Journal of Neurologic Physical Therapy最新文献

Background and purpose: Gait dysfunction in people with Parkinson disease (PwPD) is common and debilitating. Internal cues (ie, mental singing) may provide a useful alternative to external cueing (ie, listening to music) to improve walking for PwPD. In this study, we individually tailored cues to each participant by allowing them to choose their own cue song and by selecting the cue rate that elicited the longest strides.

Methods: Fifty-six participants (28 controls and 28 PwPD) performed walking trials in a single-session, cross-sectional study. Initially, uncued trials were compared with cued conditions in which participants walked to music or while they mentally sang at 4 randomized cue rates (90%, 100%, 110%, and 120% of uncued walking cadence). Participants chose their songs from a curated catalog. Cues were optimized according to longest stride lengths as measured by APDM wearable sensors. Repeated measures Analysis of Variance assessed differences between gait characteristics (velocity, cadence, and stride length) and gait variabilities (coefficients of variations) across conditions and groups.

Results: Both cue types improved velocity, cadence, and stride length as compared to uncued walking. Internal cues were most beneficial to gait variability. The majority of participants exhibited the longest strides and fastest velocities at the highest cue rate of 120%, though a cue rate of 110% was most beneficial to gait variability.

Discussion and conclusions: This study shows how internal and external cues personalized by song choice and cue rate may be tailored to individuals. The information gained may help tailor cues to optimize gait performance for older adults and PwPD.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A518 ).

Background and purpose: Many physically capable stroke survivors are insufficiently active, with low self-efficacy considered an important contributor. However, validity and reliability of self-efficacy measures in stroke survivors have not been established. This research aims to evaluate the test-retest reliability and construct validity of 3 self-efficacy measures: Self-Efficacy for Exercise Scale (SEE), Spinal Cord Injury Exercise Self-Efficacy Scale (SCI-ESES), and Participation Strategies Self-Efficacy Scale (PS-SES).

Methods: A repeated measures study with community-dwelling, independently mobile adult stroke survivors (n = 51, mean age 74 years, 45% female, median 22 months poststroke) was completed. Test-retest reliability was assessed using intraclass correlation coefficients and Bland-Altman analyses. Construct validity was assessed using 8 pre-determined hypotheses concerning physical activity level (subjective and objective), comorbidities, work and volunteering, and measures of function.

Results: Retest reliability was established for the SEE (intraclass correlation coefficient, ICC = 0.77) and PS-SES (ICC = 0.78) but not for the SCI-ESES (ICC = 0.68). Bland-Altman analysis showed participants consistently scored higher on the second test for all measures. The SEE achieved construct validity by meeting 75% of hypotheses, whereas the PS-SES and SCI-ESES did not. Self-efficacy was positively related to steps/day, functional capacity, self-reported activity levels, and work or volunteering participation.

Discussion and conclusions: The SEE was found to be the most appropriate tool to measure exercise self-efficacy in independently mobile chronic stroke survivors in terms of retest reliability and validity.

Trial registration: N/A.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content 1 "Espernberger-JNPT-Video-Abstract," available at: http://links.lww.com/JNPT/A489 ).

Background and purpose: Atypical posterior canal (pc) benign paroxysmal positional vertigo (BPPV) may be caused by cupulolithiasis (cu), short arm canalithiasis (ca), or jam. The purpose of this study was to describe the clinical presentation and differential diagnosis of pc-BPPV-cu and short arm canalithiasis.

Methods: This retrospective observation study identified persons with atypical pc-BPPV based on history and findings from four positional tests. Patterns of nystagmus suggested canal involved and mechanism of BPPV. Interventions included canalith repositioning procedures (CRP).

Results: Fifteen persons, 17 episodes of care, met inclusion criteria, 65% referred following unsuccessful CRPs. Symptoms included persistent, non-positional unsteadiness, "floating" sensation, with half experiencing nausea/vomiting. Downbeat nystagmus with/without torsion in Dix-Hallpike (DH) and Straight Head Hang (SHH) position and no nystagmus upon sitting up, occurred in 76% of persons attributed to pc-BPPV-cu. Upbeat nystagmus with/without torsion and vertigo/retropulsion upon sitting up, occurred in 24% attributed to pc-BPPV-ca short arm. During SHH, canal conversion from pc-BPPV-cu to long arm canalithiasis occurred in 31%. The Half-Hallpike position identified pc-BPPV-cu in 71%. The Inverted Release position identified pc-BPPV-cu adjacent short arm and pc-BPPV-ca short arm.

Discussion and conclusion: Persistent, peripheral nystagmus that is downbeat or downbeat/torsion away from involved ear in provoking positions and no nystagmus sitting up, may be attributed to pc-BPPV-cu, and nystagmus that is upbeat or upbeat/torsion towards involved ear upon sitting up may be attributed to pc-BPPV-ca short arm. Both are effectively treated with canal- and mechanism-specific CRPs.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: (http://links.lww.com/JNPT/A487).

Background and purpose: It is unclear to what extent Canadians with stroke engage in moderate-vigorous physical activity (MVPA) and muscle-strengthening activities (MSA). The purpose of this study was to describe overall physical activity, aerobic MVPA, and MSA participation in Canadians with stroke; determine the functioning, disability, and health classes that best characterize this population; and examine the relationship between-class membership and physical activity participation.

Methods: Activity levels were quantified using the Physical Activity Scale for the Elderly in 2094 adults with stroke or transient ischemic attack (mean age 67.9 years, 9.5 years poststroke) from the CLSA. Means and percentages were used to characterize participation. Latent class analysis was used to create health and disability classes, and activity levels were compared between classes.

Results: Only 6.2% (95% confidence interval [CI], 4.8%-8.0%) met both MVPA and MSA guidelines. Most (88.2%, 95% CI, 85.0%-88.9%) engaged in MVPA <3 times/wk and 76.7% (95% CI, 73.7%-79.1%) never engaged in MSA. In latent class analyses, 2 classes for males and females were characterized by high-positive or low-negative levels of intrinsic capacity (eg, grip strength), functional mobility (eg, walking speed), and environment (eg, social support). Those in the low-negative classes had the lowest Physical Activity Scale for the Elderly scores and aerobic MVPA levels compared to the high-positive (healthiest) classes. MSA participation was not different between classes.

Discussion and conclusions: Canadians with stroke are not engaging in sufficient physical activity. Clinicians should encourage regular participation in physical activity, especially among those with lower levels of intrinsic capacity, functional mobility, and environmental support.

Video Abstract available for more insights from the authors (see Supplementary Digital Content 3 available at: http://links.lww.com/JNPT/A494).

Background and purpose: Growing numbers of clinical practice guidelines (CPGs) are available to neurologic physical therapists to guide and inform evidence-based patient care. Adherence to CPG recommendations often necessitates behavior change for therapists and patients. The purpose of this qualitative study was to gain insight into the experiences, perspectives, and drivers of behavioral change for therapists working to improve adherence to a CPG. We also sought to understand the perspectives of patients impacted by this work.

Methods: Five sites participated in a 6-month implementation study integrating a CPG into local practice using the Knowledge to Action model. At the conclusion of the intervention, therapists and patients were recruited to participate in semi-structured interviews or focus groups. An inductive phenomenological approach was used for data analysis. Two authors coded data to generate primary themes. A secondary analysis used the Capability, Opportunity, Motivation, Behavior (COM-B) model to explain the drivers of behavior change for therapists and patients.

Results: Perspectives from 16 therapists generated 6 themes around feedback/accountability, teamwork/belonging, complexity/adaptability, leadership/prioritization, engagement/benefit, and motivation/growth. Twelve patients' perspectives generated 2 themes around communication/personalization and support/recovery. Drivers for behavior change associated with the COM-B model are highlighted.

Discussion and conclusions: Therapist adherence to CPG recommendations was supported by inclusive and goal-directed teams, regular quantitative audit and feedback, opportunities for learning, and a sense of accountability to their coworkers, patients, and themselves. Patients' engagement in rehabilitation was supported by personalized education, objective measures of progress, and a strong therapeutic relationship.

Video abstract available: for more insights from the authors (see the video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A491).

Background and purpose: In individuals with unilateral vestibulopathy (UVP), physical activity (PA) is recommended to stimulate central vestibular compensation. However, the presence of fear avoidance beliefs might negatively influence PA. The objectives of this study were to investigate the relationship between fear avoidance beliefs and PA and to compare PA levels between individuals with UVP in an acute/subacute vs chronic phase.

Methods: In this cross-sectional study, PA was measured using a triaxial accelerometer. Fear avoidance beliefs were quantified using the Vestibular Activities Avoidance Instrument. The correlation between fear avoidance beliefs and PA was evaluated using regression analyses, with other potential influencing factors also considered.

Results: A total of 102 participants were included. The average age was 56.1 (SD 15.2) years, and 57.8% were male. Participants with chronic UVP presented with shorter sedentary time (4,591 vs 5129 min/wk; P = 0.004), longer standing time (1443 vs 1165 min/wk; P = 0.025), higher vigorous PA (187 vs 107 min/wk; P = 0.005), and higher total PA (773 vs 623 min/wk; P = 0.003) compared to participants with acute/subacute UVP. In participants with acute/subacute UVP, variability in total PA was explained up to 54.7% by fear avoidance beliefs, etiology of the UVP, and gender (R2 = 0.547, F4,45 = 13.6, P < 0.001). In participants with chronic UVP, fear avoidance beliefs explained 4.1% of the variability in total PA (R2 = 0.041, F1,49 = 2.086, P = 0.155).

Discussion and conclusions: In acute/subacute UVP, assessing fear avoidance beliefs helps to understand physical inactivity. In chronic UVP, no significant association between fear avoidance beliefs and PA was observed.

Video abstract available: for more insights from the authors (see the video, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A488).

Background and purpose: Chronic diabetes is a prevalent systemic disease that impairs neuromotor functioning and often leads to increased risk of falls. Adopting an external focus of attention during motor skill practice has been shown to improve learning outcomes; however, it has not been examined in this population. We examined how attentional focus instructions (internal vs external) affect balance performance and learning in older adults with and without diabetes.

Methods: Fifty-three older adults (27 with diabetes, 63.7 ± 7.0 years) participated in the randomized, pre-post intervention study. The balance training involved 50 practice trials of a stabilometer task that was novel to all participants. Participants were randomized to receive either internal or external focus task instruction. Task performance was assessed at baseline, during training, and during a retention test. Primary outcomes were changes in balance task performance before and after training.

Results: Participants who received external focus instruction showed a significantly greater increase in balance performance than individuals who received internal focus instruction (95% confidence interval, 0.02-4.05; P = 0.048). While participants with diabetes exhibited poorer baseline task performance (P = 0.02), both groups improved their relative task performance after training (95% confidence interval, 5.25-18.14; P < 0.0001).

Discussion and conclusions: Adopting an external focus of attention benefits performance during short-term training of a novel balance task in older adults with and without diabetes. Participants with diabetes were capable of learning the challenging balance task with practice, at a relative rate similar to those without diabetes. This information may be useful for designing interventional strategies to improve physical function and mitigate fall risks in older adults with diabetes.