The immediate effect of attentional, auditory, and a combined cue strategy on gait during single and dual tasks in Parkinson's disease

Baker K, Rochester L, Nieuwboer A. The immediate effect of attentional, auditory, and a combined cue strategy on gait during single and dual tasks in Parkinson’s disease.

Objective

To compare the effect of rhythmic auditory and attentional cues, and a combination of both cues on gait, in people with Parkinson’s disease (PD) during single and dual tasks.

Design

A repeated-measures study requiring participants to perform single and dual-motor tasks under different cueing conditions.

Setting

Human movement analysis laboratory.

Participants

Fifteen participants with idiopathic PD and a comparison group of 12 healthy participants.

Interventions

Three cueing strategies were compared: a rhythmic auditory cue (walking in time to a metronome beat), an attentional strategy (asked to focus on taking big step), and a combination cue (asked to walk in time to a metronome beat while taking big steps).

Main Outcome Measures

Walking speed, step amplitude, and step frequency.

Results

Walking speed of PD participants improved significantly compared with noncued walking in the single- and dual-task condition with the attentional (P<.001, P=.037) and combination cue strategies (P=.013, P=.028). Step amplitude also increased significantly with the attentional and combination cue strategies in single- (P<.001, P<.001) and dual-task (P<.001, P<.001) conditions. Step frequency was reduced significantly with the attentional strategy (P=.042) in the single and dual tasks (P<.001) and combination cue strategy (P=.009) in the dual task. The rhythmic auditory cue alone did not alter significantly any parameter of gait in the single or dual tasks.

Conclusions

The attentional strategy and the combination of a rhythmic auditory cue with an attentional strategy were equally effective, and improved walking speed and step amplitude significantly during both single and dual tasks. The combination cue, however, may still be a useful alternative in situations of increased attentional demand, or where problems exist with executive function.     

Poster 24: Relationship of independent living status, vocational outcome status, and satisfaction with life after traumatic brain injury

Objective: To determine whether independent living status or vocational outcome status predicts satisfaction with life for patients after moderate to severe traumatic brain injury (TBI). Design: Prospective cohort study. Setting: Acute care, rehabilitation hospital. Participants: 26 men and 23 women with moderate to severe TBI. Interventions: Not applicable. Main Outcome Measures: Satisfaction with Life Scale (SWLS), Vocational Outcome Scale (VOS), and Independent Living Scale (ILS) collected at hospital discharge and at 1- and 2-year follow-up. Results: Discharge SWLS predicted 1-year SWLS score (n=49; r=.51, P<.001); 1-year SWLS score predicted SWLS score at 2 years (n=28, r=.60, P<.001). Discharge ILS and VOS scores did not predict SWLS score at 1 year. 1-year SWLS score correlated mildly (r=.39, P<.01) with 1-year VOS and with 1-year ILS (r=.38, P<.01) scores. 78% indicated positive life satisfaction (SWLS score, >19) at discharge and 61% at 1 year. Of those satisfied at discharge, 79% remained satisfied at 1 year. Of those dissatisfied at discharge, 82% remained dissatisfied at 1 year. Conclusions: SWLS score appears relatively stable over time. Life satisfaction may be less dependent on vocational and independent living status than on longstanding personality or social factors.     

Effects of Taping and Exercise on Ankle Joint Movement in Subjects With Chronic Ankle Instability: A Preliminary Investigation

Delahunt E, O'Driscoll J, Moran K. Effects of taping and exercise on ankle joint movement in subjects with chronic ankle instability: a preliminary investigation.

Objective

To examine the effects of ankle joint taping and exercise on ankle joint sagittal plane and rear-foot frontal plane movement in subjects with chronic ankle instability.

Design

Laboratory-based, repeated-measures study.

Setting

University biomechanics laboratory.

Participants

Subjects with chronic ankle instability (N=11) as defined by the Cumberland Ankle Instability Tool.

Interventions

Each participant performed 3 single-leg drop landings onto a forceplate under 3 different conditions. These conditions were: condition 1 (no tape), condition 2 (taped), and condition 3 (postexercise taped).

Main Outcome Measures

Kinematic data were used to identify ankle joint sagittal plane and rear-foot frontal plane positions at 50ms before initial contact (IC) and at IC, under each of the conditions.

Results

There was a significant effect on the angle of ankle joint plantar flexion, both at 50ms before IC (F_2,18=29.4, P<.001) and at IC (F_2,18=16.1, P<.001), as a result of the application of tape. Post hoc analysis revealed that condition 1 (no tape) resulted in significantly greater plantar flexion angle at 50ms before IC than condition 2 (taped) (7.7±3.0°; P=.002) and condition 3 (postexercise taped) (8.3±4.8°; P=.01). Similarly, condition 1 (no tape) resulted in significantly greater plantar flexion at IC than both condition 2 (taped) (5.3±3.2°; P<.001) and condition 3 (postexercise taped) (5.3±4.4°; P=.001). No significant differences were evident between condition 2 (taped) and condition 3 (postexercise taped) (P>.05).

Conclusions

These results indicate that taping acted to reduce the degree of plantar flexion at both 50ms before and at IC with the ground, and that these reductions were retained even after exercise.     

Motivational enhancement therapy in addition to physical therapy improves motivational factors and treatment outcomes in people with low back pain: a randomized controlled trial

Vong SK, Cheing GL, Chan F, So EM, Chan CC. Motivational enhancement therapy in addition to physical therapy improves motivational factors and treatment outcomes in people with low back pain: a randomized controlled trial.

Objectives

To examine whether the addition of motivational enhancement treatment (MET) to conventional physical therapy (PT) produces better outcomes than PT alone in people with chronic low back pain (LBP).

Design

A double-blinded, prospective, randomized, controlled trial.

Setting

PT outpatient department.

Participants

Participants (N=76) with chronic LBP were randomly assigned to receive 10 sessions of either MET plus PT or PT alone.

Intervention

MET included motivational interviewing strategies and motivation-enhancing factors. The PT program consisted of interferential therapy and back exercises.

Main Outcome Measures

Motivational-enhancing factors, pain intensity, physical functions, and exercise compliance.

Results

The MET-plus-PT group produced significantly greater improvements than the PT group in 3 motivation-enhancing factors; proxy efficacy (P<.001), working alliance (P<.001), and treatment expectancy (P=.011). Furthermore, they performed significantly better in lifting capacity (P=.015), 36-Item Short Form Health Survey General Health subscale (P=.015), and exercise compliance (P=.002) than the PT group. A trend of a greater decrease in visual analog scale and Roland-Morris Disability Questionnaire scores also was found in the MET-plus-PT group than the PT group.

Conclusion

The addition of MET to PT treatment can effectively enhance motivation and exercise compliance and show better improvement in physical function in patients with chronic LBP compared with PT alone.     

Predictors and Outcomes of Antibiotic Adequacy for Bloodstream Infections in Veterans With Spinal Cord Injury

Evans CT, Burns SP, Chin A, Weaver FM, Hershow RC. Predictors and outcomes of antibiotic adequacy for bloodstream infections in veterans with spinal cord injury.

Objective

To identify predictors and outcomes associated with receiving inadequate empirical antimicrobial treatment for bloodstream infections (BSIs) in persons with spinal cord injury (SCI).

Design

Retrospective cohort study from October 1, 1997, through September 30, 2004.

Setting

A Department of Veterans Affairs SCI center that serves approximately 700 patients a year.

Participants

Hospitalized patients with SCI (N=123) who had 1 or more BSIs during the study period.

Interventions

Not applicable.

Main Outcome Measures

Adequacy of antimicrobial treatment (inadequate treatment was defined as the absence of antimicrobial agents for a particular organism within 2 days after the collection of blood cultures and/or the microorganism's resistance to the antimicrobial administered), hospital length of stay (LOS) post-BSI infection, and in-hospital and 30-day mortality. Cluster-adjusted multivariable models were assessed.

Results

Over one third (88; 37.4%) of the 235 episodes of BSI identified received inadequate empirical antibiotic treatment. Having a polymicrobial BSI was associated with inadequate treatment (odds ratio [OR]=3.28; 95% confidence interval [CI]=1.62–6.65; P=.001). Factors protective against inadequate therapy included having a comorbid pressure ulcer (OR=0.37; 95% CI=0.21–0.68; P=.001) or a BSI that was not primary (OR=0.30; 95% CI=0.15–0.58; P<.0001). Mortality did not differ between the inadequate and adequate treatment groups (11.4% vs 10.9%; P=.92). Similarly LOS postinfection was not affected by treatment status (inadequate treatment median=22d vs adequate treatment median=27d; P=.98).

Conclusions

Over one third of patients received inadequate empirical treatment, which was associated with having a polymicrobial BSI. However, inadequate treatment was not associated with increased mortality or LOS postinfection.     

Reducing Risk of Falling in Older People Discharged From Hospital: A Randomized Controlled Trial Comparing Seated Exercises, Weight-Bearing Exercises, and Social Visits

Vogler CM, Sherrington C, Ogle SJ, Lord SR. Reducing risk of falling in older people discharged from hospital: a randomized controlled trial comparing seated exercises, weight-bearing exercises, and social visits.

Objective

To compare the efficacy of seated exercises and weight-bearing (WB) exercises with social visits on fall risk factors in older people recently discharged from hospital.

Design

Twelve-week randomized, controlled trial.

Setting

Home-based exercises.

Participants

Subjects (N=180) aged 65 and older, recently discharged from hospital.

Interventions

Seated exercises (n=60), WB exercises (n=60), and social visits (n=60).

Main Outcome Measures

Primary outcome factors were Physiological Profile Assessment (PPA) fall risk score, and balance while standing (Coordinated Stability and Maximal Balance Range tests). Secondary outcomes included the component parts of the PPA and other physical and psychosocial measures.

Results

Subjects were tested at baseline and at completion of the intervention period. After 12 weeks of interventions, subjects in the WB exercise group had significantly better performance than the social visit group on the following: PPA score (P=.048), Coordinated Stability (P<.001), Maximal Balance Range (P=.019); body sway on floor with eyes closed (P=.017); and finger-press reaction time (P=.007) tests. The seated exercise group performed better than the social visit group in PPA score (P=.019) but for no other outcome factor. The seated exercise group had the highest rate of musculoskeletal soreness.

Conclusions

In older people recently discharged from the hospital, both exercise programs reduced fall risk score in older people. The WB exercises led to additional beneficial impacts for controlled leaning, reaction time, and caused less musculoskeletal soreness than the seated exercises.     

Effects of 12 weeks of supported treadmill training on functional ability and quality of life in progressive multiple sclerosis: a pilot study

Pilutti LA, Lelli DA, Paulseth JE, Crome M, Jiang S, Rathbone MP, Hicks AL. Effects of 12 weeks of supported treadmill training on functional ability and quality of life in progressive multiple sclerosis: a pilot study.

Objective

To examine the effects of body-weight supported treadmill training (BWSTT) on functional ability and quality of life in patients with progressive multiple sclerosis (MS) of high disability.

Design

Before–after trial.

Setting

Exercise rehabilitation research center.

Participants

Patients with progressive MS (N=6; 5 primary progressive, 1 secondary progressive) with high disability (mean ± SD expanded disability status scale, [EDSS]=6.9±1.07). All participants completed the trial.

Interventions

Subjects completed 36 sessions of BWSTT (30-min sessions, 3×wk) over 12 weeks.

Main Outcome Measures

Outcome measures included functional ability assessed by EDSS and Multiple Sclerosis Functional Composite (MSFC). Quality of life and fatigue were assessed by the MS Quality of Life-54 (MSQoL-54) and the Modified Fatigue Impact Scale (MFIS), respectively. All tests were administered at baseline and after 12 weeks of training.

Results

All participants progressively improved training intensity; treadmill walking speed increased (34%; P<.001), and percent body weight support was reduced (42%; P<.001). A significant improvement in both physical (P=.02) and mental (P=.01) subscales of the MSQoL-54 was found. Fatigue was nonsignificantly reduced by 31% (P=.22); however, a large effect size (ES) was noted (ES=–.93). Functional ability remained stable with nonsignificant improvements in MSFC (P=.35; ES=.23) and EDSS (P=.36; ES=–.08) scores.

Conclusions

Twelve weeks of BWSTT produces beneficial effects on quality of life and potentially reduces fatigue in patients with primary progressive MS of high disability level. Larger trials will be required to confirm these findings and to evaluate further the effects of BWSTT in progressive MS.     

Computer and internet use by persons after traumatic spinal cord injury

Goodman N, Jette AM, Houlihan B, Williams S. Computer and internet use by persons after traumatic spinal cord injury.

Objective

To determine whether computer and internet use by persons post spinal cord injury (SCI) is sufficiently prevalent and broad-based to consider using this technology as a long-term treatment modality for patients who have sustained SCI.

Design

A multicenter cohort study.

Setting

Twenty-six past and current U.S. regional Model Spinal Cord Injury Systems.

Participants

Patients with traumatic SCI (N=2926) with follow-up interviews between 2004 and 2006, conducted at 1 or 5 years postinjury.

Interventions

Not applicable.

Results

Results revealed that 69.2% of participants with SCI used a computer; 94.2% of computer users accessed the internet. Among computer users, 19.1% used assistive devices for computer access. Of the internet users, 68.6% went online 5 to 7 days a week. The most frequent use for internet was e-mail (90.5%) and shopping sites (65.8%), followed by health sites (61.1%). We found no statistically significant difference in computer use by sex or level of neurologic injury, and no difference in internet use by level of neurologic injury. Computer and internet access differed significantly by age, with use decreasing as age group increased. The highest computer and internet access rates were seen among participants injured before the age of 18. Computer and internet use varied by race: 76% of white compared with 46% of black subjects were computer users (P<.001), and 95.3% of white respondents who used computers used the internet, compared with 87.6% of black respondents (P<.001). Internet use increased with education level (P<.001): eighty-six percent of participants who did not graduate from high school or receive a degree used the internet, while over 97% of those with a college or associate's degree did.

Conclusions

While the internet holds considerable potential as a long-term treatment modality after SCI, limited access to the internet by those who are black, those injured after age 18, and those with less education does reduce its usefulness in the short term for these subgroups.     

Associations between perceived proximity to neighborhood resources, disability, and social participation among community-dwelling older adults: results from the VoisiNuAge study

Levasseur M, Gauvin L, Richard L, Kestens Y, Daniel M, Payette H, for the NuAge Study. Associations between perceived proximity to neighborhood resources, disability, and social participation among community-dwelling older adults: results from the VoisiNuAge Study.

Objective

To examine the associations between perceived proximity to neighborhood resources, disability, and social participation and the potential moderating effect of perceived proximity to neighborhood resources on the association between disability and social participation in community-dwelling older women and men.

Design

Cross-sectional.

Setting

Community.

Participants

Older adults (296 women, 258 men).

Interventions

Not applicable.

Main Outcome Measures

Data for age, education, depressive symptoms, frequency of participation in community activities, perceived proximity to neighborhood resources (services, amenities), and functional autonomy in daily activities (disability) were collected by means of interviewer-administered questionnaire.

Results

Greater perceived proximity to resources and lower level of disability were associated with greater social participation for both women (R²=.10; P<.001) and men (R²=.05; P<.01). The association between disability and social participation did not vary as a function of perceived proximity to neighborhood resources in women (no moderating effect; P=.15). However, in men, greater perceived proximity to neighborhood resources enhanced social participation (P=.01), but only in those with minor or no disability.

Conclusions

Future studies should investigate why perceived proximity to services and amenities is associated with social participation in older men with minor or no disabilities and with women overall, but has no association in men with moderate disabilities.     

Racial Differences in Employment Outcome After Traumatic Brain Injury at 1, 2, and 5 Years Postinjury

Gary KW, Arango-Lasprilla JC, Ketchum JM, Kreutzer JS, Copolillo A, Novack TA, Jha A. Racial differences in employment outcome after traumatic brain injury at 1, 2, and 5 years postinjury.

Objectives

To examine racial differences in competitive employment outcomes at 1, 2, and 5 years after traumatic brain injury (TBI) and to determine whether changes in not competitive employment rates over time differ between blacks and whites with TBI after adjusting for demographic and injury characteristics.

Design

Retrospective cohort study.

Setting

Sixteen TBI Model System Centers.

Participants

Blacks (n=615) and whites (n=1407) with moderate to severe TBI.

Interventions

Not applicable.

Main Outcome Measure

Employment status dichotomized as competitively employed versus not competitively employed.

Results

After adjusting for demographic and injury characteristics, repeated-measures logistic regression indicated that (1) the odds of not being competitively employed were significantly greater for blacks than whites regardless of the follow-up year (all P<.001); (2) the odds of not being competitively employed declined significantly over time for each race (P≤.004); and (3) changes over time in the odds of not being competitively employed versus being competitively employed were not different between blacks and whites (P=.070). In addition, age, discharge FIM and Disability Rating Scale, length of stay in acute and rehabilitation, preinjury employment, sex, education, marital status, and cause of injury were significant predictors of employment status postinjury.

Conclusions

Short- and long-term employment is not favorable for people with TBI regardless of race; however, blacks fare worse in employment outcomes compared with whites. Rehabilitation professionals should work to improve return to work for all persons with TBI, with special emphasis on addressing specific needs of blacks.     

Timed Up & Go Test Score in Patients With Hip Fracture Is Related to the Type of Walking Aid

Kristensen MT, Bandholm T, Holm B, Ekdahl C, Kehlet H. Timed Up & Go test score in patients with hip fracture is related to the type of walking aid.

Objective

To determine the relationship between Timed Up & Go (TUG) test scores and type of walking aid used during the test, and to determine the feasibility of using the rollator as a standardized walking aid during the TUG in patients with hip fracture who were allowed full weight-bearing (FWB).

Design

Prospective methodological study.

Setting

An acute orthopedic hip fracture unit at a university hospital.

Participants

Patients (N=126; 90 women, 36 men) with hip fracture with a mean age ± SD of 74.8±12.7 years performed the TUG the day before discharge from the orthopedic ward.

Interventions

Not applicable.

Main Outcome Measures

The TUG was performed with the walking aid the patient was to be discharged with: a walker (n=88) or elbow crutches (n=38). In addition, all patients also performed the TUG using a rollator.

Results

Patients who performed the TUG with a walker were on average 13.6 (95% confidence interval [CI], 11.2–16.1) seconds faster using a rollator compared with the walker (P<.001). Correspondingly, patients who performed the TUG with crutches were on average 3.5 (95% CI, 1.5–5.4) seconds faster using a rollator compared with elbow crutches (P=.001). In both patient groups, the between walking-aid scores were strongly correlated (r>.833, P<.001).

Conclusions

TUG scores are significantly related to the type of walking aid used during the test in patients with hip fracture who are allowed FWB when discharged from the hospital, but all patients were able to perform the TUG using the rollator as a standardized walking aid. Our findings indicate the importance of using a standardized walking aid when evaluating changes or comparing TUG scores in patients with hip fracture.     

Normalizing hip muscle strength: establishing body-size-independent measurements

Bazett-Jones DM, Cobb SC, Joshi MN, Cashin SE, Earl JE. Normalizing hip muscle strength: establishing body-size-independent measurements.

Objective

To investigate the effectiveness of computing body-size-independent hip strength measures using muscle-specific allometric scaling and ratio standard normalization methods.

Design

Cross-sectional study.

Setting

University laboratory.

Participants

A convenience sample of healthy participants (N=113; 42 men, 71 women).

Interventions

Not applicable.

Main Outcome Measures

Anthropometric measurements of the leg and thigh were obtained, and maximal hip strength was tested (medial and lateral rotation, abduction, adduction, flexion, extension). Strength was measured isometrically as force (kg) and then converted to torque (Nm).

Results

The allometric scaling analysis resulted in exponents for normalizing body mass (BM) in each muscle group assessed. In addition, a 6-muscle average exponent was also computed (bavg) for force (men, .554; women, .335) and torque (men, .792; women, .482). The nonsignificant results of the linear regression analysis revealed that normalizing hip strength to BM^bavg (hip strength/BM^bavg) effectively removed the influence of BM on force and torque. However, sex should be factored into analyses of allometric scaling because men have higher b-values than women for both force and torque. The linear regression analyses also demonstrated that force normalized to BM (P=.162–.895) and torque normalized to BM × Height (P=.146–.889) were body-size-independent measures. Force normalized to BM^0.67 (P=.001–.191) and body mass index (BMI) (P=<.001–.066), and torque normalized to BM (P=.004–.415) and BMI (P<.001) were significantly related to BM and therefore were not body-size independent.

Conclusions

Normalizing force and torque to BM^bavg is the most effective method of removing body-size dependence and allowing comparisons of persons with differing body sizes.     

The Reliability of Spatiotemporal Gait Data for Young and Older Women During Continuous Overground Walking

Paterson KL, Hill KD, Lythgo ND, Maschette W. The reliability of spatiotemporal gait data for young and older women during continuous overground walking.

Objective

To examine the reliability and systematic bias in spatiotemporal gait parameters recorded in healthy women during repeated single and continuous overground walking trials.

Design

Test-retest.

Setting

University laboratory.

Participants

Young (n=13) and older adult (n=14) women volunteers.

Interventions

Not applicable.

Main Outcome Measures

Spatiotemporal data were collected from an 8.1-m GAITRite mat during 10 trials of discrete single walks and 10 laps of a continuous circuit presented in random order over 2 separate test sessions. Paired t tests, intraclass correlation coefficients (ICCs), SE of measurement, and coefficients of variation (CV) were calculated.

Results

The relative and absolute measures of reliability showed most spatiotemporal variables recorded during the single and continuous walking protocols were reliable. Step length, foot angle, and step and stance times were found to be the most reliable parameters, with ICCs ranging from 0.84 to 0.95, CVs from 2.06% to 4.02%, and SE of measurements of 1.59 to 2.04cm for step length, 1.32° to 1.71° for foot angle, and 0.011 to 0.025 seconds for step and stance times. Reliability estimates were similar for the single and continuous trial conditions and between the young and older women. Although small mean differences in the gait parameters were found across the test sessions, many of these parameters showed systematic bias (P≤.05). In the single trial condition, the majority (65%) of the gait parameters showed significant bias, whereas in the continuous condition only 19% of the parameters exhibited bias. For the young women, 54% of the parameters showed systematic bias (P≤.05) in the single trial condition, whereas 77% of the parameters exhibited bias for the older women. In the continuous walking condition, 38% of the gait parameters showed systematic bias (P≤.05) for the young women, whereas no systematic bias was found in the gait parameters of the older women.

Conclusions

This study shows that both the single and continuous walking protocols are reliable methods for the collection of gait data in young and older women. It also shows that a continuous overground walking protocol produces less bias in test-retest spatiotemporal gait data. Therefore, a continuous protocol may be a better method when attempting to monitor gait changes over time, especially for older women.     

A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial

Galea MP, Levinger P, Lythgo N, Cimoli C, Weller R, Tully E, McMeeken J, Westh R. A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.

Objective

To examine the physical function, gait, and quality of life of patients after total hip replacement (THR) randomly assigned to either a targeted home- or center-based exercise program.

Design

Randomized controlled trial.

Setting

Rehabilitation research center in Australia.

Participants

Twenty-three patients with unilateral THR were randomly assigned to a supervised center-based exercise group (n=11) or an unsupervised home-based exercise group (n=12).

Intervention

The center-based group completed an 8-week targeted exercise program while under the direct supervision of a physiotherapist. After initial instruction, the home-based group completed the 8-week targeted exercise program at home without further supervision.

Main Outcome Measures

Quality of life, physical function, and spatiotemporal measures of gait.

Results

No significant interaction (group by time) or main effects of grouping were found. Within each group, quality of life, and stair climbing improved significantly (P<.05) as did Timed Up & Go test and 6-minute walk test performances (P<.05). Walking speed increased by 16cm/s (P<.01), cadence by 8 steps/min (P<.05), step length by 4.7cm (P<.05), and double-support time reduced by a factor of 16%. Step length symmetry showed significant improvement (P<.05) over time. Step length differential between the affected and unaffected limbs reduced from 4.0 to 2.7cm.

Conclusions

The targeted strengthening program was effective for both the home- and center-based groups. No group differences were found in the majority of the outcome measures. This finding is important because it shows that THR patients can achieve significant improvements through a targeted strengthening program delivered at a center or at home.     

Comparison of virtual reality versus physical reality on movement characteristics of persons with Parkinson's disease: effects of moving targets

Wang C-Y, Hwang W-J, Fang J-J, Sheu C-F, Leong I-F, Ma H-I. Comparison of virtual reality versus physical reality on movement characteristics of persons with Parkinson's disease: effects of moving targets.

Objective

To compare the performance of reaching for stationary and moving targets in virtual reality (VR) and physical reality in persons with Parkinson's disease (PD).

Design

A repeated-measures design in which all participants reached in physical reality and VR under 5 conditions: 1 stationary ball condition and 4 conditions with the ball moving at different speeds.

Setting

University research laboratory.

Participants

Persons with idiopathic PD (n=29) and age-matched controls (n=25).

Interventions

Not applicable.

Main Outcome Measures

Success rates and kinematics of arm movement (movement time, amplitude of peak velocity, and percentage of movement time for acceleration phase).

Results

In both VR and physical reality, the PD group had longer movement time (P<.001) and lower peak velocity (P<.001) than the controls when reaching for stationary balls. When moving targets were provided, the PD group improved more than the controls did in movement time (P<.001) and peak velocity (P<.001), and reached a performance level similar to that of the controls. Except for the fastest moving ball condition (0.5-s target viewing time), which elicited worse performance in VR than in physical reality, most cueing conditions in VR elicited performance generally similar to those in physical reality.

Conclusions

Although slower than the controls when reaching for stationary balls, persons with PD increased movement speed in response to fast moving balls in both VR and physical reality. This suggests that with an appropriate choice of cueing speed, VR is a promising tool for providing visual motion stimuli to improve movement speed in persons with PD. More research on the long-term effect of this type of VR training program is needed.     

Ventilatory Response to Hypercapnia in C5–8 Chronic Tetraplegia: The Effect of Posture

Ben-Dov I, Zlobinski R, Segel MJ, Gaides M, Shulimzon T, Zeilig G. Ventilatory response to hypercapnia in C_5–8 chronic tetraplegia: the effect of posture.

Objective

To study the effect of posture on the hypercapnic ventilatory responses (HCVR).

Design

Nonrandomized controlled study.

Setting

Rehabilitation hospital and a pulmonary institute.

Participants

Patients with neurologically stable C_5–8 tetraplegia (n=12) and healthy control subjects (n=7).

Interventions

Not applicable.

Main Outcome Measures

Supine and seated forced vital capacity (FVC) and HCVR, and supine and erect blood pressure.

Results

FVC in the sitting position was reduced in patients with tetraplegia (52±13% predicted); supine FVC was 21% higher (P=.0005). In the sitting position, HCVR was lower in patients than in controls (0.8±0.4 vs 2.46±0.3L/min/mmHg, P<.001). Supine HCVR was not significantly different between the groups. When HCVR was normalized to FVC, there was still a significant difference between patients and controls in the sitting position. Patients with tetraplegia were orthostatic (mean supine blood pressure 91±13mmHg vs mean erect blood pressure 61±13mmHg, respectively, P<.0001). The magnitude of the orthostatism correlated with that of the postural change in HCVR (r=.93, P<.0001).

Conclusions

Respiratory muscle weakness may contribute to the attenuated HCVR in tetraplegia. However, the observation that supine HCVR is still low even when normalized to FVC suggests a central posture-dependent effect on the HCVR, which may be linked to the postural effect on arterial blood pressure.     

Relationship Between Sleep,Pain, and Disability in Patients With Spinal Pathology

Objective

To characterize sleep and its relationship with disability and pain in patients with spine pathology.

Design

A survey study.

Setting

A university-based hospital spine clinic.

Participants

Subjects (N=121) with mixed-etiology spine pathology.

Interventions

Not applicable.

Main Outcome Measures

Self-reported disability (Oswestry Disability Index [ODI]), back and leg pain intensity, the effect of back or leg pain on function, and sleep (Pittsburgh Sleep Quality Index [PSQI]) assessments were completed.

Results

Severe disability was evident with a mean ODI ± SD of 54.9±14, with mean pain intensities ± SD of 50±30mm and 54±27mm of 100mm for the leg and back, respectively. The mean PSQI ± SD was 10.4±5.3, with 87% of participants scoring greater than the sleep-disordered threshold of 5. PSQI was correlated to ODI (r=.53, P<.001), and ODI without the sleep component (r=.47, P<.001). Six of the subscales of PSQI were all also significantly correlated to ODI (.25<r<.42, P<.05). Stepwise regression (ODI dependent variables; PSQI, pain intensity and function, age, body mass index as independent variables) was performed. PSQI was retained in the model along with 2 pain measures (r²=.50, P<.001). Substitution of the 7 subscales for the overall PSQI score revealed 2 subscales (sleep quality, use of sleep medications) as predictors of ODI (r²=.490, P<.001).

Conclusions

Despite its being intuitive that sleep disorders will be present in patients with spinal disorders, it was surprising that sleep quality was an independent predictor of disability along with pain. Furthermore, sleep quality is more closely correlated to disability than leg pain, which is the current focus of medical interventions.     

Functional muscle power testing in young, middle-aged, and community-dwelling nonfrail and prefrail older adults

Zech A, Steib S, Freiberger E, Pfeifer K. Functional muscle power testing in young, middle-aged, and community-dwelling nonfrail and prefrail older adults.

Objective

To evaluate the stair climb (SC) and sit-to-stand (STS) transfer test for functional power assessment in young, middle-aged, and community-dwelling nonfrail and prefrail older adults.

Design

Cross-sectional study.

Setting

Sport science institute providing health-related exercise programs for older people.

Participants

Participants (N=60; age, 22–81y) were divided into groups of young (n=15; 20–30y), middle-aged (n=16; 40–60y), nonfrail older (n=16; >65y), and prefrail older adults (n=13; >65y).

Interventions

Not applicable.

Main Outcome Measures

SC and STS transfer power were measured on 2 separate occasions.

Results

Age and height correlated positively (P<.001) with both power measures. Multiple linear regression analysis showed that 67.9% (R²) of the variance in SC power and 31.3% (R²) of the variance in STS transfer power can be attributed to age and height. Significant age-related subgroup differences were found for SC power (P=.001). Nonfrail and prefrail older adults differed significantly in both power measures (P<.001).

Conclusions

The findings indicate that SC and STS transfer power are sensitive enough to distinguish between nonfrailty and prefrailty. This suggests that both tests are relevant clinical measures in older people.     

A novel video game--based device for measuring stepping performance and fall risk in older people

Schoene D, Lord SR, Verhoef P, Smith ST. A novel video game–based device for measuring stepping performance and fall risk in older people.

Objective

To determine whether a dance mat test of choice stepping reaction time (CSRT) is reliable and can detect differences in fall risk in older adults.

Design

Randomized order, crossover comparison.

Setting

Balance laboratory, medical research institute, and retirement village.

Participants

Older (mean age, 78.87±5.90y; range, 65–90y) independent-living people (N=47) able to walk in place without assistance.

Interventions

Not applicable.

Main Outcome Measures

Reaction (RT), movement, and response times of dance pad–based stepping tests, Physiological Profile Assessment (PPA) score, Digit Symbol Substitution Test (DSST) score, time to complete the Trail Making Test (TMT) A+B, Fall Efficacy Scale International (FES-I) score, Activities-specific Balance Confidence (ABC) Scale score, and Incidental and Planned Exercise Questionnaire (IPEQ) incidental IPEQ activity subscore.

Results

Test-retest reliability of the dance mat CSRT response time was high (intraclass correlation coefficient model 3,k=.90; 95% confidence interval [CI], .82–.94; P<.001) and correlated highly with the existing laboratory-based measure (r=.86; 95% CI, .75–.92; P<.001). Concurrent validity was shown by significant correlations between response time and measures of fall risk (PPA: r=.42; 95% CI, .15–.63; P<.01; TMT A: r=.61; 95% CI, .39–.77; TMT B: r=.55; 95% CI, .31–.72; DSST: r=−.53; 95% CI, −.71 to −.28; P<.001; FES-I: Spearman ρ=.50; 95% CI, .25–.69; ABC Scale: Spearman ρ=−.58; 95% CI, −.74 to −.35; P<.01). Participants with moderate/high fall-risk scores (PPA score >1) had significantly slower response times than people with low/mild fall-risk scores (PPA score <1) at 1146±182 and 1010±132ms, respectively (P=.005), and multiple fallers and single/nonfallers showed significant differences in RT (883±137 vs 770±100ms; P=.009) and response time (1180±195 vs 1031±145ms; P=0.017).

Conclusions

The new dance mat device is a valid and reliable tool for assessing stepping ability and fall risk in older community-dwelling people. Because it is highly portable, it can be used in clinic settings and the homes of older people as both an assessment and training device.     

Efficacy of intra-articular injection of botulinum toxin type A in refractory hemiplegic shoulder pain

Castiglione A, Bagnato S, Boccagni C, Romano MC, Galardi G. Efficacy of intra-articular injection of botulinum toxin type A in refractory hemiplegic shoulder pain.

Objective

To evaluate the efficacy of intra-articular injection of botulinum toxin type A (BTX-A) in relieving hemiplegic shoulder pain (HSP).

Design

Pilot study with assessments before and after BTX-A intra-articular injection.

Setting

Hospital rehabilitation department.

Participants

Patients (N=5) with HSP refractory to standard treatments and pain score at rest greater than 7 on a pain visual analog scale (VAS) of 0 to 10cm.

Intervention

Intra-articular BTX-A injection.

Main Outcome Measure

Variation in VAS score at rest and during 90° passive arm abduction 2 and 8 weeks after BTX-A intra-articular injection.

Results

Baseline VAS score was 8.7±1 at rest and 9.8±0.4 during passive arm abduction. It clearly decreased at 2 (1.5±1.1 at rest, P=.001; 3±1.2 during arm abduction, P<.001) and 8 weeks (1.5±1.2 at rest, P=.001; 2.3±1.1 during arm abduction, P<.001) after BTX-A intra-articular injection.

Conclusions

We found a strong correlation between intra-articular BTX-A injection and pain relief in patients with HSP. This result could provide the rationale for blind randomized controlled trials designed to better evaluate the safety and efficacy of intra-articular BTX-A injection in patients with refractory HSP.