Christian T. Haas

Effects of random whole-body vibration on postural control in Parkinson's disease.

We investigated spontaneous effects of random whole-body vibration (rWBV) on postural control in Parkinsonian subjects. Effects were examined in biomechanical tests from a total of 52 patients divided equally into one experimental and one control group. Postural control was tested pre- and post-treatment in two standardized conditions (narrow standing and tandem standing). The intervention was based on rWBV (y: 3 mm, f: 6 Hz 1 Hz/sec) consisting of 5 series lasting 60 seconds each. The main findings from this study were that (1) rWBV can improve postural stability in Parkinsons disease (PD) spontaneously (2) these effects depend on the test condition. Based on the results of this study, rWBV can be regarded as an additional device in physical therapy in PD.

Proprioceptive and Sensorimotor Performance in Parkinson's Disease

We explored the effects of random whole-body vibration on leg proprioception in Parkinsons disease (PD). In earlier studies it was found that this treatment leads to improved postural control in these patients. Thus, one could speculate that these effects result from modified proprioceptive capabilities. Twenty-eight PD patients were subdivided in one experimental and one control group. Proprioceptive performance was analyzed using a tracking task basing on knee extension and flexion movements. Treatment consisted of 5 series of random whole-body vibration taking 60 seconds each. Control subjects had a rest period instead. Prominent over- and undershooting errors were found in both groups representing proprioceptive impairments. No significant differences became evident, however, either between pre- and post-tests or between experimental and control group. One might therefore conclude that spontaneous improvements in postural control are not directly connected with proprioceptive changes. Nevertheless, one also should keep in mind the general aspects and difficulties of analyzing proprioception.

Detrended fluctuation analysis and adaptive fractal analysis of stride time data in Parkinson's disease: stitching together short gait trials.

Variability indicates motor control disturbances and is suitable to identify gait pathologies. It can be quantified by linear parameters (amplitude estimators) and more sophisticated nonlinear methods (structural information). Detrended Fluctuation Analysis (DFA) is one method to measure structural information, e.g., from stride time series. Recently, an improved method, Adaptive Fractal Analysis (AFA), has been proposed. This method has not been applied to gait data before. Fractal scaling methods (FS) require long stride-to-stride data to obtain valid results. However, in clinical studies, it is not usual to measure a large number of strides (e.g., strides). Amongst others, clinical gait analysis is limited due to short walkways, thus, FS seem to be inapplicable. The purpose of the present study was to evaluate FS under clinical conditions. Stride time data of five self-paced walking trials ( strides each) of subjects with PD and a healthy control group (CG) was measured. To generate longer time series, stride time sequences were stitched together. The coefficient of variation (CV), fractal scaling exponents (DFA) and (AFA) were calculated. Two surrogate tests were performed: A) the whole time series was randomly shuffled; B) the single trials were randomly shuffled separately and afterwards stitched together. CV did not discriminate between PD and CG. However, significant differences between PD and CG were found concerning and . Surrogate version B yielded a higher mean squared error and empirical quantiles than version A. Hence, we conclude that the stitching procedure creates an artificial structure resulting in an overestimation of true . The method of stitching together sections of gait seems to be appropriate in order to distinguish between PD and CG with FS. It provides an approach to integrate FS as standard in clinical gait analysis and to overcome limitations such as short walkways.

Adherence to Worksite Health Interventions: Practical Recommendations Based on a Theoretical Framework

Health promotion at the workplace aims at environmental and/or behavioral changes. Numerous health promotion programs have shown positive effects on employees’ health and productivity. However, success is affected by insufficient adherence to long-term change of behavior. This article provides an overview of factors that influence employees’ adherence to worksite health interventions (WHIs). Strategies to enhance participation and adherence are outlined based on a review of the current literature. The findings are evaluated by reference to the health action process approach. We propose a theoretical framework for WHIs and make recommendations for supporting workers’ adherence to behavioral changes based on this model.

Dual-tasking and aging—About multiple perspectives and possible implementations in interventions for the elderly

Abstract It is well known that dual-tasking is adversely affected by physiological degenerative processes. Furthermore, the completion of a secondary task while walking is frequently discussed as a key contributor for falls in the elderly. Age-related differences in both activated neural structures and human behavior are indicated in numerous previous studies. Besides a general overview of dual-tasking and aging, this article reviews studies aiming at improving gait or postural control in older adults using dual- or multi-task interventions. Approximately, 130 parameters out of 17 illustrated studies presented significant changes after dual-task-specific interventions regarding gait, postural control/balance, and falls. On the one hand, the article at hand shows highly consistent results in all of the dual-task intervention studies analyzed, indicating significant improvements related to postural control, gait, falls, or the performance of a secondary task. On the other hand, the results represent a heterogeneous structure and a gap between theoretical aspects and practical use. To optimize the use of dual-task, a systematization of underlying tasks is inevitable and should be focused on in further research.

Short-Term and Long-Term Effects of an Exercise-Based Patient Education Programme in People with Multiple Sclerosis: A Pilot Study

Background. Although people with Multiple Sclerosis (pwMS) benefit from physical exercise, they still show reduced physical activity and exercise behaviour. This study aimed to investigate short- and long-term effects of an exercise-based patient education programme (ePEP) that focuses on empowering pwMS to a sustainable and self-regulated exercise training management. Methods. Fourteen pwMS were randomly assigned to immediate experimental group (EG-I: n = 8) and waitlist-control group (EG-W: n = 6) and attended biweekly in a six-week ePEP. All participants were measured for walking ability, quality of life, fatigue, and self-efficacy towards physical exercise before and after the ePEP, after 12 weeks, and one year after baseline. Short-term effects were analysed in a randomised control trial and long-term effects of all ePEP participants (EG-I + EG-W = EG-all) in a quasi-experimental design. Results. Only functional gait significantly improved in EG-I compared to EG-W (p = 0.008, r = −0.67). Moderate to large effects were found in EG-all for walking ability. Not significant, however, relevant changes were detected for quality of life and fatigue. Self-efficacy showed no changes. Conclusion. The ePEP seems to be a feasible option to empower pwMS to a self-regulated and sustainable exercise training management shown in long-term walking improvements.

Bewegungssteuerung und -training bei Morbus Parkinson

Bewegungs- und Trainingsprogramme weisen ein bedeutendes Potenzial bei der Behandlung von Morbus Parkinson auf. Vor allem durch gezielt variable Trainingsinhalte konnen hier krankheitsbedingte Storungen im Bereich der Gang- und Gleichgewichtsmotorik reduziert werden. Zudem gibt es Hinweise, dass ein solches Bewegungstraining uber die Freisetzung neurotropher Faktoren neuroprotektive Funktionen hat. Die Ubersicht erlautert die aktuelle Studienlage zur Bewegungsvariabilitat und gibt einen Ausblick auf infrage kommende Trainingsansatze.

Biomechanical Analysis of Gait Adaptability in Parkinson's Disease

Parkinsons Disease (PD) subjects are less able to adapt gait to fluctuating motor demands in daily life situations than the healthy elderly, e.g. in crowded places, crossing the road, and starting or stopping at traffic lights. Several studies proved gait abnormalities in PD. However, to our knowledge there is currently no biomechanical test that deals with the ability in gait adaptation. The aim of this study was to develop and evaluate a new biomechanical test which proves the adaptability of gait to fluctuating external conditions. In order to have a reproducible, quantitative gait-test, a treadmill was used, accessed by a special software. The so called adaptability-of-gait test (AOG) changed the treadmills velocity ballistically and unpredictably for the test subjects. 49 PD-subjects and 10 age-matched controls (HC) participated in the study. In order to subdivide PD subjects in homogeneous groups, we used a cluster analysis. In a first-step of evaluation we focused on differences between PD with moderate (PDM) and severe disease stages (PDS) and HC and examined correlations according to existing, valid tests, e.g. Unified Parkinson Disease Rating Scale (UPDRS) subscales, clinical and biomechanical gait-assessments. Results showed significant differences in gait-adaptation between the groups. Severe PD had a worse gait adaptation compared to PD moderate and HC. Correlation analysis of the PD sample showed significance differences between the AOG-test and bradykinesia and facial expression, but no significances differences according to conventional clinical gait assessments, e.g. Webster gait-test. We conclude that the AOG-test has potentials to identify a new gait performance: the adaptation of gait.

Comparison of biomechanical and clinical assessment of postural stability in Parkinson’s disease

ditional: 3.8; optimized: 5.6). Conclusion: This study employed a novel design in a combined EEG and MEG setting to compare the efficiency of ‘‘oddball’’ and ‘‘optimum’’ paradigm. MEG may reflect earlier processes than EEG. The larger differences in latency may suggest that the deviance detection as measured by the traditional oddball design reflect more specific stimulus representations. Direct statistical comparison and source analysis should verify these suggestions and allow reliable clinical applications. Supported by IZKF BIOMAT (VV N68h), AstraZeneca.