Baseline predictors of progression of Parkinson’s disease in a sample of Egyptian patients: clinical and biochemical

Background Clinical progression of Parkinson’s disease (PD) is highly heterogeneous, and its predictors are generally lacking. Identifying predictors of early disease progression is important for patients’ management and follow-up. The current study aims to identify clinical, neuroimaging and biochemical baseline predictors of motor progression in patients with PD. Forty-five PD patients were assessed at baseline, 6 months and 1 year using MDS-UPDRS total and subscores, Hoehn and Yahr (H&Y), Schwab and England (S&E), International Physical Activity Questionnaire (IPAQ). Baseline New Freezing of Gait Questionnaire (NFOG-Q), Berg Balance Scale (BBS), Ten-Meter Walking Test (10-MWT), and Time Up and Go Test (TUG), Non-Motor Symptoms Scale (NMSS), Beck Depression Inventory (BDI), PD questionnaire 39 (PDQ-39), MRI brain, uric acid, lipid profile and glycated hemoglobin were performed. Results Significant worsening of MDS-UPDRS total, part III scores, H&Y, S&E and IPAQ (p < 0.001) was detected. One-year progression of H&Y and S&E were significantly correlated to disease duration (p = 0.014, p = 0.025, respectively). Progression of H&Y was correlated to baseline TUG (p = 0.035). S&E progression was correlated to baseline MDS-UPDRS total score (rho = 0.478, p = 0.001) and part III (rho = 0.350, p = 0.020), H&Y (rho = 0.401, p = 0.007), PIGD (rho = 0.591, p < 0.001), NFOG-Q (rho = 0.498, p = 0.001), and TUG (rho = 0.565, p = 0.001). Using linear regression, there was no predictors of clinical progression among the used baseline variables. Conclusion Despite the significant motor and physical activity progression over 1 year that was correlated to baseline motor and gait severity, but without predictive value, further similar and longitudinal studies are warranted to detect predictors of early progression and confirm findings.

Acupuncture Therapy on Patients with Flaccid Hemiplegia after Stroke: A Systematic Review and Meta-Analysis

Background. Acupuncture is a commonly used complementary treatment for flaccid hemiplegia caused by stroke, but evidences from previous randomized trials were inconclusive. The purpose of this study was to evaluate the efficacy and safety of acupuncture in a comprehensive synthesis. Methods. We searched literature from eight databases from their inception to December 2020. We included randomized controlled trials of acupuncture for the treatment of flaccid hemiplegia following stroke. The meta-analysis was carried out using Review Manager 5.3 and Stata 16.0. The main indicator was the Fugl-Meyer Assessment scale. The modified Barthel Index scale, Quality Of Life Assessment scale, Mini-Mental State Examination scale, Berg Balance Scale, Neurological Deficit Assessment scale, and the treatment effective rate were used to measure the secondary indicators. Adverse events from individual studies were used to determine safety. Results. Our search returned 7624 records, of which 27 studies involving a total of 1,293 patients fulfilled our inclusion criteria. To be noted, our results indicated that significant improvements in the scores of the primary indicator showed better clinical scores among the three groups with acupuncture than without acupuncture: acupuncture compared with rehabilitation, 13.53 (95% CI 11.65–14.41, P < 0.01 ); acupuncture plus rehabilitation compared with rehabilitation, 9.84 (95% CI 6.45–13.24, P < 0.01 , I2 = 98%); and acupuncture plus Western medicine therapy compared with Western medicine, 16.86 (95% CI 15.89–17.84, P < 0.01 , I2 = 38%), and the secondary indicators showed the same tendency. Conclusion. Acupuncture was effective and safe in the patients with flaccid hemiplegia after stroke, although there was high heterogeneity between studies.

Effect of Ankle Kinesio Taping on Dynamic Balance in Stroke Patients- A Pilot Study

Background: Stroke causes partial brain loss, which leads to a functional abnormality of the brain, which produces a variety of symptoms the most prevalent of which is balance affection. Kinesio tape is a thin, light and elastic material which does not immobilize the joint and allows for free movement irrespective of the tape. It serves to facilitate or inhibit the muscle as needed and provides joint stability which will help improve balance function. It is also used to reduce pain, which is a typical complaint in stroke patients. Objective: To assess for immediate and post effects of kinesio tape in stroke patients using Berg Balance Scale and 10 Meter walk test. Method: A total of 15 participants were chosen based on inclusion and exclusion criteria. Before application of kinesio tape, the Berg balance scale and a 10-meter walk test were performed and recorded. Following the application, the subjects were reassessed, and the outcomes of the 5-day follow-up were recorded. These scores were statistically analyzed. Result: The statistical analysis showed that there is a significant increase in the dynamic balance function post kinesio tape application. An average increase of 5 scores in BBS was noted and average improvement of 5.70 seconds in 10MWT. Conclusion: This study concludes that there is a significant improvement on dynamic balance after application of kinesio tape in stroke patients. Key words: Stroke, kinesio tape, dynamic balance.

Changes in Function and Muscle Strength of Encephalitis Survivors After Inpatient Rehabilitation

Objective To investigate the clinical demographics and rehabilitative assessments of encephalitis survivors admitted to a rehabilitation center, and to confirm the effects of inpatient rehabilitation manifested by changes in muscle strength and function after hospitalization.Methods Data of encephalitis survivors who received rehabilitation at our institution from August 2009 to August 2019 were reviewed. Medical charts were retrospectively reviewed, and motor, functional, and cognitive assessments were collected. Manual muscle testing (MMT), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), Korean version of Modified Barthel Index (K-MBI), grip strength, Box and Block Test (BBT), and Korean version of Mini-Mental State Examination (K-MMSE) were performed, and the results upon admission and discharge were compared and analyzed.Results Most of the patients with encephalitis admitted to our institution had viral or autoimmune etiologies. The assessment results of 18 encephalitis patients upon admission and discharge were compared. The total K-MBI score, FAC, grip strength, and BBT significantly improved, but not the MMT and FMA. Subgroup analysis was performed for viral and autoimmune encephalitis, which are the main causes of the disease, but there was no difference in items with significant changes before and after hospitalization.Conclusion Encephalitis survivors showed a significant improvement in functional assessment scale during their hospital stay through rehabilitation, without significant changes in motor strength. Hence, we can conclude that encephalitis survivors benefit from inpatient rehabilitation, targeting functional gains in activities of daily living training more than motor strength.

Effect of Swiss Ball Training on Balance and Postural Stability in Stroke Patient

Stroke is sudden loss of neurological function. It is caused by interruption in cerebral blood flow. Objectives: To analyze the difference in the balance and postural stability score pre &post swiss ball training in stroke patients. Study Design: Randomized control trial. Methodology: This study was performed on stroke patients which are selected according to inclusion and exclusion criteria. The patients were allocated randomly into two groups, experimental group with exercises being performed on swiss ball and control group with exercises performed as per conventional methods with no additional intervention. Statistical analysis: SPSS software, v 20 analyzed data. Independent samples t test and paired sample test were applied. Results: The results showed mean difference of Berg Balance Scale at pre-intervention level and post-interventional level was 0.15 and 14.15 with p values 0.653 and 0.000, respectively. The TIS also showed non-significant difference at pre-interventional level as shown by p value 0.170 , which was significant at post interventional level with a p value to be 0.000 . Paired sample statistics showed a significant improvement for both groups at pre-post level of measurement with a p value of 0.000. Conclusion: We concluded that in stroke patients performing exercises on swiss ball showed significant better outcomes as compared to control group in improving balance and postural stability. However, both groups improved significantly when tested at pre-post levels of measurement. Keywords: Swiss Ball, Stroke, Physical Therapy, Exercise Therapy and Balance.

Change in Balance and Neuropsychological Measures Post-Lumbar Drain Trial in Patients with Suspected Normal Pressure Hydrocephalus

<b><i>Objective:</i></b> Ventriculoperitoneal (VP) shunting is commonly used to treat normal pressure hydrocephalus (NPH). Assessment of cognition and balance pre- and post-lumbar drain (LD) can be used to provide objective metrics which may help determine the potential benefit of VP shunting. The aim of this investigation was to determine which measures identify clinical change as a result of a LD trial and to develop recommendations for standard NPH clinical assessment procedures. <b><i>Methods:</i></b> The Berg Balance Scale (BBS) and a brief battery of commonly used neuropsychological tests pre- and post-LD (MMSE, trail making test, animal fluency, Hopkins Verbal Learning Test – Revised, and digit span) were administered to 86 patients with a diagnosis of NPH. Subjects were divided into groups based on whether or not clinical change was present, and thus, VP shunting was recommended post-LD, and predictors of group membership were examined. <b><i>Results:</i></b> Significant improvements (<i>p</i> &#x3c; 0.05) were seen on the BBS and Trail Making Part B in the VP shunt-recommended group, with no other significant changes over time in either group. Regression analyses found that VP shunt recommendation was accurately predicted for 80% of the sample using the BBS score alone, with accuracy increasing to 85% when Trails B was added. <b><i>Conclusions:</i></b> Scores from the BBS and Trails B were most likely to change in those chosen to undergo VP shunting post-LD. Given that the typical clinical presentation of NPH includes gait disturbance and cognitive impairment, it is recommended that a standard pre-/post-LD evaluation include the BBS and trail making test.

Аналіз наявних інструментів оцінювання впливу фізичної терапії на осіб з хворобою Паркінсона

Резюме. Правильний і обґрунтований вибір інструментальних методів оцінювання функціо-нального стану пацієнта є обов’язковою умовою адекватної фізичної терапії. Особливе місце цей аспект займає в системі нейрореабілітації пацієнтів з хворобою Паркінсона в Україні, оскільки на сьогодні кількість осіб, що потребують систематичної фізичної терапії, сягає 23 900 тис. Наростаюча маніфестація моторних і немоторних симптомів при хворобі Паркін-сона, від яких часто вирішальною мірою залежить тяжкість стану пацієнта, негативно впливає на якість його життя. Наявні функціональні порушення, які є самостійними проявами хвороби Паркінсона, вимагають специфічного підходу до комплексного інструментального досліджен-ня цих порушень для визначення диференційно-діагностичних критеріїв та оцінювання впливу фізіотерапевтичного втручання. Мета. Проаналізувати наявні інструменти оцінювання впливу фізичної терапії на осіб з хворобою Паркінсона. Методи. Теоретичний аналіз та узагальнення зарубіжних даних спеціальної науково-методичної літератури з питань застосування інстру-ментів оцінювання при хворобі Паркінсона та їх інформативності і надійності у фізичній терапії. Результати. Представлені дані свідчать, що ефективність запроваджених заходів фізичної терапії при хворобі Паркінсона залежить від правильно підібраних інструментів оцінювання, які дозволяють оцінити моторні і немоторні проблеми через призму життєдіяльності і якості життя пацієнта. Основним інструментом оцінювання для вирішення цього питання вважаєть-ся Уніфікована рейтингова шкала хвороби Паркінсона MDS-UPDRS, яка дозволяє об’єктивно оцінити моторні і немоторні аспекти життя пацієнта і його рухову активність. Оскільки наявні моторні й аксіальні рухові порушення негативно впливають на повсякденну функціональну активність пацієнта, для верифікації цих порушень пропонують використовувати тест для оці-нювання часу підйому і ходьби (Timed Up and Go (TUG)); тест з подвійним завданням (Dual-Task TUG (TUG-DT)) та шкалу рівноваги Берга (Berg Balance Scale (BBS)). Але виходячи з того, що ці тести недостатньо чутливі до невеликих змін у рухливості при хворобі Паркінсона, особливо на середніх і пізніх стадіях захворювання, їх доцільно поєднувати з одним із кількісних тестів для оцінювання ходьби: 10-метровим тестом ходьби (10 Meter Walk Test (10MW)) та 6-хвилинним тестом ходьби (Six Minute Walk Distance (6MWT)). Поняття «життєдіяльність» включає в себе не тільки переміщення, її оцінювання має бути доповнено аналізом ступеня впливу наявних по-рушень на повсякденну діяльність, тобто на якість життя пацієнта. Найбільш інформативними інструментами для проведення цього аналізу є універсальні і специфічні при хворобі Паркінсо-на опитувальники з метою оцінювання стану здоров’я SF-36, EuroQOL (EQ-5D) і PDQ-39 (The Parkinson’s Disease Questionnaire). Результати аналізу та узагальнення даних науково-мето-дичної літератури дають підставу встановити, що маніфестація порушень та їх варіабельність при хворобі Паркінсона стають серйозною проблемою у досягненні кінцевого результату за-проваджених заходів фізичної терапії на всіх стадіях захворювання. Використання в комплексі стандартної експертно-реабілітаційної діагностики спеціальних інструментів оцінювання дозволяє об’єктивізувати оцінювання клінічної інформації та стимулює розроблення особисто-орієнтованих реабілітаційних стратегій із застосуванням заходів фізичної терапії, спрямованих на покращення якості життя пацієнтів з хворобою Паркінсона. Ключові слова: хвороба Паркінсона, фізична терапія, якість життя, інструменти оцінювання, достовірність, надійність, валідність.

Associations Between Time After Stroke and Exercise Training Outcomes: A Meta‐Regression Analysis

Background Knowledge gaps exist regarding the effect of time elapsed after stroke on the effectiveness of exercise training interventions, offering incomplete guidance to clinicians. Methods and Results To determine the associations between time after stroke and 6‐minute walk distance, 10‐meter walk time, cardiorespiratory fitness and balance (Berg Balance Scale score [BBS]) in exercise training interventions, relevant studies in post‐stroke populations were identified by systematic review. Time after stroke as continuous or dichotomized (≤3 months versus >3 months, and ≤6 months versus >6 months) variables and weighted mean differences in postintervention outcomes were examined in meta‐regression analyses adjusted for study baseline mean values (pre‐post comparisons) or baseline mean values and baseline control‐intervention differences (controlled comparisons). Secondary models were adjusted additionally for mean age, sex, and aerobic exercise intensity, dose, and modality. We included 148 studies. Earlier exercise training initiation was associated with larger pre‐post differences in mobility; studies initiated ≤3 months versus >3 months after stroke were associated with larger differences (weighted mean differences [95% confidence interval]) in 6‐minute walk distance (36.3 meters; 95% CI, 14.2–58.5), comfortable 10‐meter walk time (0.13 m/s; 95% CI, 0.06–0.19) and fast 10‐meter walk time (0.16 m/s; 95% CI, 0.03–0.3), in fully adjusted models. Initiation ≤3 months versus >3 months was not associated with cardiorespiratory fitness but was associated with a higher but not clinically important Berg Balance Scale score difference (2.9 points; 95% CI, 0.41–5.5). In exercise training versus control studies, initiation ≤3 months was associated with a greater difference in only postintervention 6‐minute walk distance (baseline‐adjusted 27.3 meters; 95% CI, 6.1–48.5; fully adjusted, 24.9 meters; 95% CI, 0.82–49.1; a similar association was seen for ≤6 months versus >6 months after stroke (fully adjusted, 26.6 meters; 95% CI, 2.6–50.6). Conclusions There may be a clinically meaningful benefit to mobility outcomes when exercise is initiated within 3 months and up to 6 months after stroke.

Gambaran Funtional Electrical Stmulation (FES) Untuk Memperbaiki Drop Foot Gait Pasca Stroke: Literature Review

Stroke sufferers who survive experience gait disorders because of damage to brain blood vessels that occurs when the arteries that supply blood to the brain are blocked, so that brain cells lose their oxygen supply which can lead to complaints of feeling weak in the lower limbs and the legs tend to wither or drop foot. . The Drop Foot Gait Rehabilitation Program is essential for improving muscle strength and muscle contraction. One of the Rehabilitation for Drop Foot Gait Post Stroke is FES. This study aims to analyze the effect of Functional Electrical Stimulation to correct Drop Foot Gait post stroke from various references. Selection of articles on literature review it uses PICO. Article writing using search literature through PubMed, Science Direct and Google Scholar with the inclusion criteria and exclusion criteria that have been determined. Literature restricted from 2010 – 2020. From result literature review The five articles show that the results of the characteristics of the respondents based on the gender of male 54.9% and female 45.1%, the results of the characteristics of the respondents based on the age of 100% less than 50 years, and the results of 4 articles of the characteristics of the respondents based on increasing gait using Berg Balance Scale measuring instrument is the average value of pre-test 5.40 and post-test average of 3.57 with a difference of 1.83. The results of a literature review of 1 article using a measuring toolElectroencephalogram that is with the results of the pre-test score of 5.5 and the post-test average of 0.8 with a difference of 4.7. So there is an increase in the patient's gaitDrop Foot Gait Post Stroke using Functional Electrical Stimulation (FES). Functional Electrical Stimulation has an effect on improving the gait of Drop Foot patients after stroke. As a basis for further research, especially regarding. Functional Electrical Stimulation to improve Drop Foot Gait after stroke.Keywords : strokes; post stroke;berg balance scale; drop foot gaitpost stroke Abstrak Penderita Stroke yang bertahan hidup mengalami gangguan berjalan akibat terjadinya kerusakan pembuluh darah otak yang terjadi ketika arteri yang memasok darah ke otak tersumbat, sehingga sel sel otak kehilangan suplai oksigen yang mengakibatkan keluhan merasa lemah pada anggota gerak bawah dan kaki cenderung layuh atau Drop Foot. rogram Rehabilitasi Drop Foot Gait sangat penting untuk meningkatkan kekuatan otot dan kontraksi otot. Salah satu Rehabilitasi untuk Drop Foot Gait Pasca Stroke adalah Functional Electrical Stimulation. Penelitian ini bertujuan untuk menganalisa pengaruh Functional Electrical Stimulation untuk memperbaiki Drop Foot Gait pasca stroke dari berbagai referensi. Pemilihan artikel pada literature review ini menggunakan PICO. Penulisan artikel menggunakan penelusuran literature melalui PubMed, Science Direct dan Google Scholar dengan kriteria inklusi dan kriteria eksklusi yang telah ditentukan. Literature diberi batasan dari tahun 2010 – 2020. Dari hasil literature review kelima artikel menunjukan bahwa hasil dari karakteristik responden berdasarkan jenis kelamin laki-laki 54,9% dan perempuan 45,1%, hasil dari karakteristik responden berdasarkan usia dari 4 artikel yaitu dengan rentang usia 20-80 tahun dan 1 artikel dengan rata-rata usia 60,7 tahun, hasil 4 artikel dari karakteristik responden berdasarkan peningkatan gaya berjalan menggunakan alat ukur Berg Balance Scale yaitu nilai rata-rata pre test 5,40 dan rata-rata post-test 3,57 dengan selisih 1,83. Hasil literature review 1 artikel menggunakan alat ukur Electroensefalogram mendapatkan hasil nilai pre test 5,5 dan post test 0,8 dengan selisih 4,7. Sehingga ada peningkatan gaya berjalan pada pasien Drop Foot Gait Pasca Stroke menggunakan Functional Electrical Stimulation (FES). Functional Electrical Stimulation berpengaruh untuk memperbaiki gaya berajalan pasien Drop Foot pasca stroke. sebagai dasar untuk penelitian-penelitian lebih lanjut khususnya mengenai Functional Electrical Stimulation untuk memperbaiki Drop Foot Gait pasca stroke dan direkomendasikan untuk profesi fisioterapi sebagai bahan literasi untuk pemberian intervensi pada kasus Drop Foot Gait Pasca Stroke menggunakan FES.Kata Kunci : stroke; pasca stroke; berg balance scale; drop foot gait post stroke.

Efficacy of Virtual Reality and Exergaming in Improving Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Multiple sclerosis (MS) is one of the most common causes of neurological progressive disease and can lead to loss of mobility, walk impairment, and balance disturbance. Among several rehabilitative approaches proposed, exergaming and virtual reality (VR) have been studied in the recent years. Active video game therapy could reduce the boredom of the rehabilitation process, increasing patient motivation, providing direct feedback, and enabling dual-task training. Aim of this systematic review was to assess the efficacy of exergaming and VR for balance recovery in patients with MS. PubMed, Scopus, and Web of Science were systematically searched from the inception until May 14, 2021 to identify randomized controlled trials (RCTs) presenting: patients with MS as participants, exergaming and VR as intervention, conventional rehabilitation as comparator, and balance assessment [Berg Balance Scale (BBS)] as outcome measure. We also performed a meta-analysis of the mean difference in the BBS via the random-effects method. Out of 93 records, this systematic review included and analyzed 7 RCTs, involving a total of 209 patients affected by MS, of which 97 patients performed exergaming or VR and 112 patients underwent conventional rehabilitation. The meta-analysis reported a significant overall ES of 4.25 (p &lt; 0.0001), showing in the subgroup analysis a non-significant ES of 1.85 (p = 0.39) for the VR and a significant ES of 4.49 (p &lt; 0.0001) for the exergames in terms of the BBS improvement. Taken together, these findings suggested that balance rehabilitation using exergames appears to be more effective than conventional rehabilitation in patients affected by MS.