The relation between falls risk and movement variability in Parkinson's disease.

Falls are a major health concern for older adults with Parkinson's disease (PD). This study was designed to examine differences in falls risk and its relation to changes in the average and variability (i.e. intra-individual variability) of reaction time (RT), finger tapping, standing balance and walking between healthy older adults and persons with PD. Thirty-nine adults with PD (70.0 ± 8.1 years) and 29 healthy older adults (66.8 ± 10.4 years) participated in this study. Falls risk (using the physiological profile assessment), gait, RT, balance and tapping responses were assessed for all persons. Results demonstrated that individuals with PD exhibited a greater risk of falling coupled with a general slowing of motor function covering declines in walking, RT and finger tapping. In addition, the movement responses of the PD group were more variable than the healthy older adults. Correlation results revealed group differences with regards to the neuromotor measures which were significantly correlated with falls risk. For the PD group, gait measures were highly correlated with their falls risk while, for the healthy older adults, falls risk was linked to balance measures even though PD persons had increased sway. Overall, persons with PD were at greater falls risk, moved slower and with increased variability compared to the healthy older adults. Further, while there are some similarities between the two groups in terms of those measures related to falls risk, there were also several differences which highlight that persons with PD can have different risk factors for falling compared to healthy adults of similar age.

Dopaminergic modulation of semantic priming in Parkinson disease.

OBJECTIVE: Our purpose is to examine the effect of D2/D3 agonists on semantic priming. BACKGROUND: Dopamine seems to restrict the semantic network in semantic priming. However, which dopamine receptor mediates this effect is unknown. METHODS: To better understand the receptors involved, 15 nondemented Parkinson disease patients performed a lexical decision task before and 1 hour after they received their first morning medication dose, 8 after D2 and D3 agonists pramipexole or ropinirole, and 7 after L-dopa. Semantic priming was measured for closely, distantly, and unrelated word pairs across a stimulus onset asynchrony of 700 ms. RESULTS: Closely related pairs were recognized significantly faster than unrelated and distantly related pairs before the drugs, as well as after D2/D3 agents. After L-dopa, closely related pairs remained faster than unrelated, but not faster than distantly related pairs. CONCLUSIONS: This suggests that D1 receptors may mediate the dopaminergic modulation of semantic priming.

Reliability and validity of the Tinetti Mobility Test for individuals with Parkinson disease.

BACKGROUND AND PURPOSE: This study examined the interrater and intrarater reliability, concurrent validity, and criterion validity of the Tinetti Mobility Test (TMT) as a fall risk screening tool in individuals with Parkinson disease (PD). SUBJECTS: Thirty individuals with PD voluntarily participated in the study, and data from a retrospective review of 126 patient records were included. METHODS: Physical therapists and physical therapist students rated live and videotaped performances of the TMT. Tinetti Mobility Test scores were correlated with Unified Parkinson's Disease Rating Scale (UPDRS) motor scores and comfortable gait speed. The ability of the TMT to accurately assess fall risk was determined. RESULTS: Interrater and intrarater reliability was good to excellent (intraclass correlation coefficient of >.80). Tinetti Mobility Test scores correlated with UPDRS motor scores (r(s)=-.45) and gait speed (r(s)=.53). The sensitivity and specificity of the TMT to identify fallers were 76% and 66%, respectively. DISCUSSION AND CONCLUSION: The TMT is a reliable and valid tool for assessing the mobility status of and fall risk for individuals with PD.

Is guided imagery effective in reducing pain and anxiety in the postoperative total joint arthroplasty patient?

PURPOSE: To evaluate the effect of guided imagery as an intervention to reduce pain and anxiety in patients undergoing a total joint arthroplasty. SAMPLE: A total of 121 patients scheduled for elective total joint arthroplasty. METHODS: The design for this study was a 2-group quasi-experimental design. The intervention group listened to a guided imagery CD containing a message to develop a sense of relaxation and harmony. The intervention and control groups were compared on self-reported pain and anxiety levels postoperatively on Days 1, 2, and 3. RESULTS: There was no significant difference in pain and anxiety levels between the groups. However, the intervention group had lower levels of anxiety and pain at all time points. Both groups followed a similar anxiety and pain pattern with the highest reported levels at Day 2. CONCLUSIONS: Conduct further research of guided imagery as an intervention for reducing pain and anxiety utilizing randomized controlled trials with a diverse sample of patients.

An investigation of the effects of preoperative interdisciplinary patient education on understanding postoperative expectations following a total joint arthroplasty.

This study aimed at evaluating the effect of a preoperative interdisciplinary educational intervention on understanding postoperative expectations following a total joint arthroplasty. The study sample consisted of 156 patients scheduled for elective total joint replacement surgery. The approach for this study was a two-group quasi-experimental design. The treatment group received an additional interdisciplinary educational session whereas the control group did not. Subjects who chose to attend the program were compared with those who received standard outpatient teaching in the preadmission testing center. Subjects who received the interdisciplinary teaching intervention were significantly better at verbalizing and demonstrating postoperative skills, and they rated all aspects of the interdisciplinary educational session as very satisfactory. The study demonstrated that the preoperative interdisciplinary educational program for patients scheduled for total joint replacement surgery had a positive effect on the understanding of postoperative expectations. The educational sessions have continued providing an option that will enhance preoperative education.