A brief intervention decreases student distress.

PURPOSE OF THE ARTICLE: Health professions graduate students have experienced substantial increases in stress and anxiety in recent years. This can result in decreased academic performance, poor retention, and burnout. Interventions to help students cope are therefore a critical need for academic institutions. The current study sought to demonstrate the effectiveness of a brief multimodal intervention in reducing student distress. METHOD: The study was a randomised controlled design that evaluated a brief intervention of cognitive-behavioural therapy, mindfulness, and healthy lifestyle choices. The Depression Anxiety Stress Scale-21 was administered to participants at baseline and two post-intervention time points. Control participants did not participate in any intervention. Participants were recruited from graduate students in first-year classes within the School of Health Professions at UT Southwestern Medical Center. RESULTS: Analysis revealed an overall mild to moderate decline in Depression Anxiety Stress Scale-21 total scores over three assessment periods for both treatment and control groups, with no statistical differences noted between groups; however, the treatment group's scores declined approximately 6 weeks before the control participants' scores declined. CONCLUSION: The pattern of change in the two groups suggests that our intervention facilitated the reduction in student anxiety more quickly than would have occurred normally and with sustained results.

The effect of a multi-modal boxing exercise program on cognitive locomotor tasks and gait in persons with Parkinson disease.

BACKGROUND: Parkinson disease (PD) is a progressive neurological disease resulting in motor impairments, postural instability, and gait alterations which may result in self-care limitations and loss of mobility reducing quality of life. OBJECTIVE: This study's purpose was to determine the impact of a community-based boxing program on gait parameters, dual task and backwards walking in individuals with PD. METHODS: This study included 26 community dwelling individuals with PD who participated in 12-week boxing classes (1 hour, 2 times a week). The focus was on upper/lower extremity exercises using punching bags, agility drills, and strengthening activities. Pre/post testing was performed for dual task and gait parameters and was analyzed using t-tests. RESULTS: Analysis of the scores indicated participants performed significantly better at post-test compared to pre-test on self-selected walking velocity (P = 0.041), cadence (P = 0.021); backwards walking velocity (P = 0.003), step length (P = 0.022); dual task walking velocity (P = 0.044), step length (P = 0.023), and gait variability index (P = 0.008). No significant differences for fast walking. CONCLUSIONS: Multi-modal boxing produced improvements in gait velocity, dual task velocity, step length, and gait variability, as well as backwards walking velocity and step length. These improvements may impact independence with functional mobility and may improve safety but require further studies.

Biomechanical analysis of an unpowered hip flexion orthosis on individuals with and without multiple sclerosis.

BACKGROUND: Gait impairment is a common complication of multiple sclerosis (MS). Gait limitations such as limited hip flexion, foot drop, and knee hyperextension often require external devices like crutches, canes, and orthoses. The effects of mobility-assistive technologies (MATs) prescribed to people with MS are not well understood, and current devices do not cater to the specific needs of these individuals. To address this, a passive unilateral hip flexion-assisting orthosis (HFO) was developed that uses resistance bands spanning the hip joint to redirect energy in the gait cycle. The purpose of this study was to investigate the short-term effects of the HFO on gait mechanics and muscle activation for people with and without MS. We hypothesized that (1) hip flexion would increase in the limb wearing the device, and (2) that muscle activity would increase in hip extensors, and decrease in hip flexors and plantar flexors. METHODS: Five healthy subjects and five subjects with MS walked for minute-long sessions with the device using three different levels of band stiffness. We analyzed peak hip flexion and extension angles, lower limb joint work, and muscle activity in eight muscles on the lower limbs and trunk. Single-subjects analysis was used due to inter-subject variability. RESULTS: For subjects with MS, the HFO caused an increase in peak hip flexion angle and a decrease in peak hip extension angle, confirming our first hypothesis. Healthy subjects showed less pronounced kinematic changes when using the device. Power generated at the hip was increased in most subjects while using the HFO. The second hypothesis was not confirmed, as muscle activity showed inconsistent results, however several subjects demonstrated increased hip extensor and trunk muscle activity with the HFO. CONCLUSIONS: This exploratory study showed that the HFO was well-tolerated by healthy subjects and subjects with MS, and that it promoted more normative kinematics at the hip for those with MS. Future studies with longer exposure to the HFO and personalized assistance parameters are needed to understand the efficacy of the HFO for mobility assistance and rehabilitation for people with MS.

Differences in predictors for gait speed and gait endurance in Parkinson's disease.

INTRODUCTION: Both gait speed and gait endurance directly impact independence and community engagement for individuals with Parkinson's disease (PD). However, factors accounting for variability in gait speed and gait endurance performance are unclear. The purpose of this study was to investigate whether key factors associated with gait speed in individuals with PD also predicted gait endurance. METHODS: Community dwelling ambulatory individuals with PD were recruited for a single session. Key measures included 10 Meter Walk Test (10MWT) and 6 Minute Walk Test (6MWT) and key factors: age, disease severity [Movement Disorders Society United Parkinson's Disease Rating Scale (motor scale only) (MDS-UPDRS motor)], plantar flexor strength [Calf Raise Senior (CRS)], fatigue [Fatigue Severity Scale (FSS)], cognition [Montreal Cognitive Assessment (MoCA)], and balance [Four Square Step Test (FSST)]. Multiple linear regression analyses were conducted to determine clinical relationships. RESULTS: Seventy-two individuals with PD (mean (standard deviation) (age = 70.83 (7.91) years; 50 males; MDS-UPDRS motor = 30.67 (13.50)) completed all assessments. The model predicting gait speed was significant, F(6, 65) = 15.143, p <.001, accounting for 54 % of the variance. Of the predictor variables age, MDS-UPDRS motor, CRS, MoCA and FSST scores were significant predictors. The model predicting gait endurance was significant, F(6, 65) = 15.608, p <.001, accounting for 55 % of the variance. Of the predictor variables, age, MDS-UPDRS motor scale, and CRS scores were significant predictors. DISCUSSION: Gait speed and gait endurance are similarly influenced by age, motor impairment, and plantarflexion strength. However, cognition and balance were predictors only of gait speed, which may suggest unique task differences exist between gait speed and gait endurance.

Plantarflexor strength, gait speed, and step length change in individuals with Parkinson's disease.

Parkinson's disease affects the ability to walk often resulting in decreased independence and low quality of life. The purpose of this study was to examine differences in plantarflexor strength (PFS), gait speed, and step length in persons with Parkinson's disease (PwP) and healthy peers using clinical measures. A secondary purpose was to examine the relationship between these gait components across disease severity. The study was a convenience sample of 71 PwP and 25 community healthy peers. Outcome measures included 10-Meter Walk, step length, and Calf-Raise Senior Test. PwP were separated into mild and moderate impairment groups using the Movement Disorders Society United Parkinson's Disease Rating Scale Motor Subscale. Between group differences for gait speed (F2,93 = 24.560, P = 0.000), step length (F2,93 = 21.93, P = 0.000) and PFS (F2,93 = 19.49, P < 0.000) were observed. Post hoc testing determined a difference (P < 0.00) in gait speed, step length, and PFS testing between moderate impairment versus healthy peers and mild impairment. A difference (P = 0.045) in step length and a trend towards significance (P = 0.064) for PFS was found between healthy peers and mild impairment group. This study revealed that PwP with mild impairment also have significant changes in step length and trends toward plantarflexor weakness without a significant difference in gait speed. These early changes may warrant early assessment and intervention to prevent decline. This study may bring clinical focus onto the plantarflexor and step length for early comprehensive assessment and treatment of gait and mobility for PwP.

Description of novel instrumented analysis of the Four Square Step Test with clinical application: A pilot study.

BACKGROUND: Falls are a common problem for adults in the United States raising concerns about injuries and the resulting economic burden. As a result, it is critical to develop objective measures to assess dynamic balance and the track progress related to interventions or disease progression over time. RESEARCH QUESTION: Are there differences in balance between individuals in the community, individuals post-stroke, persons with Multiple Sclerosis (MS), and individuals living with Parkinson's Disease (PD) as measured with a new instrumented Four Square Step Test (i-FSST)? METHODS: The i-FSST was utilized to assess dynamic balance in 41 individuals (11 community dwelling adults and 10 individuals in each group of persons post stroke, with PD, and with MS). Outcome data including the overall duration of the FSST as well unique temporal-spatial stepping patterns through the test, timing of transitions between each quadrant, and the time in each quadrant prior to transitioning. RESULTS: One-way ANOVAs were conducted to determine whether i-FSST duration, Over Double Support (ODS), and Changes in Main Support (CMS) differed by participants' groups. There was a significant difference between groups in test Duration (F = 9.56, P =  .000), ODS (F = 15.71, P =  .001), and CMS (F = 7.03, P =  .001). Further differences in these variables were found between various groups using Bonferroni post-hoc testing. SIGNIFICANCE: The i-FSST is an innovative and potentially beneficial tool for quantitatively measuring the dynamics that occur in the traditional FSST including a general measure of dynamic balance as well as transition times and stability during the test. This technology can provide objective data on stability, weight shifting, and weight acceptance that may guide interventions and further assessment.

Dynamic neural network approach to targeted balance assessment of individuals with and without neurological disease during non-steady-state locomotion.

BACKGROUND: Clinical balance assessments often rely on functional tasks as a proxy for balance (e.g., Timed Up and Go). In contrast, analyses of balance in research settings incorporate quantitative biomechanical measurements (e.g., whole-body angular momentum, H) using motion capture techniques. Fully instrumenting patients in the clinic is not feasible, and thus it is desirable to estimate biomechanical quantities related to balance from measurements taken from a subset of the body segments. Machine learning algorithms are well-suited for this type of low- to high-dimensional mapping. Thus, our goal was to develop and test an artificial neural network that to predict segment contributions to whole-body angular momentum from linear acceleration and angular velocity signals (i.e., those typically available to wearable inertial measurement units, IMUs) taken from a sparse set of body segments. METHODS: Optical motion capture data were collected from five able-bodied individuals and five individuals with Parkinson's disease (PD) walking on a non-steady-state locomotor circuit comprising stairs, ramps and changes of direction. Motion data were used to calculate angular momentum (i.e., "gold standard" output data) and body-segment linear acceleration and angular velocity data from local reference frames at the wrists, ankles and neck (i.e., network input). A dynamic nonlinear autoregressive neural network was trained using the able-bodied data (pooled across subjects). The neural network was tested on data from individuals with PD with noise added to simulate real-world IMU data. RESULTS: Correlation coefficients of the predicted segment contributions to whole-body angular momentum with the gold standard data were 0.989 for able-bodied individuals and 0.987 for individuals with PD. Mean RMS errors were between 2 and 7% peak signal magnitude for all body segments during completion of the locomotor circuits. CONCLUSION: Our results suggest that estimating segment contributions to angular momentum from mechanical signals (linear acceleration, angular velocity) from a sparse set of body segments is a feasible method for assessing coordination of balance-even using a network trained on able-bodied data to assess individuals with neurological disease. These targeted estimates of segmental momenta could potentially be delivered to clinicians using a sparse sensor set (and likely in real-time) in order to enhance balance rehabilitation of people with PD.

A machine learning approach to targeted balance rehabilitation in people with Parkinson's disease using a sparse sensor set.

Clinical Balance Assessments Often Rely On Functional Tasks As A Proxy For Balance (E.G., Timed Up And Go). In Contrast, Analyses Of Balance In Research Settings Incorporate Quantitative Biomechanical Measurements (E.G., Whole-Body Angular Momentum, H) Using Motion Capture Techniques. Fully Instrumenting Patients In The Clinic Is Not Feasible, And Thus It Is Desirable To Estimate Biomechanical Quantities Related To Balance From Measurements Taken From A Subset Of The Body Segments. Machine Learning Algorithms Are Well-Suited For This Type Of Low- To High-Dimensional Mapping. Thus, Our Objective Was To Develop And Validate An Artificial Neural Network For Estimating Contributions To H From 12 Body Segments Using Only Five Inertial Measurement Units. The Network Was Trained, Tested And Validated On Data From Five Able-Bodied Individuals Performing Forty Trials Each Of A Circuit Involving Complex Walking Tasks, Including Stairs, Ramp, And Direction Changes. The Network Was Also Separately Tested On Four Trials Of An Individual With Parkinson'S Disease Walking On The Circuit. The Output Of The Network Was Strongly Correlated With The Segment Contributions To H In Both Able-Bodied (R= 0.997) And Parkinson'S Disease (R= (0.998) Subjects. The Estimated Values Also Had Low Error Relative To The Signal Magnitude, With The Largest Mean ± SD Rootmean-Squared Errors Of 8.04 ± 1.76% Peak Signal Magnitude In Able-Bodied Individuals And 7.96 ± 0.91% In The Individual With Parkinson'S Disease. These Promising Results Establish The Feasibility Of Using A Sparse Set Of Inertial Measurement Units To Provide Quantitative Data To Clinicians For Targeted Balance Rehabilitation Across Different Patients.

A Clinical Framework for Functional Recovery in a Person With Chronic Traumatic Brain Injury: A Case Study.

BACKGROUND AND PURPOSE: This case study describes a task-specific training program for gait walking and functional recovery in a young man with severe chronic traumatic brain injury. CASE DESCRIPTION: The individual was a 26-year-old man 4 years post-traumatic brain injury with severe motor impairments who had not walked outside of therapy since his injury. He had received extensive gait training prior to initiation of services. His goal was to recover the ability to walk. INTERVENTION: The primary focus of the interventions was the restoration of walking. A variety of interventions were used, including locomotor treadmill training, electrical stimulation, orthoses, and specialized assistive devices. A total of 79 treatments were delivered over a period of 62 weeks. OUTCOMES: At the conclusion of therapy, the client was able to walk independently with a gait trainer for approximately 1km (over 3000 ft) and walked in the community with the assistance of his mother using a rocker bottom crutch for distances of 100m (330 ft). DISCUSSION: Specific interventions were intentionally selected in the development of the treatment plan. The program emphasized structured practice of the salient task, that is, walking, with adequate intensity and frequency. Given the chronicity of this individual's injury, the magnitude of his functional improvements was unexpected.Video Abstract available for additional insights from the Authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A175).

Auditing the Physical Activity and Parkinson Disease Literature Using the Behavioral Epidemiologic Framework.

Motor and nonmotor symptoms associated with Parkinson disease place individuals at greater risk of sedentary behaviors and comorbidities. Physical activity is one modifiable means of improving health and reducing the risk of morbidity. We applied a behavioral framework to classify existing research on physical activity and Parkinson disease to describe the current evolution and inform knowledge gaps in this area. Research placed in phase 1 establishes links between physical activity and health-related outcomes; phase 2 develops approaches to quantify physical activity behavior; phase 3 identifies factors associated with implementation of physical activity behaviors; phase 4 assesses the effectiveness of interventions to promote activity; and phase 5 disseminates evidence-based recommendations. Peer-reviewed literature was identified by searching PubMed, Google Scholar, and EBSCO-host. We initially identified 287 potential articles. After further review, we excluded 109 articles, leaving 178 included articles. Of these, 75.84% were categorized into phase 1 (n = 135), 10.11% in phase 2 (n = 18), 9.55% into phase 3 (n = 17), 3.37% into phase 4 (n = 6), and 1.12% into phase 5 (n = 2). By applying the behavioral framework to the physical activity literature for people with Parkinson disease, we suggest this area of research is nascent with more than 75% of the literature in phase 1. LEVEL OF EVIDENCE: III.