Jessica Janssen

Effect of three cueing devices for people with Parkinson's disease with gait initiation difficulties

BACKGROUND Freezing of gait (FOG) remains one of the most common debilitating aspects of Parkinsons disease and has been linked to injuries, falls and reduced quality of life. Although commercially available portable cueing devices exist claiming to assist with overcoming freezing; their immediate effectiveness in overcoming gait initiation failure is currently unknown. This study investigated the effects of three different types of cueing device in people with Parkinsons disease who experience freezing. METHODS Twenty participants with idiopathic Parkinsons disease who experienced freezing during gait but who were able to walk short distances indoors independently were recruited. At least three attempts at gait initiation were recorded using a 10 camera Qualisys motion analysis system and four force platforms. Test conditions were; Laser Cane, sound metronome, vibrating metronome, walking stick and no intervention. RESULTS During testing 12 of the 20 participants had freezing episodes, from these participants 100 freezing and 91 non-freezing trials were recorded. Clear differences in the movement patterns were seen between freezing and non-freezing episodes. The Laser Cane was most effective cueing device at improving the forwards/backwards and side to side movement and had the least number of freezing episodes. The walking stick also showed significant improvements compared to the other conditions. The vibration metronome appeared to disrupt movement compared to the sound metronome at the same beat frequency. CONCLUSION This study identified differences in the movement patterns between freezing episodes and non-freezing episodes, and identified immediate improvements during gait initiation when using the Laser Cane over the other interventions.

Laserlight visual cueing device for freezing of gait in Parkinson’s disease: a case study of the biomechanics involved

Abstract Background: Freezing of gait (FOG) is a serious gait disorder affecting up to two-thirds of people with Parkinson’s disease (PD). Cueing has been explored as a method of generating motor execution using visual transverse lines on the floor. However, the impact of a laser light visual cue remains unclear. Objective: To determine the biomechanical effect of a laser cane on FOG in a participant with PD compared to a healthy age- and gender-matched control. Methods: The participant with PD and healthy control were given a task of initiating gait from standing. Electromyography (EMG) data were collected from the tibialis anterior (TA) and the medial gastrocnemius (GS) muscles using an 8-channel system. A 10-camera system (Qualisys) recorded movement in 6 degrees of freedom and a calibrated anatomical system technique was used to construct a full body model. Center of mass (COM) and center of pressure (COP) were the main outcome measures. Results: The uncued condition showed that separation of COM and COP took longer and was of smaller magnitude than the cued condition. EMG activity revealed prolonged activation of GS, with little to no TA activity. The cued condition showed earlier COM and COP separation. There was reduced fluctuation in GS, with abnormal, early bursts of TA activity. Step length improved in the cued condition compared to the uncued condition. Conclusion: Laserlight visual cueing improved step length beyond a non-cued condition for this patient indicating improved posture and muscle control.

Keep/refer decision making abilities of European final year undergraduate physiotherapy students: A cross-sectional survey using clinical vignettes

Abstract Purpose: The recognition of pathological processes, which are not appropriate for physiotherapy, is a crucial part of the clinical reasoning process. Over recent years, there have been several research efforts investigating qualified physiotherapists and doctoral students’ capability in making precise clinical decisions on whether a patient’s condition is suitable for physiotherapy intervention (keep), or rather requires medical check-up (refer). No study so far has examined the keep/refer decision making abilities of final year undergraduate physiotherapy students within Europe. Materials and methods: A survey containing 12 validated vignettes was distributed among 2238 final year undergraduate physiotherapy students from 15 different member countries of the European Network of Physiotherapy in Higher Education (ENPHE). Results: Seventy-three respondents were included in the final analysis. Only slightly more than half (mean: 53%; median: 67%) of the medical critical vignettes were answered correctly. Just eight respondents (11%) correctly identified all three medical critical vignettes. Conclusion: European final year undergraduate physiotherapy students are not sufficiently equipped with enough knowledge and skills to make very precise keep/refer decisions (based on clinical vignettes) and, most importantly, seem insufficiently trained to accurately identify more critical medical conditions which need a timely referral to another health care professional.

Anterior knee pain subgroups: the first step towards a personalized treatment

Identification of subgroups within the patellofemoral pain (PFP) population has gained a lot of interest and attention from the research community in recent years due to the recognition of the relatively poor patient outcomes associated with the multimodal approach and following the success of subgrouping approaches used in the management of low back pain. This paper reviews early attempts at PFP subgrouping and introduces readers to some of the modern methodological approaches employed to derive subgroups. Summaries of the results of two research projects illustrating the use of these more robust methods to derive subgroups in the PFP population are provided. In conclusion, it appears there are probably 3 or 4 discrete subgroups within the PFP population that may require a more personalised approach to treatment. However, to date no definitive randomized controlled trials (RCTs) have been conducted to evaluate the potential benefits of targeted interventions for PFP subgroups in terms of improved patient outcomes so this warrants further research.

Mental Health staff views on improving burnout and mental toughness

Purpose Burnout in mental health staff is acknowledged as a major problem. The purpose of this paper is to gain an understanding of mental health staff views on improving burnout and mental toughness in mental health staff. Design/methodology/approach Ten participants from two mental health rehabilitation units across the north-west of England took part in a Nominal Group Technique. Participants consisted of mental health workers from varied roles in order to capture views from a multidisciplinary team. The main question posed to the staff was “What strategies and techniques do you think could help improve burnout and mental toughness in mental health staff”. Findings The study revealed that the top three ideas to take forward to help improve burnout and mental toughness in mental health staff were improving the culture/organisation, improving staff wellbeing and education. Additionally, staff were highly motivated and enthusiastic about engaging in discussion about what could be done to improve their wellbeing and the importance of taking this forward. Originality/value This study is unique in involving mental health staff in discussing their ways of improving their mental health. It is also unique as it has found the nine strategies to do this and these could be used in targeted training for mental health staff.

Use of thoracic ultrasound by physiotherapists: a scoping review of the literature

BACKGROUND Use of diagnostic thoracic ultrasound (TUS) in medical professions to examine the pleura, lung parenchyma and diaphragm is gaining in popularity, however the ways in which physiotherapists are using TUS is unclear. OBJECTIVE The aim of this scoping review is to gain an understanding of the emerging evidence base surrounding physiotherapy use of TUS to inform research and clinical practice. DATA SOURCES A systematic search was conducted of the following databases: Cochrane, EPPI centre, PROSPERO, Medline, CINAHL, AMED, EMBASE, HMIC, and BNI. STUDY SELECTION Inclusion criteria: primary research reporting the use of diagnostic TUS; a physiotherapist as part of the study design or as the chief investigator; published in English. SYNTHESIS METHODS Data regarding demographics, design, type of conditions and anatomical structures investigated and profession leading the TUS of included papers were compiled in a tabular format. RESULTS Of the 26 included papers, nine studied healthy participants, four studied COPD and four studied critical care patients. Most papers (n=23) involved scanning the diaphragm. In eight studies the physiotherapist operated the TUS. LIMITATIONS The paper selection process was performed by one author; with no cross-checking by another individual. CONCLUSION Use of TUS by physiotherapists is an emerging area in both diaphragm and lung diagnostics. A wide range of patient populations may benefit from physiotherapists using TUS. Papers in this review are heterogeneous making any generalisability difficult but does show its potential for varied uses. TUS is an innovative skill in the hands of physiotherapists, but more research is needed.