Jeffrey D. Holmes

Validity of the Nintendo Wii® balance board for the assessment of standing balance in Parkinson’s disease

Background: Impaired postural stability places individuals with Parkinson’s at an increased risk for falls. Given the high incidence of fall-related injuries within this population, ongoing assessment of postural stability is important. Objective: To evaluate the validity of the Nintendo Wii® balance board as a measurement tool for the assessment of postural stability in individuals with Parkinson’s. Subjects: Twenty individuals with Parkinson’s participated. Intervention: Subjects completed testing on two balance tasks with eyes open and closed on a Wii® balance board and biomechanical force platform. Main Measures: Bland–Altman plots and a two-way, random-effects, single measure intraclass correlation coefficient model were used to assess concurrent validity of centre-of-pressure data. Results: Concurrent validity was demonstrated to be excellent across balance tasks (intraclass correlation coefficients = 0.96, 0.98, 0.92, 0.94). Conclusions: This study suggests that the Wii® balance board is a valid tool for the quantification of postural stability among individuals with Parkinson’s.

Hockey Concussion Education Project, Part 2. Microstructural white matter alterations in acutely concussed ice hockey players: a longitudinal free-water MRI study

OBJECT Concussion is a common injury in ice hockey and a health problem for the general population. Traumatic axonal injury has been associated with concussions (also referred to as mild traumatic brain injuries), yet the pathological course that leads from injury to recovery or to long-term sequelae is still not known. This study investigated the longitudinal course of concussion by comparing diffusion MRI (dMRI) scans of the brains of ice hockey players before and after a concussion. METHODS The 2011-2012 Hockey Concussion Education Project followed 45 university-level ice hockey players (both male and female) during a single Canadian Interuniversity Sports season. Of these, 38 players had usable dMRI scans obtained in the preseason. During the season, 11 players suffered a concussion, and 7 of these 11 players had usable dMRI scans that were taken within 72 hours of injury. To analyze the data, the authors performed free-water imaging, which reflects an increase in specificity over other dMRI analysis methods by identifying alterations that occur in the extracellular space compared with those that occur in proximity to cellular tissue in the white matter. They used an individualized approach to identify alterations that are spatially heterogeneous, as is expected in concussions. RESULTS Paired comparison of the concussed players before and after injury revealed a statistically significant (p < 0.05) common pattern of reduced free-water volume and reduced axial and radial diffusivities following elimination of free-water. These free-water-corrected measures are less affected by partial volumes containing extracellular water and are therefore more specific to processes that occur within the brain tissue. Fractional anisotropy was significantly increased, but this change was no longer significant following the free-water elimination. CONCLUSIONS Concussion during ice hockey games results in microstructural alterations that are detectable using dMRI. The alterations that the authors found suggest decreased extracellular space and decreased diffusivities in white matter tissue. This finding might be explained by swelling and/or by increased cellularity of glia cells. Even though these findings in and of themselves cannot determine whether the observed microstructural alterations are related to long-term pathology or persistent symptoms, they are important nonetheless because they establish a clearer picture of how the brain responds to concussion.

Hockey Concussion Education Project, Part 1. Susceptibility-weighted imaging study in male and female ice hockey players over a single season.

OBJECT Concussion, or mild traumatic brain injury (mTBI), is a commonly occurring sports-related injury, especially in contact sports such as hockey. Cerebral microbleeds (CMBs), which appear as small, hypointense lesions on T₂*-weighted images, can result from TBI. The authors use susceptibility-weighted imaging (SWI) to automatically detect small hypointensities that may be subtle signs of chronic and acute damage due to both subconcussive and concussive injury. The goal was to investigate how the burden of these hypointensities changes over time, over a playing season, and postconcussion, in comparison with subjects who did not suffer a medically observed and diagnosed concussion. METHODS Images were obtained in 45 university-level adult male and female ice hockey players before and after a single Canadian Interuniversity Sports season. In addition, 11 subjects (5 men and 6 women) underwent imaging at 72 hours, 2 weeks, and 2 months after concussion. To identify subtle changes in brain tissue and potential CMBs, nonvessel clusters of hypointensities on SWI were automatically identified, and a hypointensity burden index was calculated for all subjects at the beginning of the season (BOS), the end of the season (EOS), and at postconcussion time points (where applicable). RESULTS A statistically significant increase in the hypointensity burden, relative to the BOS, was observed for male subjects with concussions at the 2-week postconcussion time point. A smaller, nonsignificant rise in the burden for female subjects with concussions was also observed within the same time period. There were no significant changes in burden for nonconcussed subjects of either sex between the BOS and EOS time points. However, there was a statistically significant difference in the burden between male and female subjects in the nonconcussed group at both the BOS and EOS time points, with males having a higher burden. CONCLUSIONS This method extends the utility of SWI from the enhancement and detection of larger (> 5 mm) CMBs, which are often observed in more severe cases of TBI, to cases involving smaller lesions in which visual detection of injury is difficult. The hypointensity burden metric proposed here shows statistically significant changes over time in the male subjects. A smaller, nonsignificant increase in the burden metric was observed in the female subjects.

The Sport Concussion Education Project. A brief report on an educational initiative: from concept to curriculum

Current research on concussion is primarily focused on injury identification and treatment. Prevention initiatives are, however, important for reducing the incidence of brain injury. This report examines the development and implementation of an interactive electronic teaching program (an e-module) that is designed specifically for concussion education within an adolescent population. This learning tool and the accompanying consolidation rubric demonstrate that significant engagement occurs in addition to the knowledge gained among participants when it is used in a school curriculum setting.

Toward a Mixed-Methods Research Approach to Content Analysis in The Digital Age: The Combined Content-Analysis Model and its Applications to Health Care Twitter Feeds

Background Twitter’s 140-character microblog posts are increasingly used to access information and facilitate discussions among health care professionals and between patients with chronic conditions and their caregivers. Recently, efforts have emerged to investigate the content of health care-related posts on Twitter. This marks a new area for researchers to investigate and apply content analysis (CA). In current infodemiology, infoveillance and digital disease detection research initiatives, quantitative and qualitative Twitter data are often combined, and there are no clear guidelines for researchers to follow when collecting and evaluating Twitter-driven content. Objective The aim of this study was to identify studies on health care and social media that used Twitter feeds as a primary data source and CA as an analysis technique. We evaluated the resulting 18 studies based on a narrative review of previous methodological studies and textbooks to determine the criteria and main features of quantitative and qualitative CA. We then used the key features of CA and mixed-methods research designs to propose the combined content-analysis (CCA) model as a solid research framework for designing, conducting, and evaluating investigations of Twitter-driven content. Methods We conducted a PubMed search to collect studies published between 2010 and 2014 that used CA to analyze health care-related tweets. The PubMed search and reference list checks of selected papers identified 21 papers. We excluded 3 papers and further analyzed 18. Results Results suggest that the methods used in these studies were not purely quantitative or qualitative, and the mixed-methods design was not explicitly chosen for data collection and analysis. A solid research framework is needed for researchers who intend to analyze Twitter data through the use of CA. Conclusions We propose the CCA model as a useful framework that provides a straightforward approach to guide Twitter-driven studies and that adds rigor to health care social media investigations. We provide suggestions for the use of the CCA model in elder care-related contexts.

The Effects of a Home Based Virtual Reality Rehabilitation Program on Balance Among Individuals with Parkinson’s Disease

ABSTRACT Background and Purpose: Recently, the Nintendo Wii has emerged as an innovation in rehabilitation. Although research findings to date have contributed to our understanding of the effects of implementing the Wii as a rehabilitation tool, evidence supporting the Wii for improving symptoms in Parkinsons disease (PD) remains limited. The purpose of this study, therefore, was to evaluate the effectiveness of a 12-week home-based exercise program designed around the Wii, in improving balance, balance confidence, and maintaining exercise adherence among individuals with PD. Methods: Fifteen participants were recruited to engage in 30 minutes of Wii activity 3×/week for 12 weeks. Results: Balance and balance confidence improved from baseline to midintervention, but reverted back to near baseline values at postintervention. Exercise adherence was maintained equally throughout the study. Conclusions: The Nintendo Wii has potential to be an effective treatment strategy for improving balance, balance confidence, and fostering programmatic adherence among individuals with PD.

Clinical Presentation of Anxiety in Parkinson’s Disease A Scoping Review

Up to 40% of all individuals with Parkinson’s disease (PD) are estimated to experience anxiety that interferes with daily functioning. This article describes research regarding the presentation of anxiety in PD and the influence anxiety has on participation in this population. A scoping review identified 1,635 articles, of which 49 met the inclusion criteria. This review identified that anxiety in PD is often associated with a range of clinical correlates related to demographic and clinical characteristics (age, gender, disease stage, duration, progression), motor symptoms (tremor, bradykinesia, dystonia, freezing of gait, symptom severity), treatment-related complications (on/off fluctuations, on with dyskinesia, unpredictable off), and non-motor symptoms (sleep abnormalities, fatigue, cognitive impairment, depression). These findings can be used to increase clinicians’ awareness toward the specific clinical correlates linked to anxiety in PD so that mental health concerns can be detected and addressed more readily in practice.

Clinical Assessments as Predictors of Primary On-Road Outcomes in Parkinson's Disease.

Parkinson’s disease (PD) is a neurodegenerative disorder that affects fitness to drive. Research that has examined clinical predictors of fitness to drive in PD, using the on-road assessment as the gold standard, has generally used a dichotomous pass/fail decision. However, on-road assessments may also result in one of two additional outcomes (pass with recommendations, or fail-remediable). Individuals within these subgroups may benefit from interventions to improve their fitness to drive abilities. This study investigated clinical predictors that could be indicative of the pass, pass with recommendations, or fail-remediable categories for drivers with PD (N = 99). Trails B, Left Finger to Nose Test, and contrast sensitivity measures were identified as significant predictors for the pass, and pass with recommendations subgroups. No significant predictors were identified for the fail-remediable subgroup. Results from this study provide a foundation for clinicians to identify drivers who can benefit from recommendations to preserve their driving abilities.

Executive functions and driving in people with Parkinson's disease

In this issue of Movement Disorders, Ranchet and colleagues 1 investigated the impact of specific executive functions on driving performance in 19 people with Parkinson’s disease (PD) compared to 21 agematched healthy controls. This empirical work is timely and interesting as the literature supports that mild cognitive impairment is evident in people with PD at the time of diagnosis, 2 and may have future

Understanding Parkinson’s through visual narratives: “I’m not Mrs. Parkinson’s”:

Introduction Although it is accepted that individuals with Parkinson’s disease must navigate challenges such as receiving their diagnosis and changing daily occupations, little is known about how they navigate. The purpose of this study is to deepen the current understanding of the experience of living with Parkinson’s disease and its implications for occupation through a narrative visual methodology (photo-elicitation). Method Six individuals with Parkinson’s disease were asked to take photographs and share verbal narrative accounts to illustrate their experience of living with Parkinson’s disease. Findings Results highlight the interrelationship between occupation and identity, as many of the participants’ stories were interpreted as foregrounding the negotiation of occupation, and how such negotiation shaped their sense of identity. Overall, three major themes were identified: (1) Framing the meaning of Parkinson’s disease (accepting the disease as part of who they were); (2) Negotiating engagement in occupation (ongoing deliberation over whether to continue engaging in certain aspects of life as Parkinson’s disease progressed); and (3) Being ready to accept changes that impact personal or social identity (readiness to accept help and to identify as someone with Parkinson’s disease). Conclusion Attending to insights regarding the lived experience of Parkinson’s disease will enhance quality of care through informing an enriched client-centered, occupation-based approach.