Investigating Immersive Augmented Reality as a Rehabilitation Tool for Parkinson disease

Physical rehabilitation programs are often prescribed in an effort to maintain range of motion, and to adapt strategies for managing the debilitating symptoms of Parkinson disease (PD) in everyday life. An emerging trend to overcome the limitations of traditional rehabilitation is the use of virtual reality technologies. IThe goal of the present study was to determine the feasibility of augmented reality technology (IAR) in a rehabilitative setting. Three IAR environments were designed and a corresponding task was completed in each one. Not surprisingly, the control group generally performed better than the PD group on the tasks. All participants typically performed better in the real-world than the IAR environment. Additionally both the PD and control groups’ performances improved with repeated visits. The system was well-tolerated and important lessons are highlighted about future implementation of this rehabilitation approach (e.g., the need for a familiarization period to the system)

A review of the effectiveness of lower limb orthoses used in cerebral palsy

To produce this review, a systematic literature search was conducted for relevant articles published in the period between the date of the previous ISPO consensus conference report on cerebral palsy (1994) and April 2008. The search terms were 'cerebral and pals* (palsy, palsies), 'hemiplegia', 'diplegia', 'orthos*' (orthoses, orthosis) orthot* (orthotic, orthotics), brace or AFO

'Staying safe' – A narrative review of falls prevention in people with Parkinson’s -'PDSAFE'

This is the author accepted manuscript. The final version is available from Taylor & Francis via the DOI in this record.Background: Parkinson's disease demonstrates a spectrum of motor and non-motor symptoms. Falling is common and disabling. Current medical management shows minimal impact to reduce falls, or fall related risk factors such as deficits in gait, strength and postural instability. Despite evidence supporting rehabilitation in reducing fall risk factors, the most appropriate intervention to reduce overall fall rate remains inconclusive. This paper aims to 1) synthesise current evidence and conceptual models of falls rehabilitation in Parkinson's in a narrative review; and based on this evidence 2) introduce the treatment protocol used in the falls prevention, multi-centre clinical trial 'PDSAFE'. Method: Search of four bibliographic databases using the terms ‘Parkinson*’ and ‘Fall*’ combined with each of the following; ‘Rehab*, Balanc*, Strength*, Strateg*and Exercis*' and a framework for narrative review was followed. 3557 papers were identified, 416 were selected for review. The majority report the impact of rehabilitation on isolated fall risk factors. Twelve directly measure the impact on overall fall rate. Discussion: Results were used to construct a narrative review with conceptual discussion based on the 'International Classification of Functioning’, leading to presentation of the 'PDSAFE' intervention protocol. Conclusion: Evidence suggests training single, fall risk factors may not affect overall fall rate. Combining with behavioural and strategy training in a functional, personalised multi-dimensional model, addressing all components of the ‘International Classification of Functioning’ is likely to provide a greater influence on falls reduction. 'PDSAFE' is a multi-dimensional, physiotherapist delivered, individually tailored, progressive, home-based programme. It is designed with a strong evidence based approach and illustrates a model for the clinical delivery of the conceptual theory discussed.This project was funded by the National Institute for Health Research Health Technologies Assessment programme (project number 10/57/21). VG is supported by the National Institute of Health Research Collaboration for Applied Health Research and Care South West Peninsula.

Effects of dance therapy on balance, gait and neuro-psychological performances in patients with Parkinson's disease and postural instability

Postural Instability (PI) is a core feature of Parkinson’s Disease (PD) and a major cause of falls and disabilities. Impairment of executive functions has been called as an aggravating factor on motor performances. Dance therapy has been shown effective for improving gait and has been suggested as an alternative rehabilitative method. To evaluate gait performance, spatial-temporal (S-T) gait parameters and cognitive performances in a cohort of patients with PD and PI modifications in balance after a cycle of dance therapy

The Effect of Dopaminergic Medication on Straight Walking and Turning in Parkinson’s Disease Patients during Single and Dual Tasking

Das idiopathische Parkinson-Syndrom (IPS) ist eine neurodegenerative Erkrankung, die mit der Beeinträchtigung von Motorik, Kognition und Verhalten einhergeht. Die Krankheit führt zu einer zunehmenden Degeneration von Dopamin-ausschüttenden Neuronen in den Basalganglien, welche in der Regel durch dopaminerge Medikamente behandelt wird. Dopaminerge Medikation hat verschiedene Effekte auf die unterschiedlichen Symptome des IPS. Sie verbessert verschiedene motorische und kognitive Funktionen, wie zum Beispiel Bewegungsabläufe, kognitive Flexibilität und Aufmerksamkeit. Jedoch hat die Medikation auf andere Bereiche, wie Gang und Drehbewegungen, keine positiven Effekte und kann auf bestimmte kognitive Prozesse sogar negativ einwirken. Beim hier untersuchten Geradeausgehen und Drehen, zwei gewöhnlichen Komponenten beim Gehen im Alltag, die von besonderem Interesse bei Parkinsonpatienten sind, hat die Medikation einen positiven Einfluss auf einige Gangparameter wie zum Beispiel Ganggeschwindigkeit. Sie hat jedoch keinen Effekt in anderen Bereichen wie Variabilität und Rhythmus. Anders als in den meisten Studien wird das Gangbild hier nicht nur unter Single Task (ST) Bedingungen, sondern auch unter Dual Task (DT) Bedingungen untersucht. Dies bildet den Alltag der Parkinsonpatienten deutlich besser ab, da sie während ihrer alltäglichen Aktivitäten oft mindestens zwei Aufgaben gleichzeitig durchführen. Daher werden in dieser Studie die Effekte dopaminerger Medikation bei Personen mit Parkinson auf das Geradeausgehen und Drehen unter ST und DT Bedingungen untersucht. Als DT wurden zwei sekundäre Aufgaben verwendet, eine Ankreuzaufgabe, welche eine motorische Komponente beinhaltet und eine komplexere kognitive Aufgabe, bei der die Probanden fortlaufend subtrahieren. Die Daten zeigen, dass die dopaminerge Medikation bei der DT Bedingung keinerlei Einfluss auf die untersuchten Parameter beim Gehen und Drehen hatte. Während der ST Bedingung konnte nur die Ganggeschwindigkeit durch die Medikation erhöht werden. Beim Drehen wurden die Schrittzeit und die maximale Geschwindigkeit verbessert. Zusätzlich hatte die Medikation einen positiven Einfluss auf die Schnelligkeit der Ankreuzaufgabe, jedoch nicht auf die Schnelligkeit der Subtraktionsaufgabe. Unsere Ergebnisse weisen darauf hin, dass dopaminerge Medikation keinen signifikanten Effekt auf das Geradeausgehen und Drehen bei alltagsrelevanten DT Aufgaben hat. Dieses Ergebnis betont die Bedeutung von alternativen Behandlungsstrategien und eines alternativen Behandlungsmanagements. Zudem ist der positive Effekt der Medikation auf kognitive Aufgaben mit motorischer Komponente hervorzuheben, der im Gegensatz zum fehlenden Effekt der Medikation auf komplexere, forderndere kognitive Aufgaben steht. Diese Erkenntnisse sind wichtig um Funktionseinschränkungen der Parkinsonpatienten gezielt zu behandeln, mit dem Wissen welche Bereiche durch die dopaminerge Medikation positiv beeinflusst werden können

Telerehabilitation for neurological motor impairment: a systematic review and meta-analysis on quality of life, satisfaction, and acceptance in stroke, multiple sclerosis, and Parkinson’s disease

Telerehabilitation (TR) seems to be a viable and feasible solution to face the rehabilitative challenges posed by neurological impairments and to improve patients’ quality of life (QoL). This review aims to synthesize and analyze the evidence on the impact of physiotherapy intervention through TR on QoL in patients with stroke, Parkinson’s disease (PD), and multiple sclerosis (MS), together with an evaluation of their satisfaction and technology acceptance levels. Through a systematic search of the literature and a screening process, treatment effects were assessed with meta-analyses using the standardized mean difference, setting the confidence interval at 95%. We included 28 studies in the review, which were analyzed for methodological quality, whereas 16 studies were included in the meta-analyses. The results suggest a significant improvement in QoL in patients who underwent TR. We were unable to perform analyses for satisfaction and technology acceptance outcomes due to insufficient data. Overall, motor TR has a positive impact on the QoL of patients with neurological diseases, especially in stroke patients; although caution is needed in the interpretation of the results due to the high heterogeneity found. For PD and MS, TR seems to yield comparable results to in-person treatment

USE OF A VIDEO GAME BASED BALANCE TRAINING INTERVENTION ON THE BALANCE AND FUNCTION OF CHILDREN WITH DEVELOPMENTAL DISABILITIES

Many children with developmental disabilities (DD) have physical impairments and limitations in their participation. Rehabilitation research often focuses on either physical impairments or participation restrictions, when both need to be investigated. The purposes of these two studies were to evaluate an at home therapist directed video game balance training intervention on balance, gait velocity (GV), hip strength and activities of children with DD. The pilot study was a single-subject non-concurrent multiple baseline design. Balance measures included: weight bearing symmetry; center of pressure area and velocity; time to boundary mean minima and standard deviation; and timed up and go. The participant’s enjoyment and perceived difficulty was also explored. Five children (7 to 10 years) with cerebral palsy (CP) participated in a 6 week, 30 minute intervention 3 times per week, with four preselected balance games. Minimal improvements were found in balance, GV, and hip strength, and participants reported the intervention enjoyable and challenging. Three of five participants had significant increases in activities, as measured by the Activities Scale for Kids (ASK). The second study expanded on pilot study results and included 5 children (5 to 10 years) with different diagnoses. Another non-concurrent multiple baseline design was utilized, and the same measures of balance were used except single leg stance time was substituted for timed up and go. No changes were made to the intensity of intervention, but two games were added to the repertoire. There were minimal changes in balance and hip strength; and no changes were found in the ASK. A majority of participants increased GV, and reported the intervention was enjoyable and challenging. Positive changes were found in the combined results for: center of pressure area with eyes open and closed; time to boundary mean minima with eyes closed in the anterior-posterior direction; and GV. These studies suggest this intervention was insufficient to make improvements in the majority of balance measurements and hip strength for children with DD. Increased activities in children with CP were found in the pilot study. These results suggest video game balance training alone for children with DD was insufficient to demonstrate clinically meaningful change. KEYWORDS: Balance, Developmental Disabilities, Gait Velocity, Hip Strength, Activities and Participatio