Implementation of a Community-Based Exercise Program for Parkinson Patients: Using Boxing as an Example.

BACKGROUND: Persons with Parkinson's disease (PD) benefit from continuous exercise through participation in community-based exercise programs. However, community programs often lack PD-specific knowledge needed to provide safe and adequately dosed exercise. OBJECTIVE: To evaluate the acceptability and safety of a PD-specific boxing program in the community. METHODS: We developed specific educational resources to facilitate the boxing instructors. We also organized an educational and practical workshop for patients (n = 26) and instructors (n = 10), and assessed: (a) participants' satisfaction; (b) instructors' appreciation of the educational resources; and (c) numbers of patients interested in participating in the boxing program. After 18 months, patients and instructors completed a questionnaire evaluating: (a) participants' satisfaction; (b) adverse events; (c) facilitators and barriers; and (d) proportion of participants at follow-up. RESULTS: Twenty-six persons with PD (62% men) and 10 boxing instructors participated in the workshop. 81% of patients and 80% of instructors were very satisfied. Instructors found the educational materials "very helpful" (60%) or "helpful" (40%). Patients expressed a clear interest (54%) or possible interest (46%) in the program. We initiated classes with 10 participants. At 18-months follow-up, the program consisted of four boxing sessions/week, led by three instructors, with 40 participants. Seventeen patients responded to the questionnaire at follow-up. Participants were "very satisfied" (53%), "satisfied" (35%) and neither satisfied nor unsatisfied (12%) with the program. Adverse effects were mild (e.g., muscle aches). Transportation and physical disability were the main barriers for participation. CONCLUSIONS: The boxing program was well-received, with increasing numbers of participants at 18 months. The educational resources can support boxing instructors participating in current and future boxing classes being delivered in the community.

Introduction to the international classification of functioning disability and health - ICF - in the context of vestibular rehabilitation.

Vestibular rehabilitation focuses at decreasing the impact of symptoms, such as vertigo dizziness and imbalance have on people's daily life and their role in society. The international Classification of Functioning Disability and Health - ICF offers a unified and standard language and framework for describing health and health related states. The ICF aims at facilitating communication information about health, like functioning and disability. For this purpose the ICF has a systematic coding scheme for health data with more than 1400 categories. The big number of categories is impractical to apply in a specific area like vestibular disorders. Therefore a narrowing down to the relevant categories in a comprehensive core set for vertigo (100 categories) and a brief core set (29 categories) were developed. The purpose of this article is to reflect on the potential use of ICF in vestibular rehabilitation.

International guidelines for education in vestibular rehabilitation therapy.

The Barany Society Ad Hoc Committee on Vestibular Rehabilitation Therapy has developed guidelines for developing educational programs for continuing education. These guidelines may be useful to individual therapists who seek to learn about vestibular rehabilitation or who seek to improve their knowledge bases. These guidelines may also be useful to professional organizations or therapists who provide continuing education in vestibular rehabilitation. We recommend a thorough background in basic vestibular science as well as an understating of current objective diagnostic testing and diagnoses, understanding of common tests used by therapists to assess postural control, vertigo and ability to perform activities of daily living. We recommend that therapists be familiar with the evidence supporting efficacy of available treatments as well as with limitations in the current research.

International survey of vestibular rehabilitation therapists by the Barany Society Ad Hoc Committee on Vestibular Rehabilitation Therapy.

The goal of this study was to determine how occupational and physical therapists learn about vestibular rehabilitation therapy, their educational backgrounds, referral patterns, and their ideas about entry-level and advanced continuing education in vestibular rehabilitation therapy. The Barany Society Ad Hoc Committee for Vestibular Rehabilitation Therapy invited therapists around the world to complete an E-mail survey. Participants were either known to committee members or other Barany Society members, known to other participants, identified from their self-listings on the Internet, or volunteered after reading notices published in publications read by therapists. Responses were received from 133 therapists in 19 countries. They had a range of educational backgrounds, practice settings, and referral patterns. Few respondents had had any training about vestibular rehabilitation during their professional entry-level education. Most respondents learned about vestibular rehabilitation from continuing education courses, interactions with their colleagues, and reading. All of them endorsed the concept of developing standards and educating therapists about vestibular anatomy and physiology, vestibular diagnostic testing, vestibular disorders and current intervention strategies. Therefore, the Committee recommends the development of international standards for education and practice in vestibular rehabilitation therapy.

ExoMars alternative escape trajectories with Soyuz/Fregat.

The objectives of ExoMars are to inject an orbiter around Mars and to land a rover on the surface to look for possible traces of life. During the first stages of the feasibility analysis, the mass margin of the orbiter was very small for a direct transfer in the Soyuz/Fregat scenario. An analysis of the combined use of lunar swing-bys and the Sun gravity gradient is performed with WESBOT in order to obtain alternative trajectories for injecting higher mass into Mars transfer. WESBOT is a GMV tool to find WSB transfers to the Moon and to design escape trajectories by performing several swing-bys with the Moon and the Earth. The weak stability boundary has been successfully used for lunar transfers (Hiten, SMART-1). For escape trajectories from the Earth, the potential mass gains depend on the escape direction and the departure date to make a series of gravity assists with the help of the Sun gravity gradient to save DeltaV. Several strategies are studied depending on the number and order of swing-bys. The departing conditions (date and orbit) are optimized but the arrival date to Mars is maintained because of mission requirements. For each type of strategy, a systematic search of initial guess trajectories is performed. The initial guess trajectory is made up of patched conics arcs and multiple shooting arcs when necessary. The optimal trajectories for the various scenarios are presented and show different morphologies. An analysis in terms of applicability to the ExoMars mission is included.

Autonomous low-thrust guidance: application to SMART-1 and BepiColombo.

Several techniques have been developed to obtain optimum trajectories with low-thrust propulsion. However, few low-thrust guidance schemes have been investigated to fly the reference optimum trajectories. The guidance algorithm successfully employed in the DeepSpace1 mission was the first approximation through the presented guidance schemes, valid for various interplanetary low-thrust trajectories, independently of the optimization technique they result from. A method is presented to transform any given thrust profile to a thrust law defined by a finite set of control variables. This law allows the definition of a control vector to be optimized for the guidance purposes. Simulations were carried out to compare the performances of the algorithms to very different missions, such as SMART-1 and BepiColombo. The good performance of the enhanced guidance schemes prove the generic applicability of the algorithm. Parametric analysis allows the assessment of stability and robustness of the schemes and the sensitivity to certain parameters. Table.