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To summarize the effects of rehabilitation interventions to reduce freezing of gait (FOG) in people with Parkinson's disease. A systematic review with meta-analyses of randomized trials of rehabilitation interventions that reported a FOG outcome was conducted. Quality of included studies and certainty of FOG outcome were assessed using the PEDro scale and GRADE framework. Sixty-five studies were eligible, with 62 trialing physical therapy/exercise, and five trialing cognitive and/or behavioral therapies. All meta-analyses produced very low-certainty evidence. Physical therapy/exercise had a small effect on reducing FOG post-intervention compared to control (Hedges' g= −0.26, 95% CI= −0.38 to −0.14, 95% prediction interval (PI)= −0.38 to −0.14). We are uncertain of the effects on FOG post-intervention when comparing: exercise with cueing to without cueing (Hedges' g= −0.58, 95% CI= −0.86 to −0.29, 95% PI= −1.23 to 0.08); action observation training plus movement strategy practice to practice alone (Hedges' g= −0.56, 95% CI= −1.16 to 0.05); and dance to multimodal exercises (Hedges' g= −0.64, 95% CI= −1.53 to 0.25). We are uncertain if physical therapy/exercise, cognitive or behavioral therapies, are effective at reducing FOG. FOG leads to impaired mobility and falls, but the effect of rehabilitation interventions (including physical therapy/exercise and cognitive/behavioral therapies) on FOG is small and uncertain. Until more robust evidence is generated, clinicians should assess FOG using both self-report and physical measures, as well as other related impairments such as cognition, anxiety, and fear of falling. Interventions for FOG should be personalized based on the individual's triggers and form part of a broader exercise program addressing gait, balance, and falls prevention. Interventions should continue over the long term and be closely monitored and adjusted as individual circumstances change. [ABSTRACT FROM AUTHOR]

Positive emotions have been found to be analgesic and can be induced by positive psychology exercises. This study tested if positive psychology exercises provide beneficial effects on pain, responses to pain, physical (pain interference), and emotional function. Randomized parallel-group controlled single-blinded superiority-trial including community-dwelling individuals with chronic pain secondary to spinal cord injury. Participants in the intervention group were instructed to practice 4 personalized positive psychology exercises for 8 weeks. Participants in the control group were asked to be mindful and write about current life events. 108 (64%) completed the study. At post-treatment, the intervention participants reported significant reductions in pain intensity and improvements in pain catastrophizing and pain control, relative to baseline. Both groups reported significant decreases in pain interference and negative emotions. Significant between-group differences emerged for pain intensity at post-treatment. At 3-months follow-up, improvements maintained for the intervention group and improvements in positive emotions reached statistical significance. Between-group differences were identified for pain intensity at post-treatment. Positive psychology exercises represent a potential effective complementary treatment that result in benefits on pain which can be readily implemented into daily living. Trials designed with an inactive control condition should be conducted to further address efficacy. Swiss ethics committee (EKNZ 2014-317)/clinicaltrials.gov (NCT02459028) Registration date: Ethics approval 25.10.2014/Study start date: May 2015 URL of the record: Pain engenders negative emotions (e.g., fear, anger, sadness) which can negatively affect psychological, social, and physical function. Positive emotions have been found to be analgesic and can be induced by practicing positive psychology exercises. The findings of the current randomized controlled trial provide support for practicing positive psychology exercises (beyond the effects of pain medication intake), in particular on the reduction of pain intensity, but also in improving pain catastrophizing and pain control. The majority of the positive psychology exercises are brief and self-administered positive activities that have no known negative side effects nor financial cost, can be tailored to a person's preferences in activities and can be readily implemented into daily living with chronic pain, complementing standard treatment of pain. [ABSTRACT FROM AUTHOR]

Background: People with Parkinson's disease find that exercise helps to improve their physical performance. However, when performed in a group, they also tend to appreciate each other's company. Purpose: After people with Parkinson's disease participated in a community-based group balance exercise program, our aims were to explore the participants' general attitude to their balance ability and exercise, and specifically their experiences of participating in a group exercise. Materials and Methods: Informants were people living with Parkinson's disease at an early stage (n = 15) who had participated in a community-based "Somatosensory Focused Balance Training without Cues." Each informant took part in one face-to-face interview. The interviews were transcribed, according to content analysis, coded independently by two researchers and triangulated together with a third experienced researcher. Categories and themes were derived in consensus. Results: The participants felt limited by their body. They agreed that the group balance exercise program did help with their balance control. Moreover, the vast majority found that the group context implied a positive social contribution to their lives and to their ability to cope with living with the disease. Conclusion: Group balance exercise might constitute a context with potential to improve quality of life for people with Parkinson's disease, not only by improving balance control, but also contributing to social connections, fellowship and the exchange of mutual experiences. Group-based exercise in early Parkinson seems to add more than just the physical effects of training, since it also gives a platform for meeting social and emotional needs, as well as addressing physical ability. The group dynamics and the support of peers seem to promote a positive attitude to life and enable people to learn coping strategies from each other. Community-based exercise groups for people with early Parkinson seem to be a way to get out in society and regain a feeling of being part of society. Due to body limits, people with Parkinson's disease must struggle daily, already at an early stage of their disease; this stresses the need to begin rehabilitation early. [ABSTRACT FROM AUTHOR]

Background: The presence of early balance impairment in patients with Parkinson's disease has not been fully investigated. Purpose: The purpose of this study was to examine balance and mobility, self-perceived unsteadiness, self-reported falls, and effects of medication on balance among patients at their first visit to a neurological clinic and during the ensuing five years. Materials and methods: The participants were collected from a prospective longitudinal study. One hundred and forty-five patients with idiopathic Parkinson's disease and 31 healthy controls were included. The outcome measures were the Berg Balance Scale, the Timed Up and Go, the Postural Stability test and a questionnaire. Results: At their first visit to the neurological clinic, the patients performed less well on the Berg Balance Scale (p < 0.001, r = 0.36), the Timed Up and Go (p < 0.001, r = 0.32), and the Postural Stability test (p < 0.001, r = 0.35) compared with the controls. In addition, a higher percentage of the patients reported self-perceived unsteadiness (p < 0.001, phi = 0.47). During the ensuing five years, balance and mobility worsened both with and without medication (p < 0.01, r = 0.24-0.37), although with small median differences. Conclusions: Further studies are needed to confirm that minor balance impairments exist even at the time of diagnosis and worsen during the ensuing five years. Impairments in balance and mobility may occur early in Parkinson's disease, especially in the elderly patients, and seem to worsen during the first five years. There is a need to use sensitive outcome measures and to ask the patients about unsteadiness and falls to detect balance impairment in this cohort. Parkinsonian medication has a limited effect on balance and may preferably be complemented with balance exercises to target balance impairment early in Parkinson's disease. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease demonstrates a spectrum of motor and non-motor symptoms. Falling is common and disabling. Current medical management shows minimal impact to reduce falls or fall-related risk factors, such as deficits in gait, strength, and postural instability. Despite evidence supporting rehabilitation in reducing fall risk factors, the most appropriate intervention to reduce overall fall rate remains inconclusive. This article aims to 1) synthesise current evidence and conceptual models of falls rehabilitation in Parkinson's in a narrative review; and based on this evidence, 2) introduce the treatment protocol used in the falls prevention and multi-centre clinical trial "PDSAFE". Method: Search of four bibliographic databases using the terms "Parkinson*" and "Fall*" combined with each of the following; "Rehab*, Balanc*, Strength*, Strateg*and Exercis*" and a framework for narrative review was followed. A total of 3557 papers were identified, 416 were selected for review. The majority report the impact of rehabilitation on isolated fall risk factors. Twelve directly measure the impact on overall fall rate. Discussion: Results were used to construct a narrative review with conceptual discussion based on the "International Classification of Functioning", leading to presentation of the "PDSAFE" intervention protocol. Conclusions: Evidence suggests training single, fall risk factors may not affect overall fall rate. Combining with behavioural and strategy training in a functional, personalised multi-dimensional model, addressing all components of the "International Classification of Functioning" is likely to provide a greater influence on falls reduction. "PDSAFE" is a multi-dimensional, physiotherapist delivered, individually tailored, progressive, home-based programme. It is designed with a strong evidence-based approach and illustrates a model for the clinical delivery of the conceptual theory discussed. Parkinson's disease demonstrates a spectrum of motor and non-motor symptoms, where falling is common and disabling. Current medical and surgical management have minimal impact on falls, rehabilitation of falls risk factors has strong evidence but the most appropriate intervention to reduce overall fall rate remains inconclusive. Addressing all components of the International Classification of Function in a multifactorial model when designing falls rehabilitation interventions may be more effective at reducing fall rates in people with Parkinson's than treating isolated risk factors. The clinical model for falls rehabilitation in people with Parkinson's should be multi-dimensional. [ABSTRACT FROM AUTHOR]

Purpose:In this study, we aimed to investigate effects of Ai Chi on balance, functional mobility, health-related quality of life, and motor impairment in patients with Parkinson’s disease. Method:This study was conducted as an open-label randomized controlled trial (ISRCTN26292510) with repeated measures. Forty patients with Parkinson’s disease stages 2 to 3 according to the Hoehn and Yahr Scale were randomly allocated to either an Ai Chi exercise group or a land-based exercise control group for 5 weeks. Balance was measured using the Biodex-3,1 and the Berg Balance Scale. Functional mobility was evaluated using the Timed Up and Go Test. Additionally, health-related quality of life and motor activity were assessed with the Parkinson’s Disease Questionnaire-39 and the Unified Parkinson’s Disease Rating Scale-III. Results:Although patients in both groups showed significant improvement in all outcome variables, improvement of dynamic balance was significantly greater in the Ai Chi group (p < 0.001), Berg Balance Scale (p < 0.001), Timed Up and Go Test (p = 0.002), Parkinson’s Disease Questionnaire-39 (p < 0.001), Unified Parkinson’s Disease Rating Scale-III (p < 0.001). Conclusion:Our results suggest that an Ai Chi exercise program improves balance, mobility, motor ability, and quality of life. In addition, Ai Chi exercise was more effective as an intervention than land-based exercise in patients with mild to moderate Parkinson’s disease.Implications for rehabilitationAi Chi exercises (aquatic exercises) may help improve balance, functional mobility, health-related quality of life, and motor ability in patients with mild to moderate Parkinson’s disease more efficiently than similar land-based exercises.Ai Chi exercises should be considered as a rehabilitation option for treatment of patients with mild or moderate Parkinson’s disease. [ABSTRACT FROM PUBLISHER]

Purpose:Balance impairment is a common sensorimotor symptom in mild traumatic brain injury (mTBI). We designed an affordable, portable virtual reality (VR)-based balance screening device (Virtual Environment TBI Screen [VETS]), which will be validated relative to the Neurocom Sensory Organization Test (SOT) to determine if it can replace commonly used postural assessments. Methods:This preliminary study examines healthy adults (n = 56) and adults with mTBI (n = 11). Participants performed six upright postural tasks on the VETS and the SOT. Analysis of variance was used to determine between-group differences. Pearson’s correlations were used to establish construct validity. Known-groups approach was used to establish classification accuracy. Results:The mTBI cohort performed significantly worse than the healthy cohort on the new device (p = 0.001). The new device has 91.0% accuracy and an ROC curve with a significant area-under-the-curve (AUC = 0.865,p < 0.001). Conditions with dynamic visual stimulation were the most sensitive to health status. The SOT had an 84.8% accuracy and AUC =0.703 (p = 0.034). Conclusions:The new VR-based device is a valid measure for detecting balance impairment following mTBI and can potentially replace more expensive and cumbersome equipment. Assessments that test visual-vestibular processing, such as VETS, increase sensitivity to mTBI-related balance deficits, which can be used to guide rehabilitation.Implications for rehabilitationEmerging technology using virtual reality can be economically integrated into the clinical setting for easy testing of postural control in neurologically impaired populations.Tailoring postural assessments to include tasks that rely on visual and vestibular integration will increase the accuracy of detecting balance impairment following mild traumatic brain injury. [ABSTRACT FROM PUBLISHER]

Purpose: The aim of the present study was to develop a valid Geriatric ICF Core Set reflecting relevant health-related problems of community-living older adults without dementia.Methods: A Delphi study was performed in order to reach consensus (≥70% agreement) on second-level categories from the International Classification of Functioning, Disability and Health (ICF). The Delphi panel comprised 41 older adults, medical and non-medical experts. Content validity of the set was tested in a cross-sectional study including 267 older adults identified as frail or having complex care needs.Results: Consensus was reached for 30 ICF categories in the Delphi study (fourteen Body functions, ten Activities and Participation and six Environmental Factors categories). Content validity of the set was high: the prevalence of all the problems was >10%, except ford530 Toileting. The most frequently reported problems wereb710 Mobility of joint functions(70%),b152 Emotional functions(65%) andb455 Exercise tolerance functions(62%). No categories had missing values.Conclusion: The final Geriatric ICF Core Set is a comprehensive and valid set of 29 ICF categories, reflecting the most relevant health-related problems among community-living older adults without dementia. This Core Set may contribute to optimal care provision and support of the older population.Implications for RehabilitationThe Geriatric ICF Core Set may provide a practical tool for gaining an understanding of the relevant health-related problems of community-living older adults without dementia.The Geriatric ICF Core Set may be used in primary care practice as an assessment tool in order to tailor care and support to the needs of older adults.The Geriatric ICF Core Set may be suitable for use in multidisciplinary teams in integrated care settings, since it is based on a broad range of problems in functioning.Professionals should pay special attention to health problems related to mobility and emotional functioning since these are the most prevalent problems in community-living older adults. [ABSTRACT FROM AUTHOR]