A qualitative analysis of a progressive resistance exercise programme for people with Parkinson's disease

Purpose. This qualitative study explored the perceptions of adults with Parkinson's disease (PD) about the positive and negative aspects and outcomes of a community-based progressive resistance strengthening programme (PRST), motivators to begin and continue with the PRST program, and factors that might facilitate or create barriers to participation in and completion of a PRST programme.

Methods. Three women and 10 men with PD participated in a 10-week community-based strengthening programme. Participants were interviewed at the end of the programme. A phenomenological theoretical framework and a grounded theory methodology were used to underpin the analysis of these data.

Results. Four themes emerged about the participants' experiences of the programme. These were: (i) Motivators for participation in the PRST programme were broader than physical outcomes, (ii) the outcomes were broader than just physical outcomes, (iii) the indicators of success for participants varied, and (iv) the participants' experience of a disease-specific exercise programme was positive.

Conclusions. The outcomes of this study provide insights, not identified through the quantitative results, into the experiences of people with PD, which have implications for clinicians running future strength training programmes for people with PD.     

A comparison of a hospital-based and two home-based rehabilitation programmes

Purpose.?This paper compares the service models of three different types of rehabilitation programmes provided in Victoria, Australia: One hospital-based and two types of rehabilitation in the home (RITH).

Method.?Nine focus group interviews were conducted with multidisciplinary staff working in rehabilitation teams in one hospital-based and eight RITH programmes. Additional data were collected for 164 clients and 75 carers from eight of these programmes at admission, discharge and three months post discharge. Interviews were conducted with 32 clients and 14 carers.

Results.?The criteria for admission and model of rehabilitation adopted in the three programmes were similar. There were differences in programme aims, characteristics of the clients admitted and the type and level of therapy clients received, both between hospital and home-based programmes and between the three programmes. In general, staff and clients saw the home as providing a relevant context that enabled individualized, goal directed therapy for medically stable rehabilitation clients. The hospital offered an opportunity to socialize with others and specialized equipment.

Conclusions.?Results of this study suggest clients and carers require a mix of hospital and home-based rehabilitation that is able to respond to their needs and preferences at each phase of the rehabilitation continuum.     

Influencing physiotherapy student attitudes toward exercise for adolescents with Down syndrome

Background.?Negative attitudes of physiotherapists may prevent them from implementing exercise as an intervention among people with disabilities. The aim of this study was to examine whether physiotherapy student attitudes towards the barriers to exercise for adolescents with Down syndrome changed as a result of participating in a 10-week exercise programme.

Method.?Data were collected as part of a randomised controlled trial. Twenty physiotherapy students (2 men, 18 women; mean age 19.5±1.3 years) volunteered to act as mentors. Each mentor was matched with an adolescent with Down syndrome from the same metropolitan suburb, who had been randomly allocated to either the intervention or the control group. The 10 adolescents and students in the intervention group all completed a 10-week, twice a week progressive resistance exercise training programme. The 10 adolescents and students in the control group continued with their usual activities. The students completed the 18-item Exercise Barriers Scale at baseline and after 10 weeks.

Results.?There was a positive change in attitudes, significant at the p <0.05 level, favouring the intervention group on 9 of the 18 items on the Exercise Barriers Scale.

Conclusions.?After engagement in a 10-week exercise programme with an adolescent with Down syndrome, physiotherapy students identified fewer barriers that would prevent adolescents with Down syndrome from exercising. Results indicate that contact with adolescents with Down syndrome during clinical placement can positively influence attitudes towards exercise for people with Down syndrome among physiotherapy students.     

Effects of dance on balance and gait in severe Parkinson disease: A case study

Purpose.?Dance may improve functional mobility in individuals with mild-to-moderate Parkinson disease (PD), yet dance effects in severe PD remain unexamined. This study's purpose was to evaluate the feasibility and effects of partnered tango classes on balance, endurance and quality of life in an individual with severe PD.

Design.?Over 10 weeks, the participant attended 20, 1-h tango classes for individuals with PD. Balance, walking, and quality of life were evaluated before and after the intervention and at a 1-month follow-up in this single case design. Caregiver burden was also assessed at all time points.

Results.?The participant improved on the Berg Balance Scale, 6-min walk test, and functional reach. He reported increased balance confidence and improved quality of life as measured by the Parkinson Disease Questionnaire-39 summary index. Gains were maintained at the 1-month follow-up. Caregiver burden increased from baseline immediately post-intervention and at follow-up.

Conclusion.?Twenty partnered tango lessons improved balance, endurance, balance confidence, and quality of life in a participant with severe PD. This is the first report of the use of dance as rehabilitation for an individual with advanced disease who primarily used a wheelchair for transportation.     

Adaptations to pain rehabilitation programmes for non-native patients with chronic pain

Purpose.?(i) To determine whether adaptations for non-native patients have been implemented in pain rehabilitation programmes; (ii) to determine whether characteristics of the rehabilitation institute are related to having adaptations for non-native patients in place.

Subjects.?Rehabilitation institutes and rehabilitation departments of general hospitals in The Netherlands who offer a pain rehabilitation programme.

Method.?A questionnaire was handed over in person or by e-mail to the rehabilitation physicians of the participating institutes. Twenty-seven (90%%) questionnaires were returned. The questionnaire concerned programme adaptations and institute characteristics. The data were analysed by χ² tests or Fischer's exact tests and logistic regression analysis.

Results.?Twelve institutes (44.4%%) reported having adaptations in place for non-native patients in their pain rehabilitation programme. The most common adaptations were as follows: increased number of consultations (25.9%% of the institutes); longer consultations (25.9%%) and education for employees regarding cultural competency (11.1%%). Institutes which treated a high percentage (≥11%%) of non-native patients had implemented significantly more frequently adaptations to their rehabilitation programme (p == 0.04). The number of adaptations was neither associated with the proportion of non-native citizens in the local population nor with the number of the institutes' employees.

Conclusion.?Less than half of the institutes had implemented one or more programme adaptations for non-native patients. Institutes which had made adaptations to their rehabilitation programme treated more non-native patients.     

Art after stroke: the qualitative experience of community dwelling stroke survivors in a group art programme

Purpose.?This study aimed to qualitatively explore the experience of community dwelling stroke survivors' participation in an arts health group programme and possible health benefits to quality of life (QOL) and wellbeing.

Method.?Sixteen participants were conveniently sampled to participate in two group art programmes, both held weekly over a period of 8 weeks. Qualitative data were collected through two focus groups (n == 9) and individual interviews (n == 11). Qualitative analysis of the data was undertaken, using a grounded theory approach incorporating constant comparison.

Results.?Age ranged from 43 to 81 years. Four themes emerged including: experience of stroke, benefit of art, benefit for self and benefit of group experience. Participants experienced improved confidence, self-efficacy, QOL and community participation through involvement in an arts health programme.

Conclusions.?The implementation of an arts health programme after stroke made a substantial impact on well-being and QOL. Results from this study are promising and this is a model that warrants rigorous investigation regarding the impact of art on QOL and wellbeing. This study also highlighted the need for community resources to address community re-integration and service provision in the form of age appropriate, activity-based groups for stroke survivors.     

Effect of a yoga programme on an individual with Parkinson's disease: a single-subject design

Purpose.?To investigate the effect of eight weekly yoga sessions on balance, mobility and reported quality of life of an individual with Parkinson's disease (PD). Furthermore, to test the methodology in order to inform future research.

Method.?A 69-year-old female with an 8-year history of PD (Hoehn and Yahr rating two) was selected for the study, which had a single subject ABA design. A 1-week baseline was followed by an 8-week period of weekly 60?min yoga classes and a further 5 weeks of treatment withdrawal. Main outcome measures used were Berg Balance Scale (BBS), Timed Up and Go (TUG) and the Parkinson's Disease Questionnaire-39 (PDQ-39); collected at baseline, before, during and after the intervention and at follow-up.

Results.?An improvement was noted in the BBS and TUG during the intervention phase; although these changes did not appear to be clinically significant. No change in quality of life as measured by the PDQ-39 was noted.

Conclusions.?The objective improvements in functional activities during the intervention period were not clinically significant. Subjectively, the participant gained much enjoyment and relaxation from the yoga classes. This study justifies the need for further studies using a larger sample size. Additionally, it will inform the methodological design.     

A small group aerobic exercise programme that reduces body weight is feasible in adults with severe chronic schizophrenia: a pilot study

Purpose.?To evaluate the feasibility and effects of an exercise programme on people with severe, chronic schizophrenia.

Method.?A single-group, pre-post pilot study incorporating a baseline familiarisation phase was followed by a 24-week, small-group aerobic exercise programme for up to 30-min each session, twice a week and a 30-min weekly walking session. Adherence was assessed by attendance, and by analysing the exercise supervisor's comments in a programme diary and in each participant's exercise logbook. Body weight, cardio-respiratory fitness (VO₂ max), walking endurance (6-min walk test) and psychiatric symptoms (the Positive and Negative Syndrome Scale) were measured at each time point.

Results.?Eight participants (6 men, 2 women; mean age 45 years, 9 months (SD 10 years, 1 month); mean body mass index 27.0 (SD 4.2)) attended a mean of 73%% of the scheduled exercise sessions, and 83%% of the walking sessions, with no adverse events and no dropouts. All participants displayed positive and negative behaviours during training sessions. There were significant reductions in weight (2.4%%) and body mass index (2.2%%), but no changes in other measures.

Conclusions.?It was feasible and safe to conduct a small-group aerobic exercise programme for adults with severe chronic schizophrenia that reduced body weight.     

Changing perceptions of self as a communicator in Parkinson's disease: a longitudinal follow-up study

Purpose.?Dysarthria in neurological conditions can impact on people's view of themselves as communicators. How views might evolve and how they relate to changes in other variables remains unclear. We investigated patterns of change in self-perception as a communicator in people with Parkinson's disease (PD) and compared outcomes to changes in other clinical measures.

Methods.?Thirty-one people with initially early-stage PD completed a 22-item self-administered semantic differential questionnaire aimed at characterising their view of themselves as communicators before they had PD and at two assessment points 3 years apart. Patterns of change across time were analysed, and compared to intelligibility, motor, mood and cognitive measures.

Results.?Negative changes in perceptions of self as a communicator occurred, in particular in reactions around competence, adequacy, control and ease in communication. There was variability between individuals and between items. No significant relationship was established between changes on self-perception scores and other measures.

Conclusions.?Individuals' views of themselves as communicators evolve over time in progressive neurological conditions. Changes do not relate straightforwardly to other clinical measures. Major impact can occur despite good intelligibility levels. Exploring self-perceptions, individual reactions and coping strategies are argued to be a vital part of assessment and management.     

Effect of robotic locomotor training in an individual with Parkinson's disease: a case report

Purpose.?The purpose was to test the effect of robot-assisted gait therapy with the Lokomat system in one representative individual with Parkinson's disease (PD).

Methods.?The patient was a 67-year-old female with more than an 8-year history of PD. The manifestations of the disease included depressive mood with lack of motivation, moderate bradykinesia, rigidity and resting tremor, both involving more the right side of the body, slow and shuffling gait with episodes of freezing and risk of falling. The patient underwent six sessions of robot-assisted gait training. The practice included treadmill walking at variable speed for 25–40?min with a partial body weight support and assistance from the Lokomat orthosis.

Results.?After the therapy, the patient increased the gait speed, stride length and foot clearance during over ground walking. She reduced the time required to complete a 180° turn and the latency of gait initiation. Improvements were observed in some items of the Unified Parkinson's Disease Rating Scale including motivation, bradykinesia, rigidity, freezing, leg agility, gait and posture.

Conclusions.?Although the results supported the feasibility of using robot-assisted gait therapy in the rehabilitation an individual with PD, further studies are needed to assess a potential advantage of the Lokomat system over conventional locomotor training for this population.     

Assistive technology training: Diverse audiences and multidisciplinary content

Purpose.?This study surveyed US programmes that train professionals in assistive technology (AT). Surveys contained questions regarding programme characteristics, audiences, training content, and approaches.

Method.?This multi-method, longitudinal study gathered information from 55 programmes in 27 states concerning their courses, curricula, and training audiences in 2002 and again in 2004. The study focused on 45 unique programmes conducting AT training for formal credit, which included graduate or undergraduate credit or degrees, continuing education units (CEUs), and/or AT credential.

Results.?Twenty-five programmes at universities and colleges (average age 10 years) trained mainly graduate students, and typically offered five or six three-unit AT courses. Twenty community-based programmes (average age 7 years) offered mainly 1- or 2-day workshops. Special educators represented the largest group of trainees. Thirty-two training directors and 135 instructors described training barriers, curriculum issues, distance and hands-on learning methods, and future AT training directions.

Conclusions.?Multidisciplinary AT training not only reaches core audiences of disability-related professionals, but has expanded to include new audiences. Special and general educator training may be a model for inclusion. Although distance learning can reach diverse audiences, faculty in training programmes also emphasised hands-on training. AT training programmes experience considerable turnover and remain vulnerable to funding losses.     

Community ambulation: Influences on therapists and clients reasoning and decision making

Background. Community ambulation is an important element of a rehabilitation training programme and its achievement is a goal shared by rehabilitation professionals and clients. The factors that influence a physiotherapist's or health professionals decision making around the preparation of a client for community ambulation and the factors that influence a client's decision to return to walking in their community are unclear.

Objective. To review the available literature about the factors that have influenced the reasoning and decision making of rehabilitation therapists and clients around the topic of ambulation in the community.

Method. Three separate searches of the available literature were undertaken using Ovid, Cinahl, ProQuest, Medline and Ebscohost databases. Databases were searched from 1966 to October 2006.The first search explored the literature for factors that influence the clinical reasoning of rehabilitation therapists. The second search explored the literature for factors that influence client's decision to ambulate in the community. A third search was undertaken to explore the literature for the demands of community ambulation in rural communities.

Results. Very few studies were found that explored community ambulation in the context of clinical reasoning and decision making, the facilitators and barriers to a clients return to ambulation in their community or the demands of ambulation in a rural community.

Conclusion. Consideration of the environment is key to the successful return to walking in the community of clients with mobility problems yet little literature has been found to guide physiotherapist's decision making about preparing a clients to return to walking in the community. An individual's participation in their society is also a result of the interaction between their personal characteristics and his or her environment. The influence of these characteristics may vary from one individual to another yet the factors that influence a person's decision to return to walking in their community after stroke remain unclear.     

Rehabilitation after severe stroke - an enthusiastic approval and a cautionary note

Purpose.?To develop a scale to measure (social) participation for use in rehabilitation, stigma reduction and social integration programmes.

Method.?A scale development study was carried out in Nepal, India and Brazil using standard methods. The instrument was to be based on the Participation domains of the International Classification of Functioning, Disability and Health (ICF), be cross-cultural in nature and assess client-perceived participation. Respondents rated their participation in comparison with a ‘peer’, defined as ‘someone similar to the respondent in all respects except for the disease or disability’.

Results.?An 18-item instrument was developed in seven languages. Crohnbach's α was 0.92, intra-tester stability 0.83 and inter-tester reliability 0.80. Discrimination between controls and clients was good at a Participation Score threshold of 12. Responsiveness after a ‘life change’ was according to expectation.

Conclusions.?The Participation Scale is reliable and valid to measure client-perceived participation in people affected by leprosy or disability. It is expected to be valid in other (stigmatised) conditions also, but this needs confirmation. The scale allows collection of participation data and impact assessment of interventions to improve social participation. Such data may be compared between clients, interventions and programmes. The scale is suitable for use in institutions, but also at the peripheral level.     

Effectiveness of a community-based low intensity exercise programme for ambulatory stroke survivors

Purpose.?To establish the feasibility and effectiveness of a community-based exercise programme for ambulatory patients with stroke discharged from rehabilitation

Method.?Eighteen participants were recruited 3–12 months after onset of first stroke. Using a time series experimental design, the group completed a baseline period of 4 weeks (A1), a group exercise programme of low-intensity progressive resistive exercise and functional tasks for lower limb muscles (B) and repeat assessment after cessation of exercise (A2). Fitness instructors delivered sessions at Leisure Centres twice weekly for 14 weeks with physiotherapy support and the minimum attendance requirement was 16 sessions. Measures included muscle strength, gait velocity, Berg Balance Scale and Nottingham Extended Activities of Daily Living.

Results.?Lower limb muscle strength improved after training (ANOVA, p?<?0.02). Paretic knee extension strength increased from 43.4?±?5.9 to 60.4?±?6.8 Nm after 16 exercise sessions. Walking velocity increased significantly (ANOVA, p?<?0.001), from 0.54?±?0.07 to 0.75?±?0.08 m/s (t?=??3.31, p?<?0.01). Balance and everyday function were also significantly improved (p?<?0.003). There were marked individual variation in the response to training, and those who completed additional training did not show benefit.

Conclusions.?This community-based exercise programme was feasible and delivered positive improvements in physical function for participants. Further issues raised for investigation include the individual response to training and the benefits of extended training.     

Multidisciplinary cognitive behavioural pain management programmes for people with a spinal cord injury: design and implementation

Purpose.?This article seeks to outline the design and implementation of cognitive behavioural pain management programmes (PMPs) for people with spinal cord injury (SCI), illustrated by the experiences in a recently evaluated programme (SpinalADAPT). It is hoped that this will provide an easily accessible account of the relevant design and implementation issues for those who seek to deliver such programmes to persons with a SCI.

Methods.?A collaborative team of pain and SCI professionals developed a modified version of a standard cognitive behavioural pain management programme (ADAPT) based upon experiences of those with SCI who had previously attempted ADAPT. A number of structural and content elements of the programme were identified that required modification in order to accommodate the particular needs of those with SCI.

Results.?The modified programme was subsequently successfully delivered by a combination of SCI and pain health professionals. Three groups of individuals completed the SpinalADAPT, and an evaluation of outcomes compared to standard care are reported elsewhere (Nicholson Perry et al., Clin J Pain 2010;26:206–216).

Conclusions.?It appears feasible to appropriately modify standard PMPs for participants with SCI, and that such programmes may offer benefits in terms of improved quality of life. Further revision and evaluation of such programmes is required.