Balance control in older adults with Parkinson’s disease : effects of medication and exercise

Aim: To investigate the effects of dopaminergic medications on turning while walking in older adults with mild to moderate Parkinson’s disease (PD). A further aim was to develop a training program targeting balance impairments related to PD, to verify the progression of this program and the specific effects on balance and gait, as well as the transfer effects on everyday living. Methods: This thesis contains an experimental and a clinical part. In the experimental part, quantitative motion analysis was used to evaluate pre- and unplanned walking turns. Nineteen individuals with PD were tested after overnight withdrawal of dopaminergic medication and approximately one hour after taking their usual dose of medication, and were compared with 17 healthy control subjects. In the clinical part, a training program with highly-challenging balance exercise and dual-tasking was developed through workshops and pilot testing. Thereafter, training progression of dynamic exercises throughout this program was evaluated with accelerometers in two training groups (n = 6 and 4). In a randomized controlled trial, 100 individuals with PD were randomized, either to a training group that received a 10-week highly-challenging balance exercise intervention with dual-tasking or to a control group (usual care). The efficacy of this intervention was evaluated before and after the intervention which included specific effects; balance, gait with and without performing a concurrent cognitive task, and transfer effects which were concerns about falling, level of physical activity and activities of daily living. Results: Dopaminergic medication had a positive increasing effect on turning distance, whereas no effects on body rotation were found. Compared with the healthy control group, individuals with PD demonstrated lower turning distance and body rotation, and turned with a narrower step width. The objective evaluation of training activity revealed that training progression was accomplished in two independent training groups. The randomized controlled trial demonstrated significant improvements in balance control and gait performance in the training group, compared with the control group. The training group also improved their performance of the cognitive task while walking; however, no group differences were found for any gait parameters during dual-tasking. Significant differences, in favor of the training group, were found for the level of physical activity and activities of daily living, while no group difference was found for concerns about falling. Conclusions: Compared with the performance of the healthy control group, dopaminergic medication does not normalize turning performance. These residual turning impairments were accompanied by difficulties alternating step width during turning, which could be important to address in the rehabilitation of individuals with PD. Highly-challenging balance exercises, including dual-task, for a 10-week period was progressive and improved balance and gait performance in older adults with PD, compared with usual care. Positive transfer effects on activities of everyday living were also revealed, indicating that appropriate training programs could promote physical activity and daily activities in individuals with PD

Physical activity and influencing factors in people post stroke or transient ischemic attack across diverse regions in Sweden

Background and purposePhysical activity (PA) and sedentary behavior are key targets for secondary stroke prevention, yet their characteristics and contributing factors are not well understood. This study aims to explore PA and sedentary behavior in individuals' post-stroke or transient ischemic attack (TIA) and identify factors linked to low PA (≤5,000 steps/day) and prolonged sedentary time (≥8 h/day).MethodsA cross-sectional study comparing sensor-derived (activPAL) PA and sedentary time among community-dwelling individuals post stroke or TIA residing in diverse geographical regions of Sweden. Multiple logistic regression models were performed to determine potential factors associated with low PA and prolonged sedentary time.ResultsThe study included 101 participants post-stroke (n = 68) and TIA (n = 33), with a mean age of 70.5 years (65% female), mostly with no or mild disability (91%), living in metropolitan (69%) and rural (31%) areas of Sweden. Most participants (72%) had ≥ 8 h of sedentary time per day and 38% performed ≤5,000 steps per day. Using a walking aid (OR = 11.43, p = 0.002) was independently associated with low PA, whereas contextual factors; living alone (OR = 3.49, p = 0.029) and living in metropolitan areas (OR = 2.79, p = 0.036), were associated with prolonged sedentary time.Discussion and conclusionsIn this study encompassing people post stroke or TIA from diverse geographical regions across Sweden, PA was associated with mobility status whereas sedentary behavior was associated with contextual factors. The results also showed a large variation in PA highlighting the need for tailored strategies to promote PA post stroke or TIA

Whole home exercise intervention for depression in older care home residents (the OPERA study) : a process evaluation

Background: The ‘Older People’s Exercise intervention in Residential and nursing Accommodation’ (OPERA) cluster randomised trial evaluated the impact of training for care home staff together with twice-weekly, physiotherapist-led exercise classes on depressive symptoms in care home residents, but found no effect. We report a process evaluation exploring potential explanations for the lack of effect. Methods: The OPERA trial included over 1,000 residents in 78 care homes in the UK. We used a mixed methods approach including quantitative data collected from all homes. In eight case study homes, we carried out repeated periods of observation and interviews with residents, care staff and managers. At the end of the intervention, we held focus groups with OPERA research staff. We reported our first findings before the trial outcome was known. Results: Homes showed large variations in activity at baseline and throughout the trial. Overall attendance rate at the group exercise sessions was low (50%). We considered two issues that might explain the negative outcome: whether the intervention changed the culture of the homes, and whether the residents engaged with the intervention. We found low levels of staff training, few home champions for the intervention and a culture that prioritised protecting residents from harm over encouraging activity. The trial team delivered 3,191 exercise groups but only 36% of participants attended at least 1 group per week and depressed residents attended significantly fewer groups than those who were not depressed. Residents were very frail and therefore most groups only included seated exercises. Conclusions: The intervention did not change the culture of the homes and, in the case study homes, activity levels did not change outside the exercise groups. Residents did not engage in the exercise groups at a sufficient level, and this was particularly true for those with depressive symptoms at baseline. The physical and mental frailty of care home residents may make it impossible to deliver a sufficiently intense exercise intervention to impact on depressive symptoms

The role of environmental factors on health conditions, general health and quality of life in persons with spinal cord injuries in South Africa

The objective was to describe the individual items of the environmental factors and to investigate the relationship between the environmental factors to health conditions, general health and quality of life in people with SCI in South Africa. Methods: Two hundred persons with SCI participated in a cross-sectional survey design. This study formed part of the International Spinal Cord Injury (InSCI) Community Survey. Four major domains, environmental factors, health conditions, general health and quality of life of the survey questionnaire responses, were used for the analysis. Regression models were used to determine the association between the independent variable, which consisted of the specific environmental factors items, and the dependent variables comprising health conditions, general health and quality of life. Results: The commonly reported environmental barriers were public access, lack of short- and long-distance transport and finances. Environmental factors such as public access (p < 0.001), short- (p < 0.001) and long-distance transport (p = 0.001), and friends’ (p = 0.003) and colleagues’ (p < 0.001) attitudes and communication (p = 0.042) were significantly associated with the presence of secondary health conditions. Finances (p = 0.026), family attitudes (p = 0.037) and communication (p = 0.039) had a significant association with worsened mental health. Services (p = 0.022) and communication (p = 0.042) were also significantly associated with decreased general health

Factors influencing employment among people with spinal cord injury in South Africa

Theunemploymentratepostspinalcordinjury(SCI)in SouthAfricais highwithlimitedknow-ledgeof environmentalfactorsoutsidethehealthservices,especiallyin an unevenlydevelopedresourcesettinglikeSouthAfrica,affectingtheemploymentratein peoplewithSCI.Ourpurposewasto investi-gatefactorsassociatedwithemploymentin peoplewithSCIin SouthAfrica. TwohundredpersonswithSCIparticipatedin a cross-sectionalsurveydesign.Thisstudyformedpartof theInternationalSpinalCordInjuryCommunitySurvey.Subsectionsof thequestionnaireresponseswereusedas explanatoryvariablesto predictemploymentafterSCIusinglogisticregres-sionanalysis

Establishing accelerometer cut-points to classify walking speed in people post stroke

While accelerometers could be used to monitor important domains of walking in daily living (e.g., walking speed), the interpretation of accelerometer data often relies on validation studies performed with healthy participants. The aim of this study was to develop cut-points for waistand ankle-worn accelerometers to differentiate non-ambulation from walking and different walking speeds in people post stroke. Forty-two post-stroke persons wore waist and ankle accelerometers (ActiGraph GT3x+, AG) while performing three non-ambulation activities (i.e., sitting, setting the table and washing dishes) and while walking in self-selected and brisk speeds. Receiver operating characteristic (ROC) curve analysis was used to define AG cut-points for non-ambulation and different walking speeds (0.41–0.8 m/s, 0.81–1.2 m/s and >1.2 m/s) by considering sensor placement, axis, filter setting and epoch length. Optimal data input and sensor placements for measuring walking were a vector magnitude at 15 s epochs for waist- and ankle-worn AG accelerometers, respectively

Levels and patterns of physical activity in stroke survivors with different ambulation status living in low-income areas of Cape Town, South Africa

Little is known about physical activity (PA) in people with stroke living in low-income areas. The aim of this study was to characterize and contrast the levels and patterns of PA between stroke survivors with different ambulation status living in low-income areas in Cape Town, South Afric

The Mini-BESTest - a clinically reproducible tool for balance evaluations in mild to moderate Parkinson’s disease?

BACKGROUND: The Mini-BESTest is a clinical balance test that has shown a high sensitivity in detecting balance impairments in elderly with Parkinson's disease (PD). However, its reproducibility between different raters and between test occasions has yet to be investigated in a clinical context. Moreover, no one has investigated the reproducibility of the Mini-BESTest's subcomponents (i.e. anticipatory postural adjustments; postural responses; sensory orientation and dynamic gait). We aimed to investigate the inter-rater and test-retest reproducibility (reliability as well as agreement) of the Mini-BESTest, as well as its subcomponents, in elderly with mild to moderate PD, performed under conditions assimilating clinical practice. METHOD: This was an observational measurement study with a test-retest design. Twenty-seven individuals with idiopathic PD (66 - 80 years, mean age: 73; Hoehn & Yahr: 2-3; 1-15 years since diagnosis) were included. Two test administrators, having different experiences with the Mini-BESTest, administered the test individually, in separate rooms in a hospital setting. For the test-retest assessment, all participants returned 7 days after the first test session to perform the Mini-BESTest under similar conditions. Intra-class correlation coefficients (ICC(2.1)), standard error of measurement (SEM(agreement)), and smallest real difference (SRD) were analyzed. RESULTS: The Mini-BESTest showed good reliability for both inter-rater and test-retest reproducibility (ICC = 0.72 and 0.80). Regarding agreement, the measurement error (SRD) was found to be 4.1 points (accounting for 15% of the maximal total score) for inter-rater reproducibility and 3.4 points (12% of the maximal total score) for test-retest reproducibility. The investigation of the Mini-BESTest's subcomponents showed a similar pattern for both inter-rater and test-retest reproducibility, where postural responses had the largest proportional measurement error, and sensory orientation showed the highest agreement. CONCLUSIONS: Our findings indicate that the Mini-BESTest is able to distinguish between individuals with mild to moderate PD; however, when used in clinical balance assessments, the large measurement error needs to be accounted for

Structured feedback on students’ concept maps: the proverbial path to learning?

Good conceptual knowledge is an essential requirement for health professions students, in that they are required to apply concepts learned in the classroom to a variety of different contexts. However, the use of traditional methods of assessment limits the educator’s ability to correct students’ conceptual knowledge prior to altering the educational context. Concept mapping (CM) is an educational tool for evaluating conceptual knowledge, but little is known about its use in facilitating the development of richer knowledge frameworks. In addition, structured feedback has the potential to develop good conceptual knowledge. The purpose of this study was to use Kinchin’s criteria to assess the impact of structured feedback on the graphical complexity of CM’s by observing the development of richer knowledge frameworks. Fifty-eight physiotherapy students created CM’s targeting the integration of two knowledge domains within a case-based teaching paradigm. Each student received one round of structured feedback that addressed correction, reinforcement, forensic diagnosis, benchmarking, and longitudinal development on their CM’s prior to the final submission. The concept maps were categorized according to Kinchin’s criteria as either Spoke, Chain or Net representations, and then evaluated against defined traits of meaningful learning. The inter-rater reliability of categorizing CM’s was good. Pre-feedback CM’s were predominantly Chain structures (57%), with Net structures appearing least often. There was a significant reduction of the basic Spoke- structured CMs (P = 0.002) and a significant increase of Net-structured maps (P < 0.001) at the final evaluation (post-feedback). Changes in structural complexity of CMs appeared to be indicative of broader knowledge frameworks as assessed against the meaningful learning traits. Feedback on CM’s seemed to have contributed towards improving conceptual knowledge and correcting naive conceptions of related knowledge. Educators in medical education could therefore consider using CM’s to target individual student development

The role of environmental factors on health conditions, general health and quality of life in persons with spinal cord injuries in South Africa

DATA AVAILABILITY STATEMENT: Data are available upon request from the corresponding author.SUPPLEMENTARY MATERIALS: FILE S1: International Spinal Cord Injury Survey (InSCI) in Xhosa and Afrikaans languages; TABLE S1: Linear Regression model showing the association between Environmental factors with Health conditions (Secondary health conditions, Pain Intensity and Mental Health) adjusted for age, sex and severity of SCI. TABLE S2: Logistic Regression model showing the association between Environmental factors with General Health and QoL adjusted for age, sex and severity of SCI.Please read abstract in article.The South African Medical Research Council (SAMRC) funding through its Division of Research Capacity Development under the RCDI.http://www.mdpi.com/journal/ijerphPhysiotherapySDG-03:Good heatlh and well-beingSDG-10:Reduces inequalitie