Patricia C. Heyn

The effects of exercise training on elderly persons with cognitive impairment and dementia: A meta-analysis

OBJECTIVE To determine by meta-analysis whether physical exercises are beneficial for people with dementia and related cognitive impairments. DATA SOURCES Published articles and nonpublished manuscripts from 1970 to 2003 were identified by using electronic and manual searches. Key search words included exercise, rehabilitation, activities of daily living, dementia, Alzheimers disease, aged, and geriatrics. STUDY SELECTION Reviewed studies were limited to randomized trials evaluating exercise in persons 65 years of age or older with cognitive impairment. Studies included quantitative results (means, standard deviations, t tests, F tests) for physical fitness, physical functioning, cognition, or behavior outcomes. DATA EXTRACTION One reviewer extracted data on study characteristics and findings. Selected articles were evaluated for methodologic quality by 2 raters. DATA SYNTHESIS A total of 2020 subjects participated in the 30 trials that met the inclusion criteria. Summary effects were computed using a fixed effects (Hedges g(i)) model. Significant summary effect sizes (ES) were found for strength (ES=.75; 95% confidence interval [CI], .58-.92), physical fitness (ES=.69; 95% CI, .58-.80), functional performance (ES=.59; 95% CI, .43-.76), cognitive performance (ES=.57; 95% CI, 0.43-1.17), and behavior (ES=.54; 95% CI, .36-.72). The overall mean ES between exercise and nonexercise groups for all outcomes was .62 (95% CI, .55-.70). CONCLUSIONS Exercise training increases fitness, physical function, cognitive function, and positive behavior in people with dementia and related cognitive impairments.

The effect of a multisensory exercise program on engagement, behavior, and selected physiological indexes in persons with dementia.

A multisensory exercise approach that evokes the stimulation and use of various senses, such as combining physical and cognitive stimuli, can assist in the management of persons with Alzheimers disease (AD). The objective of this study was to evaluate the outcomes of a multisensory exercise program on cognitive function (engagement), behavior (mood), and physiological indices (blood pressure, resting heart rate, and weight) in 13 nursing home residents diagnosed with moderate to severe AD. A one-group pretest/post-test, quasi-experimental design was used. The program combined a variety of sensory stimulations, integrating storytelling and imaging strategies. Results showed an improvement in resting heart rate, overall mood, and in engagement of physical activity. The findings suggest that a multisensory exercise approach can be beneficial for individuals with AD.

The effects of exercise training on elderly persons with cognitive impairment and dementia

OBJECTIVE To determine by meta-analysis whether physical exercises are beneficial for people with dementia and related cognitive impairments. DATA SOURCES Published articles and nonpublished manuscripts from 1970 to 2003 were identified by using electronic and manual searches. Key search words included exercise, rehabilitation, activities of daily living, dementia, Alzheimers disease, aged, and geriatrics. STUDY SELECTION Reviewed studies were limited to randomized trials evaluating exercise in persons 65 years of age or older with cognitive impairment. Studies included quantitative results (means, standard deviations, t tests, F tests) for physical fitness, physical functioning, cognition, or behavior outcomes. DATA EXTRACTION One reviewer extracted data on study characteristics and findings. Selected articles were evaluated for methodologic quality by 2 raters. DATA SYNTHESIS A total of 2020 subjects participated in the 30 trials that met the inclusion criteria. Summary effects were computed using a fixed effects (Hedges g(i)) model. Significant summary effect sizes (ES) were found for strength (ES=.75; 95% confidence interval [CI], .58-.92), physical fitness (ES=.69; 95% CI, .58-.80), functional performance (ES=.59; 95% CI, .43-.76), cognitive performance (ES=.57; 95% CI, 0.43-1.17), and behavior (ES=.54; 95% CI, .36-.72). The overall mean ES between exercise and nonexercise groups for all outcomes was .62 (95% CI, .55-.70). CONCLUSIONS Exercise training increases fitness, physical function, cognitive function, and positive behavior in people with dementia and related cognitive impairments.

The use and application of assistive technology to promote literacy in early childhood: a systematic review.

The Individuals with Disabilities Act was implemented in 1975 to assure that all children aged 0–21 years old have access and the right to an equal education. However, young children with disabilities continue to need additional support to meet the reading readiness standards as outlined in The No Child Left Behind legislation (2004). Although all children benefit from readiness skills, it is essential for children with special needs. With the technology boom of the past decade, assistive technology (AT) has been used increasingly to enhance emerging literacy skills. In order to identify current trends in the use of AT as a means to enhance emergent literacy skills in young children with disabilities, a systematic review of the literature was undertaken. The findings from this review support the scarcity of empirical research demonstrating the benefit of AT to promote emergent literacy with young children with disabilities. We also found a need for evidence supporting education approaches for the proper use of AT in early childhood literacy as well as little family knowledge regarding the implementation and instructional use of AT.

Incidence of Epilepsy in Adults with Cerebral Palsy and Secondary Health Outcomes: A Review and Proposed Feasibility Study

Cerebral palsy is one of the most common chronic childhood disorders, occurring in 2-2.5 of every 1000 live births; it is a persistent disorder of movement and posture caused by non-progressive lesions of the immature brain. Epilepsy is an important problem in children with cerebral palsy, with past studies showing an average incidence of epilepsy in about one-third in cases of cerebral palsy. Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate seizures, common in patients who have other factors (such as cerebral palsy) that are associated with a very high likelihood of a persistently lowered seizure threshold and therefore a high recurrence risk. A few studies were conducted in the past analyzing the correlation of cerebral palsy and epilepsy in children; however, no study has been conducted yet evaluating the evolution of cerebral palsy in the transition from childhood to adulthood, and how the incidence, prevalence and clinical course of epilepsy change in such a time lapse. Furthermore, no studies yet evaluated the classification of seizures in this adult population, their correlations to cerebral palsy and its degrees of severity, and associated secondary health conditions, causing epidemiological data to be lacking in that regard. This aim of this manuscript is to introduce to the reader the current evidence regarding epilepsy in adults with cerebral palsy, as well as present recommendations for future research.

Coping With Caregiver Burnout When Caring for a Person With Neurodegenerative Disease: A Guide for Caregivers

Caring for a person with a neurodegenerative disease (eg, Alzheimer disease, Parkinson disease, multiple sclerosis, amyotrophic lateral sclerosis, Huntington disease) can be extremely challenging. The challenges grow as the disease gets worse. If you are a caregiver of a person with a neurodegenerative disease, there are steps you may need to consider to decrease the risk or amount of caregiver burnout. This may help maintain or improve your health and wellness. It is important for you to know if you have caregiver burnout, or the common triggers that may cause your burnout. By recognizing and addressing these factors, you will be able to take healthy and manageable control over your caregiver duties.

What Is Mild Stroke

Persons who experience mild stroke typically have a short hospital stay and will show symptoms of stroke that last longer than a day. Most likely the symptoms will go away after a short period. If the symptoms of stroke last <24 hours, this is usually called a transient ischemic attack. If brain lesions are detected by a brain scan (diagnostic magnetic resonance imaging or computed tomography) at the hospital, a diagnosis of mild stroke will be made even if the symptoms of stroke last <24 hours.

A comparative study of mini-mental state exam and the Saint Louis University mental status for detecting mild cognitive impairment

Background: Screening instruments for cognitive impairment are frequently used in the elderly. The concept of mild cognitive impairment (MCI) is aimed to capture patients in the transition from normality to dementia. If MCI is identified patients could be informed about options for intervention and treatment that could delay the progression of this syndrome. Objective(s): To examine the Saint Louis University Mental Status (SLUMS) as a screen for mild cognitive impairment; and to test if the SLUMS is more sensitive than the Mini-Mental State Exam (MMSE) in mild cognitive screening. Methods: 100 patients age 55 and older attending the University of Texas Medical Branch Eye Clinic were consented to administer SLUMS and MMSE. After educational adjustments, 60% of the sample scored in the cognitive impairment range of the SLUMS but not on the MMSE. African American and Hispanic adults presented more cognitive impairment compared to white patients as defined by the SLUMS examination (OR, 2.80; 95% CI,1.05-7.44), independent of age, years of education and chronic diseases. Conclusion: These results suggest that the SLUMS examination is more sensitive to detect MCI than the MMSE.

The Effects of a Mixed-Reality Computer System on Leisure Activity For Brain Injury Individuals: A Pilot Study

Over the past decade, the acceptance of Virtual Reality (VR) systems as effective tools for both basic research and various training has rapidly expanded (Picture.1). Continuing advances in VR technology has supported the development of a more usable, useful, and accessible system. While therapeutic VR has largely focused on developing virtual environments as an assessment tool, increasing evidence is favoring the use of VR systems in clinical research as an effective rehabilitation tool (Figure1). Grealy and colleagues1 observed significant cognitive and physical gains of Brain Injury (BI) patients who were treated in a VR-based physical therapeutic setting.

Poster 232 Cerebral Palsy Adult Transition (CPAT) Cross-Sectional Study Preliminary Findings: Chronic Pain Correlates with Memory Difficulties in Adults with Cerebral Palsy

Setting: Acute inpatient rehabilitation. Results: With physical, occupational, and speech therapy interventions, and physiatric care of secondary stroke prevention and PV the patient’s condition improved. Upon discharge he was modified independent with mobility and set up for supervision with activities of daily living. Discussion: PV is a myeloproliferative genetic disorder that exerts its effect through hyperviscosity of the blood inducing a hypercoagulable state. Symptoms of PV commonly include pruritis, and erythromelalgia. Ischemic infarct as a presenting symptom of PV is rare and treatment includes hemodilution and in severe cases phlebotomy. Reinfarction may occur in these patients and physiatrists treating these patients must have high index of suspicion in patients with PV in order to initiate treatment to prevent further cerebrovascular accidents. Conclusions: This case highlights a rare case of PV presenting as acute ischemic infarct. PV is a rare but potentially life threatening disorder, and therapy must be initiated immediately as reinfarction can occur in these patients. Level of Evidence: Level V