Responsiveness to sensory cues using the Timed Up and Go test in patients with Parkinson's disease: a prospective cohort study.

Objective: To test the effectiveness of the Timed Up and Go (TUG) test to define responsiveness to auditory and visual cues in patients with Parkinson's disease. Methods: Consecutive patients > 50 years old were enrolled if they were classified as stage 1–3 of the Hoehn and Yahr scale; scored ≤ 45 on part III of the Unified Parkinson's Disease Rating Scale; > 23 on the Mini-Mental State Examination; and were able to perform the TUG test without assistance. Within-subject analysis identified positive-responders, negative-responders and non-responders. TUG times with and without sensory cues were studied among all patients, and among responders only using the Friedman Test. Results: Twenty-two patients (16 men, 6 women), mean age 72.4 years (standard deviation (SD) 8.7 years) were included. Basal mean TUG time was 12.3 (SD 4.0). TUG times after visual cues (11.7 (SD 4.8)) were lower than in basal conditions (p = 0.006), whereas TUG times after auditory cues were not (p > 0.05). In the 16 patients who were positive-responders, mean TUG times after visual (11.0 (SD 3.1)) and auditory (11.3 (SD 3.6)) cues were lower than in basal conditions (12.5 (SD 3.8)) (p = 0.0002). Conclusion: The TUG test may be used to tailor the rehabilitation programme in patients with Parkinson's disease, identifying those who respond to visual and auditory cueing

Crouch gait can be an effective form of forced-use/no constraint exercise for the paretic lower limb in stroke

In hemiplegic gait the paretic lower limb provides less muscle power and shows a briefer stance compared with the unaffected limb. Yet, a longer stance and a higher power can be obtained from the paretic lower limb if gait speed is increased. This supports the existence of a 'learned non-use' phenomenon, similar to that underlying some asymmetric impairments of the motion of the eyes and of the upper limbs. Crouch gait (CG) (bent-hip bent-knee, about 30 degrees minimum knee flexion) might be an effective form of 'forced-use' treatment of the paretic lower limb. It is not known whether it also stimulates a more symmetric muscle power output. Gait analysis on a force treadmill was carried out in 12 healthy adults and seven hemiplegic patients (1-127 months after stroke, median: 1.6). Speed was imposed at 0.3 m/s. Step length and single and double stance times, sagittal joint rotations, peak positive power, and work in extension of the hip, knee, and ankle (plantar flexion), and surface electromyography (sEMG) area from extensor muscles during the generation of power were measured on either side during both erect and crouch walking. Significance was set at P less than 0.05; corrections for multiplicity were applied. Patients, compared with healthy controls, adopted in both gait modalities and on both sides a shorter step length (61-84%) as well as a shorter stance (76-90%) and swing (63-83%) time. As a rule, they also provided a higher muscular work (median: 137%, range: 77-250%) paralleled by a greater sEMG area (median: 174%, range: 75-185%). In erect gait, the generation of peak extensor power across hip, knee, and ankle joints was in general lower (83-90%) from the paretic limb and higher (98-165%) from the unaffected limb compared with control values. In CG, peak power generation across the three lower limb joints was invariably higher in hemiparetic patients: 107-177% from the paretic limb and 114-231% from the unaffected limb. When gait shifted from erect to crouch, only for hemiplegic patients, at the hip, the paretic/unaffected ratio increased significantly. For peak power, work, sEMG area, and joint rotation, the paretic/unaffected ratio increased from 55 to 85%, 56 to 72%, 68 to 91%, and 67 to 93%, respectively. CG appears to be an effective form of forced-use exercise eliciting more power and work from the paretic lower limb muscles sustained by a greater neural drive. It also seems effective in forcing a more symmetric power and work from the hip extensor muscles, but neither from the knee nor the ankle

Nutritional status in post SARS-Cov2 rehabilitation patients

After prolonged hospitalization, the assessment of nutritional status and the identification of adequate nutritional support is of paramount importance. In this observational study, we aimed at assessing the presence of a malnutrition condition in SARS-Cov2 patients after the acute phase and the effects of a multidisciplinary rehabilitation program on nutritional and functional status

Prevalence of urinary incontinence in a cohort of women with obesity

Urinary incontinence (UI) is frequently associated with obesity. The prevalence of the different UI types in women with obesity remains scarcely investigated and controversial. OBJECTIVE: The goal of this study was to investigate the prevalence of the different types of UI (stress urinary incontinence, SUI, urge, UUI, or mixed, MUI) in a large sample of female patients with obesity by means of a specific questionnaire and non-invasive tests. METHODS: In this observational study, 248 obese female patients (BMI≥30 Kg/m2, age: 62.8+10.9 years) admitted to hospital from April 2019 to September 2019 for a multidisciplinary rehabilitation program were recruited for this study. The International Consultation on Incontinence Questionnaire - short form (ICIQ-sf) was used to screen the presence of symptoms of UI and to differentiate the different UI types. Patients with ICIQ-sf score≥4, were asked to undertake the Pad Test for quantifying urine leaks under stress. RESULTS: 61.69% of our sample presented UI symptoms. The prevalence of UI appears to be lower in younger age groups (57% in 31-46 years of age and 52% in 47-62 years of age) and higher (69%) between 63 and 79 years of age. MUI was the most frequent form (57.5%), followed by UUI (21.5%) and SUI (20.9%). SUI was most prevalent in younger participants (31-46 years old). CONCLUSION: This study demonstrated that UI has a high prevalence in females with obesity and it is not an exclusive concern of older women. This high prevalence calls for specific rehabilitation interventions within multidisciplinary programs

Spinal Cord Stimulation in Failed Back Surgery Syndrome: Effects on Posture and Gait—A Preliminary 3D Biomechanical Study

We studied 8 patients with spinal cord stimulation (SCS) devices which had been previously implanted to treat neuropathic chronic pain secondary to Failed Back Surgery Syndrome. The aim of our study was to investigate the effects of SCS on posture and gait by means of clinical scales (Short Form Health Survey-36, Visual Analogue Scale for pain, and Hamilton Depression Rating Scale) and instrumented evaluation with 3D Gait Analysis using a stereophotogrammetric system. The latter was performed with the SCS device turned both OFF and ON. We recorded gait and posture using the Davis protocol and also trunk movement during flexion-extension on the sagittal plane, lateral bending on the frontal plane, and rotation on the transversal plane. During and 30 minutes after the stimulation, not only the clinical scales but also spatial-temporal gait parameters and trunk movements improved significantly. Improvement was not shown under stimulation-OFF conditions. Our preliminary data suggest that SCS has the potential to improve posture and gait and to provide a window of pain-free opportunity to optimize rehabilitation interventions

Genetics and evolution of anthocyanin methylation.

Anthocyanins are a chemically diverse class of secondary metabolites that color most flowers and fruits. They consist of three aromatic rings that can be substituted with hydroxyl, sugar, acyl, and methyl groups in a variety of patterns depending on the plant species. To understand how such chemical diversity evolved, we isolated and characterized METHYLATION AT THREE2 (MT2) and the two METHYLATION AT FIVE (MF) loci from Petunia spp., which direct anthocyanin methylation in petals. The proteins encoded by MT2 and the duplicated MF1 and MF2 genes and a putative grape (Vitis vinifera) homolog Anthocyanin O-Methyltransferase1 (VvAOMT1) are highly similar to and apparently evolved from caffeoyl-Coenzyme A O-methyltransferases by relatively small alterations in the active site. Transgenic experiments showed that the Petunia spp. and grape enzymes have remarkably different substrate specificities, which explains part of the structural anthocyanin diversity in both species. Most strikingly, VvAOMT1 expression resulted in the accumulation of novel anthocyanins that are normally not found in Petunia spp., revealing how alterations in the last reaction can reshuffle the pathway and affect (normally) preceding decoration steps in an unanticipated way. Our data show how variations in gene expression patterns, loss-of-function mutations, and alterations in substrate specificities all contributed to the anthocyanins' structural diversity. © 2014 American Society of Plant Biologists. All rights reserved