Mary E. Jenkins

Definition and Classification of Negative Motor Signs in Childhood

In this report we describe the outcome of a consensus meeting that occurred at the National Institutes of Health in Bethesda, Maryland, March 12 through 14, 2005. The meeting brought together 39 specialists from multiple clinical and research disciplines including developmental pediatrics, neurology, neurosurgery, orthopedic surgery, physical therapy, occupational therapy, physical medicine and rehabilitation, neurophysiology, muscle physiology, motor control, and biomechanics. The purpose of the meeting was to establish terminology and definitions for 4 aspects of motor disorders that occur in children: weakness, reduced selective motor control, ataxia, and deficits of praxis. The purpose of the definitions is to assist communication between clinicians, select homogeneous groups of children for clinical research trials, facilitate the development of rating scales to assess improvement or deterioration with time, and eventually to better match individual children with specific therapies. “Weakness” is defined as the inability to generate normal voluntary force in a muscle or normal voluntary torque about a joint. “Reduced selective motor control” is defined as the impaired ability to isolate the activation of muscles in a selected pattern in response to demands of a voluntary posture or movement. “Ataxia” is defined as an inability to generate a normal or expected voluntary movement trajectory that cannot be attributed to weakness or involuntary muscle activity about the affected joints. “Apraxia” is defined as an impairment in the ability to accomplish previously learned and performed complex motor actions that is not explained by ataxia, reduced selective motor control, weakness, or involuntary motor activity. “Developmental dyspraxia” is defined as a failure to have ever acquired the ability to perform age-appropriate complex motor actions that is not explained by the presence of inadequate demonstration or practice, ataxia, reduced selective motor control, weakness, or involuntary motor activity.

Cueing and gait improvement among people with Parkinson's disease: a meta-analysis.

OBJECTIVE To compare the relative efficacy of visual versus auditory cueing on gait among individuals with Parkinsons disease (PD). DATA SOURCES A systematic search was completed up to September 2011, using the following databases: EMBASE, Scopus, Medline, CINAHL, and PubMed. STUDY SELECTION Four authors searched the databases using the following terms: Parkinsons disease (including abbreviations), gait, cadence, step, pace, cueing, cues, and prompt. All studies that evaluated the effect of cueing on gait in PD were selected by consensus of 2 pairs of authors who reviewed the titles and abstracts. Each pair of authors then applied the inclusion and exclusion criteria to each study, and 25 articles were chosen. Inclusion criteria were cueing studies that reported pre- and postoutcome measures of gait parameters. Exclusion criteria were lack of data and studies that evaluated gait aids. DATA EXTRACTION Gait measures of cadence, stride length, and velocity, before and after cueing, were collected from each study. If data were represented in graphs, a pair of authors extracted the data points individually, then compared and averaged values. DATA SYNTHESIS The data were synthesized using a meta-analysis based on cue type. Auditory cueing demonstrated significant improvement of cadence (Hedge g=.556; 95% confidence interval [CI], .291-.893), stride length (Hedge g=.497; 95% CI, .289-.696), and velocity (Hedge g=.544; 95% CI, .294-.795). In contrast, visual cueing significantly improved stride length only (Hedge g=.554; 95% CI, .072-1.036). CONCLUSIONS The findings suggest that auditory cueing is more effective for treating gait disorders in PD. Further research is needed to determine the optimum auditory cueing strategy for gait improvements.

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.

Dual-Task Interference: The Effects of Verbal Cognitive Tasks on Upright Postural Stability in Parkinson's Disease

Although dual-task interference has previously been demonstrated to have a significant effect on postural control among individuals with Parkinsons disease, the impact of speech complexity on postural control has not been demonstrated using quantitative biomechanical measures. The postural stability of twelve participants with idiopathic Parkinsons disease and twelve healthy age-matched controls was evaluated under three conditions: (1) without a secondary task, (2) performing a rote repetition task and (3) generating a monologue. Results suggested a significant effect of cognitive load on biomechanical parameters of postural stability. Although both groups increased their postural excursion, individuals with Parkinsons disease demonstrated significantly reduced excursion as compared with that of healthy age-matched controls. This suggests that participants with Parkinsons disease may be overconstraining their postural adjustments in order to focus attention on the cognitive tasks without losing their balance. Ironically, this overconstraint may place the participant at greater risk for a fall.

Plantar cutaneous sensory stimulation improves single-limb support time, and EMG activation patterns among individuals with Parkinson's disease.

Parkinsons disease is a chronic neurological disorder that results in gait and posture impairment. There is increasing evidence that these motor impairments may be partially due to deficits within the sensory system. In this study, the effects of a facilitatory insole that provides increased plantar sensory stimulation, was evaluated during gait, in a group of individuals with Parkinsons disease in comparison with healthy age-matched controls. Spatial-temporal parameters of gait were evaluated using an instrumented carpet, and muscle activation patterns were evaluated using surface EMG. All participants were tested with both a facilitatory (ribbed) insole and a conventional (flat) insole while walking 20 feet. Results indicated that the use of the facilitatory insole produced a significant increase in single-limb support time. Additionally, the muscle activation sequence of the tibialis anterior was normalized by the facilitatory insole, at the time of initial ground contact. These changes may lead to an overall improvement in gait pattern and stability, and suggest that the use of this type of facilitatory insole may be a useful treatment strategy for improving the gait of individuals with Parkinsons disease. This also provides support for the role of facilitation of the sensory system in improving motor output in individuals with Parkinsons disease.

The Problems of Recruitment: A Local Study

Based on a questionnaire survey of all occupational therapists employed in the Western Health and Social Services Board, Northern Ireland, the study highlighted a number of factors which contribute to the acknowledged problems of recruitment and retention. Fundamental to occupational therapists staying in post is their degree of satisfaction with the job. The survey established four specific factors of job satisfaction: multiprofessional teamwork, adequate staffing, further training/retraining and involvement in decision making. Reasons for leaving and deterrents from applying for jobs were viewed together as factors which take or keep occupational therapists out of posts. High weightings were given to lack of resources, unrealistic workload, personal reasons and lack of professional status. The attractive features of occupational therapy that were noted included variety of the work, good working relationships and the challenge of the job.

Prevalence of ataxia in children: A systematic review

Objective: To estimate the prevalence of childhood ataxia resulting from both genetic and acquired causes. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Five databases were searched for articles reporting a frequency measure (e.g., prevalence, incidence) of ataxia in children. Included articles were first grouped according to the World Health Organization (WHO) regions and subsequently classified according to etiology (genetic, acquired, or mixed). Each article was assessed for its risk of bias on the domains of sampling, measurement, and analysis. Incidence values were converted to prevalence estimates whenever possible. European prevalence estimates for different etiologies of ataxia were summed to gauge the overall prevalence of childhood ataxia. Results: One hundred fifteen articles were included in the review. More than 50% of the data originated from the Europe WHO region. Data from this region also showed the least susceptibility to bias. Little data were available for Africa and Southeast Asia. The prevalence of acquired ataxias was found to vary more greatly across regions than the genetic ataxias. Ataxic cerebral palsy was found to be a significant contributor to the overall prevalence of childhood ataxia across WHO regions. The prevalence of childhood ataxias in Europe was estimated to be ∼26/100,000 children and likely reflects a minimum prevalence worldwide. Conclusions: The findings show that ataxia is a common childhood motor disorder with a higher prevalence than previously assumed. More research concerning the epidemiology, assessment, and treatment of childhood ataxia is warranted.

Predictive Validity of the UPDRS Postural Stability Score and the Functional Reach Test, when Compared with Ecologically Valid Reaching Tasks

Balance problems and falls are a common concern among individuals with Parkinsons disease (PD). Falls frequently occur during daily activities such as reaching into cupboards in the kitchen or bathroom. This study compared the correlation among two standard postural stability tests - the postural stability score on the Unified Parkinsons Disease Rating Scale (UPDRS) and the Functional Reach Test (FRT) - and ecologically valid reaching tasks that correspond to reaching at different cupboard heights among 20 individuals with PD and 20 age-matched controls. Both the FRT and the UPDRS postural stability tests are quick measures that can be performed during the clinical examination. The FRT, but not the postural stability score, demonstrated a significant correlation with the ecologically valid reaching tasks, among individuals with PD. Furthermore the FRT scores did not correlate with the UPDRS postural stability scores, indicating that these are measuring different aspects of balance. This study suggests that the FRT score may better predict the risk of postural instability encountered during daily activities among individuals with PD.

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.

Reversible parkinsonism and MRI diffusion abnormalities in cortical venous thrombosis

To the Editor: We read with interest the recent published article by Jenkins et al.1 The authors report an interesting and well-documented patient with reversible parkinsonism due to deep venous system (incidentally, the title wrongly reports cortical venous thrombosis). MR diffusion-weighted images (DWI) demonstrated reversible hyperintensities in basal ganglia. The authors speculate that the reversible cellular swelling due to the increased venous pressure restricts water motion; this would lead to a reversible alteration of the diffusion without producing irreversible neuronal damage. In effect, diffusion hyperintensities partially disappeared at follow-up. Although this hypothesis is interesting, alternative explanations are possible. Contributions other than restricted diffusion may account for the hyperintensity on DWI. In particular, residual T2 contrast may variously contribute (T2 shine-through effect). The only way to quantify the diffusion alterations separating the contribution of the T2 shine-through effect is to calculate the apparent diffusion coefficient (ADC).2 Various conditions with increased extracellular water content but …