Background: A number of studies evaluating physical therapy and exercise interventions in Hunting... more Background: A number of studies evaluating physical therapy and exercise interventions in Huntington's disease have been conducted over the past 15 years. However, an assessment of the quality and strength of the evidence in support of these interventions is lacking. Objective: The purpose of this systematic review was to investigate the effectiveness of physical therapy and exercise interventions in people with Huntington's disease, and to examine the perceptions of patients, families and caregivers of these interventions. Methods: This mixed-methods systematic review utilized the Joanna Briggs Institute (JBI) approach and extraction tools to evaluate the literature from January 2003 until May 2016. The review considered interventions that included exercise and physical therapy interventions, and included both quantitative and qualitative outcome measures. Results: Twenty (20) studies met the inclusion criteria, including eighteen (18) that had quantitative outcome measures and two (2) that utilized qualitative methods. JBI Levels of evidence for the 18 quantitative studies were as follows: Eight studies were at evidence Level 1, seven were at Level 2, two were at Level 3, and one was at Level 4. Conclusions: Our review suggests that there is preliminary support for the benefits of exercise and physical activity in Huntington's disease in terms of motor function, gait speed, and balance, as well as a range of physical and social benefits identified through patient-reported outcomes. Variability in mode of intervention as well as outcome measures limits the interpretability of these studies, and high-quality studies that incorporate adaptive trial designs for this rare disease are needed.
American Journal of Occupational Therapy, Aug 1, 2021
Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limi... more Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Both action observation and repetitive-task practice are efficacious interventions for poststroke upper limb hemiplegia individually, yet these interventions have not been combined before. A feasibility study was completed to determine preliminary evidence of the response to intervention and whether a Phase III study should be completed to test efficacy of the combined intervention. The functional impact of improving poststroke upper limb performance could benefit millions of stroke survivors. Primary Author and Speaker: Christine Griffin Contributing Authors: Marcia Bockbrader, Erinn Hade, Anne Kloos, John A. Buford
The Internet journal of allied health sciences and practice, 2019
The purpose of this case study was to examine the effectiveness of integrated vision and vestibul... more The purpose of this case study was to examine the effectiveness of integrated vision and vestibular therapy for an individual with oculomotor and vestibular system impairments secondary to a concussion further defined as vestibulo-ocular post-concussion disorder. A secondary purpose was to suggest an appropriate timeline to introduce vision therapy and integrate vestibular rehabilitation therapy based on protocol used in an outpatient concussion rehabilitation clinic. Method This was a case study on a 16-year-old female with protracted concussion recovery. Treatment consisted of 9 in-clinic visits for vision therapy with the final 6 visits addressing vision and vestibular deficits. A home exercise program supplemented the weekly clinic sessions. Outcomes measures included the Activity-Specific Balance Confidence Scale (ABC Scale), Brain Injury Vision Symptom Survey (BIVSS), Convergence Insufficiency Symptom Survey (CISS), Dizziness Handicap Inventory (DHI), and Post-Concussion Symptom Scale (PCSS). Improvements in vision and vestibular function were assessed with a comprehensive visuovestibular re-evaluation at discharge and 5 month follow up. Results: Improvements in oculomotor control, vergences, vestibular function, and symptomology were reported and measured at discharge and corresponded with clinically meaningful functional outcome improvements. The patient improved from 68% to 96.88% on the ABC (<67% indicates fall risk); 78 to 14 on the DHI (MDC 17.18 points, MCID 18 points); and 46 points to 10 points on the PCSS (MCID 6.8 points). Improvements were maintained at 5 month follow up, despite occurrence of two subsequent subconcussive head injuries. The patient reported improvements in participation in social activities and academic performances at follow up. Conclusion: Results from this case study suggest integrated vision and vestibular therapy, when done in the appropriate timeline, may be used to efficiently and effectively manage vestibulo-ocular post-concussion disorder.
Background. Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive d... more Background. Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive domains, resulting in impairment in dual-task walking ability. The goal of this study was to compare performance of forward walking and backward walking in singleand dual-task conditions in persons with MS to age-and sex-matched healthy controls. We also examined relationships between forward and backward walking to cognitive function, balance, and retrospective fall reports. Methods. All measures were collected in a single session. A 2 × 2 × 2 mixed model ANOVA was used to compare differences in forward and backward walking in singleand dual-task conditions between MS and healthy controls. Spearman correlations were used to examine relationships between gait and cognitive function, falls, and balance. Results. Eighteen individuals with relapsing-remitting MS and 14 age-and sex-matched healthy controls participated. Backward walking velocity revealed significant differences between groups for both single-task (p = 0:015) and dual-task (p = 0:014) conditions. Persons with MS demonstrated significant differences between single-and dual-task forward and backward walking velocities (p = 0:023; p = 0:004), whereas this difference was only apparent in the backward walking condition for healthy controls (p = 0:004). In persons with MS, there were significant differences in double support time between single-and dual-task conditions in both backward (p < 0:001) and forward (p = 0:001) directions. More falls at six months were significantly associated with shorter backward dual-task stride length (r = −0:490; p = 0:046) and slower velocity (r = −0:483; p = 0:050). Conclusion. Differences in MS and age-and sex-matched healthy controls are more pronounced during backward compared to forward walking under single-and dual-task conditions. Future work with a larger sample size is needed to validate the clinical utility of backward walking and dual-task assessments and mitigate the limited sensitivity of the current dual-task assessments that primarily rely upon forward walking.
American Journal of Emergency Medicine, Feb 1, 2017
Objectives-The American College of Emergency Physicians (ACEP) Geriatric Emergency Department (ED... more Objectives-The American College of Emergency Physicians (ACEP) Geriatric Emergency Department (ED) guidelines and the Center for Disease Control (CDC) recommend that older adults be assessed for risk of falls. The standard ED assessment is a verbal query of fall risk factors, which may be inadequate. We hypothesized that the addition of a functional balance test endorsed by the CDC STEADI falls prevention guidelines, the 4 Stage Balance Test (4SBT), would improve the detection of patients at risk for falls. Methods-Prospective pilot study of a convenience sample of ambulatory adults ≥65 years old in the ED. All participants received the standard nursing triage fall risk assessment. After patients were stabilized in their ED room, the 4SBT was administered. Results-The 58 participants had an average age of 74.1 years (range 65-94), 40.0% were women, and 98% were community dwelling. Five (8.6%) presented to the ED for a fall-related chief complaint. The nursing triage screen identified 39.7% (n=23) as at risk for falls, while the 4SBT identified 43% (n=25). Combining triage questions with the 4SBT identified 60.3% (n=35) as high risk for falls as compared to 39.7% (n=23) with triage questions alone (p<0.01). Ten (17%)
Spinal cord injury (SCI) impairs sensory systems causing allodynia. Measuring the development of ... more Spinal cord injury (SCI) impairs sensory systems causing allodynia. Measuring the development of allodynia in rodent models of SCI is challenging due to spinal shock and marked motor impairments. Assessment of SCI-induced allodynia is not standardized across labs, making interpretation of results difficult. Therefore, we validated sensory threshold assessment after SCI and developed a novel assessment of allodynia prior to motor recovery in a rat SCI model. One hundred fifty-six Sprague-Dawley rats received T8 laminectomy or mild to moderate SCI using the OSU SCI device (0.3 mm to 1.3mm cord displacement). To determine tactile thresholds, von Frey hairs (VFH) were applied in Up-Down or ascending order to the dorsal or plantar hindpaw. The most efficient and valid procedures that maintain high sensitivity and specificity were identified. Ten Up-Down VFH applications yielded stable thresholds; reducing the risk of threshold decay and unnecessary exposure to painful stimuli. Importantly, distraction of SCI-rats with food revealed differential decay of thresholds than when distraction is not provided. The new test uses dorsal VFH stimulation and is independent of trunk or hindlimb control. Acute dorsal VFH thresholds collected before recovery of hindlimb weight support accurately predicted plantar VFH thresholds measured at late timepoints (χ 2 =8.479; p<0.05). Thus, standardized testing early
This study presents a framework for physical therapy through the course of Huntington disease (HD... more This study presents a framework for physical therapy through the course of Huntington disease (HD) which includes coordinated care plans with neurologists. HD is an inherited neurodegenerative disorder that leads to impaired strength and coordination and ultimately progressive loss of function. Interdisciplinary HD care teams provide patient-centered, comprehensive evaluations and make recommendations for pharmacologic, healthcare, and lifestyle interventions based on best available evidence. Physical therapists work to improve movement and mobility using specific therapeutic interventions and individualized exercise programs. The proposed framework recommends that neurologists refer persons with HD to physical therapy at all disease stages, ideally beginning in premanifest and early stages, and that they regularly communicate with physical therapists to ensure implementation of a coordinated care plan. Resources are provided for neurologists to facilitate appropriate referral for individuals with HD to physical therapy based on clinical practice guidelines, including a referral decision guide.
BACKGROUND Treadmill training may improve gait disorders associated with neurodegenerative diseas... more BACKGROUND Treadmill training may improve gait disorders associated with neurodegenerative diseases. In Parkinson's disease (PD), treadmill training alters gait patterns after one session, and long-term training improves gait parameters, fall risk, and quality of life. RESEARCH QUESTION What is the feasibility and safety of using this intervention for people with Lewy body dementia (LBD) or Huntington's disease (HD)? METHODS In this observational study, 10 individuals with HD, 8 individuals with LBD, and 10 control individuals walked for 20 min on a treadmill using a speed dependent protocol starting at a slow comfortable speed and increasing incrementally toward their normal overground speed. Feasibility was determined by compliance to protocol and safety by no incidents of abnormal vital signs or expressions of distress. Changes in gait measures, Timed Up and Go (TUG) scores and quantitative motor function measures (Q-Motor; precision grasp force variability, finger and foot tapping frequency) before and after treadmill walking were analyzed using linear models. RESULTS Treadmill training is feasible and safe in LBD and HD; although, participants could not initiate treadmill walking at their comfortable overground speeds, and only 3 participants with HD were able to achieve their overground walking speed within the 20-minute session. No changes in gait measures, TUG times, and Q-Motor measures were found among LBD and HD participants after treadmill walking, although control participants demonstrated significant increases in several gait measures, and foot tap frequency (estimated difference = 0.290; p = 0.026). SIGNIFICANCE Longer and more frequent treadmill sessions may be needed to see gait and motor function effects in LBD and HD. Motor and cognitive impairments associated with these diseases may make them less amenable to the effects of treadmill training.
Thi s is a n O p e n Acc e s s d o c u m e n t d o w nlo a d e d fro m ORCA, C a r diff U niv e r... more Thi s is a n O p e n Acc e s s d o c u m e n t d o w nlo a d e d fro m ORCA, C a r diff U niv e r si ty' s in s ti t u tio n al r e p o si t o ry: h t t p s://o r c a. c a r diff.a c. u k/i d/ e p ri n t/ 1 5 2 8 9 3/ This is t h e a u t h o r's v e r sio n of a w o r k t h a t w a s s u b mi t t e d t o / a c c e p t e d fo r p u blic a tio n. Cit a tio n fo r fin al p u blis h e d ve r sio n: Jon e s , U n a , Ke g el m ey er, D e b o r a h A. a n d Kloos, An n e D. 2 0 2 2. I m pl e m e n ti n g p h y sio t h e r a p y H u n ti n g t o n ' s Dis e a s e g ui d elin e s in clinic al p r a c ti c e. Jou r n al of H u n ti n g t o n ' s Dis e a s e 1 1 (3) , p p .
Journal of Neurologic Physical Therapy, Apr 1, 2020
N europlasticity is the capacity of the nervous system to change its chemistry, structure, and fu... more N europlasticity is the capacity of the nervous system to change its chemistry, structure, and function in response to intrinsic or extrinsic stimuli. 1 Neuroplastic mechanisms are activated by environmental, behavioral, or neural processes, and by disease; they underpin the motor and cognitive learning associated with physical therapy or exercise. Neuroplasticity can lead to positive or negative changes in function, which are referred to as adaptive and maladaptive neuroplasticity, respectively. In their roles as clinicians and as scientists, physical therapists and other rehabilitation professionals harness neuroplasticity using evidence-based interventions to maintain or enhance functional performance in individuals with neurological disorders. There is still much to learn about the optimal interventions and parameters of dose and intensity necessary to achieve adaptive neuroplastic changes. Beyond questions related to dose and intensity, more information is needed regarding the degree to which factors such as past experiences, age, sex, genetics, and the presence of a neurological disorder affects capacity for neuroplastic change. In addition, it is likely that these factors interact with each other, making it even harder to understand their influence on neuroplastic change. Improved measures for assessment of neuroplasticity in humans are needed, such as biomarkers (including movement-related biomarkers) for diagnosing disorders, and predicting and monitoring treatment effectiveness. Greater knowledge of effective rehabilitation and exercise interventions that drive adaptive neuroplasticity, and are tailored to each person's unique characteristics, will improve patient outcomes. The idea for this special issue was born out of a desire to advance understanding of the mechanisms driving functional change. Two studies in this special issue use a newer neuroimaging method called functional near-infrared spectroscopy to measure cortical activity during dual-task walking. 2,3 Impaired dual-task walking is common in neurological populations and can interfere with the ability to perform daily life activities. Hoppes et al 2 examine frontal lobe activation patterns in individuals with and without visual vertigo during dual-task walking. The differences in cortical activation patterns identified increase our understanding of possible mechanisms underlying decrements in dual-task performance in individuals with vestibular disorders, and may be useful for diagnosis, and for predicting or determining functional recovery in this population. Stuart and Mancini 3 investigate how open and closed-loop tactile cueing influences prefrontal cortex activity during single-and dual-task walking and turning in individuals with Parkinson disease. Tactile cues delivered to the feet in an open-loop (continuous rhythmic stimuli) or closed-loop (intermittent stimuli based on an individual's movement) mode are associated with improved gait and turning performance, and it is hypothesized that attention arising from the prefrontal cortex may underlie these cueing effects. 4 Their findings of unchanged prefrontal cortex activity are unexpected, and raise additional questions regarding the role of the prefrontal cortex during gait. Rehabilitation approaches such as task-oriented training that emphasize high repetition and challenge have been shown to facilitate recovery of mobility and function in neurological populations, but responses are varied and residual deficits often remain. 5,6 There is still much to be learned about how to deliver the best interventions to optimize The author declares no conflicts of interest.
Journal of the Neurological Sciences, Jan 15, 2019
Background.-Despite the prevalence of dual-task (e.g., walking while talking) deficits in people ... more Background.-Despite the prevalence of dual-task (e.g., walking while talking) deficits in people with multiple sclerosis (MS), no neuroimaging studies to date have examined neuronal networks used for dual-task processing or specific brain areas related to dual-task performance in this population. A better understanding of the relationship among underlying brain areas and dualtask performance may improve targeted rehabilitation programs. The objective of this study was to examine relationships between neuroimaging measures and clinical measures of dual-task performance, and reported falls in persons with MS. Materials and methods.-All participants completed measures of dual-task performance, a fall history, and neuroimaging on a 3T MRI scanner. Spearman correlations were used to examine relationships among dual-task performance, falls and neuroimaging measures. Results.-Eighteen females with relapsing-remitting MS [mean age= 45.5 ± 8.2 SD; mean symptom duration = 12.3±6.7 years; Expanded Disability Status Scale median 2.25 (range 1.5-4)] participated in this study. Structural imaging measures of supplementary motor area (SMA) interhemispheric connectivity were significantly related to dual-task walking variability. Conclusions.-The SMA interhemispheric tract may play a role in dual-task performance. Structural neuroimaging may be a useful adjunct to clinical measures to predict performance and provide information about recovery patterns in MS. Functional recovery can be challenging to *
Spinal cord injury (SCI) causes motor and sensory deficits that impair functional performance. Wh... more Spinal cord injury (SCI) causes motor and sensory deficits that impair functional performance. While more functional recovery occurs with greater white matter sparing (WMS), it is unclear which locomotor features are more vulnerable to SCI than others, if recovery of certain features depends on specific amounts of WMS, and whether motor recovery patterns differ from sensory recovery. Locomotor and sensory recovery after graded contusive SCI with cord displacements of 0.3, 0.5, 0.7, 0.9, 1.1, 1.25, and 1.3 mm was examined for 6 weeks in 80 female Sprague-Dawley rats. Seven SCI gradations resulted in three locomotor performance levels measured with BBB (P b 0.01): High: laminectomy (LAM) controls and 0.3 (19.87 F 0.35 SEM); Intermediate: 0.5-0.9 (13.71 F 0.32); and Low: 1.1-1.3 (9.23 F 0.36). Normal paw position was most susceptible to SCI requiring 90% WMS, while consistent plantar stepping was least susceptible depending on 10% WMS. A threshold at the 0.9 severity for coordination, toe clearance, and nearly normal trunk stability and tail usage required 25% WMS. Analysis of interlimb coordination using new phase dispersion (PD) techniques delineated three recovery patterns: synchronous (0.3), modified concordance (0.5, 0.7), and disengaged (0.9, 1.1). Lesion severity correlated to WMS (r 2 = 0.96) and to BBB (r 2 = 0.87) by nonlinear polynomial regressions. Mechanical allodynia developed only after injuries resulting in V10% WMS. Nonlinear motor and sensory recovery patterns suggest that small reparative changes may substantially improve function in individuals with SCI. A hierarchical locomotor recovery based on simple segmental versus complex supraspinal motor control is proposed.
American Journal of Occupational Therapy, Aug 1, 2021
Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limi... more Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Both action observation and repetitive-task practice are efficacious interventions for poststroke upper limb hemiplegia individually, yet these interventions have not been combined before. A feasibility study was completed to determine preliminary evidence of the response to intervention and whether a Phase III study should be completed to test efficacy of the combined intervention. The functional impact of improving poststroke upper limb performance could benefit millions of stroke survivors. Primary Author and Speaker: Christine Griffin Contributing Authors: Marcia Bockbrader, Erinn Hade, Anne Kloos, John A. Buford
Background: A number of studies evaluating physical therapy and exercise interventions in Hunting... more Background: A number of studies evaluating physical therapy and exercise interventions in Huntington's disease have been conducted over the past 15 years. However, an assessment of the quality and strength of the evidence in support of these interventions is lacking. Objective: The purpose of this systematic review was to investigate the effectiveness of physical therapy and exercise interventions in people with Huntington's disease, and to examine the perceptions of patients, families and caregivers of these interventions. Methods: This mixed-methods systematic review utilized the Joanna Briggs Institute (JBI) approach and extraction tools to evaluate the literature from January 2003 until May 2016. The review considered interventions that included exercise and physical therapy interventions, and included both quantitative and qualitative outcome measures. Results: Twenty (20) studies met the inclusion criteria, including eighteen (18) that had quantitative outcome measures and two (2) that utilized qualitative methods. JBI Levels of evidence for the 18 quantitative studies were as follows: Eight studies were at evidence Level 1, seven were at Level 2, two were at Level 3, and one was at Level 4. Conclusions: Our review suggests that there is preliminary support for the benefits of exercise and physical activity in Huntington's disease in terms of motor function, gait speed, and balance, as well as a range of physical and social benefits identified through patient-reported outcomes. Variability in mode of intervention as well as outcome measures limits the interpretability of these studies, and high-quality studies that incorporate adaptive trial designs for this rare disease are needed.
American Journal of Occupational Therapy, Aug 1, 2021
Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limi... more Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Both action observation and repetitive-task practice are efficacious interventions for poststroke upper limb hemiplegia individually, yet these interventions have not been combined before. A feasibility study was completed to determine preliminary evidence of the response to intervention and whether a Phase III study should be completed to test efficacy of the combined intervention. The functional impact of improving poststroke upper limb performance could benefit millions of stroke survivors. Primary Author and Speaker: Christine Griffin Contributing Authors: Marcia Bockbrader, Erinn Hade, Anne Kloos, John A. Buford
The Internet journal of allied health sciences and practice, 2019
The purpose of this case study was to examine the effectiveness of integrated vision and vestibul... more The purpose of this case study was to examine the effectiveness of integrated vision and vestibular therapy for an individual with oculomotor and vestibular system impairments secondary to a concussion further defined as vestibulo-ocular post-concussion disorder. A secondary purpose was to suggest an appropriate timeline to introduce vision therapy and integrate vestibular rehabilitation therapy based on protocol used in an outpatient concussion rehabilitation clinic. Method This was a case study on a 16-year-old female with protracted concussion recovery. Treatment consisted of 9 in-clinic visits for vision therapy with the final 6 visits addressing vision and vestibular deficits. A home exercise program supplemented the weekly clinic sessions. Outcomes measures included the Activity-Specific Balance Confidence Scale (ABC Scale), Brain Injury Vision Symptom Survey (BIVSS), Convergence Insufficiency Symptom Survey (CISS), Dizziness Handicap Inventory (DHI), and Post-Concussion Symptom Scale (PCSS). Improvements in vision and vestibular function were assessed with a comprehensive visuovestibular re-evaluation at discharge and 5 month follow up. Results: Improvements in oculomotor control, vergences, vestibular function, and symptomology were reported and measured at discharge and corresponded with clinically meaningful functional outcome improvements. The patient improved from 68% to 96.88% on the ABC (<67% indicates fall risk); 78 to 14 on the DHI (MDC 17.18 points, MCID 18 points); and 46 points to 10 points on the PCSS (MCID 6.8 points). Improvements were maintained at 5 month follow up, despite occurrence of two subsequent subconcussive head injuries. The patient reported improvements in participation in social activities and academic performances at follow up. Conclusion: Results from this case study suggest integrated vision and vestibular therapy, when done in the appropriate timeline, may be used to efficiently and effectively manage vestibulo-ocular post-concussion disorder.
Background. Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive d... more Background. Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive domains, resulting in impairment in dual-task walking ability. The goal of this study was to compare performance of forward walking and backward walking in singleand dual-task conditions in persons with MS to age-and sex-matched healthy controls. We also examined relationships between forward and backward walking to cognitive function, balance, and retrospective fall reports. Methods. All measures were collected in a single session. A 2 × 2 × 2 mixed model ANOVA was used to compare differences in forward and backward walking in singleand dual-task conditions between MS and healthy controls. Spearman correlations were used to examine relationships between gait and cognitive function, falls, and balance. Results. Eighteen individuals with relapsing-remitting MS and 14 age-and sex-matched healthy controls participated. Backward walking velocity revealed significant differences between groups for both single-task (p = 0:015) and dual-task (p = 0:014) conditions. Persons with MS demonstrated significant differences between single-and dual-task forward and backward walking velocities (p = 0:023; p = 0:004), whereas this difference was only apparent in the backward walking condition for healthy controls (p = 0:004). In persons with MS, there were significant differences in double support time between single-and dual-task conditions in both backward (p < 0:001) and forward (p = 0:001) directions. More falls at six months were significantly associated with shorter backward dual-task stride length (r = −0:490; p = 0:046) and slower velocity (r = −0:483; p = 0:050). Conclusion. Differences in MS and age-and sex-matched healthy controls are more pronounced during backward compared to forward walking under single-and dual-task conditions. Future work with a larger sample size is needed to validate the clinical utility of backward walking and dual-task assessments and mitigate the limited sensitivity of the current dual-task assessments that primarily rely upon forward walking.
American Journal of Emergency Medicine, Feb 1, 2017
Objectives-The American College of Emergency Physicians (ACEP) Geriatric Emergency Department (ED... more Objectives-The American College of Emergency Physicians (ACEP) Geriatric Emergency Department (ED) guidelines and the Center for Disease Control (CDC) recommend that older adults be assessed for risk of falls. The standard ED assessment is a verbal query of fall risk factors, which may be inadequate. We hypothesized that the addition of a functional balance test endorsed by the CDC STEADI falls prevention guidelines, the 4 Stage Balance Test (4SBT), would improve the detection of patients at risk for falls. Methods-Prospective pilot study of a convenience sample of ambulatory adults ≥65 years old in the ED. All participants received the standard nursing triage fall risk assessment. After patients were stabilized in their ED room, the 4SBT was administered. Results-The 58 participants had an average age of 74.1 years (range 65-94), 40.0% were women, and 98% were community dwelling. Five (8.6%) presented to the ED for a fall-related chief complaint. The nursing triage screen identified 39.7% (n=23) as at risk for falls, while the 4SBT identified 43% (n=25). Combining triage questions with the 4SBT identified 60.3% (n=35) as high risk for falls as compared to 39.7% (n=23) with triage questions alone (p<0.01). Ten (17%)
Spinal cord injury (SCI) impairs sensory systems causing allodynia. Measuring the development of ... more Spinal cord injury (SCI) impairs sensory systems causing allodynia. Measuring the development of allodynia in rodent models of SCI is challenging due to spinal shock and marked motor impairments. Assessment of SCI-induced allodynia is not standardized across labs, making interpretation of results difficult. Therefore, we validated sensory threshold assessment after SCI and developed a novel assessment of allodynia prior to motor recovery in a rat SCI model. One hundred fifty-six Sprague-Dawley rats received T8 laminectomy or mild to moderate SCI using the OSU SCI device (0.3 mm to 1.3mm cord displacement). To determine tactile thresholds, von Frey hairs (VFH) were applied in Up-Down or ascending order to the dorsal or plantar hindpaw. The most efficient and valid procedures that maintain high sensitivity and specificity were identified. Ten Up-Down VFH applications yielded stable thresholds; reducing the risk of threshold decay and unnecessary exposure to painful stimuli. Importantly, distraction of SCI-rats with food revealed differential decay of thresholds than when distraction is not provided. The new test uses dorsal VFH stimulation and is independent of trunk or hindlimb control. Acute dorsal VFH thresholds collected before recovery of hindlimb weight support accurately predicted plantar VFH thresholds measured at late timepoints (χ 2 =8.479; p<0.05). Thus, standardized testing early
This study presents a framework for physical therapy through the course of Huntington disease (HD... more This study presents a framework for physical therapy through the course of Huntington disease (HD) which includes coordinated care plans with neurologists. HD is an inherited neurodegenerative disorder that leads to impaired strength and coordination and ultimately progressive loss of function. Interdisciplinary HD care teams provide patient-centered, comprehensive evaluations and make recommendations for pharmacologic, healthcare, and lifestyle interventions based on best available evidence. Physical therapists work to improve movement and mobility using specific therapeutic interventions and individualized exercise programs. The proposed framework recommends that neurologists refer persons with HD to physical therapy at all disease stages, ideally beginning in premanifest and early stages, and that they regularly communicate with physical therapists to ensure implementation of a coordinated care plan. Resources are provided for neurologists to facilitate appropriate referral for individuals with HD to physical therapy based on clinical practice guidelines, including a referral decision guide.
BACKGROUND Treadmill training may improve gait disorders associated with neurodegenerative diseas... more BACKGROUND Treadmill training may improve gait disorders associated with neurodegenerative diseases. In Parkinson's disease (PD), treadmill training alters gait patterns after one session, and long-term training improves gait parameters, fall risk, and quality of life. RESEARCH QUESTION What is the feasibility and safety of using this intervention for people with Lewy body dementia (LBD) or Huntington's disease (HD)? METHODS In this observational study, 10 individuals with HD, 8 individuals with LBD, and 10 control individuals walked for 20 min on a treadmill using a speed dependent protocol starting at a slow comfortable speed and increasing incrementally toward their normal overground speed. Feasibility was determined by compliance to protocol and safety by no incidents of abnormal vital signs or expressions of distress. Changes in gait measures, Timed Up and Go (TUG) scores and quantitative motor function measures (Q-Motor; precision grasp force variability, finger and foot tapping frequency) before and after treadmill walking were analyzed using linear models. RESULTS Treadmill training is feasible and safe in LBD and HD; although, participants could not initiate treadmill walking at their comfortable overground speeds, and only 3 participants with HD were able to achieve their overground walking speed within the 20-minute session. No changes in gait measures, TUG times, and Q-Motor measures were found among LBD and HD participants after treadmill walking, although control participants demonstrated significant increases in several gait measures, and foot tap frequency (estimated difference = 0.290; p = 0.026). SIGNIFICANCE Longer and more frequent treadmill sessions may be needed to see gait and motor function effects in LBD and HD. Motor and cognitive impairments associated with these diseases may make them less amenable to the effects of treadmill training.
Thi s is a n O p e n Acc e s s d o c u m e n t d o w nlo a d e d fro m ORCA, C a r diff U niv e r... more Thi s is a n O p e n Acc e s s d o c u m e n t d o w nlo a d e d fro m ORCA, C a r diff U niv e r si ty' s in s ti t u tio n al r e p o si t o ry: h t t p s://o r c a. c a r diff.a c. u k/i d/ e p ri n t/ 1 5 2 8 9 3/ This is t h e a u t h o r's v e r sio n of a w o r k t h a t w a s s u b mi t t e d t o / a c c e p t e d fo r p u blic a tio n. Cit a tio n fo r fin al p u blis h e d ve r sio n: Jon e s , U n a , Ke g el m ey er, D e b o r a h A. a n d Kloos, An n e D. 2 0 2 2. I m pl e m e n ti n g p h y sio t h e r a p y H u n ti n g t o n ' s Dis e a s e g ui d elin e s in clinic al p r a c ti c e. Jou r n al of H u n ti n g t o n ' s Dis e a s e 1 1 (3) , p p .
Journal of Neurologic Physical Therapy, Apr 1, 2020
N europlasticity is the capacity of the nervous system to change its chemistry, structure, and fu... more N europlasticity is the capacity of the nervous system to change its chemistry, structure, and function in response to intrinsic or extrinsic stimuli. 1 Neuroplastic mechanisms are activated by environmental, behavioral, or neural processes, and by disease; they underpin the motor and cognitive learning associated with physical therapy or exercise. Neuroplasticity can lead to positive or negative changes in function, which are referred to as adaptive and maladaptive neuroplasticity, respectively. In their roles as clinicians and as scientists, physical therapists and other rehabilitation professionals harness neuroplasticity using evidence-based interventions to maintain or enhance functional performance in individuals with neurological disorders. There is still much to learn about the optimal interventions and parameters of dose and intensity necessary to achieve adaptive neuroplastic changes. Beyond questions related to dose and intensity, more information is needed regarding the degree to which factors such as past experiences, age, sex, genetics, and the presence of a neurological disorder affects capacity for neuroplastic change. In addition, it is likely that these factors interact with each other, making it even harder to understand their influence on neuroplastic change. Improved measures for assessment of neuroplasticity in humans are needed, such as biomarkers (including movement-related biomarkers) for diagnosing disorders, and predicting and monitoring treatment effectiveness. Greater knowledge of effective rehabilitation and exercise interventions that drive adaptive neuroplasticity, and are tailored to each person's unique characteristics, will improve patient outcomes. The idea for this special issue was born out of a desire to advance understanding of the mechanisms driving functional change. Two studies in this special issue use a newer neuroimaging method called functional near-infrared spectroscopy to measure cortical activity during dual-task walking. 2,3 Impaired dual-task walking is common in neurological populations and can interfere with the ability to perform daily life activities. Hoppes et al 2 examine frontal lobe activation patterns in individuals with and without visual vertigo during dual-task walking. The differences in cortical activation patterns identified increase our understanding of possible mechanisms underlying decrements in dual-task performance in individuals with vestibular disorders, and may be useful for diagnosis, and for predicting or determining functional recovery in this population. Stuart and Mancini 3 investigate how open and closed-loop tactile cueing influences prefrontal cortex activity during single-and dual-task walking and turning in individuals with Parkinson disease. Tactile cues delivered to the feet in an open-loop (continuous rhythmic stimuli) or closed-loop (intermittent stimuli based on an individual's movement) mode are associated with improved gait and turning performance, and it is hypothesized that attention arising from the prefrontal cortex may underlie these cueing effects. 4 Their findings of unchanged prefrontal cortex activity are unexpected, and raise additional questions regarding the role of the prefrontal cortex during gait. Rehabilitation approaches such as task-oriented training that emphasize high repetition and challenge have been shown to facilitate recovery of mobility and function in neurological populations, but responses are varied and residual deficits often remain. 5,6 There is still much to be learned about how to deliver the best interventions to optimize The author declares no conflicts of interest.
Journal of the Neurological Sciences, Jan 15, 2019
Background.-Despite the prevalence of dual-task (e.g., walking while talking) deficits in people ... more Background.-Despite the prevalence of dual-task (e.g., walking while talking) deficits in people with multiple sclerosis (MS), no neuroimaging studies to date have examined neuronal networks used for dual-task processing or specific brain areas related to dual-task performance in this population. A better understanding of the relationship among underlying brain areas and dualtask performance may improve targeted rehabilitation programs. The objective of this study was to examine relationships between neuroimaging measures and clinical measures of dual-task performance, and reported falls in persons with MS. Materials and methods.-All participants completed measures of dual-task performance, a fall history, and neuroimaging on a 3T MRI scanner. Spearman correlations were used to examine relationships among dual-task performance, falls and neuroimaging measures. Results.-Eighteen females with relapsing-remitting MS [mean age= 45.5 ± 8.2 SD; mean symptom duration = 12.3±6.7 years; Expanded Disability Status Scale median 2.25 (range 1.5-4)] participated in this study. Structural imaging measures of supplementary motor area (SMA) interhemispheric connectivity were significantly related to dual-task walking variability. Conclusions.-The SMA interhemispheric tract may play a role in dual-task performance. Structural neuroimaging may be a useful adjunct to clinical measures to predict performance and provide information about recovery patterns in MS. Functional recovery can be challenging to *
Spinal cord injury (SCI) causes motor and sensory deficits that impair functional performance. Wh... more Spinal cord injury (SCI) causes motor and sensory deficits that impair functional performance. While more functional recovery occurs with greater white matter sparing (WMS), it is unclear which locomotor features are more vulnerable to SCI than others, if recovery of certain features depends on specific amounts of WMS, and whether motor recovery patterns differ from sensory recovery. Locomotor and sensory recovery after graded contusive SCI with cord displacements of 0.3, 0.5, 0.7, 0.9, 1.1, 1.25, and 1.3 mm was examined for 6 weeks in 80 female Sprague-Dawley rats. Seven SCI gradations resulted in three locomotor performance levels measured with BBB (P b 0.01): High: laminectomy (LAM) controls and 0.3 (19.87 F 0.35 SEM); Intermediate: 0.5-0.9 (13.71 F 0.32); and Low: 1.1-1.3 (9.23 F 0.36). Normal paw position was most susceptible to SCI requiring 90% WMS, while consistent plantar stepping was least susceptible depending on 10% WMS. A threshold at the 0.9 severity for coordination, toe clearance, and nearly normal trunk stability and tail usage required 25% WMS. Analysis of interlimb coordination using new phase dispersion (PD) techniques delineated three recovery patterns: synchronous (0.3), modified concordance (0.5, 0.7), and disengaged (0.9, 1.1). Lesion severity correlated to WMS (r 2 = 0.96) and to BBB (r 2 = 0.87) by nonlinear polynomial regressions. Mechanical allodynia developed only after injuries resulting in V10% WMS. Nonlinear motor and sensory recovery patterns suggest that small reparative changes may substantially improve function in individuals with SCI. A hierarchical locomotor recovery based on simple segmental versus complex supraspinal motor control is proposed.
American Journal of Occupational Therapy, Aug 1, 2021
Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limi... more Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Both action observation and repetitive-task practice are efficacious interventions for poststroke upper limb hemiplegia individually, yet these interventions have not been combined before. A feasibility study was completed to determine preliminary evidence of the response to intervention and whether a Phase III study should be completed to test efficacy of the combined intervention. The functional impact of improving poststroke upper limb performance could benefit millions of stroke survivors. Primary Author and Speaker: Christine Griffin Contributing Authors: Marcia Bockbrader, Erinn Hade, Anne Kloos, John A. Buford
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