Chad Swank

Aerobic Exercise in People with Multiple Sclerosis: Its Feasibility and Secondary Benefits

The aims of this study were to explore the feasibility of structured aerobic exercise followed by a period of unstructured physical activity and determine the impact of such exercise on cognition, mood, and quality of life in people with multiple sclerosis (MS). A convenience sample of 9 individuals with relapsing-remitting MS performed 30 minutes of aerobic exercise (upper- and lower-extremity ergometry and treadmill ambulation) twice weekly for 8 weeks, followed by 3 months of unstructured physical activity. Eight participants completed the intervention and posttest; 6 returned for the 3-month follow-up. Cardiovascular fitness, cognition, mood (measured with the Beck Depression Inventory-II; BDI-II), and quality of life (measured with the Multiple Sclerosis Quality of Life-54; MSQOL-54) were assessed. Participants completed 27.9 minutes of exercise per session, with an 85.1% attendance rate. Evaluation using the Wilcoxon signed rank test revealed no deleterious effects and improved results on the BDI-II and MSQOL-54 mental subscale. Analysis of change scores using the one-sample t test revealed that the BDI-II and MSQOL-54 were changed from zero after structured exercise, but only the BDI-II maintained improvement after unstructured physical activity. Further analysis of BDI-II subscales revealed that improvement occurred only in the Somato-Affective subscale. In this study, program feasibility was demonstrated in several ways. There were no declines in cognitive function over the 5-month period. Despite unchanged cognitive function, participants may value the improved mood enough to continue both the structured and unstructured physical activity. The role of unstructured physical activity in concert with periodic structured exercise programs merits further investigation.

Classifying physical activity research following stroke using the behavioral epidemiologic framework

Abstract Background: Stroke is a significant public health issue in the USA and a need emerges to better understand how to reduce an individuals co-morbidity risk. Physical activity is one approach to improving the health of individuals and comprehensive literature supports increased activity as a means to reduce risk of morbidity and mortality. One approach to examining whether research in a field is addressing a public health issue is through application of the behavioral epidemiological framework. Objective: To classify physical activity research for individuals following stroke into distinct phases so that efforts can be made to systematically address gaps and disseminate evidence-based practice. Methods: Specific key words were identified and then searched through EBSCOhost, PubMed, and Google Scholar. Physical activity and stroke literature from 2000–2014 was categorized into one of five discrete phases. Research in Phase 1 identified associations between activity and health; Phase 2 established valid measures of activity; Phase 3 examined determinants of behavior; Phase 4 evaluated activity interventions; and Phase 5 disseminated evidence-based practice. Results: A comprehensive review of literature identified 202 articles with 70% categorized in Phase 1 (n = 141), 11% in Phase 2 (n = 23), 10% in Phase 3 (n = 20), 8% in Phase 4 (n = 15), and 1% in Phase 5 (n = 3). Conclusion: Findings suggest that physical activity research for individuals following stroke is in the early stages of development with less than 10% of research evaluating or disseminating interventions.

Transcranial direct current stimulation lessens dual task cost in people with Parkinson’s disease

BACKGROUND Parkinsons disease (PD) progressively impairs motor and cognitive function. Gait dysfunction in PD is exacerbated during dual task gait. Transcranial direct current stimulation (tDCS) may therapeutically benefit motor and cognitive deficits. We examined the effect of a bilateral tDCS protocol on dual task gait in people with PD. MATERIAL AND METHODS Participants with PD between 50 and 80 years received two sessions of tDCS protocol (1 active, 1 sham) separated by 7days. tDCS protocols were randomized and blinded to participants. After each tDCS protocol, participants performed single and dual task gait. Single 20-min session of bilateral tDCS (dorsolateral prefrontal cortex; left=anode, right=cathode) at 2mA and one sham session. Each participant was assessed at baseline for disease severity [Unified Parkinsons Disease Rating Scale (UPDRS)] and executive function [Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)]. Following each tDCS condition (active and sham), participants performed Timed Up and Go (TUG) single and dual task conditions (TUGalone, TUGmotor, TUGcognitive) and PDQ-39. RESULTS Ten participants average age of 68.7 years (±10.2) and average PD duration average 7.9 years (±7.1) were included. The UPDRS (M=37) and RBANS (M=13%ile) were administered prior to testing. No differences were observed on dependent t-test for TUG conditions or PDQ-39. Dual task cost TUGmotor was -20.95% (tDCSactive) versus -22.58% (tDCSsham) and TUGcognitive was -25.24% (tDCSactive) versus -41.85% (tDCSsham). CONCLUSIONS Our bilateral tDCS protocol in people with PD did not significantly improve dual task gait. However, dual task cost following tDCS was lessened, most dramatically in the presence of a cognitive distractor. A larger sample size is warranted to draw further conclusions about our bilateral tDCS approach.

Reliability and clinical feasibility of measuring dual-task gait in the inpatient rehabilitation setting following traumatic brain injury

ABSTRACT Background: To prepare patients with traumatic brain injury (TBI) for discharge from inpatient rehabilitation, physical therapists may incorporate dual-task gait activities. Reliability of common dual-task measures for people with TBI in inpatient rehabilitation is undetermined. Our purpose was to assess inter-rater and intra-rater reliability and clinical feasibility of dual-task measures [Walking While Talking Test (WWTT), Modified Walking and Remembering Task (mWART), Timed Up and Go-cognitive (TUG-COG)] in inpatient rehabilitation for patients with TBI. Methods: A total of 22 individuals with TBI completing the dual-task measures (WWTT, Walking and Remembering Task (WART), and TUG-COG) in inpatient rehabilitation were rated concurrently by two physical therapists in a single testing session. Sessions were video recorded and rated by the same raters viewing the video 7–10 days later. Raters completed a survey assessing feasibility of conducting the dual-task measures in patients with TBI in inpatient rehabilitation. Data were analyzed by calculating ICC(2,1) for inter-rater reliability and ICC(3,1) for intra-rater reliability. Results: All dual-task measures (WWTT, mWART, TUG-COG) had excellent inter-rater and intra-rater reliability. Raters considered dual-task measures feasible for patients with TBI during inpatient rehabilitation. Conclusions: The WWTT, mWART, and TUG-COG have excellent reliability and appear clinically feasible for incorporation into clinical practice in inpatient rehabilitation following TBI.

Walking In A Robotic Exoskeleton Does Not Mimic Natural Gait (Preprint)

Background Robotic exoskeleton devices enable individuals with lower extremity weakness to stand up and walk over ground with full weight-bearing and reciprocal gait. Limited information is available on how a robotic exoskeleton affects gait characteristics. Objective The purpose of this study was to examine whether wearing a robotic exoskeleton affects temporospatial parameters, kinematics, and muscle activity during gait. Methods The study was completed by 15 healthy adults (mean age 26.2 [SD 8.3] years; 6 males, 9 females). Each participant performed walking under 2 conditions: with and without wearing a robotic exoskeleton (EKSO). A 10-camera motion analysis system synchronized with 6 force plates and a surface electromyography (EMG) system captured temporospatial and kinematic gait parameters and lower extremity muscle activity. For each condition, data for 5 walking trials were collected and included for analysis. Results Differences were observed between the 2 conditions in temporospatial gait parameters of speed, stride length, and double-limb support time. When wearing EKSO, hip and ankle range of motion (ROM) were reduced and knee ROM increased during the stance phase. However, during the swing phase, knee and ankle ROM were reduced when wearing the exoskeleton bionic suit. When wearing EKSO, EMG activity decreased bilaterally in the stance phase for all muscle groups of the lower extremities and in the swing phase for the distal muscle groups (tibialis anterior and soleus) as well as the left medial hamstrings. Conclusions Wearing EKSO altered temporospatial gait parameters, lower extremity kinematics, and muscle activity during gait in healthy adults. EKSO appears to promote a type of gait that is disparate from normal gait in first-time users. More research is needed to determine the impact on gait training with EKSO in people with gait impairments.

Physical activity intensity of patient's with traumatic brain injury during inpatient rehabilitation.

ABSTRACT Objective: Use actigraphy to (1) describe the intensity of physical activity completed by patients with traumatic brain injury (TBI) during inpatient rehabilitation, and (2) examine the association between physical activity intensity and demographic, injury, and programmatic characteristics. Design: Observational. Method: Fifty individuals with TBI undergoing inpatient rehabilitation wore accelerometers for an average of 8.7 ± 1.8 days to capture physical activity intensity that was summarized using activity counts (ACs). Intensity of activity was described for categories of the participant’s day including physical and occupational therapy, non-active therapy, recreation, and sleep. Descriptive statistics, Pearson’s correlations, and general linear regression were computed. Results: Participants average physical activity intensity was considered “inactive” during physical (M = 242.7.7 ± 105.2 AC/min) and occupational therapy (M = 244 ± 105), non-active therapy (M = 142.2 ± 74.1), and recreation (M = 112.8 ± 59.5), and “sedentary” during sleep (M = 26.7 ± 14.8). Significant positive associations were identified between physical activity intensity and categories of the participant’s day suggesting that participants who complete more intense activity in therapy also complete more intense activity during non-active therapy and recreation time. General linear regression indicated that age significantly predicted physical activity intensity. Conclusions: Findings demonstrate that patients with TBI undergoing inpatient rehabilitation are largely inactive or sedentary. Strategies to promote a safe increase in physical activity intensity are required if cardiovascular conditioning is to be improved during inpatient rehabilitation.

Proposing Development and Utility of a Mobility Composite Measure in Patients with a Neurologic Disorder

Background Outcome measures typically assess single domains making holistic assessment difficult. Our purpose was to develop a mobility composite measure (MCM) based on four commonly used outcome measures and compare this composite score to the individual measures in patients with neurologic disorders. Methods We retrospectively reviewed 148 medical records for inclusion of primary neurologic diagnosis and scoring for 5 times sit-to-stand test (5TSST), 10-meter walk test (10MWT), 2-minute walk test (2MWT), and activities-specific balance confidence (ABC) scale. Results After establishing that a single concept was being assessed with interitem correlations, raw scores were converted to percentage of normal and combined into the MCM for analysis from admission to discharge. Scores on each measure significantly improved after intervention (5TSST, p < .001; 10MWT, p < .001; 2MWT, p < .001; ABC, p = .02). Mean MCM (n = 93) admission scores were 67.55 ± 31.88% and discharge scores were 74.81 ± 34.39% (p = .002). On average, patients improved 7.26% on the MCM exceeding the threshold of expected error (MDC95 = 3.59%). Conclusions MCM detected change in patient outcomes statistically and clinically and appears to capture a holistic picture of functional status. We recommend a prospective study to further investigate a “composite measure” incorporating measures from several functional domains.

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.

A Comparison of Physical Activity and Dual Task Gait Among Persons with Parkinson's Disease and Healthy Older Adults

ABSTRACT Aims: To identify if dual task gait differed between persons with PD (high versus low physical activity levels) and healthy peers. Methods: Persons with PD (n = 19) and matched healthy controls (HC) (n = 19) completed Timed Up and Go single (TUGalone) and dual task conditions (TUGmotor/TUGcognitive), Beck Depression Inventory-II (BDI-II), and step activity monitoring. Participants with PD were classified low active (LAPD; n = 11) or high active (HAPD; n = 8) using HC mean steps/day cut-point (M = 4,658). Results: PD groups were equivalent for mental status, disease severity, and PD duration. LAPD steps/day (M = 2,482.00 ± 1,466.33) differed from HAPD (M = 5,675.13 ± 1,198.93) and HC (M = 4,657.74 ± 1,604.99) (p = 0.001). LAPD completed the TUG slower than HAPD and HC (MANOVA, p < 0.02; post-hoc analysis, p < 0.04). BDI-II scores were greater in LAPD than HC (p = 0.013). Conclusions: Physical activity impacted mobility and depression. HAPD were similar to HC in walking activities and affect but LAPD walked slower with higher levels of depression.