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Background and purpose: This study examined the association of a commonly used gait assessment, the Dynamic Gait Index, with falls and lower extremity and trunk muscle function in people with multiple sclerosis. Materials and methods: Cross-sectional data from 72 people with multiple sclerosis (Expanded Disability Status Scale 3.5 ± 1.14) were used. The ability of the Dynamic Gait Index to identify fallers was evaluated using the receiver operating characteristic curve. Multiple linear regression determined contributions of muscle function variables to Dynamic Gait Index scores. Results: Thirty-seven participants reported at least one fall in the previous 3 months (51%). The area under the curve for the Dynamic Gait Index was 0.80 (95% CI: 0.69–0.90), indicating a good ability to identify fallers with a cutoff of ≤19/24. After adjusting for age, sex, and disability level, a one standard deviation increase in ankle plantarflexion (15.2 repetitions) and trunk flexion (15.1 repetitions) endurance were associated with an increase in Dynamic Gait Index score of 0.73 (95% CI: 0.07–1.39) and 0.62 (95% CI: 0.002–1.25), respectively. Conclusions: The Dynamic Gait Index may be a useful tool to identify fallers, and was associated with ankle plantarflexion and trunk flexion endurance. The Dynamic Gait Index appears to be a useful tool to identify people with multiple sclerosis at increased risk for falls using a cutoff score of ≤19/24. The ability to do fewer than 13 single leg heel raises had a moderate ability to identify fallers in this study. Out of 11 lower extremity and trunk muscles, only ankle plantarflexion and trunk flexion muscle endurance were significant predictors of Dynamic Gait Index scores. Clinicians may consider targeting ankle plantarflexion and trunk muscle endurance to improve dynamic gait and fall risk in patients with multiple sclerosis. [ABSTRACT FROM AUTHOR]

Disturbances in the visual, vestibular, and oculomotor systems have been identified in Parkinson's disease (PD). Patients' perspectives regarding these symptoms remain unexplored and may provide insights on functional implications of these symptoms and guide future interventions. The goal of this study is to elicit perceptions of individuals with PD with respect to visual, vestibular, and oculomotor deficits. Methods: Twenty-nine individuals with PD participated in focus group discussions. Participants discussed visual, vestibular, and oculomotor deficits they experience and how these deficits affect function. Discussions were recorded, transcribed, and coded. Inductive qualitative data analysis techniques were used to interpret responses. Results: Four themes emerged: 1) participants perceived visual, vestibular, and oculomotor deficits and related these deficits to their PD diagnosis; 2) participants perceive that these deficits affect function; 3) participants suggested these deficits are not recognized by healthcare providers; and 4) participants indicated they receive limited treatment for these deficits. Conclusions: Visual, vestibular, and oculomotor deficits are under-reported and under-assessed symptoms, which have a significant impact on the lives of people with PD. Healthcare providers should be aware of such deficits. The findings suggest that the healthcare team can better identify these deficits and identify important future areas of research. [ABSTRACT FROM AUTHOR]

Purpose of this study was to characterize side-to-side differences in quadriceps, hamstrings strength, and quadriceps activation in individuals with Parkinson disease (PD). Participants were individuals with PD (n = 17) with Unified Parkinson's Disease Rating Scale motor scores ranging from 9.5 to 61.0. Paired t tests compared strength and muscle activation between limbs for all individuals. The stronger quadriceps was 15.2% stronger (P < .001) and the stronger hamstring was 12.9% stronger (P = .001). Side-to-side differences in quadriceps activation was 18.9%, but insignificant (P = .072). No pattern explained side-to-side differences. Muscle strength asymmetry is variable, but present across a range of PD disease severity, which emphasizes the importance of a detailed clinical examination. [ABSTRACT FROM AUTHOR]

Background. The relative importance of lower extremity and trunk muscle function to gait in people with multiple sclerosis (MS) is unknown. Objective. This study aimed to investigate the association of lower extremity and trunk muscle function with gait performance in people who have MS and mild-to-moderate disability. Design. This was a cross-sectional, observational study. Methods. Participants were people who had an Expanded Disability Status Scale score of ≤5.5. Eleven lower extremity and trunk muscles were assessed using handheld dynamometry or endurance tests. Gait performance was assessed with the Timed 25-Foot (7.62 m) Walk (T25FW) and 6-Minute Walk Test (6MWT). Regression analysis was used to quantify the association between gait outcomes and muscle variables. Results. Seventy-two participants with MS and a mean Expanded Disability Status Scale score of 3.5 (SD = 1.14) were enrolled. Adjusted for age and sex, the multivariate model including hip abduction, ankle plantar flexion, trunk flexion, and knee flexion explained 57% of the adjusted variance in the T25FW; hip abduction, ankle plantar flexion, and trunk flexion explained 61% of the adjusted variance in the 6MWT. The strongest predictors were ankle plantar flexion endurance for the T25FW and hip abduction strength for the 6MWT: a 1-SD increase in ankle plantar flexion (15.2 heel-raise repetitions) was associated with a 0.33-second reduction in the T25WT (95% CI = -0.71 to -0.14 seconds); a 1-SD increase in normalized hip abduction strength (0.14 kg/body mass index) was associated with a 54.4-m increase in the 6MWT (28.99 to 79.81 m). Limitations. Different measurement scales for independent variables were included because the muscle function assessment used either force or endurance. Conclusions. For the major muscles in the lower extremity and trunk, hip abduction, ankle plantar flexion, trunk flexion, and knee flexion were the strongest predictors of gait performance. [ABSTRACT FROM AUTHOR]

Background. Early rehabilitation improves outcomes, and increased use of physical therapist services in the intensive care unit (ICU) has been recommended. Little is known about the implementation of early rehabilitation programs or physical therapists' preparation and perceptions of care in the United States. Objective. A national survey was conducted to determine the current status of physical therapist practice in the ICU. Design. This study used a cross-sectional, observational design. Methods. Self-report surveys were mailed to members of the Acute Care Section of the American Physical Therapy Association. Questions addressed staffing, training, barriers, and protocols, and case scenarios were used to determine perceptions about providing rehabilitation. Results. The response rate was 29% (667/2,320). Staffing, denned as the number of physical therapists per 100 ICU beds, was highest in community hospitals (academic: median=5.4 [range=3-6-9.2]; community: median=6.7 [range=4.4-10.0]) and in the western United States (median=7.5 [range=4.2-12.9]). Twelve percent of physical therapists reported no training. Barriers to providing ICU rehabilitation included insufficient staffing and training, departmental prioritization policies, and inadequate consultation criteria. Responses to case scenarios demonstrated differences in the likelihood of consultation and physical therapists' prescribed frequency and intensity of care based on medical interventions rather than characteristics of patients. Physical therapists in academic hospitals were more likely to be involved in the care of patients in each scenario and were more likely to perform higher-intensity mobilization. Limitations. Members of the Acute Care Section of the American Physical Therapy Association may not represent most practicing physical therapists, and the 29% return rate may have contributed to response bias. Conclusions. Although staffing was higher in community hospitals, therapists in academic and community hospitals cited insufficient staffing as the most common barrier to providing rehabilitation in the ICU. Implementing strategies to overcome barriers identified in this study may improve the delivery of ICU rehabilitation services. [ABSTRACT FROM AUTHOR]

Purpose: To examine the association between activity and physical participation in older adults with Parkinson's disease (PD) and those without PD. Methods: Participants were 190 volunteers with PD (n = 74) and without PD (n = 116) between 50 and 94 years. They completed the Continuous Scale Physical Functional Performance 10-item test and the Community Healthy Activities Model Program for Seniors physical activity questionnaire for older adults as measures of activity and participation, respectively. Conclusions: Associations between participation and activity were small to moderate for adults with PD and small for those without PD. Participants with PD also had significantly lower activity scores than participants without PD. Older adults with PD are more limited in activity and are approaching a point where activity limitations also constrain participation. [ABSTRACT FROM AUTHOR]

Background. Exercise confers short-term benefits for individuals with Parkinson disease (PD). Objective. The purpose of the study was to compare short- and long-term responses among 2 supervised exercise programs and a home-based control exercise program. Design. The 16-month randomized controlled exercise intervention investigated 3 exercise approaches: flexibility/balance/function exercise (FBF), supervised aerobic exercise (AE), and home-based exercise (control). Setting. This study was conducted in outpatient clinics. Patients. The participants were 121 individuals with PD (Hoehn & Yahr stages 1-3). Interventions. The FBF program (individualized spinal and extremity flexibility exercises followed by group balance/functional training) was supervised by a physical therapist. The AE program (using a treadmill, bike, or elliptical trainer) was supervised by an exercise trainer. Supervision was provided 3 days per week for 4 months, and then monthly (16 months total). The control group participants exercised at home using the National Parkinson Foundation Fitness Counts program, with 1 supervised, clinic-based group session per month. Measurements. Outcomes, obtained by blinded assessors, were determined at 4, 10, and 16 months. The primary outcome measures were overall physical function (Continuous Scale-Physical Functional Performance [CS-PFP]), balance (Functional Reach Test [FRT]), and walking economy (oxygen uptake [mL/kg/min]). Secondary outcome measures were symptom severity (Unified Parkinson's Disease Rating Scale [UPDRS] activities of daily living [ADL] and motor subscales) and quality of life (39-item Parkinson's Disease Quality of Life Scale [PDQ-39D- Results. Of the 121 participants, 86.8%, 82.6%, and 79.3% completed 4, 10, and 16 months, respectively, of the intervention. At 4 months, improvement in CS-PFP scores was greater in the FBF group than in the control group (mean difference=4.3, 95% confidence interval [CI] = 1.2 to 7.3) and the AE group (mean difference = 3.1, 95% CI=0.0 to 6.2). Balance was not different among groups at any time point. Walking economy improved in the AE group compared with the FBF group at 4 months (mean difference =-1.2, 95% CI=-1.9 to -0.5), 10 months (mean differ- ence=-1.2, 95% CI=-1.9 to -0.5), and 16 months (mean difference=-1.7, 95% CI = - 2.5 to -1.0). The only secondary outcome that showed significant differences was UPDRS ADL subscale scores: the FBF group performed better than the control group at 4 months (mean difference = - 1.47, 95% CI=-2.79 to -0.15) and 16 months (mean difference=-1.95, 95% CI=-3.84 to -0.08). Limitations. Absence of a non-exercise control group was a limitation of the study. Conclusions. Findings demonstrated overall functional benefits at 4 months in the FBF group and improved walking economy (up to 16 months) in the AE group. [ABSTRACT FROM AUTHOR]

Background. Neuromuscular electrical stimulation (NMES) can facilitate the recovery of quadriceps muscle strength after total knee arthroplasty (TKA), yet the optimal intensity (dosage) of NMES and its effect on strength after TKA have yet to be determined. Objective. The primary objective of this study was to determine whether the intensity of NMES application was related to the recovery of quadriceps muscle strength early after TKA. A secondary objective was to quantify quadriceps muscle fatigue and activation immediately after NMES to guide decisions about the timing of NMES during rehabilitation sessions. Design. This study was an observational experimental investigation. Methods. Data were collected from 30 people who were 50 to 85 years of age and who received NMES after TKA. These people participated in a randomized controlled trial in which they received either standard rehabilitation or standard rehabilitation plus NMES to the quadriceps muscle to mitigate strength loss. For the NMES intervention group, NMES was applied 2 times per day at the maximal tolerable intensity for 15 contractions beginning 48 hours after surgery over the first 6 weeks after TKA. Neuromuscular electrical stimulation training intensity and quadriceps muscle strength and activation were assessed before surgery and 35 and 6.5 weeks after TKA. Results. At 3.5 weeks, there was a significant association between NMES training intensity and a change in quadriceps muscle strength ( R2 = .68) and activation < R2=.22). At 6.5 weeks, NMES training intensity was related to a change in strength ( R2 = .25) but not to a change in activation ( R2=.00). Furthermore, quadriceps muscle fatigue occurred during NMES sessions at 3-5 and 6.5 weeks, whereas quadriceps muscle activation did not change. Limitations. Some participants reached the maximal stimulator output during at least 1 treatment session and might have tolerated more stimulation. Conclusions. Higher NMES training intensities were associated with greater quadriceps muscle strength and activation after TKA. INSET: The Bottom Line. [ABSTRACT FROM AUTHOR]

Background. Overall functional ability declines over time in people with Parkinson disease (PD). Established benchmarks are needed to allow clinicians and researchers to facilitate meaningful interpretation of data. Objective. The purposes of this study were: (1) to report typical values for standard measures of functional ability commonly used in intervention studies and clinical practice with individuals in the early and middle stages of PD and (2) to describe the profile of functional limitations using the Hoehn and Yahr (H&Y) stages of disease and Unified Parkinson's Disease Rating Scale (UPDRS) motor scores. Design. Cross-sectional data were obtained from 5 different studies. Methods. Three hundred thirty-nine patients were evaluated for disease severity (UPDRS motor score); functional capacity (Continuous Scale Physical Functional Performance Test [CS-PFP]); balance and gait (Functional Reach Test [FRT], Timed "Up & Go" Test [TUG], 360-degree turn, Six-Minute Walk Test [6MWT], and Two- Minute Walk Test); and basic functional activities (supine-to-stand task, stand-to-supine task, and functional axial rotation [FAR]). Results. The mean UPDRS motor score for the sample was 39.2 (SD= 12.93). At each stage of PD (from least to most involved), scores on functional measures indicated a significant and progressively reduced functional status. Limitations began early in the disease for the CS-PFP and FAR. Losses in performance were consistent across all stages of disease for the CS-PFP, FRT, 6MWT, and FAR. Several measures demonstrated meaningful losses of function only in later stages of disease. Findings extend current appreciation of functional limitations that begin early in PD and can guide the choice of functional outcome measures at different stages of disease severity. Limitations. Data were obtained only from participants in H&Y stages 1 through 3 and only for some of the performance measures typically used. Conclusions. The findings demonstrate that functional loss occurs at different points in the disease process, depending on the task under consideration. The resulting profile of functional limitations provides benchmarks that clinicians and researchers can use to interpret and monitor status of patients. INSET: The Bottom Line. [ABSTRACT FROM AUTHOR]