Determination of optimal vibration dose to treat Parkinson's disease gait symptoms: A clinical trial.

Introduction: Most people with Parkinson's disease (PD) will experience gait problems. Previous studies demonstrated improved gait and balance after vibration stimulation was applied to the feet of PD patients. However, not all study participants showed improvement, perhaps due to sub-optimal vibration stimulus. Thus far, the optimal frequency and amplitude of vibration for mitigating gait dysfunction in PD have yet to be systematically explored. This study aimed to deliver vibration to the feet of 26 people with PD gait disturbances. We hypothesized that a global frequency, amplitude, and minimum duration of vibration therapy are required to improve PD gait issues. Methods: This was a phase Ib trial to identify optimal vibration parameters. Thirteen participants were recruited at Hoehn & Yahr (H&Y) stage II and 13 participants at stage III. Each group was randomly assigned to different frequency and amplitude settings prescribed by the central composite design methodology. Each participant received vibration for 18 min per walking session, for eight sessions spread over one week. Results: Results showed an optimal response to treatment for frequency (Hz) and amplitude (mm) of vibration based on the Functional Ambulation Performance score for stages II and III. In the H&Y stage II group, stabilization of outcomes occurred after the 4th treatment. This stabilization was not seen in stage III participants. Conclusions: A global frequency and vibration amplitude have been identified for treating PD gait disorders. Patients with more advanced disease may require a longer duration of therapy.

FoG-Finder: Real-time Freezing of Gait Detection and Treatment.

Freezing of gait is a serious symptom of Parkinson's disease that increases the risk of injury through falling, and reduces quality of life. Current clinical freezing of gait treatments fail to adequately address the fall risk posed by freezing of gait symptoms, and current real-time treatment systems have high false positive rates. To address this problem, we designed a closed-loop, non-intrusive, and real-time freezing of gait detection and treatment system, FoG-Finder, that automatically detects and treats freezing of gait. To evaluate FoG-Finder, we first collected 716 freezing of gait events from 11 patients. We then compared FoG-Finder against other real-time systems with our dataset. Our system was able to achieve a 13.4% higher F1 score and a 10.7% higher overall accuracy while achieving a reduction of 85.8% in the false positive treatment rate compared with other validated real-time freezing of gait detection and treatment systems. Additionally, FoG-Finder achieved an average treatment latency of 427ms and 615ms for subject-dependent and leave-one-subject-out settings, respectively, making it a viable system to treat freezing of gait in the real-world.

Parkinson's Disease Action Tremor Detection with Supervised-Leaning Models.

People with Parkinson's Disease (PD) have multiple symptoms, such as freezing of gait (FoG), hand tremors, speech difficulties, and balance issues, in different stages of the disease. Among these symptoms, hand tremors are present across all stages of the disease. PD hand tremors have critical consequences and negatively impact the quality of PD patients' everyday lives. Researchers have proposed a variety of wearable devices to mitigate PD tremors. However, these devices require accurate tremor detection technology to work effectively while the tremor occurs. This paper introduces a PD action tremor detection method to recognize PD tremors from regular activities. We used a dataset from 30 PD patients wearing accelerometers and gyroscope sensors on their wrists. We selected time-domain and frequency-domain hand-crafted features. Also, we compared our hand-crafted features with existing CNN data-driven features, and our features have more specific boundaries in 2-D feature visualization using the t-SNE tool. We fed our features into multiple supervised machine learning models, including Logistic Regression (LR), K-Nearest Neighbours (KNNs), Support Vector Machines (SVMs), and Convolutional Neural Networks (CNNs), for detecting PD action tremors. These models were evaluated with 30 PD patients' data. The performance of all models using our features has more than 90% of F1 scores in five-fold cross-validations and 88% F1 scores in the leave-one-out evaluation. Specifically, Support Vector Machines (SVMs) perform the best in five-fold cross-validation with over 92% F1 scores. SVMs also show the best performance in the leave-one-out evaluation with over 90% F1 scores.

Challenges and opportunities faced by nurse scientists in integrating data and technology in research to promote health equity.

Advances in technologies including omics, apps, imaging, sensors, and big data are increasingly being integrated into research by nurse scientists, but the impact on improving health equity is still unclear. In this article, nursing research faculty from one institution discuss challenges and opportunities experienced when integrating various technologies into their research aimed at promoting health equity. Using exemplars from faculty experiences, a three-pronged approach to keeping patients and communities and the goal of health equity central in research while incorporating advancing technologies is described. This approach includes establishing long-term engagement with populations underrepresented in research, adopting strategies to increase diversity in study participant recruitment, and training and collaboration among a diverse workforce of educators, clinicians, and researchers. Training nurse scientists in integrating data and technology for advancing the science on health equity will shift the culture of how we understand, collaborate, and grow with the communities in which we train and practice as nurse scientists.

Bringing Transdisciplinary Aging Research From Theory to Practice.

There is a growing emphasis to use a transdisciplinary team approach to accelerate innovations in science to solve complex conditions associated with aging. However, the optimal organizational structure and process for how to accomplish transdisciplinary team science is unclear. In this forum, we illustrate our team's experience using transdisciplinary approaches to solve challenging and persistent problems for older adults living in urban communities. We describe our challenges and successes using the National Institutes of Health four-phase model of transdisciplinary team-based research. Using a de-identified survey, the team conducted an internal evaluation to identify features that created challenges including structural incongruities, interprofessional blind spots, group function, and group dynamics. This work resulted in the creation of the team's Transdisciplinary Conceptual Model. This model became essential to understanding the complex interplay between societal factors, community partners, and academic partners. Conducting internal evaluations of transdisciplinary team processes is integral for teams to move beyond the multi- and interdisciplinary niche and to reach true transdisciplinary success. More research is needed to develop measures that assess team transdisciplinary integration. Once the process of transdisciplinary integration can be reliably assessed, the next step would be to determine the impact of transdisciplinary team science initiatives on aging communities.

Poster: Kinetic Tremor Measurement via IMU Sensing Data Analysis.

Tremor is a common symptom among all stages of Parkinson's Disease (PD) patients. To measure daily tremor events, we utilized IMU sensing data from wrists while PD patients were drawing. We secured 30 patients' IMU sensing data, following standard rating scale activities. With the collected data, we conducted data analysis for identifying any tremor episodes and extracting tremor amplitude. Our preliminary analysis and results show the potential of measuring kinetic tremors effectively. We plan to further analyze tremor events of PD patients via wearable sensing devices.

IMU Sensing Data-based Kinetic Tremor Detection in Parkinson's Disease Patients.

Tremor is a common symptom among Parkinson's disease (PD) patients at all stages. To measure tremor, we utilized IMU sensing data from the wrists while PD patients were drawing. With 30 patients' IMU sensing data obtained from standard tremor rating scale activities, we conducted data analysis for identifying any tremor episodes and extracting tremor amplitude. In this demo, we demonstrate that our preliminary analysis and results show the potential of measuring kinetic tremors effectively using these methods.

Using a GPS Watch to Characterize Life-Space Mobility in Dementia: A Dyadic Case Study.

Persons with dementia (PWD) often experience difficulty navigating their environments and performing out-of-home activities. Life-space mobility (LSM) is an effective way of assessing functional levels and independence. We present a dyadic case study to explore the feasibility of using a global positioning system (GPS) watch to measure LSM of a Latino PWD. Methods included travel diary, LSM questionnaire, and qualitative interviews in addition to the GPS-based mobility characterization. GPS data indicated that the PWD made outdoor trips regularly and was active socially, with day-to-day variations. Caregiver and PWD interviews revealed contextual information about mobility patterns captured by other methods. The dyad had positive perceptions of the GPS watch for tracking health and activities. This study demonstrated a use for wearable location tracking technology to support accurate LSM assessment in dementia that can inform nursing practice, policy, and research to promote well-being and delay functional deterioration in PWD. [Journal of Gerontological Nursing, 47(10), 15-22.].

The Implications of Parkinson's Disease for Women's Health.

Parkinson's disease affects more than 10 million people worldwide, and this number is expected to grow substantially during the next 25 years. Women are two thirds as likely as men to have Parkinson's disease. The symptoms associated with Parkinson's disease are complex and span a spectrum of motor and nonmotor manifestations. We provide an overview of Parkinson's disease, including sex-specific differences in prevalence, clinical presentation, diagnosis, and treatment.

Implementation of an Integrative Holistic Healthcare Model for People Living with Parkinson's Disease.

PURPOSE: Research demonstrates that people with Parkinson's disease (PD) benefit greatly from multidisciplinary medical care. Delaware does not have a Movement Disorder Center or a movement disorder specialist. To address this issue, the University of Delaware Nurse Managed Health Center (NMHC) developed a novel PD Telehealth Clinic serving individuals with PD and their caregivers throughout Delaware. DESIGN AND METHODS: The PD clinic is based on a collaborative framework that uses synchronous videoconferencing telehealth technology to bring together out-of-state clinicians and scientists with expertise in PD to help deliver specialized care to PD patients and their caregivers. The team includes a movement disorder specialist, psychologists, nurse practitioners, researchers, physical and speech therapists, exercise physiologists, nutritionists, and graduate students. The PD Clinic delivery model seamlessly blends telehealth provider and onsite provider interactions, enabling the diagnosis, treatment, and ongoing management of PD. RESULTS: In the first 6 months of the Parkinson's clinic opening, the nurse practitioners along with the movement disorder specialist evaluated 36 PD patients. Several patients have received recommendations to change their medication regimen by the movement disorder specialist. About 20 patients were referred to physical therapy, 7 to speech therapy, 9 to mental health services, 1 to occupational therapy, and 12 to local support groups. The location of the NMHC-PD clinic has reduced travel time and distance by as much as 1.5 hr or 80 miles, each way, and wait time for a new patient appointment is less than 3 months. IMPLICATIONS: The NMHC - PD Telehealth Clinic provides access to specialized multidisciplinary and advanced care and was successfully implemented. This model can be replicated in other nurse managed health centers across the United States.

Challenges and strategies of medication adherence in Parkinson's disease: A qualitative study.

Little is known about strategies used by people with Parkinson's disease (PD) to facilitate medication adherence in the U.S. The purpose of this study was to describe challenges in adherence to medication regimens and to identify strategies used to facilitate adherence to medication regimens. A qualitative research design was used to interview sixteen community-dwelling people with PD and five caregivers. Data analysis was performed using content analysis. The majority of the participants (81.3%) reported decreased adherence to medication regimens. Seven themes emerged from the data. The main challenges of medication adherence included medication responses, cost of medications, and forgetfulness. Strategies used to facilitate adherence to medication regimens included seeking knowledge about antiparkinsonian medications, seeking advice from family and friends, use of devices, and use of reminders. These findings may be important in formulating interventions to improve adherence to medication regimens for people living with PD.

Immediate effects of high-speed cycling intervals on bradykinesia in Parkinson's disease.

There is growing evidence that speed-based exercise training benefits people with Parkinson's disease (PD). The present study investigates the effects of a single session of volitional, high-speed cycling intervals on a battery of timed functional tests selected for their relevance to the symptom of bradykinesia. Ten subjects with PD (Hoehn-Yahr stage ≤ 3.0) participated in a familiarization session and three test sessions. Functional testing occurred before and after 30 minute sessions in which subjects performed no exercise (NO), pedaled at their preferred cadence (PC), or performed 20, 15-second intervals of high-speed low-resistance cycling (HS-LR). In addition to testing the exercise effects in a within-subjects design, we provide test-retest reliability data, minimal detectable change scores, and correlations among the selected functional tests. Despite the relatively low dose of speed-based exercise, HS-LR elicited significant (p < 0.05) improvements in the four square step test and 10 m walk test. Excepting reaction times, there was high reliability and adequate sensitivity to detect moderate and small differences. Strong correlations among tests of mobility inform the future selection of measures in the experimental design. In addition to what is known about continuous exercise sessions involving high-speed exercise, the present results suggest that brief intervals of HS-LR bicycling are promising and should be examined in a longer duration exercise program.

Robust Automated Step Extraction From Time-Series Contact Force Data Using the PDShoe.

This paper presents a method of stride identification, extraction, and analysis of data sets of time-series contact force data for ambulating subjects both with and without Parkinson's disease (PD). This method has been made robust with the use of seeded K-Means clustering, fast Fourier transformation (FFT) spectral analysis, and minimum window size rejection. These methods combine to produce well selected strides of active walking data. We are able to calculate quality of walking measures of stride duration, stance duration (as percent of gait cycle - %GC), swing duration (%GC), time to maximum heel force (%GC), time to maximum toe force (%GC), time spent in heel contact (%GC), and time spent in toe contact (%GC).

The effect of step-synchronized vibration on patients with Parkinson's disease: case studies on subjects with freezing of gait or an implanted deep brain stimulator.

Identifying noninvasive treatments to alleviate the symptoms of Parkinson's disease (PD) is important to improving the quality of life for those with PD. Several studies have explored the effects of visual, auditory, and vibratory cueing to improve gait in PD patients. Here, we present a wireless vibratory feedback system, called the PDShoe, and an associated intervention study with four subjects. The PDShoe was used on two control subjects, one subject with PD who experienced freezing of gait (FOG), and one subject with PD with an implanted deep brain stimulator (DBS). This short intervention study showed statistically significant improvements in peak heel pressure timing, peak toe pressure timing, time on the heel sensor, and stance to swing ratio after just one week of twice-daily therapy. Thus, step-synchronized vibration applied to the feet of patients with PD may be an effective way to improve gait in those subjects.

Adherence to a community-based exercise program is a strong predictor of improved back pain status in older adults: an observational study.

OBJECTIVES: To identify factors that were predictive of improved pain status among older adults with chronic back pain participating in the Adaptive Physical Activity (APA) program and to identify factors that were predictive of adherence to APA. METHODS: An observational cohort study of 392 older adults (ages 50 to 88) with chronic back pain participating in APA for 12 months. APA was a community-based group exercise program given for 1-hour, twice weekly, in local gyms. Primary outcome measures were improved pain based on a global rating of change evaluation and adherence to the APA program (defined as participation in >75% of exercise sessions). Potential predictor variables were entered into multivariate logistic regression models to determine the most accurate set of variables for predicting improved pain and adherence. RESULTS: Presence of depressive symptoms, poor self-rated health and adherence to APA were the best predictors of improved pain status, with adherence being the strongest predictor [odds ratio: 13.88 (95% confidence interval: 8.17, 23.59)]. Better physical function, longer pain duration, and positive rating of the trainer were all positively associated with adherence to APA; whereas poor self-rated health and further distance from the gym were inversely associated. CONCLUSIONS: Given that adherence to APA is the key predictor of improved back pain, future efforts should focus on strategies to improve adherence. Our data suggest that enhanced training of exercise trainers, development of separate classes for people with different functional levels, and use of psychosocial interventions to reduce health pessimism and depression may be potential targets for improving adherence.

An untethered shoe with vibratory feedback for improving gait of Parkinson's patients: the PDShoe.

Subjects with Parkinson's disease (PD) often have trouble with ambulation. Some research has shown that auxiliary cueing in the form of vision, audio, or vibration can improve the gait of PD patients. We have developed a new vibratory feedback shoe, known as the PDShoe, which builds on existing research. This device can modulate both frequency and amplitude of feedback for the wearer. It is untethered, and thus can be worn during daily activities. Pressure and tactor status data are transmitted wirelessly over a personal area network to a notebook computer. This computer can also control the tactor actuation and stimulation frequency. This paper describes the details of design and construction of the PDShoe. A preliminary evaluation with four Parkinson's disease subjects and two healthy subjects is included to show the usability of the device.

Feasibility and impact of a function focused care intervention for Parkinson's disease in the community.

BACKGROUND: Parkinson's disease (PD) results in a progressive loss of function such that family caregivers provide a large percentage of the personal care to PD patients living in the home setting. OBJECTIVES: The aim of this study was to test the feasibility and impact of function-focused care for PD (FFC-PD) developed to optimize function and physical activity among people with PD who live in the community. METHODS: This pilot study was a single-group, 2 pretest, 3 posttest repeated-measures design to investigate the impact of the FFC-PD intervention over a 12-month period. Measurements included the Self-Efficacy and Outcome Expectations for Exercise and Functional Activities, Yale Physical Activity Scale, Unified Parkinson's Disease Rating Scale, Barthel Index, Schwab & England, Timed Chair Rise, Parkinson's Disease Questionnaire-39, and Geriatric Depression Scale. RESULTS: The impact of FFC-PD on a person with PD showed a statistically significant increase in outcome expectations for exercise, F(3, 60) = 3.09, p = .034; hours a week exercising, F(1, 24) = 4.95, p = .004; mean weekly energy expenditure, F(2,43) = 4.32, p = .017; hours spent in overall activities, F(3, 60) = 6.06, p = .001; decreased disability based on the Unified Parkinson's Disease Rating Scale, F(2, 40) = 9.48, p < .001; improved Parkinson's Disease Questionnaire-39 score, F(3, 60) = 3.81, p = .014; and a trend toward significance on Barthel Index, F(1.6, 31) = 3.47, p = .055. DISCUSSION: Function-focused care for PD has a significant effect on increasing and on strengthening outcome expectations related to exercise, time spent in exercise, and physical activity and in improving functional performance in people with PD. Further research is needed to explore the use of objective measurements of functional performance and activity and to test FFC-PD in a randomized controlled trial.

Implementation of the 6-week educational component in the Res-Care intervention: process and outcomes.

A 6-week restorative care educational program (30 minutes weekly) was conducted for nursing assistants. A total of 523 nursing assistants from 12 nursing homes were recruited: 265 were at treatment sites and 258 were at control sites. The mean age of the participants was 38.1 years (SD = 12.0). The majority were female (486; 93%) and African American (466; 89%). The nursing assistants had an average of 14.7 (SD = 3.8) years of education and 11.5 (SD = 8.6) years of experience. Control sites had a single 30-minute in-service on managing behavioral problems commonly associated with dementia. A total of 33% of the nursing assistants who consented to participate at the treatment sites attended all six classes, and 53% of those who did not attend at least three classes received one-on-one review of the class content. Overall, 86% of the nursing assistants who consented to participate attended the 6-week educational program. At the control sites, 18% of the nursing assistants who consented to participate attended the in-service training. There was a significant increase in restorative care knowledge (SD = 2.7, F = 280.4, p < .05) in treatment group participants. The techniques used in this intervention were effective in helping to expose nursing assistants to educational sessions and increase their knowledge of nursing care practices.

Nursing home resident outcomes from the Res-Care intervention.

OBJECTIVES: To test the effectiveness of a restorative care (Res-Care) intervention on function, muscle strength, contractures, and quality of life of nursing home residents, with secondary aims focused on strengthening self-efficacy and outcome expectations. DESIGN: A randomized controlled repeated-measure design was used, and generalized estimating equations were used to evaluate status at baseline and 4 and 12 months after initiation of the Res-Care intervention. SETTING: Twelve nursing homes in Maryland. PARTICIPANTS: Four hundred eighty-seven residents consented and were eligible: 256 from treatment sites and 231 from control sites. The majority were female (389, 80.1%) and white (325, 66.8%); 85 (17.4%) were married and the remaining widowed, single, or divorced/separated. Mean age was 83.8 +/- 8.2, and mean Mini-Mental State Examination score was 20.4 +/- 5.3. INTERVENTION: Res-Care was a two-tiered self-efficacy-based intervention focused on motivating nursing assistants and residents to engage in functional and physical activities. MEASUREMENTS: Barthel Index, Tinetti Gait and Balance, grip strength, Dementia Quality-of-Life Scale, self-efficacy, and Outcome Expectations Scales for Function. RESULTS: Significant treatment-by-time interactions (P<.05) were found for the Tinetti Mobility Score and its gait and balance subscores and for walking, bathing, and stair climbing. CONCLUSION: The findings provide some evidence for the utility and safety of a Res-Care intervention in terms of improving function in NH residents.

Psychological impact of implantable cardioverter defibrillator on their recipients.

This 12-month longitudinal prospective study tracked the depression and anxiety levels of implantable cardioverter defibrillator recipients after implantation of the device. Depression and anxiety levels dropped significantly over time. These findings suggest that interventions should be implemented early because the needs are greatest in the first few weeks after device implantation.