Effects of water-based exercise on activities of daily living in Parkinson's disease patients

Physical exercise plays an important role in reducing the physical and psychological symptoms of those who suffer from Parkinson’s Disease (PD). One form of exercise, water exercise, is a relatively untested means in the treatment of patients suffering from PD. Very few studies have tested the effects of such a program for PD patients. In this pilot study, four patients with PD aged 71-89 years of age followed a six week exercise program in water, three days weekly for a duration from 20 minutes up to one hour in an attempt to improve physical and psychological functions. Testing was done prior to and after the program. The study showed that patients improved on their physical strength, endurance and balance, however tests of perceived self confidence showed no difference between the beginning and end of the study. The results suggest that water exercise is a beneficial medium for PD patients to exercise in and is useful in maintaining and/or improving on strength, endurance and balance. Further research with a randomized controlled trial and a larger sample size is needed to verify the beneficial effects of water exercises for sufferers of PD

The Effect of High and Low Antiepileptic Drug Dosage on Simulated Driving Performance in Person’s with Seizures: A Pilot Study

Background: Prior studies examining driving performance have not examined the effects of antiepileptic drugs (AED’s) or their dosages in persons with epilepsy. AED’s are the primary form of treatment to control seizures, but they are shown to affect cognition, attention, and vision, all which may impair driving. The purpose of this study was to describe the characteristics of high and low AED dosages on simulated driving performance in persons with seizures. Method: Patients (N = 11; mean age 42.1 ± 6.3; 55% female; 100% Caucasian) were recruited from the Epilepsy Monitoring Unit and had their driving assessed on a simulator. Results: No differences emerged in total or specific types of driving errors between high and low AED dosages. However, high AED drug dosage was significantly associated with errors of lane maintenance (r = .67, p \u3c .05) and gap acceptance (r = .66, p \u3c .05). The findings suggest that higher AED dosages may adversely affect driving performance, irrespective of having a diagnosis of epilepsy, conversion disorder, or other medical conditions. Conclusion: Future studies with larger samples are required to examine whether AED dosage or seizure focus alone can impair driving performance in persons with and without seizures

Using In-Vehicle Devices to Examine Exposure and Patterns in Drivers with Parkinson’s Disease Compared to an Age-Matched Control Group

Symptoms associated with Parkinson’s disease (PD), as well as medications, can influence safe driving. Some studies have shown that drivers with PD make more errors and may have more crashes. Although a few studies have suggested drivers with PD may self-regulate by reducing amount of driving and avoiding challenging situations, findings are based on self-report data. The purpose of this study was to objectively examine naturalistic driving exposure and patterns in drivers with PD compared to an age-matched group of healthy drivers using electronic, in-vehicle devices over a two week monitoring period. Compared to the controls, the PD group drove significantly less overall (number of trips, kilometres, duration), on weekends and at night. When adjusted for number of days of driving, the PD group still made fewer trips and drove proportionately less at night. This was the first study to examine the actual driving practices of a PD population using objective measures

Intelligent Behaviour Analytics: A Novel Framework for Effective Leadership Style Transitioning

The last three decades saw a reliance on the use of personality tests by businesses and organisations trying to gain a competitive advantage in the market through avenues such as recruitment, team building, leadership development and culture alignment. The commissioning of early 20th Century personality models such as DISC and Myers-Briggs are claimed to provide valuable insights and benefits in various aspects of the employment process. They have however been controversially debated in the academic community due to issues surrounding validity and reliability. Discussions concerning leadership styles and leaders responsible for managing employees, are similarly indeterminate despite being subject to extensive research and analysis for many decades. Academics have yet to provide a comprehensive explanation of the holistic mechanisms underlying effective leadership. Instead, they have argued over factors such as a leader’s traits, attributes, power relations or unidimensional versus collaborative models of engaging a work force. Current leadership theory literature demonstrates a paucity of leader self-understanding and self-reflection. We consider these two attributes as fundamental qualities of effective leadership, whereby an individual can transform and enhance their use of any leadership style. In thispaper, we propose an advanced 21st Century solution that leverages the Intelligent Behaviour Analytics (IBA) framework, incorporating a deep and more effective understanding of leaders and their ability to transition between different leadershipstyles. Additionally, this framework offers methods for transitioning to more effective leadership styles based on situational requirements and takes into account a leader’s own emotional and behavioural registers. This approach offers a structured opportunity for leaders to identify any biases, understand the reasons that these may develop and furthermore, evaluate the efficacy of their own behavioural traits and the way they, as individuals interact, manage and lead a team. The IBA framework is a multi-stage, holistic approach that proposes to improve performance metrics, organisational culture, business outcomes and increased wellbeing

Physiotherapy for Parkinson's disease: a comparison of techniques (Review)

Background: Despite medical therapies and surgical interventions for Parkinson's disease (PD), patients develop progressive disability. The role of physiotherapy is to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person. The overall aim is to optimise independence, safety and wellbeing, thereby enhancing quality of life. Trials have shown that physiotherapy has short-term benefits in PD. However, which physiotherapy intervention is most effective remains unclear. Objectives: To assess the effectiveness of one physiotherapy intervention compared with a second approach in patients with PD. Search methods: Relevant trials were identified by electronic searches of numerous literature databases (for example MEDLINE, EMBASE) and trial registers, plus handsearching of major journals, abstract books, conference proceedings and reference lists of retrieved publications. The literature search included trials published up to the end of January 2012. Selection criteria: Randomised controlled trials of one physiotherapy intervention versus another physiotherapy intervention in patients with PD. Data collection and analysis: Data were abstracted independently from each paper by two authors. Trials were classified into the following intervention comparisons: general physiotherapy, exercise, treadmill training, cueing, dance and martial arts. Main results: A total of 43 trials were identified with 1673 participants. All trials used small patient numbers (average trial size of 39 participants); the methods of randomisation and concealment of allocation were poor or not stated in most trials. Blinded assessors were used in just over half of the trials and only 10 stated that they used intention-to-treat analysis.A wide variety of validated and customised outcome measures were used to assess the effectiveness of physiotherapy interventions. The most frequently reported physiotherapy outcomes were gait speed and timed up and go, in 19 and 15 trials respectively. Only five of the 43 trials reported data on falls (12%). The motor subscales of the Unified Parkinson?s Disease Rating Scale and Parkinson?s Disease Questionnaire-39 were the most commonly reported clinician-rated disability and patient-rated quality of life outcome measures, used in 22 and 13 trials respectively. The content and delivery of the physiotherapy interventions varied widely in the trials included within this review, so no quantitative meta-analysis could be performed. Authors' conclusions: Considering the small number of participants examined, the methodological flaws in many of the studies, the possibility of publication bias, and the variety of interventions, formal comparison of the different physiotherapy techniques could not be performed. There is insufficient evidence to support or refute the effectiveness of one physiotherapy intervention over another in PD.This review shows that a wide range of physiotherapy interventions to treat PD have been tested . There is a need for more specific trials with improved treatment strategies to underpin the most appropriate choice of physiotherapy intervention and the outcomes measured

Physiotherapy versus placebo or no intervention in Parkinson's disease

Background: Despite medical therapies and surgical interventions for Parkinson's disease (PD), patients develop progressive disability. Physiotherapy aims to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person. The overall aim is to optimise independence, safety, and well-being, thereby enhancing quality of life.  Objectives: To assess the effectiveness of physiotherapy intervention compared with no intervention in patients with PD.  Search methods: We identified relevant trials by conducting electronic searches of numerous literature databases (e.g. MEDLINE, EMBASE) and trial registers, and by handsearching major journals, abstract books, conference proceedings, and reference lists of retrieved publications. The literature search included trials published up to the end of January 2012.  Selection criteria: Randomised controlled trials of physiotherapy intervention versus no physiotherapy intervention in patients with PD.  Data collection and analysis: Two review authors independently extracted data from each article. We used standard meta-analysis methods to assess the effectiveness of physiotherapy intervention compared with no physiotherapy intervention. Trials were classified into the following intervention comparisons: general physiotherapy, exercise, treadmill training, cueing, dance, and martial arts. We used tests for heterogeneity to assess for differences in treatment effect across these different physiotherapy interventions.  Main results: We identified 39 trials with 1827 participants. We considered the trials to be at a mixed risk of bias as the result of unreported allocation concealment and probable detection bias. Compared with no intervention, physiotherapy significantly improved the gait outcomes of speed (mean difference 0.04 m/s, 95% confidence interval (CI) 0.02 to 0.06, P = 0.0002); two- or six-minute walk test (13.37 m, 95% CI 0.55 to 26.20, P = 0.04) and Freezing of Gait questionnaire (-1.41, 95% CI -2.63 to -0.19, P = 0.02); functional mobility and balance outcomes of Timed Up & Go test (-0.63 s, 95% CI -1.05 to -0.21, P = 0.003), Functional Reach Test (2.16 cm, 95% CI 0.89 to 3.43, P = 0.0008), and Berg Balance Scale (3.71 points, 95% CI 2.30 to 5.11, P < 0.00001); and clinician-rated disability using the Unified Parkinson’s Disease Rating Scale (UPDRS) (total -6.15 points, 95% CI-8.57 to -3.73, P < 0.00001; activities of daily living: -1.36, 95% CI -2.41 to -0.30, P = 0.01; and motor: -5.01, 95% CI -6.30 to -3.72, P < 0.00001). No difference between arms was noted in falls (Falls Efficacy Scale: -1.91 points, 95% CI -4.76 to 0.94, P = 0.19) or patient-rated quality of life (PDQ-39 Summary Index: -0.38 points, 95% CI -2.58 to 1.81, P = 0.73). One study reported that adverse events were rare; no other studies reported data on this outcome. Indirect comparisons of the different physiotherapy interventions revealed no evidence that the treatment effect differed across physiotherapy interventions for any of the outcomes assessed.  Authors' conclusions: Benefit for physiotherapy was found in most outcomes over the short term (i.e. < 3 months) but was significant only for speed, two- or six-minute walk test, Freezing of Gait questionnaire, Timed Up & Go, Functional Reach Test, Berg Balance Scale, and clinician-rated UPDRS. Most of the observed differences between treatments were small. However, for some outcomes (e.g. speed, Berg Balance Scale, UPDRS), the differences observed were at, or approaching, what are considered minimal clinically important changes. These benefits should be interpreted with caution because the quality of most of the included trials was not high. Variation in measurements of outcome between studies meant that our analyses include a small proportion of the participants recruited.  This review illustrates that a wide range of approaches are employed by physiotherapists to treat patients with PD. However, no evidence of differences in treatment effect was noted between the different types of physiotherapy interventions being used, although this was based on indirect comparisons. A consensus menu of 'best practice' physiotherapy is needed, as are large, well-designed randomised controlled trials undertaken to demonstrate the longer-term efficacy and cost-effectiveness of 'best practice' physiotherapy in PD

Design and baseline characteristics of the ParkFit study, a randomized controlled trial evaluating the effectiveness of a multifaceted behavioral program to increase physical activity in Parkinson patients

<p>Abstract</p> <p>Background</p> <p>Many patients with Parkinson's disease (PD) lead a sedentary lifestyle. Promotion of physical activities may beneficially affect the clinical presentation of PD, and perhaps even modify the course of PD. However, because of physical and cognitive impairments, patients with PD require specific support to increase their level of physical activity.</p> <p>Methods</p> <p>We developed the ParkFit Program: a PD-specific and multifaceted behavioral program to promote physical activity. The emphasis is on creating a behavioral change, using a combination of accepted behavioral motivation techniques. In addition, we designed a multicentre randomized clinical trial to investigate whether this ParkFit Program increases physical activity levels over two years in sedentary PD patients. We intended to include 700 sedentary patients. Primary endpoint is the time spent on physical activities per week, which will be measured every six months using an interview-based 7-day recall.</p> <p>Results</p> <p>In total 3453 PD patients were invited to participate. Ultimately, 586 patients - with a mean (SD) age of 64.1 (7.6) years and disease duration of 5.3 (4.5) years - entered the study. Study participants were younger, had a shorter disease duration and were less sedentary compared with eligible PD patients not willing to participate.</p> <p>Discussion</p> <p>The ParkFit trial is expected to yield important new evidence about behavioral interventions to promote physical activity in sedentary patients with PD. The results of the trial are expected in 2012.</p> <p>Trial registration</p> <p><url>http://clinicaltrials.gov</url> (nr NCT00748488).</p

Self-Regulatory Driving Behaviour, Perceived Abilities and Comfort Level of Older Drivers with Parkinson's disease compared to Age-Matched Healthy Controls

Introduction: Multiple studies have shown the symptoms of Parkinson's disease (PD) can impair driving performance. Studies have also found elevated crash rates in drivers with PD, however, none have controlled for exposure or amount of driving. Although a few studies have suggested that drivers with PD may self-regulate (e.g., by reducing exposure or avoiding challenging situations), findings were based on self-report data. Studies with healthy older drivers have shown that objective driving data is more accurate than self-estimates. Purposes: The primary objectives of this study were to examine whether drivers with PD restrict their driving (exposure and patterns) relative to an age-matched control group and explore possible reasons for such restrictions: trip purposes, perceptions of driving comfort and abilities, as well as depression, disease severity and symptoms associated with PD. Methods: A convenience sample of 27 drivers with PD (mean 71.6±6.6, range 57 to 82, 78% men) and 20 age-matched control drivers from the same region (70.6±7.9, range 57 to 84, 80% men) were assessed between October 2009 and August 2010. Driving data was collected for two weeks using two electronic devices (one with GPS) installed in each person‟s vehicle. Participants completed trip logs, questionnaires on background and usual driving habits, and measures of cognitive functioning, depression, quality of life, daytime sleepiness, driving comfort and abilities. Contrast sensitivity and brake response time were also assessed. Severity of PD was assessed using the Unified Parkinson‟s Disease Rating Scale (UPDRS) motor scores. An interview was conducted at the end of the second assessment to examine influence of the devices, driving problems and any departures from usual patterns over the monitoring period. Results: Of the 128 PD patients screened for possible study participation, 35% had already stopped driving. Former drivers were older, more likely to be women and had poorer UPDRS motor scores. Only 48% of those who were eligible for the study agreed to participate. Compared to controls, the PD group had significantly slower brake response times, higher depression and quality of life scores, less comfort driving at night and poorer perceptions of their driving abilities. The PD group also had significantly lower cognitive functioning scores than controls, and a significantly greater proportion (74% versus 45%) were classified as having mild cognitive impairment. Compared to vehicle recordings, both groups mis-estimated the amount they drove over two weeks (measurement error was 94 km for the PD group and 210 km for the controls). The PD group drove significantly less overall (days, trips, distance and duration), at night, on week-ends and in bad weather and for different purposes. Four of the PD drivers had minor accidents over the two weeks, while one lost his license. Conclusions: Self-estimates of exposure were inaccurate warranting the continued use of objective driving data. Overall, the findings suggest that drivers with PD appear to restrict their driving exposure and patterns relative to controls. The PD group were more likely to combine several activities into one trip, possibly due to fatigue. Moreover, they were more likely than controls to drive for medical appointments and less likely to drive for leisure activities and make out of town trips. The findings need to be replicated with larger samples and longer monitoring periods to examine changes in self-regulatory practices associated with disease progression and symptomatology. Other researchers are also likely to have similar difficulty in recruiting drivers with PD as this group may quit driving at an earlier age and those who are still driving are fearful of being reported to licensing authorities. Future studies also need to screen for cognitive impairment which often goes undetected, particularly in otherwise healthy drivers

Evidence Based Review of Fitness-to-Drive and Return-to-Driving Following Traumatic Brain Injury

The purpose of this study was to conduct an evidence-based review to determine predictors of fitness to drive and return to driving in persons with traumatic brain injury (TBI). Relevant databases (MEDLINE/PubMed, CINAHL, Cochrane Library, and SCOPUS) were searched for primary articles published before June 2016 using MeSH search terms. Using the American Academy of Neurology’s classification criteria, 24 articles were included after reviewing 1998 articles. Studies were rated by class (I–IV), with I being the highest level of evidence. Articles were classified according to TBI severity, as well as types of assessments (on-road, simulator and surveys). There were no Class I studies. Based on Class II studies, only Post-traumatic amnesia (PTA) duration was found to be probably predictive of on-road driving performance. There is limited evidence concerning predictors of return to driving. The findings suggest further evidence is needed to identify predictors of on-road driving performance in persons with TBI. Class I studies reporting Level A recommendations for definitive predictors of driving performance in drivers with TBI are needed by policy makers and clinicians to develop evidence-based guidelines

Impact of health and transportation on accessing healthcare in older adults living in rural regions

Introduction: Living in rural areas pose challenges to accessing healthcare, often requiring individuals to travel to major cities. This study examined the impact of health and transportation among older adults using no healthcare services, family doctor services, and medical specialist services, and compared to those living in rural and small population centers. Methods: Between 2020 and 2021, a survey was disseminated to 244 older adults (Mean age = 72.2 years ± 5.3 years, 50.2% male) living in rural (n = 139) and small communities (n = 105) of Saskatchewan, Canada. Results: In total, 135 participants did not use healthcare services (i.e., family doctor or medical specialist); 55 used family doctor services, and 54 used medical specialist services; 10.6% reported cancelling medical appointments due to the lack or cost of transportation. Living in a rural community was a significant predictor of using family doctors. Additionally, living in a rural environment, not perceiving health as excellent or good, receiving rides from others, and traveling to larger centers for medical care were significant predictors of using medical specialists. Living in a senior’s complex and having diabetes were significantly associated with poorer health. Receiving rides from friends, family, or volunteer driving programs was the most available transportation option in rural vs small population centers. Conclusions: Accessing healthcare is influenced by both health and transportation for older adults living in rural versus small communities. The lack of available and affordable transportation, coupled with the distance and occurrence of medical appointments, impacts healthcare access or cancelling medical appointments