Analysis of Transition of Patients with Parkinson’s Disease into Institutional Care: A Retrospective Pilot Study

Parkinson’s disease (PD) is a neurodegenerative disease which gives a person a high risk of becoming care-dependent. During disease progression, the amount of care concerning activities of daily living can increase, possibly resulting in transition of the people with Parkinson’s disease (PwP) to a care facility. However, there is a lack of knowledge concerning the factors leading to institutionalization of PwP and the consequences for them and their informal caregivers. The aim of this cross-sectional retrospective study was to investigate reasons leading to the transition into an institutional care facility, the process of decision-making and its effects on PwP symptoms and caregiver burden. Participating PwP had to be institutionalized for at most one year after transition at study inclusion. Participants completed a range of semiquantitative questionnaires as well as the caregiving tasks questionnaire. Fourteen patient–caregiver pairs were included. PwP suffered from late-stage PD symptoms with high dependence on help, experiencing several hospitalizations before transition. Analyses revealed a significant decrease in caregiver burden and depressive symptoms of the caregivers after PwP institutionalization. Factors influencing the transition were, e.g., fear of PwP health issues and concerns about caregivers’ health. This study presents new insights into the process of institutionalization and its influence on caregiver burden, including aspects for discussions of physicians with PwP and their caregivers for counselling the decision to move to institutional care

Shank muscle strength training changes foot behaviour during a sudden ankle supination

Background: The peroneal muscles are the most effective lateral stabilisers whose tension braces the ankle joint complex against excessive supination. The purpose of this study was to identify the morphological and biomechanical effects of two machine-based shank muscle training methods. Methods: Twenty-two healthy male recreationally active sports students performed ten weeks of single-set high resistance strength training with 3 training sessions per week. The subjects conducted subtalar pronator/supinator muscle training (ST) with the right leg by using a custom-made apparatus; the left foot muscles were exercised with machine-based talocrural plantar and dorsiflexor training (TT). Muscle strength (MVIC), muscle volume and foot biomechanics (rearfoot motion, ground reaction forces, muscle reaction times) during a sudden ankle supination were recorded before and after the intervention. Results: Compared to TT, ST resulted in significantly higher pronator (14% vs. 8%, P<0.01) and supinator MVIC (25% vs. 12%, P<0.01). During sudden foot inversions, both ST and TT resulted in reduced supination velocity (-12%; P<0.01). The muscle reaction onset time was faster after the training in peroneus longus (PL) (P<0.01). Muscle volume of PL (P<0.01) and TA (P<0.01) increased significantly after both ST and TT. Conclusion: After both ST and TT, the ankle joint complex is mechanically more stabilised against sudden supinations due to the muscle volume increase of PL and TA. As the reduced supination velocities indicate, the strength training effects are already present during free-fall. According to a sudden ankle supination in standing position, both machine-based dorsiflexor and pronator strength training is recommended for enhancing the mechanical stability of the ankle

Strength training-induced changes in muscular reaction time of peroneus longus (A) and anterior tibial (B) muscles (means and standard errors).

<p>TT = plantar-/dorsiflexor training; ST = functional subtalar pronator/supinator training; ** indicates significant main effect (time) (p<0.01).</p

Three-step intensity procedure during single-set strength training.

<p>Three-step intensity procedure during single-set strength training.</p

Laboratory setting of the sudden ankle supination.

<p>Laboratory setting of the sudden ankle supination.</p

Examplary biomechanical changes (rearfoot motion (top), vertical forces (middle), EMG (bottom)) after strength training (dotted line) when compared to pre-testing.

<p>The arrows indicate a significant reduction of supination velocity (SDGN, rate of decline in the goniometer signal during free fall) and a significantly shorter muscular reaction time after releasing the tilting platform.</p

Strength training-induced changes in maximum supination velocity (means and standard errors).

<p>TT = plantar-/dorsiflexor training; ST = functional subtalar pronator/supinator training; ** indicates significant main effect (time) (p<0.01).</p

Functional strength training of pronators (left) and supinators (right) at the custom-made functional pronator/supinator strength training machine.

<p>Functional strength training of pronators (left) and supinators (right) at the custom-made functional pronator/supinator strength training machine.</p