Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks

BACKGROUND AND PURPOSE: Exacerbation of movement disorders while doing 2 tasks (dual task performance) is a characteristic feature of Parkinson disease (PD). The aim of this investigation was to identify whether the type of secondary task (motor or cognitive) determined the severity of dual task interference. SUBJECTS AND METHODS: Footstep patterns for 15 people with PD and 15 comparison subjects without PD were compared when they walked: (1) at a self-selected speed, (2) while simultaneously performing a motor task (coin transference), and (3) while simultaneously performing a cognitive task (digit subtraction). Gait speed, stride length, cadence, and the percentage of the gait cycle in double-limb stance (DS) were examined with a computerized stride analyzer. RESULTS: When there was no second task, the mean stride length was less in the group with PD (1.29 m) than in the comparison group (1.51 m), and the mean gait speed was less in the group with PD (71.47 m/min) than in the comparison group (87.29 m/min). The mean cadence was less in the group with PD (110.79 steps/min) than in the comparison group (115.81 steps/min). The percentage of the gait cycle in DS was greater in the group with PD (33.38%) than in the comparison group (31.21%). Both groups reduced their stride length and speed when they had to change from unitask performance to dual task performance and DS increased. For the group with PD, cadence also decreased. For both groups, the type of secondary task had a negligible effect on the performance decrement. DISCUSSION AND CONCLUSION: Although the performance of simultaneous motor or cognitive tasks compromised gait in people with PD, the type of secondary task was not a major determinant of the severity of dual task interference.     

Relationship between plasma sialic acid concentration and microvascular and macrovascular complications in type 1 diabetes: the EURODIAB Complications Study

OBJECTIVE: To test the hypothesis that an increased plasma concentration of sialic acid, a marker of the acute-phase response, is related to the presence of diabetic micro- and macrovascular complications in type 1 diabetes. RESEARCH DESIGN AND METHODS: We investigated the relationship between plasma sialic acid concentration and nephropathy, retinopathy, neuropathy, and coronary heart disease (CHD) in a cross-sectional survey of 1,369 people with type 1 diabetes. Subjects were participants in the EURODIAB IDDM Complications Study, which involved 31 centers in 16 European countries. RESULTS: There was a significantly increasing trend of plasma sialic acid with severity of retinopathy (P < 0.001 in men) and with degree of urinary albumin excretion (P < 0.001 men, P < 0.01 women). Plasma sialic acid correlated with increasing plasma creatinine concentration (P < 0.009 men, P < 0.0002 women), and men with neuropathy had a higher plasma sialic acid concentration than those without (P < 0.006). There was no significant correlation between plasma sialic acid and CHD in either sex. Elevated plasma sialic acid concentrations were also associated with several risk factors for diabetic vascular disease: diabetes duration, HbA1c, plasma triglyceride and cholesterol concentrations, waist-to-hip ratio, hypertension and smoking (in men), and low physical exercise (in women). In multiple logistic regression analysis, plasma sialic acid was independently related to proliferative retinopathy and urinary albumin excretion rate in men. CONCLUSIONS: We conclude that an elevated plasma sialic concentration is strongly related to the presence of microvascular complications in type 1 diabetes, especially retinopathy and nephropathy. Further study of acute-phase response markers and mediators as indicators or predictors of diabetic microvascular complications is therefore justified.     

T1-weighted cine FLASH is superior to IR imaging of post-infarction myocardial viability at 4.7T.

PURPOSE: Data are unavailable for rational selection of pulse sequences to assess postinfarction myocardial viability in rodents at high field strength. We implemented a widely used clinical inversion recovery (IR) sequence at 4.7T and compared the results to a heavily T1-weighted cine FLASH sequence (T1-CF) for assessment of infarction size. MATERIALS AND METHODS: Eleven infarcted rats were examined within 24 h of infarction after injection of Gadophrin-3 contrast agent. Images were acquired using both pulse sequences and a standard cine (SC) sequence. Estimates of infarct size were compared to TTC. Global LV function was compared between the T1-CF and SC sequences. RESULTS: SNR, relative SNR, and CNR for the infarcted and normal myocardium were significantly greater for the IR sequence. Infarction size was overestimated by both sequences, but correlated highly and showed very close agreement with TTC. Global function revealed no significant differences between T1-CF and SC. Conclusion: Both IR and T1-CF produced reliable results for assessment of infarction size at 4.7T. While the IR sequence delivers better overall SNR and CNR, the T1-CF allows concomitant assessment of global cardiac function with a much shorter acquisition time.     

The impact of parolees' perception of confidentiality of their self-reported sex crimes

Parole officers who supervise sex offenders need to know if parolees continue to be a risk for child molestation after their incarceration. One hundred and twenty convicted child molesters under Parole Supervision were asked to participate in two interviews about their sexual offenses: first by a parolee officer in the parole office and then in a non-parole, psychologic setting by a psychologist. Seventy-four subjects agreed to participate in the parole setting, and 18 of those 74 agreed to participate in the psychologic setting. Hypotheses tested included whether perceived confidentiality affects reports of past child molestation or current urges to molest children or whether it improves the consistency between the offender's reports of their sex crimes and their arrest records. Results indicated that as confidentiality increased, reports of prior sex offenses and current urges to molest increased. The relevance of this finding to our current system of parole supervision is discussed.     

Initial development and validation of a fecal incontinence-specific quality of life measure

Background/Purpose

Fecal incontinence is a prevalent pediatric condition with psychosocial impacts on both children and their caregivers. We sought to develop and validate the Cincinnati Fecal Incontinence Scale (CINCY-FIS) as a psychometrically valid measure to assess the quality of life and caregiver impacts of pediatric fecal incontinence.

Eating Habits and Dietary Status in Young Children with Autism

While clinical lore appears to accept that young children with autism have limited or narrow diets and unusual food aversions in comparison to same age peers, the empirical basis for this is missing. The goals of this preliminary study were to examine the eating habits and nutritional intake of a young cohort of well characterized children with autism compared to young children with no evidence of autism or other autism spectrum disorders. Parents reported on 19 young children with autism and 15 similar aged children with typical development using a number of informant instruments. Results indicated that children with autism had more mealtime behavioral differences, but these did not translate to significant differences in nutritional status compared to typically developing children. However, there was much variability within both groups. Results are discussed in relationship to what has been previously found in older children with autism spectrum disorders.     

Lateral pelvic displacement during gait: abnormalities after stroke and changes during the first month of rehabilitation

OBJECTIVES: To measure the amplitude and symmetry of lateral pelvic displacement (LPD) in patients with acute hemiparetic stroke; to assess the relationship between LPD and walking speed; and to quantify changes in LPD during 1- and 4-week intervals in the early stages of gait rehabilitation. DESIGN: LPD amplitude and symmetry were measured in stroke patients on admission to acute rehabilitation, 1 week later, and at 4-week follow-up. Performance was compared with sex-, height-, and age-matched control subjects. SETTING: Urban geriatric inpatient rehabilitation facility in Australia. PARTICIPANTS: Fifteen patients with a single-hemisphere stroke, confirmed by computed tomography, were compared with the data from 12 control subjects. Patients' FIM trade mark instrument scores ranged from 54 to 124. INTERVENTION: Gait rehabilitation involved twice-daily individual physical therapy sessions of 45 to 60 minutes, 5 days a week, incorporating whole and part practice, mental rehearsal, verbal feedback on performance, manual guidance, and strengthening techniques. MAIN OUTCOME MEASURES: Three-dimensional motion analysis of LPD amplitude and symmetry; and preferred walking speed over 10m. RESULTS: Compared with controls, stroke patients initially showed increased amplitude of LPD, with no difference in LPD symmetry. A statistically significant linear relationship existed between walking speed and amplitude of LPD (r=-.53; P=.04), yet not between walking speed and symmetry (r=-.41, P=.13). Amplitude and symmetry values remained consistent during the 4-week period of rehabilitation. CONCLUSIONS: These results provide baseline LPD values for patients with acute hemiparetic stroke and demonstrate the relationship between LPD and walking speed. Change in LPD during inpatient rehabilitation was not uniform or predictable, particularly during longer periods. This highlights the need for therapists to regularly reassess each patient during the early rehabilitation phase after stroke, especially given that individual differences can be marked.     

Health practices of school nurses.

The health practices of school nurses affect our role as advocates and educators to promote the health of youth. This study describes the health practices of a convenience sample of 388 school nurses who attended the business meeting at an annual school nurse conference. A self-administered, 40-item questionnaire identified health practices of school nurses in the following areas: (a). health promoting behaviors, (b). exercise, (c). nutrition, (d). relaxation and well-being, (e). safety, and (f). substance use. The subjects most often avoided tobacco and wore seatbelts. The majority did not maintain their weight or exercise consistently. Statistical relationships were explored among the subscales and background items. These data document the need to design strategies to narrow the gap between actual school nurse health practices and the important health messages being delivered in our schools.     

NIDDM as a disease of the innate immune system: association of acute-phase reactants and interleukin-6 with metabolic syndrome X

Summary Non-insulin-dependent diabetes mellitus (NIDDM) is commonly associated with hypertriglyceridaemia, low serum HDL-cholesterol concentrations, hypertension, obesity and accelerated atherosclerosis (metabolic syndrome X). Since a similar dyslipidaemia occurs with the acute-phase response, we investigated whether elevated acute-phase/stress reactants (the innate immune system's response to environmental stress) and their major cytokine mediator (interleukin-6, IL-6) are associated with NIDDM and syndrome X, and may thus provide a unifying pathophysiological mechanism for these conditions. Two groups of Caucasian subjects with NIDDM were studied. Those with any 4 or 5 features of syndrome X (n = 19) were compared with a group with 0 or 1 feature of syndrome X (n = 25) but similar age, sex distribution, diabetes duration, glycaemic control and diabetes treatment. Healthy non-diabetic subjects of comparable age and sex acted as controls. Overnight urinary albumin excretion rate, a risk factor for cardiovascular disease, was also assayed in subjects to assess its relationship to the acute-phase response. Serum sialic acid was confirmed as a marker of the acute-phase response since serum concentrations were significantly related to established acute-phase proteins such as α-1 acid glycoprotein (r = 0.82, p < 0.0001). There was a significant graded increase of serum sialic acid, α-1 acid glycoprotein, IL-6 and urinary albumin excretion rate amongst the three groups, with the lowest levels in non-diabetic subjects, intermediate levels in NIDDM patients without syndrome X and highest levels in NIDDM patients with syndrome X. C-reactive protein and cortisol levels were also higher in syndrome X-positive compared to -negative patients and serum amyloid A was higher in both diabetic groups than in the control group. We conclude that NIDDM is associated with an elevated acute-phase response, particularly in those with features of syndrome X. Abnormalities of the innate immune system may be a contributor to the hypertriglyceridaemia, low HDL cholesterol, hypertension, glucose intolerance, insulin resistance and accelerated atherosclerosis of NIDDM. Microalbuminuria may be a component of the acute-phase response. [Diabetologia (1997) 40: 1286–1292] Received: 17 April 1997 and in revised form: 6 June 1997