Improving telehealth for persons with multiple sclerosis - a cross-sectional study from the Australian MS longitudinal study.

PURPOSE: The COVID-19 pandemic impacted healthcare delivery, especially for people with chronic disease. We investigated telehealth use by persons with multiple sclerosis (MS) during the COVID-19 pandemic and their suggestions to improve their telehealth experience. METHODS: From persons with MS, we collected data on demographic, disease-related and social determinants of health, telehealth use during the COVID-19 pandemic, satisfaction with telehealth, and suggestions to improve telehealth. We conducted univariate log-binomial regression to establish factors associated with telehealth use versus no use, summarised experiences and suggestions for improvement with frequency tables, and conducted thematic analysis on free-text suggestions for improvement. RESULTS: Of 1,485 participants, 69.8% used telehealth during the first phase of the COVID-19 pandemic. Only small differences were observed for demographic, disease and social health determinants between telehealth users and non-users. Most participants who used telehealth had good or very good experiences (new providers:74.3%; existing providers:78.6%). The most common suggestion for improving telehealth experience was "guidance on preparing for telehealth sessions." Participants also wanted expansion in telehealth availability and utility. CONCLUSION: Persons with MS in Australia commonly used telehealth during the COVID-19 pandemic and were generally satisfied with their experiences. Implementing the suggested improvements will help optimise telehealth for persons with MS. REGISTRATION: N/A.

Australians with multiple sclerosis (MS) had good or very good experiences of telehealth during the first year of the pandemic.Telehealth is a useful consultation tool for many rehabilitation professions and may be appropriate for use across the whole MS population.To improve the delivery of rehabilitation through telehealth, provision of better guidance on preparing for telehealth consultations and provision of digital equipment to monitor their health is wanted by persons with MS.Rehabilitation professionals and researchers should take opportunities to identify if proficiency in the English language and cultural background may influence experiences with telehealth in persons with MS.

Fast reconstruction of centre of mass and foot kinematics during a single-legged horizontal jump: A point-cloud processing approach.

Horizontal jumps are discrete, fast, over-ground movements requiring coordination of the centre of mass (CoM) and base of support and are routinely assessed in sports settings. There is currently no biomechanics-based system to aid in their quick and objective large-scale assessment. We describe a practical system combining a single low-cost depth-sensing camera and point-cloud processing (PCP) to capture whole-body CoM and foot kinematics. Fourteen participants performed 10 single-leg horizontal jumps for distance. Foot displacement, CoM displacement, CoM peak velocity and CoM peak acceleration in the anterior-posterior direction of movement were compared with a reference 15-segment criterion model, captured concurrently using a nine-camera motion capture system (Vicon Motion Systems, UK). Between-system Pearson's correlations were very-large to near-perfect (n = 140; foot displacement = 0.99, CoM displacement = 0.98, CoM peak velocity = 0.97, CoM peak acceleration = 0.79), with mean biases being trivial-small (-0.07 cm [0.12%], 3.8 cm [3.5%], 0.03 m·s-1 [1.6%], 0.42 m·s-2 [7%], respectively) and typical errors being trivial-small for displacement (foot: 0.92 cm [0.8%]; CoM: 3.8 cm [3.4%]) and CoM peak velocity (0.07 m·s-1 [4.3%]), and large for CoM peak acceleration (0.72 m·s-2 [15%]). Limits of agreement were -1.9 to 2.0 cm for foot displacement, -11.3 to 3.6 cm for CoM displacement, -0.17 to 0.12 m·s-1 for CoM peak velocity and -2.28 to 1.43 m·s-2 for CoM peak acceleration. The practical system captured CoM and foot kinematics during horizontal jumps with acceptable precision. Further work to improve estimates of CoM accelerations and different populations are warranted.

Trajectories of pain over 6 years in early Parkinson's disease: ICICLE-PD.

INTRODUCTION: Pain is a common non-motor symptom in Parkinson's disease (PD), affecting up to 85% of patients. The frequency and stability of pain over time has not been extensively studied. There is a paucity of high-quality studies investigating pain management in PD. To develop interventions, an understanding of how pain changes over the disease course is required. METHODS: One hundred and fifty-four participants with early PD and 99 age-and-sex-matched controls were recruited as part of a longitudinal study (Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in PD, ICICLE-PD). Pain data were collected at 18-month intervals over 72 months in both groups using the Nonmotor Symptom Questionnaire (NMSQ), consisting of a binary yes/no response. Two questions from the Parkinson's Disease Questionnaire (PDQ-39) were analysed for the PD group only. RESULTS: Unexplained pain was common in the PD group and occurred more frequently than in age-matched controls. 'Aches and pains' occurred more frequently than 'cramps and muscle spasms' at each time point (p < 0.001) except 54 months. CONCLUSIONS: This study shows that pain is prevalent even in the early stages of PD, yet the frequency and type of pain fluctuates as symptoms progress. People with PD should be asked about their pain at clinical consultations and given support with describing pain given the different ways this can present.

Accuracy and re-test reliability of mobile eye-tracking in Parkinson's disease and older adults.

Mobile eye-tracking is important for understanding the role of vision during real-world tasks in older adults (OA) and people with Parkinson's disease (PD). However, accuracy and reliability of such devices have not been established in these populations. We used a novel protocol to quantify accuracy and reliability of a mobile eye-tracker in OA and PD. A mobile eye-tracker (Dikablis) measured the saccade amplitudes of 20 OA and 14 PD on two occasions. Participants made saccades between targets placed 5°, 10° and 15° apart. Impact of visual correction (glasses) on saccadic amplitude measurement was also investigated in 10 OA. Saccade amplitude accuracy (median bias) was -1.21° but a wide range of bias (-7.73° to 5.81°) was seen in OA and PD, with large vertical saccades (15°) being least accurate. Reliability assessment showed a median difference between sessions of <1° for both groups, with poor to good relative agreement (Spearman rho: 0.14 to 0.85). Greater accuracy and reliability was observed in people without visual correction. Saccade amplitude can be measured with variable accuracy and reliability using a mobile eye-tracker in OA and PD. Human, technological and study-specific protocol factors may introduce error and are discussed along with methodological recommendations.

The nature of dual-task interference during gait in incident Parkinson's disease.

Dual-task interference during gait is a common phenomenon in older adults and people with Parkinson's disease (PD). Dual-task performance is driven by cognitive processes involving executive function, attention and working memory which underpin resource capacity and allocation. The underlying processes that contribute to dual-task interference are poorly understood, and confounded by methodological differences. The aim of this study was to explore the nature of dual-task interference in PD with respect to age-matched controls. We examined 121 people with early PD and 189 controls and controlled for baseline task demand on both tasks allowing between-group differences to be attributed to dual-task interference rather than differences in baseline performance. We also compared a wide range of gait characteristics to evaluate the pattern of interference. Participants walked for two minutes at a preferred pace under single- and dual-task (test of working memory capacity-digit span recall) conditions. In a subgroup task demand was increased (digit span+1) (n=55 control, n=44 PD) to assess the influence of resource capacity. Finally the association between dual-task interference with motor and cognitive characteristics was examined to evaluate resource capacity and allocation. PD and controls responded similarly to the dual-task for all gait characteristics except for step width and step width variability and this was the same when task demand increased (dual+1). Control participants took wider steps (p=0.006) and step width variability increased significantly for controls (p=0.001) but not PD. Interference was specific to the gait characteristic rather than a global pattern of impairment. Digit span error rates were not significantly different between groups during dual-task performance. There were no significant correlations with dual-task interference and global cognition, motor deficit, and executive function for either group. Effects of dual-tasks on gait performance are twofold and specific to the gait characteristic. They reflect an age-related reduction in gait performance (especially forward progression) in PD and controls possibly due to reduced resource capacity; and secondly, show postural stability during walking in early PD is disproportionately affected highlighting a PD-specific dual-task co-ordination deficit. Further work is required to identify the cognitive, executive and motor correlates of dual-task interference from which inferences about underlying cognitive processes can be made. These findings inform an understanding of dual-task impairment in early PD and suggest that management should target postural control under dual-task conditions from the early stages.

Gait adaptation during obstacle crossing reveals impairments in the visual control of locomotion in Williams syndrome.

Recent evidence indicates that individuals with Williams syndrome (WS), a rare genetically based neurodevelopmental disorder, show abnormalities of parietal and cerebellar regions of the brain that may be involved in the visual control of locomotion. Here we examined whether parietal and cerebellar abnormalities contribute to deficits in spatiotemporal characteristics and foot placement variability during obstacle crossing in adults with WS, when compared with an IQ-matched group of adults with Down syndrome (DS) and typically developing adult controls. We used the GAITRite walkway to examine the spatiotemporal characteristics and foot placement variability relative to a small ground-based obstacle in the travel path. We found that adults with WS showed late adjustments to spatiotemporal gait characteristics alongside an exaggerated and more spatially constrained visual guidance of foot positioning in the final steps prior to stepping over the obstacle. In contrast, the adults with DS showed longer step duration and more variable step length and step duration during the crossing and recovery steps after the obstacle, suggestive of cerebellar dysfunction. Although the controls were able to reduce the variability of foot placement across the obstacle crossing trials, both the WS and DS groups did not become more consistent with practice. These findings indicate a less flexible and overly constrained visuomotor system in WS, which is consistent with more widespread and diffuse abnormalities in parietal and cerebellar regions.