scholarly journals Traditional Chinese Medicine Improves Activities of Daily Living in Parkinson's Disease

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Weidong Pan ◽  
Shin Kwak ◽  
Yun Liu ◽  
Yan Sun ◽  
Zhenglong Fang ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Activities Of Daily Living ◽  
Power Law ◽  
Daily Living ◽  
Rating Scale ◽  
Drug Efficacy ◽  
Disease Rating

We evaluated the effects of a traditional Chinese medicine (TCM), named Zeng-xiao An-shen Zhi-chan 2 (ZAZ2), on patients with Parkinson's disease (PD). Among 115 patients with idiopathic PD enrolled (mean age, 64.7 ± 10.2 years old), 110 patients (M = 65, F = 45; mean age, 64.9 ± 10.7 years old) completed the study. Patients took either ZAZ2 () or placebo granule () in a blind manner for 13 weeks while maintaining other anti-Parkinson medications unchanged. All participants wore a motion logger, and we analyzed the power-law temporal autocorrelation of the motion logger records taken on 3 occasions (before, one week, and 13 weeks after the drug administration). Drug efficacy was evaluated with the conventional Unified Parkinson Disease Rating Scale (UPDRS), as well as the power-law exponentα, which corresponds to the level of physical activity of the patients. ZAZ2 but not placebo granule improved the awake-sleep rhythm, the UPDRS Part II, Part II + III, and Part IV scores, and theαvalues. The results indicate that ZAZ2 improved activities of daily living (ADL) of parkinsonism and, thus, is a potentially suitable drug for long-term use.

Use of the Unified Parkinson’s Disease Rating Scale Activities of Daily Living Subscale to Assess Response to Rasagiline in Early Parkinson’s Disease

US Neurology ◽  
2011 ◽  
Vol 07 (02) ◽  
pp. 91
Author(s):  
Daniel E Kremens ◽  
James Gilbart ◽  
◽  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Activities Of Daily Living ◽  
Disease Progression ◽  
Daily Living ◽  
Rating Scale ◽  
Response To Treatment ◽  
Early Start ◽  
Secondary Analyses ◽  
Disease Rating

Various assessment scales are used to measure the severity and rate of progression of Parkinson’s disease (PD)—for example, the Unified Parkinson's Disease Rating Scale (UPDRS) and its Activities of Daily Living (ADL) subscale. The relative merits of these scales for accurately determining the degree of disease progression have recently come under scrutiny. Analyses of data from the recent Attenuation of disease progression with Azilect given once daily (ADAGIO) trial demonstrated that patients receiving early-start rasagiline (Azilect®, Teva Neuroscience, North Wales, PA) 1 mg/day experienced slower disease progression, as assessed by their mean total UPDRS score, than patients receiving placebo followed by delayed-start rasagiline treatment. Subsequent secondary analyses showed that 1 and 2 mg/day doses of early-start rasagiline delayed the need for antiparkinsonian drugs and improved other parameters, including ADL scores and fatigue, when compared with placebo followed by delayed-start rasagiline. Furthermore, the analyses highlighted that, over time, the motor and mentation sections of the UPDRS-ADL subscale increasingly reflect the response to treatment of the early- and delayed-start rasagiline 1 mg/day patient groups. The results from the ADAGIO trial suggest that rasagiline has potential disease-modifying effects, but more clinical data are required to confirm their effect on PD progression.

Microelectrode-guided posteroventral medial radiofrequency pallidotomy for Parkinson's disease

1997 ◽  
Vol 87 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Oleg Kopyov ◽  
Deane Jacques ◽  
Christopher Duma ◽  
Galen Buckwalter ◽  
Alex Kopyov ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Side Effects ◽  
Daily Living ◽  
Rating Scale ◽  
Target Region ◽  
Content Type ◽  
Significant Control ◽  
Yahr Scale ◽  
Disease Rating

✓ The outcome of radiofrequency-guided posteroventral medial pallidotomy was investigated in 29 patients with recalcitrant Parkinson's disease. Extracellular recordings were obtained in the target region to differentiate the internal from the external globus pallidus, and distinct waveforms were recorded in each region. Stimulation of the target site further verified the lesion location. Of the 29 patients treated during the course of 1 year, none showed any adverse side effects (such as hemianopsia or hemiparesis) from the procedure. Significant and immediate improvement in motor involvement (dyskinesia, rigidity, dystonia, freezing, and tremor) was observed as measured by the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr scale. Patients experienced improvements in their condition as measured on a self-rating scale, and their ability to perform the activities of daily living was also significantly improved. Although the onset and duration of the effect of a single dose of levodopa did not change, the number of hours in an “off” state of dyskinesia per day was significantly decreased. These results provide further evidence, in a large group of patients, that posteroventral medial pallidotomy results in significant control of the motor symptoms of Parkinson's disease with a minimum of undesirable side effects.

scholarly journals Προσδιορισμός των επιπέδων της α-συνουκλεΐνης στο εγκεφαλονωτιαίο υγρό και το πλάσμα ασθενών με νόσο Parkinson, άνοια της νόσου Parkinson και άνοια με σωμάτια Lewy

2019 ◽  
Author(s):  
Αναστασία Μπουγέα
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Daily Living ◽  
Mini Mental State Examination ◽  
Rating Scale ◽  
Neuropsychiatric Inventory ◽  
Clinical Dementia Rating ◽  
Compulsive Disorder ◽  
Disease Rating ◽  
State Examination

Θεωρητικό υπόβαθρο: Η νόσος του Πάρκινσον(PD), η άνοια στη νόσο του Πάρκινσον (PDD) και η άνοια με τα σώματα Lewy (DLB) αποτελούν κλινικά σύνδρομα γνωστά ως διαταραχές των σωματίων Lewy (LBD) επειδή έχουντα σωμάτια Lewyως κοινό παθολο-ανατομικό χαρακτηριστικό. Δεδομένου ότι η διάγνωσή τους παραμένει κυρίως κλινική, υπάρχει μεγάλο ενδιαφέρον για τη χρήση ενός ή περισσοτέρων βιοδεικτών για την έγκαιρη και έγκυρη διάγνωση και τη διαφορική διάγνωση μεταξύ αυτών των διαφορετικών μορφών παρκινσονισμού. Η α-συνουκλεΐνη (α-Syn) έχει κερδίσει την προσοχή ως εν δυνάμει βιοδείκτηςγια τις συνουκλεϊνοπάθειες. Ωστόσο,ο προσδιορισμός της ολικής α-Syn στο εγκεφαλονωτιαίο υγρό (ΕΝΥ) με τη μέθοδο ELISA και άλλες παρόμοιες τεχνικές απέδωσε αντικρουόμενα αποτελέσματα. Αντίστοιχες μελέτες της α-Syn στο πλάσμα/ορό έχουν επίσης δώσει αβέβαια αποτελέσματα. Τέτοιες αποκλίσεις έχουν συχνά αποδοθεί σε προ-αναλυτικούς και αναλυτικούς συγχυτικούς παράγοντες (ημερήσια διακύμανση, κεφαλοουραία διαβάθμιση της συγκλεντρωσης εντός του κεντρικού νευρικού συστήματος, το φύλο, την ηλικία και, κυρίως, η επιμόλυνση του ΕΝΥ από αίμα), στις διαφορετικές μεθόδους ELISA και στη μέτρηση διαφορετικών τύπων της α-Syn στο ΕΝΥ και το πλάσμα. Σκοπός: Έτσι, λαμβάνοντας υπόψη τις αδυναμίες των προηγούμενων ερευνών, η παρούσα διατριβή στοχεύει να ελέγξει για πιθανή διαφορά των επιπέδων της α-Syn στο ΕΝΥ, τον ορό και το πλάσμα ανάμεσα σε ασθενείς με νόσο PD, PDD, DLB και υγιείς μάρτυρες και τη διαγνωστική της αξία χρησιμοποιώντας βέλτιστες δυνατές μεθόδους και αυστηρή τήρηση των προαναλυτικών και αναλυτικών κατευθυντήριων οδηγιών.Μεθοδολογία: Στη μελέτη συμμετείχαν 77 ασθενείς (30 με PD, 18 με PDD και 29 με DLB) οι οποίοι νοσηλευτηκαν στην Α΄ Νευρολογική κλινική του Αιγινητείου Νοσοκομείου της Ιατρικής Σχολής του Πανεπιστημίου Αθηνών. Η διάγνωση ετέθη βάσει των πλέον πρόσφατων διαγνωστικών κλινικών κριτηρίων. Σε όλους τους ασθενείς ελήφθη πλήρες ιστορικό και διενεργήθηκε ενδελεχής αντικειμενική νευρολογική εξέταση. Επίσης υποβλήθησαν σε πλήρη κλινικοεργαστηριακό και απεικονιστικό έλεγχο, συμπεριλαμβανομένου τομοσπινθηρογραφήματος βασικών γαγγλίων με 123Ι-ioflupane (SPECT). Επίσης διενεργήθηκε νευροψυχολογικός έλεγχος με τις κάτωθι δοκιμασίες: Mini Mental State Examination (MMSE), CLOX 1-2, Frontal Assessment Battery (FAB), Clinical Dementia Rating (CDR), Neuropsychiatric Inventory (NPI),Questionnaire for Impulsive-Compulsive Disorder in Parkinson's Disease-Rating Scale (QUIP) και Instrumental Activities of Daily Living (IADL). Η κινητική αναπηρία των παρκινσονικών ασθενών αξιολογήθηκε με βάση την κλίμακα Unified Parkinson's Disease Rating Scale (UPDRS Ι-ΙV), η σταδιοποίησή τους με τις κλίμακες των Hoehn και Yahrκαι των Schwab και England. Η ομάδα ελέγχου αποτελείται από 30 υγιή άτομα χωρίς ιστορικό νευρολογικής ή ψυχιατρικής νόσου και φυσιολογική βαθμολογία στις ανωτέρω δοκιμασίες και κλίμακες. Όλοι οι συμμετέχοντες υποβλήθηκαν σε οσφυϊκή παρακέντηση μεταξύ 9-12 π.μ. μετά από ολονύκτια νηστεία. Δείγματα ΕΝΥ και πλάσματος/ ορού ελήφθησαν σε σωληνάρια από πολυπροπυλένιο, φυγοκεντρήθηκαν σε 2000xg για 10 λεπτά και αποθηκεύτηκαν στους -80 ° C μέχρι την ανάλυση. Δείγματα ΕΝΥ με περισσότερα από 50 ερυθρά αιμοσφαίρια απορρίφθηκαν. Αποτελέσματα: Η ηλικία κατά την έναρξη της νόσου ήταν μεγαλύτερη στους ασθενείς με DLB και οι βαθμολογίες MMSE ήταν υψηλότερες σε ασθενείς με PD. Μεγαλύτερες μέσες τιμές UPDRS-III καταγράφηκαν στους PDD και χαμηλότερες σε ασθενείς με PD. Μετά τη διόρθωση του Bonferroni διαπιστώθηκαν σημαντικά χαμηλότερες τιμές του Αβ42 σε ασθενείς με DLB σε σύγκριση με μάρτυρες (p = 0,002), ασθενείς με PD (p <0,001) και ασθενείς με PDD (p = 0,021). Επιπλέον, ηΤΡ-181 είχε σημαντικά χαμηλότερες τιμές σε ασθενείς με PD σε σύγκριση με ασθενείς με DLB (p = 0,028). Μεγαλύτερες τιμές α-Syn στο ΕΝΥ βρέθηκαν σε ασθενείς με DLB σε σύγκριση με τους μάρτυρες (p <0,001), ασθενείς με PD (p <0,001) και με PDD (p <0,001). Η ομάδα έλεγχου είχε σημαντικά χαμηλότερες τιμές α-Syn ορού σε σύγκριση με τους ασθενείς με PD (p <0,001), με PDD (p <0,001) και με DLB (p <0,001). Επιπλέον, οι ασθενείς με PDD είχαν σημαντικά υψηλότερες τιμές του πλάσματος α-Syn σε σύγκριση με τους μάρτυρες (p= 0,023). Ανεξαρτήτως ομάδας ασθενών, τα επίπεδα της α-Syn στο ΕΝΥ συσχετίζονταν σημαντικά με την Aβ42, ενώ τα επίπεδα της α-Syn στο πλάσμα συσχετίζονταν με την Τp-181. Αφαιρώντας τους 7 ασθενείς με DLB με προφιλ ΕΝΥ παθολογίας τύπου Alzheimer (Τt≥ 376, Aβ42≤580 and ΤP-181≥ 62.5 pg/ml) ανεύρεθηκαν σημαντικά υψηλότερες τιμές για την α-Syn ορού και πλάσματος αλλά οριακά για την πρωτεϊνη ΤP-181 στην ομάδα των LBDs συγκριτικά με την ομάδα ελέγχου. Η ανάλυση ROC έδειξε ότι οι α-Syn και Αβ42 στο ΕΝΥ είχαν την καλύτερη διακριτική ικανότητα μεταξύ PD και DLB. Επιπλέον, η διακριτική ικανότητα μεταξύ PDD και DLB ήταν παρόμοια για τις α-Syn και Αβ42 στο ΕΝΥ. Η α-Syn στον ορό έδειξε την καλύτερη διακριτική ικανότητα μεταξύ των PD και μαρτύρων ή μεταξύ PDD και μαρτύρων. Προέκυψαν τέλος οριακές συσχετίσεις μεταξύ βιοδεικτών της α-Syn και της Τp-181 και συγκεκριμένων νευροψυχολογικών/συμπεριφορικών κλιμάκων. Συμπεράσματα: Η α-Syn και η Αβ42 στο ΕΝΥ και τον ορο θα μπορούσαν να θεωρηθουν εν δυναμει βιοδεικτες για την διαφοροδιαγνωση των ασθενών στο φάσμα της LBD αφού έδειξαν την καλύτερη διακριτική ικανότητα μεταξύ των ομάδων PD- PDD και DLB. Εφ’ όσον επιβεβαιωθούν τα αποτελέσματα, η α-Syn του ορού, και, σε μικρότερο βαθμό, του πλάσματος, θα μπορούσαν να θεωρηθούν βιοδείκτες διάγνωσης των LBDs, καθώς εμφανίζουν υψηλότερες τιμές σε σχέση με άτομα ελέγχου.

scholarly journals Dementia and functional decline in patients with Parkinson's disease

2008 ◽  
Vol 2 (2) ◽  
pp. 96-101 ◽  
Author(s):  
Florindo Stella ◽  
Claudio Eduardo Muller Banzato ◽  
Elizabeth Maria Aparecida Barasnevicius Quagliato ◽  
Maura Aparecida Viana ◽  
Gustavo Christofoletti
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Rating Scale ◽  
Clinical Stage ◽  
Functional Decline ◽  
Clinical Staging ◽  
Consecutive Series ◽  
Significant Difference

Abstract Functional decline in Parkinson's disease (PD), characterized by reduced ability to carry out activities of daily living, usually results from typical motor impairment and may be aggravated by concomitant cognitive impairment. Objective: To compare the functional decline in Parkinson's disease between patients with dementia and cognitively preserved patients. Methods: From an original sample composed of 50 patients with a clinical diagnosis of idiopathic PD seen in a consecutive series, 33 non-depressed patients were selected comprising 13 with dementia and 20 cognitively preserved individuals. All patients enrolled in this study were drawn from a public outpatient clinic, specialized in movement disorders. The clinical stage of PD was determined by the Hoehn & Yahr scale, and the functional capacity was verified using the Unified Parkinson's Disease Rating Scale UPDRS ADL (subscale II: activities of daily living) and the Schwab & England scale. The two last scales measure the functional degree of independence in activities of daily living. The neuropsychological assessment was performed using The Cambridge Examination for Mental Disorders of the Elderly - CAMCOG, Cognitive Section and the Stroop Color Word Test. Results: As expected, in comparison with cognitively preserved patients, the group with dementia presented significantly lower scores throughout the neuropsychological evaluation. The patients with dementia were found to have a longer period of disease, a more advanced clinical staging according to the Hoehn & Yahr, and greater functional decline according both to the UPDRS ADL and Schwab & England, with statistically significant difference between the groups. Conclusion: Patients with dementia were at a more advanced clinical stage of Parkinson's disease and evidenced greater functional decline in comparison with patients without dementia.

Systematic Review of Traditional Chinese Medicine for Depression in Parkinson's Disease

2014 ◽  
Vol 42 (05) ◽  
pp. 1035-1051 ◽  
Author(s):  
Yi Zhang ◽  
Zhen-Zhen Wang ◽  
Hong-Mei Sun ◽  
Ping Li ◽  
Yun-Feng Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Rating Scale ◽  
Weighted Mean Difference ◽  
Motor Symptom ◽  
Literature Searches ◽  
Conventional Drug

Depression is the most common non-motor symptom of Parkinson's disease (PD). Recent clinical trials have evaluated the effectiveness of traditional Chinese medicine (TCM) in the treatment of depression in PD (dPD). However, the results are conflicting rather than conclusive. To investigate the effectiveness of TCM for the treatment of dPD, a systematic review was conducted. Literature searches and collections were performed to identify studies addressing the treatment of TCM for dPD. The methodological quality and risk of bias in all studies included were evaluated. Weighted mean difference (WMD) with 95% confidence interval (CI) was used as the effect measure. Finally, a total of 10 studies involving 582 patients were identified. The pooled results revealed that TCM combined with conventional drugs significantly improved the total scores of the unified Parkinson's disease rating scale (WMD = -7.35, 95% CI: -11.24 to -3.47) and the score of the Hamilton rating scale for depression (HAM-D) (WMD = -4.19, 95% CI: -5.14 to -3.24) compared with conventional drug, respectively. Conclusively, there is evidence that TCM may be beneficial to the treatment of dPD in spite of the methodological weakness of the included studies.

Minimal clinically important differences for the experiences of daily living parts of movement disorder society-sponsored unified Parkinson's disease rating scale

2017 ◽  
Vol 32 (5) ◽  
pp. 789-793 ◽  
Author(s):  
Krisztina Horváth ◽  
Zsuzsanna Aschermann ◽  
Márton Kovács ◽  
Attila Makkos ◽  
Márk Harmat ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Movement Disorder ◽  
Daily Living ◽  
Rating Scale ◽  
Disease Rating ◽  
Movement Disorder Society

scholarly journals Quality of life in Parkinson’s disease patients: progression markers of mild to moderate stages

2017 ◽  
Vol 75 (8) ◽  
pp. 497-502 ◽  
Author(s):  
Raissa Carla Moreira ◽  
Marise Bueno Zonta ◽  
Ana Paula Serra de Araújo ◽  
Vera Lúcia Israel ◽  
Hélio A. G. Teive
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Daily Living ◽  
Rating Scale ◽  
Older Individuals ◽  
Daily Living Activities ◽  
Disease Rating ◽  
Progression Markers

ABSTRACT Objective To investigate which factors are associated with the quality of life decline in Parkinson’s disease patients from mild to moderate stages. Methods The Unified Parkinson’s Disease Rating Scale and Parkinson’s Disease Questionnaire-39 were used to evaluate clinical/functional data and the quality of life. Results The markers of clinical/functional worsening were drooling (p < 0.004), need for assistance with hygiene (p = 0.02), greater freezing frequency (p = 0.042), bradykinesia (p = 0.031), greater intensity of the resting tremor (p = 0.035) and “pill rolling” (p = 0.001). The decline in quality of life was related to stigma (p = 0.043), greater impairment in cognition (p = 0.002), mobility (p = 0.013) and for daily living activities (p = 0.05), and was considered more significant in men, married, older individuals, and those with a longer time of disease. Conclusions The quality of life worsening markers at the moderate stage were related to stigma, worsening of cognition, and to greater impairment in mobility and daily living activities.

scholarly journals Relation of chair rising ability to activities of daily living and physical activity in Parkinson’s disease

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mon S. Bryant ◽  
Gu Eon Kang ◽  
Elizabeth J. Protas
Keyword(s):  
Physical Activity ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Rating Scale ◽  
Motor Impairment ◽  
The Elderly ◽  
Activity Levels ◽  
Cross Sectional

Abstract Background Many persons living with Parkinson’s disease (PD) have difficulty rising from a chair. Impaired ability to perform the chair rise may be associated with low physical activity levels and reduced ability to perform activities of daily living (ADL). Methods Cross-sectional analysis was performed in 88 persons with PD to study the association of chair rising ability with ADL and physical activity. Results We found that the participants who pushed themselves up from the chair had more severe PD, higher motor impairment and more comorbidity than those who rose from a chair normally. The Unified Parkinson’s Disease Rating Scale ADL (UPDRS-ADL), Schwab and England Activities of Daily Living Scale (SE-ADL) and the Physical Activity Scale for the Elderly (PASE) scores for the participants who pushed themselves up to rise (17.20 ± 7.53; 76.67 ± 13.23; 46.18 ± 52.64, respectively) were significantly poorer than for those who rose normally (10.35 ± 3.79; 87.64 ± 8.30; 112.90 ± 61.40, respectively) (all p < .05). Additionally, PASE scores were significantly poorer for participants who pushed themselves up to rise compared to those who rose slowly (95.21 ± 60.27) (p < .01). Pushing up to rise from a chair was a significant predictor of UPDRS-ADL (β = .357; p < .001; R2 = .403), SE-ADL (β = −.266; p = .009; R2 = .257) and PASE (β = −.250; p = .016; R2 = .162). Conclusions Ability to rise from a chair was associated with ADL limitation and physical activity in persons with PD. Poor ability to rise from a chair may prevent persons from living independently and engaging in physical activity.

Clinical Study of Fetal Mesencephalic Intracerebral Transplants for the Treatment of Parkinson's Disease

1996 ◽  
Vol 5 (2) ◽  
pp. 327-337 ◽  
Author(s):  
Oleg V. Kopyov ◽  
Deane “Skip” Jacques ◽  
Abraham Lieberman ◽  
Christopher M. Duma ◽  
Robert L. Rogers
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Daily Living ◽  
Rating Scales ◽  
Rating Scale ◽  
Motor Tasks ◽  
Patients Âgés ◽  
Foot Tapping ◽  
Disease Rating ◽  
Ventral Mesencephalic

This study reports our findings from 22 patients (ages ranging from 42 to 73 yr; mean = 55.2) with recalcitrant idiopathic Parkinson's disease (PD) who received implants of fetal ventral mesencephalic tissue using an MRI-guided stereotactic procedure and who have been followed for at least 6 mo postoperatively, employing the guidelines established by the Core Assessment Program for Intracerebral Transplantations. Evaluations were videotaped and were performed both on and off levodopa medications. To date, we have seven patients with 24 mo, three with 18 mo, three with 12 mo, and nine with 6 mo of postsurgical assessments. Comparing surgical outcomes to levels prior to fetal transplants we found: 1) mean levodopa levels were reduced 46% at 6 mo, 12% at 12 mo, 20% at 18 mo, and 54% at 24 mo; 2) Unified Parkinson's Disease Rating Scale (UPDRS) scores with patients on levodopa were improved by an average of 38% (6 mo), 50.2% (12 mo), 69.3% (18 mo), and 73.9% (24 mo), while off medication scores showed reductions ranging from 24.7% at 6 mo to 55.1% at 24 mo. Other measures, including Hoehn-Yahr staging, Activities of Daily Living, and dyskinesia rating scales, were also significantly improved following fetal transplants. Timed motor tasks (finger dexterity, supination-pronation, foot tapping, and Stand-Walk-Sit) performance also demonstrated highly significant improvements. Patient's self-rating scores indicated that the patients typically perceived substantial improvements in their condition. However, substantial variability in the improvements following surgery still persists and range from nominal improvements in performance to significant changes that can be classified as altering the overall lifestyle of the patients. To date, 4 of the 22 subjects were considered by the physicians to be nonresponders; that is, there were no clinically relevant improvements in these patients' conditions.

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