Effects of the agility boot camp with cognitive challenge (ABC-C) exercise program for Parkinson's disease.

Few exercise interventions practice both gait and balance tasks with cognitive tasks to improve functional mobility in people with PD. We aimed to investigate whether the Agility Boot Camp with Cognitive Challenge (ABC-C), that simultaneously targets both mobility and cognitive function, improves dynamic balance and dual-task gait in individuals with Parkinson's disease (PD). We used a cross-over, single-blind, randomized controlled trial to determine efficacy of the exercise intervention. Eighty-six people with idiopathic PD were randomized into either an exercise (ABC-C)-first or an active, placebo, education-first intervention and then crossed over to the other intervention. Both interventions were carried out in small groups led by a certified exercise trainer (90-min sessions, 3 times a week, for 6 weeks). Outcome measures were assessed Off levodopa at baseline and after the first and second interventions. A linear mixed-effects model tested the treatment effects on the Mini-BESTest for balance, dual-task cost on gait speed, SCOPA-COG, the UPDRS Parts II and III and the PDQ-39. Although no significant treatment effects were observed for the Mini-BESTest, SCOPA-COG or MDS-UPDRS Part III, the ABC-C intervention significantly improved the following outcomes: anticipatory postural adjustment sub-score of the Mini-BESTest (p = 0.004), dual-task cost on gait speed (p = 0.001), MDS-UPDRS Part II score (p = 0.01), PIGD sub-score of MDS-UPDRS Part III (p = 0.02), and the activities of daily living domain of the PDQ-39 (p = 0.003). Participants with more severe motor impairment or more severe cognitive dysfunction improved their total Mini-BESTest scores after exercise. The ABC-C exercise intervention can improve specific balance deficits, cognitive-gait interference, and perceived functional independence and quality of life, especially in participants with more severe PD, but a longer period of intervention may be required to improve global cognitive and motor function.

Responsiveness of Objective vs. Clinical Balance Domain Outcomes for Exercise Intervention in Parkinson's Disease.

Background: Balance deficits in people with Parkinson's disease (PD) are often not helped by pharmacological or surgical treatment. Although balance exercise intervention has been shown to improve clinical measures of balance, the efficacy of exercise on different, objective balance domains is still unknown. Objective: To compare the sensitivity to change in objective and clinical measures of several different domains of balance and gait following an Agility Boot Camp with Cognitive Challenges (ABC-C) intervention. Methods: In this cross-over, randomized design, 86 individuals with PD participated in 6-week (3×/week) ABC-C exercise classes and 6-week education classes, consisting of 3-6 individuals. Blinded examiners tested people in their practical off state. Objective outcome measures from wearable sensors quantified four domains of balance: sway in standing balance, anticipatory postural adjustments (APAs) during step initiation, postural responses to the push-and-release test, and a 2-min natural speed walk with and without a cognitive task. Clinical outcome measures included the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III, the Mini Balance Evaluation Systems Test (Mini-BESTest), the Activities of Balance Confidence (ABC), and the Parkinson's Disease Questionnaire (PDQ-39). The standardized response means (SRM) of the differences between before and after each intervention compared responsiveness of outcomes to intervention. A linear mixed model compared effects of exercise with the active control-education intervention. Results: The most responsive outcome measures to exercise intervention with an SRM > 0.5 were objective measures of gait and APAs, specifically arm range of motion, gait speed during a dual-task walk, trunk coronal range of motion, foot strike angle, and first-step length at step initiation. The most responsive clinical outcome measure was the patient-reported PDQ-39 activities daily living subscore, but all clinical measures had SRMs <0.5. Conclusions: The objective measures were more sensitive to change after exercise intervention compared to the clinical measures. Spatiotemporal parameters of gait, including gait speed with a dual task, and APAs were the most sensitive objective measures, and perceived functional independence was the most sensitive clinical measure to change after the ABC-C exercise intervention. Future exercise intervention to improve gait and balance in PD should include objective outcome measures.

Predictability of speech-in-noise performance from real ear measures of directional hearing AIDS.

OBJECTIVE: Inability to understand speech in noise has been cited repeatedly as the principal complaint of hearing aid users. While data exist documenting the benefit provided by hearing aids with directional microphones when listening to speech in noise, little work has been done to develop a standard clinical protocol for fitting these hearing aids. Our goal was to evaluate a clinical measure of the acoustic directivity of a directional hearing aid, including its association with a test of speech perception in noise. DESIGN: The performance of two commercially available directional behind-the-ear (BTE) hearing aids was evaluated using the Hearing in Noise Test (HINT) and the Real Ear Aided Response (REAR) on 24 adult participants with symmetric, mild to moderately severe, sensorineural hearing loss. The HINT was conducted with the speech signal presented from 0 degrees and the noise from 180 degrees and either 135 degrees or 225 degrees, depending on the ear tested. REAR was measured at the above three angles using swept pure tones, and these measures were used to compute in situ directivity for each subject and hearing aid. CONCLUSIONS: Directional benefit for the HINT was greatest when noise was presented from the azimuth of the published polar diagram null of a given hearing aid in its directional mode (180 or 135/225 degrees). The only significant correlation between HINT and REAR results, however, was found when the noise source was at 180 degrees. These results confirm the validity of using real ear measures as a way to assess directionality in situ, but also indicate the complexity of predicting perceptual benefit from them. These data suggest that factors beyond acoustic directionality may contribute to improvement in speech perception in noise when such improvements are found.

A comparison of two measures of hearing aid satisfaction in a group of elderly hearing aid wearers.

OBJECTIVE: The objective of this study was to compare the results of two measures of hearing aid satisfaction, an indirect measure (Satisfaction with Amplification in Daily Living, SADL; Cox & Alexander, 1999) and a direct measure (an expanded version of the MarkeTrak-IV survey; Kochkin, 1996), in a group of elderly hearing aid wearers. DESIGN: A total of 43 elderly hearing aid wearers completed both satisfaction measures (order counterbalanced across wearers) after 1 mo of wearing 2-channel wide dynamic range compression (WDRC) in-the-canal (ITC) hearing aids. A correlational research design was employed. RESULTS: The elderly hearing aid wearers in this study yielded results on each measure of hearing aid satisfaction that were generally consistent with those found previously in larger groups of similar samples. The correlation between each measure of satisfaction (r = 0.75) was positive, moderately strong, and significant (p < 0.01) for the global scores of the SADL and MarkeTrak-IV scales. CONCLUSIONS: Although different approaches to the measurement of satisfaction were followed in the development of the SADL (indirect approach) and the MarkeTrak-IV (direct measurement) scales, similar results were obtained with each scale. The 15-item SADL instrument, however, is much shorter than the MarkeTrak-IV instrument and, as a result, is more efficient to administer clinically.

Longitudinal changes in hearing aid satisfaction and usage in the elderly over a period of one or two years after hearing aid delivery.

OBJECTIVE: The objective of this study was to measure hearing aid satisfaction and usage for extended periods of time, up to 2 yr after hearing aid delivery, to determine whether longitudinal changes occur in the elderly for these outcome measures. DESIGN: A longitudinal study of hearing aid satisfaction and usage was performed in a group comprised of 134 elderly hearing aid wearers with these outcome measures obtained at 1, 6, and 12 mo postfit. A total of 49 of the original 134 elderly returned 2 yr after hearing aid delivery to complete the satisfaction and usage measures again. Multiple self-report measures of hearing aid satisfaction and hearing aid usage were obtained at each follow-up session. RESULTS: Most between-interval comparisons of the various measures of satisfaction and usage failed to reveal significant changes over time. However, some significant changes were observed in both satisfaction and usage. When such changes occurred, they were always in a direction that suggested a decrease in satisfaction or usage over time. Correlations across various postfit interval pairs were found to be positive, statistically significant, and moderate to strong in strength for all measures of satisfaction and usage. CONCLUSIONS: Although there were slight declines in hearing aid usage and satisfaction over time, measures of hearing aid satisfaction obtained at 1 mo postfit and of hearing aid usage obtained at 6 mo postfit are generally stable for up to 2 yr after hearing aid delivery.

Changes in hearing-aid benefit following 1 or 2 years of hearing-aid use by older adults.

This study reports the results of a large number of hearing-aid benefit measures obtained from 134 elderly hearing-aid wearers during the first year of hearing-aid usage. Benefit measures were obtained after 1 month, 6 months, and 1 year of hearing-aid use by all participants. In addition, follow-up measurements of hearing-aid benefit were performed on 49 of these same hearing-aid wearers following 2 years of hearing-aid use. All participants in this study were fit binaurally with identical full-concha in-the-ear (ITE) hearing aids that used linear Class-D amplifiers with output-limiting compression. Benefit measures included several objective tests of speech recognition, as well as the subjective self-report scales of the Hearing Aid Performance Inventory (HAPI; B. E. Walden, M. E. Demorest, & E. L. Hepler) and the Hearing Handicap Inventory for the Elderly (HHIE; I. Ventry & B. Weinstein, 1982). Although group means changed only slightly over time for all of the benefit measures, significant differences were observed for some of the benefit measures, especially among the subjective, self-report measures of benefit. In almost all of the cases exhibiting significant changes, performance was significantly worse (less benefit) at both the 6-month and 1-year post-fit interval compared to the measurements at 1 month post-fit. In general, the individual data from the 134 participants who were represented in the 1-year data set were consistent with the trends in the group data described above. Regarding longer term changes in benefit following 2 years of hearing-aid use, minimal changes were again observed. In all, there was little evidence for acclimatization of hearing-aid benefit in this study in either the group or the individual data.