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Objective: he purpose of the study was to determine the impact of novel coronavirus 2019 (COVID-19) restrictions on community-based exercise classes for people with Parkinson disease (PD) and their instructors. Methods: Data were collected via custom-designed electronic surveys for people with PD and class instructors who reported attending or teaching PD-specific exercise class ≥1 time/week for ≥3 months prior to pandemic restrictions (March 2020). The PD group also completed the Godin Leisure-Time Questionnaire, Self-Efficacy for Exercise scale, Schwab-England scale, and Parkinson's Disease Questionnaire 8. Results: Eighty-seven people with PD (mean = 70 [7.3] years old) and 43 instructors (51 [12.1] years old) from the United States completed surveys (October 2020 to February 2021). Mean Schwab-England (84 [16]) and Parkinson's Disease Questionnaire 8 (21 [15]) scores indicated low-to-moderate disability in the PD group. Ninety-five percent of the PD group had COVID-19 exposure concerns, and 54% reported leaving home ≤1 time/week. Although 77% of the PD group scored "active" on the Godin Leisure-Time Questionnaire, the mean Self-Efficacy for Exercise Scale score (55 [24]) indicated only moderate exercise self-efficacy, and >50% reported decreased exercise quantity/intensity compared with pre-COVID. There was decreased in-person and increased virtual class participation for both groups. The top in-person class barrier for the PD (63%) and instructor (51%) groups was fear of participant COVID-19 exposure. The top virtual class barriers were lack of socialization (20% of PD group) and technology problems (74% of instructor group). Conclusion: During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and decreased exercise quantity and intensity. Virtual classes may not fully meet the needs of people with PD, and primary barriers include technology and lack of socialization. Impact: As COVID-19 restrictions wane, it is imperative to help people with PD increase exercise and activity. The barriers, needs, and facilitators identified in this study might help inform approaches to increase participation in exercise and activity for people with PD. Lay Summary: During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and a decrease in exercise quantity and intensity. If you have PD, virtual classes might not fully meet your needs. Primary barriers may include technology problems and lack of social interaction. [ABSTRACT FROM AUTHOR]

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]

Background: Family‐centred care (FCC) is an approach to paediatric rehabilitation service delivery endorsing shared decision making and effective communication with families. There is great need to understand how early intervention (EI) programmes implement these processes, how EI caregivers perceive them, and how they relate to EI service use. Therefore, the purpose of this study is to examine (a) parent and provider perceptions about EI FCC processes and (b) the association between FCC perceptions and EI service intensity. Methods: In this cross‐sectional study, parent perceptions of EI FCC were measured using the electronically administered Measures of Processes of Care (MPOC‐56 and MPOC‐SP; using 7‐point scales). Participants included EI parents (n = 29) and providers (n = 9) from one urban EI programme (1/1/18–6/1/18). We linked survey responses with child characteristics and service use ascertained through EI records. We estimated parent–provider MPOC score correlations and the association between EI service intensity (hr/month) and parent MPOC scores using adjusted linear regression accounting for child characteristics. Results: Parents (M = 4.2, SD = 1.1) and providers (M = 5.8, SD = 1.3) reported low involvement related to general information exchange. Parent and provider subscale scores were not correlated except that parent‐reported receipt of specific information was inversely associated with provider‐reported provision of general information (r = −0.4, P <.05). In adjusted models, parent perceptions related to respectful and supportive (b = 1.57, SE = 0.56) and enabling (b = 1.42, SE = 0.67) care were positively associated with EI intensity, whereas specific information exchange and general information exchange were not associated with intensity. Conclusion: We found that EI parents and providers reported high levels of investment in the family centredness of their EI care, with the exception of information sharing. Greater EI service intensity was associated with higher perception of involvement with some metrics of family centredness. [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: Strength training in people with multiple sclerosis (MS) is an important component of rehabilitation, but it can be challenging for clinicians to quantify strength accurately and reliably. This study investigated the psychometric properties of a clinical strength assessment protocol using handheld dynamometry and other objective, quantifiable tests for the lower extremities and trunk in people with MS. Methods: This study determined discriminant validity between 25 participants with MS and 25 controls and between participants with MS who had higher versus lower disability; test-retest reliability across 7 to 10 days; and response stability. The protocol included handheld dynamometry measurements of ankle dorsiflexion, knee flexion and extension; hip flexion, extension, abduction, and adduction; and trunk lateral flexion. Muscular endurance tests were used to measure trunk extension, trunk flexion, and ankle plantarflexion. Results: The protocol discriminated between participants with MS and controls for all muscles tested (P < .001-.003). The protocol also discriminated between low- and moderate-disability groups (P = .001-.046) for 80% of the muscles tested. Test-retest reliability intraclass correlation coefficients were high (0.81-0.97). Minimal detectable change as a percentage of the mean was 13% to 36% for 85% of muscles tested. Conclusions: This study provides evidence for the discriminant validity, test-retest reliability, and response stability of a strength assessment protocol in people with MS. This protocol may be useful for tracking outcomes in people with MS for clinical investigations and practice. [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]

Background. Although studies have established the safety and feasibility of physical therapy in the critical care setting, minimal information about physical therapist practice in the neurological intensive care unit (NICU) is available. Objective. This study describes physical therapists' treatment of people admitted to a NICU. Design. People admitted to the NICU with a diagnosis of subarachnoid hemorrhage, subdural hematoma, intracranial hemorrhage, or trauma were retrospectively studied. Methods. Data on patient demographics, use of mechanical ventilation, and intracranial pressure (ICP) monitoring were collected. For each physical therapy session, the length of the session, the location (NICU or post-NICU setting), and the presence of mechanical ventilation or ICP monitoring were recorded. Data on safety parameters, including vital sign response, falls, and dislodgement of lines, were collected. Results. Over 1 year, 180 people were admitted to the NICU; 86 were evaluated by a physical therapist, for a total of 293 physical therapy sessions in the NICU (n=132) or post-NICU setting (n=161). Only one session (0.3%) was stopped, secondary to an increase in ICP. The first physical therapy session occurred on NICU day 3-0 (25%-75% interquartile range=2.0-6.0). Patients received a median of 3.4 sessions per week (25%-75% interquartile range= 1.8-5.9). Patients with mechanical ventilation received less frequent physical therapy sessions than those without mechanical ventilation. Patients with ICP monitoring received less frequent sessions than those without ICP monitoring. However, after multivariate analysis, only the admission Glasgow Coma Score was independently associated with physical therapy frequency in the NICU. Patients were more likely to stand, transfer, and walk in the post-NICU setting than in the NICU. Limitations. The results are limited by the retrospective, single-center nature of the study. There is inherent bias of evaluating only those patients who had physical therapy, and therapists were unable to completely adjust for the severity of illness of a given patient. Conclusions. Physical therapy was performed safely in the NICU. Patients who required invasive support received less frequent physical therapy. [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. Recent studies have demonstrated safety, feasibility, and decreased hospital length of stay for patients with weakness acquired in the intensive care unit (ICU) who receive early physical rehabilitation. The scored Physical Function in Intensive Care Test (PFIT-s) was specifically designed for this population and demonstrated excellent psychometrics in an Australian ICU population. Objective. The purpose of this study was to determine the responsiveness and predictive capabilities of the PFIT-s in patients in the United States admitted to the ICU who required mechanical ventilation (MV) for 4 days or longer. Methods. This nested study within a randomized trial administered the PFIT-s, Medical Research Council (MRC) sum score, and grip strength test at ICU recruitment and then weekly until hospital discharge, including at ICU discharge. Spearman rho was used to determine validity. The effect size index was used to calculate measurement responsiveness for the PFIT-s. The receiver operating characteristic curve was used in predicting participants’ ability to perform functional components of the PFIT-s. Results. From August 2009 to July 2012, 51 patients were recruited from 4 ICUs in the Denver, Colorado, metro area. At ICU discharge, PFIT-s scores were highly correlated to MRC sum scores (rho=.923) and grip strength (rho=.763) (P<.0005). Using baseline test with ICU discharge (26 pairs), test responsiveness was large (1.14). At ICU discharge, an MRC sum score cut-point of 41.5 predicted participants’ ability to perform the standing components of the PFIT-s. Limitations. The small sample size was a limitation. However, the findings are consistent with those in a larger sample from Australia. Conclusions. The PFIT-s is a feasible and valid measure of function for individuals who require MV for 4 days or longer and who are alert, able to follow commands, and have sufficient strength to participate. [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]