) during gait. Results: Mediolateral movement trajectory amplitudes and CV were not significantly different
between the nMLBI group and HCs, whereas the mediolateral movement trajectory amplitude
in the MLBI group was significantly higher than that in the nMLBI group. Moreover, the
CV of the mediolateral movement trajectory amplitude in the MLBI group was significantly
lower than that in the nMLBI group. The mediolateral movement trajectory amplitude was
significantly correlated with the fall score. Conclusions: The current results suggest that PD patients with mediolateral balance impairments
showed mediolateral postural sway during gait compared with PD patients without
mediolateral balance impairments. It is necessary to focus on the instabilities in the
mediolateral direction to avoid falls in PD patients.
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Affiliation(s)
- Yuki Kawami
- Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - Yasutaka Nikaido
- Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Shoma Nose
- Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - Maya Unekawa
- Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - Kohei Marumoto
- Department of Physical Medicine and Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - Mika Kawami
- Department of Occupational Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - So Matsugashita
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Tsuyoshi Kozuki
- Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan
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27
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Cubo E, Garcia-Bustillo A, Arnaiz-Gonzalez A, Ramirez-Sanz JM, Garrido-Labrador JL, Valiñas F, Allende M, Gonzalez-Bernal JJ, Gonzalez-Santos J, Diez-Pastor JF, Jahouh M, Arribas J, Trejo J. Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson's disease. Protocol for a longitudinal, randomized clinical trial. PLoS One 2021; 16:e0260889. [PMID: 34932580 PMCID: PMC8691608 DOI: 10.1371/journal.pone.0260889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022] Open
Abstract
Background Approximately 40–70% of people with Parkinson’s disease (PD) fall each year, causing decreased activity levels and quality of life. Current fall-prevention strategies include the use of pharmacological and non-pharmacological therapies. To increase the accessibility of this vulnerable population, we developed a multidisciplinary telemedicine program using an Information and Communication Technology (ICT) platform. We hypothesized that the risk for falling in PD would decrease among participants receiving a multidisciplinary telemedicine intervention program added to standard office-based neurological care. Objective To determine the feasibility and cost-effectiveness of a multidisciplinary telemedicine intervention to decrease the incidence of falls in patients with PD. Methods Ongoing, longitudinal, randomized, single-blinded, case-control, clinical trial. We will include 76 non-demented patients with idiopathic PD with a high risk of falling and limited access to multidisciplinary care. The intervention group (n = 38) will receive multidisciplinary remote care in addition to standard medical care, and the control group (n = 38) standard medical care only. Nutrition, sarcopenia and frailty status, motor, non-motor symptoms, health-related quality of life, caregiver burden, falls, balance and gait disturbances, direct and non-medical costs will be assessed using validated rating scales. Results This study will provide a cost-effectiveness assessment of multidisciplinary telemedicine intervention for fall reduction in PD, in addition to standard neurological medical care. Conclusion In this challenging initiative, we will determine whether a multidisciplinary telemedicine intervention program can reduce falls, as an alternative intervention option for PD patients with restricted access to multidisciplinary care. Trial registration ClinicalTrials.gov Identifier: NCT04694443.
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Affiliation(s)
- Esther Cubo
- Hospital Universitario Burgos, Burgos, Spain
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
- * E-mail:
| | - Alvaro Garcia-Bustillo
- Hospital Universitario Burgos, Burgos, Spain
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | | | | | | | | | | | | | | | - Maha Jahouh
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | - Jose Trejo
- Hospital Universitario Burgos, Burgos, Spain
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Kapur S, Vaughan C, Hawkins J, Stebbins G, Hall D. Varenicline for the Treatment of Postural and Gait Dysfunction in Parkinson Disease. Neurol Clin Pract 2021; 11:457-461. [PMID: 34992953 DOI: 10.1212/cpj.0000000000000958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether varenicline is effective for the balance in Parkinson disease (PD). METHODS This was an investigator-initiated, double-blind, placebo-controlled study. Participants with a clinical diagnosis of PD were randomized to receive varenicline or placebo for 8 weeks. After dose escalation, participants took 1 mg of drug twice daily until the end of the study. Patients with severe tremor were excluded. Primary outcome was a change on the Berg Balance Scale (BBS) from baseline to 8 weeks. The BBS is a 14-item measure consisting of basic balance tasks. The study had a secondary, exploratory outcome of a change in cognition, measured with the Frontal Assessment Battery (FAB) and the Mini-Mental State Exam (MMSE) from baseline to 8 weeks. The FAB is a 6-item measure of executive functioning. RESULTS Thirty-six participants were randomized (82% men, 100% White). Average age was 71.0 years (± 8.1). Average baseline motor Movement Disorder Society Unified Parkinson's Disease Rating Scale was 34.7 (± 11.6). There were no differences between treatment groups on the BBS (F[1,28] = 2.85, p = 0.10) or FAB (d = 0.16, 95% confidence interval [CI] = [-1.39 to 1.53]) or MMSE (d = 0.81, 95% CI = [-0.40 to 1.40]). CONCLUSION The results did not suggest that varenicline had an effect on balance in patients with PD. Furthermore, varenicline did not seem to affect cognition. Perhaps, if an objective measure of balance had been used in place of the BBS, the analysis would show a difference between the groups. However, the authors do not recommend further study. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that in patients with PD with Hoehn and Yahr stages 2, 3, or 4, varenicline does not improve balance as assessed by the BBS.
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Affiliation(s)
- Sachin Kapur
- Department of Neurological Sciences, Rush University, Department of Neurological Sciences, Chicago, IL
| | - Christina Vaughan
- Department of Neurological Sciences, Rush University, Department of Neurological Sciences, Chicago, IL
| | - Jacob Hawkins
- Department of Neurological Sciences, Rush University, Department of Neurological Sciences, Chicago, IL
| | - Glenn Stebbins
- Department of Neurological Sciences, Rush University, Department of Neurological Sciences, Chicago, IL
| | - Deborah Hall
- Department of Neurological Sciences, Rush University, Department of Neurological Sciences, Chicago, IL
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Risk factors for falls in older people with cognitive impairment living in the community: Systematic review and meta-analysis. Ageing Res Rev 2021; 71:101452. [PMID: 34450352 DOI: 10.1016/j.arr.2021.101452] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/21/2021] [Accepted: 08/22/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE This systematic review aimed to identify risk factors for prospectively ascertained falls, focusing on those that are potentially modifiable (physical and neuropsychological factors), in older people with cognitive impairment living in the community. RESULTS A comprehensive search of five databases identified 16 high quality (Newcastle-Ottawa Scale ≥8/9) relevant articles. Meta-analyses were undertaken for five potential fall risk factors. Of these, fallers had significantly poorer balance (standardized mean difference = 0.62, 95 %CI 0.45, 0.79) with low heterogeneity. Global cognition was not significantly associated with faller status in a meta-analysis with low heterogeneity. Meta-analyses of mobility (Timed Up-and-Go), gait speed and depressive symptoms had high heterogeneity and were not statistically significant or were borderline significant (p = 0.05). Sensitivity analyses (removing one study sample's results that differed markedly from the other included samples) reduced heterogeneity to 0% and revealed fallers had significantly poorer mobility and more depressive symptoms than non-fallers. Fallers also walked significantly slower, but heterogeneity remained high. CONCLUSIONS In older people with cognitive impairment, fallers presented with balance deficits, poor mobility, slow gait speed and depressive symptoms. Reduced global cognition was not associated with falls. These findings suggest that interventions should target balance impairment and reveal that more high-quality research is needed.
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Assessment of Risk Factors for Falls among Patients with Parkinson's Disease. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5531331. [PMID: 34621895 PMCID: PMC8492255 DOI: 10.1155/2021/5531331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 08/23/2021] [Accepted: 09/03/2021] [Indexed: 12/22/2022]
Abstract
Introduction The aim of this study was to assess the risk factors for falls in patients with Parkinson's disease. Materials and Methods The study comprised 53 participants (52.8% women and 47.2% men). The Hoehn and Yahr 5-point disability scale was used to assess the severity of Parkinson's disease. The Tinetti Balance and Gait Scale were used to evaluate the risk of falls. The Katz scale was used to test the independence of people with PD. The Falls Efficacy Scale-International Short Form (FES-I) was implemented to assess fear of falling. Results The majority of participants was at a high risk of falls, being at the same level for women and men. A significant relationship was noted between the risk of falls and subjective assessment of mobility (χ2 = 31.86, p < 0.001), number of falls (χ2 = 37.92, p < 0.001), independence of the subjects (χ2 = 19.28, p < 0.001), type of injury suffered during the fall (χ2 = 36.93, p < 0.001), external factors (χ2 = 33.36, p < 0.001), and the level of fear of falling (χ2 = 8.88, p < 0.001). A significant relationship also occurred between the number of falls and the fear of falling (χ2 = 33.49, p < 0.001) and between the number of falls and disease severity (χ2 = 45.34, p < 0.001). The applied physiotherapy did not reduce the risk of falls (χ2 = 3.18, p = 0.17). Conclusions Individuals who rated their mobility as good or excellent were at a low risk of falls. People who fell more times were at a high risk of falling. People more independent were at a low risk of falls. Previous injuries were the most associated with being at risk of falling. Uneven surfaces and obstacles on one's path are the external factors most associated with the risk of falling. People with low levels of fall anxiety were at a low risk of falls. Most people with low fall anxiety have never fallen. Additionally, the majority of patients with stage 1 of the disease have not fallen at all. The reason for the ineffectiveness of physiotherapy may be due to the exercise programs used and the lack of systematic implementation of them. PD is different for each patient; thus, it is important to select individually customized physiotherapy depending on motor and nonmotor symptoms, as well as general health of a patient.
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O'Malley N, Clifford AM, Conneely M, Casey B, Coote S. Effectiveness of interventions to prevent falls for people with multiple sclerosis, Parkinson's disease and stroke: an umbrella review. BMC Neurol 2021; 21:378. [PMID: 34587933 PMCID: PMC8480085 DOI: 10.1186/s12883-021-02402-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/29/2021] [Indexed: 03/15/2023] Open
Abstract
Background The implementation of condition-specific falls prevention interventions is proving challenging due to lack of critical mass and resources. Given the similarities in falls risk factors across stroke, Parkinson’s Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for groups comprising of people with these three neurological conditions may provide a pragmatic solution to these challenges. The aims of this umbrella review were to investigate the effectiveness of falls prevention interventions in MS, PD and stroke, and to identify the commonalities and differences between effective interventions for each condition to inform the development of an intervention for mixed neurological groups. Methods A systematic literature search was conducted using 15 electronic databases, grey literature searches and hand-screening of reference lists. Systematic reviews of studies investigating the effects of falls prevention interventions in MS, PD and stroke were included. Methodological quality of reviews was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2. A matrix of evidence table was used to assess the degree of overlap. The Grading of Recommendations Assessments, Development and Evaluation framework was used to rate the quality of evidence. Findings were presented through narrative synthesis and a summary of evidence table. Results Eighteen reviews were included; three investigating effectiveness of falls prevention interventions in MS, 11 in PD, three in stroke, and one in both PD and stroke. Exercise-based interventions were the most commonly investigated for all three conditions, but differences were identified in the content and delivery of these interventions. Low to moderate quality evidence was found for the effectiveness of exercise-based interventions at reducing falls in PD. Best available evidence suggests that exercise is effective at reducing falls in stroke but no evidence of effect was identified in MS. Conclusions The findings suggest that exercise-based interventions are effective at reducing falls in PD, however, the evidence for MS and stroke is less conclusive. A strong theoretical rationale remains for the use of exercise-based interventions to address modifiable physiological falls risk factors for people with MS, PD and stroke, supporting the feasibility of a mixed-diagnosis intervention. Given the high overlap and low methodological quality of primary studies, the focus should be on the development of high-quality trials investigating the effectiveness of falls prevention interventions, rather than the publication of further systematic reviews. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02402-6.
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Affiliation(s)
- Nicola O'Malley
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland. .,Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Amanda M Clifford
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Bláthín Casey
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Susan Coote
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland.,Multiple Sclerosis Society of Ireland, Limerick, Ireland
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Tiihonen M, Westner BU, Butz M, Dalal SS. Parkinson's disease patients benefit from bicycling - a systematic review and meta-analysis. NPJ Parkinsons Dis 2021; 7:86. [PMID: 34561455 PMCID: PMC8463550 DOI: 10.1038/s41531-021-00222-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/10/2021] [Indexed: 12/17/2022] Open
Abstract
Many Parkinson's disease (PD) patients are able to ride a bicycle despite being severely compromised by gait disturbances up to freezing of gait. This review [PROSPERO CRD 42019137386] aimed to find out, which PD-related symptoms improve from bicycling, and which type of bicycling exercise would be most beneficial. Following a systematic database literature search, peer-reviewed studies with randomized control trials (RCT) and with non-randomized trials (NRCT) investigating the interventional effects of bicycling on PD patients were included. A quality analysis addressing reporting, design and possible bias of the studies, as well as a publication bias test was done. Out of 202 references, 22 eligible studies with 505 patients were analysed. An inverse variance-based analysis revealed that primary measures, defined as motor outcomes, benefitted from bicycling significantly more than cognitive measures. Additionally, secondary measures of balance, walking speed and capacity, and the PDQ-39 ratings improved with bicycling. The interventions varied in durations, intensities and target cadences. Conclusively, bicycling is particularly beneficial for the motor performance of PD patients, improving crucial features of gait. Furthermore, our findings suggest that bicycling improves the overall quality-of-life of PD patients.
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Affiliation(s)
- Marianne Tiihonen
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Aarhus, Denmark.
| | - Britta U Westner
- Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Markus Butz
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sarang S Dalal
- Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Zak M, Sikorski T, Wasik M, Krupnik S, Andrychowski J, Brola W. Pisa syndrome: Pathophysiology, physical rehabilitation and falls risk. NeuroRehabilitation 2021; 49:363-373. [PMID: 34542040 DOI: 10.3233/nre-210167] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pisa syndrome (PS) is a postural disorder characterised by lateral flexion of the spine (> 10°), predisposing the affected individuals to falls, and contributing to increased mortality in neurodegenerative diseases. OBJECTIVE An overview of currently applied therapeutic management options, primarily focused on specifically structured rehabilitation exercises, in conjunction with falls-risk assessment in the individuals affected by PS. METHODS A narrative literature review, augmented with the authors' own experience in physical rehabilitation management. RESULTS As individuals affected by PS are evidenced to be intrinsically exposed to higher falls-risk through acquired postural deformities, they often fall victims of traumatic accidents, occasionally also facing relocation into 24-hour nursing facilities due to the injuries sustained/resultant disability, consequently having overall quality of their life appreciably reduced. CONCLUSIONS sA comprehensive approach is postulated in designing optimal therapeutic management, comprised of the exercises controlling postural stability, whilst reducing lower back pain, and the ones also promoting specific skills essential for coping unassisted after an accidental fall effectively. Rehabilitation of individuals affected by PS should be a fully integrated service, eliminating all identified risk factors for falls. As clinical PS symptoms tend to recur after completion of a full course of therapeutic management, all PS patients should continue the pursuit of therapeutic exercises on an individual basis, to effectively retard their recurrence. In view of overall scarcity of clinical studies completed on the large population samples of PS patients, further in-depth research is still required to ensure higher credence to overall efficacy of the presently proposed therapeutic solutions.
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Affiliation(s)
- Marek Zak
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Tomasz Sikorski
- Doctoral School, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Magdalena Wasik
- Doctoral School, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Szymon Krupnik
- Symmetry, Medical Rehabilitation Centre, Sosnowiec, Poland
| | - Jaroslaw Andrychowski
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Waldemar Brola
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
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Luis-Martínez R, Di Marco R, Weis L, Cianci V, Pistonesi F, Baba A, Carecchio M, Biundo R, Tedesco C, Masiero S, Antonini A. Impact of social and mobility restrictions in Parkinson's disease during COVID-19 lockdown. BMC Neurol 2021; 21:332. [PMID: 34461838 PMCID: PMC8404403 DOI: 10.1186/s12883-021-02364-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 08/18/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The consequences of strict COVID-19 mobility restrictions on motor/non-motor features in Parkinson's disease (PD) have not been systematically studied but worse mobility and quality of life have been reported. To elucidate this question, 12 mild to moderate PD patients were assessed in March 2020 before and after two months of isolation as part of a clinical study that had to be interrupted due to the pandemic and the implementation of COVID19 mobility restrictions. METHODS Twelve patients were systematically evaluated before and after the lockdown period as part of a larger cohort that previously underwent thermal water rehabilitation. Clinical outcomes were the Body Mass index, the Mini-Balance Evaluation Systems Test, the MDS-Unified Parkinson's Disease Rating Scale part III, the 6 Minute Walking Test and the New Freezing of Gait Questionnaire. Global cognition was evaluated with the Montreal Cognitive Assessment scale. The impact of COVID-19 restrictions on quality of life and functional independence was evaluated with The Parkinson's disease Quality of life (PDQ-39), the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living questionnaires (IADL) and the Parkinson's disease cognitive functional rating scales (PD-CFRS). RESULTS After two months of isolation the Mini-BESTest score worsened (p=0.005), and four patients reported one or more falls during the lockdown. BMI increased (p=0.031) while the remaining clinical variables including quality of life did not change. CONCLUSION We observed moderate worsening at Mini-BESTest, greater risk of falls and increased body weight as consequence of prolonged immobility. We believe negative effects were partially softened since patients were in contact with our multidisciplinary team during the lockdown and had previously received training to respond to the needs of this emergency isolation. These findings highligh the importnace of patient-centered interventions in PD management.
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Affiliation(s)
- Raquel Luis-Martínez
- Department of Neurosciences, University of the Basque Country, (UPV/EHU), Leioa, Spain
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Roberto Di Marco
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Luca Weis
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Valeria Cianci
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Francesca Pistonesi
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Alfonc Baba
- Rehabilitation Unit, Azienda Ospedaliera Universitaria di Padova, Padova, Italy
| | - Miryam Carecchio
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Roberta Biundo
- Department of General Psychology, University of Padova, Padova, Italy
| | - Chiara Tedesco
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Stefano Masiero
- Physical Medicine and Rehabilitation School, University of Padova, Padova, Italy
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy.
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Huang Y, Canning CG, Song J, Clemson L, Allen NE. How does perceived fall risk influence decisions about whether to undertake activities in people with Parkinson's disease and their care partners? A qualitative study. Disabil Rehabil 2021; 44:6000-6008. [PMID: 34314280 DOI: 10.1080/09638288.2021.1955983] [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] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore how perceptions of fall risk influence decisions to undertake activities in people with Parkinson's disease who have fallen, along with their care-partners. MATERIALS AND METHODS This qualitative study used semi-structured interviews to collect data from eight people with moderate to severe Parkinson's Disease and freezing of gait (including those with cognitive impairments) and their care-partners. An inductive approach to thematic analysis was used to analyse the data. RESULTS Four main, interconnected themes emerged, and a framework was developed to illustrate these connections. Weighing up the risks and benefits reflected the constant tension between assessing the likelihood of falling and potential benefit of any activity; Being fearful heightened the perceived risk resulting in a tendency to avoid or modify activities; Desire to lead a normal life heightened the perceived benefit of any activity, leading towards risk taking behaviour; It's a part of Parkinson's provided the context in which the decision-making process took place, with the reality of a progressive disorder influencing choices and contributing to a belief that falls were inevitable. CONCLUSIONS There is a complex interaction between perceptions of fall risk and behaviour. An understanding of these interactions will assist therapists to tailor individualised fall prevention interventions.IMPLICATIONS FOR REHABILITATIONPeople are constantly weighing up the risks and benefits of activities while balancing fear of falling and a desire to lead a normal life in the context of Parkinson's disease.The resulting activity choices vary along a continuum from avoiding activities to taking risks, with a common approach to minimise the risk and then embrace the activity.Therapists can help people with Parkinson's and their care-partners to determine what level of risk is acceptable for them when balancing risk with quality of life.Understanding how people decide if they will undertake an activity that poses a risk of falling will allow therapists and patients to co-design fall prevention and management interventions based on the patient's values and priorities.
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Affiliation(s)
- Yingli Huang
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jooeun Song
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lindy Clemson
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Natalie E Allen
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Ghislieri M, Agostini V, Rizzi L, Knaflitz M, Lanotte M. Atypical Gait Cycles in Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2021; 21:5079. [PMID: 34372315 PMCID: PMC8347347 DOI: 10.3390/s21155079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 12/15/2022]
Abstract
It is important to find objective biomarkers for evaluating gait in Parkinson's Disease (PD), especially related to the foot and lower leg segments. Foot-switch signals, analyzed through Statistical Gait Analysis (SGA), allow the foot-floor contact sequence to be characterized during a walking session lasting five-minutes, which includes turnings. Gait parameters were compared between 20 PD patients and 20 age-matched controls. PDs showed similar straight-line speed, cadence, and double-support compared to controls, as well as typical gait-phase durations, except for a small decrease in the flat-foot contact duration (-4% of the gait cycle, p = 0.04). However, they showed a significant increase in atypical gait cycles (+42%, p = 0.006), during both walking straight and turning. A forefoot strike, instead of a "normal" heel strike, characterized the large majority of PD's atypical cycles, whose total percentage was 25.4% on the most-affected and 15.5% on the least-affected side. Moreover, we found a strong correlation between the atypical cycles and the motor clinical score UPDRS-III (r = 0.91, p = 0.002), in the subset of PD patients showing an abnormal number of atypical cycles, while we found a moderate correlation (r = 0.60, p = 0.005), considering the whole PD population. Atypical cycles have proved to be a valid biomarker to quantify subtle gait dysfunctions in PD patients.
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Affiliation(s)
- Marco Ghislieri
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy; (V.A.); (M.K.)
- PoliToBIOMed Lab, Politecnico di Torino, 10129 Turin, Italy
| | - Valentina Agostini
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy; (V.A.); (M.K.)
- PoliToBIOMed Lab, Politecnico di Torino, 10129 Turin, Italy
| | - Laura Rizzi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (L.R.); (M.L.)
- AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Marco Knaflitz
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy; (V.A.); (M.K.)
- PoliToBIOMed Lab, Politecnico di Torino, 10129 Turin, Italy
| | - Michele Lanotte
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (L.R.); (M.L.)
- AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
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Pol F, Salehinejad MA, Baharlouei H, Nitsche MA. The effects of transcranial direct current stimulation on gait in patients with Parkinson's disease: a systematic review. Transl Neurodegener 2021; 10:22. [PMID: 34183062 PMCID: PMC8240267 DOI: 10.1186/s40035-021-00245-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022] Open
Abstract
Background Gait problems are an important symptom in Parkinson’s disease (PD), a progressive neurodegenerative disease. Transcranial direct current stimulation (tDCS) is a neuromodulatory intervention that can modulate cortical excitability of the gait-related regions. Despite an increasing number of gait-related tDCS studies in PD, the efficacy of this technique for improving gait has not been systematically investigated yet. Here, we aimed to systematically explore the effects of tDCS on gait in PD, based on available experimental studies. Methods Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach, PubMed, Web of Science, Scopus, and PEDro databases were searched for randomized clinical trials assessing the effect of tDCS on gait in patients with PD. Results Eighteen studies were included in this systematic review. Overall, tDCS targeting the motor cortex and supplementary motor area bilaterally seems to be promising for gait rehabilitation in PD. Studies of tDCS targeting the dorosolateral prefrontal cortex or cerebellum showed more heterogeneous results. More studies are needed to systematically compare the efficacy of different tDCS protocols, including protocols applying tDCS alone and/or in combination with conventional gait rehabilitation treatment in PD. Conclusions tDCS is a promising intervention approach to improving gait in PD. Anodal tDCS over the motor areas has shown a positive effect on gait, but stimulation of other areas is less promising. However, the heterogeneities of methods and results have made it difficult to draw firm conclusions. Therefore, systematic explorations of tDCS protocols are required to optimize the efficacy.
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Affiliation(s)
- Fateme Pol
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Hamzeh Baharlouei
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
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Chang SJ, Cajigas I, Guest JD, Noga BR, Widerström-Noga E, Haq I, Fisher L, Luca CC, Jagid JR. Deep brain stimulation of the Cuneiform nucleus for levodopa-resistant freezing of gait in Parkinson's disease: study protocol for a prospective, pilot trial. Pilot Feasibility Stud 2021; 7:117. [PMID: 34078477 PMCID: PMC8169408 DOI: 10.1186/s40814-021-00855-7] [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: 08/15/2020] [Accepted: 05/21/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Freezing of gait (FOG) is a particularly debilitating motor deficit seen in a subset of Parkinson's disease (PD) patients that is poorly responsive to standard levodopa therapy or deep brain stimulation (DBS) of established PD targets such as the subthalamic nucleus and the globus pallidus interna. The proposal of a DBS target in the midbrain, known as the pedunculopontine nucleus (PPN) to address FOG, was based on its observed pathology in PD and its hypothesized involvement in locomotor control as a part of the mesencephalic locomotor region, a functionally defined area of the midbrain that elicits locomotion in both intact animals and decerebrate animal preparations with electrical stimulation. Initial reports of PPN DBS were met with much enthusiasm; however, subsequent studies produced mixed results, and recent meta-analysis results have been far less convincing than initially expected. A closer review of the extensive mesencephalic locomotor region (MLR) preclinical literature, including recent optogenetics studies, strongly suggests that the closely related cuneiform nucleus (CnF), just dorsal to the PPN, may be a superior target to promote gait initiation. METHODS We will conduct a prospective, open-label, single-arm pilot study to assess safety and feasibility of CnF DBS in PD patients with levodopa-refractory FOG. Four patients will receive CnF DBS and have gait assessments with and without DBS during a 6-month follow-up. DISCUSSION This paper presents the study design and rationale for a pilot study investigating a novel DBS target for gait dysfunction, including targeting considerations. This pilot study is intended to support future larger scale clinical trials investigating this target. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04218526 (registered January 6, 2020).
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Affiliation(s)
- Stephano J Chang
- The Miami Project to Cure Paralysis, Miami, FL, USA.,Department of Neurosurgery, University of British Columbia, Vancouver, BC, Canada
| | - Iahn Cajigas
- The Miami Project to Cure Paralysis, Miami, FL, USA.,Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 N.W. 14th Terrace, Miami, FL, 33136, USA
| | - James D Guest
- The Miami Project to Cure Paralysis, Miami, FL, USA.,Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 N.W. 14th Terrace, Miami, FL, 33136, USA
| | - Brian R Noga
- The Miami Project to Cure Paralysis, Miami, FL, USA.,Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 N.W. 14th Terrace, Miami, FL, 33136, USA
| | - Eva Widerström-Noga
- The Miami Project to Cure Paralysis, Miami, FL, USA.,Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 N.W. 14th Terrace, Miami, FL, 33136, USA
| | - Ihtsham Haq
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Letitia Fisher
- The Miami Project to Cure Paralysis, Miami, FL, USA.,Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 N.W. 14th Terrace, Miami, FL, 33136, USA
| | - Corneliu C Luca
- The Miami Project to Cure Paralysis, Miami, FL, USA.,Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jonathan R Jagid
- The Miami Project to Cure Paralysis, Miami, FL, USA. .,Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 N.W. 14th Terrace, Miami, FL, 33136, USA.
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Espiritu AI, Anna C Brillantes MM, G Layog AV, G Jamora RD. Reasons for hospitalization and factors of mortality in patients with Parkinson's disease in the Philippines. Neurodegener Dis Manag 2021; 11:229-238. [PMID: 33966488 DOI: 10.2217/nmt-2020-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We aimed to determine the reasons for hospitalizations and factors of mortality of Filipino Parkinson's disease (PD) patients in a tertiary hospital. Methods: We conducted a retrospective review of medical records of PD patients admitted to our institution between 2016 and 2018. Demographic and clinical data were analyzed. Results: We included 166 PD patients. The most common cause of admission was infectious (pneumonia, urinary tract, and skin-soft tissue infections) (n = 65, 39.2%). The most common cause of mortality was sepsis (n = 9, 5.4%). Renal comorbidity was a significant factor of mortality (OR: 3.67, 95% CI: 1.11-12.12; p = 0.033). Conclusion: Interventions designed to reduce the risk of complications in PD patients should be prioritized to potentially decrease the probability of eventual hospitalization.
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Affiliation(s)
- Adrian I Espiritu
- Department of Neurosciences, College of Medicine & Philippine General Hospital, University of The Philippines Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of The Philippines Manila, Manila, Philippines
| | | | - Allister Vincent G Layog
- Department of Internal Medicine, Section of Neurology, Cardinal Santos Medical Center, San Juan City, Philippines.,Department of Clinical Neurosciences, University of The East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Roland Dominic G Jamora
- Department of Neurosciences, College of Medicine & Philippine General Hospital, University of The Philippines Manila, Manila, Philippines.,Department of Internal Medicine, Section of Neurology, Cardinal Santos Medical Center, San Juan City, Philippines.,Movement Disorders Service & Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City & Global City, Philippines
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Almeida LRS, Piemonte MEP, Cavalcanti HM, Canning CG, Paul SS. A Self-Reported Clinical Tool Predicts Falls in People with Parkinson's Disease. Mov Disord Clin Pract 2021; 8:427-434. [PMID: 33816673 PMCID: PMC8015904 DOI: 10.1002/mdc3.13170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/14/2021] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A 3-step clinical prediction tool including falling in the previous year, freezing of gait in the past month and self-selected gait speed <1.1 m/s has shown high accuracy in predicting falls in people with Parkinson's disease (PD). The accuracy of this tool when including only self-report measures is yet to be determined. OBJECTIVES To validate the 3-step prediction tool using only self-report measures (3-step self-reported prediction tool), and to externally validate the 3-step clinical prediction tool. METHODS The clinical tool was used with 137 individuals with PD. Participants also answered a question about self-reported gait speed, enabling scoring of the self-reported tool, and were followed-up for 6 months. An intraclass correlation coefficient (ICC2,1) was calculated to evaluate test-retest reliability of the 3-step self-reported prediction tool. Multivariate logistic regression models were used to evaluate the performance of both tools and their discriminative ability was determined using the area under the curve (AUC). RESULTS Forty-two participants (31%) reported ≥1 fall during follow-up. The 3-step self-reported tool had an ICC2,1 of 0.991 (95% CI 0.971-0.997; P < 0.001) and AUC = 0.68; 95% CI 0.59-0.77, while the 3-step clinical tool had an AUC = 0.69; 95% CI 0.60-0.78. CONCLUSIONS The 3-step self-reported prediction tool showed excellent test-retest reliability and was validated with acceptable accuracy in predicting falls in the next 6 months. The 3-step clinical prediction tool was externally validated with similar accuracy. The 3-step self-reported prediction tool may be useful to identify people with PD at risk of falls in e/tele-health settings.
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Affiliation(s)
- Lorena Rosa S. Almeida
- Movement Disorders and Parkinson's Disease ClinicRoberto Santos General HospitalSalvadorBrazil
- Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBrazil
| | - Maria Elisa Pimentel Piemonte
- Physical Therapy, Speech Therapy and Occupational Therapy DepartmentFaculty of Medicine of University of São PauloSão PauloBrazil
| | - Helen M. Cavalcanti
- Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBrazil
- Postgraduate Program in Health SciencesFederal University of Bahia School of MedicineSalvadorBrazil
- Bahia Adventist CollegeCachoeiraBrazil
| | - Colleen G. Canning
- Discipline of Movement Sciences, Sydney School of Health Sciences, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
| | - Serene S. Paul
- Discipline of Movement Sciences, Sydney School of Health Sciences, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
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Cai Y, Feng F, Wei Q, Jiang Z, Ou R, Shang H. Sarcopenia in Patients With Parkinson's Disease: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:598035. [PMID: 33746871 PMCID: PMC7973225 DOI: 10.3389/fneur.2021.598035] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/19/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Parkinson's disease (PD) and sarcopenia are two common diseases in aging people. To date, the prevalence of sarcopenia in PD patients and the relationship between clinical features and sarcopenia in PD patients are not clear. The aim of the study was to (1) assess the prevalence of sarcopenia in PD patients and (2) reveal the clinical features between PD patients with and without sarcopenia. Method: A systematic review was carried out through screening PubMed, EMBASE, and Cochrane database in May 2020. All study designs (case-control, cohort, and cross-sectional studies) were eligible for meta-analysis. Data of patients' characteristics, sarcopenia criteria, sarcopenia prevalence, and sarcopenia measures were retrieved. The primary outcome was estimated prevalence of sarcopenia by a pooled prevalence (%) and its 95% confidence interval (CI), using a random-effects model. The secondary outcome was the differences in clinical features between PD patients with and without sarcopenia by meta-analysis. Included articles were assessed for risk of bias. Potential sources of variation were investigated by using subgroup analyses and meta-regression. Result: Ten studies were included in the review. Among them, nine were cross-sectional studies, and one was a prospective cohort study. Age of participants with PD in the studies ranged from 51.1 to 80.7 years. The estimated prevalence of sarcopenia ranged from 6 to 55.5%. The random-effects pooled prevalence was 29% (95% CIs: 0.18-0.40). When only studies at low risk of bias were considered, pooled prevalence decreased to 17% (95% CIs: 0.02-0.33), with still high heterogeneity. The incidence of falls in PD patients with sarcopenia was higher than that in PD patients without sarcopenia. There was no difference in sex ratio between PD patients with and without sarcopenia. Conclusion: Sarcopenia seems to be common in patients with PD. Early assessment of sarcopenia should be implemented in PD to avoid fall and disability.
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Affiliation(s)
- Yingying Cai
- Laboratory of Neurodegenerative Disorders, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.,Department of Geriatrics, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Fei Feng
- Laboratory of Neurodegenerative Disorders, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qianqian Wei
- Laboratory of Neurodegenerative Disorders, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Zheng Jiang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ruwei Ou
- Laboratory of Neurodegenerative Disorders, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Shang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Ranchet M, Hoang I, Cheminon M, Derollepot R, Devos H, Perrey S, Luauté J, Danaila T, Paire-Ficout L. Changes in Prefrontal Cortical Activity During Walking and Cognitive Functions Among Patients With Parkinson's Disease. Front Neurol 2020; 11:601686. [PMID: 33362703 PMCID: PMC7758480 DOI: 10.3389/fneur.2020.601686] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Walking becomes more and more degraded as Parkinson's Disease (PD) progresses. Previous research examined factors contributing to this deterioration. Among them, changes in brain cortical activity during walking have been less studied in this clinical population. Objectives: This study aimed to: (1) investigate changes in dorsolateral prefrontal cortex (DLPFC) activation during usual walking and dual-task walking conditions in patients with PD; (2) examine the association between cortical activity and behavioral/cognitive outcomes; and (3) explore which factors best predict increased activation of the DLPFC during usual walking. Methods: Eighteen patients with early stage PD and 18 controls performed 4 conditions: (1) standing while subtracting, (2) usual walking, (3) walking while counting forward, and (4) walking while subtracting. Cortical activity in DLPFC, assessed by changes in oxy-hemoglobin (ΔHbO2) and deoxy-hemoglobin (ΔHbR), was measured using functional near infrared spectroscopy (fNIRS). Gait performance was recorded using wearables sensors. Cognition was also assessed using neuropsychological tests, including the Trail Making Test (TMT). Results: DLPFC activity was higher in patients compared to controls during both usual walking and walking while subtracting conditions. Patients had impaired walking performance compared to controls only during walking while subtracting task. Moderate-to-strong correlations between ΔHbO2 and coefficients of variation of all gait parameters were found for usual walking and during walking while counting forward conditions. Part-B of TMT predicted 21% of the variance of ΔHbO2 during usual walking after adjustment for group status. Conclusions: The increased DLPFC activity in patients during usual walking suggests a potential compensation for executive deficits. Understanding changes in DLPFC activity during walking may have implications for rehabilitation of gait in patients with PD.
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Affiliation(s)
- Maud Ranchet
- TS2-LESCOT, Univ Gustave Eiffel, IFSTTAR, Univ Lyon, Lyon, France
| | - Isabelle Hoang
- TS2-LESCOT, Univ Gustave Eiffel, IFSTTAR, Univ Lyon, Lyon, France
| | - Maxime Cheminon
- Service de Médecine Physique et de Réadaptation Neurologique, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Lyon, France
| | | | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Stephane Perrey
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mînes Ales, Montpellier, France
| | - Jacques Luauté
- Service de Médecine Physique et de Réadaptation Neurologique, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Lyon, France.,Inserm UMR-S 1028, CNRS UMR 529, ImpAct, Center de Recherche en Neurosciences de Lyon, Université Lyon-1, Bron, France.,Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Teodor Danaila
- Center de Neurosciences Cognitives, Service de Neurologie C, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
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O'Malley N, Clifford AM, Comber L, Coote S. Effectiveness of non-pharmacological falls prevention interventions for people with Multiple Sclerosis, Parkinson's Disease and stroke: protocol for an umbrella review. HRB Open Res 2020; 3:17. [PMID: 33392439 PMCID: PMC7745191 DOI: 10.12688/hrbopenres.13023.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Falls are common among people with neurological diseases and have many negative physical, psychosocial and economic consequences. Implementation of single-diagnosis falls prevention interventions is currently problematic due to lack of participants and resources. Given the similarities in falls risk factors across stroke, Parkinson's Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for mixed neurological populations seems plausible and may provide a pragmatic solution to current implementation challenges. This umbrella review aims to summarise the totality of evidence regarding the effectiveness of non-pharmacological falls prevention interventions for people with MS, PD and stroke and identify the commonalities and differences between effective interventions for each disease to inform the development of an evidence-based intervention that can be tailored for people with mixed diagnoses. Methods: This umbrella review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. 15 electronic databases and grey literature will be searched. Systematic reviews of randomised controlled trials and studies investigating the effects of non-pharmacological falls prevention interventions on falls outcomes among people with MS, PD and stroke will be included. Methodological quality of included reviews will be assessed using the Assessment of Multiple Systematic Reviews 2 tool. The Grading of Recommendations Assessments, Development and Evaluation framework will be used to rate the quality of evidence. A summary of evidence table and narrative synthesis will be utilised to clearly indicate the findings. Discussion: This umbrella review presents a novel and timely approach to synthesise existing falls literature to identify effective non-pharmacological interventions for people with MS, PD and stroke. Of importance, a robust methodology will be used to explore the differences and similarities in effective interventions for individuals with these neurological conditions to facilitate the development of an intervention for these mixed neurological groups.
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Affiliation(s)
- Nicola O'Malley
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Amanda M. Clifford
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Centre, University of Limerick, Limerick, Ireland
| | - Laura Comber
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Susan Coote
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
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Using machine learning-based analytics of daily activities to identify modifiable risk factors for falling in Parkinson's disease. Parkinsonism Relat Disord 2020; 82:77-83. [PMID: 33249293 DOI: 10.1016/j.parkreldis.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although risk factors that lead to falling in Parkinson's disease (PD) have been previously studied, the established predictors are mostly non-modifiable. A novel method for fall risk assessment may provide more insight into preventable high-risk activities to reduce future falls. OBJECTIVES To explore the prediction of falling in PD patients using a machine learning-based approach. METHOD 305 PD patients, with or without a history of falls within the past month, were recruited. Data including clinical demographics, medications, and balance confidence, scaled by the 16-item Activities-Specific Balance Confidence Scale (ABC-16), were entered into the supervised machine learning models using XGBoost to explore the prediction of fallers/recurrent fallers in two separate models. RESULTS 99 (32%) patients were fallers and 58 (19%) were recurrent fallers. The accuracy of the model to predict falls was 72% (p = 0.001). The most important factors were item 7 (sweeping the floor), item 5 (reaching on tiptoes), and item 12 (walking in a crowded mall) in the ABC-16 scale, followed by disease stage and duration. When recurrent falls were analysed, the models had higher accuracy (81%, p = 0.02). The strongest predictors of recurrent falls were item 12, 5, and 10 (walking across parking lot), followed by disease stage and current age. CONCLUSION Our machine learning-based study demonstrated that predictors of falling combined demographics of PD with environmental factors, including high-risk activities that require cognitive attention and changes in vertical and lateral orientations. This enables physicians to focus on modifiable factors and appropriately implement fall prevention strategies for individual patients.
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Ma L, Mi TM, Jia Q, Han C, Chhetri JK, Chan P. Gait variability is sensitive to detect Parkinson's disease patients at high fall risk. Int J Neurosci 2020; 132:888-893. [PMID: 33256488 DOI: 10.1080/00207454.2020.1849189] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Gait disturbance is an important risk factor for falls in Parkinson's disease (PD). Using wearable sensors, we can obtain the spatiotemporal parameters of gait and calculate the gait variability. This prospective study aims to objectively evaluate the gait characteristics of PD fallers, and further explore the relationship between spatiotemporal parameters of gait, gait variability and falls in PD patients followed for six months. METHODS Fifty-one PD patients were enrolled in this study. A seven-meter timed up and go test was performed. Gait characteristics were determined by a gait analysis system. Patients were followed monthly by telephone until the occurrence of falls or till the end of six months. The patients were categorized into fallers and non-fallers based on whether fell during the follow-up period. Gait parameters were compared between two groups, and binary logistic regression was used to establish the falls prediction model. In the receiver-operating characteristic curve, area under the curve (AUC) was utilized to evaluate the prediction accuracy of each indicator. RESULTS All subjects completed the follow-up, and 14 (27.5%) patients reported falls. PD fallers had greater gait variability. The range of motion of the trunk in sagittal plane variability was an independent risk factor for falls and achieved moderate prediction accuracy (AUC = 0.751), and the logistic regression model achieved a good accuracy of falls prediction (AUC = 0.838). CONCLUSIONS Increased gait variability is a significant feature of PD fallers and is more sensitive to detect PD patients at high risk of falls than spatiotemporal parameters.
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Affiliation(s)
- Lin Ma
- Department of Neurobiology, Neurology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing, China
| | - Tao-Mian Mi
- Department of Neurobiology, Neurology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Qian Jia
- Department of Neurobiology, Neurology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing, China
| | - Chao Han
- National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Jagadish K Chhetri
- Department of Neurobiology, Neurology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Piu Chan
- Department of Neurobiology, Neurology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China.,Clinical Center for Parkinson's Disease, Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Disease of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Bacanoiu MV, Mititelu RR, Danoiu M, Olaru G, Buga AM. Functional Recovery in Parkinson's Disease: Current State and Future Perspective. J Clin Med 2020; 9:jcm9113413. [PMID: 33114424 PMCID: PMC7692963 DOI: 10.3390/jcm9113413] [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: 09/21/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 12/05/2022] Open
Abstract
Parkinson’s disease (PD) is one of the most frequent neurodegenerative disorders, affecting not only the motor function but also limiting the autonomy of affected people. In the last decade, the physical exercises of different intensities carried out by kinetic therapeutic activities, by robotic technologies or with the participation of sensory cues, have become increasingly appreciated in the management of Parkinson’s disease impairments. The aim of this paper was to evaluate the impact of physical exercises with and without physical devices on the motor and cognitive variables of PD patients. In order to achieve our objectives, we performed a systematic review of available original articles based on the impact of kinetic therapeutic activity. Through the search strategy, we selected original papers that were laboriously processed using characteristics related to physical therapy, or the tools used in physiological and psychological rehabilitation strategies for PD patients. In this study, we presented the most current intervention techniques in the rehabilitation programs of patients with Parkinson’s disease, namely the use of assisted devices, virtual imagery or the performing of physical therapies that have the capacity to improve walking deficits, tremor and bradykinesia, to reduce freezing episodes of gait and postural instability, or to improve motor and cognitive functions.
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Affiliation(s)
- Manuela Violeta Bacanoiu
- Department of Physical Therapy and Sports Medicine, University of Craiova, 200207 Craiova, Romania; (M.D.); (G.O.)
- Department of Laboratory Medicine, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
- Correspondence: (M.V.B.); (A.M.B.); Tel.: +40-0351-443-500 (A.M.B.)
| | - Radu Razvan Mititelu
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; or
| | - Mircea Danoiu
- Department of Physical Therapy and Sports Medicine, University of Craiova, 200207 Craiova, Romania; (M.D.); (G.O.)
| | - Gabriela Olaru
- Department of Physical Therapy and Sports Medicine, University of Craiova, 200207 Craiova, Romania; (M.D.); (G.O.)
| | - Ana Maria Buga
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; or
- Correspondence: (M.V.B.); (A.M.B.); Tel.: +40-0351-443-500 (A.M.B.)
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Ashburn A, Pickering R, McIntosh E, Hulbert S, Rochester L, Roberts HC, Nieuwboer A, Kunkel D, Goodwin VA, Lamb SE, Ballinger C, Seymour KC. Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson's: the PDSAFE RCT. Health Technol Assess 2020; 23:1-150. [PMID: 31339100 DOI: 10.3310/hta23360] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND People with Parkinson's disease are twice as likely to experience a fall as a healthy older person, often leading to debilitating effects on confidence, activity levels and quality of life. OBJECTIVE To estimate the effect of a physiotherapy programme for fall prevention among people with Parkinson's disease. DESIGN A multicentre, pragmatic, investigator-masked, individually randomised controlled trial (RCT) with prespecified subgroup analyses. SETTING Recruitment from NHS hospitals and clinics and community and social services in eight English regions with home-based interventions. PARTICIPANTS A total of 474 people with Parkinson's disease (i.e. Hoehn and Yahr scale stages 1-4) were recruited: 238 were assigned to a physiotherapy programme and 236 were assigned to usual care. Random allocation was 50 : 50. INTERVENTIONS All participants received routine care; the usual-care group received an information digital versatile disc (DVD) and a single advice session at trial completion. The intervention group had an individually tailored, progressive, home-based fall avoidance strategy training programme with balance and strengthening exercises: PDSAFE. MAIN OUTCOME MEASURES The primary outcome was the risk of repeat falling, collected by self-report monthly diaries between 0 and 6 months after randomisation. Secondary outcomes included near-falls, falls efficacy, freezing of gait (FoG), health-related quality of life, and measurements taken using the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Chair Stand Test (CST), the Geriatric Depression Scale, the Physical Activity Scale for the Elderly and the Parkinson's Disease Questionnaire. RESULTS PDSAFE is the largest RCT of falls management among people with Parkinson's disease: 541 patients were screened for eligibility. The average age was 72 years, and 266 out of 474 (56%) participants were men. Of the 474 randomised participants, 238 were randomised to the intervention group and 236 were randomised to the control group. No difference in repeat falling within 6 months of randomisation was found [PDSAFE group to control group odds ratio (OR) 1.21, 95% confidence interval (CI) 0.74 to 1.98; p = 0.447]. An analysis of secondary outcomes demonstrated better balance (Mini-BESTest: mean difference 0.95, 95% CI 0.24 to 1.67; p = 0.009), functional strength (CST: p = 0.041) and falls efficacy (Falls Efficacy Scale - International: mean difference 1.6, 95% CI -3.0 to -0.19; p = 0.026) with near-falling significantly reduced with PDSAFE (OR 0.67, 95% CI 0.53 to 0.86; p = 0.001) at 6 months. Prespecified subgroup analysis (i.e. disease severity and FoG) revealed a PDSAFE differing effect; the intervention may be of benefit for people with moderate disease but may increase falling for those in the more severe category, especially those with FoG. LIMITATIONS All participants were assessed at primary outcome; only 73% were assessed at 12 months owing to restricted funding. CONCLUSIONS PDSAFE was not effective in reducing repeat falling across the range of people with Parkinson's disease in the trial. Secondary analysis demonstrated that other functional tasks and self-efficacy improved and demonstrated differential patterns of intervention impact in accordance with disease severity and FoG, which supports previous secondary research findings and merits further primary evaluation. FUTURE WORK Further trials of falls prevention on targeted groups of people with Parkinson's disease are recommended. TRIAL REGISTRATION Current Controlled Trials ISRCTN48152791. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 36. See the NIHR Journals Library website for further project information. Sarah E Lamb is funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) at Oxford Health NHS Foundation Trust, the NIHR Oxford Biomedical Research Centre at the Oxford University Hospitals NHS Foundation Trust and CLAHRC Oxford. Victoria A Goodwin is supported by the NIHR Collaborations for Leadership in Applied Health Research and Care in the South West Peninsula (PenCLAHRC). Lynn Rochester is supported by the NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. The research was also supported by the NIHR Newcastle Clinical Research Facility Infrastructure funding. Helen C Roberts is supported by CLAHRC Wessex and the NIHR Southampton Biomedical Research Centre.
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Affiliation(s)
- Ann Ashburn
- Faculty of Health Science, University of Southampton, Southampton, UK
| | - Ruth Pickering
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Sophia Hulbert
- Faculty of Health Science, University of Southampton, Southampton, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Helen C Roberts
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Dorit Kunkel
- Faculty of Health Science, University of Southampton, Southampton, UK
| | | | - Sarah E Lamb
- Oxford Clinical Trials Research Unit, University of Oxford Medical Sciences Division, Oxford, UK
| | - Claire Ballinger
- Wessex Public Involvement Network (PIN), University of Southampton, Southampton General Hospital, Southampton, UK
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Li H, Liang S, Yu Y, Wang Y, Cheng Y, Yang H, Tong X. Effect of Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) on balance performance in Parkinson's disease. PLoS One 2020; 15:e0238936. [PMID: 32915893 PMCID: PMC7486080 DOI: 10.1371/journal.pone.0238936] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/26/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To study the effect of STN-DBS on balance performance of Parkinson's disease. Method 16 idiopathic PD patients treated with bilateral STN-DBS (DBS Group) and 20 PD patients treated with Levodopa (Medicine group) were included in the study. Clinical material including Levodopa Equivalent Daily Dose (LEDD, mg/day), life quality (PDQ-39) were collected. For DBS group and Medicine group, The motor disability (Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale Ⅲ, MDS-UPDRSIII) and balance performance (MDS-UPDRS 3.12, Berg Balance Scale BBS) and the Limits of Stability (LoS) (target acquisition percentage, trunk swing angle standard deviation, time) in state of Med-Off/Med-On at preoperation, postoperation, 6 months postoperation and 12 months postoperation were evaluated. Repeated ANOVA was used to analyze the effect of STN-DBS on balance performance. Result The Clinical material (age, gender, duration, LEDD preoperation, PDQ39), motor disability (Med-on/Med-Off), balance performance (Med-on/Med-Off) and LoS preoperation had no differences in DBS-group and Medical-group (P>0.05). During the follow up, LEDD, PDQ39, Motor disability (MDS-UPDRSIII), balance performance (MDS-UPDRS 3.12, BBS) in Medicine-group had no significant changes in both Med-Off and Med-On. For DBS-group, immediately improvement of motor disability (MDS-UPDRSIII), LoS (target acquisition percentage, trunk swing angle standard deviation, time) and LEDD were observed postoperation (P<0.05); PDQ39, balance performance (MDS-UPDRS 3.12, BBS) began to improve at 6 months and 12 months postoperation. Repeated ANOVA showed that DBS could significantly improve the motor disability, balance performance and LoS in PD. Conclusion STN-DBS could improve the balance performance of PD patients in H&Y3.
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Affiliation(s)
- Haitao Li
- Department of Neurosurgery, Tianjin Huanhu Hosptial, Tianjin, China
| | - Siquan Liang
- Department of Neurosurgery, Tianjin Huanhu Hosptial, Tianjin, China
- * E-mail: (SL); (XT)
| | - Yang Yu
- Department of Neurological Rehabilitation, Tianjin Huanhu Hosptial, Tianjin, China
| | - Yue Wang
- Department of Neurological Rehabilitation, Tianjin Huanhu Hosptial, Tianjin, China
| | - Yuanyuan Cheng
- Department of Neurological Rehabilitation, Tianjin Huanhu Hosptial, Tianjin, China
| | - Hechao Yang
- Department of Psychology, Tianjin Huanhu Hosptial, Tianjin, China
| | - Xiaoguang Tong
- Department of Neurosurgery, Tianjin Huanhu Hosptial, Tianjin, China
- * E-mail: (SL); (XT)
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Hulbert S, Chivers-Seymour K, Summers R, Lamb S, Goodwin V, Rochester L, Nieuwboer A, Rowsell A, Ewing S, Ashburn A. 'PDSAFE' - a multi-dimensional model of falls-rehabilitation for people with Parkinson's. A mixed methods analysis of therapists' delivery and experience. Physiotherapy 2020; 110:77-84. [PMID: 33153764 DOI: 10.1016/j.physio.2020.08.006] [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: 01/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the clinical reasoning of physiotherapists using PDSAFE; according to disease severity and their experiences of treatment delivery in a large fall-prevention trial for people with Parkinson's (PwP). DESIGN A descriptive study of delivering PDSAFE. Semi-structured interviews explored therapists' experiences. SETTING A two-group, home-based, multi-centred, single-blinded, randomised controlled trial showed no overall effect on fall reduction between groups but demonstrated a significant secondary effect relating to disease severity with benefits to balance, falls efficacy and near-falls for all. PARTICIPANTS Physiotherapists with a background in neurology and older-person rehabilitation were trained in the delivery of PDSAFE INTERVENTION: A multi-dimensional, individually tailored and progressive, home-based programme. RESULTS Fifteen physiotherapists contributed to the 2587 intervention sessions from the PDSAFE trial and six of those physiotherapists took part in the interviews. The personalised intervention was reflected in the range of strategies and exercises prescribed. Most commonly prescribed fall-avoidance strategies were 'Avoiding tripping', 'Turning' and 'Freezing Cues' and all possible combinations of balance and strength training within the programme were selected. PwP with greater disease severity were more likely to have received less challenging strategies, balance and strengthening exercises than those with lower disease severity. Therapists considered the focus on fall events and fall avoidance strategies an improvement on 'impairment only' treatment. The presence of cognitive deficits, co-morbidities and dyskinesia were the most challenging aspects of delivering the intervention. CONCLUSION Falls management for PwP is complex and compounded by the progressive nature of the condition. Physiotherapists both delivered and positively received PDSAFE. (248 words) The trial registration number is ISRCTN 48152791.
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Affiliation(s)
| | | | - R Summers
- Health Sciences, University of Southampton
| | - S Lamb
- Oxford Clinical Trial Research Unit, University of Oxford
| | | | | | | | - A Rowsell
- Health Sciences, University of Southampton
| | - S Ewing
- Health Sciences, University of Southampton
| | - A Ashburn
- Health Sciences, University of Southampton
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Dias SB, Grammatikopoulou A, Diniz JA, Dimitropoulos K, Grammalidis N, Zilidou V, Savvidis T, Konstantinidis E, Bamidis PD, Jaeger H, Stadtschnitzer M, Silva H, Telo G, Ioakeimidis I, Ntakakis G, Karayiannis F, Huchet E, Hoermann V, Filis K, Theodoropoulou E, Lyberopoulos G, Kyritsis K, Papadopoulos A, Delopoulos A, Trivedi D, Chaudhuri KR, Klingelhoefer L, Reichmann H, Bostantzopoulou S, Katsarou Z, Iakovakis D, Hadjidimitriou S, Charisis V, Apostolidis G, Hadjileontiadis LJ. Innovative Parkinson's Disease Patients' Motor Skills Assessment: The i-PROGNOSIS Paradigm. FRONTIERS IN COMPUTER SCIENCE 2020. [DOI: 10.3389/fcomp.2020.00020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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