Journal of Neurologic Physical Therapy最新文献

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.

Background and objective: There has been a substantial increase in the number of studies demonstrating improvements in walking capacity in people with chronic stroke following moderate-to-high intensity walking exercise interventions. Yet, there is significant variability in response to these interventions. This is likely due to the heterogeneity in this population and the variability in the exercise dose parameters actually attained within these walking interventions. Exercise prescription can be optimized by understanding how individual variables impact walking exercise dose. This study leveraged a large, clinical dataset to classify people with chronic stroke into homogeneous groups (called classes) and compare classes on the walking exercise dose achieved in a walking intervention.

Methods: One hundred sixty-nine people with chronic (>6-Months) stroke completed clinical evaluations and a 12-week high-intensity treadmill intervention. Baseline measures of walking capacity, physical health, and psychosocial factors were used in a latent variable mixture model to assess if latent, homogeneous classes existed within the dataset. Objective criteria determined the optimal number of classes, which were compared to the walking exercise dose attained across the intervention.

Results: Four homogeneous classes were distinguished by differences in baseline walking capacity, steps-per-day, comorbidity burden, and balance self-efficacy. Despite clear "clinical profiles" of people with chronic stroke, these classes did not differ on the walking exercise dose attained.

Discussion and conclusions: Prior literature and clinical intuition suggest individuals with lower baseline walking capacity, physical health, and self-efficacy are less likely to tolerate high-intensity exercise, however our results demonstrate this is not true for people with chronic stroke.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A524 .

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: Slowed somatosensory conduction in multiple sclerosis (MS) increases postural instability and decreases proprioception. Despite these delays, individuals with MS rely more on proprioception for balance compared to controls. This heightened reliance, combined with slowed signal transduction, increases fall risk. Backward walking (BW) increases proprioceptive reliance by reducing visual cues. However, no study has conclusively linked proprioception to BW. This study aims to assess proprioception's role in BW compared to forward walking (FW) in MS and to compare differences in proprioception between MS fallers and non-fallers.

Methods: Fifty participants (average age: 50.34 ± 11.84, median Patient Determined Disease Steps [PDDS]: 2) completed the study. Participants completed BW and FW at comfortable and fast speeds. We have previously established vibration sensation as a proxy measure for proprioception. Vibration thresholds were quantified at the great toe bilaterally using a 2-alternative forced-choice procedure.

Results: Significant correlations were seen for vibration sensation and FW comfortable ( ρ  = 0.35), FW fast ( ρ  = 0.34), BW comfortable ( ρ  = 0.46), and BW fast ( ρ  = 0.46). After controlling for age, sex, and PDDS, vibration sensation significantly predicted performance during all walking tasks, with larger beta coefficients seen during BW (comfortable β  = 0.57; fast β  = 0.58) compared to FW (comfortable β  = 0.41; fast β  = 0.45). Fallers performed significantly worse than non-fallers for vibration sensation ( P = 0.04).

Discussion and conclusions: Considering the notable decrease in proprioception in participants with MS and the clear distinction between fallers and non-fallers, it is crucial to conduct fall risk assessments and interventions focusing on proprioception. With its heightened reliance on proprioception, BW offers a promising method for assessing fall risk and could be an effective exercise intervention.

Video Abstract available for more insights from the authors (see the Supplemental Digital Content available at: http://links.lww.com/JNPT/A490 ).