Comorbidity and Functional Mobility in Persons with Parkinson Disease

Objectives

To report the frequency, severity, and types of comorbidities in people with Parkinson disease (PD) using a validated self-report comorbidity screening tool, and to determine the relationship between comorbidity and functional mobility.

Design

A secondary analysis and cross-sectional observational study design.

Setting

University hospital; outpatient balance disorders laboratory.

Participants

Persons with mild to moderate idiopathic PD (N=76).

Intervention

Not applicable.

Main Outcome Measures

The Cumulative Illness Rating Scale-Geriatric (CIRS-G) and a comprehensive mobility assessment including gait (distance walked in 3min), balance (mini-Balance Evaluation Systems Test), and physical function (Physical Performance Test).

Results

All participants reported comorbidities in addition to their diagnosed PD. The average ± SD number of comorbidities was 6.96±2.0 (range, 2–11), and the total CIRS-G score ± SD was 12.7±4.8. The most commonly reported organ systems with comorbidity were eyes and ears (89%), psychiatric (68%), musculoskeletal (64%), lower gastrointestinal (62%), respiratory (60.5%), upper gastrointestinal (59.2%), and genitourinary (53.9%). The total CIRS-G score was significantly related to functional mobility: gait (r=−.53, P=.0001), balance (r=−.43, P=.0003), and physical performance (r=−.36, P=.0041). Of the original 14 organ systems measured, there were 7 systems that, when combined, best predicted gait performance, 6 systems combined that best predicted balance performance, and 4 systems combined that predicted functional performance.

Conclusions

This study reports a high frequency of multiple medical system comorbidity in people with mild to moderate PD. Furthermore, comorbidity scores were associated with mobility disability: gait, balance, and physical function. Early intervention is important to delay mobility disability in PD, and we recommend that people with PD found to have comorbidities should be screened for balance and gait deficits.     

Dual-Task Effect on Gait Balance Control in Adolescents With Concussion

Objective

To prospectively and longitudinally examine how concussion affects gait balance control in adolescents during single- and dual-task walking.

Design

Cohort, prospective, repeated-measures design.

Setting

Motion analysis laboratory.

Participants

Adolescents (N=20) identified as suffering a concussion were matched with healthy control subjects (N=20) and tested 5 times across a 2-month period after injury.

Interventions

Not applicable.

Main Outcome Measures

Gait temporal-distance parameters included average walking speed, step length, and step width; whole body center of mass (COM) parameters included medial/lateral displacement and peak COM medial/lateral and anterior velocities; dual-task cost, which was defined as percent change from single- to dual-task conditions; and Stroop test accuracy.

Results

No between-group differences were observed for step length and step width. The dual-task cost for average walking speed for subjects with concussion was greater than control subjects across the 2-month testing period (main effect of group P=.019), as was the dual-task costs for peak anterior COM velocity (main effect of group P=.017) and total COM medial/lateral displacement (main effect of group P=.013). The total COM medial/lateral displacement (group × task interaction P=.006) and peak COM medial/lateral velocity (main effect of group P=.027; main effect of task P=.01) were significantly greater in subjects with concussion compared with control subjects during dual-task walking. Subjects with concussion were significantly less accurate than controls on the Stroop test (main effect of group P=.004).

Conclusions

The findings suggest that concussion affects the ability of adolescents to control body posture during gait up to 2 months after injury. Furthermore, dual-task paradigms may provide additional useful information in the clinical assessment and recovery of concussion.     

Changes in Walking Activity and Endurance Following Rehabilitation for People With Parkinson Disease

White DK, Wagenaar RC, Ellis TD, Tickle-Degnen L. Changes in walking activity and endurance following rehabilitation for people with Parkinson disease.

Objective

To investigate changes in walking activity and endurance after interdisciplinary rehabilitation in people with Parkinson disease (PD).

Design

Randomized controlled trial.

Setting

Clinic, home, and community.

Participants

Mild to moderate PD (Hoehn and Yahr stage 2-3).

Interventions

Three experimental conditions lasting 6 weeks in duration: (1) no active rehabilitation; (2) 3.0 hours of interdisciplinary rehabilitation a week; or (3) 4.5 hours of interdisciplinary rehabilitation a week. Participants had stable medication regimes during the study.

Main Outcome Measures

Walking activity was estimated with an activity monitor (AM) (time spent walking and number of 10-second walking periods) in the home and community settings over a 24-hour period. Walking endurance was measured in the clinic with the two-minute walk test (2MWT). Linear contrast analyses were applied to examine changes in walking activity and endurance after higher doses of rehabilitation, and 2-way analysis of variance models with interaction were applied to examine the effect of high and low baseline walking levels on changes.

Results

The 2MWT was completed by 108 people with PD (mean age, 66.53y; with PD, 6.59y), and AM data were used from 74 of these people (mean age, 66.7y; with PD, 5.8y). Improvement in AM measures and the 2MWT did not significantly change across increasing dosages of interdisciplinary rehabilitation. Higher doses of rehabilitation resulted in significant improvements in the 2MWT for subjects with low baseline walking endurance (P=.001), and in AM measures for subjects with high baseline walking activity (P<.02).

Conclusions

Interdisciplinary rehabilitation can improve walking activity and endurance depending on baseline walking levels.     

Effects of Wrist Weights on Kinematic and Myographic Movement Characteristics During a Reaching Task in Individuals With Parkinson Disease

Objective

To investigate the kinematic and myographic effects of weighted wrist cuffs on individuals with Parkinson disease (PD) during a reaching task.

Type of Hip Fracture in Patients With Parkinson Disease is Associated With Femoral Bone Mineral Density

Di Monaco M, Vallero F, Di Monaco R, Tappero R, Cavanna A. Type of hip fracture in patients with Parkinson disease is associated with femoral bone mineral density.

Objective

To investigate the association between bone mineral density (BMD) and hip fracture type (cervical or trochanteric) in a sample of fallers with Parkinson disease (PD).

Design

Observational study.

Setting

Rehabilitation hospital in Italy.

Patients

We investigated 1040 of 1120 white fallers consecutively admitted to a rehabilitation hospital for hip fracture. Thirty-eight (3.65%) of the 1040 patients suffered from PD secondarily. Thirty-eight controls matched for sex, age, and hip fracture type were found among the 1002 non-PD fallers.

Interventions

Not applicable.

Main Outcome Measures

BMD was assessed by dual-energy x-ray absorptiometry at a mean ± SD of 21.9±7.5 days after fracture occurrence in the 38 PD patients and 21.6±5.9 days after fracture occurrence in the 38 controls.

Results

BMD assessed at total femur, trochanter, and intertrochanteric region was significantly lower in the 15 PD patients with trochanteric fractures than in the 23 with cervical fractures; the mean T score differences were 0.57 (95% confidence interval [CI], 0.07–1.08; P=.028), 0.66 (95% CI, 0.04–1.28; P=.037), and 0.63 (95% CI, 0.11–1.15; P=.019), respectively. A significant association between femoral BMD and hip fracture type was found at logistic regression after adjustment for several confounders. Results in the 38 controls were similar to those obtained in the 38 PD fallers.

Conclusions

In a sample of PD fallers as in a control group of non-PD fallers, BMD levels assessed at 3 femoral sites were significantly lower in the patients who sustained trochanteric fractures than in those with cervical fractures of the hip.     

Effect of Pulmonary Rehabilitation on Balance in Persons With Chronic Obstructive Pulmonary Disease

Beauchamp MK, O'Hoski S, Goldstein RS, Brooks D. Effect of pulmonary rehabilitation on balance in persons with chronic obstructive pulmonary disease.

Objectives

To describe within-subject effects of pulmonary rehabilitation (PR) on balance in persons with chronic obstructive pulmonary disease (COPD) and to determine whether any observed changes in balance were associated with change in exercise tolerance or health-related quality of life.

Design

Single-arm longitudinal study.

Setting

Inpatient PR center.

Participants

Subjects with COPD (N=29; mean ± SD age, 69.8±10.3y; forced expiratory volume in 1 second, 46.3%±22.3% predicted; 59% men [n=17]).

Interventions

A standardized 6-week multidisciplinary PR program (exercise training, breathing exercises, education, and psychologic support).

Main Outcome Measures

Balance was assessed using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and the Activities-Specific Balance Confidence (ABC) scale. Exercise tolerance was determined from the 6-minute walk test (6MWT), and health-related quality of life from the Chronic Respiratory Questionnaire (CRQ).

Results

Subjects showed small improvements in BBS (2.8±2.8 points; P<.001) and TUG (−1.5±2.4s; P=.003) scores, but not in ABC scores (4.8±15.4 points; P>.05). There was a weak relationship between change in BBS and change in CRQ scores (r=.40; P=.045) and no relationship with change in 6MWT.

Conclusions

PR contributed to minor improvements in balance and had no effect on balance confidence in subjects with COPD. Further work is warranted to determine the optimal intervention for improving balance in this population.     

Feasibility and Outcomes of a Home-Based Exercise Program on Improving Balance and Gait Stability in Women With Lower-Limb Osteoarthritis or Rheumatoid Arthritis: A Pilot Study

Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study.

Objective

To evaluate the feasibility and gait stability and balance outcomes of a 4-month individualized home exercise program for women with arthritis.

Design

Pre-post interventional study.

Setting

General community.

Participants

Women (N=49) (volunteers) with lower-limb osteoarthritis or lower-limb rheumatoid arthritis were enrolled. Only 39 subjects were eligible and completed the study.

Intervention

After completion of the initial assessment, all participants received home balance exercises from an experienced physiotherapist based on assessment findings and exercises available from commercially available kits. All measures were repeated 4 months later.

Main Outcome Measures

Falls risk (Falls Risk of Older People—Community Setting) and balance measures.

Results

Thirty-nine women (mean age, 69.3y; 95% confidence interval, 65.7-72.9) completed the 4-month program. At baseline, 64% of participants reported falling in the preceding 12 months, and the average falls risk (Falls Risk of Older People—Community Setting) score was 14.5, with 42% rated as moderate risk (16-23). Participants achieved improved performance on most balance and related measures after the exercise program, including falls risk (P=.01), activity levels (P=.015), fear of falling (P=.022), functional reach test (P=.001), rising index for sit to stand (P=.001), step width in walking (P=.001), and body mass index (P=.006).

Conclusions

An individualized balance training home exercise program is feasible for older women with osteoarthritis or rheumatoid arthritis and may improve stability during walking and other functional activities.     

Detection of Gait and Postures Using a Miniaturized Triaxial Accelerometer-Based System: Accuracy in Patients With Mild to Moderate Parkinson's Disease

Dijkstra B, Kamsma YP, Zijlstra W. Detection of gait and postures using a miniaturized triaxial accelerometer-based system: accuracy in patients with mild to moderate Parkinson's disease.

Objective

To examine whether gait and postures can accurately be detected with a single small body-fixed device in patients with mild to moderate Parkinson's disease (PD).

Design

Results of a triaxial accelerometer-based method were evaluated against video observation scores (criterion measure). Study 1: Subjects performed basic mobility-related activities (walking, lying, sitting, standing) in a fixed and free sequence. Study 2: Subjects were monitored while doing similar activities as in study 1 and while doing usual domestic activities.

Setting

Study 1: Standardized set-up in a movement laboratory. Study 2: Home environment.

Participants

(N=37) Study 1: Patients with PD (n=32; mean age ± SD, 67.3±6.6y; mean disease duration ± SD, 6.1±3.4y). Study 2: Patients with PD (n=5; mean age ± SD, 76.0±7.3y; mean disease duration ± SD, 3.8±4.7y).

Interventions

Not applicable.

Main Outcome Measures

The degree of correspondence between the monitor and the video observation for the duration of each activity. Overall agreement, sensitivity, specificity, and positive predictive values were calculated.

Results

Study 1: Overall agreement ranged between 69.8% and 90.8% (fixed sequence) and 57.5% and 96.9% (free sequence). Study 2: Overall agreement ranged between 60.0% and 89.2%. Lying, sitting (home), and walking were detected most accurately with mean sensitivity varying from 81.7% to 99.9%. Lower values were found for sitting (laboratory), standing, and shuffling.

Conclusions

This triaxial monitor system is a practical and valuable tool for objective, continuous evaluation of walking and postures in patients with mild to moderate PD. Detection of sitting and standing requires further fine-tuning.     

Postural Control and Fear of Falling Assessment in People With Chronic Obstructive Pulmonary Disease: A Systematic Review of Instruments, International Classification of Functioning,Disability and Health Linkage,and Measurement Properties

Objectives

To systematically review the instruments used to assess postural control and fear of falling in people with chronic obstructive pulmonary disease (COPD), and to synthesize and evaluate their breadth of content and measurement properties.

Data Sources

MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL, PsycINFO, PEDro, and OTSeeker databases searched in September 2012.

Study Selection

Two independent reviewers performed the selection of articles, the ICF linking process and quality assessment. Only quantitative studies were included, irrespective of language or publication date.

Data Extraction

This systematic review comprised two phases. Phase 1 aimed to identify the commonly used instruments to assess postural control and fear of falling in the COPD literature. The breadth of content of each instrument was examined based on the International Classification of Functioning, Disability and Health (ICF). In phase 2, a measurement property search filter was adopted and used in four electronic databases to retrieve properties reported in the COPD population. The COSMIN checklist was used to assess the methodological quality of each measurement property reported.

Data Synthesis

Seventeen out of 401 publications were eligible in phase 1. Seventeen instruments were identified including 15 for postural control and 2 for fear of falling assessment. The Berg Balance Scale, the Short Physical Performance Battery, and the Activities-specific Balance Confidence (ABC) scale were the most frequently used instruments to assess postural control and fear of falling respectively. The ICF categories covered varied considerably among instruments. The Balance Evaluation Systems test and ABC presented the greatest breadth of content. Measurement properties reported included criterion predictive validity (4 instruments), construct validity (11 instruments) and responsiveness (1 instrument), with inconsistent findings based on ‘fair’ and ‘poor’ quality studies.

Conclusions

Different instruments with heterogeneous content have been used to assess postural control and fear of falling outcomes. Standardized assessment methods and best evidence on measurement properties is required in the COPD literature.     

Automated Mechanical Peripheral Stimulation Effects on Gait Variability in Individuals With Parkinson Disease and Freezing of Gait: A Double-Blind,Randomized Controlled Trial

Objective

To assess the effects of automated peripheral stimulation (AMPS) in reducing gait variability of subjects with Parkinson disease (PD) and freezing of gait (FOG) treated with AMPS and to explore the effects of this treatment on gait during a single task (walking) and a dual task (walking while attending the word-color Stroop test).

Prediction of Falls in Subjects Suffering From Parkinson Disease,Multiple Sclerosis,and Stroke

Objective

To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design.

Similarities and Differences of Gait Patterns in Women and Men With Parkinson Disease With Mild Disability

ObjectiveThis study aimed to quantitatively investigate the existence of differences in spatiotemporal and kinematic parameters of gait in men and women with Parkinson disease (PD) using computerized 3-dimensional gait analysis.DesignRetrospective cohort study.SettingLaboratory of Biomechanics.ParticipantsIndividuals with PD (N=35; 17 female, 18 male) of mean age 70.7 years characterized by mild disability (Hoehn and Yahr ≤2.5) who were tested in On medication state approximately 60 to 90 minutes after intake of the usual morning Levodopa dose.InterventionNot applicable.Main Outcome MeasuresSpatiotemporal parameters of gait (speed, stride length, cadence, step width, duration of stance, swing, double support phases) and kinematics of hip, knee, and ankle joints in the sagittal plane.ResultsMen and women exhibit similar spatiotemporal parameters, except for step width (wider in men). In contrast, relevant differences were found in terms of ankle kinematics. In particular, women presented increased ankle dorsiflexion through all the stance phase and mid to late swing phase, and reduced plantarflexion at the stance-swing phase transition.ConclusionsGait patterns of men and women with PD with mild disability are similar in terms of spatiotemporal parameters but characterized by marked differences regarding the ankle kinematics on the sagittal plane. The findings of the present study support the concept that investigations seeking to clarify the complex pathophysiology of PD-related gait disturbances should consider the role played by an individual's sex, thereby achieving more effective designing of physical and rehabilitative treatments.     

Balance Control and Energetics of Powered Exoskeleton-Assisted Sit-to-Stand Movement in Individuals With Paraplegic Spinal Cord Injury

Objective

To quantify the effects of initial hip angle and angular hip velocity settings of a lower-limb wearable robotic exoskeleton (WRE) on the balance control and mechanical energy requirements in patients with paraplegic spinal cord injuries (SCIs) during WRE-assisted sit-to-stand (STS).