Journal of Neurologic Physical Therapy最新文献

Background and purpose: Subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats some of the motor manifestations of Parkinson disease (PD). However, previous work suggests STN-DBS may lead to worsening of balance and gait in some people with PD. Physical therapy (PT) is often used to improve balance and gait in PD, but its safety, feasibility, and efficacy have not been tested in people with STN-DBS. The purpose of this study was to test the safety, feasibility, and preliminary efficacy of PT for improving gait and balance in persons with PD and STN-DBS.

Methods: This randomized pilot study compared the effects of an 8-week PT intervention ( n = 15) on balance and gait to a usual care control group ( n = 14) among people with PD with STN-DBS. Individuals were evaluated in the on medication/on stimulation state as well as off medication/off stimulation state.

Results: PT was safe as there were no serious adverse events during treatment. PT was feasible as the average percentage of session attendance was 93%. PT significantly improved balance as measured by the Balance Evaluation Systems Test (BESTest) in the on medication/on stimulation state but did not significantly improve gait. No significant differences between groups were found in the off medication/off stimulation state.

Discussion and conclusions: PT was safe, feasible, and may improve balance for individuals with PD with STN-DBS. Further work is needed to understand how modifying the frequency and intensity of PT interventions may impact balance and gait in individuals with STN-DBS.

Background and purpose: This cross-sectional study aimed to (1) establish the safety and tolerability of head-mounted display (HMD) assessment of sensory integration for postural control in participants with chronic traumatic brain injury (TBI); (2) investigate whether responses to visual and auditory cues differ between persons with TBI and healthy controls; and (3) evaluate the relationship between postural responses, postural visual dependence, and self-reported perception of disability.

Methods: 20 healthy adults and 19 participants with TBI completed an HMD assessment of with visual and auditory perturbations. Head sway was quantified as a directional path in the anteroposterior and mediolateral directions. Participants also completed the Simulator Sickness Questionnaire (SSQ) and the Dizziness Handicap Inventory (DHI).

Results: All participants completed testing. The average change in SSQ scores from pre to post postural control assessment was 0.8 points for healthy controls and 3.2 points for participants with TBI. Head sway in the TBI group was consistently higher in both directions, especially with dynamic visuals. In addition, a significant sound by visual by group interaction in the mediolateral direction indicates that participants with TBI responded more to the visual perturbations when sounds were present. Under the most challenging conditions, people with mild-to-moderate dizziness handicap showed little head sway, while those with severe symptoms were more variable.

Discussion and conclusions: HMD assessment of participants with TBI is feasible and provides a clinic-based assessment of postural visual dependence in this population. This assessment carries the potential to evaluate postural control and monitor progress of participants with TBI.

Background and purpose: Muscle strength is important for functional independence after a stroke. Given the rise in telerehabilitation, there is a need to study the measurement properties of virtually administered performance-based measures. The purpose of this study was to assess the validity and responsiveness of a virtually administered 30-second chair stand test (30sCST-Virtual) in people with stroke.

Methods: Thirty-two hypotheses were generated about construct validity and responsiveness using several outcome measures (Stroke Impact Scale, strength domain [SIS-S], Timed Up and Go [TUG], Activities-Specific Balance Confidence Scale, Fugl-Meyer Lower Extremity Assessment, Functional Reach Test, and SIS cognition domain). Hypotheses were tested using Spearman's correlations. Scores on the 30sCST-Virtual were compared between higher- and lower-functioning participants using the modified Rankin Scale (mRS) and NIH Stroke Scale (NIHSS) with Wilcoxon rank-sum tests to assess known-groups validity.

Results: Sixty-seven participants ( n = 19 female, 9.3 months post-stroke) with mild to moderate stroke were included. The 30sCST-Virtual demonstrated acceptable construct validity and responsiveness, as 14 (82%) and 12 (80%) hypotheses were confirmed, respectively. Its baseline scores were most highly correlated with the TUG ( r = - 0.64) and change scores with the SIS-S ( r = 0.35). The 30sCST-Virtual scores were also lower in those with lower function using the mRS (median difference [MD] = 4.0 repetitions, P < 0.001) and NIHSS (MD = 3.5 repetitions, P = 0.003), meeting our hypotheses for known-groups validity.

Discussion and conclusions: The 30sCST-Virtual demonstrated acceptable construct validity and responsiveness, as well as adequate known-groups validity. It was also moderately correlated with other measures of physical function, indicating that the 30sCST-Virtual may measure the construct of functional strength.

Video abstract available: For more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A526 ).

Background and purpose: Enhancing health care through the implementation of evidence-based practices is a complex task, demanding specialized expertise and a distinct set of skills to facilitate success. A knowledge translation (KT) capacity-building initiative is a process that leads to greater individual, organizational, or system capabilities to translate high-quality evidence, such as clinical practice guidelines, into practice. The KT Summit, a KT capacity-building initiative, was developed by the Academy of Neurologic Physical Therapy and includes an in-person workshop, quarterly reports, mentoring for 2 years, and a funding opportunity. The purpose of this manuscript is to describe the development, implementation, and outcomes of the KT Summit over a 6-year period.

Summary of key points: In this special interest article, we describe the KT Summit's development and evolution, application process, education and training format, curriculum, funding opportunity, outcomes, and lessons learned. Over the initial 3 cohorts, there was a notable increase in the number of projects initiated and groups. Furthermore, there was a substantial decline in the failure rate of projects, decreasing from 50% to 15% over time. This article outlines the reported contributors to success and the ways the participants used their KT education.

Recommendations for clinical practice: This article highlights an education and training method that resulted in successful implementation initiatives across several health care organizations. Factors that contributed to KT success included participating in the KT Summit, support from organizational leadership, and a local champion. More research is needed to evaluate the optimal components and economic outcomes of KT capacity-building initiatives.

Background and purpose: It is unknown whether persons with multiple sclerosis (pwMS) can retain sustained attention and gait quality during long-distance walking tests. This study aimed to investigate changes in sustained attention and gait parameters during prolonged walking in pwMS with different levels of disability and healthy controls (HCs) and correlations of these changes with self-reported daily life difficulties.

Methods: The 6-Minute Walk Test was performed with an auditory sustained attention task while wearing inertial measurement sensors. Participants were asked to respond verbally as quickly as possible to randomly presented auditory stimuli during 6 minutes of walking. The accuracy of answers, average reaction time, and gait parameters per minute were determined.

Results: Thirty pwMS with mild disability (Expanded Disease Status Scale [EDSS] < 4.0), 16 pwMS with moderate-to-severe disability (EDSS 4.0 to 6.5), and 27 age-gender matched HCs were included. A significant group-by-time interaction effect as found for reactions times, which increased in mild and moderate-to-severe disability groups but not in HCs. Gait parameters deteriorated over time in all groups, but no significant group-by-time interaction was found. The decrease in sustained attention was not related to changes in gait or clinical outcomes, while deterioration in gait parameters was associated with perceived walking disability and dual-task difficulties in daily life.

Discussion and conclusions: Sustained attention during walking declined over time in pwMS, but not in HCs. However, gait parameters deteriorated in all groups. Worsening gait during simultaneous cognitive task execution may contribute to walking and dual-task difficulties in pwMS.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A520.

Background and purpose: Physical activity (PA) can be neuroprotective for people with neurodegenerative diseases; however, rehabilitation programs often fail to address strategies to increase long-term PA. This study evaluated the feasibility, acceptability, and effect estimates of a PA coaching program in people with degenerative cerebellar disorders (PwDCD).

Methods: Engage-Ataxia was a single-cohort intervention consisting of 5 physical therapist-delivered telehealth PA-coaching sessions over 12 weeks, with assessments pre- and post-intervention. The intervention was grounded in self-determination theory and incorporated individualized exercise recommendations, goal setting, and strategies to overcome exercise barriers. Participants received a wearable PA monitor and disease-specific workbook.

Results: Thirty-four PwDCD were screened and 25 (11M:14F) were enrolled (73.5% recruitment rate); 22 completed post-assessments (retention 88%) and attended all 5 intervention sessions (adherence 100%). Participants focused goals on improving or maintaining balance or balance confidence, with additional goals focused on other exercise (n = 19), task-specific practice (n = 6), PA/steps (n = 5), motivation (n = 3), and mobility/gait (n = 3). Post-intervention interviews revealed the program was acceptable. Medium-large effect sizes comparing pre-post intervention were found for modified Scale for Assessment and Rating of Ataxia, Cerebellar Cognitive Affective Syndrome Scale, Timed Up and Go, exercise identity, balance confidence, and patient-specific goals. Small-medium effect sizes were found for ESE and self-reported PA.

Discussion and conclusion: Engage-Ataxia is a feasible and acceptable low-dose intervention for PwDCD, with improvements in mobility, balance, balance confidence, and ataxia. Impairments in balance and balance confidence superseded goals for PA-uptake, which is important to inform outcomes for future trials evaluating PA-coaching models in PwDCD.

Background and purpose: Multiple sclerosis (MS) presents significant challenges due to its inflammatory and degenerative nature, often manifesting in debilitating symptoms such as gait disturbances. Non-invasive stimulation techniques, such as trans-spinal direct current stimulation (tsDCS), offer promising avenues for enhancing functional recovery, but evidence on tsDCS effectiveness in neurological disorders remains sparse. This study aimed to investigate the effects of cathodal tsDCS on gait function and fatigue in people with MS (pwMS) compared to sham tsDCS.

Methods: Twenty-two pwMS received 6 sessions of 20-minute cathodal tsDCS (n = 11) or sham tsDCS (n = 11) in addition to a physiotherapy program. The primary outcomes were the Timed 25-Foot Walk (T25-FW), Timed Up and Go test (TUG), gait speed, and the Multiple Sclerosis Walking Scale-12 (MSWS-12) evaluated before and after treatment. The secondary outcome was fatigue, measured with the Fatigue Severity Scale (FSS) and Fatigue Impact Scale (FIS).

Results: Intergroup comparisons showed a significant improvement in the cathodal tsDCS group compared to the sham tsDCS group. Specifically, there was a greater reduction in pre-post values for T25-FW (Median: -4.43; Range: -12.1 to -1.0), MSWS-12 (-16.70; -31.7 to -5.0), TUG (-6.03; -20.8 to -0.7), FSS (-0.30; -2.2 to 0.1), and FIS-Physical (4.00; -13.0 to 0.0). Additionally, walking speed increased significantly (0.15; 0.02 to 0.24) in the cathodal tsDCS group. Moreover, all gait-related outcomes and FSS showed large effect sizes (r > 0.5), indicating a strong intervention effect.

Discussion and conclusions: Incorporating cathodal tsDCS into a physiotherapy program improved walking function and fatigue in pwMS. Although replication is warranted, these results hold promise for clinical applications, highlighting tsDCS as a potential tool for enhancing motor function and reducing fatigue in pwMS.

Video abstract available: for more insights from the authors (see Supplemental Digital Content available at http://links.lww.com/JNPT/A542).

Background and purpose: This study determined the prevalence of loneliness in a regional community-based exercise class program for people with Parkinson disease (PwPD) and examined relationships with demographic characteristics, functional independence, functional mobility, and quality of life (QOL).

Methods: This study was a cross-sectional analysis of 231 PwPD, all of whom were participating in community-based exercise class programs. Participants completed questionnaires on loneliness (UCLA 3-Item Loneliness Scale [UTILS]), functional independence (Schwab & England Scale), performance-based measures of functional mobility (Timed Up & Go, 10 Meter Walk Test, 30 Second Sit-to-Stand), and QOL (Parkinson's Disease Questionnaire-8). UTILS scores of ≤ 4 were classified as "non-lonely," and scores > 4 were classified as "lonely."

Results: Participants were, on average, 71.9 (±7.5) years old, 5.4 (±5.4) years since their Parkinson disease diagnosis, had been participating in group exercise classes for 2.3 (±2.4) years, and almost one-third of participants (n = 76/231, 32.9%) scored in the "lonely" range on the UTILS. There were significant differences between the lonely and non-lonely groups in sex distribution, functional independence, Timed Up & Go, and QOL. Age, functional independence, and loneliness scores accounted for 55.8% of the variance in QOL scores.

Discussion and conclusion: In this study, loneliness was present even in PwPD actively engaged with an exercise community. Loneliness among PwPD was also related to functional independence, functional mobility, and QOL. While further study is needed, having rehabilitation clinicians and exercise class instructors screen for loneliness in PwPD may help inform plans of care and recommendations to address loneliness.