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1.
BMJ Open ; 12(3): e059988, 2022 Mar 31.
Article in English | MEDLINE | ID: covidwho-1774970

ABSTRACT

INTRODUCTION: Physical exercise and cognitive training have the potential to enhance cognitive function and mobility in older adults at risk of Alzheimer's disease and related dementia (ADRD), but little is known about the feasibility of delivering multidomain interventions in home settings of older adults at risk of ADRD. This study aims to assess the feasibility of home-based delivery of exercise and cognitive interventions, and to evaluate the relationship between participants' intervention preferences and their subsequent adherence. Secondary objectives include the effect of the interventions on ADRD risk factors, including frailty, mobility, sleep, diet and psychological health. METHODS AND ANALYSIS: The SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home) feasibility trial is a randomised control trial that follows a 2×2 factorial design, with a 16-week home-based intervention programme (3 sessions per week) of physical exercises and cognitive training. Participants will be randomised in blocks of four to one of the following four arms: (1) combined exercise (aerobic and resistance)+cognitive training (NEUROPEAK); (2) combined exercise+control cognitive training (web searching); (3) control exercise (balance and toning)+cognitive training; and (4) control exercise+control cognitive training. SYNERGIC@Home will be implemented through video conferencing. Baseline and post-intervention assessments at 4-month and 10-month follow-up will include measures of cognition, frailty, mobility, sleep, diet and psychological health. Primary feasibility outcome is adherence to the interventions. Primary analytic outcome is the relationship between pre-allocation preference for a given intervention and subsequent adherence to the allocated intervention. A series of secondary analytic outcomes examining the potential effect of the individual and combined interventions on cognitive, mobility and general well-being will be measured at baseline and follow-up. ETHICS AND DISSEMINATION: Ethics approval was granted by the relevant research ethics boards. Findings of the study will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences. TRIAL REGISTRATION NUMBER: NCT04997681, Pre-results.


Subject(s)
Alzheimer Disease , Cognition , Aged , Double-Blind Method , Exercise , Feasibility Studies , Gait , Humans , Randomized Controlled Trials as Topic
2.
BMJ Open ; 12(3): e055880, 2022 Mar 24.
Article in English | MEDLINE | ID: covidwho-1765125

ABSTRACT

IntroductionSilent cerebrovascular disease (SCD), which is a common disease in the elderly, leads to cognitive decline, gait disorders, depression and urination dysfunction, and increases the risk of cerebrovascular events. Our study aims to compare the accuracy of the diagnosis of SCD-related gait disorders between the intelligent system and the clinician. Our team have developed an intelligent evaluation system for gait. This study will evaluate whether the intelligent system can help doctors make clinical decisions and predictions, which aids the early prevention and treatment of SCD. METHODS AND ANALYSIS: This study is a multi-centred, prospective, randomised and controlled trial.SCD subjects aged 60-85 years in Shanghai and Guizhou will be recruited continuously. All subjects will randomly be divided into a doctor with intelligence assistance group or a doctor group, at a 1:1 ratio. The doctor and intelligent assistant group will accept the intelligent system evaluation. The intelligent system obtains gait parameters by an Red-Green-Blue-depth camera and computer vision algorithm. The doctor group will accept the clinicians' routine treatment procedures. Meanwhile, all subjects will accept the panel's gait assessment and recognition rating scale as the gold standard. The primary outcome is the sensitivity of the intelligent system and clinicians to screen for gait disorders. The secondary outcomes include the healthcare costs and the incremental cost effectiveness ratio of intelligent systems and clinicians to screen for gait disorders. ETHICS AND DISSEMINATION: Approval was granted by the Ethics Committee of Zhongshan Hospital affiliated with Fudan University on 26 November 2019. The approval number is B2019-027(2) R. All subjects will sign an informed consent form before enrolment. Serious adverse events will be reported to the main researchers and ethics committees. The subjects' data will be kept strictly confidential. The results will be disseminated in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04457908.


Subject(s)
Cerebrovascular Disorders , Gait , Aged , Cerebrovascular Disorders/diagnosis , China , Cost-Benefit Analysis , Humans , Multicenter Studies as Topic , Prospective Studies , Randomized Controlled Trials as Topic
3.
Exp Gerontol ; 162: 111747, 2022 Jun 01.
Article in English | MEDLINE | ID: covidwho-1739732

ABSTRACT

BACKGROUND: The use of telehealth has increased since the COVID-19 pandemic; however, the lack of reliable and valid tools to measure balance and gait remotely makes assessing these outcomes difficult. Thus, we investigated whether balance and gait measures used in clinical practice are reliable and valid when assessed remotely through telehealth. METHOD: In this pilot study, we investigated 15 healthy older adults who performed validated tests: Timed Up and Go simple, dual cognitive and motor tasks; Berg Balance Scale; Functional Gait Assessment and Dynamic Gait Index. The tests were assessed on two dates: (i) face-to-face, (ii) and remotely, via videoconference between 7 and 14 days after the initial assessment. Participants also undertook the Physiological Profile Assessment (PPA) to assess their risk of falling. Reliability was measured using intraclass correlation (ICC) two-way mixed with absolute agreement to contrast the score of the assessments undertaken face-to-face and remotely in real-time and recorded. We also assessed inter-rater reliability. Criterion validity was measured using Pearson correlation between the tests that were undertaken remotely and PPA. RESULTS: All tests showed good reliability between face-to-face and real-time telehealth (ICC = 0.79-0.87) and face-to-face and recorded telehealth (ICC = 0.78-0.88) assessments and good to excellent inter-rater reliability (ICC = 0.80-1.00). Correlation between the tests and PPA were significantly (p < 0.05) moderate for real-time (r = -0.68-0.64) and recorded (r = -0.69-0.71) telehealth assessments. CONCLUSIONS: The good reliability between face-to-face and remote measurements together with moderate validity of these measures to assess fall risk suggest that health professionals could use these measures to evaluate the balance and gait of healthy older adults remotely.


Subject(s)
COVID-19 , Telemedicine , Aged , COVID-19/diagnosis , Gait/physiology , Humans , Pandemics , Pilot Projects , Postural Balance/physiology , Reproducibility of Results
4.
PLoS One ; 16(12): e0260889, 2021.
Article in English | MEDLINE | ID: covidwho-1592578

ABSTRACT

BACKGROUND: Approximately 40-70% of people with Parkinson's disease (PD) fall each year, causing decreased activity levels and quality of life. Current fall-prevention strategies include the use of pharmacological and non-pharmacological therapies. To increase the accessibility of this vulnerable population, we developed a multidisciplinary telemedicine program using an Information and Communication Technology (ICT) platform. We hypothesized that the risk for falling in PD would decrease among participants receiving a multidisciplinary telemedicine intervention program added to standard office-based neurological care. OBJECTIVE: To determine the feasibility and cost-effectiveness of a multidisciplinary telemedicine intervention to decrease the incidence of falls in patients with PD. METHODS: Ongoing, longitudinal, randomized, single-blinded, case-control, clinical trial. We will include 76 non-demented patients with idiopathic PD with a high risk of falling and limited access to multidisciplinary care. The intervention group (n = 38) will receive multidisciplinary remote care in addition to standard medical care, and the control group (n = 38) standard medical care only. Nutrition, sarcopenia and frailty status, motor, non-motor symptoms, health-related quality of life, caregiver burden, falls, balance and gait disturbances, direct and non-medical costs will be assessed using validated rating scales. RESULTS: This study will provide a cost-effectiveness assessment of multidisciplinary telemedicine intervention for fall reduction in PD, in addition to standard neurological medical care. CONCLUSION: In this challenging initiative, we will determine whether a multidisciplinary telemedicine intervention program can reduce falls, as an alternative intervention option for PD patients with restricted access to multidisciplinary care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04694443.


Subject(s)
Accidental Falls/prevention & control , Exercise Therapy/methods , Gait , Parkinson Disease/physiopathology , Patient Care Team/statistics & numerical data , Telemedicine/methods , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Female , Humans , Longitudinal Studies , Male , Middle Aged , Randomized Controlled Trials as Topic , Young Adult
5.
Pract Neurol ; 21(6): 554, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1526525

Subject(s)
Cerebellar Ataxia , Masks , Gait , Humans
6.
BMC Neurol ; 21(1): 326, 2021 Aug 24.
Article in English | MEDLINE | ID: covidwho-1371955

ABSTRACT

BACKGROUND: Parkinson's Disease (PD) is a highly prevalent neurodegenerative disease whose incidence is increasing with an aging population. One of the most serious manifestations of PD is gait instability, leading to falls and subsequent complications that can be debilitating, even fatal. Boxing therapy (BT) uses gait and balance exercises to improve ambulation in people with PD, though its efficacy has not yet been fully proven. METHODS: In the current longitudinal observational study, 98 participants with idiopathic PD underwent twice-weekly BT sessions. Primary outcome was self-reported falls per month; secondary outcomes were quantitative and semi-quantitative gait and balance performance evaluations. Statistical methods included segmented generalized estimating equation with an independent correlation structure, binomial distribution, and log link. RESULTS: The average number of self-reported falls per month per participant decreased by 87%, from 0.86 ± 3.58 prior to BT, to 0.11 ± 0.26 during BT. During the lockdown imposed by COVID-19, this increased to 0.26 ± 0.48 falls per month. Females and those > 65 years old reported the greatest increase in falls during the lockdown period. Post-lockdown resumption of BT resulted in another decline in falls, to 0.14 ± 0.33. Quantitative performance metrics, including standing from a seated position and standing on one leg, largely mirrored the pattern of falls pre-and post-lockdown. CONCLUSIONS: BT may be an effective option for many PD patients.


Subject(s)
Boxing , COVID-19/prevention & control , Communicable Disease Control , Exercise Therapy , Parkinson Disease/psychology , Parkinson Disease/therapy , Accidental Falls/prevention & control , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Gait , Humans , Longitudinal Studies , Male , Middle Aged , Postural Balance
7.
Int J Environ Res Public Health ; 18(12)2021 06 15.
Article in English | MEDLINE | ID: covidwho-1282475

ABSTRACT

Gait impairment often limits physical activity and negatively impacts quality of life. EMG-Biofeedback (EMG-BFB), one of the more effective interventions for improving gait impairment, has been limited to laboratory use due to system costs and technical requirements, and has therefore not been tested on a larger scale. In our research, we aimed to develop and validate a cost-effective, commercially available EMG-BFB device for home- and community-based use. We began by repurposing mTrigger® (mTrigger LLC, Newark, DE, USA), a cost-effective, portable EMG-BFB device, for gait application. This included developing features in the cellphone app such as step feedback, success rate, muscle activity calibration, and cloud integration. Next, we tested the validity and reliability of the mTrigger device in healthy adults by comparing it to a laboratory-grade EMG system. While wearing both devices, 32 adults walked overground and on a treadmill at four speeds (0.3, 0.6, 0.9, and 1.2 m/s). Statistical analysis revealed good to excellent test-retest reliability (r > 0.89) and good to excellent agreement in the detection of steps (ICC > 0.85) at all speeds between two systems for treadmill walking. Our results indicated that mTrigger compared favorably to a laboratory-grade EMG system in the ability to assess muscular activity and to provide biofeedback during walking in healthy adults.


Subject(s)
Gait , Quality of Life , Adult , Biofeedback, Psychology , Humans , Reproducibility of Results , Walking
8.
Neurol Sci ; 42(8): 3089-3092, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1245657

ABSTRACT

BACKGROUND: Falls could be serious events in Parkinson's disease (PD). Patient remote monitoring strategies are on the raise and may be an additional aid in identifying patients who are at risk of falling. The aim of the study was to evaluate if balance and timed-up-and-go data obtained by a smartphone application during COVID-19 lockdown were able to predict falls in PD patients. METHODS: A cohort of PD patients were monitored for 4 weeks during the COVID-19 lockdown with an application measuring static balance and timed-up-and-go test. The main outcome was the occurrence of falls (UPDRS-II item 13) during the observation period. RESULTS: Thirty-three patients completed the study, and 4 (12%) reported falls in the observation period. The rate of falls was reduced with respect to patient previous falls history (24%). The stand-up time and the mediolateral sway, acquired through the application, differed between "fallers" and "non-fallers" and related to the occurrence of new falls (OR 1.7 and 1.6 respectively, p < 0.05), together with previous falling (OR 7.5, p < 0.01). In a multivariate model, the stand-up time and the history of falling independently related to the outcome (p < 0.01). CONCLUSIONS: Our study provides new data on falls in Parkinson's disease during the lockdown. The reduction of falling events and the relationship with the stand-up time might suggest that a different quality of falls occurs when patient is forced to stay home - hence, clinicians should point their attention also on monitoring patients' sit-to-stand body transition other than more acknowledged features based on step quality.


Subject(s)
COVID-19 , Parkinson Disease , Communicable Disease Control , Gait , Gait Analysis , Humans , Parkinson Disease/complications , Parkinson Disease/diagnosis , Postural Balance , SARS-CoV-2 , Smartphone , Time and Motion Studies
11.
Mult Scler Relat Disord ; 51: 102928, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1157625

ABSTRACT

BACKGROUND: The current coronavirus disease (COVID-19) pandemic makes it difficult to obtain physical therapy in rehabilitation centres, particularly for persons with multiple sclerosis (pwMS), who are a population at high risk, since viral infections may contribute to MS exacerbations and relapses. Active video games could be a way to maintain physical therapy at home as part of the rehabilitation. The aim of this review is to summarise the current best evidence for the effectiveness of home-based active video games on gait and balance, user compliance, feasibility and safety for pwMS. METHODS: We searched for studies in five databases (PubMed, Scopus, Cochrane, CINAHL and Science direct) up to October 2020. Selection of studies, extraction of data and methodological quality assessment through the PEDro scale were made independently by two authors and discussed with a third author. RESULTS: Nine studies were included in this systematic review. We found significant improvements in balance; results were mixed concerning mobility, physical activity and gait. Home-based active video games are feasible and safe, with good compliance and adherence. The methodological quality of the studies was moderate (PEDro scale: 5.3 ± 2). CONCLUSION: Overall, home-based active video games were found safe and effective improving static and dynamic balance in pwMS. Compliance was good, probably because it is a motivating and enjoyable training. Active video games can be a relevant alternative for physical rehabilitation at home in pwMS. Future studies should follow more rigorous methodological standards (larger sample sizes, more randomised controlled trials) to improve the quality of evidence and include cost-effectiveness in the analysis.


Subject(s)
COVID-19 , Multiple Sclerosis , Video Games , Gait , Humans , Multiple Sclerosis/therapy , Quality of Life , SARS-CoV-2
12.
BMJ Open ; 10(7): e037138, 2020 07 14.
Article in English | MEDLINE | ID: covidwho-1133213

ABSTRACT

INTRODUCTION: Aside from primary vestibular symptoms such as vertigo and dizziness, persons with vestibular dysfunction frequently express cognitive and motor problems. These symptoms have mainly been assessed in single-task setting, which might not represent activities of daily living accurately. Therefore, a dual-task protocol, consisting of the simultaneous performance of cognitive and motor tasks, was developed. This protocol assesses cognitive and motor performance in general, as well as cognitive-motor interference in specific. METHODS AND ANALYSIS: The motor component of the 2BALANCE protocol consists of a static and dynamic postural task. These motor tasks are combined with different cognitive tasks assessing visuospatial cognition, processing speed, working memory and response inhibition. First, test-retest reliability will be assessed with an interval of 2 weeks in a group of young adults. Second, the 2BALANCE protocol will be validated in persons with bilateral vestibulopathy. Finally, the protocol will be implemented in persons with unilateral vestibular loss. DISCUSSION AND CONCLUSIONS: The 2BALANCE project aims to elucidate the impact of vestibular dysfunction on cognitive and motor performance in dual-task setting. This protocol represents everyday situations better than single-task protocols, as dual-tasks such as reading street signs while walking are often encountered during daily activities. Ultimately, this project could enable individualised and holistic clinical care in these patients, taking into account single as well as dual-task performance. ETHICS AND DISSEMINATION: The current study was approved by the ethics committee of Ghent University Hospital on 5 July 2019 with registration number B670201940465. All research findings will be disseminated in peer-reviewed journals and presented at vestibular as well as multidisciplinary international conferences and meetings. TRIALS REGISTRATION NUMBER: NCT04126798, pre-results phase.


Subject(s)
Cognition , Activities of Daily Living , COVID-19 , Gait , Humans , Pandemics , Postural Balance , Reproducibility of Results , SARS-CoV-2
13.
Top Stroke Rehabil ; 29(1): 74-81, 2022 01.
Article in English | MEDLINE | ID: covidwho-1087603

ABSTRACT

The COVID-19 pandemic has disrupted non-essential in-person research activities that require contact with human subjects. While guidelines are being developed for ramping up human subjects research, one component of research that can be performed remotely is participant screening for lower limb function and gait impairments. In this commentary, we summarize evidence-supported clinical assessments that have potential to be conducted remotely in a safe manner, to make an initial determination of the functional mobility status of persons with neurological disorders. We present assessments that do not require complex or costly equipment, specialized software, or trained personnel to administer. We provide recommendations to implement remote functional assessments for participant recruitment and continuation of lower limb neurorehabilitation research as a rapid response to the COVID-19 pandemic and for utilization beyond the current pandemic. We also highlight critical research gaps related to feasibility and measurement characteristics of remote lower limb assessments, providing opportunities for future research to advance tele-assessment and tele-rehabilitation.


Subject(s)
COVID-19 , Stroke , Gait , Humans , Pandemics , SARS-CoV-2
14.
J Bodyw Mov Ther ; 26: 1-6, 2021 04.
Article in English | MEDLINE | ID: covidwho-1065284

ABSTRACT

BACKGROUND: Bounce rope-skip holds immense scope as an aerobic exercise in space and time constrained urban setting with additional constraints placed by pandemic situations such as Covid 19, wherein adherence to commonly performed weight-bearing, aerobic activities like walking and running is a challenge. Limited knowledge informing biomechanical demands and misconceptions about knee joint loading, confines safe application of bounce rope-skip in health promotion. Thus, present study aimed to explore kinematics and lower-extremity joint loading during rope-skipping compared to walking and running. METHODS: Following ethical approval, 3D motion analysis of bounce rope-skip, walk and run was captured from 22 healthy female participants aged 18-25yr using 12-camera Vicon system and 2AMTI force plates. Three trials for bounce rope-skip were recorded with five skip-jumps on force-plates at a cadence of 105 skips/min. Mid-skip, mid-gait and mid-run data were averaged to compute kinetic and kinematic variables for hip, knee and ankle during loading/initial contact, take-off/push-off and flight/mid-swing phases of rope-skip, walk and run. RESULT: Average time of one rope-skip cycle was 1.2sec; mean foot contact time was 0.55sec and flight time was 0.65sec. In one bounce rope-skip cycle, hip motion ranged between 13.4o-35.3oflexion; knee between 13.6 o-67.9° flexion and ankle between 34.5odorsiflexion to-13.40plantarflexion. Vertical ground reaction force (vGRF) during rope-skip (landing-phase) was lower compared to run; however, it was higher than walk (p < 0.001). In coronal plane, peak hip and knee adductor moment during rope-skip were lower compared to run and higher than walk (p < 0.001). CONCLUSION: Bounce rope-skip generated low lower extremity joint loading compared to run; supporting its prescription as a hip and knee joint-protective aerobic weight-bearing exercise for health promotion in young adults.


Subject(s)
Ankle Joint/physiology , Knee Joint/physiology , Running , Walking , Weight-Bearing , Adolescent , Adult , Biomechanical Phenomena , Female , Gait , Humans , Lower Extremity/physiology , Young Adult
15.
Environ Res ; 191: 110087, 2020 12.
Article in English | MEDLINE | ID: covidwho-739813

ABSTRACT

To determine whether gait and balance dysfunction are present in young urbanites exposed to fine particular matter PM2.5 ≥ annual USEPA standard, we tested gait and balance with Tinetti and Berg tests in 575 clinically healthy subjects, age 21.0 ±â€¯5.7 y who were residents in Metropolitan Mexico City, Villahermosa and Reynosa. The Montreal Cognitive Assessment was also applied to an independent cohort n:76, age 23.3 ±â€¯9.1 y. In the 575 cohort, 75.4% and 34.4% had abnormal total Tinetti and Berg scores and high risk of falls in 17.2% and 5.7% respectively. BMI impacted negatively Tinetti and Berg performance. Gait dysfunction worsen with age and males performed worse than females. Gait and balance dysfunction were associated with mild cognitive impairment MCI (19.73%) and dementia (55.26%) in 57/76 and 19 cognitively intact subjects had gait and balance dysfunction. Seventy-five percent of urbanites exposed to PM2.5 had gait and balance dysfunction. For MMC residents-with historical documented Alzheimer disease (AD) and CSF abnormalities, these findings suggest Alzheimer Continuum is in progress. Early development of a Motoric Cognitive Risk Syndrome ought to be considered in city dwellers with normal cognition and gait dysfunction. The AD research frame in PM2.5 exposed young urbanites should include gait and balance measurements. Multicity teens and young adult cohorts are warranted for quantitative gait and balance measurements and neuropsychological and brain imaging studies in high vs low PM2.5 exposures. Early identification of gait and balance impairment in young air pollution-exposed urbanites would facilitate multidisciplinary prevention efforts for modifying the course of AD.


Subject(s)
Air Pollution , Alzheimer Disease , Cognitive Dysfunction , Adolescent , Air Pollution/adverse effects , Alzheimer Disease/epidemiology , Cities , Cognitive Dysfunction/chemically induced , Cognitive Dysfunction/epidemiology , Female , Gait , Humans , Male , Mexico/epidemiology , Young Adult
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