Predictors of Sustained Physical Activity During the COVID-19 Pandemic in People With Parkinson Disease in Sweden.

BACKGROUND AND PURPOSE: During the first wave of the COVID-19 pandemic, people with Parkinson disease (PwPD) reported deterioration in health and physical activity. The aim of this study was to describe 1-year changes in physical activity and perceived health in PwPD during the COVID-19 pandemic and to identify predictors of sustained physical activity. METHODS: This study compared perceived health and sensor-derived physical activity (Actigraph GT3x) in PwPD between the first (June to July 2020) and third waves (June to July 2021) of the pandemic. Multiple logistic regression analyses were used to predict sustained physical activity across the study period using personal factors, disease severity, and functioning as independent variables. RESULTS: Sixty-three PwPD (mean age 71.0 years, 41% females) completed both baseline and 1-year follow-up (26 lost to follow-up). PwPD showed a decrease in average number of steps per day (Δ415 steps, P = 0.048), moderate-to-vigorous-physical activity (Δ7 minutes, P = 0.007) and increase in sedentary time (Δ36 minutes, P <.001) between baseline and 1-year follow-up. While self-perceived walking impairments and depressive symptoms increased significantly, balance confidence decreased between baseline and 1-year follow-up, no significant changes occurred for self-rated health, quality of life, or anxiety. Significant predictors of sustained physical activity levels were 15 years or more of education (odds ratio [OR] = 7.38, P = 0.013) and higher perceived walking ability (OR = 0.18, P = 0.041). DISCUSSION AND CONCLUSION: Among PwPD with mild to moderate disease severity living in Sweden, factors associated with reduced physical activity levels during the COVID-19 pandemic included older age, lower education levels, and greater perceived walking difficulties.

Mobile health to promote physical activity in people post stroke or transient ischemic attack - study protocol for a feasibility randomised controlled trial.

BACKGROUND: Physical activity is essential to improve health and reduce the risk of recurrence of stroke or transient ischemic attack (TIA). Still, people post stroke or TIA are often physically inactive and the availability of physical activity promotion services are often limited. This study builds on an existing Australian telehealth-delivered programme (i-REBOUND- Let's get moving) which provides support for home-based physical activity for people post stroke or TIA. The aim of this study is to test the feasibility, acceptability, and preliminary effects of a mobile Health (mHealth) version of the i-REBOUND programme for the promotion of physical activity in people post stroke or TIA living in Sweden. METHODS: One hundred and twenty participants with stroke or TIA will be recruited via advertisement. A parallel-group feasibility randomised controlled trial design with a 1:1 allocation ratio to 1) i-REBOUND programme receiving physical exercise and support for sustained engagement in physical activity through behavioural change techniques, or 2) behavioural change techniques for physical activity. Both interventions will proceed for six months and be delivered digitally through a mobile app. The feasibility outcomes (i.e., reach, adherence, safety and fidelity) will be monitored throughout the study. Acceptability will be assessed using the Telehealth Usability Questionnaire and further explored through qualitative interviews with a subset of both study participants and the physiotherapists delivering the intervention. Clinical outcomes on preliminary effects of the intervention will include blood pressure, engagement in physical activity, self-perceived exercise self-efficacy, fatigue, depression, anxiety, stress and health-related quality of life and will be measured at baseline and at 3, 6 and 12 months after the baseline assessments. DISCUSSION: We hypothesise that the mHealth delivery of the i-REBOUND programme will be feasible and acceptable in people post stroke/TIA living in rural and urban regions of Sweden. The results of this feasibility trial will inform the development of full-scale and appropriately powered trial to test the effects and costs of mHealth delivered physical activity for people after stroke or TIA. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05111951. Registered November 8, 2021.

Telerehabilitation during the COVID-19 pandemic in Sweden: a survey of use and perceptions among physiotherapists treating people with neurological diseases or older adults.

BACKGROUND : Telerehabilitation, i.e. rehabilitation at a distance using Information and Communication Technology (ICT), is a promising avenue for improving health among people with neurological diseases or older adults who often experience limited access to services. Still, little is known about physiotherapists' use, perceptions and needs with regards to telerehabilitation services. AIMS: To describe physiotherapists use and perceptions of, as well as needs for, telerehabilitation services for the rehabilitation of people with neurological diseases or older adults in Sweden. METHODS: In this cross-sectional study, an author-created survey was sent out to members of the Swedish Association of Physiotherapists including questions about the use and perceptions of existing telerehabilitation services (e.g. telephone, internet-based applications and mobile applications) as well as needs of future telerehabilitation services. The results were presented descriptively as numbers and percentages. RESULTS: Three hundred seven physiotherapists were included in this study with 139 (45%) treating people with neurological diseases and 168 (55%) treating older adults. Most respondents did not provide telerehabilitation before (74%) or during (51%) the COVID-19 pandemic. Telephone, which was predominantly used for administrative tasks, was the most frequent utilised ICT used by 68% of the physiotherapist using ICTs several days/week. Few respondents used internet-based applications (12%), mobile applications (3%) or SMS services (8%) and videoconferencing (3%). A majority of the respondents were interested in ICT (78%), felt comfortable using ICT (57%) and were interested in learning how ICT can be used in rehabilitation (92%). Still, few respondents perceived that people with neurological diseases or older adults can use existing ICTs for rehabilitation purposes (18%) and that existing reimbursement system within health care facilitates remote rehabilitation (16%). Important functionality of future ICT perceived by physiotherapists covered patient communication (e.g. chat, SMS and video), assessments (e.g. digital surveys and assessment of physical activity) and treatment (e.g. exercise prescription). CONCLUSION: While physiotherapists had an overall positive perception to use and willingness to learn about telerehabilitation, few used telerehabilitation services before nor during the COVID-19 pandemic and they also perceived multilevel barriers for implementation, ranging from patients ability to use ICT to existing reimbursement systems within health care. Our findings emphasize the need to strengthen the expertise regarding remote services among physiotherapists.

Establishing Accelerometer Cut-Points to Classify Walking Speed in People Post Stroke.

While accelerometers could be used to monitor important domains of walking in daily living (e.g., walking speed), the interpretation of accelerometer data often relies on validation studies performed with healthy participants. The aim of this study was to develop cut-points for waist- and ankle-worn accelerometers to differentiate non-ambulation from walking and different walking speeds in people post stroke. Forty-two post-stroke persons wore waist and ankle accelerometers (ActiGraph GT3x+, AG) while performing three non-ambulation activities (i.e., sitting, setting the table and washing dishes) and while walking in self-selected and brisk speeds. Receiver operating characteristic (ROC) curve analysis was used to define AG cut-points for non-ambulation and different walking speeds (0.41−0.8 m/s, 0.81−1.2 m/s and >1.2 m/s) by considering sensor placement, axis, filter setting and epoch length. Optimal data input and sensor placements for measuring walking were a vector magnitude at 15 s epochs for waist- and ankle-worn AG accelerometers, respectively. Across all speed categories, cut-point classification accuracy was good-to-excellent for the ankle-worn AG accelerometer and fair-to-excellent for the waist-worn AG accelerometer, except for between 0.81 and 1.2 m/s. These cut-points can be used for investigating the link between walking and health outcomes in people post stroke.

Physical Activity and Perceived Health in People With Parkinson Disease During the First Wave of Covid-19 Pandemic: A Cross-sectional Study From Sweden.

BACKGROUND: People with Parkinson disease (PD) are known to be at risk of physical inactivity and may therefore be especially vulnerable to negative health outcomes during the COVID-19 pandemic due to social distancing recommendations. PURPOSE: To investigate sensor-derived physical activity and perceived health of people with PD during the first wave of the COVID-19 pandemic, as well as the factors associated with these outcomes. METHODS: Physical activity was measured over 7 days using the Actigraph GT3x accelerometer. Data were collected regarding perceived health status and physical activity habits, as well as rehabilitation attendance during the pandemic. Multiple linear and logistic regression analyses were used to identify factors associated with physical activity and perceived changes in health. RESULTS: Of 89 participants, a majority (67%) reported a pandemic-related reduction in exercise habits. Women more commonly reported a reduction in scheduled exercise and cancelled rehabilitation than men. Study participants took on average 5876 ± 3180 steps per day. In the multivariate analysis, female gender, being 70 years of age and older, and greater reported mobility problems were associated with being less physically active. A pandemic-induced deterioration in health was reported by 42% and women were 5 times more likely than men to do so (odds ratio: 5.12, 95% confidence interval, 1.87-15.03; P = 0.002). DISCUSSION AND CONCLUSIONS: Despite a pandemic-related reduction in reported exercise habits and rehabilitation, the participants in this Swedish sample were relatively physically active. However, women were less active at moderate-vigorous levels and were at greater risk of deterioration in perceived health during this time.Video Abstract available for more insight from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A359).

Sex, support and society: a journey to reclaiming sexuality for individuals living with paraplegia in Cape Town, South Africa.

STUDY DESIGN: Qualitative descriptive study with inductive thematic content analysis. OBJECTIVES: To explore how individuals living with paraplegia in South Africa experience sex and intimacy and how they perceive the related health services and support they received whilst adapting to life post injury. SETTING: Community based in Cape Town, South Africa. METHODS: Purposive and snowball sampling were combined to enrol ten individuals with paraplegia who were all users of the public health system and had been injured for more than 1 year. Semi-structured interviews were conducted, and data analysed using inductive thematic content analysis. RESULTS: Four categories were derived and captured by the overarching theme of 'a journey to reclaiming sexuality', as depicted by each participant. Psychological consequences of the injury led to challenges with sex and intimacy including a strong emphasis on partner satisfaction. A perceived lack of support mechanisms particularly in relation to poor timing of health services and insufficient peer support led to a lack of understanding and difficulties adjusting to changes in sexual function. Meaningful relationships including elements of sex and/or intimacy were rediscovered following a re-adjustment period although participants often felt disabled by society as socio-cultural norms, such as gender concepts, influenced each individual journey. CONCLUSIONS: Complex interactions between intrinsic psychological factors, such as low sexual self-esteem and external factors such as socio-cultural norms, affect sex and intimacy in individuals with paraplegia in this novel context. South Africa's health system should be strengthened to support optimal sexual outcomes of persons with a spinal cord injury.

Validity of Hip and Ankle Worn Actigraph Accelerometers for Measuring Steps as a Function of Gait Speed during Steady State Walking and Continuous Turning.

This study aimed to investigate the accuracy and reliability of hip and ankle worn Actigraph GT3X+ (AG) accelerometers to measure steps as a function of gait speed. Additionally, the effect of the low frequency extension filter (LFEF) on the step accuracy was determined. Thirty healthy individuals walked straight and walked with continuous turns in different gait speeds. Number of steps were recorded with a hip and ankle worn AG, and with a Stepwatch (SW) activity monitor positioned around the right ankle, which was used as a reference for step count. The percentage agreement, interclass correlation coefficients and Bland-Altmann plots were determined between the AG and the reference SW across gait speeds for the two walking conditions. The ankle worn AG with the default filter was the most sensitive for step detection at >0.6 m/s, whilst accurate step detection for gait speeds < 0.6 m/s were only observed when applying the LFEF. The hip worn AG with the default filter showed poor accuracy (12-78%) at gait speeds < 1.0 m/s whereas the accuracy increased to >87% for gait speeds < 1.0 m/s when applying the LFEF. Ankle worn AG was the most sensitive to measure steps at a vast range of gait speeds. Our results suggest that sensor placement and filter settings need to be taken into account to provide accurate estimates of step counts.

Participation in social/lifestyle activities in people with multiple sclerosis: Changes across 10 years and predictors of sustained participation.

BACKGROUND: Identification of people with multiple sclerosis (PwMS) with increased risk of restricted participation in social and lifestyle activities (e.g. social outings and pursuing a hobby) could guide the development of interventions supporting sustained participation. OBJECTIVE: To explore changes in participation in complex and social everyday activities over 10 years in PwMS in relation to multiple sclerosis (MS) severity and to identify predictors of sustained participation. METHODS: This study was based on a 10-year follow-up of 264 PwMS living in Stockholm County, Sweden. Ten-year changes in participation in social/lifestyle activities were assessed and compared between PwMS with different MS severity with the Frenchay Activities Index using age- and sex-related normative values. Multiple logistic regression analyses were used to predict sustained participation at 10 years using personal factors, disease severity and functioning as independent variables. RESULTS: While a majority of people with mild MS demonstrated sustained participation (67%), a minority of PwMS moderately (26%) and severely affected by MS (5%) demonstrated sustained participation. Significant predictors of sustained participation after 10 years were walking speed ⩾1.2 m/s and ⩾32 correct responses on the Symbol Digit Modalities Test. CONCLUSION: Our findings accentuate the importance for health services to support mobility and cognition to obtain sustained participation.

Factors Associated With Responsiveness to Gait and Balance Training in People With Parkinson Disease.

BACKGROUND AND PURPOSE: Although increasing evidence supports the benefit- of exercise among people with Parkinson disease (PwPD), it is unclear whether a given exercise modality suits all PwPD, given the heterogeneity of the disease. The purpose of this study was to explore factors associated with responsiveness to a highly challenging training intervention that incorporated dual-task exercises. METHODS: Forty-seven PwPD (mean age: 73 years; 19 females, Hoehn and Yahr stages 2-3) who had participated in 10 weeks of highly challenging gait and balance training were included. Baseline demographics, disease-related factors, physical and cognitive ability, and perceived health were used for the prediction of percent change in balance performance (the Mini-BESTest) and comfortable gait speed between the pre- and postassessments, using multiple linear regression analyses. RESULTS: Thirty-five percent of the variance of change in balance performance was explained by General Health Perceptions (ß = -0.36), the Timed Up and Go test (ß = -0.33), and the single-task performance of a cognitive task (ß = -0.24). Forty-nine percent of change in gait speed was explained by gait speed while performing a dual task (ß = -0.46), dual-task interference while walking (ß = 0.43), time to complete the Timed Up and Go test (ß = -0.29), and percent error on a cognitive task (ß = -0.25). DISCUSSION AND CONCLUSIONS: The results may suggest that the PwPD with overall lower perceived health, functional mobility, and cognitive functions are the ones most likely to benefit from highly challenging and attention-demanding gait and balance training.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A240).

Risk indicators of length of acute hospital stay after traumatic spinal cord injury in South Africa: a prospective, population-based study.

STUDY DESIGN: Population-based cohort study. OBJECTIVES: To determine non-modifiable and modifiable risk indicators of acute length of hospital stay (LOHS) after traumatic spinal cord injury (TSCI). SETTING: Government-funded hospitals within the City of Cape Town, South Africa. METHODS: Newly injured survivors of TSCI during a 1 year period were prospectively included. Non-modifiable (e.g., demographic factors and clinical characteristics) and modifiable risk indicators (e.g., clinical processes, timing of surgery, secondary complications) of prolonged LOHS (31 days) were determined using univariate and multivariable logistic regression analyses. RESULTS: Of the total population-based cohort of 145 individuals, 139 (96%) had valid LOHS data and were included in the analyses. Significant univariate non-modifiable risk indicators of LOHS were age, complete injury and vertebral injury, whereas modifiable risk indicators were delayed spinal surgery (>72 h) and the occurrence of any secondary complications, as well as specifically pressure ulcers, pneumonia and urinary tract infection. In the final multivariable model showing good fit and acceptable discrimination (AUC = 0.86), older age (OR: 1.04, 95% CI: 1.00-1.07), vertebral injury (OR: 3.18, 95% CI: 1.07-9.44), pneumonia (OR: 8.40, 95% CI: 2.76-25.55) and pressure ulcers (OR: 7.16, 95% CI: 2.54-20.22) remained significant independent factors. Only injury completeness was insignificant in the final model. CONCLUSIONS: Our findings shed light on the need of developing prevention programs for secondary complications to improve the quality and efficiency of acute SCI care in South Africa. SPONSORSHIP: The National Research Foundation of South Africa.

Turning Stability in Individuals With Parkinson Disease.

BACKGROUND AND PURPOSE: Although instability during turning is a disabling feature of Parkinson disease (PD), little is known about the associated postural characteristics. Our goals were to compare turning stability between individuals with PD and healthy individuals and to investigate whether dopaminergic medication improves turning stability. METHODS: Nineteen older adults with mild to moderate PD and 19 healthy individuals walked straight or walked and turned 180° to the right or left. The turning direction was visually cued before (preplanned) or during (unplanned) straight walking. Participants with PD were assessed off and on medication. As a proxy for mediolateral stability, we calculated the difference between pelvis lateral displacement and the lateral edge of the support base. RESULTS: While healthy individuals regulated mediolateral stability in a steady-state manner during turning, mediolateral stability in PD was reduced for crossover steps (narrow steps by the foot contralateral to the turning direction) and increased for side steps (widening steps by the foot ipsilateral to the turning direction) (P ≤ 0.008). Individuals with PD turned with narrower step width (P ≤ 0.024) and smaller pelvis displacement than healthy individuals (P ≤ 0.002). Dopaminergic medication only improved mediolateral stability while using side steps to initiate unplanned turns (P < 0.001). DISCUSSION AND CONCLUSIONS: Turning stability was compromised in PD, but only for crossover steps with a narrow support base. As dopaminergic medication showed limited effect on turning stability, rehabilitation plays an important role to promote safe turning strategies with a specific emphasis on sustainment of a wide support base.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A236).

Long-term effects of highly challenging balance training in Parkinson's disease-a randomized controlled trial.

OBJECTIVES:: To determine long-term effects of a highly challenging training program in people with Parkinson's disease, as well as describe how initially observed improvements of the program deteriorated over time. DESIGN:: Long-term follow-up of previously reported outcomes at 10 weeks of a randomized controlled trial. SETTING:: University hospital setting. PARTICIPANTS:: One-hundred elderly with mild-to-moderate (Hoehn and Yahr 2-3) Parkinson's disease. INTERVENTIONS:: Participants in the training group ( n = 51) received 10 weeks (three times/week) of balance and gait exercises, incorporating dual-tasks, while the control group ( n = 49) received care as usual. MAIN OUTCOME MEASURES:: Balance control (Mini-Balance Evaluation System Test (Mini-BESTest)) and gait velocity. Mixed-design analyses of variance were used to determine potential training effects at 6- and 12-month follow-up, and piecewise regression models predicted the rate of deterioration. RESULTS:: Seventy-six participants were included at final follow-up. No significant ( P > .05) between-group differences remained at either 6 or 12 months following the intervention. The mean Mini-BESTest scores of the training and control group were 19.9 (SD 4.4) and 18.6 (SD 4.3), respectively, at the 12-month follow-up. Gait speed was 1.2 (SD 0.2) m/s in both groups at 12 months. The training group showed a larger deterioration rate per month in balance performance (0.21 point) and gait velocity (0.65 cm/s) than controls ( P < .05). CONCLUSION:: These results suggest that training effects diminish within 6 months after balance training, implying that the program may need to be repeated regularly.

Monitoring training activity during gait-related balance exercise in individuals with Parkinson's disease: a proof-of-concept-study.

BACKGROUND: Despite the benefits of balance exercise in clinical populations, balance training programs tend to be poorly described, which in turn makes it difficult to evaluate important training components and compare between programs. However, the use of wearable sensors may have the potential to monitor certain elements of balance training. Therefore, this study aimed to investigate the feasibility of using wearable sensors to provide objective indicators of the levels and progression of training activity during gait-related balance exercise in individuals with Parkinson's disease. METHODS: Ten individuals with Parkinson's disease participated in 10 weeks of group training (three sessions/week) addressing highly-challenging balance exercises. The training program was designed to be progressive by gradually increasing the amount of gait-related balance exercise exercises (e.g. walking) and time spent dual-tasking throughout the intervention period. Accelerometers (Actigraph GT3X+) were used to measure volume (number of steps/session) and intensity (time spent walking >1.0 m/s) of dynamic training activity. Training activity was also expressed in relation to the participants' total daily volume of physical activity prior to the training period (i.e. number of steps during training/the number of steps per day). Feasibility encompassed the adequacy of data sampling, the output of accelerometer data and the participants' perception of the level of difficulty of training. RESULTS: Training activity data were successfully obtained in 98% of the training sessions (n = 256) and data sampling did not interfere with training. Reflecting the progressive features of this intervention, training activity increased throughout the program, and corresponded to a high level of the participants' daily activity (28-43%). In line with the accelerometer data, a majority of the participants (n = 8) perceived the training as challenging. CONCLUSIONS: The findings of this proof-of-concept study support the feasibility of applying wearable sensors in clinical settings to gain objective informative measures of gait-related balance exercise in individuals with Parkinson's disease. Still, this activity monitoring approach needs to be further validated in other populations and programs including gait-related balance exercises. TRIAL REGISTRATION: NCT01417598 , 15th August 2011.

Structured feedback on students' concept maps: the proverbial path to learning?

BACKGROUND: Good conceptual knowledge is an essential requirement for health professions students, in that they are required to apply concepts learned in the classroom to a variety of different contexts. However, the use of traditional methods of assessment limits the educator's ability to correct students' conceptual knowledge prior to altering the educational context. Concept mapping (CM) is an educational tool for evaluating conceptual knowledge, but little is known about its use in facilitating the development of richer knowledge frameworks. In addition, structured feedback has the potential to develop good conceptual knowledge. The purpose of this study was to use Kinchin's criteria to assess the impact of structured feedback on the graphical complexity of CM's by observing the development of richer knowledge frameworks. METHODS: Fifty-eight physiotherapy students created CM's targeting the integration of two knowledge domains within a case-based teaching paradigm. Each student received one round of structured feedback that addressed correction, reinforcement, forensic diagnosis, benchmarking, and longitudinal development on their CM's prior to the final submission. The concept maps were categorized according to Kinchin's criteria as either Spoke, Chain or Net representations, and then evaluated against defined traits of meaningful learning. RESULTS: The inter-rater reliability of categorizing CM's was good. Pre-feedback CM's were predominantly Chain structures (57%), with Net structures appearing least often. There was a significant reduction of the basic Spoke- structured CMs (P = 0.002) and a significant increase of Net-structured maps (P < 0.001) at the final evaluation (post-feedback). Changes in structural complexity of CMs appeared to be indicative of broader knowledge frameworks as assessed against the meaningful learning traits. CONCLUSIONS: Feedback on CM's seemed to have contributed towards improving conceptual knowledge and correcting naive conceptions of related knowledge. Educators in medical education could therefore consider using CM's to target individual student development.

The Mini-BESTest--a clinically reproducible tool for balance evaluations in mild to moderate Parkinson's disease?

BACKGROUND: The Mini-BESTest is a clinical balance test that has shown a high sensitivity in detecting balance impairments in elderly with Parkinson's disease (PD). However, its reproducibility between different raters and between test occasions has yet to be investigated in a clinical context. Moreover, no one has investigated the reproducibility of the Mini-BESTest's subcomponents (i.e. anticipatory postural adjustments; postural responses; sensory orientation and dynamic gait). We aimed to investigate the inter-rater and test-retest reproducibility (reliability as well as agreement) of the Mini-BESTest, as well as its subcomponents, in elderly with mild to moderate PD, performed under conditions assimilating clinical practice. METHOD: This was an observational measurement study with a test-retest design. Twenty-seven individuals with idiopathic PD (66 - 80 years, mean age: 73; Hoehn & Yahr: 2-3; 1-15 years since diagnosis) were included. Two test administrators, having different experiences with the Mini-BESTest, administered the test individually, in separate rooms in a hospital setting. For the test-retest assessment, all participants returned 7 days after the first test session to perform the Mini-BESTest under similar conditions. Intra-class correlation coefficients (ICC2.1), standard error of measurement (SEMagreement), and smallest real difference (SRD) were analyzed. RESULTS: The Mini-BESTest showed good reliability for both inter-rater and test-retest reproducibility (ICC = 0.72 and 0.80). Regarding agreement, the measurement error (SRD) was found to be 4.1 points (accounting for 15% of the maximal total score) for inter-rater reproducibility and 3.4 points (12% of the maximal total score) for test-retest reproducibility. The investigation of the Mini-BESTest's subcomponents showed a similar pattern for both inter-rater and test-retest reproducibility, where postural responses had the largest proportional measurement error, and sensory orientation showed the highest agreement. CONCLUSIONS: Our findings indicate that the Mini-BESTest is able to distinguish between individuals with mild to moderate PD; however, when used in clinical balance assessments, the large measurement error needs to be accounted for.

Is highly challenging and progressive balance training feasible in older adults with Parkinson's disease?

OBJECTIVE: To develop a highly challenging and progressive group balance training regime specific to Parkinson's disease (PD) symptoms and to investigate its feasibility in older adults with mild to moderate PD. DESIGN: Intervention study, before-after trial with a development and feasibility design. SETTING: University hospital setting. PARTICIPANTS: Feasibility was evaluated in older adults (N=5; mean age, 72y; age range, 69-80y) with mild to moderate idiopathic PD. INTERVENTION: A balance training regime emphasizing specific and highly challenging exercises, performed 3 times per week for 12 weeks, was developed through discussion and workshops by a group of researchers and physiotherapists. MAIN OUTCOME MEASURES: Indicators of feasibility included attendance rate, safety (adverse events, physical function, and pain), participants' perceptions of the intervention (level of difficulty of the exercises, motivation level, and appreciation), and efficacy of the intervention (balance performance assessed with the Mini-Balance Evaluation Systems Test [Mini-BESTest]). RESULTS: The incidence rate was high (93%) for attendance and low (1.2%) for adverse events. Ratings by the participants indicated progression throughout the training period. All participants considered the training motivational and stated that they would recommend it to others. The efficacy of the intervention measured with the Mini-BESTest showed that 4 out of 5 participants improved their balance performance. CONCLUSIONS: These findings support the overall feasibility of this novel balance program in older adults with mild to moderate PD. However, to further evaluate the efficacy of the program, a larger randomized controlled trial is required.

Validation of fNIRS measurement of executive demand during walking with and without dual-task in younger and older adults and people with Parkinson's disease.

BACKGROUND: Walking with a concurrent cognitive task (dual-task walking) can pose a challenge to some populations due to aging or neurodegenerative disease. These tasks require cognitive resources involving the prefrontal cortex and can be studied using functional near-infrared spectroscopy (fNIRS). An important step in understanding fNIRS measures during such walking tasks is validating that measures reflect the demands of the tasks and not confounding sources or movement artifacts. AIM: This study aimed to investigate the validity of fNIRS measures of prefrontal cortex activity as an indicator of executive demand during usual walking (single-task) and dual-task walking against clinical and objective measures of motor behavior in young adults, older adults, and people with Parkinson's disease (PD), by evaluating several validation hypotheses. METHODS: In total, 133 participants were recruited from younger adults (18-50 years, n = 42), older adults (≥60 years, n = 49) and people with PD (≥60 years, n = 42). Activity in the prefrontal cortex during walking with and without an auditory Stroop task was measured with fNIRS. A combined hemoglobin measure (correlation-based signal improvement, CBSI) was calculated for use in a region of interest analysis in the dorsolateral prefrontal cortex (dlPFC). Pre-registered hypotheses regarding convergent validity, discriminant validity and known group validity were tested. An exploratory analysis of different hemoglobin measures was also performed. RESULTS: Increases in dlPFC activity were found from single- to dual-task walking in the younger adults group and from rest to single-task walking in the older adults and PD groups. In line with hypotheses, a positive relationship was found between between dlPFC activity during dual-task walking and dual-task cost in the younger adults group, as well as a positive relationship to step time variability during single-task walking and a negative relationship to walking speed during single-task walking in the PD group. However, several clinical and gait measures lacked a relationship with dlPFC activity. CONCLUSION: The fNIRS results point towards the CBSI measure of dlPFC activity being a valid measure of executive demand during both single and dual-task walking. Some relationships between clinical and gait measures and brain activity during walking need further investigation.

Validation of algorithms for calculating spatiotemporal gait parameters during continuous turning using lumbar and foot mounted inertial measurement units.

Spatiotemporal gait parameters such as step time and walking speed can be used to quantify gait performance and determine physical function. Inertial measurement units (IMUs) allow for the measurement of spatiotemporal gait parameters in unconstrained environments but must be validated against a gold standard. While many IMU systems and algorithms have been validated during treadmill walking and overground walking in a straight line, fewer studies have validated algorithms during more complex walking conditions such as continuous turning in different directions. This study explored the concurrent validity in a population of healthy adults (range 26-52 years) of three different algorithms using lumbar and foot mounted IMUs to calculate spatiotemporal gait parameters: two methods utilizing an inverted pendulum model, and one method based on strapdown integration. IMU data was compared to a Vicon twelve-camera optoelectronic system, using data collected from 9 participants performing straight walking and continuous walking trials at different speeds, resulting in 162 walking trials in total. Intraclass correlation coefficients (ICCA,1) for absolute agreement were calculated between the algorithm outputs and Vicon output. Temporal parameters were comparable in all methods and ranged from moderate to excellent, except double support time which was poor. Strapdown integration performed better for estimating spatial parameters than pendulum models during straight walking, but worse during turning. Selecting the most appropriate model should take into consideration both speed and walking condition.

Is active sitting as active as we think?

The aim of this study was to compare the biomechanical characteristics of sitting on a stool without a backrest (so as to encourage active sitting), sitting on a conventional office chair and standing in healthy participants. Thirteen healthy participants performed a keyboard-writing task during four (stable and unstable) sitting conditions and standing. Body segment positions and posture, postural sway and muscle activity of neck and trunk muscles were assessed with a motion capture system, a force plate and surface electromyography. The results showed that body segment positions, postural sway and trunk muscle activity were relatively similar for the stools without backrests compared with standing. All sitting conditions showed lower vertical upper body alignment, less anterior pelvic tilt and larger hip angles, compared with standing (p = 0.000). Unexpectedly, the muscle activity levels and total postural sway, sway velocity and sway in M/L and A/P directions were lower (p = 0.000) for the conditions that encouraged active sitting and standing, compared with the conventional office chair conditions. PRACTITIONER SUMMARY: Thirteen healthy participants performed a keyboard-writing task during different sitting conditions and standing and were analysed regarding posture, postural sway and trunk muscle activity. Surprisingly, less postural sway and less muscle activity were observed during the conditions that encourage active sitting, compared with sitting on a conventional office chair.

Factors influencing employment among people with spinal cord injury in South Africa.

PURPOSE: The unemployment rate post spinal cord injury (SCI) in South Africa is high with limited knowledge of environmental factors outside the health services, especially in an unevenly developed resource setting like South Africa, affecting the employment rate in people with SCI. Our purpose was to investigate factors associated with employment in people with SCI in South Africa. METHODS: Two hundred persons with SCI participated in a cross-sectional survey design. This study formed part of the International Spinal Cord Injury Community Survey. Subsections of the questionnaire responses were used as explanatory variables to predict employment after SCI using logistic regression analysis. RESULTS: The response rate of the study was 54%. Of the 200 participants included, 61% reported being employed before SCI onset whereas only 25% reported being engaged in paid work at the time of this study. The logistic regression model showed not requiring physical assistance in the home environment (p = 0.016), the number of education years before SCI (p = 0.007), household income (p < 0.001), having worked before SCI onset (p = 0.041), and environmental factors (p = 0.029) to be factors associated with employment after SCI. CONCLUSION: The finding suggests multiple factors influence the employment rate, advocating for interdisciplinary rehabilitation approaches and social development interventions to address meaningful occupations in persons with SCI in South Africa.Implications for rehabilitationRehabilitation programs should be adapted and tailored to enhance physical independence.Public policies regarding environmental factors such as access to reliable transport, assistive devices, and public places for wheelchair users are important and could potentially support individuals with spinal cord injury (SCI) becoming employed/re-employed.For successful social/community/civic reintegration for individuals with SCI an intersectional collaboration (i.e., between policymakers, health professionals, and the labor market) needs to be considered to improve the employment opportunities post-SCI.