Search

There is a growing body of literature assessing the potential benefits of dance for individuals post-stroke.We conducted a scoping review mapping the state of the literature on feasibility, intervention procedures, and efficacy of dance to improve health-related outcomes for individuals post-stroke.Included studies were original research that described the use of a dance intervention for individuals post-stroke, included any health-related outcome, and were written in English.Databases selected were Pubmed, Scopus, Google Scholar, Proquest, MedRxiv, and CINHAL.Two reviewers extracted relevant data and results were organized into themes and categories determined by all authors through discussion.We searched electronic databases were in February 2021. We included 18 publications from 14 studies. Ten were quantitative, five were qualitative, one was mixed-methods, and two were community project descriptions. Twelve publications evaluated in-person dance classes and six evaluated dance exergaming. Based on the limited studies included, evidence suggests dance is a feasible and potentially effective intervention for individuals post-stroke. Studies demonstrate dance may facilitate changes in balance and fall risk, encourage confidence, promote comfort with the changed body, increase rehabilitation motivation, and facilitate community reintegration. Evidence is limited by number of studies, design (lack of control groups and blinded assessments), intervention descriptions, and outcomes reporting.There is growing interest in dance for stroke interventions. Further research should focus on rigorous study design, optimal intervention timing, consistency of reporting outcomes, key elements of dance classes, and the impact of cultural dance styles.

BackgroundHuntington’s disease (HD) and Parkinson’s disease (PD) are neurodegenerative diseases resulting in motor impairments of gait initiation (GI). However, the neurophysiological underpinnings of GI in HD and PD are not well understood. The aims of this study were to 1) evaluate the feasibility of a wireless EEG system to identify EEG-derived movement-related potentials (MRPs) in individuals with HD and PD during GI, and to 2) determine the tolerance of a high repetition GI protocol.New Method3 participants with HD and 3 participants with PD performed 3 blocks of 15 trials of GI. EEG-derived MRPs of readiness potential (RPs) and contingent negative variation (CNV) were identified during GI, using a wireless EEG system synced with kinetic measures of GI. Tolerance of the protocol was determined from changes in COP across GI blocks.ResultsThere were no differences between HD and PD for CNV and RP amplitudes and latencies, although they were within acceptable ranges of MRP values in HD and PD. There were no differences of COP values between GI blocks.Comparison with old methodA wireless EEG system elicits naturalistic GI biomechanical responses as opposed to previous methods employing tethered systems. In contrast to single-trial EEG studies, this study implemented a larger number of GI trials, which produces greater MRP resolution.ConclusionsThis study validated the use of a wireless EEG headset in determining MRP values during GI in HD and PD. Participants within these populations were able to tolerate a high repetition GI protocol. Future work will explore MRPs in larger cross-sectional studies for the development of clinical outcome measures.

PURPOSE To compare home-based unimanual mirror therapy (UMT) and bimanual mirror therapy (BMT) for upper limb recovery in subacute/chronic stroke individuals with moderate-to-severe arm impairment. METHOD Twenty-two participants were randomized into 1 of 3 groups: UMT, BMT or traditional occupational therapy (TOT) home-based programs. The intervention was 6-weeks and consisted of OT 2 days a week, weekly sessions with the research OT, and 30-minutes of the home-based program 5 days a week, according to group allocation. The Action Research Arm Test (ARAT), ABILHAND, Fugl-Meyer Assessment (FMA), grip strength, and Stroke Impact Scale (SIS) were used for outcome measures. RESULTS All groups significantly improved over time on all outcome measures and adhered to the prescribed dosage regardless of group (p

This study presents a framework for physical therapy through the course of Huntington disease (HD) which includes coordinated care plans with neurologists. HD is an inherited neurodegenerative disorder that leads to impaired strength and coordination and ultimately progressive loss of function. Interdisciplinary HD care teams provide patient-centered, comprehensive evaluations and make recommendations for pharmacologic, healthcare, and lifestyle interventions based on best available evidence. Physical therapists work to improve movement and mobility using specific therapeutic interventions and individualized exercise programs. The proposed framework recommends that neurologists refer persons with HD to physical therapy at all disease stages, ideally beginning in premanifest and early stages, and that they regularly communicate with physical therapists to ensure implementation of a coordinated care plan. Resources are provided for neurologists to facilitate appropriate referral for individuals with HD to physical therapy based on clinical practice guidelines, including a referral decision guide.

Background: In 2020, our group published physical therapy clinical practice guidelines (CPG) for people with Huntington’s disease (HD). The guideline recommendations were categorized according to six primary movement impairment classifications. Objective: To facilitate implementation of this CPG, we have developed guideline-based algorithms for physical therapy assessments and interventions and recommendations for therapists to overcome barriers to CPG implementation for people with HD. Methods: We conducted a literature review of papers that evaluated physical therapy interventions in individuals with HD (n = 26) to identify assessments for each of the primary movement impairment classifications, and then searched for papers (n = 28) that reported their clinometric/psychometric properties in HD. Assessments were evaluated using modified Movement Disorder Society Committee on Rating Scales criteria and other relevant criteria. Results: We identified a “core set” of physical therapy assessments for persons with HD, including the Six Minute Walk Test, Timed Up and Go Test, Berg Balance Scale, and the Medical Outcomes Study Short Form 36 (SF-36). We then developed guideline-based decision trees to assist in decision making and implementation of the CPG into practice for persons with HD across the continuum of care. Finally, we developed strategies for overcoming barriers to implementation, such as seeking specialized training in HD, engaging caretakers or family members to help the person with HD to exercise, and establishing clinical pathways that support early physical therapy referrals. Conclusion: Knowledge translation documents such as this are essential to promoting implementation of the physical therapy CPGs into clinical practice.

Background/aims: COVID-19 is a global pandemic, which has seen over 198 million cases as of August 2021. This case study highlights the rehabilitation of a young patient with respiratory and neurologic sequalae of COVID-19 across the continuum of care, from the intensive care unit to the inpatient rehabilitation unit. Case description: A 45-year-old woman, with past medical history of fibromyalgia and morbid obesity, presented with complaints of shortness of breath. She tested positive for SARS-CoV-2, was transferred to the intensive care unit, and was intubated for 17 days. The day after extubation, she experienced worsened mental status; computed tomography and magnetic resonance imaging scans revealed bilateral strokes. On hospital day 21, she was transferred to the stroke step-down unit. On hospital day 24, she recovered some cognitive ability and movement of her lower extremities. On hospital day 30, she was admitted to the inpatient rehabilitation unit. Examination by occupational and physiotherapists found motor and sensory impairments of multiple peripheral nerves, including musculocutaneous, axillary and radial nerves. Interventions included passive range of motion, sitting balance, transfer training, rigid taping, upper extremity strengthening and functional training (gait, stair, activities of daily living). Her activities of daily living performance was limited by upper extremity weakness, sensory loss and pain. Conclusions This case highlights the medical, neurological and functional implications of COVID-19 on patients after prolonged hospitalisation. The plan of care was informed by collaboration between rehabilitation disciplines. Causes of her injuries are unclear but could include positioning, brachial plexus injuries, or post-critical illness syndrome. Further research on the evaluation and care of patients with COVID-19 that result in profound neurological impairments is warranted.

Background Understanding the contribution of anticipatory postural adjustments (APA) to walking ability in individuals with Huntington’s disease (HD) may provide insight into motor planning and the functional consequences of HD-specific cortical-basal ganglia pathway dysfunctions. Research question How do inertial measurement unit (IMU)-derived APAs and first step parameters differ between individuals with HD and non-HD peers under no load and cognitive load conditions, and what is their relationship to gait speed and clinical measures? Methods 33 individuals with manifest HD and 15 non-HD peers wore three Opal APDM IMUs during a 14-meter walk under no load and cognitive load conditions. APA acceleration amplitudes, APA durations, first step range of motion (ROM), and first step durations were compared, along with their relationship to gait speed. Results Individuals with HD had greater APA acceleration amplitudes, smaller first step ROM and longer first step durations compared to non-HD peers. No differences in APA durations were present between groups in both conditions. Cognitive loading influenced first step ROM but not other APA parameters. Mediolateral APA acceleration amplitudes were a significant predictor of gait speed and were related to disease-specific measures. Significance Larger acceleration amplitudes and smaller first step ROMs of greater duration, accompanied by the preservation of APA durations, reveal a discrepancy in movement scaling in HD. Additionally, the mediolateral component of the APA is likely a rate-limiting factor that drives a compensatory response in gait initiation. Further research is needed to explore the neural correlates of HD-related movement scaling.

Aim: In Huntington's disease (HD) and Parkinson's disease (PD), apathy is a frequently cited barrier to participation in physical activity. Current diagnostic criteria emphasize dissociable variants of apathy that differentially affect goal-directed behavior. How these dimensions present and affect physical activity in HD and PD is unknown. Methods: Using a qualitative approach, we examined the experience of apathy and its impact on physical activity in 20 people with early-manifest HD or idiopathic PD. Results: Two major themes emerged: the multidimensionality of apathy, including initiation or goal-identification difficulties, and the interplay of apathy and fatigue; and facilitators of physical activity, including routines, safe environments and education. Conclusion: Physical activity interventions tailored to apathy phenotypes may maximize participant engagement.

BACKGROUND Action tremor is a debilitating symptom of Parkinson’s Disease (PD) and there is a need for effective interventions. The Microsoft Emma Watch, a wristband with five vibrating motors, is a non-invasive, non-pharmaceutical intervention for tremor attenuation. OBJECTIVE This pilot study investigated the use of the Emma Watch device to attenuate action tremor in people with PD (PwPD). METHODS The sample included nine PwPD who were assessed on handwriting and hand function tasks. The tasks were completed with the Emma Watch at a high vibration intensity, a low intensity (sham), and compared these to their baseline (no vibration) to see if there were changes in performance. RESULTS Results indicated there were no significant differences found in the outcomes of interest measured with the tablet (duration, mean velocity, number of peaks, pause time, and number of pauses). Acceleration and jerk variables measured by APDM did not have significant differences between vibration intensities, except for normalized acceleration peaks, where a main effect of frequency was found. However, a post-hoc Tukey test revealed no pairwise differences between vibration intensities. CONCLUSIONS There were visually depicted and subjectively reported improvements in handwriting for a small subset of individuals. Our study did not indicate significant differences in any outcome measures. Future studies may benefit from a larger sample size and should focus on finding safe and effective ways to address Parkinson-induced action tremor and combining the Emma Watch with task specific training to study its effect on increasing hand function and/or writing ability.

Objective There is mounting evidence in support of exercise and physical activity as a first-line approach to managing symptoms and potentially altering disease progression in people with Parkinson disease (PD). For many patients, a critical gap is the need for expert guidance to overcome barriers, set realistic goals, and provide personalized advice to optimize exercise uptake and adherence. The purpose of this case report is to describe a physical activity coaching program (Engage-PD) for individuals newly diagnosed with PD and to highlight rapid modifications made to this program in response to the COVID-19 pandemic. Methods (Case Description) Engage-PD is a single cohort implementation study of a coaching intervention grounded in self-determination theory being conducted at Columbia University Parkinson’s Foundation Center of Excellence in New York City, NY (USA), the early epicenter of the COVID-19 pandemic in the United States. The project was uniquely positioned to be adapted to telehealth delivery and to address an immediate need for support and guidance in the home environment, including people with early-mid–stage PD. Participants completed baseline and follow-up (3 months) assessments and participated in up to 4 coaching sessions, all delivered via a telehealth platform. The intervention incorporated 1:1 coaching, goal-setting, physical activity monitoring, and use of a disease-specific workbook to promote and support safe exercise uptake. Results While the program is ongoing, 52 referrals were received and 27 individuals with PD enrolled in the first 2 months of the pandemic for a recruitment rate of 52%. Although direct comparisons with pre-coronavirus recruitment are difficult due to the recency of the Engage-PD implementation study, this recruitment rate was larger than expected, which may have been due to several factors (eg, most patients had limited, if any, access to in-person programs and therapy services during this time, so the Engage program filled an immediate need to provide exercise and activity guidance). There was a wide range of scores for both baseline physical activity and self-efficacy measures. Conclusion Remotely delivered interventions may serve as a sustainable platform for physical activity coaching programs for people with PD as well as other neurodegenerative diseases. Impact With the uncertainty brought about by the current pandemic, this case report highlights the opportunity to shift the current model of care for individuals with neurodegenerative diseases such as PD.

Introduction Goal setting is an important component of school-based physical therapy; however, evidence suggests that therapists may not consistently write goals that are relevant, context specific, and measurable. The aims of this knowledge translation study were to evaluate implementation of a goal-setting method for school-based therapists. Method This study was created to align with the Knowledge to Action framework and included 1-day training and follow-up mentorship. Goals were assessed pre- and posttraining, and questionnaires assessed barriers and facilitators. Results Twenty-two physical therapists participated. Nineteen participants (90%) strongly agreed/agreed that the training helped change their perspectives about goal setting in the school environment. There was a statistically significant difference in goal quality pre- and posttraining. Therapists identified barriers and facilitators to implementation of effective goal setting in practice. Discussion Results indicate that this method may be effective at improving goal writing that is relevant, context specific, and measurable in school settings.

PurposeTo evaluate the feasibility of using wearable activity monitors as part of a physical activity (PA) intervention and describe patterns of device weartime and PA behavior in people with Parkinson (PD) and Huntington disease (HD).Materials and MethodsSecondary analyses were conducted on two pilot studies where people with early-stage PD (n=13) and HD (n=14) enrolled in a 4-month PA coaching program. Participants wore a Fitbit Charge 2 and physical and occupational therapists guided them through understanding of PA data and goal-setting to build autonomy and facilitate PA uptake. Wear time, wear habits (delineated based on nighttime wear), and activity metrics including steps, resting heart rate, and metabolic equivalent of task (MET) *minutes were analyzed.ResultsRetention rate of the intervention was 85%. Participants had a mean (SD) of 92.3(9.2)% valid wear days over the intervention period. Average daily wear time was 18.4(4.5) hours, with an initial 2-week period of high wear time fluctuation. Regardless of diagnosis, day & night Fitbit wearers had more improvements in steps (d=1.02) and MET*min/week (d=0.69) compared to day-only wearers.ConclusionsImplementing wearable activity monitors in a PA coaching intervention was feasible and provided insight into longitudinal PA behavior in people with neurodegenerative diseases.

Over the past 3 decades, the volume of human motor learning research has grown enormously. As such, the understanding of motor learning (ie, sustained change in motor behavior) has evolved. It has been learned that there are multiple mechanisms through which motor learning occurs, each with distinctive features. These mechanisms include use-dependent, instructive, reinforcement, and sensorimotor adaptation-based motor learning. It is now understood that these different motor learning mechanisms contribute in parallel or in isolation to drive desired changes in movement, and each mechanism is thought to be governed by distinct neural substrates. This expanded understanding of motor learning mechanisms has important implications for physical therapy. It has the potential to facilitate the development of new, more precise treatment approaches that physical therapists can leverage to improve human movement. This Perspective describes scientific advancements related to human motor learning mechanisms and discusses the practical implications of this work for physical therapist practice and education.

Parkinsonism & related disorders 101, 75-89 (2022). doi:10.1016/j.parkreldis.2022.06.013, Published by Elsevier Science, Amsterdam [u.a.]

BackgroundIndividuals with hemiparesis post-stroke often have difficulty with tasks requiring upper extremity (UE) intra- and interlimb coordination, yet methods to quantify both are limited. Objective: To develop a quantitative yet sensitive method to identify distinct features of UE intra- and interlimb coordination. MethodsTwenty adults post-stroke and 20 controls wore five inertial sensors (wrists, upper arms, sternum) during 12 seated UE tasks. Three sensor modalities (acceleration, angular rate of change, orientation) were examined for three metrics (peak to peak amplitude, time, and frequency). To allow for comparison between sensor data, the resultant values were combined into one motion parameter, per sensor pair, using a novel algorithm. This motion parameter was compared in a group-by-task analysis of variance as a similarity score (0-1) between key sensor pairs: sternum to wrist, wrist to wrist, and wrist to upper arm. A use ratio (paretic/non-paretic arm) was calculated in persons post-stroke from wrist sensor data for each modality and compared to scores from the Adult Assisting Hand Assessment (Ad-AHA Stroke) and UE Fugl-Meyer (UEFM). ResultsA significant group x task interaction in the similarity score was found for all key sensor pairs. Post-hoc tests between task type revealed significant differences in similarity for sensor pairs in 8/9 comparisons for controls and 3/9 comparisons for persons post stroke. The use ratio was significantly predictive of the Ad-AHA Stroke and UEFM scores for each modality. ConclusionsOur algorithm and sensor data analyses distinguished task type within and between groups and were predictive of clinical scores. Future work will assess reliability and validity of this novel metric to allow development of an easy-to-use app for clinicians.

Background Evidence of best practice for long term physical activity Huntington’s disease (HD) is lacking, due in part, to inherent challenges in the delivery and evaluation of such life-style interventions. Aim To investigate the feasibility of a nested randomized controlled trial (RCT) of physical activity into Enroll-HD, an established HD cohort study. Methods We conducted a ‘Trial within a Cohort’ (TWiC) evaluation of an exercise intervention compared to usual activity in individuals with early-mid stage HD. All participants completed their usual Enroll-HD assessments and PACE-HD assessments, which included measures of fitness (predicted maximal oxygen uptake) and self-reported and quantitative measures of physical activity. We explored the use of propensity score weighting to compare the individuals in the intervention arm of the RCT to those in the cohort. Results Of the 274 participants screened, 204 met the inclusion criteria and of those, 54 (26.5%) declined to participate and 34 (16.7%) were not contactable. Recruitment targets were only narrowly missed; 59/60 (98.3%) for the cohort and 57/60 (93.5%) for the RCT. Retention rates at 12 months were ~ 85 in both groups. Percentage (%) data completeness for outcomes measures at baseline ranged from 42.3-100% and at 12 month follow up from 19.2–85.2 %. Imbalances in pretreatment confounders for the cohort and the RCT could not to be addressed via propensity score weighting likely due to small sample sizes. Conclusion A targeted recruitment strategy was instrumental in achieving target recruitment; retention at 12 months was excellent. Pre-specified criteria for minimum dataset data completion (both PACE-HD and linked Enroll-HD datasets) were met. The TWiC design, with linkage to Enroll-HD, is feasible for long-term physical activity evaluation in HD provided sample size requirements can be achieved. *PACE-HD & Enroll-HD site principal investigators Teresa Montojo. Neurology Department, Fundacion Jimenez Diaz, Madrid, Spain. Jesus Miguel Ruiz Idiago. Neuropsychiatry Unit, Hospital Mare de Deu de la Merce, Barcelona, Spain. Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Spain. Julie Hershberg. University of Southern California, Division of Biokinesiology and Physical Therapy. Re+active physical therapy & wellness, Los Angeles, CA, USA. Yvette Bordelon. Department of Neurology, University of California, Los Angeles, CA, USA. Karen Marder, Columbia University Irving Medical Center, New York, NY, USA. Lori Quinn, Teachers College, Columbia University, New York, NY, USA. Ralf Reilmann. George-Huntington-Institute and Institute for Clinical Radiology, University of Munster, Munster, Germany. Kathrin Reetz. University Hospital Aachen, Germany. Bernhard Landwehrmeyer. University Hospital Ulm, Germany.

Background:\ud Physical activity may be beneficial in Huntington's disease, however studies to date have been underpowered to detect change. We combined data from five randomized controlled feasibility trials using individual patient data meta‐analyses.\ud \ud Methods/Design:\ud All trial interventions comprised a combination of supervised and self‐directed physical activity, with varied emphasis on aerobic, strength, endurance, flexibility, and task training. Duration ranged from eight to 16 weeks. The primary outcome was the modified Unified Huntington's Disease Rating Motor Score. Secondary outcomes included the Symbol Digit Modality Test, Berg Balance Scale, 30‐second Chair stand, Timed Up and Go, Gait speed, Physical Performance Test, six‐minute Walk, International Physical Activity Questionnaire, Hospital Anxiety and Depression Scale, EuroQol Health Utility Index, Short‐Form 36 Health Related Quality of Life Scale. The primary analysis employed a two‐stage approach. A one‐stage approach was explored as a sensitivity analysis using a cross‐classified (by study site) linear mixed effects model.\ud \ud Results:\ud 121 participants provided complete data. Risk of bias was moderate; however primary outcomes were blind assessed. Primary pooled effect estimates adjusted for baseline modified motor score (95% CI) were 0.2 (‐2.1 to 2.6) favoring control. There was considerable heterogeneity between the studies.\ud \ud Conclusions:\ud There was no evidence of an exercise effect on the modified motor score in these relatively short duration interventions. Longer duration trials incorporating supervised components meeting frequency, intensity, time and type principles are required. Lack of common outcomes limited the analysis and highlight the importance of a core outcome set for evaluating exercise in Huntington's disease.

Background\ud Postural control impairments begin early in Huntington's disease yet measures most sensitive to progression have not been identified. The aims of this study were to: 1) evaluate postural control and gait in people with and without Huntington's disease using wearable sensors; and 2) identify measures related to diagnosis and clinical severity.\ud \ud Methods\ud 41 individuals with Huntington's disease and 14 age-matched peers performed standing with feet together and feet apart, sitting, and walking with wearable inertial sensors. One-way analysis of variance determined differences in measures of postural control and gait between early and mid-disease stage, and age-matched peers. A random forest analysis identified Features of Importance for Huntington's disease diagnosis. Stepwise and ordinal regressions were used to determine predictors of clinical chorea and tandem walking scores respectively.\ud \ud Findings\ud There was a significant main effect for all postural control and gait measures comparing early stage, mid stage and age-matched peers, except for gait cycle duration and step duration. Total sway, root mean square and mean velocity during sitting, as well as gait speed had the greatest importance in classifying disease status. Stepwise regression showed that root mean square during standing with feet apart significantly predicted clinical measure of chorea, and ordinal regression model showed that root mean square and total sway standing feet together significantly predicted clinical measure of tandem walking.\ud \ud Interpretations\ud Root mean square measures obtained in sitting and standing using wearable sensors have the greatest potential to serve as biomarkers of postural control impairments in Huntington's disease.

The movement system was identified as the focus of our expertise as physical therapists in the revised vision statement for the profession adopted by the American Physical Therapy Association in 2013. Attaining success with the profession’s vision requires the development of movement system diagnoses that will be useful in clinical practice, research, and education. To date, only a few movement system diagnoses have been identified and described, and none of these specifically address balance dysfunction. Over the past 2 years, a Balance Diagnosis Task Force, a subgroup of the Movement System Task Force of the Academy of Neurologic Physical Therapy, focused on developing diagnostic labels (or diagnoses) for individuals with balance problems. This paper presents the work of the task force that followed a systematic process to review available diagnostic frameworks related to balance, identify 10 distinct movement system diagnoses that reflect balance dysfunction, and develop complete descriptions of examination findings associated with each balance diagnosis. A standardized approach to movement analysis of core tasks, the Framework for Movement Analysis developed by the Academy of Neurologic Physical Therapy Movement Analysis Task Force, was integrated into the examination and diagnostic processes. The aims of this perspective paper are to (1) summarize the process followed by the Balance Diagnosis Task Force to develop an initial set of movement system (balance) diagnoses; (2) report the recommended diagnostic labels and associated descriptions; (3) demonstrate the clinical decision-making process used to determine a balance diagnosis and develop a plan of care; and (4) identify next steps to validate and implement the diagnoses into physical therapist practice, education, and research. Impact The development and use of diagnostic labels to classify distinct movement system problems is needed in physical therapy. The 10 balance diagnosis proposed can aid in clinical decision making regarding intervention.

The American Physical Therapy Association’s Vision Statement of 2013 asserts that physical therapists optimize movement in order to improve the human experience. In accordance with this vision, physical therapists strive to be recognized as experts in movement analysis. However, there continues to be no accepted method to conduct movement analysis, nor an agreement of key terminology to describe movement observations. As a result, the Academy of Neurologic Physical Therapy organized a task force that was charged with advancing the state of practice with respect to these issues, including the development of a proposed method for movement analysis of tasks. This paper presents the work of the Task Force, which includes (1) development of a method for conducting movement analysis within the context of the movement continuum during 6 core tasks (sitting, sit to stand, standing, walking, step up/down, and reach/grasp/manipulate); (2) glossary of movement constructs that can provide a common language for movement analysis across a range of tasks: symmetry, speed, amplitude, alignment, verticality, stability, smoothness, sequencing, timing, accuracy, and symptom provocation; and (3) recommendations for task and environmental variations that can be systematically applied. The expectation is that this systematic framework and accompanying terminology will be easily adapted to additional patient or client-specific tasks, contribute to development of movement system diagnostic labels, and ultimately improve consistency across patient/client examination, evaluation, and intervention for the physical therapy profession. Next steps should include validation of this framework across patient/client groups and settings.

The purpose of this scoping review will be to explore the current literature on dance interventions for individuals post-stroke. Specifically, we will conduct a systematic search of published studies to map the state of the literature on feasibility, intervention procedures, and efficacy of dance to improve health-related outcomes for individuals post-stroke. Stroke is the leading cause of long-term disability frequently causing motor and cognitive impairments that impact functional abilities. Dance inherently encompasses key principles of motor learning including cognitive-motor specific task practice, sensory feedback, and social engagement. Dance and music create an enriched environment, engaging emotion and promoting positive affect.Electronic databases were searched in February 2021. Original, peer-reviewed studies will be included if they broadly describe the use of a dance intervention for individuals post-stroke. Studies including other neurological populations will be considered only if stroke results can be isolated. We will categorize studies based on dance style, study type, population characteristics, and study setting. We will narratively synthesize results, assessing feasibility, intervention procedures, and efficacy of dance to improve health-related outcomes in stroke survivors, including potential motor, cognitive, psychological, and social benefits.This scoping review will be the first to broadly describe the existing literature on dance interventions for individuals post-stroke. We hope to identify trends in outcomes measures as well as reveal successes, limitations, and gaps in the literature to inform potential directions for future research in the field.

Background\ud Individuals with Huntington's disease (HD) have impairments in performing dual-tasks, however, there is limited information about the effects of changing postural and cognitive demands as well as which measures are best suited as markers of underlying motor-cognitive interference.\ud \ud Methods\ud Forty-three individuals with HD and 15 healthy controls (HC) completed single tasks of walking (Timed Up & Go (TUG), 7 m walk), standing (feet together, feet apart and foam surface) and seated cognitive performance (Stroop, Symbol Digit Modalities Test (SDMT), Delis-Kaplan Executive Function System (DKEFS) Sorting test) and dual cognitive-motor tasks while standing (+ Stroop) and walking (+ DKEFS, TUG cognitive). APDM Opal sensors recorded measures of postural sway and time to complete motor tasks.\ud \ud Results\ud Individuals with HD had a greater increase in standing postural sway compared to HC from single to dual-tasks and with changes to support surface. Both groups demonstrated a decrease in gait performance during the TUG cognitive, however, this difference was greater in people with HD compared to HC. While those with HD showed a greater dual-task motor cost compared to HC, both groups behaved similarly as condition complexity increased.\ud \ud Conclusions\ud Standing postural sway is a more sensitive marker of instability than change in standard gait speed, particularly under dual-task conditions. The more complex TUG cognitive is a sensitive measure of walking dual-task performance. The results of this study provide insights about the nature of motor-cognitive impairments in HD and provide support for a distinction between static and dynamic postural control mechanisms during performance of dual-tasks.

The "wobble room" is a wellness intervention designed to guide staff through unpredictable times that are not going away quickly. Emergency department teams are accustomed to trauma events and trauma debriefing, but the prolonged uncertainties and fears associated with COVID-19 have posed a unique challenge for healthcare workers. The wobble room has become a place where staff can make sense of how the pandemic is affecting them and create a "new normal" with respect to personal safety and team cohesion.

Huntington’s disease (HD)―the facts provides an overview of the condition aimed at families and carers understanding the condition. It describes the key features of: a movement disorder, disturbance of mood (affect), and problems with thinking (cognition) and behaviour. The movement problems of chorea, dystonia, and bradykinesia are explained but there is equal emphasis on depression impulsive behaviour and temper outbursts. Understanding the cause of these may help families cope better when they arise. The genetic change is discussed as is its effect on the protein huntingtin. Options for genetic testing of those at risk (predictive testing) as well as options for tests in pregnancy (prenatal diagnosis) and preimplantation genetic diagnosis (PGD) are described. Currently treatment is symptomatic and supportive. There is a discussion of clinical trials in general and the current huntingtin lowering studies using anti-sense oligonucleotides (ASOs) in particular. The book also includes vignettes written by family members.

Aim: To determine the effectiveness of a targeted dance intervention to improve walking speed for people with Parkinson disease (PD) by increasing motor motivation. Materials & methods: 11 participants with PD participated in a 6-week pilot study in which they learned a contemporary dance composed of walking steps and designed to mimic everyday walking. 1 h classes occurred twice-weekly. Results: Pre- and post-intervention assessments revealed a significant increase in gait speed (t9 = 3.30; p = 0.009), cadence (t9 = 2.345; p = 0.044), and stride length (t9 = 3.757; p = 0.005), and a significant decrease (improvement) in single support time variability (t9 = -2.744; p = 0.022). There were no significant changes in other measures of gait variability nor in motor symptoms, mood and anxiety, extent of life-space mobility, or quality of life. No adverse events were reported. Conclusion: Joywalk provides preliminary evidence that a targeted physical intervention for people with PD may specifically counter bradykinesia.

Background and PurposeUnderstanding the contribution of anticipatory postural adjustments (APA) on walking ability in individuals with Huntington’s disease (HD) may provide insight into motor planning and the functional consequences of HD-specific cortical-basal ganglia pathway dysfunctions. The purpose of this study was to evaluate inertial measurement unit (IMU)-derived measures of APAs and first step parameters, and their contribution to gait speed, in individuals with and without manifest HD during a single-task and cognitive load condition.Methods33 individuals with manifest HD and 15 age-matched healthy controls wore three Opal APDM IMUs during a 14-meter walk during a single task and cognitive load condition. APA acceleration amplitudes, APA durations, first step range of motion (ROMs), and first step duration were compared, along with their relationship to gait speed.ResultsIndividuals with HD had significantly greater APA acceleration amplitudes, smaller first step ROMs and longer first step durations compared to healthy controls. No difference in APA durations were present between groups across conditions. Linear model results and significant correlations between mediolateral APA acceleration amplitudes and APA durations were found.ConclusionsLarger acceleration amplitudes, smaller first step ROMs of greater duration, accompanied by the preservation of APA durations reveal a discrepancy in movement scaling in HD. Additionally, the mediolateral component of the APA is likely a rate-limiting factor that drives a compensatory response in gait initiation. Additional research is needed to explore the neural correlates of HD-related movement scaling.

After a stroke, individuals often exhibit upper extremity (UE) motor dysfunction, influencing the performance of everyday tasks. Characterizing UE movements is useful to track recovery and response to intervention. Yet, due to the complexity of the recovery process, UE movements may be extremely variable and person-specific. While this renders automatic recognition of these gestures challenging, machine learning methods could be used to classify UE movements in atypical populations. In the current study, we utilize data from 20 individuals post-stroke and 20 age-matched controls to identify an optimal set of sensor-extracted features for the classification of unimanual and bimanual gestures during task performance. We found that using fewer than 100 features along with a random forest classifier produced the best performance across both groups, with both user-dependent and user-independent models.

© 2019 – IOS Press and the authors. All rights reserved, In this edition of the Huntington's Disease Clinical Trials Corner we expand on the GENERATION-HD1 and PACE-HD trials, and we list all currently registered and ongoing clinical trials in Huntington's disease.

Limitation of functional ability is a major feature of Huntington's disease (HD). The International Parkinson and Movement Disorder Society (MDS) commissioned the appraisal of the use and clinimetric properties of clinical measures of functional ability that have been applied in HD studies and trials to date, to make recommendations regarding their use based on standardized criteria. After a systematic literature search, we included a total of 29 clinical measures grouped into two categories: (1) performance-based measures (e.g., balance, walking, and reaching/grasping), and (2) rating scales. Three performance-based measures are rated as "recommended": the Tinetti Mobility Test for screening of fall risk and for severity assessment of mobility in patients with manifest HD (up to stage III); the Berg Balance Scale for severity of balance impairment; and the Six-Minute Walk Test for assessment of walking endurance (severity) in HD subjects with preserved ambulation. No rating scale targeting functional ability reached a "recommended" status either for screening or severity measurement. The main challenges identified in this review include applying widely accepted conceptual frameworks to the identified measures, the lack of validation of clinical measures to detect change over time, and absence of validated measures for upper limb function. Furthermore, measures of capacity or ability to perform activities of daily living had ceiling effects in people with early and pre-manifest HD. We recommend that the MDS prioritize the development of new scales that capture small, but meaningful changes in function over time for outcome assessment in clinical trials, particularly in earlier stages of HD.

The APTA recently established a vision for physical therapists to transform society by optimizing movement to promote health and wellness, mitigate impairments, and prevent disability. An important element of this vision entails the integration of the movement system into the profession, and necessitates the development of movement system diagnoses by physical therapists. At this point in time, the profession as a whole has not agreed upon diagnostic classifications or guidelines to assist in developing movement system diagnoses that will consistently capture an individual's movement problems. We propose that, going forward, diagnostic classifications of movement system problems need to be developed, tested, and validated. The Academy of Neurologic Physical Therapy's Movement System Task Force was convened to address these issues with respect to management of movement system problems in patients with neurologic conditions. The purpose of this article is to report on the work and recommendations of the Task Force.The Task Force identified 4 essential elements necessary to develop and implement movement system diagnoses for patients with primarily neurologic involvement from existing movement system classifications. The Task Force considered the potential impact of using movement system diagnoses on clinical practice, education and, research. Recommendations were developed and provided recommendations for potential next steps to broaden this discussion and foster the development of movement system diagnostic classifications.The Task Force proposes that diagnostic classifications of movement system problems need to be developed, tested, and validated with the long-range goal to reach consensus on and adoption of a movement system diagnostic framework for clients with neurologic injury or disease states.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A198).

The compromise of quality of life in Huntington's disease is a major issue, both for individuals with the disease as well as for their caregivers. The International Parkinson and Movement Disorder Society commissioned a review of the use and clinimetric validation status of measures used in Huntington's disease to assess aspects related with quality of life and to make recommendations on their use following standardized criteria. We included both patient‐centered measures (patient health‐related quality‐of‐life measures) and caregiver‐centered measures (caregiver quality‐of‐life measures). After conducting a systematic literature search, we included 12 measures of patient health‐related quality of life and 2 measures of caregiver quality of life. Regarding patient‐centered measures, the Medical Outcomes Study 36‐Item Short‐Form Health Survey is “recommended” as a generic assessment of health‐related quality of life in patients with Huntington's disease. The 12‐Item Short Form Health Survey, the Sickness Impact Profile, the 12‐item World Health Organization Disability Assessment Schedule, and the Huntington's Disease Health‐Related Quality of Life questionnaire are “suggested.” No caregiver‐centered quality‐of‐life measure obtained a “recommended” status. The Alzheimer's Carer's Quality of Life Inventory and the Huntington's Disease Quality of Life Battery for Carers are “suggested.” Recognizing that the assessment of patient health‐related quality of life can be challenging in Huntington's disease, as patients may lack insight and there is insufficient clinimetric testing of these scales, the committee concluded that further validation of currently available health‐related quality‐of‐life measures should be undertaken, namely, those Huntington's disease–specific health‐related quality‐of‐life measures that have recently been reported and used.

Background. A number of studies evaluating physical therapy and exercise interventions in Huntington’s disease have been conducted over the past 15 years. However, an assessment of the quality and strength of the evidence in support of these interventions is lacking.\ud Objective: The purpose of this systematic review was to investigate the effectiveness of physical therapy and exercise interventions in people with Huntington’s disease, and to examine the perceptions of patients, families and caregivers of these interventions.\ud Methods: This mixed-methods systematic review utilized the Joanna Briggs Institute (JBI) approach and extraction tools to evaluate the literature from January 2003 until May 2016. The review considered interventions that included exercise and physical therapy interventions, and included both quantitative and qualitative outcome measures. \ud Results: Twenty (20) studies met the inclusion criteria, including eighteen (18) that had quantitative outcome measures and two (2) that utilized qualitative methods. JBI Levels of evidence for the 18 quantitative studies were as follows: Eight studies were at evidence Level 1, seven were at Level 2, two were at Level 3, and one was at Level 4.\ud Conclusions: Our review suggests that there is preliminary support for the benefits of exercise and physical activity in Huntington’s disease in terms of motor function, gait speed, and balance, as well as a range of physical and social benefits identified through patient-reported outcomes. Variability in mode of intervention as well as outcome measures limits the interpretability of these studies, and high-quality studies that incorporate adaptive trial designs for this rare disease are needed.

Individuals with Huntington disease (HD), a rare neurological disease, experience impairments in mobility and cognition throughout their disease course. The Medical Research Council framework provides a schema that can be applied to the development and evaluation of complex interventions, such as those provided by physical therapists. Treatment-based classifications, based on expert consensus and available literature, are helpful in guiding physical therapy management across the stages of HD. Such classifications also contribute to the development and further evaluation of well-defined complex interventions in this highly variable and complex neurodegenerative disease. The purpose of this case series was to illustrate the use of these classifications in the management of 2 individuals with late-stage HD.Two females, 40 and 55 years of age, with late-stage HD participated in this case series. Both experienced progressive declines in ambulatory function and balance as well as falls or fear of falling. Both individuals received daily care in the home for activities of daily living.Physical therapy Treatment-Based Classifications for HD guided the interventions and outcomes. Eight weeks of in-home balance training, strength training, task-specific practice of functional activities including transfers and walking tasks, and family/carer education were provided.Both individuals demonstrated improvements that met or exceeded the established minimal detectible change values for gait speed and Timed Up and Go performance. Both also demonstrated improvements on Berg Balance Scale and Physical Performance Test performance, with 1 of the 2 individuals exceeding the established minimal detectible changes for both tests. Reductions in fall risk were evident in both cases.These cases provide proof-of-principle to support use of treatment-based classifications for physical therapy management in individuals with HD. Traditional classification of early-, mid-, and late-stage disease progression may not reflect patients' true capabilities; those with late-stage HD may be as responsive to interventions as those at an earlier disease stage.Video Abstract available for additional insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A172).

Review question/objective:\ud : The review seeks to evaluate the effectiveness of physical therapy and exercise interventions in Huntington's disease (HD). The review question is: What is the effectiveness of physiotherapy and therapeutic exercise interventions in people with HD, and what are patients’, families’ and caregivers’ perceptions of these interventions?\ud Review question/objective:\ud The specific objectives are:\ud Review question/objective:\ud This mixed methods review seeks to develop an aggregated synthesis of quantitative, qualitative and narrative systematic reviews on physiotherapy and exercise interventions in HD, in an attempt to derive conclusions and recommendations useful for clinical practice and policy decision-making.

Purpose: Huntington’s disease is an autosomal dominant neurodegenerative disease. Progressive physical, behavioural and cognitive impairments cause loss of independent function. Physical activity interventions are important components of comprehensive intervention strategies and may help alter the functional decline trajectory. Qualitative research has an important role to play in developing theoretically sound, well-defined physical activity interventions in Huntington’s disease. Materials and methods: Eight focus groups were conducted with people with prodromal to late stage Huntington’s disease, caregivers (family members/formal), and healthcare professionals. An analytical coding framework was developed from the data and Levanthal’s self-regulation model to assist analysis. Results and conclusions: Key themes were identified: evolving representations of Huntington’s disease and physical activity; varying social environment of the person with Huntington’s disease and the impact on physical activity; achieving physical activity participation while coping with the nuances of Huntington’s disease. Levanthal’s model facilitated understanding of physical activity experiences, however with progression, self-regulation of activities needs to become more collaborative with caregivers. A modified self-regulation model specific to physical activity in Huntington’s disease is presented. Using a novel approach to generate new understanding of physical activity across the Huntington’s disease lifespan facilitated development of an original and significant theoretical foundation to underpin development of a range of much needed physical activity and exercise interventions in Huntington’s disease. •Implications for rehabilitation •Social and familial context of individuals with HD is a key consideration for health care professionals supporting physical activity participation. •Strategies such as using physical activity as a way of achieving control and adjusting expectations can help people with HD to continue to be active. •People with HD adapt physical activity from high level to more functional activities with symptom progression.

Background Exercise is emerging as an important aspect in the management of disease-related symptoms and functional decline in people with Huntington disease (HD). Long-term evaluation of physical activity and exercise participation in HD has yet to be undertaken. Objective The objective is to investigate the feasibility of a nested randomized controlled trial (RCT) alongside a longitudinal observational study of physical activity and exercise outcomes in people with HD. Design This will be a 12-month longitudinal observational study (n = 120) with a nested evaluation of a physical activity intervention (n = 30) compared with usual activity (n = 30) using a “trial within a cohort” design. Setting The study will take place in HD specialist clinics in Germany, Spain, and the United States, with intervention delivery in community settings. Participants The participants will have early-mid–stage HD and be participating in the Enroll-HD study. Intervention This will be a 12-month physical activity behavioral change intervention, delivered by physical therapists in 18 sessions, targeting uptake of aerobic exercise and increased physical activity. Measurements All participants (n = 120) will complete Enroll-HD assessments (motor, cognitive, behavioral, and quality of life) at baseline and at 12 months. Additional Physical ACtivity and Exercise Outcomes in Huntington Disease (PACE-HD) assessments include fitness (predicted maximal oxygen uptake [V o2max]), self-reported and quantitative measures of physical activity, disease-specific symptoms, and walking endurance. RCT participants (n = 60) will complete an additional battery of quantitative motor assessments and a 6-month interim assessment. Enroll-HD data will be linked to PACE-HD physical activity and fitness data. Limitations The limitations include that the embedded RCT is open, and assessors at RCT sites are not blinded to participant allocation. Conclusion PACE-HD will enable determination of the feasibility of long-term physical activity interventions in people with HD. The novel “trial within a cohort” design and incorporation of data linkage have potential to reduce participant burden. This design could be applied to other neurological diseases and movement disorders where recruitment and retention are challenging.

Aim: This study aimed to evaluate the feasibility and cultural considerations of a minimally supervised, home-based exercise program in Jordan. Methods: Quantitative and qualitative approaches were used. Thirty participants were randomly allocated to either an 8-week intervention group (n = 16), or a standard care group (n = 14). The intervention incorporated the home use of an exercise DVD, walking program and initial instructional sessions and weekly phone calls provided by a physiotherapist. Interviews were used to explore feasibility. Unified Parkinson's disease rating scale (UPDRS-III); balance and walking speed were assessed. Results: The retention rate was 86.7% and mean adherence rate was 77%. Personal and sociocultural barriers of adherence to the exercise program were identified. UPDRS-III at follow-up was lower in the intervention group. Conclusion: A home exercise program was feasible. Sociocultural barriers specific to Arabic culture may affect the uptake of such an intervention in Parkinson's disease in these countries.