ABSTRACT
Objective: Alexander technique (AT) is a cognitive embodiment approach applied during daily life. We tested the feasibility and potential of online AT-based group courses for people living with PD (PwP) and included care partners to enhance dyadic relationship and retention of benefits. Background: An RCT showed that 1:1 AT sessions reduced motor symptoms in PwP with retention of benefits at 6 months [1-2]. Recent data suggest in-person AT-based group courses also hold promise. The COVID-19 pandemic gave an opportunity to test synchronous online AT-based courses. Methods: Design: Uncontrolled feasibility trial;3 groups met for 105 min, twice/wk, for 8 or 9 wks. Participants: 16 PwP and 14 care partners began the course. Intervention: Courses were delivered in-home via Zoom. Coursework included functional anatomy and self-management strategies via verbal instruction, anatomical models and images, demonstration, and activities. AT principles were embedded in everyday acts such as gait, sit-to-stand, speech, and IADLs. Review handouts and session recordings were provided. Outcome Measures: Functional reach, one-leg stance, TUG, 7-item Physical Performance Test, symptommanagement self-report, anonymous course evaluations, posture photos, audio interviews. Results: 94% of PwP completed the course (c.f. 65% for in-person course). Average course attendance by PwP was 86% (c.f. 91% in-person). PwP improved functional reach (p = .03) and simulated eating (p = .06). Subjectively, PWP reported improved physical self-control and ability to manage falls, shuffling gait, upright posture, garbled speech, and anxiety (all p < .05). On a 0-10 scale, evaluations averaged >9 for novelty of ideas and practicality of tools for physical symptom-management and for care partners' likelihood to remember and use what they had learned, and > 8.5 for everyone feeling better prepared to meet the daily demands of living with PD. Conclusion: AT training shows promise to improve selfmanagement of PD motor and non-motor symptoms. Online classes can increase accessibility and retention for PwP and their care partners. Larger RCTs are needed to statistically verify improvement, optimize delivery, compare to other approaches, and investigate AT combined with exercise. Six-month follow-up data are being collected for presentation, along with subjective data from care partners about their partners' symptom management.
ABSTRACT
Introduction & Objectives: Workshops with hands-on training using phantoms (anatomical models) are well-known methods for training clinicians and residents. However, during the Covid-19 pandemic it was not possible to attend workshops owing to the restrictions imposed by the lock-down. As a result, both the medical device industry and clinicians were not able to keep current with their skills. We introduce a novel method of education using augmented reality that virtually places the trainer (proctor) in the same room as the student during the procedure.(Figure Presented)A training simulation was created where a proctor trained a student in transperineal local anesthesia and biopsy using a prostate phantom. The hardware platform consisted of a headset containing see-through optic displays with an imbedded webcam. The image from the ultrasound machine was displayed in the optics of the headset, allowing the proctor to view the ultrasound image while looking at the phantom and his hands simultaneously (figure). A web-based software program was developed that displayed the ultrasound image and the video of the proctor’s hands (captured by the imbedded web cam) in a stacked format. These images were transmitted to the student (in a different room) who also wore a comparable headset. Both proctor and student had an ultrasound unit (BK Medical 5000 and 3000 with model 9048 probes) and prostate phantoms (SIM, Inc.). The proctor then demonstrated how to perform the local anesthesia and transperineal biopsy procedure, step by step, while the student observed these in his headset. After each step of the procedure the proctor changed the active feed so he could watch in his own headset the student performing that same step and further instruct him. s EAU22 – 37th Annual EAU Congress Eur Urol Suppl 2022;81(S 1):S1769 Results: The Remote Training Platform allowed the proctor to successfully demonstrate the prostate block and transperineal biopsy techniques to the student. The student was able to ask the proctor for instructions while the proctor was able to annotate additional information on the student’s ultrasound. Successful completion of both procedures was accomplished. Conclusions: The beta testing of this Remote Training Platform demonstrated that augmented reality combined with dedicated hardware and software could provided an efficient means of training physicians in new technology. Eliminating the need for the proctor to travel could increase the safety and efficiency for the introduction of new medical devices and resident education.