The clinical utility of multidisciplinary rehabilitation in individuals with Huntington’s Disease

Background Huntington’s disease (HD) is a chronic neurodegenerative disorder characterised by a progressive loss of cognitive function, motor control and psychiatric features. Individuals also display a variety of systemic features. Progressive neuronal dysfunction and neuronal cell death are thought to underlie the onset and progression of many clinical features of HD. Despite scientific progress, there is still no cure or disease modifying therapy for HD, and available pharmaceutical agents only provide partial relief of motor and psychiatric features. An emerging body of evidence indicates that lifestyle enrichment may delay the onset and progression of clinical features, and exert favourable effects on neuropathological aspects of HD. Few studies have evaluated the effects of lifestyle enrichment strategies like multidisciplinary rehabilitation on the clinical features of HD. Moreover, no study has evaluated the effects of multidisciplinary rehabilitation on neuropathological aspects of HD. Aims The initial aim of this thesis was to determine factors that contribute to features of the disease that negatively impact on activities of daily living such as mobility and balance (Chapter 2), and to identify, using a literature review, a rehabilitation strategy that could positively impact on these features of HD (Chapter 3). These studies informed our ultimate aim which was to investigate the clinical utility of multidisciplinary rehabilitation on clinical and neuropathological features of HD (Chapters 4, 5 and 6) Methods In study 1 (Chapter 2), 22 participants were assessed using a battery of balance, mobility, cognitive tests, assessments of muscle strength and body composition measures. Data was . then statistically examined using stepwise linear regression to identify factors that contribute to balance and mobility impairments in individuals with manifest HD. In study 2 (Chapter 3), a systematic search of journal databases was made from inception to July 2014 for studies reporting on resistance exercise in patients with neurodegenerative disorders. Selected studies were abstracted and critically appraised using a quality control checklist. For the intervention studies, (3 and 4 Chapters 4 and 5), 20 participants with manifest HD were randomly assigned to either a control or training group. Individuals randomised to the intervention group were provided with a nine month multidisciplinary intervention comprising once weekly supervised clinical exercise, thrice weekly home based exercise and fortnightly occupational therapy, while those randomised to the control group were asked to continue with their standard care and daily activities. Participants were assessed using motor, cognitive, psychological, body composition and quality of life measures at baseline and at the completion of the intervention. In study 5 (Chapter 6), 15 participants with manifest HD were assessed using magnetic resonance imaging and a battery of cognitive assessments after nine months of multidisciplinary rehabilitation to see whether such a therapy is capable of inducing favourable changes in brain structure and cognitive function. Results The main factors that contribute to mobility and balance impairments in patients with manifest HD were found to be lower limb muscle weakness and a loss of cognitive function (Study 1). Systematic evaluation of the effects of resistance exercise for neurodegenerative disorders showed that it is beneficial for multiple sclerosis and Parkinson’s disease. In particular, improvements in muscle strength, mobility, balance, clinical disease progression, fatigue, functional capacity, quality of life, disease biology, electromyography activity, mood, skeletal muscle volume and architecture were reported in individuals with multiple sclerosis or Parkinson’s disease (PD) after resistance exercise. The most robust effects of resistance exercise were found for muscle strength outcomes, and were more pronounced in individuals with PD (Study 2). The multidisciplinary rehabilitation intervention studies conducted as part of this thesis significantly improved isometric and isokinetic muscle strength, self-perceived balance, body mass, lean tissue mass and fat mass in patients with HD (Studies 3 and 4). Moreover, multidisciplinary rehabilitation also increased grey matter (GM) volume in the caudate nucleus and dorsolateral prefrontal cortex of patients. The significant increases in GM volume were accompanied by, and correlated to, a significant improvement in performance in verbal learning and memory. Conclusions The work presented here shows that lower extremity muscle weakness and a loss of cognitive function significantly contribute to impairments in mobility and balance. This work also shows that strength training has favourable effects on motor function, including strength, mobility and balance, as well as other clinical features in similar neurodegenerative disorders, and thus should be integrated into multidisciplinary rehabilitation interventions for HD. In addition, this study provides evidence that multidisciplinary rehabilitation can significantly improve aspects of motor control, cognitive function and body composition. Finally we show, for the first time, that multidisciplinary rehabilitation can increase GM volume in structures known to degenerate in HD, and that such increases are functionally related to changes in verbal learning and memory. Future work is urgently required to confirm and expand on these exciting findings, particularly with respect to the neurorestorative properties of multidisciplinary rehabilitation

Change in mental health, physical health, and social relationships during highly restrictive lockdown in the COVID-19 pandemic: Evidence from Australia

Background A novel coronavirus first reported in Wuhan City in China in 2019 (COVID-19) developed into a global pandemic throughout 2020. Many countries around the world implemented strict social distancing policies to curb the spread of the virus. In this study we aimed to examine potential change in mental/physical health and social relationships during a highly restrictive COVID-19 lockdown period in Australia during April 2020. Methods Our survey (n = 1, 599) included questions about concerns, social behaviour, perceived change in relationship quality, social media use, frequency of exercise, physical health, and mental health during COVID-19 lockdown (April, 2020). Results When estimating their mental health for the previous year 13% of participants reported more negative than positive emotion, whereas this increased to 41% when participants reflected on their time during COVID-19 lockdown. A substantial proportion (39–54%) of participants reported deterioration in mental health, physical health, financial situation, and work productivity. However, most of these participants reported ’somewhat’ rather than ’a lot’ of deterioration, and many others reported ’no change’ (40–50%) or even ’improvement’ (6–17%). Even less impact was apparent for social relationships (68% reported ’no change’) as participants compensated for decreased face-to-face interaction via increased technology-mediated interaction. Conclusions The psychological toll of COVID-19 on Australians may not have been as large as other parts of the world with greater infection rates. Our findings highlight how technology-mediated communication can allow people to adequately maintain social relationships during an extreme lockdown event

Pulmonary function in patients with Huntington\u27s Disease

Background: Huntington\u27s disease (HD) is a neurodegenerative disorder characterized by progressive motor, cognitive and psychiatric disturbances. Chest muscle rigidity, respiratory muscle weakness, difficulty in clearing airway secretions and swallowing abnormalities have been described in patients with neurodegenerative disorders including HD. However limited information is available regarding respiratory function in HD patients. The purpose of this study was to investigate pulmonary function of patients with HD in comparison to healthy volunteers, and its association with motor severity.Methods: Pulmonary function measures were taken from 18 (11 male, 7 female) manifest HD patients (53 ± 10 years), and 18 (10 male, 8 female) healthy volunteers (52 ± 11 years) with similar anthropometric and life-style characteristics to the recruited HD patients. Motor severity was quantified by the Unified Huntington\u27s Disease Rating Scale-Total Motor Score (UHDRS-TMS). Maximum respiratory pressure was measured on 3 separate days with a week interval to assess test-retest reliability.Results: The test-retest reliability of maximum inspiratory and expiratory pressure measurements was acceptable for both HD patient and control groups (ICC ≥0.92), but the values over 3 days were more variable in the HD group (CV \u3c 11.1%) than in the control group (CV \u3c 7.6%). The HD group showed lower respiratory pressure, forced vital capacity, peak expiratory flow and maximum voluntary ventilation than the control group (p \u3c 0.05). Forced vital capacity, maximum voluntary ventilation and maximum respiratory pressures were negatively (r = -0.57; -0.71) correlated with the UHDRS-TMS (p \u3c 0.05).Conclusion: Pulmonary function is decreased in manifest HD patients, and the magnitude of the decrease is associated with motor severity

The impact of sleep-wake behaviour on tennis match performance in junior state grade tennis players

Purpose: To date, no study has investigated the extent to which sleep-wake behaviour (SWB) influences match performance in junior tennis players. This study aimed to assess the influence of SWB for the week and night before on match performance, particularly match analytics and activity. Methods: This study recruited 10 junior state grade tennis players who wore an actigraphy device and completed a sleep diary for the week before their match on two separate occasions throughout their competition season. Players wore a global positioning system device to track their movement during matches, and an experienced tennis coach recorded players\u27 match analytics. Results: This study showed that the sleep fragmentation index was significantly lower the week before matches in females who had won than those who had lost. Additionally, the sleep fragmentation index was significantly lower the night before a given match than the week before. Only sleep fragmentation index and sleep latency significantly influenced match performance in junior tennis players. The percentage of second serves points won differed between match wins and losses for male players, while winners and forced errors differed for female players. Conclusion: These findings provide a detailed profile of tennis match play in junior state grade players. Despite individual differences, reduced restlessness the night before a match coincides with increased match performance

A Systematic Review and Meta-Analysis of Strength Training in Individuals With Multiple Sclerosis or Parkinson Disease

Strength training has, in recent years, been shown to be beneficial for people with Parkinson disease and multiple sclerosis. Consensus regarding its utility for these disorders nevertheless remains contentious among healthcare professionals. Greater clarity is required, especially in regards to the type and magnitude of effects as well as the response differences to strength training between individuals with Parkinson disease or multiple sclerosis. This study examines the effects, magnitude of those effects, and response differences to strength training between patients with Parkinson disease or multiple sclerosis. A comprehensive search of electronic databases including Physiotherapy Evidence Database scale, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL was conducted from inception to July 2014. English articles investigating the effect of strength training for individuals with neurodegenerative disorders were selected. Strength training trials that met the inclusion criteria were found for individuals with Parkinson disease or multiple sclerosis. Individuals with Parkinson diseaseormultiple sclerosis were included in the study. Strength training interventions included traditional (free weights/machine exercises) and nontraditional programs (eccentric cycling). Included articles were critically appraised using the Physiotherapy Evidence Database scale. Of the 507 articles retrieved, only 20 articles met the inclusion criteria. Of these, 14 were randomized and 6 were nonrandomized controlled articles in Parkinson disease or multiple sclerosis. Six randomized and 2 nonrandomized controlled articles originated from 3 trials and were subsequently pooled for systematic analysis. Strength training was found to significantly improve muscle strength in people with Parkinson disease (15%-83.2%) and multiple sclerosis (4.5%-36%). Significant improvements in mobility (11.4%) and disease progression were also reported in people with Parkinson disease after strength training. Furthermore, significant improvements in fatigue (8.2%), functional capacity (21.5%), quality of life (8.3%), power (17.6%), and electro-myography activity (24.4%) were found in individuals with multiple sclerosis after strength training. The limitations of the study were the heterogeneity of interventions and study outcomes in Parkinson disease and multiple sclerosis trials. Strength training is useful for increasing muscle strength in Parkinson disease and to a lesser extent multiple sclerosis

Factors that contribute to balance and mobility impairments in individuals with Huntington\u27s disease

Mobility and balance problems are common and often debilitating features of Huntington\u27s disease (HD). In this exploratory study we aimed to investigate the influence of disease severity, severity of motor deficits, lower limb muscle strength, cognition, executive function, lean muscle mass and reactivity on mobility and balance.Twenty-two individuals with HD were recruited from the North Metropolitan Area Mental Health Service, Perth, Australia. Pertinent demographic, genetic and disease progression information was recorded prior to testing. Balance was assessed using dynamic and static balance tasks. Mobility was assessed using self-paced and fast-paced mobility measures. Cognitive and executive measures were used to assess verbal learning and memory, information processing speed, attention, response inhibition and cognitive flexibility. Lower limb muscle strength was evaluated by maximal isokinetic and isometric voluntary contractions. Lean tissue mass was quantified using Dual-energy X-ray absorptiometry. Reactivity was measured using Moyart equipment.Univariate and multivariate linear regression statistical models were used to examine the influence of these measures on mobility and balance. Univariate analyses showed that disease severity as well as measures of information processing speed, attention, cognitive flexibility, response inhibition and lower limb strength, were strongly related with mobility and balance. Additionally multivariate analyses showed that disease severity, cognitive flexibility and knee flexion strength together were better able to explain mobility and balance performance than any single measure (50-85%).In conclusion, our preliminary results suggest that as well as disease severity, cognitive and executive impairment and reduced lower limb strength contribute significantly to mobility and balance problems

Factors that contribute to balance and mobility impairments in individuals with Huntington's disease

AbstractMobility and balance problems are common and often debilitating features of Huntington's disease (HD). In this exploratory study we aimed to investigate the influence of disease severity, severity of motor deficits, lower limb muscle strength, cognition, executive function, lean muscle mass and reactivity on mobility and balance.Twenty-two individuals with HD were recruited from the North Metropolitan Area Mental Health Service, Perth, Australia. Pertinent demographic, genetic and disease progression information was recorded prior to testing. Balance was assessed using dynamic and static balance tasks. Mobility was assessed using self-paced and fast-paced mobility measures. Cognitive and executive measures were used to assess verbal learning and memory, information processing speed, attention, response inhibition and cognitive flexibility. Lower limb muscle strength was evaluated by maximal isokinetic and isometric voluntary contractions. Lean tissue mass was quantified using Dual-energy X-ray absorptiometry. Reactivity was measured using Moyart equipment.Univariate and multivariate linear regression statistical models were used to examine the influence of these measures on mobility and balance. Univariate analyses showed that disease severity as well as measures of information processing speed, attention, cognitive flexibility, response inhibition and lower limb strength, were strongly related with mobility and balance. Additionally multivariate analyses showed that disease severity, cognitive flexibility and knee flexion strength together were better able to explain mobility and balance performance than any single measure (50–85%).In conclusion, our preliminary results suggest that as well as disease severity, cognitive and executive impairment and reduced lower limb strength contribute significantly to mobility and balance problems

La influencia del tiempo de sueño total autorreportado y la calidad del sueño en el desempeño físico de jugadores júnior de tenis

Studies have shown the importance of sleep on tennis skill execution; however, its influence on physical performance metrics is unclear. This study aimed to examine the extent to which sleep duration and sleep quality metrics influence physical performance metrics in junior tennis players. Thirty-six junior tennis players from Australia and Germany completed the Consensus Sleep Diary over seven nights. A novel total sleep score based on current National Sleep Foundation recommendations was generated (calculated as the percentage of the average standardised sleep metrics), for each player. Players’ physical performance was measured using a comprehensive tennis-specific testing battery. This included sit and reach test for flexibility, counter movement jump and overhead medicine ball throw for power, 5-, 10- and 20-metre sprints for speed, tennis agility test for agility and reaction time, grip strength for strength, repeat sprint ability for anaerobic capacity and the Hit and Turn Tennis Test for aerobic capacity. Teenage (14 to 17 years of age) players reported significantly lower sleep duration (471 ± 116 min versus 543 ± 72 min; p <0.001, d = 0.83) and sleep efficiency (90% ± 11% versus 94 % ± 5%; p = 0.011, d = 0.49) metrics than school-aged players. Players with higher self-reported sleep quality had slower reaction times during a tennis agility test (r = 0.604, p = 0.011). However, players who reported feeling more rested and refreshed had faster reaction times during a tennis agility test (r = -0.579, p = 0.020). No other significant associations were present between self-reported sleep metrics and physical performance metrics. Nevertheless, feeling well-rested and refreshed, one of the primary outcomes of sleep, improves reaction time during a tennis-specific agility test. However, physical performance metrics are not significantly influenced by small variations in recommended sleep duration and sleep quality ranges.Diversos estudios demuestran la importancia del sueño en la ejecución de las habilidades en el tenis, sin embargo, su influencia en las métricas del desempeño físico no es clara. El objetivo de este estudio es analizar hasta qué punto las métricas de la duración y calidad del sueño influencian las métricas del desempeño físico en jugadores júnior de tenis. Treinta y seis jugadores júnior de tenis de Australia y Alemania completaron el Diario de Sueño Consensuado durante siete noches. Para cada jugador se creó una nueva puntuación del sueño total basada en las recomendaciones actuales de la Fundación Nacional del Sueño (calculada como el porcentaje de la media de las métricas de sueño estandarizadas). El desempeño físico de los jugadores fue medido con una batería integral de pruebas específicas para el tenis. Las pruebas incluidas fueron la prueba de sentarse y alcanzar para flexibilidad, el salto en contramovimiento y el lanzamiento de balón medicinal sobre la cabeza para la potencia, sprints de 5, 10 y 20 metros para la velocidad, la prueba de agilidad en tenis para la agilidad y el tiempo de reacción, fuerza de agarre para la fuerza, capacidad de repetir sprint para la capacidad anaeróbica y la prueba de golpear y girar en tenis para la capacidad aeróbica. Los jugadores adolescentes (de 14 a 17 años) reportaron métricas significativamente menores en la duración del sueño (471 ± 116 min frente a 543 ± 72 min; p <0,001, d = 0,83) y la eficiencia del sueño (90% ± 11% versus 94 % ± 5%; p = 0,011, d = 0,49) comparadas con las de jugadores en edad escolar. Los jugadores con mayor calidad de sueño autorreportada tuvieron tiempos de reacción más lentos durante la prueba de agilidad en tenis (r = 0,604, p = 0,011). Sin embargo, los jugadores que reportaron sentirse más descansados y renovados tuvieron tiempos de reacción más rápidos durante la prueba de agilidad en tenis (r = -0,579, p = 0,020). No se encontraron otras asociaciones significativas entre las métricas de sueño autorreportadas y las del desempeño físico. No obstante, sentirse descansado y renovado, uno de los resultados principales del sueño, mejora el tiempo de reacción en la prueba de agilidad específica para tenis. Por otra parte, las métricas del desempeño físico no están influenciadas significativamente por las pequeñas variaciones en la duración del sueño y los rangos de calidad del sueño recomendados

The influence of self-reported total sleep time and sleep quality on physical performance in junior tennis players

Studies have shown the importance of sleep on tennis skill execution; however, its influence on physical performance metrics is unclear. This study aimed to examine the extent to which sleep duration and sleep quality metrics influence physical performance metrics in junior tennis players. Thirty-six junior tennis players from Australia and Germany completed the Consensus Sleep Diary over seven nights. A novel total sleep score based on current National Sleep Foundation recommendations was generated (calculated as the percentage of the average standardised sleep metrics), for each player. Players’ physical performance was measured using a comprehensive tennis-specific testing battery. This included sit and reach test for flexibility, counter movement jump and overhead medicine ball throw for power, 5-, 10- and 20-metre sprints for speed, tennis agility test for agility and reaction time, grip strength for strength, repeat sprint ability for anaerobic capacity and the Hit and Turn Tennis Test for aerobic capacity. Teenage (14 to 17 years of age) players reported significantly lower sleep duration (471 ± 116 min versus 543 ± 72 min; p \u3c 0.001, d = 0.83) and sleep efficiency (90% ± 11% versus 94 % ± 5%; p = 0.011, d = 0.49) metrics than school-aged players. Players with higher self-reported sleep quality had slower reaction times during a tennis agility test (r = 0.604, p = 0.011). However, players who reported feeling more rested and refreshed had faster reaction times during a tennis agility test (r = -0.579, p = 0.020). No other significant associations were present between self-reported sleep metrics and physical performance metrics. Nevertheless, feeling well-rested and refreshed, one of the primary outcomes of sleep, improves reaction time during a tennis-specific agility test. However, physical performance metrics are not significantly influenced by small variations in recommended sleep duration and sleep quality ranges

‘Teachers are the guinea pigs’: Teacher perspectives on a sudden reopening of schools during the COVID-19 pandemic

Primary and secondary education systems experienced substantial disruption during the COVID-19 pandemic. However, little is known about how public health policy has affected Australian teachers during the pandemic. This study examines teacher perspectives on a sudden change of policy, whereby schools were abruptly opened to students at the beginning of the pandemic. At the same time, strict social distancing rules applied to the remainder of the population. Qualitative data from 372 Western Australian schoolteachers were analysed using thematic analysis. Results highlight substantial impacts on teachers’ workloads and adverse effects on wellbeing. Perceptions that they were acting as guinea pigs and subjected to different social distancing rules than other citizens were particular stressors. Findings highlight substantial consequences of public health policies on the roles and wellbeing of teachers