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[Rehabilitation in Parkinson disease]
... The demand for rapid integration of online visual feedback strengthens the ecological validity of the task, as these conditions can be said to reflect the demands of real-life motor control. High test-retest reliability has been demonstrated for the DPB protocol (Rose, 2013). ...
... STS was classified as a simpler motor task than DPB because the STS movement is routine (Bohannon, 2015) and does not require adaptation of the movement pattern to external torque signals, as in DPB. High test-retest reliability has been demonstrated for the STS protocol utilized (Rose, 2013). ...
The objective was to examine associations between motor and executive function across the adult lifespan and to investigate the role of motor complexity in these associations. Young, middle-aged and older adults (n = 82; 19–83y) performed two gross-motor tasks with different levels of complexity and a Stroop-like computer task. Performance was decreased in older adults. The association between motor and cognitive performance was significant for older adults in the complex motor task (p = 0.03, rs = −0.41), whereas no significant associations were found for young or middle-aged groups, suggesting that the link between gross-motor and executive function emerges with age and depends on motor complexity.
Improved diagnostic sophistication is increasingly enabling neurologists to differentiate between Parkinson's disease and other atypical parkinsonism (AP), such as multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, and dementia with Lewy bodies. The Handbook of Atypical Parkinsonism is a comprehensive survey of all diseases of this category, providing an authoritative guide to the recognition, diagnosis and management of these disorders. Each chapter follows a common structure, commencing with the full basic science of the disorder under consideration, followed by descriptions of the clinical picture and differential diagnosis. Subsequent chapters discuss current and future therapeutic approaches to these difficult conditions. Written and edited by leading practitioners in the field, clinicians in neurology and other specialties will find this book essential to the understanding and diagnosis of this complex group of disorders.
Physical and cognitive rehabilitation is deemed crucial to attenuate symptoms and to improve the quality of life in people with neurodegenerative disorders, such as Parkinson’s Disease. Among rehabilitation strategies, a novel and popular approach relies on exergaming: the patient performs a motor or cognitive task within an interactive videogame in a virtual environment. These strategies may widely benefit from being tailored to the patient’s needs and engagement patterns. In this pilot study, we investigated the ability of a low-cost BCI based on single-channel EEG to measure the user’s engagement during an exergame. As a first step, healthy subjects were recruited to assess the system’s capability to distinguish between (1) rest and gaming conditions and (2) gaming at different complexity levels, through Machine Learning supervised models. Both EEG and eye-blink features were employed. The results indicate the ability of the exergame to stimulate engagement and the capability of the supervised classification models to distinguish resting stage from game-play (accuracy > 95%). Finally, different clusters of subject responses throughout the game were identified, which could help define models of engagement trends. This result is a starting point in developing an effectively subject-tailored exergaming system.
While in the literature there is much interest in investigating lower limbs gait of patients affected by neurological diseases, such as Parkinson’s Disease (PD), fewer publications involving upper limbs movements are available. In previous studies, 24 motion signals (the so-called reaching tasks) of the upper limbs of PD patients and Healthy Controls (HCs) were used to extract several kinematic features through a custom-made software; conversely, the aim of our paper is to investigate the possibility to build models – using these features – for distinguishing PD patients from HCs. First, a binary logistic regression and, then, a Machine Learning (ML) analysis was performed by implementing five algorithms through the Knime Analytics Platform. The ML analysis was performed twice: first, a leave-one out-cross validation was applied; then, a wrapper feature selection method was implemented to identify the best subset of features that could maximize the accuracy. The binary logistic regression achieved an accuracy of 90.5%, demonstrating the importance of the maximum jerk during subjects upper limb motion; the Hosmer-Lemeshow test supported the validity of this model (p-value=0.408). The first ML analysis achieved high evaluation metrics by overcoming 95% of accuracy; the second ML analysis achieved a perfect classification with 100% of both accuracy and area under the curve receiver operating characteristics. The top-five features in terms of importance were the maximum acceleration, smoothness, duration, maximum jerk and kurtosis. The investigation carried out in our work has proved the predictive power of the features, extracted from the reaching tasks involving the upper limbs, to distinguish HCs and PD patients.
Physiotherapy is important to people with arthritis, and physiotherapists help them to resume or continue active, independent lives at home and work. Physiotherapy addresses many pain categories; however, this important treatment is still overlooked in Bangladesh, where many people suffer from physical pain. This study presents a multi-feature web-based physiotherapy application. A user can register as a doctor or patient via email or phone using the web application. A therapist’s information is verified manually by a system administrator. Using the application, patients can select a variety of features for treatment. Patients can watch physiotherapy video tutorials, find a physiotherapy clinic within 5 km, consult with a physiotherapist on a video call, and make appointments for a therapist to provide service in their homes.
The article presents the process of eating, and then describes dysphagia: its causes, classification and symptoms. The authors presented in the article selected diseases with which dysphagia coexists. The aim of the text is to indicate activities that can be used by caregivers of people with dysphagia in their daily care and therapy.
Background
Parkinson’s disease is caused by dopaminergic neurodegeneration resulting in motor impairments as slow movement speed and impaired balance and coordination. Pulsed electromagnetic fields are suggested to have neuroprotective effects, and could alleviate symptoms.
Objective
To study 1) effects of 8-week daily transcranial pulsed electromagnetic field treatment on functional rate of force development and movement speed during two motor tasks with different levels of complexity, 2) if treatment effects depend on motor performance at baseline.
Methods
Ninety-seven persons with Parkinson’s disease were randomized to active transcranial pulsed electromagnetic field (squared bipolar 3 ms pulses, 50 Hz) or placebo treatment with homebased treatment 30 min/day for 8 weeks. Functional rate of force development and completion time of a sit-to-stand and a dynamic postural balance task were assessed pre and post intervention. Participants were sub-grouped in high- and low-performers according to their baseline motor performance level. Repeated measure ANOVAs were used.
Results
Active treatment tended to improve rate of force development during chair rise more than placebo (P = 0.064). High-performers receiving active treatment improved rate of force development during chair rise more than high-performers receiving placebo treatment (P = 0.049, active/placebo: 11.9±1.1 to 12.5±1.9 BW/s ≈ 5% / 12.4±1.3 to 12.2±1.3 BW/s, no change). No other between-treatment-group or between-treatment-subgroup differences were found. Data on rate of force development of the dynamic balance task and completion times of both motor tasks improved but did not allow for between-treatment differentiation.
Conclusion
Treatment with transcranial pulsed electromagnetic fields was superior to placebo regarding functional rate of force development during chair rise among high-performers. Active treatment tended to increase functional rate of force development while placebo did not. Our results suggest that mildly affected persons with Parkinson’s disease have a larger potential for neural rehabilitation than more severely affected persons and indicate that early treatment initiation may be beneficial.
Purpose: To examine in people with neurological disorders, which method/s of providing external cues to improve task performance are most effective.
Methods: Medline, EMBASE, and PsycINFO were systematically searched. Two reviewers independently screened, extracted data, and assessed the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results: Twenty six studies were included. Studies examined a wide-range of cues including visual, tactile, auditory, verbal, and multi-component cues. Cueing (any type) improved walking speed when comparing cues to no cues (mean difference (95% confidence interval): 0.08 m/s (0.06–0.10), I² = 68%, low quality of evidence). Remaining evidence was analysed narratively; evidence that cueing improves activity-related outcomes was inconsistent and rated as very low quality. It was not possible to determine which form of cueing may be more effective than others.
Conclusion: Providing cues to encourage successful task performance is a core component of rehabilitation, however there is limited evidence on the type of cueing or which tasks benefit most from external cueing. Low-quality evidence suggests there may be a beneficial effect of cueing (any type) on walking speed. Sufficiently powered randomised controlled trials are needed to inform therapists of the most effective cueing strategies to improve activity performance in populations with a neurological disorder.
• Implications for rehabilitation
• Providing cues is a core component of rehabilitation and may improve successful task performance and activities in people with neurological conditions including stroke, Parkinson’s disease, Alzheimer’s disease, traumatic brain injury, and multiple sclerosis, but evidence is limited for most neurological conditions with much research focusing on stroke and Parkinson’s disease.
• Therapists should consider using a range of different types of cues depending on the aims of treatment and the neurological condition. There is currently insufficient evidence to suggest one form of cueing is superior to other forms.
• Therapists should appreciate that responding optimally to cues may take many sessions to have an effect on activities such as walking.
• Further studies should be conducted over a longer timeframe to examine the effects of different types of cues towards task performance and activities in people with neurological conditions.
Background: Physical activity (PA) is increasingly advocated as an adjunct intervention for individuals with Parkinson’s disease (PD). However, the specific benefits of PA on the wide variety of impairments observed in patients with PD has yet to be clearly identified.
Objective: Highlight health parameters that are most likely to improve as a result of PA interventions in patients with PD.
Methods: We compiled results obtained from studies examining a PA intervention in patients with PD and who provided statistical analyses of their results. 868 outcome measures were extracted from 106 papers published from 1981 to 2015. The results were classified as having a statistically significant positive effect or no effect. Then, outcome measures were grouped into four main categories and further divided into sub-categories.
Results: Our review shows that PA seems most effective in improving Physical capacities and Physical and cognitive functional capacities. On the other hand, PA seems less efficient at improving Clinical symptoms of PD and Psychosocial aspects of life, with only 50% or less of results reporting positive effects. The impact of PA on Cognitive functions and Depression also appears weaker, but few studies have examined these outcomes.
Discussion: Our results indicate that PA interventions have a positive impact on physical capacities and functional capacities. However, the effect of PA on symptoms of the disease and psychosocial aspects of life are moderate and show more variability. This review also highlights the need for more research on the effects of PA on cognitive functions, depression as well as specific symptoms of PD.
Sensory control of the natural skilled movement of reaching for a food target to eat (reach-to-eat) is closely coupled to the successive phases of the movement. Control subjects visually fixate the target from hand movement onset to the point that the digits contact the food, at which point they look away. This relationship between sensory attention and limb movement suggests that whereas limb advance is under visual control, grasping, limb withdrawal, and releasing the food to the mouth is guided by somatosensation. The pattern of sensory control is altered in Parkinson's disease (PD). PD subjects may visually fixate the target for longer durations prior to movement initiation, during the grasp, and during the initial portion of hand withdrawal suggesting that vision compensates for a somatosensory impairment. Because both medication and listening to favorite musical pieces have been reported to normalize some movements in subjects with PD, the present study compared the effect of medication and listening to preferred musical pieces on sensory attention shifts from vision to somatosensation during the reach-to-eat movement. Biometric measures of eye movement and the movement of the reaching limb were collected from PD subjects and aged-matched control subjects in four conditions in their own homes: off medication, off medication with music, on medication, and on medication with music. Unmedicated PD subjects were slower to visually disengage the target after grasping it. Their disengage latency was shortened by both music and medication. Medication and music did not improve other aspects of reaching, including reaching duration and the ratings of the movement elements of limb advance, grasping, and limb withdrawal. The results are discussed in relation to the idea that one way in which medication and music may aid movement in PD by normalizing somatosensory control of forelimb movement thus reducing compensatory visual monitoring.
Persons suffering from Parkinson's disease (PD) show variable motor manifestations such as gait dysfunction and hypokinesia as well as psychosocial manifestations like emotional and social impairment. In order to assess short- and midterm impact on PD persons from a comprehensive training concept, we launched a study with daily walks in the Swedish mountains during 1 summer week. The 3-6 km daily walking tours in hilly terrain were combined with lectures about the disease and self-training, social intercourse and a general encouraging atmosphere brought about by three accompanying leaders. The participants stayed in a mountain pension during the week. Nineteen mild to moderate PD persons volunteered and were assessed before (0 weeks), immediately after (1 week), and 4 months later (18 weeks) by a self-reporting questionnaire containing four subscales. These covered the domains PD symptoms, systemic symptoms, emotional functioning, and social functioning. There was a general improvement in PD scores at 1 week compared to baseline. This was not sustained at the 18-week follow-up. We postulate the results were due to a combination of information, professional guidance, exercise in hilly terrain with environmental visual cues, social interaction, and comparison with the others. Further research should aim at pinpointing the most essential components to achieve short- as well as midterm improvements. We believe there is a need to focus on patients' self-reported health to a greater extent than today in order to complement traditional rehabilitation and training outcome measures.
To investigate the effects of a physical therapy (PT) program in groups of people with Parkinson's disease (PD).
Randomized controlled trial with a crossover design.
Two outpatient rehabilitation clinics in Boston and Amsterdam, respectively.
Sixty-eight subjects diagnosed with typical, idiopathic PD, Hoehn and Yahr stage II or III, and stable medication use.
Group A received PT and medication therapy (MT) for the first 6 weeks, followed by MT only for the second 6 weeks. Group B received only MT for the first 6 weeks and PT and MT for the second 6 weeks.
The Sickness Impact Profile (SIP-68), the mobility portion of the SIP-68, the Unified Parkinson's Disease Rating Scale (UPDRS), and comfortable walking speed (CWS) at baseline, 6-week, 12-week, and 3-month follow-up.
At 6 weeks, differences between groups were significant for the SIP mobility ( P =.015; effect size [ES]=.55), for CWS ( P =.012; ES=.49), for the activities of daily living (ADL) section of the UPDRS ( P =.014; ES=.45), and for the total UPDRS ( P =.007; ES=.56). The total SIP and the mentation and motor sections of the UPDRS did not differ significantly between groups. Significant differences were found at 3 months compared with baseline for CWS, the UPDRS ADL, and total scores.
People with PD derive benefits in the short term from PT group treatment, in addition to their MT, for quality of life related to mobility, CWS, and ADLs; long-term benefits were found in CWS, UPDRS ADL, and total scores but varied between groups.
Current knowledge on the epidemiology of major joint contractures is limited. We systematically reviewed the literature to identify studies examining the epidemiology of joint contracture regardless of clinical condition. Epidemiologic measures of interest were prevalence, incidence, and prognostic risk factors. We used Medline to identify all epidemiologic studies of major joint contractures published from 1966 to March 2005. There was a high prevalence of major joint contractures. Most studies focused on one joint rather than including all relevant major contractures. However, most studies did provide a definition of a contracture or the measures used to assess contractures. Immobility is a highly prevalent disability in at-risk populations, and constitutes a tremendous burden to patients in nursing homes, hospitals, and the outpatient community. The lack of epidemiologic data is a major impediment to providing appropriate treatment.
Parkinson disease is a complex neurodegenerative disease with both motor and nonmotor symptoms. Levodopa remains the mainstay of therapy but is associated with motor complications as the disease progresses. A levodopa-sparing strategy may reduce or delay the onset of motor complications. New medical and surgical therapies offer improved control of motor complications in advancing disease. Recognition and treatment of nonmotor symptoms can improve quality of life throughout the course of the disease.
Objectives: To test the effects of a home-based educational intervention in reducing the incidence and the risk of falls and pressure sores in adults with progressive neurological conditions.
Design: Randomized controlled trial with 12 months follow-up.
Setting: Participants’ homes in the City of Nottingham.
Participants: One hundred and fourteen people with progressive neurological conditions recruited from general practices in Nottingham, including 53 with Parkinson's disease and 45 with multiple sclerosis.
Interventions: In the education group (EG), baseline data were reviewed by an expert panel which advised on actions most likely to promote each individual's physical, social and psychological well-being. An occupational therapist (OT) then visited EG participants to provide education and information and to discuss a personalized 12-month health action plan. The comparison group (CoG) received standardized printed information delivered to their home.
Main measures: Numbers of participants reporting falls and skin sores at two-monthly phone calls during the follow-up period of 12 months.
Results: The EG reported significantly more falls during the follow-up period and at 12 months (adjusted odds ratio 2.83 (95% CI 1.07-7.47), p=0.036) and significantly more skin sores (adjusted odds ratio 12.74 (95% CI 1.14-142.6), p=0.039) than the CoG. There was no difference between CoG and EG in the Nottingham Extended Activities of Daily Living score, but EG patients showed a significant rise in this score over the study period of 1.62 (95% CI 0.69-2.55, p=0.002).
Conclusions: Our findings provide evidence that education for people with progressive neurological conditions can have negative effects.
We studied 10 patients with Parkinson’s disease and 12 patients with Parkinson-plus-syndrome, trying to improve patients’ gait by application of various external rhythmic stimuli, including metronome stimulation (96 beats per minute=middle andante). The test course of the patients was 4×10 meters and 3 U-turns. The patients’ gait quality under stimulation was compared with their free walk (velocity, number of steps, number of freezing episodes). Metronome stimulation significantly reduced the time and number of steps needed for the test course and also diminished the number of freezing episodes. March music stimulation was less effective and tactile stimulation (rhythmically tapping on the patient’s shoulder) even produced negative results. The positive effect of metronome stimulation was also found, when the tests were not performed inside the hospital building, but outside in the hospital parc. Metronome stimulation was comparably effective in both patient sub-groups examined in this study (M. Parkinson, Parkinson-plus-syndrome) and seems to be an important additional help in the treatment of these patients. Electronical metronomes are not expensive, easy in handling, and portable. A theoretical explanation of metronome stimulation effectivity in patients with Parkinson’s disease still needs to be elucidated.
Recently a consensus has emerged that health care research should address outcomes important to patients, especially quality of life, role performance, and functional status. The assessment of such outcomes is beset by conceptual and methodological difficulties that may be especially problematic for asthma. Nevertheless, several broad conclusions may be drawn about the use of measures of these outcomes in asthma research. Asthma usually is reasonably well controlled if patients are moderately adherent to their recommended regimens. Consequently, the beneficial impacts of interventions are likely to be small, and large samples are required to detect them. Outcome assessment should combine asthma-specific measures with generic measures applicable to a variety of conditions. Generic measures aimed at severely debilitating disease are less appropriate than measures designed for use in the general population. Asthma-specific measures should emphasize the incidence and impact of such symptoms as coughing, wheezing, sputum production, and shortness of breath. Current procedures for computing utility scores and cost-benefit ratios based on them have serious measurement limitations, and use of such scores should be postponed until those limitations are overcome. These assessment issues should be addressed separately for adults and children.
Rating scales in Parkinson's disease (PD) are generally reliable but are not widely used in practice. UPDRS is the core assessment of PD, its metrologic properties are well known, and it is simple to use after training. However, cognitive and psychic disorders need complementary approaches. For example, MATTIS seems to be more appropriate in assessing the cognitive deficit and MADRS the depressive symptoms. A patient diary best appreciates motor fluctuations. Activities of daily living rated by the UPDRS allow a global assessment of the patient handicap that may be completed by "the patient's own point of view" through quality of life scales (SF36, PDQ39). For clinical research purposes, time tests and dyskinesia scales following the CAPIT or CAPSIT procedure are required.
Neurological disorders affecting musical function can produce either positive or negative symptoms. Positive phenomena include musicogenic epilepsy (seizures triggered by music), musical partial seizures (hallucinated music as the expression of the seizure), musical release hallucinations (nonepileptic musical hallucinations, usually associated with impaired hearing), and synesthesia (hallucinated colors triggered by musical tones). Negative phenomena comprise the amusias, which can be receptive, expressive, or both, and can selectively involve particular components of musical processing, including pitch, interval, contour, rhythm, meter, timbre, and emotional response. Amusia is often accompanied by aphasia, but each can occur in the absence of the other. Neurological disorders provide evidence that musical processing is multimodal and widely distributed in both cerebral hemispheres.
The internal consistency (Cronbach's alpha and item-total correlation) and construct validity (factor analysis, intercorrelations, and relationship with Hoehn and Yahr staging and Schwab and England's ADL scale) of the sections "motor examination" and "activities of daily living" of the Unified Parkinson's Disease Rating Scale (UPDRS) and of the Short Parkinson's Evaluation Scale (SPES) were analyzed in 59 subjects with Parkinson's disease (PD) with various degrees of disability. Our results indicate that the SPES is easier and quicker than UPDRS and that it maintains many psychometric properties similar to those of the UPDRS, but with the reduction of a number of items and ordinal levels of each item studied here (producing more homogenous sections than the original versions). The tremor items would be better represented as a separate section in both scales.
The present study assessed the linguistic and content validity of the Swedish version of the 39-item Parkinson's disease questionnaire (PDQ-39). The frame question, response alternatives and two of the 39 items yielded substantial linguistic and stylistic problems. Such shortcomings would be expected to influence responses to, and the quality of, the whole questionnaire. Data support content validity of the PDQ-39 as a functional health status questionnaire, although some shortcomings were identified. This preliminary study illustrates the need for documented linguistic validity before new language adaptations of patient-reported outcome measures can be considered suitable for use in clinical trials, research, and practice.
Parkinson's disease (PD) patients have a ninefold increased risk of recurring falls compared to healthy controls. The risk of falling due to cardiovascular dysautonomia (CVD) is not quantifiable. But, CVD is an integral part of the disease and at least 20% of PD patients suffer from orthostatic hypotension, an expression of CVD. One way to reduce falls due to CVD in PD patients could be to give adequate information on the relationship between falling risks and cardiovascular dysautonomia to patients and their caregivers. Moreover, drugs given for PD might contribute to OH and we propose that education and non-pharmacological strategies for its treatment might be preferable, especially because of the low efficacy of drugs available for the treatment of OH and the frailty of elderly PD patients.