Walking training augments the effects of expiratory muscle training in Parkinson's disease.

OBJECTIVES: To investigate the effects of walking training combined with respiratory muscle training (RMT) on pulmonary function, respiratory muscle strength, and functional exercise capacity in patients with Parkinson's disease. MATERIALS & METHODS: Thirty patients with Parkinson's disease were included in the study. Patients were randomly divided into two groups: the walking and RMT group (W + RMT, n = 15) and the RMT (n = 15) group. Spirometry, respiratory muscle strength, and a 6-min walking test were measured before and after the eighth week of the study. RMT was performed using inspiratory and expiratory threshold loading methods. Walking training intensity was adjusted according to the 6-min walking test. Patients performed 15 min of inspiratory muscle training and 15 min of expiratory muscle training in both groups, and 15 min of walking training in the W + RMT group in addition to RMT, twice per day, 5 days/week, for a total of 8 weeks at home. Training intensity was adjusted once per week for the groups at the hospital. RESULTS: Respiratory muscle strength and 6-min walking distance were significantly increased (p = .001), and UPDRS-III scores were significantly improved (W + RMT: p = .008 and RMT: p = .01) in the two groups. The increase in maximal expiratory pressure was significantly higher in the W + RMT group than in the RMT group (p = .007). CONCLUSION: Walking training increases the effect of expiratory muscle training in patients with Parkinson's disease.

Effects of different vibration frequencies on spinal cord reflex circuits and thermoalgesic perception.

OBJECTIVES: We studied the effect of different vibration frequencies on spinal cord excitability and heat pain perception. We hypothesized that the effects of vibration on spinal cord reflexes, and, also those on heat pain perception, depend on vibration frequency. METHODS: In 9 healthy subjects, we applied vibration over the tibialis anterior muscle at three different frequencies (50, 150, or 250 Hz) on spinal cord reflex excitably, tested with the H reflex and the T wave in the soleus muscle, as well as on sensory and pain perception, tested by measuring warm perception (WT) and heat pain perception thresholds, (HPT) in sites rostral and caudal to vibration. Exams were carried out before, during, and after vibration. RESULTS: The amplitude of the H reflex and T wave significantly decreased during vibration in comparison to baseline. Low frequencies (50 and 150Hz) induced greater reflex suppression than high frequency (250Hz). No significant changes were observed on WT and HPT. CONCLUSIONS: The effects of vibratory stimulation can be summarized as frequency-related suppression of the spinal cord excitability without an effect on warm and heat pain perception. The present results may help to design vibration-related interventions intended to diminish spinal cord reflex excitability in spastic patients.

Health related quality of life in patients with epilepsy in Turkey.

[Purpose] This study measured the quality of life in epilepsy and determined associated demographic and clinical factors by means of the Short Form-36 health survey. [Subjects and Methods] 124 consecutive epilepsy patients were enrolled and their demographic variables and clinical characteristics recorded. The Short Form-36 questionnaire was completed independently by each participant. Short Form-36 dimensional and composite scores were computed and scaled with data from an extensive survey of the healthy population. [Results] Short Form-36 scores for physical dimensions were similar to healthy values, but those for mental dimensions except for energy/vitality were remarkably and significantly lower than normal. All Short Form-36 average scores for women were lower than those for men and significantly so for mental health composite scores. Patients responding well to treatment were aware of their improving health as measured by the Change in Health score and had better dimensional scores than those with a poor response. [Conclusion] Patients with epilepsy do not perceive impaired physical health status. However, their mental health appears vulnerable, especially in women. Therefore, the major burden in epilepsy is in the mental health category. A positive treatment response is also an important determinant of the related quality of life measure.

The effect of kinesiophobia on physical activity, balance, and fear of falling in patients with Parkinson's disease.

PURPOSE: Kinesiophobia is defined as the fear of movement and activity resulting from a feeling of vulnerability to painful injury or re-injury. This study aimed to determine the effect of kinesiophobia on physical activity, balance, and fear of falling in patients with Parkinson's disease. METHODS: The study, which was designed as a cross-sectional type, was conducted with 86 patients with Parkinson's disease (age 61.25 SD [9.72] years old) by face-to-face interviews with the patients. The Tampa Scale of Kinesiophobia, International Physical Activity Questionnaire-Short Form, Berg Balance Scale, Falls Efficacy Scale, Visual Analog Scale - Fear of Falling, Unified Parkinson's Disease Rating Scale - motor score, and the Hoehn and Yahr scale were used to evaluate the patients. RESULTS: Patients with Parkinson's disease who had high levels of kinesiophobia had lower levels of physical activity, worse balance, and higher disease severity and fear of falling. A correlation was found between the Tampa Scale score and physical activity, balance, fear of falling, falls efficacy, and disease motor score (p < .001; r = -0.38, -0.54, 0.67, 0.57, and 0.37, respectively). According to multiple linear regression analysis, kinesiophobia explained the dependent variables to varying degrees ranging from 13% to 44% (p < .001). CONCLUSIONS: Patients with Parkinson's disease may have kinesiophobia. Rehabilitation programs to support functional capacity for these patients should be developed considering the presence of kinesiophobia.

The Effect of 2 Different Dual-Task Balance Training Methods on Balance and Gait in Older Adults: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to compare the effects of integrated and consecutive cognitive dual-task balance training in older adults on balance, fear of falling, and gait performance. METHODS: Fifty-eight participants (age >65 years) were randomly assigned to an integrated dual-task training group (IDTT) (n = 29) and consecutive dual-task training group (CDTT) (n = 29). Balance exercises and cognitive tasks were performed simultaneously by the IDTT group and consecutively by the CDTT group for 8 weeks. Balance was assessed using the Berg Balance Scale as a primary outcome measure and the Timed "Up & Go" Test (TUG) (standard-cognitive), fear of falling was assessed using the Tinetti Falls Efficacy Scale, and gait speed was assessed using the 10-Meter Walk Test (10MWT) (under single-task and dual-task conditions). All tests were performed before and after the training. RESULTS: There was no difference in group-time interaction in the Berg Balance Scale, TUG-standard, 10MWT-single task, and 10MWT-dual task tests. Group-time interaction was different in the TUG-cognitive and Tinetti Falls Efficacy Scale scores. Also, the effect of time was significantly different in all scales except for the 10MWT-single task in both groups. CONCLUSION: At the end of the 8-week training period, the impact of integrated and consecutive dual-task balance training on balance and gait performance in older adults was not statistically significantly different. This study suggests that consecutive dual-task balance training can be used as an alternative method to increase balance performance and gait speed in older adults who cannot perform integrated dual-task activities. IMPACT: There were no significant differences between the effects of the 2 dual-task training methods on balance and gait speed, suggesting that the consecutive dual-task balance training method can be used to improve the balance and gait of older adults. CDTT can be performed safely and considered as an alternative method for use in many rehabilitation training programs with older adults who cannot perform simultaneous activities.

Does kinesiophobia limit physical activity and quality of life in asthmatic patients?

Kinesiophobia has been studied in musculoskeletal and neurological diseases. The aim of this descriptive study was to assess the level of kinesiophobia in stable asthmatic patients, and to determine whether it is an obstacle to physical activity and quality of life. A total of 62 asthmatic patients and 50 healthy control subjects were assessed using the tampa kinesiophobia scale (TSK) for kinesiophobia, International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity levels, and Asthma Quality of Life Questionnaire (AQLQ) for quality of life. A high degree of kinesiophobia was determined in 54.8% of the asthmatic patients. The TSK scores were significantly higher ( P < 0.001), and the AQLQ scores were lower in the asthma group than in the control group ( P < 0.001). The IPAQ-SF level and AQLQ score were lower ( P < 0.001 for both) in the asthmatic group with a high kinesiophobia score. The TSK score was significantly associated with IPAQ-SF score ( r = -0.889; P < 0.001) and AQLQ score ( r = -0.820; P < 0.001) in asthmatic patients. According to linear regression analysis, kinesiophobia explained 84.40% of QoL and physical activity. Patients with a stable asthma were observed to have a high level of kinesiophobia compared with healthy subjects. High kinesiophobia levels may increase the disease burden by negatively affecting participation in physical activity and quality of life. While developing asthma education programs for asthma patients, it should be remembered that even in the stable period, kinesiophobia can develop. Preventive and therapeutic programs should include precautions to improve quality of life and physical activity against the effects of kinesiophobia.

Quantitative analysis of reduced arm swing frequency in essential tremor.

BACKGROUND: Essential tremor (ET) has recently been accepted as a heterogeneous disorder which may be associated with synuclein pathology or a variety of other genetic disorders. METHODS: We observed decreased arm swing frequency in 18 of 136 definite ET patients, and recorded the associated arm movements in 18 ET patients and 33 sex- and age-matched healthy controls. RESULTS: The mean frequency of the right arm (p = 0.047), left arm (p = 0.025) and leg (p = 0.030), and the mean arm/leg frequency on the right side (p = 0.048) were significantly lower in ET patients. The mean frequencies for both arms and legs were significantly lower for the more affected side of the body (p = 0.034 and p = 0.036, respectively). CONCLUSION: We conclude that ET may be associated with decreased arm and leg swing frequencies, especially on the more affected side of the body.

The relationship between objective balance, perceived sense of balance, and fear of falling in stroke patients.

OBJECTIVE: The objective of our study was to investigate the relationship between objective balance, fear of falling, and perceived sense of balance (PSB) in stroke patients. METHODS: Seventy patients aged 18-65 years with chronically developed hemiplegia or hemiparesis were enrolled in the study. Patients' objective balance scores, fear of falling, and PSB were obtained using the berg balance scale (BBS), the falls efficacy scale (FES), and a visual analog scale, respectively. The Standard Mini-Mental Examination was performed to exclude patients with mental disorders from the study. RESULTS: There was a moderate negative correlation between PSB and BBS scores (p = 0.001, ρ = -0.588); a strong negative correlation between BBS and FES scores (p = 0.001, ρ = -0.808); and a strong positive correlation between PSB and FES scores (p = 0.001, ρ = 0.714). We found that BBS scores had negative correlation with PBS scores in left hemiplegic patients while there was no any relationship between BBS and PBS scores in right hemiplegic patients. CONCLUSION: PSB assessment, besides the BBS, should be considered among the routine assessment methods that enable the rehabilitation team to be aware of patients' balance capacities.