Liam Johnson

Improvement in aerobic capacity after an exercise program in sporadic inclusion body myositis

Objectives: The study aimed to investigate the effects of a combined functional and aerobic exercise program on aerobic capacity, muscle strength, and functional mobility in a group of patients with sporadic inclusion body myositis (IBM). Methods: Aerobic capacity, muscle strength, and functional capacity assessments were conducted on 7 participants with sporadic IBM before and after a 12-week exercise program, which included resistance exercises and aerobic stationary cycling 3 times per week on alternative days. Results: Aerobic capacity of the group increased significantly by 38%, and significant strength improvements were observed in 4 of the muscle groups tested (P < 0.05). The exercise program was well tolerated, and there was no significant change in the serum creatine kinase level after the exercise period. Conclusions: An aerobic exercise program can be safely tolerated by patients with sporadic IBM and can improve aerobic capacity and muscle strength when combined with resistance training. These findings indicate that aerobic and functional muscle strengthening exercise should be considered in the management of patients with IBM.

Clinical and Posturographic Correlates of Falling in Parkinson's Disease

Various clinical tests and balance scales have been used to assess postural stability and the risk of falling in patients with idiopathic Parkinsons disease (IPD). Quantitative posturography allows a more objective assessment but the findings in previous studies have been inconsistent and few studies have investigated which posturographic measures correlate best with a history of falling. The purpose of this study was to determine the efficacy of clinical tests, balance scales, and stable‐platform posturography in detecting postural instability and discriminating between fallers and non‐fallers in a home‐dwelling PD cohort. Forty‐eight PD subjects (Hoehn & Yahr stage 1–3) and 17 age‐matched controls had the following assessments: Activities‐specific Balance Confidence scale, Berg Balance Scale, Unified Parkinsons Disease Rating Scale (UPDRS) (motor), pull‐test, timed up‐and‐go, static posturography, and dynamic posturography to assess multidirectional leaning balance. Of the clinical assessments, all but the pull‐test were closely correlated with a history of falling. Static posturography discriminated between PD fallers and controls but not between PD fallers and non‐fallers, whereas dynamic posturography (reaction time, velocity, and target hit‐time) also discriminated between fallers and non‐fallers. Our findings suggest that this combination of clinical and posturographic measures would be useful in the prospective assessment of falls risk in PD patients. A further prospective study is now required to assess their predictive value.

The Effectiveness of an Individualized, Home-Based Functional Exercise Program for Patients With Sporadic Inclusion Body Myositis

Objective: The objective of the study was to investigate the effects of a functional exercise program on muscle strength and mobility in a group of patients with sporadic inclusion body myositis (IBM). Methods and Materials: Seven patients with sporadic IBM were tested for muscle strength and functional capacities before and after a 16-week, patient-specific, home-based exercise program involving mild, daily, functional exercises. Results: Significant improvements in isometric strength were demonstrated in all muscle groups tested and were maximal in the hip flexor muscles. In addition, walking and stair climbing times improved in all patients. The exercise program was well-tolerated, and there was no significant change in the serum creatine kinase level following the exercise period. Conclusion: The findings of this study indicate that an individually prescribed home exercise program can be safely implemented and can result not only in significant gains in muscle strength but also in useful improvements in functional capabilities and is therefore beneficial in the management of patients with IBM.

Early Mobilization After Stroke: Early Adoption but Limited Evidence

In the last decade, increasing attention has been paid to understanding the components of care that might contribute to the stroke unit effect. Early mobilization, in its many guises, is one component of care proposed to contribute to the survival and recovery benefits of stroke unit care.1 This topical review provides an overview of the current evidence, research, and practice recommendations for early mobilization after stroke. As a term, early mobilization is problematic. There is no common understanding of the meaning of early (eg, hours, days, weeks, months) or mobilization (movement of, eg, cells, joints, limbs, people). A recurring theme in this review, inadequate definition currently limits our ability to synthesize information on the topic. For example, in some clinical trials of mobility interventions started soon after stroke, mobilization is used to describe a program of task-specific standing and walking retraining (rehabilitation) delivered by therapists or nurses and continued throughout the acute hospital stay.2,3 In other cases, mobilization refers simply to moving a patients’ limbs in bed or sitting them out of bed. The timing of commencement of activity is also highly variable and often hard to determine. As both what we do (intervention type, intensity, frequency, amount), and when we do it, may confer benefit or harm, we highlight variations in definition where relevant. We have focused our review on out-of-bed interventions commencing in the first 24 to 72 hours after stroke, as this is the period of greatest clinical uncertainty. Early mobilization was first discussed at a Swedish consensus conference on stroke care in the mid-1980s (Bo Norving and Bent Indredavik, personal communication, 2014) with several local guidelines in Norway and Sweden recommending the practice. Early mobilization became more prominent in the literature in the early 1990s when Indredavik and colleagues reported their clinical …

Energy Expenditure and Cost During Walking After Stroke: A Systematic Review

OBJECTIVES To systematically review the evidence to determine energy expenditure (EE) in volume of oxygen uptake (V̇O2) (mL/kg/min) and energy cost in oxygen uptake per meter walked (V̇O2/walking speed; mL/kg/m) during walking poststroke and how it compares with healthy controls; and to determine how applicable current exercise prescription guidelines are to stroke survivors. DATA SOURCES Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and CINAHL were searched on October 9, 2014, using search terms related to stroke and EE. Additionally, we screened reference lists of eligible studies. STUDY SELECTION Two independent reviewers screened titles and abstracts of 2115 identified references. After screening the full text of 144 potentially eligible studies, we included 29 studies (stroke survivors: n=501, healthy controls: n=123), including participants with confirmed stroke and a measure of V̇O2 during walking using breath-by-breath analysis. Studies with (9 studies) and without (20 studies) a healthy control group were included. DATA EXTRACTION Two reviewers independently extracted data using a standard template, including patient characteristics, outcome data, and study methods. DATA SYNTHESIS Mean age of stroke survivors was 57 years (range, 40-67y). Poststroke EE was highly variable across studies and could not be pooled because of high heterogeneity. EE during steady-state overground walking at matched speeds was significantly higher in stroke survivors than healthy controls (mean difference in V̇O2, 4.06 mL/kg/min; 95% confidence interval [CI], 2.21-5.91; 1 study; n=26); there was no significant group difference at self-selected speeds. Energy cost during steady-state overground walking was higher in stroke survivors at both self-selected (mean difference, .47 mL/kg/m; 95% CI, .29-.66; 2 studies; n=38) and matched speeds compared with healthy controls (mean difference, .27 mL/kg/m; 95% CI, .03-.51; 1 study; n=26). CONCLUSIONS Stroke survivors expend more energy during walking than healthy controls. Low-intensity exercise as described in guidelines might be at a moderate intensity level for stroke survivors; there is a need for stroke-specific exercise guidelines.

exergaming as a viable therapeutic tool to improve static and dynamic balance among older adults and people with idiopathic Parkinson's disease: a systematic review and meta-analysis

The use of virtual reality games (known as “exergaming”) as a neurorehabilitation tool is gaining interest. Therefore, we aim to collate evidence for the effects of exergaming on the balance and postural control of older adults and people with idiopathic Parkinson’s disease (IPD). Six electronic databases were searched, from inception to April 2015, to identify relevant studies. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were used to calculate effect sizes between experimental and control groups. I2 statistics were used to determine levels of heterogeneity. 325 older adults and 56 people with IPD who were assessed across 11 studies. The results showed that exergaming improved static balance (SMD 1.069, 95% CI 0.563–1.576), postural control (SMD 0.826, 95% CI 0.481–1.170), and dynamic balance (SMD −0.808, 95% CI −1.192 to −0.424) in healthy older adults. Two IPD studies showed an improvement in static balance (SMD 0.124, 95% CI −0.581 to 0.828) and postural control (SMD 2.576, 95% CI 1.534–3.599). Our findings suggest that exergaming might be an appropriate therapeutic tool for improving balance and postural control in older adults, but more large-scale trials are needed to determine if the same is true for people with IPD.

Lower limb progressive resistance training improves leg strength but not gait speed or balance in Parkinson's disease: A systematic review and meta-analysis

The use of progressive resistance training (PRT) to improve gait and balance in people with Parkinson’s disease (PD) is an emerging area of interest. However, the main effects of PRT on lower limb functions such as gait, balance, and leg strength in people with PD remain unclear. Therefore, the aim of the meta-analysis is to evaluate the evidence surrounding the use of PRT to improve gait and balance in people with PD. Five electronic databases, from inception to December 2014, were searched to identify the relevant studies. Data extraction was performed by two independent reviewers and methodological quality was assessed using the PEDro scale. Standardized mean differences (SMD) and 95% confidence intervals (CIs) of fixed and random effects models were used to calculate the effect sizes between experimental and control groups and I2 statistics were used to determine levels of heterogeneity. In total, seven studies were identified consisting of 172 participants (experimental n = 84; control n = 88). The pooled results showed a moderate but significant effect of PRT on leg strength (SMD 1.42, 95% CI 0.464–2.376); however, no significant effects were observed for gait speed (SMD 0.418, 95% CI −0.219 to 1.055). No significant effects were observed for balance measures included in this review. In conclusion, our results showed no discernable effect of PRT on gait and balance measures, although this is likely due to the lack of studies available. It may be suggested that PRT be performed in conjunction with balance or task-specific functional training to elicit greater lower limb functional benefits in people with PD.

Early rehabilitation after stroke

Purpose of review Early rehabilitation is recommended in many guidelines, with limited evidence to guide practice. Brain neurobiology suggests that early training, at the right dose, will aid recovery. In this review, we highlight recent trials of early mobilization, aphasia, dysphagia and upper limb treatment in which intervention is commenced within 7 days of stroke and discuss future research directions. Recent findings Trials in this early time window are few. Although the seminal AVERT trial suggests that a cautious approach is necessary immediately (<24 h) after stroke, early mobility training and mobilization appear well tolerated, with few reasons to delay initiating some rehabilitation within the first week. The results of large clinical trials of early aphasia therapy are on the horizon, and examples of targeted upper limb treatments with better patient selection are emerging. Summary Early rehabilitation trials are complex, particularly those that intervene across acute and rehabilitation care settings, but these trials are important if we are to optimize recovery potential in the critical window for repair. Concerted efforts to standardize ‘early’ recruitment, appropriately stratify participants and implement longer term follow-up is needed. Trial standards are improving. New recommendations from a recent Stroke Recovery and Rehabilitation Roundtable will help drive new research.

Light physical activity is positively associated with cognitive performance in older community dwelling adults

OBJECTIVES To evaluate the associations between an objective measure of different intensities of physical activity, upper- and lower-limb muscle strength and psychomotor performance and set-shifting domains of cognitive executive function in older adults. DESIGN A cross-sectional study. METHODS From the Tasmanian Older Adult Cohort Study, 188 community-dwelling older adults (53.7% female; mean age±SD 63.98±7.3 years) undertook 7-day physical activity behaviour monitoring using an accelerometer. Dynamometers were used to assess leg extension strength. The Trail Maker Tests were used to measure psychomotor processing speed and set-shifting performance. RESULTS When controlling for age, smoking history, alcohol intake, educational achievement and neuropsychological functioning, higher levels of light physical activity, but not sedentary behaviour or moderate or vigorous physical activity, was found to be associated with better set-shifting performance. Neither physical activity behaviour or muscle strength were found to be associated with psychomotor performance. In addition, older age, greater alcohol intake, and lower levels of educational attainment, verbal learning and memory performance were significantly associated with lower scores on the set-shifting task; whereas older age and reduced neuropsychological functioning were associated with lower psychomotor processing speed scores. CONCLUSIONS Light physical activity is associated with higher executive functioning in community-dwelling older adults and this strengthens the evidence supporting exercise as a neuroprotective agent. Further studies are needed to understand why light physical activity behaviour positively influences executive functioning, and how such physical activity can be implemented into the daily routine of older adults.

Interactive effects of GPI stimulation and levodopa on postural control in Parkinson's disease

INTRODUCTION Postural instability is a major source of disability in idiopathic Parkinsons disease (IPD). Deep brain stimulation of the globus pallidus internus (GPI-DBS) improves clinician-rated balance control but there have been few quantitative studies of its interactive effects with levodopa (L-DOPA). The purpose of this study was to compare the short-term and interactive effects of GPI-DBS and L-DOPA on objective measures of postural stability in patients with longstanding IPD. METHODS Static and dynamic posturography during a whole-body leaning task were performed in 10 IPD patients with bilateral GPI stimulators under the following conditions: untreated (OFF); L-DOPA alone; DBS alone; DBS+L-DOPA, and in 9 healthy Control subjects. Clinical status was assessed using the UPDRS and AIMS Dyskinesia Scale. RESULTS Static sway was greater in IPD patients in the OFF state compared to the Control subjects and was further increased by L-DOPA and reduced by GPI-DBS. In the dynamic task, L-DOPA had a greater effect than GPI-DBS on improving Start Time, but reduced the spatial accuracy and directional control of the task. When the two therapies were combined, GPI-DBS prevented the L-DOPA induced increase in static sway and improved the accuracy of the dynamic task. CONCLUSION The findings demonstrate GPI-DBS and L-DOPA have differential effects on temporal and spatial aspects of postural control in IPD and that GPI-DBS counteracts some of the adverse effects of L-DOPA. Further studies on larger numbers of patients with GPI stimulators are required to confirm these findings and to clarify the contribution of dyskinesias to impaired dynamic postural control.