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Croarkin E, Robinson K, Stanley CJ, Zampieri C. Training high level balance and stepping responses in atypical progressive supranuclear palsy: a case report. Physiother Theory Pract 2023; 39:1071-1082. [PMID: 35098865 PMCID: PMC9334456 DOI: 10.1080/09593985.2022.2032509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/28/2021] [Accepted: 12/25/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a neurodegenerative condition, typically presenting with, but not limited to, impairments of postural instability, gait, and gaze stability. PURPOSE This case report describes the multifactorial assessment and rehabilitation of a patient with atypical PSP who has significant gaze deficits, asymmetrical stepping responses, trunk rigidity, and reduced posterior excursion on limits of stability. CASE DESCRIPTION Evaluation utilized computerized gait and balance assessments, foot clearance analysis, a squat test, and a timed stepping test. The intervention included boxing, stepping tasks, and treadmill training each with eye movement challenges. A total of 15 hours of physical therapy was provided; 1 hour, 2 times a week. OUTCOMES Post-intervention improvements were noted subjectively, on eye-body coordination, and objectively, on limits of stability, foot clearance, and task performance (squats, timed stepping). Follow-up demonstrated some decline from posttest results; however, patient-reported adherence to the program was less than recommended. CONCLUSION A multifactorial rehabilitation program can improve balance, eye-body coordination, and strength in a high functioning patient with atypical PSP. Longitudinal randomized controlled studies are suggested to further investigate this interventional approach in high functioning individuals diagnosed with atypical PSP.
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Affiliation(s)
- Earllaine Croarkin
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Research Center, Bethesda, MD, USA
| | - Krystle Robinson
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Research Center, Bethesda, MD, USA
| | - Christopher J Stanley
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Research Center, Bethesda, MD, USA
| | - Cris Zampieri
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Research Center, Bethesda, MD, USA
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Stępień P, Kawa J, Sitek EJ, Wieczorek D, Sikorski R, Dąbrowska M, Sławek J, Pietka E. Computer Aided Written Character Feature Extraction in Progressive Supranuclear Palsy and Parkinson's Disease. SENSORS 2022; 22:s22041688. [PMID: 35214587 PMCID: PMC8880639 DOI: 10.3390/s22041688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 02/01/2023]
Abstract
Parkinson's disease (PD) and progressive supranuclear palsy (PSP) are neurodegenerative movement disorders associated with cognitive dysfunction. The Luria's Alternating Series Test (LAST) is a clinical tool sensitive to both graphomotor problems and perseverative tendencies that may suggest the dysfunction of prefrontal and/or frontostriatal areas and may be used in PD and PSP assessment. It requires the participant to draw a series of alternating triangles and rectangles. In the study, two clinical groups-51 patients with PD and 22 patients with PSP-were compared to 32 neurologically intact seniors. Participants underwent neuropsychological assessment. The LAST was administered in a paper and pencil version, then scanned and preprocessed. The series was automatically divided into characters, and the shapes were recognized as rectangles or triangles. In the feature extraction step, each rectangle and triangle was regarded both as an image and a two-dimensional signal, separately and as a part of the series. Standard and novel features were extracted and normalized using characters written by the examiner. Out of 71 proposed features, 51 differentiated the groups (p < 0.05). A classifier showed an accuracy of 70.5% for distinguishing three groups.
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Affiliation(s)
- Paula Stępień
- Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland; (P.S.); (E.P.)
| | - Jacek Kawa
- Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland; (P.S.); (E.P.)
- Correspondence:
| | - Emilia J. Sitek
- Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland; (E.J.S.); (J.S.)
- Department of Neurology, St. Adalbert Hospital, Copernicus PL Ltd., 80-462 Gdansk, Poland;
| | - Dariusz Wieczorek
- Department of Rehabilitation, Faculty of Health Sciences, Medical University of Gdansk, 80-219 Gdansk, Poland;
| | - Rafał Sikorski
- Department of Rehabilitation, Saint Vincent a Paulo Hospital, Pomeranian Hospitals Ltd., 81-519 Gdynia, Poland;
| | - Magda Dąbrowska
- Department of Neurology, St. Adalbert Hospital, Copernicus PL Ltd., 80-462 Gdansk, Poland;
| | - Jarosław Sławek
- Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland; (E.J.S.); (J.S.)
- Department of Neurology, St. Adalbert Hospital, Copernicus PL Ltd., 80-462 Gdansk, Poland;
| | - Ewa Pietka
- Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland; (P.S.); (E.P.)
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Armstrong RA. Visual signs and symptoms of dementia with Lewy bodies. Clin Exp Optom 2021; 95:621-30. [DOI: 10.1111/j.1444-0938.2012.00770.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 01/31/2012] [Accepted: 04/03/2012] [Indexed: 11/28/2022] Open
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Edwards N, Dulai J, Rahman A. A Scoping Review of Epidemiological, Ergonomic, and Longitudinal Cohort Studies Examining the Links between Stair and Bathroom Falls and the Built Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091598. [PMID: 31067692 PMCID: PMC6540131 DOI: 10.3390/ijerph16091598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 11/16/2022]
Abstract
Stair and bathroom falls contribute to injuries among older adults. This review examined which features of stairs and bathrooms have been assessed in epidemiological, ergonomic, and national aging studies on falls or their risk factors. Epidemiological and ergonomic studies were eligible if published from 2006-2017, written in English, included older persons, and reported built environment measures. The data extracted included the following: study population and design, outcome measures, and stair and bathroom features. National aging studies were eligible if English questionnaires were available, and if data were collected within the last 10 years. Sample characteristics; data collection methods; and data about falls, the environment, and assistive device use were extracted. There were 114 eligible articles assessed-38 epidemiologic and 76 ergonomic. Among epidemiological studies, 2 assessed stair falls only, 4 assessed bathroom falls only, and 32 assessed falls in both locations. Among ergonomic studies, 67 simulated stairs and 9 simulated bathrooms. Specific environmental features were described in 14 (36.8%) epidemiological studies and 73 (96%) ergonomic studies. Thirteen national aging studies were identified-four had stair data and six had bathroom data. Most epidemiologic and national aging studies did not include specific measures of stairs or bathrooms; the built environment descriptions in ergonomic studies were more detailed. More consistent and detailed environmental measures in epidemiologic and national aging studies would better inform fall prevention approaches targeting the built environment.
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Affiliation(s)
- Nancy Edwards
- School of Nursing, University of Ottawa, Ottawa, ON K1S 5L5, Canada.
| | - Joshun Dulai
- School of Nursing, University of Ottawa, Ottawa, ON K1S 5L5, Canada.
| | - Alvi Rahman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC H3A 0G4, Canada.
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Armstrong RA. Visual problems associated with traumatic brain injury. Clin Exp Optom 2018; 101:716-726. [PMID: 29488253 DOI: 10.1111/cxo.12670] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) and its associated concussion are major causes of disability and death. All ages can be affected but children, young adults and the elderly are particularly susceptible. A decline in mortality has resulted in many more individuals living with a disability caused by TBI including those affecting vision. This review describes: (1) the major clinical and pathological features of TBI; (2) the visual signs and symptoms associated with the disorder; and (3) discusses the assessment of quality of life and visual rehabilitation of the patient. Defects in primary vision such as visual acuity and visual fields, eye movement including vergence, saccadic and smooth pursuit movements, and in more complex aspects of vision involving visual perception, motion vision ('akinopsia'), and visuo-spatial function have all been reported in TBI. Eye movement dysfunction may be an early sign of TBI. Hence, TBI can result in a variety of visual problems, many patients exhibiting multiple visual defects in combination with a decline in overall health. Patients with chronic dysfunction following TBI may require occupational, vestibular, cognitive and other forms of physical therapy. Such patients may also benefit from visual rehabilitation, including reading-related oculomotor training and the prescribing of spectacles with a variety of tints and prism combinations.
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Abstract
This chapter describes the visual problems likely to be encountered in Parkinson's disease (PD) and whether such signs are useful in differentiating the parkinsonian syndromes. Visual dysfunction in PD may involve visual acuity, contrast sensitivity, color discrimination, pupil reactivity, saccadic and pursuit eye movements, motion perception, visual fields, and visual processing speeds. In addition, disturbance of visuospatial orientation, facial recognition problems, rapid eye movement (REM) sleep behavior disorder, and chronic visual hallucinations may be present. Problems affecting pupil reactivity, stereopsis, pursuit eye movement, and visuomotor adaptation, when accompanied by REM sleep behavior disorder, could be early features of PD. Dementia associated with PD is associated with enhanced eye movement problems, visuospatial deficits, and visual hallucinations. Visual dysfunction may be a useful diagnostic feature in differentiating PD from other parkinsonian symptoms, visual hallucinations, visuospatial dysfunction, and variation in saccadic eye movement problems being particularly useful discriminating features.
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Armstrong RA. Visual signs and symptoms of corticobasal degeneration. Clin Exp Optom 2016; 99:498-506. [PMID: 27553583 DOI: 10.1111/cxo.12429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/23/2016] [Accepted: 04/28/2016] [Indexed: 11/28/2022] Open
Abstract
Corticobasal degeneration is a rare, progressive neurodegenerative disease and a member of the 'parkinsonian' group of disorders, which also includes Parkinson's disease, progressive supranuclear palsy, dementia with Lewy bodies and multiple system atrophy. The most common initial symptom is limb clumsiness, usually affecting one side of the body, with or without accompanying rigidity or tremor. Subsequently, the disease affects gait and there is a slow progression to influence ipsilateral arms and legs. Apraxia and dementia are the most common cortical signs. Corticobasal degeneration can be difficult to distinguish from other parkinsonian syndromes but if ocular signs and symptoms are present, they may aid clinical diagnosis. Typical ocular features include increased latency of saccadic eye movements ipsilateral to the side exhibiting apraxia, impaired smooth pursuit movements and visuo-spatial dysfunction, especially involving spatial rather than object-based tasks. Less typical features include reduction in saccadic velocity, vertical gaze palsy, visual hallucinations, sleep disturbance and an impaired electroretinogram. Aspects of primary vision such as visual acuity and colour vision are usually unaffected. Management of the condition to deal with problems of walking, movement, daily tasks and speech problems is an important aspect of the disease.
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Kesler RM, Horn GP, Rosengren KS, Hsiao-Wecksler ET. Analysis of foot clearance in firefighters during ascent and descent of stairs. APPLIED ERGONOMICS 2016; 52:18-23. [PMID: 26360190 DOI: 10.1016/j.apergo.2015.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 04/23/2015] [Accepted: 05/27/2015] [Indexed: 06/05/2023]
Abstract
Slips, trips, and falls are a leading cause of injury to firefighters with many injuries occurring while traversing stairs, possibly exaggerated by acute fatigue from firefighting activities and/or asymmetric load carriage. This study examined the effects that fatigue, induced by simulated firefighting activities, and hose load carriage have on foot clearance while traversing stairs. Landing and passing foot clearances for each stair during ascent and descent of a short staircase were investigated. Clearances decreased significantly (p < 0.05) post-exercise for nine of 12 ascent parameters and increased for two of eight descent parameters. Load carriage resulted in significantly decreased (p < 0.05) clearance over three ascent parameters, and one increase during descent. Decreased clearances during ascent caused by fatigue or load carriage may result in an increased trip risk. Increased clearances during descent may suggest use of a compensation strategy to ensure stair clearance or an increased risk of over-stepping during descent.
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Affiliation(s)
- Richard M Kesler
- University of Illinois, Fire Service Institute, Urbana-Champaign, IL, USA
| | - Gavin P Horn
- University of Illinois, Fire Service Institute, Urbana-Champaign, IL, USA; University of Illinois, Dept. of Mechanical Science and Engineering, Urbana-Champaign, IL, USA
| | - Karl S Rosengren
- University of Wisconsin-Madison, Department of Psychology, Madison, WI, USA
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Lohnes CA, Earhart GM. Saccadic eye movements are related to turning performance in Parkinson disease. JOURNAL OF PARKINSONS DISEASE 2014; 1:109-18. [PMID: 22216083 DOI: 10.3233/jpd-2011-11019] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persons with Parkinson disease (PD) experience difficulty turning, leading to freezing of gait and falls. We hypothesized that saccade dysfunction may relate to turning impairments, as turns are normally initiated with a saccade. OBJECTIVE Determine whether saccades are impaired during turns in PD and if characteristics of the turn-initiating saccade are predictive of ensuing turn performance. METHODS 23 persons with PD off medication and 19 controls performed 90 and 180 degree in-place turns to the right and left. Body segment rotations were measured using 3-D motion capture and oculomotor data were captured using a head-mounted eye tracking system and electrooculography. Total number of saccades and the amplitude, velocity, and timing of the first saccade were determined. RESULTS Turn performance (turn duration, number of steps to turn) was impaired in PD (p<0.05). PD performed more saccades, and the velocity and timing of the first saccade was impaired for both turn amplitudes (p<0.05). Amplitude of the first saccade was decreased in PD during 180 degree turns. Turn duration correlated with oculomotor function. Characteristics of the first saccade explained 48% and 58% of the variance in turn duration for 90 and 180 degree turns, respectively. CONCLUSIONS Turning performance is impaired in PD and may be influenced by saccade dysfunction. An association between saccade function and turning performance may be indicative of the key role of saccades in initiating proper turning kinematics. Future work should focus on improving saccade performance during functional tasks and testing the effects of therapeutic interventions on related outcomes.
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Affiliation(s)
- Corey A Lohnes
- Program in Physical Therapy, Washington University in St. Louis, MO, USA
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Teixeira-Arroyo C, Barbieri FA, Vitório R, Pereira MP, Lirani-Silva E, Gobbi LTB. Parâmetros na marcha na paralisia supranuclear progressiva: um estudo de caso. FISIOTERAPIA EM MOVIMENTO 2012. [DOI: 10.1590/s0103-51502012000400021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Comprometimentos na marcha de pacientes com paralisia supranuclear progressiva (PSP) podem aumentar o risco de quedas durante o andar, especialmente em ambientes complexos. OBJETIVO: Descrever o comportamento locomotor de uma paciente com PSP, nas condições de marcha livre e marcha adaptativa. MATERIAIS E MÉTODOS: Estudo de caso de uma paciente com PSP (71 anos). Para análise cinemática, nas condições de marcha livre, com obstáculo baixo e alto, uma câmera digital registrou uma passada completa da paciente. RESULTADOS: Com o aumento da complexidade do ambiente (marcha livre, obstáculo baixo e alto, respectivamente), foi observada diminuição do comprimento do passo (0,37 ± 0,07; 0,30 ± 0,07; 0,26 ± 0,06 m), do comprimento da passada (0,71 ± 0,11; 0,58 ± 0,15; 0,47 ± 0,07 m) e da velocidade da passada (0,55 ± 0,14; 0,43 ± 0,11; 0,36 ± 0,11 m/s). Aumento progressivo ocorreu na duração do duplo suporte da passada livre (29,47%) para a passada antes do obstáculo alto (41,11%). Observou-se, ainda, ligeira diminuição na distância vertical pé/obstáculo alto (membro/abordagem: 7,18 ± 1,88; e membro/suporte: 8,84 ± 2,57 cm) em relação ao obstáculo baixo (membro de abordagem: 8,86 ± 1,88; e membro de suporte: 11,67 ± 2,09 cm). CONCLUSÃO: A PSP afetou de forma evidente a marcha da paciente. Inflexibilidade para a adaptação da marcha às demandas do ambiente foi observada durante a aproximação e a transposição dos obstáculos, o que pode aumentar o risco de tropeços e quedas.
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Affiliation(s)
| | | | - Rodrigo Vitório
- Universidade Estadual Paulista Júlio de Mesquita Filho, Brasil
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Egerton T, Williams DR, Iansek R. Comparison of gait in progressive supranuclear palsy, Parkinson's disease and healthy older adults. BMC Neurol 2012; 12:116. [PMID: 23031506 PMCID: PMC3517411 DOI: 10.1186/1471-2377-12-116] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/26/2012] [Indexed: 11/17/2022] Open
Abstract
Background Progressive supranuclear palsy and Parkinson’s disease have characteristic clinical and neuropathologic profiles, but also share overlapping clinical features. This study aimed to analyze the gait of people with progressive supranuclear palsy (n=19) and compare it with people with Parkinson’s disease (n=20) and healthy older adults (n=20). Methods Gait was recorded at self-selected preferred, fast, very fast, slow and very slow speeds. Stride length was normalized to leg length. Linear regression analyses were carried out between cadence and stride length. Other gait variables were compared for each participant’s ‘walk’ which had stride length closest to 1.4. Results All groups showed a strong linear relationship between stride length and cadence with no difference between groups (p>0.05). The intercept between cadence and stride length was lowest in the progressive supranuclear palsy group and highest for older adults (p<0.001). The progressive supranuclear palsy group had higher cadence than older adults (p>0.05), and greater step width and greater double support phase compared with the other two groups (p<0.05). Conclusions The temporal-spatial gait characteristics of progressive supranuclear palsy and Parkinson’s disease are largely similar, with similar disruption to scaling of stride length. The additional findings of increased step width and double support percentage suggest increased severity of gait abnormality compared to Parkinson’s disease, despite similar disease duration. The findings are consistent with the clinical features of greater instability and more rapid disease progression in progressive supranuclear palsy compared to Parkinson’s disease and implicates the early pathological involvement of brain regions involved in gait control.
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Affiliation(s)
- Thorlene Egerton
- National Parkinson Foundation Center of Excellence, Clinical Research Centre for Movement Disorders and Gait and Victorian Comprehensive Parkinson's Program, Kingston Centre, Cheltenham, VIC, Australia
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Abstract
Progressive supranuclear palsy is a rare, degenerative brain disorder and the second most common syndrome in which the patient exhibits 'parkinsonism', that is, a variety of symptoms involving problems with movement. General symptoms include difficulties with gait and balance; the patient walking clumsily and often falling backwards. The syndrome can be difficult to diagnose and visual signs and symptoms can help to separate it from closely related movement disorders such as Parkinson's disease, multiple system atrophy, dementia with Lewy bodies and corticobasal degeneration. A combination of the presence of vertical supranuclear gaze palsy, fixation instability, lid retraction, blepharospasm and apraxia of eyelid opening and closing may be useful visual signs in the identification of progressive supranuclear palsy. As primary eye-care practitioners, optometrists should be able to identify the visual problems of patients with this disorder and be expected to work with patients and their carers to manage their visual welfare.
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Balance and eye movement training to improve gait in people with progressive supranuclear palsy: quasi-randomized clinical trial. Phys Ther 2008; 88:1460-73. [PMID: 18948373 DOI: 10.2522/ptj.20070302] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Although vertical gaze palsy and gait instability are cardinal features of progressive supranuclear palsy (PSP), little research has been done to address oculomotor and gait rehabilitation for PSP. The purpose of this study was to compare the benefits of a program of balance training complemented with eye movement and visual awareness training versus balance training alone to rehabilitate gait in people with PSP. PARTICIPANTS Nineteen people moderately affected by the disease were assigned to either a treatment group (balance plus eye movement exercises, n=10) or a comparison group (balance exercises only, n=9) in a quasi-random fashion. METHODS The baseline characteristics assessed were diagnosis (possible versus probable), sex, age, time of symptom onset, dementia, and severity of symptoms. Within-group, between-group, and effect size analyses were performed on kinematic gait parameters (stance time, swing time, and step length) and clinical tests (8-ft [2.4-m] walk test and Timed "Up & Go" Test). RESULTS The within-group analysis revealed significant improvements in stance time and walking speed for the treatment group, whereas the comparison group showed improvements in step length only. Moderate to large effects of the intervention were observed for the treatment group, and small effects were observed for the comparison group. The between-group analysis did not reveal significant changes for either group. DISCUSSION AND CONCLUSION These preliminary findings support the use of eye movement exercises as a complementary therapy for balance training in the rehabilitation of gait in people with PSP and moderate impairments. Additional studies powered at a higher level are needed to confirm these results.
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