David Conradsson

The Effects of Highly Challenging Balance Training in Elderly With Parkinson’s Disease A Randomized Controlled Trial

Background. Highly challenging exercises have been suggested to induce neuroplasticity in individuals with Parkinson’s disease (PD); however, its effect on clinical outcomes remains largely unknown. Objective. To evaluate the short-term effects of the HiBalance program, a highly challenging balance-training regimen that incorporates both dual-tasking and PD-specific balance components, compared with usual care in elderly with mild to moderate PD. Methods. Participants with PD (n = 100) were randomized, either to the 10-week HiBalance program (n = 51) or to the control group (n = 49). Participants were evaluated before and after the intervention. The main outcomes were balance performance (Mini-BESTest), gait velocity (during normal and dual-task gait), and concerns about falling (Falls Efficacy Scale–International). Performance of a cognitive task while walking, physical activity level (average steps per day), and activities of daily living were secondary outcomes. Results. A total of 91 participants completed the study. After the intervention, the between group comparison showed significantly improved balance and gait performance in the training group. Moreover, although no significant between group difference was observed regarding gait performance during dual-tasking; the participants in the training group improved their performance of the cognitive task while walking, as compared with the control group. Regarding physical activity levels and activities of daily living, in comparison to the control group, favorable results were found for the training group. No group differences were found for concerns about falling. Conclusions. The HiBalance program significantly benefited balance and gait abilities when compared with usual care and showed promising transfer effects to everyday living. Long-term follow-up assessments will further explore these effects.

A novel conceptual framework for balance training in Parkinson’s disease-study protocol for a randomised controlled trial

BackgroundThere is increasing scientific knowledge about the interaction between physiological (musculoskeletal, neuromuscular, cognitive and sensory) systems and their influence on balance and walking impairments in Parkinson’s disease. We have developed a new conceptual framework for balance training, emphasising specific components of balance control related to Parkinson’s disease symptoms by using highly challenging, progressive and varying training conditions. The primary aim of this proposed randomised controlled trial will be to investigate the short-term and long-term effects of a 10-week balance training regime in elderly with Parkinson’s disease.Methods/DesignEighty participants with mild to moderate idiopathic Parkinson’s disease will be recruited and randomly allocated to an intervention group receiving balance training or a control group whose participants will continue to receive their usual care. The intervention will consist of a 10-week group training regime (1-hour training, three times per week), which will be led by two physiotherapists to ensure training progression and safety. The conceptual framework will be applied by addressing specific balance components (sensory integration, anticipatory postural adjustments, motor agility, stability limits) through varying training conditions and structured progression. Assessment will be conducted through a multi-dimensional battery of outcomes, prior to and immediately after the 10-week intervention, and at 9 and 15 months’ follow-up after entering the study. Primary outcome measures will be balance performance (assessed using the Mini Balance Evaluation Systems Test), change in gait velocity (m/s) between single and dual task walking, and fear of falling (evaluated using the Fall Efficacy Scale International).DiscussionThis study has the potential to provide new insight and knowledge of the effects of specific, varied and challenging balance training on a wide health spectrum in elderly with PD. If found to be effective, this pragmatic approach with translation of theory into practice, can be implemented in existing outpatient care.Trial registrationNCT01417598

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

BackgroundThe Mini-BESTest is a clinical balance test that has shown a high sensitivity in detecting balance impairments in elderly with Parkinsons 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-BESTests 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.MethodThis 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.ResultsThe 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-BESTests 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.ConclusionsOur 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 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.

Does a dynamic chair increase office workers' movements? – Results from a combined laboratory and field study

PURPOSE Dynamic chairs have the potential to facilitate movements that could counteract health problems associated with sedentary office work. This study aimed to evaluate whether a dynamic chair can increase movements during desk-based office work. METHODS Fifteen healthy subjects performed desk-based office work using a dynamic office chair and compared to three other conditions in a movement laboratory. In a field study, the dynamic office chair was studied during three working days using accelerometry. RESULTS Equivocal results showed that the dynamic chair increased upper body and chair movements as compared to the conventional chair, but lesser movements were found compared to standing. No differences were found between the conditions in the field study. CONCLUSIONS A dynamic chair may facilitate movements in static desk-based office tasks, but the results were not consistent for all outcome measures. Validation of measuring protocols for assessing movements during desk-based office work is warranted.

Pre- and unplanned walking turns in Parkinson’s disease – Effects of dopaminergic medication

Although dopaminergic medication improves functional mobility in individuals with Parkinsons disease (PD), its effects on walking turns are uncertain. Our goals was to determine whether dopaminergic medication improves preplanned and unplanned walking turns in individuals with PD, compared to healthy controls. Nineteen older adults with mild-to-moderate PD and 17 healthy controls performed one of the following three tasks, presented randomly: walking straight, or walking and turning 180° to the right or left. The walking direction was visually cued before starting to walk (preplanned) or after (unplanned, i.e., 0.6m before reaching the turning point). Subjects with PD were assessed off dopaminergic medication (OFF) and on dopaminergic medication (ON) medication. Turning strategy (step and spin turns), turning performance (turning distance and body rotation) and walking pattern were analyzed for three turning steps. Irrespective of medication state and turning condition, step and spin turns followed a nearly 50:50 distribution. After intake of dopaminergic medication, subjects with PD increased their turning distance but not the amount of body rotation or their walking pattern. Compared to controls, turning impairments in subjects with PD remained while ON medication and problems regulating step width were the most prominent features of their walking pattern. Specifically, subjects with PD turned with narrower cross-over steps, i.e. when the external foot crossed over the line of progression of the internal leg. We conclude that turning impairments remained even after dopaminergic medication and problems modulating step width appears to be a critical feature for turning in PD.

Investigating the Mini-BESTest's construct validity in elderly with Parkinson's disease.

The Mini‐BESTest consists of items relevant to balance deficiencies among people with Parkinsons disease (PwPD). However, the Mini‐BESTests construct validity has been sparsely evaluated in this population.

Objectively assessed physical activity and associated factors of sedentary behavior among survivors of stroke living in Cape Town, South Africa

Abstract Purpose: To investigate objectively measured physical activity in stroke survivors living in low-income areas of Cape Town, South Africa, specifically to: (a) describe the volume of daily physical activity and time spent in different intensity levels and (b) investigate the association of factors covering the International Classification of Functioning, Disability and Health with sedentary behavior. Materials and methods: A cross-sectional design was used, where forty-five ambulatory community-dwelling stroke survivors participated. Volume and intensity of physical activity were assessed with accelerometers for three to five consecutive days. Personal and environmental factors, along with body function and activity, were captured. Multiple linear regression was used to investigate factors associated with the percentage of days spent sedentary. Results: The median number of steps per day was 2393, and of the average 703 minutes of wear time, 80% were spent in sedentary, 15% in light, and 5% in moderate-to-vigorous intensity physical activity. Age, stroke severity, and failing to receive outpatient rehabilitation were independently associated with sedentary, which, taken together, explained 52% of the variance. Conclusions: Low volumes of physical activity and high amount of sedentary time emphasize the need to develop strategies that will increase physical activity. Providing outpatient rehabilitation in a systematic manner post-stroke is a potential target of health care programs in order to reduce sedentary behavior. Implications for rehabilitation Objectively measured physical activity among community-dwelling survivors of stroke in Cape Town, South Africa was low in volume, and the majority did not meet the recommendations of 150 minutes of at least moderate intensity physical activity. The majority of stroke survivors in South Africa spent most of their time sedentary, which could further increase the risk of cardiovascular impairments. Outpatient rehabilitation should be provided to all patients after stroke since it appears to reduce sedentary time.

Depressive symptoms associated with concerns about falling in Parkinson's disease

Concerns about falling, a construct related to fear of falling, is increased in people with Parkinsons disease (PD) and is recognized as a barrier for exercise, negatively affecting health‐related quality of life and participation.

Medio-lateral stability during walking turns in older adults

Introduction Medio-lateral stability during walking turns relies on the interaction between precise weight shifts of the body and changes in base of support by regulating step width. Although older adults and clinical populations often slow down while turning in order to compensate for balance impairments, little is known about the influence of walking speed on stability during turning. Objective To compare medio-lateral stability between walking turns and straight walking and to investigate whether walking speed affects medio-lateral stability during turning in healthy older adults. Methods Nineteen older adults walked straight or walked and turned 180° to the right and left at their comfortable speed and at a slow pace. The walking direction was visually cued before they started to walk (preplanned) or while walking straight (unplanned). As a proxy for medio-lateral stability, we calculated the absolute difference between pelvis lateral displacement and the lateral edge of the base of support during straight walking and turning. Results Overall, irrespective of turning condition, medio-lateral stability was enhanced during turning as the pelvis was further away from the boundary of the base of support resulting in a greater margin of stability compared to straight walking. Turning at a slow pace hampered medio-lateral stability as demonstrated by pelvis lateral displacement closer to the boundaries of the base of support resulting in reduced margins of stability. The reduction in stability was caused by a narrower step width during slow walking whereas pelvis lateral displacement was unaffected by turning speed. Conclusion In older adults, medio-lateral stability was augmented during turning compared to straight walking, whereas turning at a slow pace hampered medio-lateral stability. These findings provide insights into the postural strategies used by older adults in order to adapt to the postural challenges of turning and straight walking.