Trunk Exercises Improve Balance in Parkinson Disease: A Phase II Randomized Controlled Trial.

BACKGROUND AND PURPOSE: Trunk control is important for maintaining balance; hence, deficient trunk control may contribute to balance problems in people with Parkinson disease (PD). Unfortunately, this deficit is poorly managed with pharmacological therapies, emphasizing the need for alternative therapies for these patients. This randomized controlled trial sought to examine the effects of a 12-week trunk-specific exercise-based intervention on balance in people with PD. METHODS: Twenty-four people with PD and with a history of falls completed assessments of motor symptom severity, balance confidence, mobility, quality of life, and quiet-standing balance. Participants were then randomized to receive either 12 weeks of exercise or education and reassessed after 12 and 24 weeks. RESULTS: Linear mixed-models analyses showed no significant changes in clinical outcomes following the intervention. However, during quiet standing, sway area on a foam surface without vision was reduced for the exercise group at 12 (-6.9 ± 3.1 cm; 95% confidence interval [CI] = -13.1 to -0.7; P = 0.029; d = 0.66) and 24 weeks (-7.9 ± 3.1 cm; 95% CI = -14.1 to -1.7; P = 0.013; d = 0.76). Furthermore, the exercise group demonstrated reduced sway variability at 12 (-0.2 ± 0.1 cm; 95% CI = -0.4 to 0.0; P = 0.042; d = 0.62) and 24 weeks in the medial-lateral direction (-0.2 ± 0.1 cm; 95% CI = -0.4 to 0.0; P = 0.043; d = 0.62). No changes in quiet standing balance were recorded for the education group. DISCUSSION AND CONCLUSIONS: The results of this study suggest that exercise-based interventions targeting trunk strength, endurance, and mobility may be effective for improving quiet-standing balance in people with PD. However, additional research is needed to determine whether these improvements are sufficient to reduce falls risk.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A254).

Sex Differences in Physical Fitness Characteristics and Match-Play Demands in Adolescent Netball: Should Male and Female Adolescents Co-compete in Netball?

Tissera, KM, Naughton, GA, Gabbett, TJ, Krause, LM, Moresi, MP, and Benson, AC. Sex differences in physical fitness characteristics and match-play demands in adolescent netball: Should male and female adolescents co-compete in netball? J Strength Cond Res 33(3): 846-856, 2019-Sports participation offers multifaceted benefits, especially during adolescence. However, policies relating to male and female adolescents co-competing in team sports can be prohibitive and lack an evidence base. This study aimed to strengthen evidence on coparticipation of male and female adolescents playing recreational netball. Off-court fitness characteristics (power, speed, agility, and high-speed intermittent running) and match-play performances from global positioning system (GPS) and video analysis were compared in adolescent males (n = 34, mean ± SD, age, 15.2 ± 0.8 years) and females (n = 45, mean ± SD, age, 14.9 ± 0.7 years), with previous recreational netball experience. Independent t-tests showed adolescent men outperforming females in all off-court fitness characteristics (p < 0.001). Two-way analyses of variance explored sex-based interactions in match-play (GPS accelerometer data and notational analyses) and type of competition (mixed-/single-sex formats) in forty-two 7-minute matches. Overall, no differences in match-play performances were found between males and females (p > 0.05). Notational skill-based comparisons showed that male skills were better in mixed- than single-sex matches. Conversely, competition format did not alter skills of females. Despite more netball experience in females and superior off-court fitness characteristics in males, on-court performance differences between males and females were minimal in these recreational adolescent netball players. Coparticipation in netball was not detrimental to the performance of either sex.

Equity of Physical Characteristics Between Adolescent Males and Females Participating in Single- or Mixed-Sex Sport.

Krause, LM, Naughton, GA, Benson, AC, and Tibbert, S. Equity of physical characteristics between adolescent males and females participating in single- or mixed-sex sport. J Strength Cond Res 32(5): 1415-1421, 2018-Policies on single- or mixed-sex junior sports participation continue to be challenged publically and legally. Often challenges relate to perceptions of size and performance variability between adolescent males and females, yet the evidence base behind these challenges lacks recent review and rigor. Physical performance was compared between males and females from 2 groups of younger (<13 years, n = 109, 67% females, 33% males) and older (≥13 years, n = 108, 43% females, 57% males) adolescents. Using a cross-sectional design, adolescents were tested for speed, strength, power, and endurance. No sex differences were found for most of the physical test results in the <13 years age group, although males showed greater endurance (p = 0.020) and upper-body strength (p = 0.010) than females. However, among adolescents aged ≥13 years, males scored better than females in all physical tests, without exception (p > 0.05). Further explorations comparing how many females in the same age grouping shared test results equal to or greater than the top third of males were fewer in the older than younger age group. Equality of participation in mixed-sex sport becomes more difficult to guarantee for older adolescents when results from generic sport-related physical test performances are considered.

Bone Health of Young Male Gymnasts: A Systematic Review.

PURPOSE: To synthesize existing literatures on the impact of gymnastics participation on the skeletal health of young male gymnasts. METHODS: Following a systematic search, 12 studies were included in this review. Quality of included studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE modified) criteria. RESULTS: Assessment of skeletal health varied between and within imaging modality protocols. Gymnasts had higher total bone content, greater total and trabecular bone density, larger bone size, a thicker cortex, and higher estimates of bone strength than controls. Recreational studies reported no difference in height or weight between gymnasts and controls; however, elite gymnasts were shorter and lighter than nongymnasts. STROBE scores ranged from 65% to 95%. CONCLUSION: Gymnastics participation may be beneficial to the bone health of young males as gymnasts had higher bone density and bone mineral content, larger bones, and greater estimates of bone strength than controls.

Use of a Short-Form Balance Confidence Scale to Predict Future Recurrent Falls in People With Parkinson Disease.

OBJECTIVES: To assess whether the 16-item Activities-specific Balance Confidence scale (ABC-16) and short-form 6-item Activities-specific Balance Confidence scale (ABC-6) could predict future recurrent falls in people with Parkinson disease (PD) and to validate the robustness of their predictive capacities. DESIGN: Twelve-month prospective cohort study. SETTING: General community. PARTICIPANTS: People with idiopathic PD (N=79). INTERVENTIONS: Clinical tests were conducted to assess symptom severity, balance confidence, and medical history. Over the subsequent 12 months, participants recorded any falls on daily fall calendars, which they returned monthly by reply paid post. MAIN OUTCOME MEASURES: Logistic regression and receiver operating characteristic analyses estimated the sensitivities and specificities of the ABC-16 and ABC-6 for predicting future recurrent falls in this cohort, and "leave-one-out" validation was used to assess their robustness. RESULTS: Of the 79 patients who completed follow-up, 28 (35.4%) fell more than once during the 12-month period. Both the ABC-16 and ABC-6 were significant predictors of future recurrent falls, and moderate sensitivities (ABC-16: 75.0%; ABC-6: 71.4%) and specificities (ABC-16: 76.5%; ABC-6: 74.5%) were reported for each tool for a cutoff score of 77.5 and 65.8, respectively. CONCLUSIONS: The results have significant implications and demonstrate that the ABC-16 and ABC-6 independently identify patients with PD at risk of future recurrent falls.

Validity and Reliability of a Submaximal Intermittent Running Test in Elite Australian Football Players.

Veugelers, KR, Naughton, GA, Duncan, CS, Burgess, DJ, and Graham, SR. Validity and reliability of a submaximal intermittent running test in elite Australian football players. J Strength Cond Res 30(12): 3347-3353, 2016-The aim of this article was to determine the validity and reliability of a submaximal intermittent running (SIR) test in elite Australian rules football (ARF) players. Heart rate (HR) responses of 38 elite ARF players to both the SIR and the yo-yo intermittent recovery 2 (YYIR2) tests were compared over 2 trials. Linear regression analysis was used to examine the relationship between SIR test HR responses and YYIR2 test performance. Heart rate responses of 25 elite ARF players to the SIR test were monitored over 3 trials. Day-to-day reliability was determined using intraclass correlation coefficient (ICC), typical error of measurement, coefficient of variation (CV), and smallest worthwhile change. Large inverse correlations were reported between 2-, 3-, and 4-minute HR during the SIR test and YYIR2 test distance (r = -0.58 to -0.61, p < 0.01). Heart rate recovery after 2 and 3 minutes of the SIR test was moderately correlated to YYIR2 distance (r = 0.32-0.35, p ≤ 0.05). Strong correlations for ICC (r = 0.90-0.97) and low CV (1.3-9.2%) were reported for all HR variables. Monitoring HR during the SIR test is a valid and reliable indicator of YYIR2 test performance in elite ARF players. These findings support the use of the SIR test as a regular and non-fatiguing indicator of intermittent running capacity.

The impact of data reduction on the intra-trial reliability of a typical measure of lower limb musculoskeletal stiffness.

Double-leg repeated jumping tasks are commonly used as measures of lower limb stiffness in exercise science research. Within similar stiffness calculations, variation in data-reduction criteria exists. The impact of these varied data-reduction methods on stiffness measures is unknown. Sixteen adolescent female participants from varied physical activity backgrounds performed 15 self-paced, bent-knee continuous jumps (CJb) on two force plates. Leg stiffness was calculated as the ratio of the peak force and the centre of mass displacement for each contact. Using combinations of criteria based on previous literature, 83 data-reduction methods were applied to the raw data. Data reduction suitability was assessed based on intra-trial reliability, the number of participants excluded and the average contacts excluded. Four data-reduction methods were deemed suitable for use with adolescent female populations, with three consecutive contacts within 1 SD of the average jump frequency considered optimal. The average individual stiffness values were not greatly influenced by the data-reduction method; however, for a single participant, a stiffness change of up to 6 kN · m(-1) (30%) was observed. The role and potential impact of data-reduction methods used to evaluate measures of lower limb stiffness during repeated jumping tasks warrants consideration.

Mechanical loading with or without weight-bearing activity: influence on bone strength index in elite female adolescent athletes engaged in water polo, gymnastics, and track-and-field.

Bone health is considered not to benefit from water-based sports because of their weight-supported nature, but available evidence primarily relies on DXA technology. Our purpose was to investigate musculoskeletal health in the upper and lower body in well-trained adolescent female athletes using pQCT and compare these athletes with less-active, age- and sex-matched peers. Bone mineral content, volumetric cortical and trabecular BMD, total and cortical area, and bone strength index were assessed at the distal and proximal tibia and radius in four groups of adolescent females (mean age, 14.9 years) including water polo players (n = 30), gymnasts (n = 25), track-and-field athletes (n = 34), and nonactive controls (n = 28). Water polo players did not show any benefit in bone strength index or muscle size in the lower leg when compared with controls. In contrast, gymnasts showed 60.1 % and 53.4 % greater bone strength index at the distal and proximal tibia, respectively, than nonactive females (p < 0.05). Similarly, track-and-field athletes displayed 33.9 % and 14.7 % greater bone strength index at the distal and proximal tibia, respectively, compared with controls (p < 0.05). In the upper body, water polo players had 31.9 % greater bone strength index at the distal radius, but not the radial shaft, and 15.2 % larger forearm muscle cross-sectional area than controls (p < 0.05). The greatest musculoskeletal benefits in the upper body were found in gymnasts. In conclusion, despite training at an elite level, female water polo players did not show any benefits in musculoskeletal health in the lower leg and only limited benefits in the upper body when compared with nonactive girls.

Mothers supporting play as a choice for children with disabilities within a culturally and linguistically diverse community.

Background: Play is a right for children; an essential childhood occupation influenced by their family environment. Despite increasing recognition of unstructured outdoor play benefits, children with disabilities experience limited play opportunities.Aim: To apply a capabilities approach lens to understand outdoor play decision-making by mothers of children with disabilities within a culturally and linguistically diverse community.Materials and methods: Data collection for this case study involved semi-structured interviews with five mothers of primary school-aged children with disabilities and a week-long survey that profiled their children's outdoor play. Analysis was thematic and involved identifying barriers and opportunities at each ecocultural layer, aggregating strategies families used to address the barriers, and understanding their overall play decision-making.Findings: Mothers considered the child's interests and abilities, valued play as both a means and ends, planned for play, and facilitated in the moment as required. Multiple factors influenced mothers' outdoor play decisions. Mothers' values were child-centred, positively influencing the child's play opportunities.Conclusion and significance: This study's capabilities lens could inform professions such as occupational therapy to support families of children with disabilities from culturally diverse communities to advocate for play opportunities across settings.

Influence of drop-landing exercises on bone geometry and biomechanical properties in prepubertal girls: a randomized controlled study.

We conducted a 28-week school-based exercise trial of single-leg drop-landing exercise with 42 girls (Tanner stage 1, 6-10 years old) randomly assigned to control (C), low-drop (LD), or high-drop (HD) exercise groups. The LD and HD groups performed single-leg drop-landings (three sessions/week and 50 landings/session) from 14 and 28 cm, respectively, using the nondominant leg. Single-leg peak ground-reaction impact forces in a subsample ranged between 2.5 and 4.4 times body weight. Dependent variables were bone geometry and biomechanical properties using magnetic resonance imaging. No differences (P > 0.05) were found among groups at baseline for age, stature, lean tissue mass (DXA--Lunar 3.6-DPX), leisure-time physical activity, average daily calcium intake, or measures of knee extensor or flexor torque. A series of ANOVA and ANCOVA tests showed no within- or between-group differences from baseline to posttraining. Group comparisons assessing magnitude of change in side-to-side differences in geometry (area cm(2)) and cross-sectional moment of inertia (cm(4)) at proximal, mid, and distal sites revealed negligible effect sizes. Our findings suggest that strictly controlled unimodal, unidirectional single-leg drop-landing exercises involving low to moderate peak ground-reaction impact forces do not influence geometrical or biomechanical measures in the developing prepubertal female skeleton.

Effects of wearing compression garments on physiological and performance measures in a simulated game-specific circuit for netball.

This study combined compression garments and Global Positioning System (GPS) tracking to examine the effects on key physiological and performance measures in a simulated game-specific circuit for netball. Compression garments have anecdotal and research supported evidence of enhancing exercise performance. However, the absence of sport specificity warrants further investigation. A cross-over repeated measures design was used to investigate the effectiveness of compression garments in improving physiological variables in a netball-specific circuit. Field-based measures included 20m sprints, countermovement jumps and blood lactate concentrations. Circuit data also used data recorded from GPS (GPSpi 10) motion trackers, including heart rates, distance covered, and velocity. On separate occasions, three repeats of a netball-specific circuit occurred under three different garment conditions (usual netball attire, compression garment and placebo garment). Repeated measures ANOVA found no garment by dependent variable interactions during the repeated circuits under three garment conditions. Analysis of effect sizes however, showed greater distances traveled at a faster velocity (3.5ms(-1)) using compression garments in comparison to control and placebo garments (Cohen's d=0.86). Using traditional statistical analysis, performance enhancing effects of compression garments were minimal. However, results of effect sizes analyses showed repeated performances at high speeds were improved in this sample of well-trained netball players.

The lifestyle of our kids (LOOK) project: outline of methods.

This methods paper outlines the overall design of a community-based multidisciplinary longitudinal study with the intent to stimulate interest and communication from scientists and practitioners studying the role of physical activity in preventive medicine. In adults, lack of regular exercise is a major risk factor in the development of chronic degenerative diseases and is a major contributor to obesity, and now we have evidence that many of our children are not sufficiently active to prevent early symptoms of chronic disease. The lifestyle of our kids (LOOK) study investigates how early physical activity contributes to health and development, utilizing a longitudinal design and a cohort of eight hundred and thirty 7-8-year-old (grade 2) school children followed to age 11-12 years (grade 6), their average family income being very close to that of Australia. We will test two hypotheses, that (a) the quantity and quality of physical activity undertaken by primary school children will influence their psychological and physical health and development; (b) compared with existing practices in primary schools, a physical education program administered by visiting specialists will enhance health and development, and lead to a more positive perception of physical activity. To test the first hypothesis we will monitor all children longitudinally over the 4 years. To test the second we will involve an intervention group of 430 children who receive two 50min physical education classes every week from visiting specialists and a control group of 400 who continue with their usual primary school physical education with their class-room teachers. At the end of grades 2, 4, and 6 we will measure several areas of health and development including blood risk factors for chronic disease, cardiovascular structure and function, physical fitness, psychological characteristics and perceptions of physical activity, bone structure and strength, motor control, body composition, nutritional intake, influence of teachers and family, and academic performance.

Planning for outdoor play: Government and family decision-making.

BACKGROUND: Despite indisputable developmental benefits of outdoor play, children with disabilities can experience play inequity. Play decisions are multifactorial; influenced by children's skills and their familial and community environments. Government agencies have responsibilities for equity and inclusion of people with disabilities; including in play. AIM: This multiple-perspective case study aimed to understand outdoor play decision-making for children with disabilities from the perspectives and interactions of: local government and families of primary school-aged children with disabilities. MATERIAL AND METHOD: Five mothers, four local government employees, and two not-for-profit organization representatives participated in semi-structured interviews. Inductive and iterative analyzes involved first understanding perspectives of individuals, then stakeholders (local government and families), and finally similarities and differences through cross-case analysis. FINDINGS: Local government focused more on physical access, than social inclusion. Local government met only minimal requirements and had little engagement with families. This resulted in poor understanding and action around family needs and preferences when designing public outdoor play spaces. CONCLUSION AND SIGNIFICANCE: To increase meaningful choice and participation in outdoor play, government understanding of family values and agency around engagement with local government needs to improve. Supporting familial collective capabilities requires understanding interactions between individuals, play, disability, and outdoor play environments.

Alternate Subthalamic Nucleus Deep Brain Stimulation Parameters to Manage Motor Symptoms of Parkinson's Disease: Systematic Review and Meta-analysis.

BACKGROUND: The use of alternate frequencies, amplitudes, and pulse widths to manage motor symptoms in Parkinson's disease (PD) patients with subthalamic nucleus deep brain stimulation (STN-DBS) is of clinical interest, but currently lacks systematic evidence. OBJECTIVE/HYPOTHESIS: Systematically review whether alternate STN-DBS settings influence the therapy's efficacy for managing PD motor symptoms. METHODS: Systematic searches identified studies that; involved bilateral STN-DBS PD patients; manipulated ≥ 1 STN-DBS parameter (e.g., amplitude); assessed ≥ 1 motor symptom (e.g., tremor); and contrasted the experimental and chronic stimulation settings. A Mantel-Haenszel random-effects meta-analysis compared the UPDRS-III sub-scores at low (60-Hz) and high frequencies ( ≥ 130 Hz). Inter-study heterogeneity was assessed with the Cohen's χ2 and I2 index, while the standard GRADE evidence assessment examined strength of evidence. RESULTS: Of the 21 included studies, 17 investigated the effect of alternate stimulation frequencies, five examined alternate stimulation amplitudes, and two studied changes in pulse width. Given the available data, meta-analyses were only possible for alternate stimulation frequencies. Analysis of the heterogeneity amongst the included studies indicated significant variability between studies and, on the basis of the GRADE framework, the pooled evidence from the meta-analysis studies was of very low quality due to the significant risks of bias. CONCLUSIONS: The meta-analysis reported a very low quality of evidence for the efficacy of low-frequency STN-DBS for managing PD motor symptoms. Furthermore, it highlighted that lower amplitudes lead to the re-emergence of motor symptoms and further research is needed to understand the potential benefits of alternate STN-DBS parameters for PD patients.

Playful interaction: occupational therapy for all children on the school playground.

We examined the impact of an intervention on the playfulness of 5- to 7-year-old children who are developing typically. Materials that had no defined purpose were placed on a school playground for 11 weeks. The Test of Playfulness (ToP) was used to compare videotaped play segments pre- and postintervention. Teachers who did playground duty were interviewed regarding changes in play. ToP data were analyzed using a Wilcoxon signed-ranks test. Interview data were analyzed for themes. ToP scores were significantly higher after intervention (Z= -1.94; p = .025, one-tailed; Cohen's d = 0.55). Teachers reported that children were more social, creative, and resilient when the materials were on the playground. Children who were creative, rather than very physically capable, became leaders in activity. Our results revealed a potential role for occupational therapists with typically developing children in schools. This finding has clear implications for children with disability.

Neuromuscular Impairments Are Associated With Impaired Head and Trunk Stability During Gait in Parkinson Fallers.

Background The trunk plays a critical role in attenuating movement-related forces that threaten to challenge the body's postural control system. For people with Parkinson's disease (PD), disease progression often leads to dopamine-resistant axial symptoms, which impair trunk control and increase falls risk. Objective This prospective study aimed to evaluate the relationship between impaired trunk muscle function, segmental coordination, and future falls in people with PD. Methods Seventy-nine PD patients and 82 age-matched controls completed clinical assessments and questionnaires to establish their medical history, symptom severity, balance confidence, and falls history. Gait characteristics and trunk muscle activity were assessed using 3-dimensional motion analysis and surface electromyography. The incidence, cause, and consequence of any falls experienced over the next 12 months were recorded and indicated that 48 PD and 29 control participants fell at least once during this time. Results PD fallers had greater peak and baseline lumbar multifidus (LMF) and thoracic erector spinae (TES) activations than control fallers and nonfallers. Analysis of covariance indicated that the higher LMF activity was attributable to the stooped posture adopted by PD fallers, but TES activity was independent of medication use, symptom severity, and trunk orientation. Furthermore, greater LMF and TES baseline activity contributed to increasing lateral head, trunk, and pelvis movements in PD fallers but not nonfallers or controls. Conclusions The results provide evidence of neuromuscular deficits for PD fallers that are independent of medications, symptom severity, and posture and contribute to impaired head, trunk, and pelvis control associated with falls in this population.

Adaptive skeletal responses to mechanical loading during adolescence.

Adolescence, defined as the period between puberty and maturity, provides a 'window of opportunity' for positive skeletal adaptations to mechanical loading unlike any other period in life. Age-related bone loss highlights the importance of accumulating sufficient bone mass during formative years. Adolescents who regularly engage in weight-bearing mechanical loading appear advantaged in site-specific markers of bone mass. The positive influence of physical activity on bone mineral accrual during growth has been extensively studied; however, few studies have examined skeletal responses to mechanical loading during adolescence. Weight-bearing physical activity, particularly high-impact sports such as gymnastics, is recognised as being more osteogenic than weight-supported activities. Unilateral loading activities such as tennis or squash provide a direct comparison of skeletal response without sampling bias or genetic confounding. Intervention and longitudinal studies show evidence of positive skeletal adaptations; however, sustainability of skeletal advantages remains unclear. Limitations inherent with single-plane dual x-ray absorptiometry technology are well recognised. The integration of densitometric data with structural responses to mechanical loading using 3-dimensional imaging technologies such as peripheral quantitative computed tomography and magnetic resonance imaging appears vital to enhancing our understanding of adolescent musculoskeletal health.

The effect of intense exercise periods on physical and technical performance during elite Australian Football match-play: A comparison of experienced and less experienced players.

OBJECTIVES: The physical and technical responses of experienced (≥5 years) and less experienced (1-4 years) elite Australian Football (AF) players were compared following the most intense passages of match-play. DESIGN: Descriptive cohort study. METHODS: Time-motion analyses were performed using global positioning systems (MinimaxX S4, Catapult Innovations, Melbourne, Australia) on one elite AF team during 13 matches. The global positioning data were categorised into total distance, low-speed activity (0-2.78ms(-1)), moderate-speed running (2.79-4.14ms(-1)) and high-speed running (≥4.15ms(-1)) distances. A standardised 5-point technical coding criteria was used to rate the number and quality of skill involvements during match-play. RESULTS: Following the most intense 3-min running period the experienced players covered greater distances at high-speeds in match quarters two (effect size, ES=0.42±0.30) and three (ES=0.38±0.33) than their less experienced counterparts. Compared with less experienced players, experienced players performed more skill involvements during the second quarter (ES=0.42±0.33) and fourth quarter peak 3-min bouts of exercise intensity (ES=0.40±0.30) and quarter one (ES=0.49±0.29) and three subsequent periods (ES=0.33±0.20). CONCLUSIONS: Less experienced players exhibited greater reductions in physical and technical performance following peak periods of match-play. These findings suggest that training may require a greater emphasis on developing the ability of less experienced players to maintain physical performance and gain possession of the football following intense periods of match-play.

Assessing stability in mild and moderate Parkinson's disease: Can clinical measures provide insight?

This cross-sectional study aimed to investigate the relationship between accelerometer-derived measures of movement rhythmicity and clinical measures of mobility, balance confidence and gait difficulty in people with Parkinson's disease (PD). Twenty-nine independently-living PD patients (Hoehn & Yahr Stages 1-3) with no history of significant injury or orthopaedic/deep brain stimulation surgery were recruited from a database of patients who had expressed an interest to participate in research. Participants completed clinical assessments of mobility, postural stability, balance confidence and symptom severity, while head and trunk rhythmicity was evaluated during gait using accelerometers. Following data collection, patients were stratified based on disease stage into either a Mild (Hoehn & Yahr Stage 1) or Moderate (Hoehn & Yahr Stages 2-3) PD group. The results highlighted that the Moderate PD group had poorer quality of life, reduced balance confidence and increased gait and falls difficulty. Furthermore, for these patients, gait disability and the number of previous falls were both negatively correlated with multiple components of head and trunk rhythmicity. For the Mild PD group, six-meter walk time was positively correlated with ML head rhythmicity and linear regression highlighted a significant predictive relationship between these outcomes. For the Mild and Moderate PD groups, balance confidence respectively predicted anterior-posterior trunk rhythmicity and vertical head rhythmicity. While these findings demonstrate that falls history and the Gait and Falls questionnaire provide moderate insight into head and trunk rhythmicity in Moderate PD patients, objective and clinically-feasible measures of postural instability would assist with the management of these symptoms.

Wearable sensor use for assessing standing balance and walking stability in people with Parkinson's disease: a systematic review.

BACKGROUND: Postural instability and gait disability threaten the independence and well-being of people with Parkinson's disease and increase the risk of falls and fall-related injuries. Prospective research has shown that commonly-used clinical assessments of balance and walking lack the sensitivity to accurately and consistently identify those people with Parkinson's disease who are at a higher risk of falling. Wearable sensors provide a portable and affordable alternative for researchers and clinicians who are seeking to objectively assess movements and falls risk in the clinical setting. However, no consensus currently exists on the optimal placements for sensors and the best outcome measures to use for assessing standing balance and walking stability in Parkinson's disease patients. Hence, this systematic review aimed to examine the available literature to establish the best sensor types, locations and outcomes to assess standing balance and walking stability in this population. METHODS: Papers listed in three electronic databases were searched by title and abstract to identify articles measuring standing balance or walking stability with any kind of wearable sensor among adults diagnosed with PD. To be eligible for inclusion, papers were required to be full-text articles published in English between January 1994 and December 2014 that assessed measures of standing balance or walking stability with wearable sensors in people with PD. Articles were excluded if they; i) did not use any form of wearable sensor to measure variables associated with standing balance or walking stability; ii) did not include a control group or control condition; iii) were an abstract and/or included in the proceedings of a conference; or iv) were a review article or case study. The targeted search of the three electronic databases identified 340 articles that were potentially eligible for inclusion, but following title, abstract and full-text review only 26 articles were deemed to meet the inclusion criteria. Included articles were assessed for methodological quality and relevant data from the papers were extracted and synthesized. RESULTS: Quality assessment of these included articles indicated that 31% were of low methodological quality, while 58% were of moderate methodological quality and 11% were of high methodological quality. All studies adopted a cross-sectional design and used a variety of sensor types and outcome measures to assess standing balance or walking stability in people with Parkinson's disease. Despite the typically low to moderate methodological quality, 81% of the studies reported differences in sensor-based measures of standing balance or walking stability between different groups of Parkinson's disease patients and/or healthy controls. CONCLUSION: These data support the use of wearable sensors for detecting differences in standing balance and walking stability between people with PD and controls. Further high-quality research is needed to better understand the utility of wearable sensors for the early identification of Parkinson's disease symptoms and for assessing falls risk in this population. PROSPERO REGISTRATION: CRD42014010838.