Excessive postural sway and the risk of falls at different stages of Parkinson's disease.

Excessive postural sway may result in falls in Parkinson's disease (PD). We measured postural sway using the sensory organization test (SOT) of dynamic posturography in static (platform still) and dynamic (sway referenced platform) conditions with normal, no and inappropriate visual feedback in 102 subjects with PD, off medication. Twenty-five healthy subjects were used as age-matched controls. Eighteen very early stage PD subjects had never used dopaminergic medication. Postural sway was normal in those subjects in all conditions, but was abnormal in subjects with more advanced symptoms (UPDRS III > 20, P < 0.01). Postural sway increased with disease severity in all conditions except static, eyes closed (P < 0.0001). We developed the SOT Fall Severity Scale (SOTFSS) from the number of times postural sway was so large that the subject had to take a step (registered as a "fall") and showed that falls mainly occurred in dynamic conditions, and were correlated with disease severity (P < 0.0001). In dynamic conditions the SOTFSS was correlated with the retropulsion score from the UPDRS III (N = 102, P < 0.0001) and with the subjects' self-reported fall frequency from the UPDRS II (N = 62, SOT5: P = 0.0419, SOT6: P = 0.0034).

Quantitative lateralized measures of bradykinesia at different stages of Parkinson's disease: the role of the less affected side.

The onset of motor abnormalities in Parkinson's disease (PD) is usually unilateral. However, current therapeutic trials do not analyze separately the performance of the more affected (MA) and less affected (LA) limbs. From a cohort of 85 subjects at different stages of PD, we asked whether the relationship between bradykinesia and disease severity was similar on both limbs and if the MA side remained more bradykinetic than the LA side in advanced PD. MA and LA limb determination was made from the history of the side first affected. Twenty-one age-matched subjects were used as controls. The velocities of finger and arm movements on both sides were inversely correlated with disease severity (P < 0.03). The slope of the decline in wrist movement velocity was steeper on the LA side (P = 0.029). When the regression lines were extrapolated to the y-axis (UPDRS III = 0) the performance of the LA side was not different from that of controls (P = 0.954 and P = 0.829 for finger and arm movements, respectively), whereas that of the MA side was slower (P = 0.019 and P = 0.016), suggesting that at the theoretical state of no disease the LA side would reflect less or no contralateral nigral pathology. With increasing disease severity, there was less difference between MA and LA sides in both finger and arm bradykinesia (P < 0.004). These findings highlight the value of analyzing separately the MA and LA sides in subjects with PD, especially for clinical trials of potential disease modifying agents in early stages of disease.

Using a Culturally Tailored Intervention to Increase Colorectal Cancer Knowledge and Screening among Hispanics in a Rural Community.

Background: Disparities in colorectal cancer incidence and mortality rates exist among racial/ethnic minorities, especially those living in rural areas. There is an urgent need to implement interventions to improve colorectal cancer screening behaviors among such groups, particularly those living in rural areas in the United States.Methods: From a rural community of Hispanics, we recruited participants to attend home-based promotor(a)-led "home health parties" in which participants were taught about colorectal cancer screening; participants ages 50 and older were given a free fecal occult blood test (FOBT) kit to complete on their own. A pre- and posttest design was used to assess changes in colorectal cancer awareness, knowledge, and screening at baseline and at 1-month follow-up after the intervention.Results: We observed a statistically significant increase in colorectal cancer screening awareness and knowledge among participants. Colorectal cancer screening rates with FOBT increased from 51.0% to 80%. There was also a statistically significant increase in social engagement, that is, the intent to speak to friends and relatives about colorectal cancer screening.Conclusions: Findings indicate that culturally tailored colorectal cancer education facilitated by promotores in a rural environment, coupled with free stool-based test for colorectal cancer screening, is an effective way to increase colorectal cancer screening awareness, knowledge, and screening among Hispanics living in a rural area in Washington State. Impact: Culturally tailored home health interventions have the potential to achieve Healthy People 2020 colorectal cancer screening goals in Hispanic rural communities. Cancer Epidemiol Biomarkers Prev; 27(11); 1283-8. ©2018 AACR.

The effectiveness of a stroke education group on persons with stroke and their caregivers.

The educational group has been proposed as an effective way to deliver a program based on structured stroke knowledge to enhance emotional support among people with stroke and their caregivers. The aim of this study was to explore whether the stroke educational group could increase stroke-related knowledge, and improve perceived health status, in persons with stroke and their caregivers, and thus reduce the stress induced during the care-giving process. In this study a quasi-experimental design, that included a pre-test and a post-test, was employed on a total of 54 patients with stroke and 32 caregivers who participated in a 2-week stroke educational group. The outcome measures included a Stroke Knowledge Test, the Short-Form 36 and the Relatives' Stress Scale. The tests were administrated before and after the running of the stroke educational group as well as, during the 1-week, 2-week and 1-month follow-up sessions. The results showed a statistically significant increase in stroke-related knowledge in the patients (F [1,51]=7.28-9.67, P<0.01) and their caregivers (F [1,30]=44.19-80.49, P<0.01), but no similar significant improvement was noted on perceived health status and care-giving stress. A significant association between the total scores in the stroke knowledge test and the admission scores in the Mini Mental State Examination of the patients was also revealed (F [1,51]=48.03-58.87, P<0.01). In conclusion, the results suggest that there was an improvement in the acquisition of stroke-related knowledge by both patients with stroke, and their caregivers, after a stroke educational group. A further study exploring the behavioral changes of individuals with stroke and their caregivers after attending a stroke educational group is recommended.

The effects of guided imagery relaxation in people with COPD.

The aim of this study was to explore the effects of guided imagery relaxation in people with chronic obstructive pulmonary disease (COPD) using a randomized controlled design. Half of 26 participants were allocated to the treatment group in which six practice sessions on guided imagery were conducted, while the control group was instructed to take rest quietly during the six sessions. At the seventh session, physiological changes: partial percentage of oxygen saturation; heart rate; upper thoracic surface electromyography; skin conductance; and peripheral skin temperature were recorded during a 30-minute session with a sampling frequency of one minute. Repeated measures analysis of variance was used to explore the changes of the parameters between the groups. Mann-Whitney U test was used to compare the change of perceived dyspnoea between the groups. Results showed there was a statistically significant (p < 0.05) increase in partial percentage of oxygen saturation in the treatment group, but no significant effects on the other physiological parameters. Further study exploring the psychological effects of guided imagery is suggested.

Clinical motor outcome of bilateral subthalamic nucleus deep-brain stimulation for Parkinson's disease using image-guided frameless stereotaxy.

BACKGROUND: Image-guided neuronavigation has largely replaced stereotactic frames when precise, real-time anatomic localization is required during neurosurgical procedures. However, some procedures, including placement of deep-brain stimulation (DBS) leads for the treatment of movement disorders, are still performed using frame-based stereotaxy. Despite the demonstration of comparable accuracy between frame-based and "frameless" image-guided approaches, the clinical efficacy of frameless DBS placement has never been reported. OBJECTIVE: To analyze the outcomes of subthalamic nucleus (STN) DBS using the frameless technique for the treatment of Parkinson's disease (PD). METHODS: Of 31 subjects (20 men) with PD for 10 ± 4 years, 28 had bilateral STN DBS and 3 had unilateral STN DBS. The Unified Parkinson's Disease Rating Scale (UPDRS) motor scale (III) and total medication doses were assessed before surgery on and off medication and off medication/ON DBS (off/ON) after 6 to 12 months of STN DBS. RESULTS: There was a 58% improvement from bilateral STN DBS in the UPDRS III (40 ± 16 preoperatively off, 17 ± 11 off/ON) 9.6 ± 1.9 months after surgery (P < .001). This compared favorably with the published outcomes using the frame-based technique. All motor subscores improved significantly (P < .01). The mean reduction in medication was 50%. No intraoperative complications occurred, but one subject with hypertension died of a delayed hemorrhage postoperatively. Two subjects developed postoperative infections that required lead removal and antibiotics. CONCLUSIONS: Bilateral STN DBS for PD performed by an experienced team using a frameless approach results in outcomes comparable to those reported with the use of the frame-based technique.

Three-dimensional kinematics of the upper limb during a Reach and Grasp Cycle for children.

The ability to reach, grasp, transport, and release objects is essential for activities of daily living. The objective of this study was to develop a quantitative method to assess upper limb motor deficits in children with cerebral palsy (CP) using three-dimensional motion analysis. We report kinematic data from 25 typically developing (TD) children (11 males, 14 females; ages 5-18 years) and 2 children with spastic hemiplegic CP (2 females, ages 14 and 15 years) during the Reach and Grasp Cycle. The Cycle includes six sequential tasks: reach, grasp cylinder, transport to mouth (T(1)), transport back to table (T(2)), release cylinder, and return to initial position. It was designed to represent a functional activity that was challenging yet feasible for children with CP. For example, maximum elbow extension was 43+/-11 degrees flexion in the TD group. Consistent kinematic patterns emerged for the trunk and upper limb: coefficients of variation at point of task achievement for reach, T(1), and T(2) for trunk flexion-extension were (.11, .11, .11), trunk axial rotation (.06, .06, .06), shoulder elevation (.13, .11, .13), elbow flexion-extension (.25, .06, .23), forearm pronation-supination (.08, .10, .11), and wrist flexion-extension (.25, .21, .22). The children with CP demonstrated reduced elbow extension, increased wrist flexion and trunk motion, with an increased tendency to actively externally rotate the shoulder and supinate the forearm during T(1) compared to the TD children. The consistent normative data and clinically significant differences in joint motion between the CP and TD children suggest the Reach and Grasp Cycle is a repeatable protocol for objective clinical evaluation of functional upper limb motor performance.

Profiles of functional outcomes in stroke rehabilitation for Chinese population: a cluster analysis.

The objectives of study were to identify longitudinal ADL profiles and to investigate profiles characteristics of participants in stroke rehabilitation programme. 496 stroke rehabilitation records in one year were retrieved. Patients' demographics, admission scores of Cantonese version of Mini-mental State Examination and line cancellation test were retrieved. Chinese version of the Modified Barthel Index (MBI-C) records for the first four successive weeks were also obtained for cluster analysis. Four functional profiles were yielded after cluster analysis. Repeated measures ANOVA showed that Profile 1 (n = 168) with oldest age, lowest baseline MBI-C and line cancellation test scores had improvement only at the last two measurement points (p < 0.001). Profile 4 (n = 100) with youngest age and highest baseline MBI-C showed progress for the first two assessment points then slowing down progressively, while the other two profiles showed improvement on all measurement points (p < 0.001) but with different baseline MBI-C and increments. One-way ANOVA further revealed significant differences in demographics, cognitive-perceptual and receptive speech functions among the profiles. The present study revealed different recovery potential among people with stroke. The higher the initial ADL performance, younger age and the absence of unilateral neglect appeared to relate to better functional recovery.