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1.
Stud Health Technol Inform ; 290: 919-923, 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1879428

ABSTRACT

People with Parkinson's disease (PD) can have dysarthria, a voice disorder that affects speech intelligibility. To fight this disorder people may resort to speech and language therapy. Unfortunately, weekly speech therapy sessions may not be enough, because to achieve and maintain good voice quality, intensive training is required. Additionally, the COVID-19 pandemic brought attention to the need for alternative speech therapy treatments that complement face-to-face appointments. Here, we propose a serious therapy game to improve voice loudness that can be used for intensive therapy or when face-to-face appointments are not possible. The game integrates three voice exercises used in speech therapy sessions for people with PD and aims to provide motivation for patients to perform the exercises on a daily basis. This application evaluates the vocal intensity, vocal frequency and maximum phonation time, offering real-time visual feedback. It also allows pathologists to customize the exercises difficulty to the needs of each patient.


Subject(s)
COVID-19 , Parkinson Disease , Voice , Dysarthria/etiology , Dysarthria/therapy , Humans , Pandemics , Parkinson Disease/complications , Parkinson Disease/therapy , Speech Therapy
2.
Front Public Health ; 9: 772805, 2021.
Article in English | MEDLINE | ID: covidwho-1834624

ABSTRACT

INTRODUCTION: CoronaVirus Disease-2019 (COVID-19) led to social distancing and the need for alternative care models. Telehealth programs for people with Parkinson's (PWP) disease may ensure continuity of care. The goal of this observational survey study was to determine the practicability, satisfaction, and barriers to online programs, their relationship to perceived symptoms, mood, and quality of life, and program sustainability beyond the immediate pandemic. METHODS: In-person Parkinson's programs at New York Institute of Technology College of Osteopathic Medicine transitioned online at the start of the pandemic to include Rock Steady Boxing, Support Groups, and Rock Steady Buddies. A custom online survey sent to 150 participants investigated PD history, symptomatology, level of exercise before and during the pandemic, depression (PHQ-9), quality of life (PDQ-39), and practicability and perceived satisfaction related to these online programs. Descriptive statistics were reported. RESULTS: Of 69 respondents [mean age of 70.2y (SD 8.4 yrs)], >75% were satisfied with the transition to online programs. Consistent attendance and minimal barriers to programs indicated practicability, with increased adherence to exercise. Of 66 completed PHQ-9s, 22.7% had scores ≥9 (moderate to severe depression); of 61 completed PDQ-39s, scores averaged 21.4; better quality of life than national averages for PWP. Self-perceived physical and mental wellbeing were positively affected. CONCLUSIONS: Results suggest the transition to online programs met the needs of the Parkinson's community in a practicable and sustainable manner during the pandemic. With COVID-19 still prevalent, the current model of blending synchronous online and in-person classes provides a more flexible, sustainable format compared to in-person alone. Institutions may consider including online components to existing programs to promote continuity of care for aging populations as part of best practices.


Subject(s)
COVID-19 , Parkinson Disease , Aged , Humans , Pandemics , Parkinson Disease/epidemiology , Parkinson Disease/therapy , Quality of Life , SARS-CoV-2
3.
Curr Opin Neurol ; 34(4): 589-597, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1816369

ABSTRACT

PURPOSE OF REVIEW: The COVID-pandemic has facilitated the implementation of telemedicine in both clinical practice and research. We highlight recent developments in three promising areas of telemedicine: teleconsultation, telemonitoring, and teletreatment. We illustrate this using Parkinson's disease as a model for other chronic neurological disorders. RECENT FINDINGS: Teleconsultations can reliably administer parts of the neurological examination remotely, but are typically not useful for establishing a reliable diagnosis. For follow-ups, teleconsultations can provide enhanced comfort and convenience to patients, and provide opportunities for blended and proactive care models. Barriers include technological challenges, limited clinician confidence, and a suboptimal clinician-patient relationship. Telemonitoring using wearable sensors and smartphone-based apps can support clinical decision-making, but we lack large-scale randomized controlled trials to prove effectiveness on clinical outcomes. Increasingly many trials are now incorporating telemonitoring as an exploratory outcome, but more work remains needed to demonstrate its clinical meaningfulness. Finding a balance between benefits and burdens for individual patients remains vital. Recent work emphasised the promise of various teletreatment solutions, such as remotely adjustable deep brain stimulation parameters, virtual reality enhanced exercise programs, and telephone-based cognitive behavioural therapy. Personal contact remains essential to ascertain adherence to teletreatment. SUMMARY: The availability of different telemedicine tools for remote consultation, monitoring, and treatment is increasing. Future research should establish whether telemedicine improves outcomes in routine clinical care, and further underpin its merits both as intervention and outcome in research settings.


Subject(s)
COVID-19 , Parkinson Disease , Telemedicine , Humans , Pandemics , Parkinson Disease/diagnosis , Parkinson Disease/therapy , SARS-CoV-2
4.
Soc Work Health Care ; 61(3): 139-157, 2022.
Article in English | MEDLINE | ID: covidwho-1815721

ABSTRACT

Parkinson's Disease is a neurological disease affecting over 10 million people worldwide. Interdisciplinary teams provide integrated care to people with Parkinson's Disease, including care for non-motor symptoms such as anxiety and depression, and many of these teams include social workers. This study sought to learn more about (a) clinical social work utilization across the continuum of care of PWP and their family care partners and (b) how patterns in utilization and service provision have shifted during the pandemic. This mixed method study identifies the breadth of roles performed by social workers in the comprehensive care of people with Parkinson's Disease (PWP). Findings underscore the important roles social workers play in providing comprehensive care for PWP and their families and their contributions to interdisciplinary teams providing holistic, integrated care, particularly during COVID-19 and into the future.


Subject(s)
COVID-19 , Parkinson Disease , Anxiety/epidemiology , COVID-19/epidemiology , Humans , Parkinson Disease/epidemiology , Parkinson Disease/therapy , Social Work
5.
Rural Remote Health ; 22(1): 6679, 2022 01.
Article in English | MEDLINE | ID: covidwho-1789838

ABSTRACT

INTRODUCTION: The potential for coordinated, multidisciplinary telehealth to help connect people with Parkinson disease (PD) in rural areas to PD specialists is crucial in optimizing care. Therefore, this study aimed to test the feasibility, safety, and signal of efficacy of a coordinated telehealth program, consisting of speech therapy, physiotherapy, and pharmaceutical care, for people with PD living in some rural US communities. METHODS: Fifteen individuals with PD living in rural Wyoming and Nevada, USA, participated in this single-cohort, 8-week pilot study. Participants were assessed before and after 8 weeks of coordinated, one-on-one telehealth using the following outcomes: (1) feasibility: session attendance and withdrawal rate; (2) safety: adverse events; and (3) signal of efficacy: Communication Effectiveness Survey, acoustic data (intensity, duration, work (intensity times duration)), Parkinson's Fatigue Scale, 30 second Sit-to-Stand test, Parkinson's Disease Questionnaire - 39, Movement Disorder Society Unified Parkinson's Disease Rating Scale - Part III, and medication adherence. RESULTS: Average attendance was greater than 85% for all participants. There were no serious adverse events and only nine minor events during treatment sessions (0.9% of all treatment sessions had a participant report of an adverse event); all nine cases resolved without medical attention. Although 14 of 16 outcomes had effect sizes trending in the direction of improvement, only two were statistically significant using non-parametric analyses: 30 second Sit-to-Stand (pre-test median=11.0 (interquartile range (IQR)=6.0); post-test median=12.0 (IQR=3.0) and acoustic data work (pre-test median=756.0 dB s (IQR=198.4); post-test median=876.3 dB s (IQR=455.5), p<0.05. CONCLUSION: A coordinated, multidisciplinary telehealth program was safe and feasible for people in rural communities who have PD. This telehealth program also yielded a signal of efficacy for most of the outcomes measured in the study.


Subject(s)
Parkinson Disease , Pharmaceutical Services , Telemedicine , Cohort Studies , Feasibility Studies , Humans , Parkinson Disease/therapy , Physical Therapy Modalities , Pilot Projects , Rural Population , Speech Therapy
6.
Mov Disord ; 37(6): 1289-1294, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1763265

ABSTRACT

BACKGROUND: Telehealth has been widely adopted in providing Parkinson's disease care during the coronavirus disease 2019 pandemic. OBJECTIVE: The aim of this study was to survey people living with Parkinson's disease (PwPD) about their attitudes toward and utilization of telehealth services. METHODS: A survey was administered to PwPD via Parkinson's Foundation and Columbia University mailing lists. RESULTS: Of 1,163 responses, 944 complete responses were analyzed. Telehealth awareness was 90.2% (850/942), and utilization was 82.8% (780/942). More than 40% of PwPD were equally or more satisfied with telehealth compared with in-person visits in all types of services used. The highest satisfaction was observed in speech-language pathology appointments (78.8%, 52/66) followed by mental health services (69.2%, 95/137). CONCLUSIONS: In selected circumstances and indications, such as speech-language pathology and mental health services, telehealth may be a useful tool in the care of PwPD beyond the coronavirus disease 2019 pandemic. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.


Subject(s)
COVID-19 , Parkinson Disease , Telemedicine , Attitude , Humans , Parkinson Disease/psychology , Parkinson Disease/therapy , Surveys and Questionnaires
7.
Sensors (Basel) ; 22(5)2022 Feb 24.
Article in English | MEDLINE | ID: covidwho-1742605

ABSTRACT

Parkinson's disease is a chronic neurodegenerative disease that affects a large portion of the population, especially the elderly. It manifests with motor, cognitive and other types of symptoms, decreasing significantly the patients' quality of life. The recent advances in the Internet of Things and Artificial Intelligence fields, including the subdomains of machine learning and deep learning, can support Parkinson's disease patients, their caregivers and clinicians at every stage of the disease, maximizing the treatment effectiveness and minimizing the respective healthcare costs at the same time. In this review, the considered studies propose machine learning models, trained on data acquired via smart devices, wearable or non-wearable sensors and other Internet of Things technologies, to provide predictions or estimations regarding Parkinson's disease aspects. Seven hundred and seventy studies have been retrieved from three dominant academic literature databases. Finally, one hundred and twelve of them have been selected in a systematic way and have been considered in the state-of-the-art systematic review presented in this paper. These studies propose various methods, applied on various sensory data to address different Parkinson's disease-related problems. The most widely deployed sensors, the most commonly addressed problems and the best performing algorithms are highlighted. Finally, some challenges are summarized along with some future considerations and opportunities that arise.


Subject(s)
Internet of Things , Neurodegenerative Diseases , Parkinson Disease , Aged , Artificial Intelligence , Humans , Machine Learning , Parkinson Disease/diagnosis , Parkinson Disease/therapy , Quality of Life
8.
CNS Neurol Disord Drug Targets ; 21(3): 235-245, 2022.
Article in English | MEDLINE | ID: covidwho-1674157

ABSTRACT

It is noticeable how the novel coronavirus has spread from the Wuhan region of China to the whole world, devastating the lives of people worldwide. All the data related to the precautionary measures, diagnosis, treatment, and even the epidemiological data are being made freely accessible and reachable in a very little time as well as being rapidly published to save humankind from this pandemic. There might be neurological complications of COVID-19 and patients suffering from neurodegenerative conditions like Alzheimer's disease and Parkinson's disease might have repercussions as a result of the pandemic. In this review article, we have discussed the effect of SARS-CoV-2 viral infection on the people affected with neurodegenerative disorders such as Parkinson's and Alzheimer's. It primarily emphasizes two issues, i.e., vulnerability to infection and modifications of course of the disease concerning the clinical neurological manifestations, the advancement of the disease and novel approaches to support health care professionals in disease management, the susceptibility to these diseases, and impact on the severity of disease and management.


Subject(s)
Alzheimer Disease/epidemiology , Alzheimer Disease/therapy , COVID-19/epidemiology , COVID-19/therapy , Disease Management , Parkinson Disease/epidemiology , Parkinson Disease/therapy , Alzheimer Disease/metabolism , COVID-19/metabolism , Humans , Parkinson Disease/metabolism , SARS-CoV-2/metabolism
9.
BMJ Open ; 11(12): e058953, 2021 12 20.
Article in English | MEDLINE | ID: covidwho-1598545

ABSTRACT

INTRODUCTION: Parkinson's disease can be associated with speech deterioration and low communication confidence which in turn compromises social interaction. Therapeutic singing is an engaging method for combatting speech decline; however, face-to-face delivery can limit access to group singing. The aim of this study is to test the feasibility and acceptability of an online mode of delivery for a Parkinson's singing intervention (ParkinSong) as well as remote data collection procedures. METHODS AND ANALYSIS: This ParkinSong Online feasibility trial is a single-arm, pre-post study of online singing delivery and remote data collection for 30 people living with Parkinson's. The primary outcome measure is feasibility: recruitment, retention, attendance, safety, intervention fidelity, acceptability and associated costs. Secondary outcomes are speech (loudness, intelligibility, quality, communication-related quality of life) and wellbeing (apathy, depression, anxiety, stress, health-related quality of life). This mode of delivery aims to increase the accessibility of singing interventions. ETHICS AND DISSEMINATION: Ethics approval was obtained from The University of Melbourne Human Research Ethics Committee (2021-14465-16053-3) and the trial has been prospectively registered. Results will be presented at national and international conferences, published in a peer-reviewed journal, and disseminated to the Parkinson's community, researchers and policymakers. TRIAL REGISTRATION NUMBER: ACTRN12621000940875.


Subject(s)
Parkinson Disease , Singing , Telemedicine , Feasibility Studies , Humans , Parkinson Disease/complications , Parkinson Disease/therapy , Quality of Life , Telemedicine/methods
10.
Rinsho Shinkeigaku ; 62(1): 8-14, 2022 Jan 28.
Article in Japanese | MEDLINE | ID: covidwho-1579997

ABSTRACT

We conducted the multicenter questionnaire survey targeting patients with Parkinson's disease (PD) in order to investigate the impacts on their daily lives and their requests to hospitals in the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Mainly using open-ended questionnaire, we asked their anxiety, troubles they are facing, and requests toward hospitals in the pandemic of SARS-CoV-2. Two hundred fifth-eight PD patients answered the questionnaire. There were various opinions about anxiety such as "PD patients are susceptible and vulnerable to SARS-CoV-2" (36.8%). Concerning the troubles in the pandemic, the most frequent answer was that they couldn't participate in the rehabilitation and elderly day care (38.4%). Relatively many PD patients requested telemedicine (29.5%), whereas some people hoped face-to-face medical care (8.1%). There were demands about the delivery of medications (50.0%), the establishment of telephone consultations (43.8%), resources for rehabilitation at home (43.8%). The medical care adapted to the anxiety, trouble and requests of PD patients will be required in the era when we have to live with SARS-CoV-2.


Subject(s)
COVID-19 , Health Care Surveys , Health Surveys , Pandemics , Parkinson Disease/psychology , Parkinson Disease/therapy , Patients/psychology , Aged , Anxiety , COVID-19/epidemiology , Humans , Parkinson Disease/rehabilitation , Telemedicine
11.
Trials ; 22(1): 910, 2021 Dec 11.
Article in English | MEDLINE | ID: covidwho-1571920

ABSTRACT

BACKGROUND: The COVID-19 pandemic poses challenges for timely outcome assessment in randomized clinical trials (RCT). Our aim was to describe our remote neurocognitive testing (NCT) protocol administered by telephone in patients with Parkinson's disease (PD) and obstructive sleep apnea (OSA). METHODS: We studied PD patients with OSA and Montreal Cognitive Assessment (MoCA) score ≤ 27 participating in a RCT assessing OSA treatment impact on cognition. Trial outcomes included change in MoCA and specific cognitive domains from baseline to 3 and 6 months. With COVID19 pandemic-related restrictions, 3-month visits were converted from in-person to telephone administration with materials mailed to participants for compatible tests and retrieved by courier the same day. In exploratory analyses, we compared baseline vs. 3-month results in the control arm, which were not expected to change significantly (test-re-test), using a paired t-test and assessed agreement with the intraclass correlation coefficient (ICC). RESULTS: Seven participants were approached and agreed to remote NCT at 3-month follow-up. Compared to the in-person NCT control arm group, they were younger (60.6 versus 70.6 years) and had a shorter disease course (3.9 versus 9.2 years). Remote NCT data were complete. The mean test-retest difference in MoCA was similar for in-person and remote NCT control-arm groups (between group difference - 0.69; 95%CI - 3.67, 2.29). Agreement was good for MOCA and varied for specific neurocognitive tests. CONCLUSION: Telephone administration of the MoCA and a modified neurocognitive battery is feasible in patients with PD and OSA. Further validation will require a larger sample size.


Subject(s)
COVID-19 , Parkinson Disease , Sleep Apnea, Obstructive , Cognition , Feasibility Studies , Humans , Pandemics , Parkinson Disease/diagnosis , Parkinson Disease/therapy , SARS-CoV-2 , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/therapy
12.
Acta Neurol Scand ; 145(1): 119-122, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1570446

ABSTRACT

BACKGROUND: Mesenchymal stem cells are expected to have a therapeutic effect on progressive neurodegenerative diseases for which there is currently no fundamental treatment. AIMS OF THE STUDY: The aim is to confirm that repeated infusion of autologous adipose tissue-derived stem cells (ADSCs) can be safely administered to patients with Parkinson's disease, and to investigate the effects of this as a pilot study. METHODS: Three patients with Parkinson's disease received five or six repeated infusions of ADSCs at intervals of approximately one month. Observations were based on medical examinations by a neurologist and interviews with the patient and caregivers. The severity of Parkinson's disease was assessed using the Hoehn & Yahr staging scale and Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS: No adverse events were observed during the observation period from the start of treatment to six months after the end of the last dose. MDS-UPDRS improved in all three patients. CONCLUSIONS: Repeated administration of Autologous ADSCs for Parkinson's disease was safe and feasible. The results of this pilot study provide insight into the value of further research.


Subject(s)
Parkinson Disease , Adipose Tissue , Humans , Parkinson Disease/therapy , Pilot Projects , Stem Cells , Transplantation, Autologous
13.
PLoS One ; 16(12): e0260317, 2021.
Article in English | MEDLINE | ID: covidwho-1546952

ABSTRACT

BACKGROUND: During the SARS CoV-2 pandemic, telemedicine experienced an enormous boom. Also, for Parkinson's patients there are upcoming alternatives to regular care. OBJECTIVE: The aim of the present study was to interview Parkinson's patients under the impression of the first lockdown in Germany about their health care situation, but especially about the use of and attitudes towards videotherapy and -consultation. METHODS: Northern German members of the German Parkinson Association were mailed a 16-item questionnaire including demographic questions on a one-time basis. The voluntary participants answered regarding their health care situation during the first German SARS CoV-2 lockdown, as well as attitudes towards videotherapy/-consultations. RESULTS: The 332 (of 974 questionnaires) responding evaluated their care situation predominantly (58.7%) unchanged during lockdown. There was hardly any previous experience in the areas of videotherapy and -consultations (15.4% and 3%, respectively), but at the same time mostly imaginability of implementation (54.2% and 56%, respectively) and the belief that they could motivate themselves to do so (51.8%). A total of 69% welcomed technical support for the implementation of videotherapy. CONCLUSION: In principle, there seems to be both, a need and an interest in telematics in healthcare such as videotherapy and video consultations, even if further barriers such as technical implementation need to be addressed. An expansion of telemedical services and infrastructure seems desirable not only in the pandemic situation, but also in the long term against the backdrop of demographic change, especially in an area like Schleswig-Holstein. Further studies are needed.


Subject(s)
Attitude to Health , COVID-19 , Parkinson Disease/therapy , Telemedicine , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Cross-Sectional Studies , Female , Germany , Humans , Male , Middle Aged , Parkinson Disease/psychology , Remote Consultation , Surveys and Questionnaires
14.
Parkinsonism Relat Disord ; 93: 97-102, 2021 12.
Article in English | MEDLINE | ID: covidwho-1536977

ABSTRACT

Inequalities in mental healthcare and lack of social support during the COVID-19 pandemic have lowered quality of life and increased overall burden of disease in people with Parkinson's (PWP). Although the pandemic has brought attention to these inequalities, they are long standing and will persist unless addressed. Lack of awareness of mental health issues is a major barrier and even when recognized disparities based on race, gender, and socioeconomic factors limit access to already scarce resources. Stigma regarding mental illness is highly prevalent and is a major barrier even when adequate care exists. Limited access to mental healthcare during the pandemic and in general increases the burden on caregivers and families. Historically, initiatives to improve mental healthcare for PWP focused on interventions designed for specialty and academic centers generally located in large metropolitan areas, which has created unintended geographic disparities in access. In order to address these issues this point of view suggests a community-based wellness model to extend the reach of mental healthcare resources for PWP.


Subject(s)
Healthcare Disparities/trends , Mental Disorders/therapy , Mental Health/trends , Parkinson Disease/therapy , Social Support/trends , Health Resources/trends , Humans , Mental Disorders/epidemiology , Mental Disorders/psychology , Parkinson Disease/epidemiology , Parkinson Disease/psychology , Social Support/psychology
16.
J Parkinsons Dis ; 12(1): 371-380, 2022.
Article in English | MEDLINE | ID: covidwho-1506484

ABSTRACT

BACKGROUND: Traditional in-person Parkinson's disease (PD) research studies are often slow to recruit and place unnecessary burden on participants. The ongoing COVID-19 pandemic has added new impetus to the development of new research models. OBJECTIVE: To compare recruitment processes and outcomes of three remote decentralized observational PD studies with video visits. METHODS: We examined the number of participants recruited, speed of recruitment, geographic distribution of participants, and strategies used to enhance recruitment in FIVE, a cross-sectional study of Fox Insight participants with and without PD (n = 203); VALOR-PD, a longitudinal study of 23andMe, Inc. research participants carrying the LRRK2 G2019S variant with and without PD (n = 277); and AT-HOME PD, a longitudinal study of former phase III clinical trial participants with PD (n = 226). RESULTS: Across the three studies, 706 participants from 45 U.S. states and Canada enrolled at a mean per study rate of 4.9 participants per week over an average of 51 weeks. The cohorts were demographically homogenous with regard to race (over 95%white) and level of education (over 90%with more than a high school education). The number of participants living in primary care Health Professional Shortage Areas in each study ranged from 30.3-42.9%. Participants reported interest in future observational (98.5-99.6%) and interventional (76.1-87.6%) research studies with remote video visits. CONCLUSION: Recruitment of large, geographically dispersed remote cohorts from a single location is feasible. Interest in participation in future remote decentralized PD studies is high. More work is needed to identify best practices for recruitment, particularly of diverse participants.


Subject(s)
Parkinson Disease , Patient Selection , COVID-19 , Cross-Sectional Studies , Humans , Longitudinal Studies , Pandemics , Parkinson Disease/therapy
17.
Parkinsonism Relat Disord ; 92: 41-45, 2021 11.
Article in English | MEDLINE | ID: covidwho-1472127

ABSTRACT

BACKGROUND: The initial COVID-19 pandemic shutdown led to the canceling of elective surgeries throughout most of the USA and Canada. OBJECTIVE: This survey was carried out on behalf of the Parkinson Study Group (PSG) to understand the impact of the shutdown on deep brain stimulation (DBS) practices in North America. METHODS: A survey was distributed through RedCap® to the members of the PSG Functional Neurosurgical Working Group. Only one member from each site was asked to respond to the survey. Responses were collected from May 15 to June 6, 2020. RESULTS: Twenty-three sites participated; 19 (83%) sites were from the USA and 4 (17%) from Canada. Twenty-one sites were academic medical centers. COVID-19 associated DBS restrictions were in place from 4 to 16 weeks. One-third of sites halted preoperative evaluations, while two-thirds of the sites offered limited preoperative evaluations. Institutional policy was the main contributor for the reported practice changes, with 87% of the sites additionally reporting patient-driven surgical delays secondary to pandemic concerns. Pre-post DBS associated management changes affected preoperative assessments 96%; electrode placement 87%; new implantable pulse generator (IPG) placement 83%; IPG replacement 65%; immediate postoperative DBS programming 74%; and routine DBS programming 91%. CONCLUSION: The COVID-19 pandemic related shutdown resulted in DBS practice changes in almost all North American sites who responded to this large survey. Information learned could inform development of future contingency plans to reduce patient delays in care under similar circumstances.


Subject(s)
COVID-19/prevention & control , Deep Brain Stimulation/statistics & numerical data , Implantable Neurostimulators/statistics & numerical data , Movement Disorders/therapy , Parkinson Disease/therapy , Postoperative Care/statistics & numerical data , Preoperative Care/statistics & numerical data , Quarantine/statistics & numerical data , Telemedicine/statistics & numerical data , Academic Medical Centers , Canada , Health Care Surveys , Humans , Neurologists/statistics & numerical data , Neurosurgeons/statistics & numerical data , United States
18.
ACS Chem Neurosci ; 12(20): 3785-3794, 2021 10 20.
Article in English | MEDLINE | ID: covidwho-1461963

ABSTRACT

Neural precursor cells (NPCs), derived from pluripotent stem cells (PSCs), with their unique ability to generate multiple neuronal and glial cell types are extremely useful for understanding biological mechanisms in normal and diseased states. However, generation of specific neuronal subtypes (mature) from NPCs in large numbers adequate for cell therapy is challenging due to lack of a thorough understanding of the cues that govern their differentiation. Interestingly, neural stem cells (NSCs) themselves are in consideration for therapy given their potency to form different neural cell types, release of trophic factors, and immunomodulatory effects that confer neuroprotection. With the recent COVID-19 outbreak and its accompanying neurological indications, the immunomodulatory role of NSCs may gain additional significance in the prevention of disease progression in vulnerable populations. In this regard, small-molecule mediated NPC generation from PSCs via NSC formation has become an important strategy that ensures consistency and robustness of the process. The development of the mammalian brain occurs along the rostro-caudal axis, and the establishment of anterior identity is an early event. Wnt signaling, along with fibroblast growth factor and retinoic acid, acts as a caudalization signal. Further, the increasing amount of epigenetic data available from human fetal brain development has enhanced both our understanding of and ability to experimentally manipulate these developmental regulatory programs in vitro. However, the impact on homing and engraftment after transplantation and subsequently on therapeutic efficacy of NPCs based on their derivation strategy is not yet clear. Another formidable challenge in cell replacement therapy for neurodegenerative disorders is the mode of delivery. In this Perspective, we discuss these core ideas with insights from our preliminary studies exploring the role of PSC-derived NPCs in rat models of MPTP-induced Parkinson's disease following intranasal injections.


Subject(s)
COVID-19 , Neural Stem Cells , Parkinson Disease , Animals , Humans , Neurons , Parkinson Disease/therapy , Rats , SARS-CoV-2
19.
Parkinsonism Relat Disord ; 91: 66-76, 2021 10.
Article in English | MEDLINE | ID: covidwho-1377808

ABSTRACT

BACKGROUND: The COVID-19 pandemic has necessitated the social isolation of the population and the rapid implementation of remote care for patients with neurodegenerative diseases. The objective of this study was to explore the perceived impact of confinement in patients with Parkinson's disease and document the effects of gender and living environment. METHODS: We recruited two cohorts from the Canadian provinces of Québec and Alberta, which differed in the dynamics of COVID-19 spreading at the time of the study, and administered a questionnaire on the perceived effects of confinement on daily living and disease management. RESULTS: The data reveals that approximately half of the patients experienced a change in one or more clinical symptoms, with differences observed between gender (e.g. day-to-day changes in slowness in men, aggravated headaches in women) and geographic location (e.g. increased depression in Alberta but reduced sleep quality in Québec). Furthermore, participants identifying as women or living in Alberta implemented more frequently home or online exercise. Lastly, high levels of satisfaction with phone or video consultations did not translate into a sustained interest to pursue this mode of healthcare. CONCLUSIONS: This study suggests that COVID-19-related confinement affected Parkinson's disease manifestation and management. Patients also reported varying levels of interest to continue remote care. A number of differences reported in our study were seemingly related to gender and living environment.


Subject(s)
Attitude to Health , COVID-19 , Exercise , Parkinson Disease/therapy , Social Isolation , Telemedicine , Activities of Daily Living , Aged , Alberta , Canada , Cohort Studies , Disease Management , Female , Humans , Male , Middle Aged , Parkinson Disease/physiopathology , Parkinson Disease/psychology , Quebec , Residence Characteristics , SARS-CoV-2 , Sex Factors
20.
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
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