Background Clinical practice guidelines are often not optimally translated to clinical care. Foll... more Background Clinical practice guidelines are often not optimally translated to clinical care. Following the publication of the Huntington’s disease (HD) physiotherapy clinical practice guidelines in 2020, the European Huntington’s Disease Network Physiotherapy Working Group (EHDN PWG) identified a need to explore perceived facilitators and barriers to their implementation. The aims of this study were to explore physiotherapists’ awareness of and perceived barriers and facilitators to implementation of the 2020 guidelines. Methods An observational study was carried out using an online survey. Participants were physiotherapists recruited via the EHDN and physiotherapy associations in the United Kingdom, Australia, and United States of America. The survey gathered data on agreement and disagreement with statements of barriers and facilitators to implementation of each of six recommendations in the guidelines using Likert scales. Results There were 32 respondents: 18 from Europe, 7 from Australia, 5 from the USA, 1 from Africa (1 missing data). The majority were aware of the guidelines (69%), with 75% working with clients with HD Conclusions This study is the first to explore implementation of guidelines in physiotherapy clinical practice. Resources from PWG to support physiotherapists need to focus on ways to implement recommendations specifically related to management of physical, behavioural and motivational problems associated with HD. This would enhance physiotherapists’ expertise, a facilitator to implementation of clinical practice guidelines.
Background: Huntington's disease (HD) results in motor, cognitive, and psychosocial impairments. ... more Background: Huntington's disease (HD) results in motor, cognitive, and psychosocial impairments. Little is known about the specific relationships among cognitive, psychosocial, and simple and complex motor task performance. Objective: The objective of this pilot study was to explore performance on motor, cognitive, and behavioral measures between individuals with HD and healthy controls, and to determine the relationships among specific domains of cognitive function and motor function and pain. Methods: Individuals with HD and healthy controls performed a battery of cognitive, motor, and survey measures (i.e., fall reports, quality of life, and pain) in a single session. We examined differences between individuals with HD and controls, as well as relationships among motor, cognitive, and survey measures. Results: Four individuals with HD (mean(SD) age: 62.5(14.5); symptom duration: 5.8(7.1); 1 female) and six healthy controls (age: 50.7(9.7); 6 females) completed this study. There was no significant difference between groups for age, gender, or years of education. As expected, individuals with HD performed significantly worse on motor and cognitive testing, as evidenced by slower walking (p = 0.019), poorer lower extremity coordination (p = 0.038), poorer working memory (p = 0.010), and worse pain severity (p = 0.010). Poorer working memory was significantly related to poorer performance timed walking (r = − 0.705; p = 0.023); lower extremity coordination (r = − 0.657; p = 0.039); and dual-tasks (r = − 0.760; p = 0.011), as well as reports of more falls (r = − 0.709; p = 0.022). Poorer cognitive processing speed was specifically related to worse dual-task performance (r = − 0.733; p = 0.016). Worse pain severity was significantly related to slower timed walking (r = 0.679; p = 0.031); poorer lower extremity coordination (r = 0.743; p = 0.014); and worse dual-task performance (r = 0.731; p = 0.016), as well as poorer working memory (r > − 0.811; p < 0.004) and reports of more falls (r = 0.713; p = 0.021). Conclusions: Individuals with HD experience declines in motor and cognitive performance, as well as increased pain, compared to healthy controls. Quick and easily administered motor tests, such as timed walking and lower extremity coordination, as well as surveys to assess pain, may be useful in determining underlying cognitive impairments in working memory and processing speed. Assessment of these factors may help clinicians to tailor rehabilitation protocols to improve outcomes in persons with HD.
Background Individuals with neurological disorders often have difficulty negotiating stairs that ... more Background Individuals with neurological disorders often have difficulty negotiating stairs that can lead to injurious falls. Clinicians lack a clinical tool to identify impairments in stair negotiation and to assist their decision making regarding treatment plans to improve stair performance and safety. We developed a new tool called the Step Test Evaluation of Performance on Stairs (STEPS) that is designed to assess stair performance and safety in neurological populations. Objectives This study aimed to determine interrater and intrarater reliability of STEPS and its concurrent content validity to various clinical balance and mobility measures using individuals with Huntington's disease (HD) as the first test population. Methods Forty individuals with HD (mean age 50.35) participated. Three observers rated live performances of the STEPS (interrater reliability) and seven observers rated videotaped performances twice (intrarater reliability). STEPS scores correlated with clinical mobility and balance test scores. Results Excellent inter-and intrarater reliability (ICCs = 0.91 and 0.89 respectively) and good internal consistency (α = 0.83) were found. Better STEPS performance correlated with better performance on co-administered motor and mobility measures and Stair Self-Efficacy scores. Per multivariable regression analysis, the Unified Huntington's Disease Rating
Individuals with HD have progressive motor, cognitive and behavioral impairments that contribute ... more Individuals with HD have progressive motor, cognitive and behavioral impairments that contribute to difficulty with stair negotiation leading to falls on stairs. To assess stair safety, we developed a tool called the Step Test Evaluation of Performance on Stairs (STEPS) that allows systematic observation of movement and analysis of stair performance. The purpose of this study was to examine 1) the agreement of STEPs ratings between healthcare professionals who were experienced versus novice in movement analysis, and 2) STEPS items with the lowest ratings indicating areas to target fall prevention interventions. Methods Forty ambulatory individuals with a diagnosis of HD (mean age 50.35) participated. Three observers (2 experienced physical therapists (PTs) and one nurse with minimal experience in movement analysis) concurrently rated live performances of the STEPS. Results The nurse’s average total STEPS ratings did not significantly differ from the experienced PTs’ ratings with a difference of -0.05 (CI=-0.53, 0.43; p=0.83). Out of 16 items, the agreement between all raters was less than 75% for continuity of ascent (69%) and descent (72%), foot placement during ascent (74%) and eccentric control of the knee during descent (74%). Individuals with HD were most likely to have difficulty during ascent/descent of stairs with foot placement and trunk stability. Additionally many clients exhibited deficits in balance and eccentric control of the knee during descent. Conclusions Observation for continuity of movement has greater inter-rater variability than other STEPS items. Principal impairments that may negatively impact stair performance in HD are foot placement and control of descent along with trunk stability. Healthcare providers other than PTs can quickly be trained to use the STEPS tool reliably. Future areas to study would be whether therapy aimed at improving foot placement, trunk control and eccentric quadriceps strength would improve safety on stairs.
ObjectiveIn the past decade, an increasing number of studies have examined the efficacy of physic... more ObjectiveIn the past decade, an increasing number of studies have examined the efficacy of physical therapy interventions in people with Huntington disease (HD).MethodsWe performed a mixed-methods systematic review using Joanna Briggs Institute (JBI) methodology and included experimental and observational study designs. The search resulted in 23 quantitative studies and 3 qualitative studies from which we extracted data using JBI standardized extraction tools. Results of this review suggested that physical therapy interventions may improve motor impairments and activity limitations in people with HD. Here, we expand on the review findings to provide specific recommendations to guide clinical practice.ResultsWe recommend the following specific physical therapy interventions for people with HD: aerobic exercise (grade A evidence), alone or in combination with resistance training to improve fitness and motor function, and supervised gait training (grade A evidence) to improve spatiotem...
: Individuals with concomitant spinal cord injury and traumatic brain injury have cognitive defic... more : Individuals with concomitant spinal cord injury and traumatic brain injury have cognitive deficits that may limit the ability to learn novel motor tasks necessary for functional independence. Errorless learning has been shown to improve cognitive task performance in persons with brain injury but little is known about its usefulness for improving novel motor task learning. CASE DESCRIPTION A 44-year-old man with traumatic spinal cord and brain injuries from a motor vehicle accident was admitted to an inpatient rehabilitation hospital. His spinal cord injury was classified as T4 American Spinal Injury Association Impairment Scale (AIS) A, and his cognitive status was level IV on the Ranchos Los Amigos Scale. Initially, the patient required maximal assistance from 2 clinicians to complete a slide board transfer, propelled his wheelchair 25 ft with minimal assistance, and scored 9/56 on the Function in Sitting Test. INTERVENTION The therapist applied traditional motor-learning approaches during the first 37 days of the patient's inpatient rehabilitation facility stay without meaningful gains in functional mobility. A subsequent change to errorless learning was made for the following 32 days until discharge. OUTCOMES After use of errorless learning, the patient performed novel mobility-related tasks of slide board transfers with minimal assistance and wheelchair propulsion without physical assistance up to 150 ft; the Function in Sitting Test score improved to 18/56. His sensorimotor system progressed to an AIS classification of AIS B, while his cognition emerged to a level V on the Ranchos Los Amigos Scale. DISCUSSION Errorless learning may have facilitated acquisition of novel transfer and mobility skills in this individual with dual diagnoses. This approach may have value for patients with neurologic conditions who have both motor and cognitive impairment.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A201).
Huntington's disease (HD) is a progressive neurodegenerative disorder that results in a gradu... more Huntington's disease (HD) is a progressive neurodegenerative disorder that results in a gradual decline in mobility and balance. Increasing evidence has documented an important role of executive function in the safe ambulation of the elderly and people with a variety of neurological disorders. Little is known about the contribution of cognitive deficits to decline in mobility over time in HD. This study examined the relationships of mobility, motor and cognitive function measures at baseline, and of mobility and cognitive measures over four years. A retrospective chart review was performed on 70 patients with genetically confirmed HD (age 20-75 years old) across 121 HD clinic visits. Correlations between Unified Huntington's Disease Rating Scale - Total Motor, Tinetti Mobility Test (TMT), and cognitive measures (Letter Verbal Fluency, Symbol Digit Modalities Test (SDMT), and Stroop Test) were analyzed. Longitudinal relationships between TMT and cognitive measures were examin...
JBI Database of Systematic Reviews and Implementation Reports
Review question/objective: The review seeks to evaluate the effectiveness of physical therapy and... more Review question/objective: The review seeks to evaluate the effectiveness of physical therapy and exercise interventions in Huntington's disease (HD). The review question is: What is the effectiveness of physiotherapy and therapeutic exercise interventions in people with HD, and what are patients' , families' and caregivers' perceptions of these interventions? The specific objectives are: To determine the effectiveness of physiotherapy and therapeutic exercise interventions in people with HD on physical and cognitive function. To explore the perceptions of people with HD and their families and caregivers with regard to their experience of physiotherapy and exercise interventions. This mixed methods review seeks to develop an aggregated synthesis of quantitative, qualitative and narrative systematic reviews on physiotherapy and exercise interventions in HD, in an attempt to derive conclusions and recommendations useful for clinical practice and policy decision-making.
Due to the fast pace and high complexity of managing patients in intensive and acute care units (... more Due to the fast pace and high complexity of managing patients in intensive and acute care units (ICUs), healthcare students often feel challenged and unprepared to practice in this environment. Simulations and standardised patients provide &quot;hands-on&quot; learning experiences that are realistic and help students to gain competence and confidence. This study examined the impact of an intensive case simulation laboratory using a patient simulator and standardised patients on students&#39; perceptions of their confidence and preparedness to work in acute care settings. Second-year Masters of Occupational Therapy (MOT; n = 127) and Doctor of Physical Therapy (DPT; n = 105) students participated in a three-hour intensive care simulation laboratory comprised of four stations that were designed to simulate common ICU patient care scenarios. Data analysed were student pre- and post-simulation surveys and written comments, and clinical instructors&#39; (CIs; n = 51) ratings on DPT students&#39; preparedness and confidence within the first two weeks of their acute care internships obtained after the laboratory. There was a significant increase for DPT (p &lt; 0.0001) and MOT (p &lt; 0.10) students in median ratings of how prepared they felt to practice in acute care settings following the ICU simulation compared to before the laboratory. CIs rated the DPT students as either prepared or very prepared for and moderately confident or very confident in the acute care setting. The use of simulation training using standardised patients and patient simulators was beneficial in increasing student confidence and preparing OT and PT students to practice in the acute care setting. Health professional educators should consider using an interprofessional simulation experience to improve their students&#39; confidence and preparedness to provide appropriate care in the acute setting.
Limited data compares clinical profiles of Lewy Body Dementia (LBD) with Alzheimer's disease ... more Limited data compares clinical profiles of Lewy Body Dementia (LBD) with Alzheimer's disease (AD) and Parkinson's disease (PD). Twenty-one mildly demented ambulatory LBD subjects were individually matched by MMSE score with 21 AD subjects and by UPDRS motor score with 21 PD subjects. Matched by age, gender, education, and race, pairs were compared using cognitive, functional, behavioral, and motor measures. LBD group performed worse than PD on axial motor, gait, and balance measures. AD had more amnesia and orientation impairments, but less executive and visuospatial deficits than LBD subjects. LBD group had more sleepiness, cognitive/behavioral fluctuations, hallucinations, and sleep apnea than AD or PD. Axial motor, gait, and balance disturbances correlated with executive, visuospatial, and global cognition deficits. LBD is differentiated from AD and PD by retrieval memory, visuospatial, and executive deficits; axial motor, gait and balance impairments; sleepiness, cogniti...
Postural instability is common in individuals with Huntington&amp;amp;amp;amp;amp;amp;amp;amp... more Postural instability is common in individuals with Huntington&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (HD), yet little is known about control of the trunk during static and dynamic activities. We compared the trunk motion of 41 individuals with HD and 36 controls at thoracic and pelvic levels during sitting, standing, and walking using wearable iPod sensors. We also examined the ability of individuals with HD to respond to an auditory cue to modify trunk position when the pelvis moved &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;8° in sagittal or frontal planes during sitting using custom software. We found that amplitude of thoracic and pelvic trunk movements was significantly greater in participants with HD, and differences were more pronounced during static (i.e. sitting, standing) than dynamic (i.e. walking) tasks. In contrast to the slow, smooth sinusoidal trunk movements of controls, individuals with HD demonstrated rapid movements with varying amplitudes that continuously increased without stabilizing. Ninety-seven percent of participants with HD were able to modify their trunk position in response to auditory cues. Our results demonstrate that wearable iPod sensors are clinically useful for rehabilitation professionals to measure and monitor trunk stability in persons with HD. Additionally, auditory cueing holds potential as a useful training tool to improve trunk stability in HD.
Journal of Neurology, Neurosurgery & Psychiatry, 2016
Background Individuals with HD develop postural instability and gait deviations with concurrent l... more Background Individuals with HD develop postural instability and gait deviations with concurrent loss of function. While trunk sway is a prominent symptom of HD, little is known about its impact on functional task performance. Aims We explored the relationship among trunk sway during static and dynamic tasks and measures of gait, mobility, and falls. Methods Forty individuals with HD (mean age = 52.05 ± 10.09, Total Functional Capacity score = 7.32 ± 3.48) participated. Trunk (thoracic and pelvic) angular excursions in sitting, standing and walking (measured with smartphone application), gait (GAITRite), mobility (Tinetti mobility test (TMT)) and falls in past week were assessed. Results Multiple stepwise linear regression analysis showed that total pelvic anterior-posterior (AP) excursion in sitting explained 41.5% of the variance of UHDRS motor scores (p < 0.0001). Greater than 48% (R2 = 0.484) of the variance in TMT was explained by total pelvic AP excursion in walking (p < 0.0001) and total thoracic medial-lateral (ML) excursion in standing (p < 0.0001), while greater than 26% (R2 = 0.262) of the variance in velocity was explained by peak thoracic excursion in the anterior direction in walking (p = 0.015) and total pelvic AP excursion in standing (p = 0.009). Thirty-one percent (R2 = 0.310) of the variance in double support percent, the portion of the gait cycle related to balance, was explained by total pelvic excursion ML in standing (p = 0.009) and peak thoracic excursion in the posterior direction in walking (p = 0.006). Interestingly, age was negatively correlated with reported falls, with falls being associated with younger age (r = −0.44, p = 0.004) and increased posterior pelvic tilt in standing (r = 0.54, p = 0.033). Conclusions Trunk sway measures help explain impairments in gait, mobility and falls in individuals with HD, and may represent a novel rehabilitation intervention in HD.
Background Clinical practice guidelines are often not optimally translated to clinical care. Foll... more Background Clinical practice guidelines are often not optimally translated to clinical care. Following the publication of the Huntington’s disease (HD) physiotherapy clinical practice guidelines in 2020, the European Huntington’s Disease Network Physiotherapy Working Group (EHDN PWG) identified a need to explore perceived facilitators and barriers to their implementation. The aims of this study were to explore physiotherapists’ awareness of and perceived barriers and facilitators to implementation of the 2020 guidelines. Methods An observational study was carried out using an online survey. Participants were physiotherapists recruited via the EHDN and physiotherapy associations in the United Kingdom, Australia, and United States of America. The survey gathered data on agreement and disagreement with statements of barriers and facilitators to implementation of each of six recommendations in the guidelines using Likert scales. Results There were 32 respondents: 18 from Europe, 7 from Australia, 5 from the USA, 1 from Africa (1 missing data). The majority were aware of the guidelines (69%), with 75% working with clients with HD Conclusions This study is the first to explore implementation of guidelines in physiotherapy clinical practice. Resources from PWG to support physiotherapists need to focus on ways to implement recommendations specifically related to management of physical, behavioural and motivational problems associated with HD. This would enhance physiotherapists’ expertise, a facilitator to implementation of clinical practice guidelines.
Background: Huntington's disease (HD) results in motor, cognitive, and psychosocial impairments. ... more Background: Huntington's disease (HD) results in motor, cognitive, and psychosocial impairments. Little is known about the specific relationships among cognitive, psychosocial, and simple and complex motor task performance. Objective: The objective of this pilot study was to explore performance on motor, cognitive, and behavioral measures between individuals with HD and healthy controls, and to determine the relationships among specific domains of cognitive function and motor function and pain. Methods: Individuals with HD and healthy controls performed a battery of cognitive, motor, and survey measures (i.e., fall reports, quality of life, and pain) in a single session. We examined differences between individuals with HD and controls, as well as relationships among motor, cognitive, and survey measures. Results: Four individuals with HD (mean(SD) age: 62.5(14.5); symptom duration: 5.8(7.1); 1 female) and six healthy controls (age: 50.7(9.7); 6 females) completed this study. There was no significant difference between groups for age, gender, or years of education. As expected, individuals with HD performed significantly worse on motor and cognitive testing, as evidenced by slower walking (p = 0.019), poorer lower extremity coordination (p = 0.038), poorer working memory (p = 0.010), and worse pain severity (p = 0.010). Poorer working memory was significantly related to poorer performance timed walking (r = − 0.705; p = 0.023); lower extremity coordination (r = − 0.657; p = 0.039); and dual-tasks (r = − 0.760; p = 0.011), as well as reports of more falls (r = − 0.709; p = 0.022). Poorer cognitive processing speed was specifically related to worse dual-task performance (r = − 0.733; p = 0.016). Worse pain severity was significantly related to slower timed walking (r = 0.679; p = 0.031); poorer lower extremity coordination (r = 0.743; p = 0.014); and worse dual-task performance (r = 0.731; p = 0.016), as well as poorer working memory (r > − 0.811; p < 0.004) and reports of more falls (r = 0.713; p = 0.021). Conclusions: Individuals with HD experience declines in motor and cognitive performance, as well as increased pain, compared to healthy controls. Quick and easily administered motor tests, such as timed walking and lower extremity coordination, as well as surveys to assess pain, may be useful in determining underlying cognitive impairments in working memory and processing speed. Assessment of these factors may help clinicians to tailor rehabilitation protocols to improve outcomes in persons with HD.
Background Individuals with neurological disorders often have difficulty negotiating stairs that ... more Background Individuals with neurological disorders often have difficulty negotiating stairs that can lead to injurious falls. Clinicians lack a clinical tool to identify impairments in stair negotiation and to assist their decision making regarding treatment plans to improve stair performance and safety. We developed a new tool called the Step Test Evaluation of Performance on Stairs (STEPS) that is designed to assess stair performance and safety in neurological populations. Objectives This study aimed to determine interrater and intrarater reliability of STEPS and its concurrent content validity to various clinical balance and mobility measures using individuals with Huntington's disease (HD) as the first test population. Methods Forty individuals with HD (mean age 50.35) participated. Three observers rated live performances of the STEPS (interrater reliability) and seven observers rated videotaped performances twice (intrarater reliability). STEPS scores correlated with clinical mobility and balance test scores. Results Excellent inter-and intrarater reliability (ICCs = 0.91 and 0.89 respectively) and good internal consistency (α = 0.83) were found. Better STEPS performance correlated with better performance on co-administered motor and mobility measures and Stair Self-Efficacy scores. Per multivariable regression analysis, the Unified Huntington's Disease Rating
Individuals with HD have progressive motor, cognitive and behavioral impairments that contribute ... more Individuals with HD have progressive motor, cognitive and behavioral impairments that contribute to difficulty with stair negotiation leading to falls on stairs. To assess stair safety, we developed a tool called the Step Test Evaluation of Performance on Stairs (STEPS) that allows systematic observation of movement and analysis of stair performance. The purpose of this study was to examine 1) the agreement of STEPs ratings between healthcare professionals who were experienced versus novice in movement analysis, and 2) STEPS items with the lowest ratings indicating areas to target fall prevention interventions. Methods Forty ambulatory individuals with a diagnosis of HD (mean age 50.35) participated. Three observers (2 experienced physical therapists (PTs) and one nurse with minimal experience in movement analysis) concurrently rated live performances of the STEPS. Results The nurse’s average total STEPS ratings did not significantly differ from the experienced PTs’ ratings with a difference of -0.05 (CI=-0.53, 0.43; p=0.83). Out of 16 items, the agreement between all raters was less than 75% for continuity of ascent (69%) and descent (72%), foot placement during ascent (74%) and eccentric control of the knee during descent (74%). Individuals with HD were most likely to have difficulty during ascent/descent of stairs with foot placement and trunk stability. Additionally many clients exhibited deficits in balance and eccentric control of the knee during descent. Conclusions Observation for continuity of movement has greater inter-rater variability than other STEPS items. Principal impairments that may negatively impact stair performance in HD are foot placement and control of descent along with trunk stability. Healthcare providers other than PTs can quickly be trained to use the STEPS tool reliably. Future areas to study would be whether therapy aimed at improving foot placement, trunk control and eccentric quadriceps strength would improve safety on stairs.
ObjectiveIn the past decade, an increasing number of studies have examined the efficacy of physic... more ObjectiveIn the past decade, an increasing number of studies have examined the efficacy of physical therapy interventions in people with Huntington disease (HD).MethodsWe performed a mixed-methods systematic review using Joanna Briggs Institute (JBI) methodology and included experimental and observational study designs. The search resulted in 23 quantitative studies and 3 qualitative studies from which we extracted data using JBI standardized extraction tools. Results of this review suggested that physical therapy interventions may improve motor impairments and activity limitations in people with HD. Here, we expand on the review findings to provide specific recommendations to guide clinical practice.ResultsWe recommend the following specific physical therapy interventions for people with HD: aerobic exercise (grade A evidence), alone or in combination with resistance training to improve fitness and motor function, and supervised gait training (grade A evidence) to improve spatiotem...
: Individuals with concomitant spinal cord injury and traumatic brain injury have cognitive defic... more : Individuals with concomitant spinal cord injury and traumatic brain injury have cognitive deficits that may limit the ability to learn novel motor tasks necessary for functional independence. Errorless learning has been shown to improve cognitive task performance in persons with brain injury but little is known about its usefulness for improving novel motor task learning. CASE DESCRIPTION A 44-year-old man with traumatic spinal cord and brain injuries from a motor vehicle accident was admitted to an inpatient rehabilitation hospital. His spinal cord injury was classified as T4 American Spinal Injury Association Impairment Scale (AIS) A, and his cognitive status was level IV on the Ranchos Los Amigos Scale. Initially, the patient required maximal assistance from 2 clinicians to complete a slide board transfer, propelled his wheelchair 25 ft with minimal assistance, and scored 9/56 on the Function in Sitting Test. INTERVENTION The therapist applied traditional motor-learning approaches during the first 37 days of the patient's inpatient rehabilitation facility stay without meaningful gains in functional mobility. A subsequent change to errorless learning was made for the following 32 days until discharge. OUTCOMES After use of errorless learning, the patient performed novel mobility-related tasks of slide board transfers with minimal assistance and wheelchair propulsion without physical assistance up to 150 ft; the Function in Sitting Test score improved to 18/56. His sensorimotor system progressed to an AIS classification of AIS B, while his cognition emerged to a level V on the Ranchos Los Amigos Scale. DISCUSSION Errorless learning may have facilitated acquisition of novel transfer and mobility skills in this individual with dual diagnoses. This approach may have value for patients with neurologic conditions who have both motor and cognitive impairment.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A201).
Huntington's disease (HD) is a progressive neurodegenerative disorder that results in a gradu... more Huntington's disease (HD) is a progressive neurodegenerative disorder that results in a gradual decline in mobility and balance. Increasing evidence has documented an important role of executive function in the safe ambulation of the elderly and people with a variety of neurological disorders. Little is known about the contribution of cognitive deficits to decline in mobility over time in HD. This study examined the relationships of mobility, motor and cognitive function measures at baseline, and of mobility and cognitive measures over four years. A retrospective chart review was performed on 70 patients with genetically confirmed HD (age 20-75 years old) across 121 HD clinic visits. Correlations between Unified Huntington's Disease Rating Scale - Total Motor, Tinetti Mobility Test (TMT), and cognitive measures (Letter Verbal Fluency, Symbol Digit Modalities Test (SDMT), and Stroop Test) were analyzed. Longitudinal relationships between TMT and cognitive measures were examin...
JBI Database of Systematic Reviews and Implementation Reports
Review question/objective: The review seeks to evaluate the effectiveness of physical therapy and... more Review question/objective: The review seeks to evaluate the effectiveness of physical therapy and exercise interventions in Huntington's disease (HD). The review question is: What is the effectiveness of physiotherapy and therapeutic exercise interventions in people with HD, and what are patients' , families' and caregivers' perceptions of these interventions? The specific objectives are: To determine the effectiveness of physiotherapy and therapeutic exercise interventions in people with HD on physical and cognitive function. To explore the perceptions of people with HD and their families and caregivers with regard to their experience of physiotherapy and exercise interventions. This mixed methods review seeks to develop an aggregated synthesis of quantitative, qualitative and narrative systematic reviews on physiotherapy and exercise interventions in HD, in an attempt to derive conclusions and recommendations useful for clinical practice and policy decision-making.
Due to the fast pace and high complexity of managing patients in intensive and acute care units (... more Due to the fast pace and high complexity of managing patients in intensive and acute care units (ICUs), healthcare students often feel challenged and unprepared to practice in this environment. Simulations and standardised patients provide &quot;hands-on&quot; learning experiences that are realistic and help students to gain competence and confidence. This study examined the impact of an intensive case simulation laboratory using a patient simulator and standardised patients on students&#39; perceptions of their confidence and preparedness to work in acute care settings. Second-year Masters of Occupational Therapy (MOT; n = 127) and Doctor of Physical Therapy (DPT; n = 105) students participated in a three-hour intensive care simulation laboratory comprised of four stations that were designed to simulate common ICU patient care scenarios. Data analysed were student pre- and post-simulation surveys and written comments, and clinical instructors&#39; (CIs; n = 51) ratings on DPT students&#39; preparedness and confidence within the first two weeks of their acute care internships obtained after the laboratory. There was a significant increase for DPT (p &lt; 0.0001) and MOT (p &lt; 0.10) students in median ratings of how prepared they felt to practice in acute care settings following the ICU simulation compared to before the laboratory. CIs rated the DPT students as either prepared or very prepared for and moderately confident or very confident in the acute care setting. The use of simulation training using standardised patients and patient simulators was beneficial in increasing student confidence and preparing OT and PT students to practice in the acute care setting. Health professional educators should consider using an interprofessional simulation experience to improve their students&#39; confidence and preparedness to provide appropriate care in the acute setting.
Limited data compares clinical profiles of Lewy Body Dementia (LBD) with Alzheimer's disease ... more Limited data compares clinical profiles of Lewy Body Dementia (LBD) with Alzheimer's disease (AD) and Parkinson's disease (PD). Twenty-one mildly demented ambulatory LBD subjects were individually matched by MMSE score with 21 AD subjects and by UPDRS motor score with 21 PD subjects. Matched by age, gender, education, and race, pairs were compared using cognitive, functional, behavioral, and motor measures. LBD group performed worse than PD on axial motor, gait, and balance measures. AD had more amnesia and orientation impairments, but less executive and visuospatial deficits than LBD subjects. LBD group had more sleepiness, cognitive/behavioral fluctuations, hallucinations, and sleep apnea than AD or PD. Axial motor, gait, and balance disturbances correlated with executive, visuospatial, and global cognition deficits. LBD is differentiated from AD and PD by retrieval memory, visuospatial, and executive deficits; axial motor, gait and balance impairments; sleepiness, cogniti...
Postural instability is common in individuals with Huntington&amp;amp;amp;amp;amp;amp;amp;amp... more Postural instability is common in individuals with Huntington&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (HD), yet little is known about control of the trunk during static and dynamic activities. We compared the trunk motion of 41 individuals with HD and 36 controls at thoracic and pelvic levels during sitting, standing, and walking using wearable iPod sensors. We also examined the ability of individuals with HD to respond to an auditory cue to modify trunk position when the pelvis moved &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;8° in sagittal or frontal planes during sitting using custom software. We found that amplitude of thoracic and pelvic trunk movements was significantly greater in participants with HD, and differences were more pronounced during static (i.e. sitting, standing) than dynamic (i.e. walking) tasks. In contrast to the slow, smooth sinusoidal trunk movements of controls, individuals with HD demonstrated rapid movements with varying amplitudes that continuously increased without stabilizing. Ninety-seven percent of participants with HD were able to modify their trunk position in response to auditory cues. Our results demonstrate that wearable iPod sensors are clinically useful for rehabilitation professionals to measure and monitor trunk stability in persons with HD. Additionally, auditory cueing holds potential as a useful training tool to improve trunk stability in HD.
Journal of Neurology, Neurosurgery & Psychiatry, 2016
Background Individuals with HD develop postural instability and gait deviations with concurrent l... more Background Individuals with HD develop postural instability and gait deviations with concurrent loss of function. While trunk sway is a prominent symptom of HD, little is known about its impact on functional task performance. Aims We explored the relationship among trunk sway during static and dynamic tasks and measures of gait, mobility, and falls. Methods Forty individuals with HD (mean age = 52.05 ± 10.09, Total Functional Capacity score = 7.32 ± 3.48) participated. Trunk (thoracic and pelvic) angular excursions in sitting, standing and walking (measured with smartphone application), gait (GAITRite), mobility (Tinetti mobility test (TMT)) and falls in past week were assessed. Results Multiple stepwise linear regression analysis showed that total pelvic anterior-posterior (AP) excursion in sitting explained 41.5% of the variance of UHDRS motor scores (p < 0.0001). Greater than 48% (R2 = 0.484) of the variance in TMT was explained by total pelvic AP excursion in walking (p < 0.0001) and total thoracic medial-lateral (ML) excursion in standing (p < 0.0001), while greater than 26% (R2 = 0.262) of the variance in velocity was explained by peak thoracic excursion in the anterior direction in walking (p = 0.015) and total pelvic AP excursion in standing (p = 0.009). Thirty-one percent (R2 = 0.310) of the variance in double support percent, the portion of the gait cycle related to balance, was explained by total pelvic excursion ML in standing (p = 0.009) and peak thoracic excursion in the posterior direction in walking (p = 0.006). Interestingly, age was negatively correlated with reported falls, with falls being associated with younger age (r = −0.44, p = 0.004) and increased posterior pelvic tilt in standing (r = 0.54, p = 0.033). Conclusions Trunk sway measures help explain impairments in gait, mobility and falls in individuals with HD, and may represent a novel rehabilitation intervention in HD.
Uploads
Papers by Deb Kegelmeyer