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Objectives To determine whether a home-based multicomponent physical activity counseling ( PAC) intervention is effective in reducing glycemic measures in older outpatients with prediabetes mellitus. Design Controlled clinical trial. Setting Primary care clinics of the Durham Veterans Affairs ( VA) Medical Center between September 29, 2008, and March 25, 2010. Participants Three hundred two overweight (body mass index 25-45 kg/m2), older (60-89) outpatients with impaired glucose tolerance (fasting blood glucose 100-125 mg/ dL, glycosylated hemoglobin (HbA1c) <7%) randomly assigned to a PAC intervention group (n = 180) or a usual care control group (n = 122). Intervention A 12-month, home-based multicomponent PAC program including one in-person baseline counseling session, regular telephone counseling, physician endorsement in clinic with monthly automated encouragement, and customized mailed materials. All study participants, including controls, received a consultation in a VA weight management program. Measurements The primary outcome was a homeostasis model assessment of insulin resistance ( HOMA- IR), calculated from fasting insulin and glucose levels at baseline and 3 and 12 months. HbA1c was the secondary indicator of glycemic control. Other secondary outcomes were anthropometric measures and self-reported physical activity, health-related quality of life, and physical function. Results There were no significant differences between the PAC and control groups over time for any of the glycemic indicators. Both groups had small declines over time of approximately 6% in fasting blood glucose ( P < .001), and other glycemic indicators remained stable. The declines in glucose were not sufficient to affect the change in HOMA- IR scores due to fluctuations in insulin over time. Endurance physical activity increased significantly in the PAC group ( P < .001) and not in the usual care group. Conclusion Home-based telephone counseling increased physical activity levels but was insufficient to improve glycemic indicators in older outpatients with prediabetes mellitus. [ABSTRACT FROM AUTHOR]

Optogenetics has revolutionized neuroscience in small laboratory animals, but its effect on animal models more closely related to humans, such as non-human primates (NHPs), has been mixed. To make evidence-based decisions in primate optogenetics, the scientific community would benefit from a centralized database listing all attempts, successful and unsuccessful, of using optogenetics in the primate brain. We contacted members of the community to ask for their contributions to an open science initiative. As of this writing, 45 laboratories around the world contributed more than 1,000 injection experiments, including precise details regarding their methods and outcomes. Of those entries, more than half had not been published. The resource is free for everyone to consult and contribute to on the Open Science Framework website. Here we review some of the insights from this initial release of the database and discuss methodological considerations to improve the success of optogenetic experiments in NHPs. • Openly shared, non-human primate optogenetics data resource • Over 500 entries of unpublished data • Efficiency analysis of experimental parameters • Advice from leading NHP optogenetics labs To accelerate development of optogenetics in non-human primates, Tremblay et al. established an international open science initiative allowing investigators to easily share results of successful and unsuccessful experiments with the community. The resulting database reveals new insights into best practices to maximize success in primate optogenetics and spearhead translational applications. [ABSTRACT FROM AUTHOR]

Objective: To examine how known causal factors (exercise self-efficacy, balance, walking capacity) affect outcomes (moderate-intensity physical activity, community access) in people with Parkinson disease (PD): through a direct pathway, indirectly through potential mediators (nonmotor impairments), or through combined direct and mediated paths., Design: Causal mediation analyses using baseline and three-month data from pooled treatment groups in a randomized controlled trial., Setting: Data were collected at 2 university clinical research centers., Participants: One hundred thirty-eight people with PD., Interventions: Home and community-based walking and strength exercise program., Main Outcome Measure(s): Exposures were exercise self-efficacy, walking capacity, and balance. Potential mediators included pain, fatigue, mood (anxiety, depression, affect, apathy), stigma, and cognition (executive function and cognitive flexibility). The outcomes were physical activity and community access behavior at follow-up 3 months later. Separate models were developed for each causal factor-mediator-outcome combination. To minimize bias, all models were adjusted for known confounders (comorbidities, freezing of gait, severity of motor impairment, and/or age) and baseline values of the outcomes., Results: Self-efficacy of walking duration had a causal relationship with moderate-intensity physical activity through direct and combined paths (P<.001). Walking capacity had a causal relationship with community access through direct (P=.03-.04) and combined (P=.02-.03) paths. Balance did not affect community access (P>.05). There were no significant mediation effects through indirect pathways for either outcome., Conclusions: The effect of known causal factors on physical activity and community access was not mediated by nonmotor impairments. Walking self-efficacy and walking capacity remain the primary intervention targets for improving physical activity and community access, respectively, in people with PD., (Copyright © 2024 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: Few persons with Parkinson disease (PD) appear to engage in moderate-intensity walking associated with disease-modifying health benefits. How much time is spent walking at lower, yet still potentially beneficial, intensities is poorly understood. The purpose of this exploratory, observational study was to describe natural walking intensity in ambulatory persons with PD., Methods: Accelerometer-derived real-world walking data were collected for more than 7 days at baseline from 82 participants enrolled in a PD clinical trial. Walking intensity was defined according to the number of steps in each active minute (1-19, 20-39, 40-59, 60-79, 80-99, or ≥100 steps). Daily minutes of walking and duration of the longest sustained walking bout were calculated at each intensity. Number of sustained 10 to 19, 20 to 29, and 30-minute bouts and greater at any intensity also were calculated. Values were analyzed in the context of physical activity guidelines., Results: Most daily walking occurred at lower intensities (157.3 ± 58.1 min of 1-19 steps; 81.3 ± 32.6 min of 20-39 steps; 38.2 ± 21.3 min of 40-59 steps; 15.1 ± 11.5 min of 60-79 steps; 7.4 ± 7.0 min of 80-99 steps; 7.3 ± 9.6 min of ≥100 steps). The longest daily sustained walking bout occurred at the lowest intensity level (15.9 ± 5.2 min of 1-19 steps). Few bouts lasting 20 minutes and greater occurred at any intensity., Discussion and Conclusions: Despite relatively high daily step counts, participants tended to walk at remarkably low intensity, in bouts of generally short duration, with relatively few instances of sustained walking. The findings reinforced the need for health promotion interventions designed specifically to increase walking intensity.Video Abstract available for more insight from authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A426 )., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Academy of Neurologic Physical Therapy, APTA.)

Background: Reduced motor automaticity in Parkinson's disease (PD) negatively impacts the quality, intensity, and amount of daily walking. Rhythmic auditory stimulation (RAS), a clinical intervention shown to improve walking outcomes, has been limited by barriers associated with the need for ongoing clinician input., Objective: To assess the feasibility, proof-of-concept, and preliminary clinical outcomes associated with delivering an autonomous music-based digital walking intervention based on RAS principles to persons with PD in a naturalistic setting., Methods: Twenty-three persons with PD used the digital intervention independently for four weeks to complete five weekly 30-minute sessions of unsupervised, overground walking with music-based cues. The intervention progressed autonomously according to real-time gait sensing. Feasibility of independent use was assessed by examining participant adherence, safety, and experience. Intervention proof-of-concept was assessed by examining spatiotemporal metrics of gait quality, daily minutes of moderate intensity walking, and daily steps. Preliminary clinical outcomes were assessed following intervention completion., Results: Participants completed 86.4% of sessions and 131.1% of the prescribed session duration. No adverse events were reported. Gait speed, stride length, and cadence increased within sessions, and gait variability decreased (p < 0.05). Compared to baseline, increased daily moderate intensity walking (mean Δ= +21.44 minutes) and steps (mean Δ= +3,484 steps) occurred on designated intervention days (p < 0.05). Quality of life, disease severity, walking endurance, and functional mobility were improved after four weeks (p < 0.05)., Conclusions: Study findings supported the feasibility and potential clinical utility of delivering an autonomous digital walking intervention to persons with PD in a naturalistic setting.

Objective: The study examined how clinically measured walking capacity contributes to real-world walking performance in persons with Parkinson's disease (PD)., Methods: Cross-sectional baseline data (n = 82) from a PD clinical trial were analyzed. The 6-Minute Walk Test (6MWT) and 10-Meter Walk Test (10MWT) were used to generate capacity metrics of walking endurance and fast gait speed, respectively. An activity monitor worn for seven days was used to generate performance metrics of mean daily steps and weekly moderate intensity walking minutes. Univariate linear regression analyses were used to examine associations between each capacity and performance measure in the full sample and less and more active subgroups., Results: Walking capacity significantly contributed to daily steps in the full sample (endurance: R 2 =.13, p < .001; fast gait speed: R 2 =.07, p = .017) and in the less active subgroup (endurance: R 2 =.09, p = .045). Similarly, walking capacity significantly contributed to weekly moderate intensity minutes in the full sample (endurance: R 2 =.13, p < .001; fast gait speed: R 2 =.09, p = .007) and less active subgroup (endurance: R 2 = .25, p < .001; fast gait speed: R 2 =.21, p = .007). Walking capacity did not significantly contribute to daily steps or moderate intensity minutes in the more active subgroup., Conclusions: Walking capacity contributed to, but explained a relatively small portion of the variance in, real-world walking performance. The contribution was somewhat greater in less active individuals. The study adds support to the idea that clinically measured walking capacity may have limited benefit for understanding real-world walking performance in PD. Factors beyond walking capacity may better account for actual walking behavior., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background and Purpose: Walking activity in persons with Parkinson disease (PD) is important for preventing functional decline. The contribution of walking activity to home and community mobility in PD is poorly understood., Methods: Cross-sectional baseline data (N = 69) were analyzed from a randomized controlled PD trial. The Life-Space Assessment (LSA) quantified the extent, frequency, and independence across 5 expanding levels of home and community mobility, producing individual subscores and a total score. Two additional summed scores were used to represent mobility within (Levels 1-3) and beyond (Levels 4-5) neighborhood limits. An accelerometer measured walking activity for 7 days. Regression and correlation analyses evaluated relationships between daily steps and mobility scores. Mann-Whitney U tests secondarily compared differences in mobility scores between the active and sedentary groups., Results: Walking activity contributed significantly to the summed Level 1-3 score (β = 0.001, P = 0.004) but not to the summed Level 4-5 (β = 0.001, P = 0.33) or total (β = 0.002, P = 0.07) scores. Walking activity was significantly related to Level 1 (ρ = 0.336, P = 0.005), Level 2 (ρ = 0.307, P = 0.010), and Level 3 (ρ = 0.314, P = 0.009) subscores. Only the summed Level 1-3 score (P = 0.030) was significantly different between the active and sedentary groups., Discussion and Conclusions: Persons with PD who demonstrated greater mobility beyond the neighborhood were not necessarily more active; walking activity contributed more so to home and neighborhood mobility. Compared with LSA total score, the Level 1-3 summed score may be a more useful participation-level measure for assessing the impact of changes in walking activity.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A349)., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Academy of Neurologic Physical Therapy, APTA.)

A corollary discharge (CD) is a copy of a neuronal command for movement sent to other brain regions to inform them of the impending movement. In monkeys, a circuit from superior colliculus (SC) through medial-dorsal nucleus of the thalamus (MD) to frontal eye field (FEF) carries such a CD for saccadic eye movements. This circuit provides the clearest example of such internal monitoring reaching cerebral cortex. In this report we first investigated the functional organization of the critical MD relay by systematically recording neurons within a grid of penetrations. In two male rhesus macaque monkeys ( Macaca mulatta ), we found that lateral MD neurons carrying CD signals discharged before saccades to ipsilateral as well as contralateral visual fields instead of just contralateral fields, often had activity over large movement fields, and had activity from both central and peripheral visual fields. Each of these characteristics has been found in FEF, but these findings indicate that these characteristics are already present in the thalamus. These characteristics show that the MD thalamic relay is not passive but instead assembles inputs from the SC before transmission to cortex. We next determined the exact location of the saccade-related CD neurons using the grid of penetrations. The neurons occupy an anterior-posterior band at the lateral edge of MD, and we established this band in stereotaxic coordinates to facilitate future study of CD neurons. These observations reveal both the organizational features of the internal CD signals within the thalamus, and the location of the thalamic relay for those signals. SIGNIFICANCE STATEMENT A corollary discharge (CD) circuit within the brain keeps an internal record of physical movements. In monkeys and humans, one such CD keeps track of rapid eye movements, and in monkeys, a circuit carrying this CD extends from midbrain to cerebral cortex through a relay in the thalamus. This circuit provides guidance for eye movements, contributes to stable visual perception, and when defective, might be related to difficulties that schizophrenic patients have in recognizing their own movements. This report facilitates the comparison of the circuit in monkeys and humans, particularly for comparison of the location of the thalamic relay in monkeys and in humans., (Copyright © 2020 the authors.)

Background: Parkinson disease (PD) is a debilitating and chronic neurodegenerative disease resulting in ambulation difficulties. Natural walking activity often declines early in disease progression despite the relative stability of motor impairments. In this study, we propose a paradigm shift with a "connected behavioral approach" that targets real-world walking using cognitive-behavioral training and mobile health (mHealth) technology., Methods/design: The Walking and mHealth to Increase Participation in Parkinson Disease (WHIP-PD) study is a twelve-month, dual site, two-arm, randomized controlled trial recruiting 148 participants with early to mid-stage PD. Participants will be randomly assigned to connected behavioral or active control conditions. Both conditions will include a customized program of goal-oriented walking, walking-enhancing strengthening exercises, and eight in-person visits with a physical therapist. Participants in the connected behavioral condition also will (1) receive cognitive-behavioral training to promote self-efficacy for routine walking behavior and (2) use a mHealth software application to manage their program and communicate remotely with their physical therapist. Active control participants will receive no cognitive-behavioral training and manage their program on paper. Evaluations will occur at baseline, three-, six-, and twelve-months and include walking assessments, self-efficacy questionnaires, and seven days of activity monitoring. Primary outcomes will include the change between baseline and twelve months in overall amount of walking activity (mean number of steps per day) and amount of moderate intensity walking activity (mean number of minutes per day in which > 100 steps were accumulated). Secondary outcomes will include change in walking capacity as measured by the six-minute walk test and ten-meter walk test. We also will examine if self-efficacy mediates change in amount of walking activity and if change in amount of walking activity mediates change in walking capacity., Discussion: We expect this study to show the connected behavioral approach will be more effective than the active control condition in increasing the amount and intensity of real-world walking activity and improving walking capacity. Determining effective physical activity interventions for persons with PD is important for preserving mobility and essential for maintaining quality of life. Clinical trials registration NCT03517371, May 7, 2018., Trial Registration: ClinicalTrials.gov: NCT03517371. Date of registration: May 7, 2018. Protocol version: Original.

Background: Declining physical activity commonly occurs in people with Parkinson disease (PD) and contributes to reduced functional capacity and quality of life., Objective: The purpose of this study was to explore the preliminary effectiveness, safety, and acceptability of a mobile health (mHealth)-mediated exercise program designed to promote sustained physical activity in people with PD., Design: This was a 12-month single-blind (assessor), pilot, comparative-effectiveness, randomized controlled study., Methods: An mHealth-mediated exercise program (walking with a pedometer plus engagement in planned exercise supported by a mobile health application) was compared over 1 year with an active control condition (walking with a pedometer and exercise only). There were 51 participants in a community setting with mild-to-moderately severe (Hoehn and Yahr stages 1-3) idiopathic PD. Daily steps and moderate-intensity minutes were measured using a step activity monitor for 1 week at baseline and again at 12 months. Secondary outcomes included the 6-Minute Walk Test, Parkinson Disease Questionnaire 39 mobility domain, safety, acceptability, and adherence., Results: Both groups increased daily steps, moderate-intensity minutes, and 6-Minute Walk Test, with no statistically significant between-group differences observed. In the less active subgroup, changes in daily steps and moderate-intensity minutes were clinically meaningful. An improvement in the Parkinson Disease Questionnaire 39 mobility score favored mHealth in the overall comparison and was statistically and clinically meaningful in the less active subgroup., Limitations: The limitation of the current study was the small sample size., Conclusions: Both groups improved physical activity compared with expected activity decline over 1 year. The addition of the mHealth app to the exercise intervention appeared to differentially benefit the more sedentary participants. Further study in a larger group of people with low activity at baseline is needed.

When light falls within a neuronal visual receptive field (RF) the resulting activity is referred to as the visual response. Recent work suggests this activity is in response to both the visual stimulation and the abrupt appearance, or salience, of the presentation. Here we present a novel method for distinguishing the two, based on the timing of random and nonrandom presentations. We examined these contributions in frontal eye field (FEF; N = 51) and as a comparison, an early stage in the primary visual cortex (V1; N = 15) of male monkeys ( Macaca mulatta ). An array of identical stimuli was presented within and outside the neuronal RF while we manipulated salience by varying the time between stimulus presentations. We hypothesized that the rapid presentation would reduce salience (the sudden appearance within the visual field) of a stimulus at any one location, and thus decrease responses driven by salience in the RF. We found that when the interstimulus interval decreased from 500 to 16 ms there was an approximate 79% reduction in the FEF response compared with an estimated 17% decrease in V1. This reduction in FEF response for rapid presentation was evident even when the random sequence preceding a stimulus did not stimulate the RF for 500 ms. The time course of these response changes in FEF suggest that salience is represented much earlier (<100 ms following stimulus onset) than previously estimated. Our results suggest that the contribution of salience dominates at higher levels of the visual system. SIGNIFICANCE STATEMENT The neuronal responses in early visual processing [e.g., primary visual cortex (V1)] reflect primarily the retinal stimulus. Processing in higher visual areas is modulated by a combination of the visual stimulation and contextual factors, such as salience, but identifying these components separately has been difficult. Here we quantified these contributions at a late stage of visual processing [frontal eye field (FEF)] and as a comparison, an early stage in V1. Our results suggest that as visual information continues through higher levels of processing the neural responses are no longer driven primarily by the visual stimulus in the receptive field, but by the broader context that stimulus defines-very different from current views about visual signals in FEF., (Copyright © 2017 the authors 0270-6474/17/379871-09$15.00/0.)

Background and Purpose: Physical therapists seek to optimize movement as a means of reducing disability and improving health. The short-term effects of interventions designed to optimize movement ultimately are intended to be adapted for use across various future patterns of behavior, in potentially unpredictable ways, with varying frequency, and in the context of multiple tasks and environmental conditions. In this perspective article, we review and discuss the implications of recent evidence that optimal movement variability, which previously had been associated with adaptable motor behavior, contains a specific complex nonlinear feature known as "multifractality.", Summary of Key Points: Multifractal movement fluctuation patterns reflect robust physiologic interactivity occurring within the movement system across multiple time scales. Such patterns provide conceptual support for the idea that patterns of motor behavior occurring in the moment are inextricably linked in complex, physiologic ways to patterns of motor behavior occurring over much longer periods. The human movement system appears to be particularly tuned to multifractal fluctuation patterns and exhibits the ability to reorganize its output in response to external stimulation embedded with multifractal features., Recommendations for Clinical Practice: As a fundamental feature of human movement, multifractality opens new avenues for conceptualizing the link between physiologic interactivity and adaptive capacity. Preliminary evidence supporting the positive influence of multifractal rhythmic auditory stimulation on the gait patterns of individuals with Parkinson disease is used to illustrate how physical therapy interventions might be devised to specifically target the adaptive capacity of the human movement system.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A183).

Background: The ability to adapt postural responses to sensory illusions diminishes with age and is further impaired by Parkinson disease. However, limited information exists regarding training-related adaptions of sensory reweighting in these populations., Methods: This study sought to determine whether Parkinson disease or age would differentially affect acute postural recovery or adaptive postural responses to novel or repeated exposure to sensory illusions using galvanic vestibular stimulation during quiet stance., Findings: Acutely, individuals with Parkinson disease demonstrated larger center of pressure coefficient of variation compared to controls. Unlike individuals with Parkinson disease and asymptomatic older adults, healthy young adults acutely demonstrated a reduction in Sample Entropy to the sensory illusion. Following a period of consolidation Sample Entropy increased in the healthy young group, which coincided with a decreased center of pressure coefficient of variation. Similar changes were not observed in the Parkinson disease or older adult groups., Interpretation: Taken together, these results suggest that young adults learn to adapt to vestibular illusion in a more robust manner than older adults or those with Parkinson disease. Further investigation into the nature of this adaptive difference is warranted., (Published by Elsevier Ltd.)

Background and Purpose: Clinical reports suggest that wearing an oral appliance can improve the gait and balance of an individual with Parkinson disease (PD). Our primary purpose was to systematically explore this effect using a single-subject study design and quantitative motion analysis. Secondarily, we sought to examine the quality-of-life outcomes following 1-month of routine oral appliance wear., Methods: The participant was a 73-year-old ambulatory man with mid-stage PD. Using an A-B-A design, for which a custom-made oral appliance served as the intervention, kinematic and kinetic data were captured during performance of Four Square Step Test, serpentine walk, and tandem walk tasks. Grip strength was quantified with a dynamometer. Quality-of-life outcomes were collected after 1 month of appliance wear using the Parkinson Disease Questionnaire-39 (PDQ-39). Perceived changes in balance, mobility, and quality of life were captured from the participant using an 11-point Global Rate of Change (GRC) scale., Results: Changes in mobility, postural control, and grip strength during appliance wear were suggestive of reduced movement dysfunction. The PDQ-39 revealed a significant improvement in quality of life, primarily related to increased emotional well-being, decreased stigma, and increased communication. GRC scores indicated a clinically significant improvement in ease of movement in the community (+3), ease of movement during the performance of activities of daily living (+4), and in standing balance while performing activities of daily living (+4)., Discussion and Conclusions: Study findings provided quantitative evidence supporting the effectiveness of oral appliance wear for reducing movement dysfunction in a patient with mid-stage PD.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A155).

Introduction: The temporal relationship between disease and disability progression in Parkinson disease (PD) is not well understood. Our objective was to describe the natural, multidimensional trajectory of disability in persons with PD over a two-year period., Methods: We conducted a multi-center, prospective cohort study involving four institutions. Data were collected at baseline and at 6-month intervals over 2 years using standardized clinical tests representing three World Health Organization defined disability domains: impairment, activity limitation, and participation restriction. Unadjusted mixed effects growth models characterized trajectories of disability in the three disability domains. The data set was analyzed using restricted maximum likelihood (REML) estimation. Standardized estimates of change were also computed using Cohen's d for each measure., Results: Of the 266 enrolled participants, we analysed data from individuals who participated in at least 3 assessments (n = 207, 79%). Rates of disability progression over the 2-year period differed across domains. Moderate effects were detected for motor impairment (d = .28) and walking-related activity limitation (gait-related balance (d = .31); gait speed (d = .30)). Marginal effects were noted for upper extremity-related activity limitation (d = .11) and health-related quality of life participation restriction (d = .08)., Conclusions: The natural trajectory of walking-related activity limitation was the most potent indicator of evolving disability, suggesting that routine assessment of walking and periodic rehabilitation is likely to be warranted for many persons with PD. Natural trajectories of disability provide important comparison data for future intervention studies., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Saccadic eye movements direct the high-resolution foveae of our retinas toward objects of interest. With each saccade, the image jumps on the retina, causing a discontinuity in visual input. Our visual perception, however, remains stable. Philosophers and scientists over centuries have proposed that visual stability depends upon an internal neuronal signal that is a copy of the neuronal signal driving the eye movement, now referred to as a corollary discharge (CD) or efference copy. In the old world monkey, such a CD circuit for saccades has been identified extending from superior colliculus through MD thalamus to frontal cortex, but there is little evidence that this circuit actually contributes to visual perception. We tested the influence of this CD circuit on visual perception by first training macaque monkeys to report their perceived eye direction, and then reversibly inactivating the CD as it passes through the thalamus. We found that the monkey's perception changed; during CD inactivation, there was a difference between where the monkey perceived its eyes to be directed and where they were actually directed. Perception and saccade were decoupled. We established that the perceived eye direction at the end of the saccade was not derived from proprioceptive input from eye muscles, and was not altered by contextual visual information. We conclude that the CD provides internal information contributing to the brain's creation of perceived visual stability. More specifically, the CD might provide the internal saccade vector used to unite separate retinal images into a stable visual scene., Significance Statement: Visual stability is one of the most remarkable aspects of human vision. The eyes move rapidly several times per second, displacing the retinal image each time. The brain compensates for this disruption, keeping our visual perception stable. A major hypothesis explaining this stability invokes a signal within the brain, a corollary discharge, that informs visual regions of the brain when and where the eyes are about to move. Such a corollary discharge circuit for eye movements has been identified in macaque monkey. We now show that selectively inactivating this brain circuit alters the monkey's visual perception. We conclude that this corollary discharge provides a critical signal that can be used to unite jumping retinal images into a consistent visual scene., (Copyright © 2016 the authors 0270-6474/16/360031-12$15.00/0.)

Background: Declining ambulatory activity represents an important facet of disablement in Parkinson disease (PD)., Objective: The primary study aim was to compare the 2-year trajectory of ambulatory activity decline with concurrently evolving facets of disability in a small cohort of people with PD. The secondary aim was to identify baseline variables associated with ambulatory activity at 1- and 2-year follow-up assessments., Design: This was a prospective, longitudinal cohort study., Methods: Seventeen people with PD (Hoehn and Yahr stages 1-3) were recruited from 2 outpatient settings. Ambulatory activity data were collected at baseline and at 1- and 2-year annual assessments. Motor, mood, balance, gait, upper extremity function, quality of life, self-efficacy, and levodopa equivalent daily dose data and data on activities of daily living also were collected., Results: Participants displayed significant 1- and 2-year declines in the amount and intensity of ambulatory activity concurrently with increasing levodopa equivalent daily dose. Worsening motor symptoms and slowing of gait were apparent only after 2 years. Concurrent changes in the remaining clinical variables were not observed. Baseline ambulatory activity and physical performance variables had the strongest relationships with 1- and 2-year mean daily steps., Limitations: The sample was small and homogeneous., Conclusions: Future research that combines ambulatory activity monitoring with a broader and more balanced array of measures would further illuminate the dynamic interactions among evolving facets of disablement and help determine the extent to which sustained patterns of recommended daily physical activity might slow the rate of disablement in PD., (© 2015 American Physical Therapy Association.)

Objective: To compare the effects of resistance and cardiovascular exercise on functional mobility in individuals with advanced cancer., Design: Prospective, 2-group pretest-posttest pilot study with randomization to either resistance or cardiovascular exercise mode., Setting: Comprehensive community cancer center and a hospital-based fitness facility., Participants: Volunteer sample of individuals (N=66; 30 men; 36 women; mean age, 62y) with advanced cancer recruited through the cancer center, palliative care service, rehabilitation department, and a local hospice., Interventions: Ten weeks of individualized resistance or cardiovascular exercise, prescribed and monitored by oncology-trained exercise personnel., Main Outcome Measures: Functional mobility was assessed using the Short Physical Performance Battery (SPPB); self-reported pain and fatigue were assessed secondarily using visual analog scales. Data were analyzed using a split plot 2×2 analysis of variance (α=.05)., Results: Fifty-two patients (78.8%) completed the study: 23 (67.7%) of 34 patients in the resistance arm and 29 (90.6%) of 32 patients in the cardiovascular arm. No participant withdrew because of study adverse events. Ten-week outcomes (n=52) included a significant increase in SPPB total score (P<.001), increase in gait speed (P=.001), and reduction in fatigue (P=.05). Although cardiovascular exercise participants had a modestly greater improvement in SPPB total score than resistance training participants (F1,49=4.21, P=.045), the difference was not confirmed in a subsequent intention-to-treat analysis (N=66)., Conclusions: Individuals with advanced cancer appear to benefit from exercise for improving functional mobility. Neither resistance nor cardiovascular exercise appeared to have a strong differential effect on outcome., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Before each saccade, neurons in frontal eye field anticipate the impending eye movement by showing sensitivity to stimuli appearing where the neuron's receptive field will be at the end of the saccade, referred to as the future field (FF) of the neuron. We explored the time course of this anticipatory activity in monkeys by briefly flashing stimuli in the FF at different times before saccades. Different neurons showed substantial variation in FF time course, but two salient observations emerged. First, when we compared the time span of stimulus probes before the saccade to the time span of FF activity, we found a striking temporal compression of FF activity, similar to compression seen for perisaccadic stimuli in human psychophysics. Second, neurons with distinct FF activity also showed suppression at the time of the saccade. The increase in FF activity and the decrease with suppression were temporally independent, making the patterns of activity difficult to separate. We resolved this by constructing a simple model with values for the start, peak, and duration of FF activity and suppression for each neuron. The model revealed the different time courses of FF sensitivity and suppression, suggesting that information about the impending saccade triggering suppression reaches the frontal eye field through a different pathway, or a different mechanism, than that triggering FF activity. Recognition of the variations in the time course of anticipatory FF activity provides critical information on its function and its relation to human visual perception at the time of the saccade.

Background: The benefits of exercise for reducing disability in people with Parkinson disease (PD) are becoming more evident. Optimal benefit, however, requires regular and sustained participation. Factors associated with engaging in regular exercise have received little scientific scrutiny in people with PD., Objective: The purpose of this study was to explore factors associated with exercise behavior in patients with PD using the International Classification of Functioning, Disability and Health (ICF) as a guiding framework., Design: This was a cross-sectional study., Methods: The participants in this study were 260 patients with PD from 4 institutions. Participants were designated as "exercisers" or "nonexercisers" based on responses to the Stages of Readiness to Exercise Questionnaire. Exercise status was validated using the Physical Activity Scale for the Elderly and an activity monitor. Factors potentially associated with exercise behavior included measures of body structure and function, activity, participation, environmental factors, and personal factors. Their relative contributions were analyzed using logistic regression and quantified with odds ratios., Results: One hundred sixty-four participants (63%) were designated as exercisers. Participants with high self-efficacy were more than twice as likely to engage in regular exercise than those with low self-efficacy (adjusted odds ratio=2.34, 95% confidence interval=1.30-4.23). College educated and older participants also were more likely to exercise. Disabling influences of impairments, activity limitations, and participation restrictions were not associated with exercise behavior., Limitations: The cross-sectional nature of the study limited the ability to make causal inferences., Conclusions: Self-efficacy, rather than disability, appears to be strongly associated with whether ambulatory, community-dwelling people with PD exercise regularly. The results of this study suggest that physical therapists should include strategies to increase exercise self-efficacy when designing patient intervention programs for patients with PD.

Background: The natural ambulatory activity patterns of older adults are not well understood. User-worn monitors illuminate patterns of ambulatory activity and generate data suitable for analysis using measures derived from nonlinear dynamics., Methods: Ambulatory activity data were collected continuously from 157 community-dwelling older adults for 2 weeks. Participants were separated post hoc into groups based on the mean number of steps per day: highly active (steps > or = 10,000), moderately active (5,000 < or = steps < 10,000 steps), and inactive (steps <5,000 steps). Detrended fluctuation analysis (DFA), entropy rate (ER), and approximate entropy (ApEn) were used to examine the complexity of daily time series composed of 1-minute step count values. Coefficient of variation was used to examine time series variability. Between-group differences for each parameter were evaluated using analysis of variance., Results: All groups displayed patterns of fluctuating step count values containing complex temporal structure. DFA, ER, and ApEn parameter values increased monotonically and significantly with increasing activity level (p < .001). The variability of step count fluctuations did not differ among groups., Conclusions: Highly active participants had more complex patterns of ambulatory activity than less active participants. The results supported the idea that, in addition to the volume of activity produced by an individual, patterns of ambulatory activity contain unique information that shows promise for offering insights into walking behavior associated with healthy aging.

The massive visual input from the eye to the brain requires selective processing of some visual information at the expense of other information, a process referred to as visual attention. Increases in the responses of visual neurons with attention have been extensively studied along the visual processing streams in monkey cerebral cortex, from primary visual areas to parietal and frontal cortex. Here we show, by recording neurons in attending macaque monkeys (Macaca mulatta), that attention modulates visual signals before they even reach cortex by increasing responses of both magnocellular and parvocellular neurons in the first relay between retina and cortex, the lateral geniculate nucleus (LGN). At the same time, attention decreases neuronal responses in the adjacent thalamic reticular nucleus (TRN). Crick argued for such modulation of the LGN by observing that it is inhibited by the TRN, and suggested that "if the thalamus is the gateway to the cortex, the reticular complex might be described as the guardian of the gateway", a reciprocal relationship we now show to be more than just hypothesis. The reciprocal modulation in LGN and TRN appears only during the initial visual response, but the modulation of LGN reappears later in the response, suggesting separate early and late sources of attentional modulation in LGN.

Objectives: To explore the potential of using step activity monitoring to detect differences in ambulatory activity associated with advancing age and declining function in community-dwelling seniors., Design: Cross-sectional pilot study., Setting: General communities of Seattle, Washington; Catonsville, Maryland; and Durham, North Carolina., Participants: Thirty healthy younger adults, 28 healthy older adults, and 12 older adults reporting functional limitations., Measurements: Ambulatory activity data were collected over 6 days with the StepWatch 3. Average daily values were calculated for number of steps, number of minutes of activity, number of activity bouts, variability of minute-to-minute activity, and randomness of minute-to-minute activity fluctuations., Results: Healthy older adults engaged in fewer bouts of activity (P=.03) and displayed less-variable activity (P=.02) than younger adults. Older adults reporting functional limitations not only engaged in fewer bouts of activity (P=.009) and less variable activity (P<.001) than younger adults, but also accumulated fewer total steps (P=.003) and minutes of activity (P=.008) and had less-random minute-to-minute activity fluctuations (P=.02)., Conclusion: Step activity monitoring data were useful for detecting differences in ambulatory activity according to age and functional limitation. Monitor-based measures reflecting patterns of ambulatory activity show promise for use in studies of physical functioning.

Variability is a natural and important feature of human movement. Using existing theoretical frameworks as a foundation, we propose a new model to explain movement variability as it relates to motor learning and health. We contend that mature motor skills and healthy states are associated with an optimal amount of movement variability. This variability also has form and is characterized by a chaotic structure. Less than optimal movement variability characterizes biological systems that are overly rigid and unchanging, whereas greater than optimal variability characterizes systems that are noisy and unstable. Both situations characterize systems that are less adaptable to perturbations, such as those associated with abnormal motor development or unhealthy states. From our perspective, the goal of neurologic physical therapy should be to foster the development of this optimal amount of movement variability by incorporating a rich repertoire of movement strategies. The development of such a repertoire can be enhanced by incorporating a multitude of experiences within the therapeutic milieu. Promoting complex variation in human movement allows either motor development or the recovery of function after injury not to be hard coded, but determined instead by the active engagement of the individual within their environment. Measurement tools derived from nonlinear dynamics that characterize the complexity of movement variability provide useful means of testing these propositions. To illustrate, we present 2 clinical case studies, one pediatric and one adult, where we applied our theoretical framework to measuring change in postural control.

Context: The return-to-play decision after sport-related cerebral concussion depends in part on knowing when an athlete has fully recovered postural control after injury., Objective: To describe the postconcussion recovery of postural control using approximate entropy (ApEn), a regularity statistic from nonlinear dynamics., Design: Retrospective case series analysis., Setting: Sports medicine research laboratory., Patients or Other Participants: Collegiate athletes from whom center-of-pressure and symptom data were collected at preseason, less than 48 hours after injury, and 48 to 96 hours after injury., Main Outcome Measure(s): Approximate entropy values reflecting the amount of randomness contained in center-of-pressure oscillations were calculated for anterior-posterior (AP) and medial-lateral (ML) time series. Equilibrium scores reflecting the amplitude of center-of-pressure AP oscillations were used to indicate postural stability. The number and severity of symptoms were described., Results: Compared with the healthy preseason state, ApEn values for the AP and ML time series generally declined immediately after injury in both steady and unsteady injured athletes. At 48 to 96 hours after injury, ApEn values for the ML time series remained significantly depressed (mean difference compared with preseason = -0.268, standard error = 0.072), even among athletes whose initial postural instability had resolved. We found few significant relationships between changes in ApEn values and changes in symptoms before and after injury., Conclusions: The effects of cerebral concussion on postural control appear to persist for longer than 3 to 4 days, even among athletes with no signs of unsteadiness. Our results may reflect changes in neurophysiologic or mechanical constraints on postural control. Approximate entropy provides a theoretically distinct, valuable measurement alternative that may prove useful for reducing uncertainty in the return-to-play decision.

The optimal strategies for improving locomotor stability in people with vestibulopathy remain unclear. To help identify likely targets for intervention, we sought to determine whether vestibulopathic postural control impairment during locomotor activity was more localized to either the head or the whole body. We used high curvature analysis (HCA) to quantify the smoothness of head- and body-velocity trajectories during repeated stepping in 18 vestibulopathic and 17 healthy subjects. We employed a mixed-model repeated measures analysis of variance to compare differences in head- and body-trajectory HCA scores. Pearson coefficients were used to describe relationships between head- and body-trajectory HCA scores within each group. The results revealed that neither head- nor body-velocity trajectories were relatively more impaired in subjects with vestibulopathy. Importantly, however, the smoothness of head and body trajectories was more strongly related in subjects with vestibulopathy compared with healthy subjects, suggesting that the fundamental motor control impairment produced by vestibulopathy may be related to an abnormal coupling of head and body motion. We discuss implications for locomotor training in patients with vestibulopathy.

Recent research suggests that traditional biomechanical models of postural stability do not fully characterise the nonlinear properties of postural control. In sports medicine, this limitation is manifest in the postural steadiness assessment approach, which may not be sufficient for detecting the presence of subtle physiological change after injury. The limitation is especially relevant given that return-to-play decisions are being made based on assessment results. This update first reviews the theoretical foundation and limitations of the traditional postural stability paradigm. It then offers, using the clinical example of athletes recovering from cerebral concussion, an alternative theoretical proposition for measuring changes in postural control by applying a nonlinear dynamic measure known as 'approximate entropy'. Approximate entropy shows promise as a valuable means of detecting previously unrecognised, subtle physiological changes after concussion. It is recommended as an important supplemental assessment tool for determining an athlete's readiness to resume competitive activity.

In this study, the relationship was examined among clinical, criminal, and sociodemographic characteristics and the severity of the criminal charge of mentally ill female detainees admitted to the women's psychiatric unit at a large urban jail. In a cross-sectional study, 96 randomly selected female detainees were interviewed by one of two trained interviewers using the Structured Clinical Interview for DSM (SCID)-IV, the Addiction Severity Index, the Global Assessment of Functioning Scale (GAF), and the Medical Outcomes Study 36-Item Short-Form Health Survey. Criminal offense categories were based on the Federal Bureau of Investigation's Uniform Crime Reporting Program. Altogether, 48 percent of the detainees had been charged with committing at least one Part I crime; 27 percent were charged with committing a violent crime against persons. Lower GAF score and previous conviction(s) for a serious crime were associated with current arrest for a Part I crime. The data also suggest that a lower GAF score may be associated with a current charge of committing a violent crime, and placement on probation or parole before the current arrest may be protective against this charge. Mentally ill women who are more functionally impaired may be at higher risk of being arrested and charged with committing more serious and more violent crimes than those with lesser impairment.