Home-based exercise monitored with telehealth is feasible and acceptable compared to centre-based exercise in Parkinson’s disease: A randomised pilot study

2020 ◽  
pp. 026921552097626
Author(s):  
Allyson Flynn ◽  
Elisabeth Preston ◽  
Sarah Dennis ◽  
Colleen G Canning ◽  
Natalie E Allen
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
Management Program ◽  
Self Management ◽  
Randomised Control Trial ◽  
Secondary Outcome ◽  
Mixed Response ◽  
Home Based ◽  
At Home

Objectives: To investigate the feasibility and acceptability of a home-based exercise program monitored using telehealth for people with Parkinson’s disease. Design: Pilot randomised control trial. Setting: University physiotherapy clinic, participants’ homes. Participants: Forty people with mild to moderate Parkinson’s disease, mean age 72 (6.9). Intervention: In Block 1 (5 weeks) all participants completed predominantly centre-based exercise plus a self-management program. Participants were then randomised to continue the centre-based exercise ( n = 20) or to a home-based program with telehealth ( n = 20) for Block 2 (5 weeks). The exercises targeted balance and gait. Outcomes: The primary outcomes were the feasibility and acceptability of the intervention. Secondary outcomes were balance, gait speed and freezing of gait. Results: Adherence was high in Block 1 (93%), and Block 2 (centre-based group = 93%, home-based group = 84%). In Block 2, the physiotherapist spent 6.4 hours providing telehealth to the home-based group (mean 10 (4) minutes per participant) and 32.5 hours delivering the centre-based exercise classes (98 minutes per participant). Participants reported that exercise was helpful, they could follow the home program and they would recommend exercising at home or in a group. However, exercising at home was less satisfying and there was a mixed response to the acceptability of the self-management program. There was no difference between groups in any of the secondary outcome measures (preferred walking speed mean difference −0.04 (95% CI: −0.12 to 0.05). Conclusion: Home-based exercise monitored using telehealth for people with Parkinson’s disease is feasible and acceptable.

scholarly journals Sensory Electrical Stimulation Cueing May Reduce Freezing of Gait Episodes in Parkinson’s Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Lois Rosenthal ◽  
Dean Sweeney ◽  
Anne-Louise Cunnington ◽  
Leo R. Quinlan ◽  
Gearóid ÓLaighin
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Electrical Stimulation ◽  
Freezing Of Gait ◽  
The Self ◽  
Home Based ◽  
Walking Activity ◽  
Guidance Technique ◽  
Positive Effect

Introduction. Freezing of gait (FoG) is a movement abnormality that presents with advancing Parkinson’s disease (PD) and is one of the most debilitating symptoms of the disease. The mainstay of nonpharmacological management of FoG is typically through external cueing techniques designed to relieve or prevent the freezing episode. Previous work shows that electrical stimulation may prove useful as a gait guidance technique, but further evidence is required. The main objective of this study was to determine whether a “fixed” rhythmic sensory electrical stimulation (sES) cueing strategy would significantly (i) reduce the time taken to complete a walking task and (ii) reduce the number of FoG episodes occurring when performing the task. Methods. 9 participants with idiopathic PD performed a self-identified walking task during both control (no cue) and cueing conditions. The self-identified walking task was a home-based daily walking activity, which was known to result in FoG for that person. A trained physiotherapist recorded the time taken to complete the walking task and the number of FoG episodes which occurred during the task. Data were analyzed by paired t-tests for both the time to complete a walking task and the number of FoG episodes occurring. Results. sES cueing resulted in a reduction in the time taken to complete a walking task and in the number of FoG episodes occurring during performance of this task by 14.23 ± 11.15% (p=0.009) and 58.28 ± 33.89% (p=0.002), respectively. Conclusions. This study shows a positive effect of “fixed” rhythmic sES on the time taken to complete a walking task and on the number of FoG episodes occurring during the task. Our results provide evidence that sES cueing delivered in a “fixed” rhythmic manner has the potential to be an effective cueing mechanism for FoG prevention.

scholarly journals A Technological Review of Wearable Cueing Devices Addressing Freezing of Gait in Parkinson’s Disease

Sensors ◽  
2019 ◽  
Vol 19 (6) ◽  
pp. 1277 ◽  
Author(s):  
Dean Sweeney ◽  
Leo Quinlan ◽  
Patrick Browne ◽  
Margaret Richardson ◽  
Pauline Meskell ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
Review Of The Literature ◽  
What Works ◽  
Home Based ◽  
What Works Clearinghouse ◽  
Technical Operation

Freezing of gait is one of the most debilitating symptoms of Parkinson’s disease and is an important contributor to falls, leading to it being a major cause of hospitalization and nursing home admissions. When the management of freezing episodes cannot be achieved through medication or surgery, non-pharmacological methods such as cueing have received attention in recent years. Novel cueing systems were developed over the last decade and have been evaluated predominantly in laboratory settings. However, to provide benefit to people with Parkinson’s and improve their quality of life, these systems must have the potential to be used at home as a self-administer intervention. This paper aims to provide a technological review of the literature related to wearable cueing systems and it focuses on current auditory, visual and somatosensory cueing systems, which may provide a suitable intervention for use in home-based environments. The paper describes the technical operation and effectiveness of the different cueing systems in overcoming freezing of gait. The “What Works Clearinghouse (WWC)” tool was used to assess the quality of each study described. The paper findings should prove instructive for further researchers looking to enhance the effectiveness of future cueing systems.

Benefits of a Self-Management Program for the Couple Living With Parkinson’s Disease: A Pilot Study

2020 ◽  
pp. 073346482091813 ◽  
Author(s):  
Karen S. Lyons ◽  
Alex Zajack ◽  
Melissa Greer ◽  
Holly Chaimov ◽  
Nathan F. Dieckmann ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Pilot Study ◽  
Intervention Group ◽  
Management Program ◽  
Self Management ◽  
Relaxation Techniques ◽  
Community Based ◽  
Aerobic Activity ◽  
Mental Relaxation

The goal of this pilot study was to explore health benefits for couples participating together in an existing community-based self-management workshop for Parkinson’s disease (PD). A quasi-experimental two-wave design explored the effects of the Strive to Thrive program in comparison to a wait-list control condition. Preliminary data ( n = 39 couples) showed that spouses in the intervention group had greater engagement in mental relaxation techniques at 7 weeks than those in the control condition (large effect size). Small effects were observed for increases in aerobic activity and mental relaxation for the adult with PD, increases in strength-based activities and self-efficacy for spouses, declines in depressive symptoms for spouses, and decreases in protective buffering for both adults with PD and spouses. The program showed potential for existing community-based programs to benefit couples living with chronic illness.

scholarly journals Assessing inertial measurement unit locations for freezing of gait detection and patient preference

2021 ◽  
Author(s):  
Johanna O’Day ◽  
Marissa Lee ◽  
Kirsten Seagers ◽  
Shannon Hoffman ◽  
Ava Jih-Schiff ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Patient Preference ◽  
Freezing Of Gait ◽  
Home Monitoring ◽  
Inertial Measurement ◽  
Technical Performance ◽  
Percent Time ◽  
Time Freezing ◽  
At Home

ABSTRACTBackgroundFreezing of gait, a common symptom of Parkinson’s disease, presents as sporadic episodes in which an individual’s feet suddenly feel stuck to the ground. Inertial measurement units (IMUs) promise to enable at-home monitoring and personalization of therapy, but there is a lack of consensus on the number and location of IMUs for detecting freezing of gait. The purpose of this study was to assess IMU sets in the context of both freezing of gait detection performance and patient preference.MethodsSixteen people with Parkinson’s disease were surveyed about sensor preferences. Raw IMU data from seven people with Parkinson’s disease, wearing up to eleven sensors, were used to train convolutional neural networks to detect freezing of gait. Models trained with data from different sensor sets were assessed for technical performance; a best technical set and minimal IMU set were identified. Clinical utility was assessed by comparing model- and human-rater-determined percent time freezing and number of freezing events.ResultsThe best technical set consisted of three IMUs (lumbar and both ankles, AUROC = 0.83), all of which were rated highly wearable. The minimal IMU set consisted of a single ankle IMU (AUROC = 0.80). Correlations between these models and human raters were good to excellent for percent time freezing (ICC = 0.93, 0.89) and number of freezing events (ICC = 0.95, 0.86), for the best technical set and minimal IMU set, respectively.ConclusionsSeveral IMU sets consisting of three IMUs or fewer were highly rated for both technical performance and wearability, and more IMUs did not necessarily perform better in FOG detection. We openly share our data and software to further the adoption of a general, open-source model that uses raw signals and a standard sensor set for at-home monitoring of freezing of gait.

scholarly journals Home-Based Exercise And People With Parkinson's Disease: A Systematic Review

2020 ◽  
Vol 16 (5) ◽  
pp. 230-232
Author(s):  
Marianne Hare ◽  
James Hill ◽  
Andrew Clegg
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Functional Outcomes ◽  
Postural Stability ◽  
Effective Intervention ◽  
Home Based ◽  
At Home

Background Exercise is seen as an effective intervention to combat the reduction in postural stability and increased chance of falls in Parkinson's patients. However, there is some debate as to where this exercise should take place. This article critically appraises and evaluates a systematic review looking at home-based exercise versus centre-based exercise for improving balance and functional outcomes.

scholarly journals 174 Benefits of a Self-Management Program for the Older Couple Living with Parkinson’s Disease: A Pilot Study

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Karen Lyons ◽  
Alex Zajack ◽  
Melissa Greer ◽  
Holly Chaimoy ◽  
Nathan Dieckmann ◽  
...  
Keyword(s):  
Older Adults ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Intervention Group ◽  
Management Program ◽  
Self Management ◽  
Relaxation Techniques ◽  
Wait List ◽  
Wait List Control ◽  
Mental Relaxation

Abstract Background Although community-based self-management workshops have been found to benefit older adults with Parkinson’s disease (PD), it is unclear if there could be added value for the couple if the spouse also participated. Methods A quasi-experimental two-wave design (0 and seven week follow-up) was used to explore the effects of a self-management program on the health and relational outcomes of older adults with PD and their spouses in comparison to a wait-list control condition. Thirty nine couples were enrolled and completed the study (19 in the intervention group and 20 in the wait-list control). Results Adjusting for baseline outcome values, spouses in the intervention group had significantly greater engagement in mental relaxation techniques (p < .001; d = 1.28) than those in the control condition at seven weeks. Additionally, moderate effect sizes were observed for increases in the mental relaxation (d = 0.44) and aerobic activity (d = 0.44) of older adults with PD and the strength-based activities of spouses (d = 0.33) in the intervention group. Small to moderate effects were observed for declines in the depressive symptoms of spouses (d = 0.29) and older adults with PD (d = 0.14) and care strain of spouses (d = 0.15) in the intervention group. Finally, perceptions of marital quality improved for older adults with PD (d = 0.46) and spouses (d = 0.41) and reports of protective buffering (i.e. hiding concerns) declined for older adults with PD (d = 0.24) and spouses (d = 0.33) in the intervention group compared to the wait-list control condition. Conclusion Preliminary data showed promise for self-management programs benefiting couples living with Parkinson’s disease. Although larger samples and randomized controlled trials are needed to establish the full benefit of such programs, greater attention to interventions for the older couple is warranted.

Stay mindfully active during the coronavirus pandemic: a feasibility study of a mHealth-delivered home-based mindfulness yoga program for people with Parkinson’s disease (Preprint)

2020 ◽  
Author(s):  
Jojo Y. Y. Kwok ◽  
Jung Jae Lee ◽  
Edmond Pui Hang Choi ◽  
Pui Hing Chau ◽  
Man Auyueng
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Feasibility Study ◽  
Freezing Of Gait ◽  
Motor Symptoms ◽  
Balance Confidence ◽  
Functional Balance ◽  
Home Based ◽  
Neurological Conditions

BACKGROUND Patients with long-term neurological conditions, such as Parkinson’s disease (PD), are particularly vulnerable to the public health measures taken to combat the COVID-19 pandemic. The inaccessibility of center-based rehabilitation further aggravated their motor dysfunctions as well as mental distress, leading to exacerbation of motor and non-motor symptoms, high utilization of healthcare and worsened health-related quality of life (HRQOL). OBJECTIVE This study aimed to evaluate the feasibility, safety, and preliminary effects of the mHealth-delivered home-based mindfulness yoga program for physio-psycho-spiritual wellbeing in patients with PD. METHODS For this prospective, single-arm, nonrandomized feasibility study, a sequential explanatory mixed-method design was used. Ten patients with PD experiencing impaired balance and mobility were invited to participate in the mHealth-delivered home-based mindfulness yoga program, which was delivered through eight biweekly 90 min doses with purely online components. Functional balance, motor symptoms, perceived balance confidence, perceived freezing of gait symptoms, anxiety and depression, mindfulness and HRQOL were measured. All outcomes were assessed online at baseline and 1 week post-intervention. All participants were invited to attend qualitative individual interviews to explore their experience of using online mindfulness yoga program as a lifestyle intervention for PD rehabilitation. RESULTS Of the 10 patients, 80% completed the program with an adherence rate of 98.4%. After the completion of the intervention, the participants showed significant improvement in overall functional balance (P≤0.01), motor symptoms (P=0.002), as well as reduced anxiety (P=0.002) and depressive symptoms (P=0.036). Insignificant improvement regarding perceived balance confidence during ‘off’ state, freezing of gait symptoms, non-judgement of inner experience and HRQOL was noted. Qualitative interviews revealed participants had a high preference of using the tele-rehabilitation approach to stay mindful and being active, both physically and socially, while confronting the changes brought by COVID-19 pandemic. CONCLUSIONS The mHealth-delivered home-based mindfulness yoga intervention was feasible, safe, and well-accepted among people with PD to relieve the burden brought by COVID-19 pandemic. Future studies should adopt a design with enhanced rigor, a comparison group, and enlarged sample size to evaluate the efficacy of the program in patients with long-term neurological conditions and/or physical impairments. The intervention dose should be increased to twice a week for a duration of at least 8 weeks to enhance psychophysiological effects. CLINICALTRIAL ChiCTR200003377, Chinese Clinical Trial Register (ChiCTR) - WHO

scholarly journals Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

Sensors ◽  
2019 ◽  
Vol 19 (24) ◽  
pp. 5468 ◽  
Author(s):  
Niveditha Muthukrishnan ◽  
James J. Abbas ◽  
Holly A. Shill ◽  
Narayanan Krishnamurthi
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Closed Loop ◽  
Freezing Of Gait ◽  
Movement Patterns ◽  
Step Length ◽  
Open Loop ◽  
Narrative Review ◽  
Movement Initiation ◽  
At Home

Progressive gait dysfunction is one of the primary motor symptoms in people with Parkinson’s disease (PD). It is generally expressed as reduced step length and gait speed and as increased variability in step time and step length. People with PD also exhibit stooped posture which disrupts gait and impedes social interaction. The gait and posture impairments are usually resistant to the pharmacological treatment, worsen as the disease progresses, increase the likelihood of falls, and result in higher rates of hospitalization and mortality. These impairments may be caused by perceptual deficiencies (poor spatial awareness and loss of temporal rhythmicity) due to the disruptions in processing intrinsic information related to movement initiation and execution which can result in misperceptions of the actual effort required to perform a desired movement and maintain a stable posture. Consequently, people with PD often depend on external cues during execution of motor tasks. Numerous studies involving open-loop cues have shown improvements in gait and freezing of gait (FoG) in people with PD. However, the benefits of cueing may be limited, since cues are provided in a consistent/rhythmic manner irrespective of how well a person follows them. This limitation can be addressed by providing feedback in real-time to the user about performance (closed-loop cueing) which may help to improve movement patterns. Some studies that used closed-loop cueing observed improvements in gait and posture in PD, but the treadmill-based setup in a laboratory would not be accessible outside of a research setting, and the skills learned may not readily and completely transfer to overground locomotion in the community. Technologies suitable for cueing outside of laboratory environments could facilitate movement practice during daily activities at home or in the community and could strongly reinforce movement patterns and improve clinical outcomes. This narrative review presents an overview of cueing paradigms that have been utilized to improve gait and posture in people with PD and recommends development of closed-loop wearable systems that can be used at home or in the community to improve gait and posture in PD.

A Video Self-Modelling Intervention Using Virtual Reality Plus Physical Practice For Freezing of Gait in Parkinson’s Disease: A Feasibility and Acceptability Study (Preprint)

2021 ◽  
Author(s):  
Lina Goh ◽  
Natalie E Allen ◽  
Naseem Ahmadpour ◽  
Kaylena A Ehgoetz Martens ◽  
Jooeun Song ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Virtual Reality ◽  
Outcome Measures ◽  
Freezing Of Gait ◽  
Secondary Outcome ◽  
Virtual Reality System ◽  
Physical Practice ◽  
Head Mounted Display ◽  
Movement Strategies

BACKGROUND Despite optimal medical and/or surgical intervention, freezing of gait occurs commonly in people with Parkinson’s disease, leading to reduced mobility, falls, poor quality of life and increased healthcare costs. Action observation via video self-modelling, combined with physical practice, has potential as a non-invasive intervention to reduce freezing of gait. OBJECTIVE To determine the feasibility and acceptability of a home-based, personalised video self-modelling intervention delivered via a virtual reality head mounted display to reduce freezing of gait in people with Parkinson’s disease. Secondary aims included investigating the potential effect of this intervention on freezing of gait, mobility and anxiety. METHODS A single group pre/post mixed methods pilot trial. Ten participants with Parkinson’s disease and freezing of gait were recruited. A physiotherapist assessed participants in their homes to identify person-specific triggers of freezing and developed individualised movement strategies to overcome freezing of gait. 180-degree videos of participants successfully performing their movement strategies were created. Participants watched their videos using a virtual reality head mounted display, followed by physical practice of their strategies in their own homes over a six-week intervention period. Primary outcome measures included feasibility and acceptability of the intervention. Secondary outcome measures included freezing of gait physical tests and questionnaires, Timed Up and Go test, 10m walk test, Goal Attainment Scale, and Parkinson Anxiety Scale. RESULTS Ten participants were recruited. The recruitment rate was 24% and retention rate was 90%. Adherence to the intervention was high, with participants completing a mean of 84% for the prescribed video viewing and a mean of 100% for the prescribed physical practice. One participant used the virtual reality head mounted display for one week and completed the rest of the intervention using a flatscreen device due to a gradual worsening of his motion sickness. No other adverse events occurred during the intervention or assessments. Most participants found using the head mounted display to view their videos interesting and enjoyable and would choose to use this intervention to manage their freezing of gait in the future. Five themes were constructed from interview data: reflections when seeing myself; my experience of using the virtual reality system; the role of the virtual reality system in supporting my learning; developing a deeper understanding on how to manage my freezing of gait; and impact of the intervention on my daily activities. Overall, there were minimal changes to the freezing of gait, mobility or anxiety measures from baseline to post-intervention, although there was substantial variability between participants. The intervention showed potential in reducing anxiety in participants with high levels of anxiety. CONCLUSIONS Video self-modelling using an immersive virtual reality head mounted display plus physical practice of personalised movement strategies is a feasible and acceptable method of addressing freezing of gait in people with Parkinson’s disease. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR12619000139178)

Sign in / Sign up

Export Citation Format

Share Document