Reducing thrombotic risks in video gamers: investigating the benefits of walking and compression sleeves on blood hemodynamics.

With the growing popularity of video gaming, deep vein thromboses are increasingly being reported in gamers. This study aimed to compare the effects of lower leg graduated compression sleeves and a 6-min walking break during prolonged gaming on blood flow and hemodynamics in competitive sport players to help mitigate this risk. Ten healthy gamers (19.6 ± 1.2 yr old; 9 men) consented to participate in this mixed-model crossover design study that consisted of three visits. In visit 1, participants engaged in continuous 2-h video game play wearing no compression (continuous). Visits 2 and 3 involved 2-h play wearing compression sleeves (compression) and 2-h game play interrupted at 1 h by a 6-min walk (walk). Doppler ultrasound measurements of the left popliteal artery were taken at 30, 60, 90, and 120 min, to record vessel diameter, blood flow velocity, and blood flow volume. Participants completed a survey to assess their perception of each approach. There was a significant interaction between conditions for blood flow and blood velocity (P = 0.01, P < 0.001). Post hoc analysis demonstrated a greater decrease in blood flow and blood velocity in the continuous group compared with the walk group at the 90-min mark (P = 0.04, P = 0.01). No differences were found between the compression and walk groups or between the continuous and compression groups (P = 0.42, P = 0.69). No interactions were observed in diameter, mean arterial pressure, or heart rate. This study suggests that incorporating a 6-min walk every 60 min during prolonged gaming is advisable to counteract the negative effects on blood flow hemodynamics.NEW & NOTEWORTHY A 6-min light-intensity walking break during gaming can effectively combat the adverse effects of prolonged sitting, surpassing compression garments. Prolonged sitting reduces blood flow velocity, potentially leading to deep vein thrombosis (DVT). Compression sleeves help, with superior results after a 6-min walk at 60 min. Although compression stockings offer moderate improvements, a 6-min active break proves more effective. These findings offer promising interventions for gamers' health, initiating guidelines to mitigate DVT risk during gaming.

Gaming in Pandemic Times: An International Survey Assessing the Effects of COVID-19 Lockdowns on Young Video Gamers' Health.

The onset of COVID-19 coincided with the peak growth of video game usage, with 2.7 billion gamers in 2020. During the pandemic, gaming and streaming platforms offered an entertaining, social, and safe alternative to recreation during severe lockdowns and social isolations. This study aimed to examine the impact of the COVID-19 pandemic on health-related outcomes in self-proclaimed video gamers based on the type of lockdown experienced and to discuss the potential role of video games during times of preventive lockdown measures. This was a cross-sectional international survey constructed by two academic institutions, NYIT (NY, USA) and McGill University (Montreal, Canada), and Adamas Esports (BC, Canada). The survey consisted of questions including demographics, multiple choice, ratings, and Likert scales relating to the periods prior to and during the COVID-19 lockdowns. There were 897 respondents from North America (72.7%), Europe (10.9%), Asia (4.9%), and other countries (11.5%), with a mean age of 22 years. Significant increases in game time were reported in casual and competitive gamers during the first months of the pandemic. The level of gaming, type of lockdown, and physical activity level prior to the pandemic were examined as potential moderating factors. Significant increases in sedentary behaviors (video game time and sitting time) were observed, while physical activity levels remained unchanged in most participants, regardless of the type of lockdown. Sleep time, but not sleep quality, increased, while mental health exhibited opposing effects, influenced by the type of lockdown and gaming competition levels. Video games, when played moderately, could offer a cost-effective, safe strategy to promote socialization and mental health and improve the overall well-being of the non-gaming and gaming population during pandemic times when strict lockdowns are in place.

Upper body compression wear improves muscle oxygenation following intense video game training: a randomized cross-over study among competitive gamers.

BACKGROUND: Esport players require a high number of action moves per minute to play, with substantial contractions of the wrist extensor muscles. Players frequently suffer from acute fatigue. The purpose of this study was to examine the use of below the elbow compression sleeves on Sm02 during intense aim training. Secondly, to examine players' performance and perception with and without compression. METHODS: This study was conducted at the New York Institute of Technology and enrolled fifteen collegiate esport players, 2 women and 13 men (age 21.2 ± 2.2). All subjects signed written consent. Participants performed 3 high intensity bouts of an aim trainer followed by a 15-minute rest before doing another 3 bouts of high intensity training conducting the other arm of the study. The compression wear order was randomized. The primary outcome included Sm02 of the extensor carpi radialis longus using near-infrared spectrometry. Secondary outcomes included Kills Per Second (KPS), Score, Total Time to Kill (TTK), accuracy, and perceived performance. RESULTS: Following 15 min of recovery, there was a significant rise in Sm02 while wearing the compression sleeve compared to no compression sleeve (p = 0.004). No change in Sm02 was seen while gaming. In trials 1 and 2, wearing the compression sleeve resulted in a significant increase in KPS and score when compared to not wearing it (p = 0.002,0.006). Although TTK and accuracy did not alter, 46.7% of participants believed the compression sleeve aided their performance. CONCLUSIONS: This study provides support that wearing below the elbow upper body compression sleeves while performing high intensity gaming may reduce fatigue, improve muscle recovery and gaming performance. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT05037071. Registered 08/09/2021. URL: Arm Compression on Muscle Oxygen Saturation - Full Text View - ClinicalTrials.gov.

Cannabidiol and Tetrahydrocannabinol Use in Parkinson's Disease: An Observational Pilot Study.

BACKGROUND: There is a need for more research examining the use of cannabis, tetrahydrocannabinol (THC), and cannabidiol (CBD) products in people with Parkinson's disease (PD), especially given the recent increase in the use of these products. OBJECTIVES: Given the recent increase in over-the-counter CBD use as well as the prescription of medical cannabis by treating physicians, the utilization method, effects on motor and non-motor symptoms, side effects, and attitude toward cannabis use were examined in a naturalistic sample of patients with PD. METHODS: A total of 15 individuals with PD, eight of whom were prescribed CBD/THC treatment and seven who were not taking any CBD/THC product, were assessed cross-sectionally. Participants completed structured neuropsychological testing, motor assessment, and questionnaires regarding mood, subjective cognition, and symptom levels. T-tests were completed for quantitative measures and descriptive data were examined and described. Due to the small sample size, Shapiro-Wilk tests for normality were utilized and Mann-Whitney U analyses were completed when appropriate. RESULTS: We found a wide range of prescribed products and methods as well as variability in perceived benefits and untoward effects, even in our small sample. Individuals with PD who were taking a CBD/THC product had lower global cognition scores on the Montreal Cognitive Assessment (MoCA) but no detectable differences among more specific neuropsychological measures. They also had more non-motor symptoms of PD but no differences in motor symptom levels. Qualitatively, some participants with PD who were taking CBD/THC reported improved pain levels, sleep, and reductions in anxiety. A few negative effects were endorsed, including sleepiness, concentration difficulties, and forgetfulness. CONCLUSION: CBD/THC utilization in PD is varied. In our small sample, individuals who utilized the treatment had lower MoCA scores, more non-motor symptoms, and descriptively reported improvements in sleep, anxiety, and pain, and had side effects of sleepiness and cognitive difficulty. Future studies should focus on clinical trials with standardized CBD/THC methods of use.

Assessment of gastrointestinal function and its' effect on bone mineral density and body composition in hypermobility spectrum disorder and hypermobile Ehlers-Danlos syndrome.

BACKGROUND: Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are associated with hypermobility, musculoskeletal pain, a decreased bone mineral density (BMD) and gastrointestinal (GI) complications. The role of GI symptoms and diet in BMD has not been established in this population. The GI complications can lead to an energy deficit due to lack of essential macronutrients. The primary objective of this study was to determine the severity of GI symptoms compared to body composition and BMD in individuals with hEDS/HSD. The secondary objective is to examine GI symptoms on energy balance, body composition and strength. METHODOLOGY: This study was IRB approved. Eighteen female participants (aged 28.2 ± 4.9; BMI 22.5 ± 4.9) with a diagnosis of hEDS or HSD and 18 female healthy control participants (aged 28.1 ± 3.8; BMI 22.8 ±3.9) signed consent to participate. Participants were matched by sex, age, and BMI. The Gastrointestinal Symptom Rating Scale (GSRS) was used to investigate severity of GI symptoms. Dual X-ray absorptiometry was used to determine body composition (body fat%, lean body mass (LBM). BMD was measured by Z- scores of both femurs and lumbar spine. Resting metabolic rate (RMR) was measured using indirect calorimetry and strength was determined using a hand grip dynamometer. RESULTS: All hEDS/HSD participants reported GI symptoms. There was no difference in body composition between hEDS/HSD and controls. Participants with hEDS/HSD had lower BMD both femoral z scores (p=0.02,0.004) and spine z scores (p= 0.04). There was no difference in caloric intake between groups; yet both groups demonstrated caloric deficits. Additionally, hEDS/HSD consumed less protein and more carbohydrates (p=0.03, p=0.03). There were no differences in grip strength. CONCLUSIONS: This study identified that pre-menopausal women with hEDS/HSD presented with significant GI complications and lower BMD than age matched controls. The GI complications and the reduced protein intake long-term may have a lasting impact on bone health. This study found that the GSRS identified and quantified GI symptoms in persons with hEDS/HSD. Future studies are needed for the longitudinal effects of a caloric/protein deficit in this population and to help guide future preventive and nutritional treatment approaches in individuals with hEDS/HSD.

The Effect of Pedal Pump Lymphatic Technique Versus Passive Recovery Following Maximal Exercise: A Randomized Cross-Over Trial.

CONTEXT: Muscle damage and delayed onset muscle soreness (DOMS) can occur following intense exercise. Various modalities have been studied to improve blood lactate accumulation, which is a primary reason for DOMS. It has been well established that active recovery facilitates blood lactate removal more rapidly that passive recovery due to the pumping action of the muscle. The pedal pump is a manual lymphatic technique used in osteopathic manipulative medicine to increase lymphatic drainage throughout the body. Pedal pump has been shown to increase lymphatic flow and improve immunity. This may improve circulation and improve clearance of metabolites post-exercise. OBJECTIVE: This study compared the use of pedal pump lymphatic technique to passive supine recovery following maximal exercise. METHODS: 17 subjects (male n = 10, age 23 ± 3.01; female n = 7, age 24 ± 1.8), performed a maximal volume O2 test (VO2 max) using a Bruce protocol, followed by a recovery protocol using either pedal pump technique or supine passive rest for 10 min, followed by sitting for 10 min. Outcome measures included blood lactate concentration (BL), heart rate (HR), systolic blood pressure (SBP) and VO2. Subjects returned on another day to repeat the VO2 max test to perform the other recovery protocol. All outcomes were measured at rest, within 1- minute post-peak exercise, and at minutes 4, 7, 10 and 20 of the recovery protocols. A 2 × 6 repeated measures ANOVA was used to compare outcome measures (p ≤ 0.05). RESULTS: No significant differences were found in VO2, HR, or SBP between any of the recovery protocols. There was no significant difference in BL concentrations for recovery at minutes 4, 7, or 10 (p > 0.05). However, the pedal pump recovery displayed significantly lower BL concentrations at minute 20 of recovery (p = 0.04). CONCLUSION: The pedal pump significantly decreased blood lactate concentrations following intense exercise at recovery minute 20. The use of manual lymphatic techniques in exercise recovery should be investigated further.

Esports players, got muscle? Competitive video game players' physical activity, body fat, bone mineral content, and muscle mass in comparison to matched controls.

BACKGROUND: Esports players, like traditional athletes, practice for long hours and, thus, are vulnerable to the negative health effects of prolonged sitting. There is a lack of research on the physical activity and the health ramifications of prolonged sitting by competitive players. The purpose of this study was to investigate activity levels, body mass index (BMI), and body composition in collegiate esports players as compared to age-matched controls. METHODS: Twenty-four male collegiate esports players and non-esports players between 18 and 25 years of age signed a written consent to participate. Physical activity was examined using daily activity (step count) with a wrist-worn activity tracker. A questionnaire assessing physical activity was also administered. Secondary outcomes included body-fat percentage, lean-body mass, BMI, and bone mineral content measured using dual X-ray absorptiometry. RESULTS: The step count in the esports players was significantly lower than the age-matched controls (6040.2 ± 3028.6 vs. 12843.8 ± 5661.1; p = 0.004). Esports players exhibited greater body-fat percentage (p = 0.05), less lean body mass (p = 0.003), and less bone mineral content (p = 0.03), despite no difference in BMI between the esports and non-esports players. CONCLUSION: As compared to non-esports players, collegiate esports players were significantly less active and had a higher body-fat percentage, with lower lean body mass and bone mineral content. The BMIs showed no difference between the 2 groups. Esports athletes displayed significantly less activity and poor body composition, which are all correlated with potential health issues and risk of injury. BMI did not capture this difference and should not be considered as an accurate measure of health in competitive esports players.

Blood flow restriction resistance training in a recreationally active person with Parkinson's disease.

Background: Blood flow restriction (BFR) applied during low intensity resistance training (LIRT) exercise produces hypertrophy and strength gains equivalent to traditional training. The effectiveness of BFR-LIRT on persons with Parkinson Disease (PD) has not been investigated.Objective: To determine the effects of BFR-LIRT on a recreationally active person with PD in regards to function, strength, Restless Leg Syndrome (RLS) and safety. Methods: A single subject, A-B-A design was utilized. Each phase lasted 6 weeks. Outcome measures included: 30-second sit-to-stand; Timed Up and Go (TUG); RLS Questionnaire; 3-RM of Cybex Leg Press (LP); Leg Curl (LC); and Leg Extension (LE) measured every 3 weeks for 18 weeks. The intervention phase (B, weeks 6-12) included four lower extremity resistance exercises (LP, LC, LE, calf presses on the LP) with the addition of BFR. The two standard deviation band method was used to determine significance.Results: All outcome measures except the TUG improved significantly by the end of intervention phase.Conclusion: The combination of BFR with LIRT safely lead to an increase in lower extremity strength and function in a person with PD, while decreasing their RLS (improvement from moderate to mild symptoms) resulting in a better quality of life for the participant.

Physiological and Cognitive Functions Following a Discrete Session of Competitive Esports Gaming.

Competitive organized electronic video gaming, termed "esports," has become an international industry. The physiological and cognitive health results of prolonged esport practice and competition have not been adequately studied. The current study examined physiological and cognitive changes after a session of esport gameplay for two types of games, first-person shooter and multiplayer online battle arena games. Increases in systolic blood pressure, increases in speed, and decreases in accuracy and inhibitory processes were found for esport gamers overall. For peak heart rate change, first-person shooter games elicited a larger change than did multiplayer online battle arena games. These results have implications for the management of esport player cognitive and physical health as well as for the optimization of performance in competitive esport tournaments.

An Osteopathic Physician's Approach to the Esports Athlete.

Esports is gaining acceptance in the world of professional, collegiate, and high school athletics. However, there is a lack of information for osteopathic physicians about the health concerns and appropriate treatment of esports athletes. Because of the sedentary nature of the sport and accompanying poor posture, esports athletes are likely to have musculoskeletal injuries of the neck, back, and upper extremities. Additionally, these athletes may have metabolic disturbances resulting from light-emitting diode computer monitors as well as mental health concerns regarding gaming addiction and social behavior disorders. The authors explore the osteopathic physician's role in promoting health and reducing injury in this new gaming phenomenon.

Managing the health of the eSport athlete: an integrated health management model.

OBJECTIVES: eSport is a form of electronic gaming, also known as professional or competitive video gaming, and is growing at a rapid pace worldwide. Over 50 US colleges have established varsity gaming teams over the past three years; some colleges offer eSport scholarships as they do for traditional sports. There is little objective research on the health habits of these players who are often placed under the direction of the athletics department on college campuses, and there is currently no health management model on how to treat these new athletes. METHODS: Anonymous electronic surveys were sent to 65 collegiate eSport players from nine universities across the USA and Canada inquiring about gaming and lifestyle habits, and musculoskeletal complaints due to eSport competition. RESULTS: Players practiced between 3 and 10 hours per day. The most frequently reported complaint was eye fatigue (56%), followed by neck and back pain (42%). eSport athletes reported wrist pain (36%) and hand pain (32%). Forty per cent of participants do not participate in any form of physical exercise. Among the players surveyed, only 2% had sought medical attention. CONCLUSION: eSport players, just like athletes in traditional sports, are susceptible to overuse injuries. The most common complaint was eye fatigue, followed by neck and back pain. This study shows eSport athletes are also prone to wrist and hand pain. This paper proposes a health management model that offers a comprehensive medical team approach to prevent and treat eSport athletes.

Nicotine Gum as a Therapeutic Approach for Low Blood Pressure in Parkinson's Disease: A Randomized Pilot Study.

Introduction: One cause for low blood pressure (BP) in Parkinson's disease (PD) is denervation of the sympathetic nervous system and reduced levels of norepinephrine. Nicotine increases heart rate and BP acutely by causing sympathetic stimulation. The absorption rate of nicotine gum is relatively quick and absorbed at a constant rate. Our objective was to evaluate how nicotine gum affects acute low BP in PD. Methods: Ten subjects (age 69.3 ± 8.8) completed this double blind, placebo controlled, cross-over design trial using nicotine gum (4 mg) and placebo gum on two separate days. The gum was administered for 30 min. BP was recorded every 10 min for 90 min. Results: On the nicotine gum treatment day, the baseline systolic BP was 94.8 (standard deviation [SD] = 4.4), and it increased in a parabolic pattern to be 115.8 (SD = 11.2) in 20 min, 124.2 (SD = 9.3) in 40 min, and 133.2 (SD = 13.1) in 60 min reaching the highest value, and then decreased to be 121.6 (SD = 10.4) in 90 min. On the placebo day, the baseline systolic BP 95.2 (SD = 3.0) didn't show an outstanding change with the mean systolic BP values from 93.0 to 95.7 (SD from 2.1 to 3.7) at all time points. Conclusions: Our data suggests that 4 mg of nicotine gum can increase systolic BP within 10 min of administration. It is strongly warranted that further research should pursue the use of nicotine gum as an intervention to treat acute episodes of low BP in individuals with PD. Implications: More than 50% of Parkinson's disease (PD) patients have low blood pressure (BP) that fluctuates throughout the day and decreases quality of life. This study found an increase in systolic blood pressure within 10 min of administering nicotine gum to Parkinson's subjects with low BP. Their BP remained elevated for 90 min. Nicotine gum gets absorbed rapidly and may act as a therapeutic novel approach to individuals whose daily lives are interrupted with low BP.

Utilizing wearable technology to increase physical activity in future physicians: A randomized trial.

This study examined the use of activity trackers alone or combined with weekly communication through email to improve activity and body composition over one academic year in medical students. This randomized clinical trial conducted at the New York Institute of Technology from July 7, 2016 through June 4, 2017 enrolled 120 medical students. The first group (Fitbit-Plus) wore activity trackers and received weekly emails offering fitness challenges and lifestyle modification challenges. The second group (Fitbit-Only) received only activity trackers and did not receive weekly emails. The third group (Control) was asked not to purchase an activity tracker of any kind throughout the study. All groups had a body composition analysis prior to the start of the academic year and at the end of the first academic year. Outcome measures included step count and body composition (body fat percentage and lean body mass). The results showed the overall mean daily steps were greater in the Fitbit-Plus group than the Fitbit-Only group for the academic year (7429 ±â€¯2833 vs. 6483 ±â€¯2359) with only months April and May showing a significant difference between the groups (p = 0.011; p = 0.044). Body fat percentage decreased in the Fitbit-Plus overweight women (2.1 ±â€¯1.6%) lean body mass increased in the Fitbit-Plus group in overweight men (2.4 ±â€¯4.6 lbs.). A subsequent finding of this study showed improved body composition in a small sub-group of over-weight students. Weekly behavioral challenges combined with an activity tracker increased step count in medical students compared to an activity tracker alone. Clinicaltrials.gov Identifier: NCT02778009.

THE EFFECTS OF BLOOD FLOW RESTRICTION TRAINING ON FUNCTIONAL IMPROVEMENTS IN AN ACTIVE SINGLE SUBJECT WITH PARKINSON DISEASE.

BACKGROUND: Blood flow restriction (BFR) applied during low intensity exercise produces hypertrophy and strength gains equivalent to traditional training. Previous research has shown the positive effects of BFR on younger and older adults. However, the effectiveness of BFR on subjects with Parkinson Disease (PD) has not been investigated. HYPOTHESES/PURPOSE: The purpose of the study was to determine the effects of BFR on a recreationally active person with PD in regards to functional improvements and safety. The hypothesis was that BFR training will demonstrate improvements in motor function, gait and endurance, while decreasing symptoms associated with Restless Leg Syndrome (RLS) in a subject with PD. STUDY DESIGN: A single subject, B-A design was used. METHODS: The subject was an active 65-year-old male recreational boxer diagnosed with PD. Baseline data were measured on day one. The intervention (Phase B) consisted of five, two-minute bouts of walking on treadmill with lower extremity BFR cuffs interspersed with 1 minute rest, three times a week for six weeks, at 0 grade incline, and speed of 50 meters/min. The pressure increased from the initial 120 to 160 mmHg at the end of the phase B as per the subject's tolerance. A four-week baseline phase (A) without the BFR intervention followed phase B. The outcome measures which were measured every two weeks over the 10 weeks included: Timed Up and Go Test, 6-Minute Walk Test, 30-Second Chair Stand Test, and the RLS Questionnaire. RESULTS: All outcome measures steadily improved every two weeks during the six week intervention phase and steadily declined when the intervention was removed during the second four week baseline phase according to visual inspection of the graphed data points. CONCLUSION: The subject enjoyed and tolerated the intervention well without any adverse effects. The results were that BFR training can produce functional improvements, reduce restless leg syndrome symptoms and can be safely utilized with a subject with PD who wishes to maintain his ability to remain recreationally active.

Osteopathic manipulation as a complementary approach to Parkinson's disease: A controlled pilot study.

BACKGROUND: Osteopathic Manipulative Medicine (OMM) is a therapy of manual forces that is directed to improve function and homeostasis. It has been shown to improve balance in individuals with dizziness, and improve gait in Parkinson's disease (PD). This study was designed to determine if our pre-defined OMM protocol would improve motor function and balance in individuals with PD. METHODS: A randomized controlled trial to test OMM on balance and motor function in PD measured by the Mini-BESTest, Sensory Organization Test (SOT), and MDS-UPDRS. 11 Subjects (age 75±16) were randomly assigned to either bi-weekly OMM treatments first for 6 weeks or weekly counseling sessions from a medical provider for 6 weeks as a placebo-control. 9 subjects completed this study. RESULTS: There were no significant changes in SOT or Mini BESTest in either group (p < 0.05). There was significant improvement in the OMM group for MDS-UPDRS. CONCLUSIONS: Our pilot data showed OMM treatment bi-weekly for 6 weeks improved motor function. There were no significant changes in balance, however there were clinically relevant improvements after 6 weeks of OMM. Using a predefined protocol, OMM may be a complementary approach to improving balance and motor function in individuals with PD.

The Effects of Below Knee Compression Garments on Functional Performance in Individuals with Parkinson Disease.

BACKGROUND: Symptoms of Parkinson's disease (PD) include bradykinesia, gait abnormalities, balance deficits, restless leg syndrome, and muscular fatigue. Compression garments (CG) have been shown to improve performance in athletes by increasing venous return and reduce lactic acid. OBJECTIVE: Assess the effect of compression garments on the performance of 3 standardized functional tests in persons with PD. METHODOLOGY: The functional tests selected represented strength, endurance, and mobility measures in individuals with PD. Nineteen males and 2 females (age 48-85) with PD participated in this cross-over design study. Subjects were randomly assigned to test under two conditions on two separate days: 1) wearing below knee CG 2) wearing sham stockings. Outcome measures included 5 Times Sit to Stand (5XSTS), gait speed, and 6 Minute Walk Test (6MWT). There were seven days between trials. RESULTS: A paired t-test was used for each dependent variable. Significance was set at p < 0.05. There were no significant differences found between the CG and sham socks for all outcome measures. Paired t-tests for the dependent variables were Gait Speed p=.729; 5XSTS p=.880; 6MWT .265; RPE p. =1.00. CONCLUSION: Data to support the use of compression garments for enhanced proprioception, muscle power, speed, and endurance is in need of further study with the PD population. In particular, it is recommended that future studies assess the possible physiological benefits of compression garments when worn during exercise interventions.

Learning effects of the sensory organization test as a measure of postural control and balance in Parkinson's disease.

INTRODUCTION: Recent experiments examining balance in Parkinson's disease (PD) have used the sensory organization test (SOT) to measure postural control and balance. Use of the SOT raises the question as to whether people will improve after undergoing the test multiple times or if there is a learning effect plateau after multiple trials. The objective of this study was to determine whether there is a learning effect using the SOT in subjects with PD both fallers and non-fallers, and healthy controls. METHODS: Nineteen subjects completed the study. Ten subjects with PD who were non-fallers (PD-Non-fallers), nine subjects with PD who were fallers (PD-Faller), and 10 healthy controls (Controls). Subjects completed 5 SOT testing sessions over a 3 week period. Those with PD were tested at the same time in their peak 'on' period. RESULTS: The PD-Faller groups SOT composite score improved from session 1 to session 4 and 5. In the Control group the composite score improved from session 1 to session 5. There was no change from session 1 to session 5 in the PD Non-faller group. The PD-Faller group had significantly lower composite scores than our PD Non-faller group and our Controls. Our PD-Non-faller group scores were similar to Controls. CONCLUSION: Multiple baseline measures are usually recommended for any task used as an outcome measure. Our findings suggest that in PD subjects who are considered fallers that by the fourth session any improvement may be due to a learning effect.

Parkinsonian gait ameliorated with a moving handrail, not with a banister.

OBJECTIVE: To determine whether haptic (touch and proprioception) cues from touching a moving handrail while walking can ameliorate the gait symptoms of Parkinson disease (PD), such as slowness and small stride length. DESIGN: Nonrandomized, controlled before-after trial. SETTING: Physical therapy clinic. PARTICIPANTS: People with PD (n=16) and healthy age-matched control subjects (n=16) with no neurologic disorders volunteered. No participants withdrew. INTERVENTIONS: We compared gait using a moving handrail as a novel assistive aid (speed self-selected) versus a banister and unassisted walking. Participants with PD were tested on and off dopaminergic medication. MAIN OUTCOME MEASURES: Mean gait speed, stride length, stride duration, double-support duration, and medial-lateral excursion. RESULTS: With the moving handrail, participants with PD increased gait speed relative to unassisted gait by 16% (.166m/s, P=.009, d=.76; 95% confidence interval [CI], .054-.278m/s) and increased stride length by 10% (.053m, P=.022, d=.37; 95% CI, .009-.097m) without significantly changing stride or double-support duration. The banister reduced speed versus unassisted gait by 11% (-.097m/s, P=.040, d=.40; 95% CI, .002-.193m/s) and reduced stride length by 8% (.32m, P=.004, d=.26; 95% CI, .010-.054m), whereas it increased stride duration by 3% (.023s, P=.022, d=.21; 95% CI, .004-.041s) and double-support duration by 35% (.044s, P=.031, d=.58; 95% CI, .005-.083s). All medication × condition interactions were P>.05. CONCLUSIONS: Using haptic speed cues from the moving handrail, people with PD walked faster by spontaneously (ie, without specific instruction) increasing stride length without altering cadence; banisters slowed gait. Haptic cues from the moving handrail can be used by people with PD to engage biomechanical and neural mechanisms for interpreting tactile and proprioception changes related to gait speed to control gait better than static cues afforded by banisters.

Effects of Tyrosine on Parkinson's Disease: A Randomized, Double-Blind, Placebo-Controlled Trial.

Individuals with Parkinson's disease (PD) can suffer from orthostatic hypotension (OH) resulting from reduced levels of norepinephrine (NE), which inhibits the sympathetic nervous system. Levodopa reduces NE levels even further, leading to a greater decrease in blood pressure (BP) and increased OH. Tyrosine is a nonessential amino acid that is the major precursor to NE. Reduced levels of tyrosine have been shown after administration of l-dopa. This study was a single-center, randomized, double-blind, placebo-controlled trial to test the effects of supplementing l-tyrosine on BP, plasma tyrosine, NE levels, and autonomic responses to exercise in PD. Thirty-six subjects with PD receiving l-dopa medication that suffer from OH participated. Random assignment was to a placebo group or l-tyrosine 1,000 mg (500 mg of 2× daily) group for 7 days. OH testing and exercise testing was performed pre- and postsupplementation. There was no effect of tyrosine on BP after OH testing postsupplementation (tyrosine, n = 17; placebo, n = 19). There was an increase in plasma tyrosine in the tyrosine group (P > 0.05). There were no significant changes in any of the secondary outcome measures. l-tyrosine at 1,000 mg (500 mg/2× day) for 7 days is safe and well tolerated in PD. Our results were inconclusive as to whether an increase in plasma tyrosine has an effect on OH in subjects with PD. An increase in plasma tyrosine had no effect on BP or autonomic responses in subjects with PD during acute exercise stress. (Trial registration: http://ClinicalTrials.gov.; identifier: NCT01676103).