Tonya Toole

The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson’s disease

OBJECTIVE To assess immediate and near-term effects of 2 exercise training programs for persons with idiopathic Parkinsons disease (IPD). DESIGN Randomized control trial. SETTING Public health facility and medical center. PARTICIPANTS Fifteen persons with IPD. INTERVENTION Combined group (balance and resistance training) and balance group (balance training only) underwent 10 weeks of high-intensity resistance training (knee extensors and flexors, ankle plantarflexion) and/or balance training under altered visual and somatosensory sensory conditions, 3 times a week on nonconsecutive days. Groups were assessed before, immediately after training, and 4 weeks later. MAIN OUTCOME MEASURES Balance was assessed by computerized dynamic posturography, which determined the subjects response to reduced or altered visual and somatosensory orientation cues (Sensory Orientation Test [SOT]). Muscle strength was assessed by measuring the amount of weight a participant could lift, by using a standardized weight-and-pulley system, during a 4-repetition-maximum test of knee extension, knee flexion, and ankle plantarflexion. RESULTS Both types of training improved SOT performance. This effect was larger in the combined group. Both groups could balance longer before falling, and this effect persisted for at least 4 weeks. Muscle strength increased marginally in the balance group and substantially in the combined group, and this effect persisted for at least 4 weeks. CONCLUSION Muscle strength and balance can be improved in persons with IPD by high-intensity resistance training and balance training.

The learning advantages of an external focus of attention in golf.

This study examined whether the learning advantages of an external focus of attention relative to an internal focus, as demonstrated by Wulf, Höss, and Prinz (1998), would also be found for a sport skill under field-like conditions. Participants (9 women, 13 men; age range: 21-29 years) without experience in golf were required to practice pitch shots. The practice phase consisted of 80 practice trials. One group was instructed to focus on the arm swing (internal focus), whereas another group was instructed to focus on the club swing (external focus). One day after practice, a retention test of 30 trials without instructions was performed. The external-focus condition was more effective for performance during both practice and retention.

Physical Assistance Devices in Complex Motor Skill Learning: Benefits of a Self-Controlled Practice Schedule

This study examines the effects of a self-controlled use of physical assistance devices on learning a complex motor skill (i.e., producing slalom-type movements on a ski simulator). Physical assistance was provided by ski poles. One group of learners (self-control) was provided with the poles whenever they requested them, whereas another (yoked) group had no influence on the pole/no-pole schedule. While there were no group differences during the practice phase (Days 1 and 2), clear group differences emerged in the retention test without poles (Day 3). The self-control group produced significantly larger amplitudes than the yoked group. These results extend previous findings by showing learning advantages of the self-controlled use of physical assistance devices in complex motor skill learning.

A Comparison of Physical Functional Performance and Strength in Women With Fibromyalgia, Age- and Weight-Matched Controls, and Older Women Who Are Healthy

Background and Purpose. The purpose of this study was to compare functionality and strength among women with fibromyalgia (FM), women without FM, and older women. Subjects. Twenty-nine women with FM (age [X̅±SD]=46±7 years), 12 age- and weight-matched women without FM (age=44±8 years), and 38 older women who were healthy (age=71±7 years) participated. Methods. The Continuous Scale–Physical Functional Performance Test (CS-PFP) was used to assess functionality. Isokinetic leg strength was measured at 60°/s, and handgrip strength was measured using a handgrip dynamometer. Results. The women without FM had significantly higher functionality scores compared with women with FM and older women. There were no differences in functionality between women with FM and older women. Strength measures for the leg were higher in women without FM compared with women with FM and older women, and both women with and without FM had higher grip strengths compared with older women. Discussion and Conclusion. This study demonstrated that women with FM and older women who are healthy have similar lower-body strength and functionality, potentially enhancing the risk for premature age-associated disability.

Training with verbal instructional cues results in near-term improvement of gait in people with Parkinson disease.

Purpose To assess immediate and near-term effects of an instructional set on select gait parameters in people living with Parkinson disease (PD). Subjects Five individuals with early stage PD participated in a within subject design in Part One. Eleven individuals with early stage PD were randomly assigned to a treatment group (n = 5) or a control group (n = 6) in Part Two. Methods The treatment consisted of a 10-day training program of walking 1800 feet per day and with the instructions to “take long steps.” Testing occurred before treatment (baseline), immediately after treatment, one week after treatment, and one month after treatment. Measurements of step length, velocity, and cadence were taken without the use of the instructional set. Results There was a significant increase in step length and velocity and a significant decrease in cadence between baseline and all post-test measures for part one. For part 2, step length of the treatment group significantly increased between baseline and all 3 post-tests and there was a significant difference between the treatment group and control group at all post-tests for step length. Conclusions: The instructional set was effective in improving parameters of gait for at least 4 weeks. These data support the concept that people with Parkinson disease have a potential for motor learning.

The multicomponent nature of equilibrium in persons with parkinsonism: A regression approach

SummaryLower extremity strength and joint range of motion, body sway, and electromyography responses have all been determined to be factors in balance control of healthy older individuals. The purpose of this study was to identify variables which effect balance control (equilibrium scores) of persons with Parkinsonism, and examine their relationships and predictive abilities. The composite equilibrium score from the sensory organization protocol of the Equitest was used as the dependent variable for the regression analysis. The independent variables included: 1) strategy score; 2) path sway during voluntary body displacement; 3) percent peak torque of knee flexion relative to that of knee extension (%PTKFKE); 4) peak torque of inversion of the ankle at (PTINV); 5) dorsiflexion ROM; and 6) medium loop latency (EMG). The model produced a significant overall relationship accounting for 88% of the variability in equilibrium scores. Positive and significant coefficients indicated a predicted increase in the equilibrium composite score with increases in the strategy score, PTINV and %PTKFKE. These results suggest that postural control of persons with Parkinsonism can be strongly predicted by these three variables.

Functional Roles of the Proprioceptive System in the Control of Goal-Directed Movement:

This article explored functional roles of the proprioceptive system during the control of goal-directed movements. Proprioceptive information contributes to the control of movement through both reflex and central connections. Spinal and transcortical reflex loops establish a servomechanism which provides automatic corrections of unexpected changes in muscle length and allows compensation for undesirable irregularities in the mechanical properties of muscles by modulating limb stiffness at the subconscious level. Central connections provide the control system with information about peripheral states which is used in voluntary components of movement control. Before the initiation of movement, proprioceptive information about initial limb orientation becomes a basis for the programming of motor commands. During a movement, proprioceptive input about velocities and angular displacements of a limb is used to regulate movement by triggering planned sequences of muscle activation and modulating motor commands. After movement, feedback produced by responses is compared with previously stored information, verifying the quality of the movement. Considering potential roles of the reflex and central connections, the proprioceptive system seems to constitute an important aspect of motor control mechanisms, providing the control system with efficiency and flexibility in the regulation of goal-directed movements.

Association between botulinum toxin injection into the arm and changes in gait in adults after stroke.

Botulinum toxin (BTX) is often used to improve arm function in persons with hemiparesis after stroke. Persons injected into the arm sometimes report changes in their gait. The purpose of this open‐labeled pilot study was to investigate the association between injecting BTX into the upper limb and ankle and knee range of motion (ROM) and paretic‐leg stride‐time, defined as the time in seconds required to move the hemiparetic leg from initial contact of the foot to initial contact of the same foot. Gait parameters were recorded before and 4 to 6 weeks after the hemiparetic arm was injected with BTX in 13 adults with hemiparesis secondary to stroke, using a three‐dimensional computerized motion analysis system. BTX injection into the paretic arm was associated with a decrease in stride‐time of the paretic leg in all participants. Slower striding participants improved knee and ankle ROM in the paretic leg. There was no change in ankle and knee ROM in faster striding participants. Injection of BTX into the upper extremity is associated with a change in hemiparetic leg stride‐time and ankle and knee ROM. There is a variability of response, with slow striders improving to a greater extent than fast striders.

Gender Differences in Motor Performance of 50- to 79-Year-Old Adults

This study was conducted to assess gender and age differences among 73 men and women (50—59, 60—69, and 70—79 yr.) on five motor tasks (balance, standing long jump, sit and reach, hand grip, and Softball throw). Differences between men and women on the standing long jump, hand grip, and the Softball throw favored men. The men had better performance scores than the women on each of these tasks. An interaction of gender by age was noted on the balance task. Women 50—59 yr. old balanced significantly longer than the men of that age group. Age differences were found for the standing long jump, hand grip, and Softball throw. The 50—59 age group performed significantly better than the 60—69 and the 70—79 age groups Performance decreased on each task across age groups. These findings suggest gender differences in motor performance of older adults as has been noted for children.

Movement Education: Its Effect on Motor Skill Performance

Abstract The purposes of the present study were to evaluate transfer of movement education training to new skill performance and to evaluate skill improvement as a result of movement education and traditional training. The subjects were 47 first grade students who were in one of two classes. Each physical education class received one 30-minute class and one 20-minute class per week for 20 weeks. Subjects were taught movement principles either by a movement education approach or by a traditional approach. Johnsons Throw and Catch Test (1962) and a batting test for distance were used as pretests. These same tests were repeated as post tests in addition to two other tests which measured performance on striking and kicking distance and accuracy. Teaching approach groups were not significantly different on the latter two tests which measured the transfer of training effect. Traditional learning was better than movement education in developing throwing, catching, and batting performance. These results suggest ...