Factors predicting fear of falling avoidance behavior in parkinsonisms

BACKGROUND: Fear of falling avoidance behavior (FFAB) is common in parkinsonisms and results in potentially mitigable downstream consequences. OBJECTIVE: Determine the characteristics of individuals with parkinsonisms most associated with FFAB. METHODS: A retrospective, cross-sectional study was conducted from medical records data of 142 patients with parkinsonisms. These data included: demographics (age, sex), disease severity (Movement Disorders Society –Unified Parkinson’s Disease Rating Scale Part III (MDS-UPDRS III), years since diagnosis), fall history (number of fall injuries in previous year), and gait and balance function (five times sit to stand, MiniBESTest, Timed Up and Go (TUG), dual-task TUG, ten-meter walk test (10MWT), observed freezing of gait (FOG) (MDS-UPDRS III item 11)). RESULTS: 10MWT (p < .001) and MDS-UPDRS III item 11 (p < .014) were significantly associated with FFAB above and beyond disease severity, which also contributed significantly to the overall model (ps < .046). Fall history was not associated with FFAB. CONCLUSION: Our findings suggest that the largest portion of variability in FFAB is explained by gait velocity and FOG; however, disease severity also explains a significant portion of the variability of FFAB. Further investigation into factors predictive of FFAB and mitigation of downstream consequences, using more robust designs, is warranted.

Research on the application of myofascial induction therapy in the rehabilitation of patients with acute facial palsy: A nonrandomized controlled trial

BACKGROUND: In the healthy body, the fascial system maintains elasticity and coordination of movements. If these functions are destroyed, facial paraly appears. Myofascial induction therapy (MIT), a manual physical therapy method that focuses on restoring altered fascial tissue, is prevalently and widely used in clinical treatment. OBJECTIVE: The study aimed to observe the application of MIT in the rehabilitation of patients with acute facial palsy. METHODS: Sixty-eight patients with acute facial palsy were divided into control group and manual treatment group. The control group received drug treatments, such as prednisone, methylcobalamin, and vitamin B1, and instrumental physical therapy, such as semiconductor laser, shortwave therapy, and facial muscle training. In addition to these treatments, the manual treatment group received MIT. Both groups were treated for 4 weeks. The patients were assessed using the following methods: the House-Brackmann facial nerve function evaluation, Sunnybrook facial grading system, facial nerve electrophysiological examination compound muscle action potential (CMAP) amplitude, and blink reflex (BR) R1 latency. RESULTS: House-Brackmann and Sunnybrook scores and CMAP amplitude and BRR1 latencies were significantly different between the two groups (p < 0.05). Furthermore, the manual treatment group showed greater improvement than the control group (p < 0.05). CONCLUSIONS: Treatment with MIT promoted better recovery of acute facial palsy and thus may be considered a valid rehabilitation intervention that is worthy of clinical application.

Feasibility of online PD SAFEx™ exercise rehabilitation for symptom improvements of Parkinson’s disease: A pilot study

BACKGROUND: Parkinson’s Disease (PD) is a neurodegenerative disorder affecting both motor and cognitive symptoms. While medications show some improvement in motor symptoms, cognitive symptoms can worsen. In-person exercise programs, such as PD SAFEx™, are an important adjunct therapy in improving symptoms. However, coronavirus disease 2019 (COVID-19) limited in-person exercise interventions. Therefore, there is a need to investigate the effectiveness of online exercise delivery. OBJECTIVE: To identify (1) whether an online exercise intervention can achieve similar results to an identical in-person intervention and (2) if online PD SAFEx™ can alter the cognitive decline of PD patients. METHODS: 20 participants with idiopathic PD participated in a 12-week online PD SAFEx™ program and were compared to 73 participants from in-person PD SAFEx™. The primary outcome measure was the Unified Parkinson’s Disease Rating Scale-III measured before/after intervention. Three secondary cognitive measures were collected with the online group. RESULTS: Main effect of time on UPDRS-III scores of both groups were found (F(1,92) = 35.555, p < 0.001). No interaction was found between in-person and online groups (F(1,1) = 0.052, p = 0.820). TMT B in the online group showed significant improvements in executive function (F(1,17) = 7.095, p = 0.016). CONCLUSIONS: Online and in-person PD SAFEx™ both achieved clinically significant UPDRS-III improvement and are statistically equivalent. Online PD SAFEx™ reduced cognitive symptoms seen during COVID-19.

Do chronic pain syndromes in lower limb amputees have an effect on the use of prostheses?

BACKGROUND: The use of a prosthesis is critical to regain the ability to walk in lower limb amputees but the relationship between the use of a prosthesis and chronic pain syndromes (PLS, PLP, RLP), common in amputees patients, is still poorly understood. OBJECTIVE: This long-term follow-up study investigates the possible correlation between prosthesis use and the presence of PLP, PLS and RLP in lower limb amputees. METHODS: Patients undergoing transtibial, transfemoral or hemipelvectomy amputation of any aetiology at the Rizzoli Orthopaedic Institute from 2008 to 2018 were included. The Houghton scale was used to assess functional use of the prosthesis. RESULTS: The results show that, in lower limb amputees, prosthesis use is greater in individuals with below-the-knee amputation and in those who were younger at the time of amputation. No significant correlation between the presence of pain syndromes (PLS, PLP, RLP) and the various items on the Houghton scale was found. CONCLUSIONS: The study found no significant correlation indicating that phantom limb pain syndromes affect amputee use of a prosthesis.

Predictors of fatigue self-management behaviors in adults with multiple sclerosis

BACKGROUND: Fatigue is one of the most common and disabling symptoms in people with multiple sclerosis (MS). Fatigue self-management behaviors may be effective in reducing the impact of fatigue in people with MS. However, few studies have examined the factors that influence engagement in fatigue self-management behaviors. OBJECTIVE: Identify factors that directly and indirectly influence fatigue self-management behaviors. METHODS: Participants with MS (n = 300) completed online questionnaires at baseline and 6-weeks. Using the Self- and Family Management Framework, we examined the influence of health status, resources and environment, healthcare utilization, and self-management processes on fatigue self-management behaviors at 6-weeks. Multiple regression and path analyses were conducted. RESULTS: The final regression model variables accounted for 41.58% of the variance in fatigue self-management behavior, which included outcome expectation (β= 0.287), disability (β= 0.265), environmental barriers (β= 0.188), self-efficacy (β= 0.153), symptom severity (β= 0.113), living in a rural community (β= –0.108), and living alone (β= 0.103). Path analysis indicated that outcome expectations may mediate the relationship between disability levels and fatigue self-management behavior. CONCLUSIONS: Health status (i.e., disability and symptom severity), environmental factors (e.g., living situation), and self-management processes (i.e., self-efficacy and outcome expectations) may play an important role in influencing engagement in fatigue self-management behaviors.

Comparing the effectiveness of bimanual and unimanual mirror therapy in unilateral neglect after stroke: A pilot study

BACKGROUND: Unilateral neglect in stroke patients is a major obstacle to rehabilitation, which is a great challenge for therapists. OBJECTIVE: This study aimed to compare the effectiveness of bimanual mirror therapy (BMT) and unimanual mirror therapy (UMT), the two protocols of mirror therapy, for the reduction of the symptoms of unilateral neglect in stroke patients. METHODS: Twenty-eight individuals were randomly assigned to the UMT or BMT groups. Both groups received mirror therapy for 30 minutes per day, 5 days a week, for a period of 4 weeks. The Star Cancelation Test (SCT), Line Bisection Test (LBT), Picture Scanning test (PST), and Korean Catherine Bergego Scale (K-CBS) were used to measure the change in unilateral neglect, and the Korean version of the Modified Barthel Index (K-MBI) was used to evaluate activities of daily living (ADL). RESULTS: The results of SCT, LBT, PST, and K-CBS showed significant decreases in unilateral neglect in both groups (p < 0.05). K-MBI improved significantly in both groups (p < 0.05). There were significant differences between the two groups in the unilateral neglect tests (p < 0.05), but no significant difference in ADL evaluation (p > 0.05). CONCLUSIONS: Mirror therapy protocols can be applied to treat unilateral neglect in stroke patients. However, BMT may be more beneficial for reducing the symptoms of unilateral neglect.

Cognitive and psychosocial outcomes following stereotactic radiosurgery for acoustic neuroma

BACKGROUND: Acoustic Neuroma (AN) is a benign tumour of the eighth cranial nerve. Stereotactic Radiosurgery (SRS) is a common treatment approach. Studies have explored the primary effects of SRS and documented equivalent efficacy for tumour control compared to neurosurgery. OBJECTIVE: Examine the longer term cognitive and psychosocial outcomes of SRS in non-Neurofibromatosis Type II patients utilising both objective and subjective cognitive outcomes associated with quality of life and health related distress. METHODS: Nineteen individuals treated via SRS were assessed using a battery of standardised psychometric tests as well as measures of quality of life and psychological distress. RESULTS: Participants had largely preserved cognitive function except for processing speed, aspects of attention and visual memory relative to age norms. Self-reported quality of life was better than in other AN population studies. Level of psychological distress was equivalent to general population norms. More than half of participants reported subjective cognitive decline though this was not fully supported by objective testing. Subjective cognitive complaints may be associated with lower reported quality of life. CONCLUSIONS: Results are largely consistent with previous findings on the effects of SRS in other clinical groups, which supports SRS as a targeted radiation treatment for AN.

Efficacy and safety of onabotulinumtoxinA with standardized physiotherapy for the treatment of pediatric lower limb spasticity: A randomized, placebo-controlled, phase III clinical trial

BACKGROUND: Spasticity is common in cerebral palsy and can result in pain and diminished health-related quality of life. OBJECTIVE: To evaluate the safety and efficacy of onabotulinumtoxinA for lower limb spasticity treatment in children with cerebral palsy. METHODS: In this registrational phase 3, multinational, randomized, double-blind, placebo-controlled trial (NCT01603628), children (2–< 17 years) with cerebral palsy and ankle spasticity (Modified Ashworth Scale-Bohannon [MAS] score≥2) were randomized 1 : 1:1 to standardized physical therapy and onabotulinumtoxinA (4 or 8 U/kg), or placebo. Primary endpoint was average change from baseline at weeks 4 and 6 in MAS ankle score. Secondary endpoints included the Modified Tardieu Scale (MTS) and Global Attainment Scale (GAS). RESULTS: 381 participants were randomized. MAS scores averaged at weeks 4 and 6 were significantly reduced with both onabotulinumtoxinA doses (8 U/kg: –1.06, p = 0.010; 4 U/kg: –1.01, p = 0.033) versus placebo (–0.8). Significant improvements in average dynamic component of spasticity, measured by MTS, and in function, measured by GAS, were observed at several time points with both onabotulinumtoxinA doses versus placebo. Most adverse events were mild or moderate. CONCLUSIONS: OnabotulinumtoxinA was well tolerated and effective in reducing lower limb spasticity and improving functional outcomes versus placebo in children.

Can pharmacological, psychological and non-invasive brain stimulation interventions prevent depression after stroke? A cochrane review summary with commentary

BACKGROUND: Depression is very common in patients after a stroke and it can impact recovery. OBJECTIVE: The Cochrane Review aimed to determine whether psychological therapy, pharmacological interventions, non-invasive brain stimulation, or their combination can prevent depression after stroke. METHODS: The population addressed were patients who suffered from a stroke and had no previous diagnosis of depressive disorders. Studies comparing pharmacological intervention to placebo, psychological therapy to usual care, and non-invasive brain stimulation to sham stimulation or usual care were included. RESULTS: Outcome information was available for nine pharmacological and two psychological trials, showing favorable treatment effects. CONCLUSIONS: The available evidence suggests that pharmacological interventions and psychological therapy may prevent depression and improve mood after stroke. Although, the current evidence is of very low quality resulting in serious uncertainties about the estimates of effect observed.