A Home-Based, Music-Cued Movement Program Is Feasible and May Improve Gait in Progressive Supranuclear Palsy

Objectives: To understand the benefits and feasibility of using supervised, home-based, music-cued training to improve gait speed and stability in community-dwelling people with Progressive Supranuclear Palsy.Design: Feasibility trial incorporating a single group repeated-measures design.Setting: Human movement laboratory and participants' homes.Interventions:Two training sessions per week, conducted by experienced physiotherapists over 4 weeks. Each home training session consisted of a range of activities in standing or walking, with, and without auditory cues. Rhythmic auditory cues were played via a portable digital music player and consisted of metronome beats and individually chosen, commercially available rhythmic music tracks.Main Outcome Measures: Spatiotemporal gait measures were recorded using an 8 m long GAITRite® mat. Participants walked without cues at self-selected comfortable pace. The Progressive Supranuclear Palsy and Unified Parkinson's Disease Rating Scales were administered at baseline. Addenbrooke's Cognitive Examination-III, Geriatric Depression Scale, Assessment of Personal Music Preference Scale, and Physiological Profile Assessment were administered at baseline and retest.Results: At baseline, two of the five community-dwelling participants with Progressive Supranuclear Palsy walked with normal speed and low gait variability. Of the remainder who walked with slower, more variable patterns, two walked faster at retest, one by a clinically meaningful amount. Four participants reduced their timing variability at retest and three reduced step length variability. All participants reported high satisfaction levels with the program.Conclusions: When delivered at home with the support of caregivers, music-cued gait training can provide a feasible approach to improving disorders of gait stability in people with this rare, degenerative condition. Movement to music is engaging and enjoyable which can facilitate adherence to therapy.Clinical Trial Registration : ANZCTR 12616000851460. http://www.anzctr.org.au

Evaluating the effects of increasing physical activity to optimize rehabilitation outcomes in hospitalized older adults (MOVE Trial): Study protocol for a randomized controlled trial

Background: Older adults who have received inpatient rehabilitation often have significant mobility disability at discharge. Physical activity levels in rehabilitation are also low. It is hypothesized that providing increased physical activity to older people receiving hospital-based rehabilitation will lead to better mobility outcomes at discharge. Methods/Design: A single blind, parallel-group, multisite randomized controlled trial with blinded assessment of outcome and intention-to-treat analysis. The cost effectiveness of the intervention will also be examined. Older people (age >60 years) undergoing inpatient rehabilitation to improve mobility will be recruited from geriatric rehabilitation units at two Australian hospitals. A computer-generated blocked stratified randomization sequence will be used to assign 198 participants in a 1:1 ratio to either an 'enhanced physical activity' (intervention) group or a 'usual care plus' (control) group for the duration of their inpatient stay. Participants will receive usual care and either spend time each week performing additional physical activities such as standing or walking (intervention group) or performing an equal amount of social activities that have minimal impact on mobility such as card and board games (control group). Self-selected gait speed will be measured using a 6-meter walk test at discharge (primary outcome) and 6 months follow-up (secondary outcome). The study is powered to detect a 0.1 m/sec increase in self-selected gait speed in the intervention group at discharge. Additional measures of mobility (Timed Up and Go, De Morton Mobility Index), function (Functional Independence Measure) and quality of life will be obtained as secondary outcomes at discharge and tertiary outcomes at 6 months follow-up. The trial commenced recruitment on 28 January 2014. Discussion: This study will evaluate the efficacy and cost effectiveness of increasing physical activity in older people during inpatient rehabilitation. These results will assist in the development of evidenced-based rehabilitation programs for this population. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12613000884707(Date of registration 08 August 2013); ClinicalTrials.gov Identifier NCT01910740(Date of registration 22 July 2013)

MUSIC CUED EXERCISES FOR MOTOR AND NON-MOTOR SIGNS IN PEOPLE WITH DEMENTIA: PROTOCOL FOR A SYSTEMATIC REVIEW

Background: Movement disorders and non-motor problems such as cognitive decline, anxiety, depression and behavioural problems, are common in people with dementia and can progress over time. Exercise coupled with music is a promising form of therapy designed to improve both the motor and non-motor manifestations of this debilitating neurological condition. Objectives: To present a protocol for a systematic review and critical analysis of the literature to answer the following questions: (i) Is music-cued exercise more effective than usual care for the treatment of motor and non-motor symptoms of dementia? (ii) What are the outcomes of music-cued exercise for people living with dementia? Methods: We provide the protocol for a systematic review and critical analysis of the literature using the PRISMA guidelines. Studies shall be reviewed that use music cued exercises aimed at improving the management of physical and non-physical problems associated with dementia. Eligibility criteria will be applied to the title and abstract of each citation as a first step followed by full text screening. Data extraction and quality appraisal are to be performed by two reviewers. Data sources: This protocol documents the comprehensive search strategy to be performed using MEDLINE, CINAHL, EMBASE, PSYCHINFO, PUBMED, SCOPUS and web of science databases. Science, technology and engineering databases will also be searched. Eligibility criteria: All study designs incorporating data will be included in this review. The following selection criteria shall be applied: • Participants will be people diagnosed with dementia, including Alzheimer’s disease, of any stage and severity, all ages, any range of co-morbidities, any medications. • Interventions will use rhythmic music with any physical exercise or rehabilitation program. • Outcomes shall include motor impairments such as gait, postural stability and general mobility. Studies considering non-motor signs such as anxiety, depression, behavioural disturbances and cognitive decline will also be included. Results: Evidence will be built from this review regarding the effectiveness of using music-cued exercises to optimise physical abilities and improve non-motor disorders in people with dementia. Conclusions: This protocol paper documents the methods that we shall use for a forthcoming systematic review. The knowledge obtained from the review will provide guidance to people with dementia, caregivers and clinicians by clarifying the strength of the evidence for music-cued movement rehabilitation

MUSIC CUED EXERCISES FOR PEOPLE LIVING WITH DEMENTIA: A SYSTEMATIC REVIEW

Background: Dementia can be associated with motor and non-motor disorders such as cognitive impairment, depression, and behavioral disturbance. The symptoms typically progress gradually over time. Music-cued exercises have been of therapeutic interest in recent years, especially to enable people with chronic neurological diseases to move more easily and to experience greater well-being. Objective: To investigate whether music-cued exercises are more effective than usual care for the management of motor and non-motor symptoms in people living with dementia. Methods: Systematic searching of the international literature was conducted in January 2018. Keywords were searched through electronic databases including MEDLINE, CINAHL, Embase, PsycINFO, PubMed, Scopus, the Web of Science, Science Direct, Wiley online library, and JOVE. The Cochrane collaboration tool was used to assess the risk of bias of the randomized controlled trials (RCTs). The Downs and Black checklist assessed the quality of non-RCTs. Results: Twelve studies met the eligibility criteria, including 4 RCTs. Three investigated the effects of music-cued exercises on motor performance, four examined non-motor outcomes, four quantified the level of exercise participation, and one examined both motor and non-motor outcomes. The included studies were of modest to low quality. Conclusion: There is growing evidence for the beneficial effects of music-cued exercises for people living with dementia. Enjoyable music and physical exercises matched to rhythmical music appear to have benefits for some individuals.The dosage of music-cued exercise is a key determinant of the motor and non-motor outcomes in people living with a variety of forms of dementia

Dancing for Parkinson’s Disease Online: Clinical Trial Process Evaluation

Background: Dancing is an engaging physical activity for people living with Parkinson’s disease (PD). We conducted a process evaluation for a PD trial on online dancing. Methods: “ParkinDANCE Online” was co-produced by people with PD, healthcare professionals, dance instructors, and a PD organisation. The evaluation mapped the following inputs: (i) stakeholder steering group to oversee program design, processes, and outcomes; (ii) co-design of online classes, based on a research evidence synthesis, expert advice, and stakeholder recommendations; (iii) trial fidelity. The key activities were (i) the co-design of classes and instruction manuals, (ii) the education of dance teachers, (iii) fidelity checking, (iv) online surveys, (v) and post-trial focus groups and interviews with participants. The outputs pertained to: (i) recruitment, (ii) retention, (iii) adverse events, (iv) fidelity, (v) protocol variations, and (vi) participant feedback. Results: Twelve people with PD, four dance instructors and two physiotherapists, participated in a 6-week online dance program. There was no attrition, nor were there any adverse events. Program fidelity was strong with few protocol variations. Classes were delivered as planned, with 100% attendance. Dancers valued skills mastery. Dance teachers found digital delivery to be engaging and practical. The safety of online testing was facilitated by careful screening and a home safety checklist. Conclusions: It is feasible to deliver online dancing to people with early PD