Toni M. Cutson

Exercise to improve spinal flexibility and function for people with parkinson's disease : A randomized, controlled trial

OBJECTIVES: The effectiveness of an exercise intervention for people in early and midstage Parkinsons disease (stages 2 and 3 of Hoehn and Yahr) in improving spinal flexibility and physical performance in a sample of community‐dwelling older people is described.

Rehabilitation of the Older Lower Limb Amputee: A Brief Review

OBJECTIVE: To review outcomes, over the last 25 to 30 years, of prosthetic rehabilitation in the older patient with a major lower limb amputation.

Effect of a single dose of diazepam on balance measures in older people.

OBJECTIVE: This study examines the effect of a single dose of diazepam on a spectrum of balance measures in healthy older subjects. The measures include static (postural sway), dynamic (anterior tibialis muscle activation latency), and a complex self‐initiated task of balance (functional reach) in addition to neuropsychological tests of attention.

Drug-related falls in the older adult

The objective of this article was to review the recent literature (1990–1995) on drugs and falls in the older population. A computerized literature search identified 19 research articles. The quality of each study was critically evaluated, and a consistent risk relationship between the use of psychotropic drugs and falls was identified. Moreover, polypharmacy and certain cardiovascular agents may be associated with falls. Finally, it is controversial as to whether certain agents (eg, analgesics, hypoglycemics) are associated with falls. Future studies are necessary to better understand the relationship between drugs and falls in the older adult.

Early Management of Elderly Dysvascular Below-Knee Amputees

The majority of transtibial (belowknee) amputations occur in elderly patients with systemic vascular disease. Rehabilitation efforts toward prosthetic ambulation are frequently delayed awaiting postoperative healing of the vascular compromised limb. Rehabilitation becomes more difficult, more costly and less successful the longer it is delayed after surgery, especially among elderly amputees. Early ambulation reduces the risk of complications such as thromboembolism, pneumonia and deconditioning in the older patient as well as enhances remaining life. An early coordinated post-amputation rehabilitation program reduces the time to prosthetic ambulation and the risk of further debility and failure among elderly amputees. The rigid removable dressing was incorporated into the program and found to be a safe method of residual limb shrinkage among elderly dysvascular transtibial amputees.

Financial Burden of Chronic Neurological Disorders to Patients and Their Families: What Providers Need to Know

Access to financial resources influences the quality of life that individuals are able to lead. An important aspect of quality of life for persons with chronic neurological disorders and their families is the financial burden placed on the family due to the illness. Health care providers may assume that most illness related expenses are covered by insurance. While many studies examine the cost of illnesses to society, research is only beginning to explore the financial burden that such disorders place on the family. This manuscript describes several recent studies that evaluate the financial burden that 2 chronic neurological disorders, Multiple Sclerosis and Parkinsons Disease, place on persons with the disorders and their families. A better understanding of the financial burden of disorders may help health care providers to better meet the need of their patients either through improved counseling or through referral of patients to appropriately trained individuals.

DEVELOPMENT OF A CLINICAL RATING SCALE FOR PERSONS WITH PARKINSON'S DISEASE

Primary care physicians are using proper discretion in limiting the use of neuroimaging studies. However, as I stated in the editorial, primary care physicians need a simple, quick, and valid screening tool that will help them decide which patients need more in-depth testing. I believe the evidence is clear that such in-depth testing should include a formal, standardized assessment tool (such as the MMSE). Better case finding and fewer unnecessary tests will better serve older patients.

An Advanced Course in Long Term Care for Geriatric Medicine Fellows

Long term care deserves focused attention within a geriatric medicine fellowship curriculum to ensure that graduates are prepared not only for clinical care but also for the leadership, administrative, educational, quality improvement, and health policy aspects of their future roles. This report describes the curriculum development and program evaluation of an advanced course in long term care for geriatric medicine fellows and other graduate/post-graduate health professionals at Duke University. Course evaluation had 4 goals: (1) to determine how well the learning objectives were met; (2) to evaluate individual components of the course to improve subsequent offerings; (3) to determine whether additional topics needed to be added; and (4) to evaluate the effectiveness of the discussion forum component of the course. Learner self-efficacy improved within all competency areas but especially those of practice-based learning and system-based practice. Evaluation results led to curriculum revision that has maintained course relevance and sustained it within the larger geriatrics fellowship curriculum. Components of this course can be easily adapted to other curricular settings for fellows and residents.

Assessment of motor planning deficits

Aging and age-associated neurologic conditions affect motor control. Multiple paradigms have been developed to explain the effects of the central nervous system on motor control including information processing and motor planning. This article seeks to broaden the term motor planning to encompass multiple paradigms and discuss methods of assessment and measure as applied to several clinical disorders such as Parkinsons disease, dementia, and stroke.