Daily Activities Of Patients Research Articles

Cognitive Impairment in Parkinson's Disease without Dementia: Subtypes and Influences of Age

Background and PurposeCognitive impairments are common in Parkinson's disease (PD), although the severity of these impairments does not significantly impair the patient's daily activities. The aim of this study was to determine the frequency of mild cognitive impairment (MCI) of Parkinson's disease (PDMCI) and its subtypes in nondemented PD patients. We also evaluated the influence of age on the pattern of subtypes of PDMCI.MethodsA total of 141 consecutive, nondemented PD patients underwent a comprehensive neuropsychological assessment covering the five cognitive domains: attention, language, visuospatial, memory, and executive functions. PDMCI was defined as impaired performance in at least one of these five cognitive domains. The influence of age on the distribution of subtypes of PDMCI was assessed by comparing patients in two groups dichotomized according to their age at assessment (younger vs. older).ResultsFifty-seven (40.4%) of the nondemented PD patients had an impairment in at least one domain, and were therefore considered as having PDMCI. The age at assessment and age at disease onset were significantly higher in the PDMCI patients. The amnestic type of PDMCI was the most frequent, followed by the visuospatial, linguistic, executive, and attention types in that order. The frequency of PDMCI was higher for all subtypes in the older group; the domain that was influenced the most by age was executive function.ConclusionsMCI was common in PD and the subtypes were diverse. Age was found to be an important risk factor for the development of PDMCI, particularly for the executive subtype. These results indicate that the concept of MCI should be introduced in PD.

A Dynamical State Space Representation and Performance Analysis of a Feedback-Controlled Rotary Left Ventricular Assist Device

The left ventricular assist device (LVAD) is a mechanical device that can assist an ailing heart in performing its functions. The latest generation of such devices is comprised of rotary pumps which are generally much smaller, lighter, and quieter than the conventional pulsatile pumps. The rotary pumps are controlled by varying the rotor (impeller) speed. If the patient is in a health care facility, the pump speed can be adjusted manually by a trained clinician to meet the patient's blood needs. However, an important challenge facing the increased use of these LVADs is the desire to allow the patient to return home. The development of an appropriate feedback controller for the pump speed is therefore crucial to meet this challenge. In addition to being able to adapt to changes in the patient's daily activities by automatically regulating the pump speed, the controller must also be able to prevent the occurrence of excessive pumping (known as suction) which may cause collapse of the ventricle. In this paper we will discuss some theoretical and practical issues associated with the development of such a controller. As a first step, we present and validate a state-space mathematical model, based on a nonlinear equivalent circuit flow model, which represents the interaction of the pump with the left ventricle of the heart. The associated model is a six-dimensional vector of time varying nonlinear differential equations. The time variation occurs over four consecutive intervals representing the contraction, ejection, relaxation, and filling phases of the left ventricle. The pump in the model is represented by a nonlinear differential equation which relates the pump rotational speed and the pump flow to the pressure difference across the pump. Using this model, we discuss a feedback controller which adjusts the pump speed based on the slope of the minimum pump flow signal, which is one of the model state variables that can be measured. The objective of the controller is to increase the speed until the envelope of the minimum pump flow signal reaches an extreme point and maintain it afterwards. Simulation results using the model equipped with this feedback controller are presented for two different scenarios of patient activities. Performance of the controller when measurement noise is added to the pump flow signal is also investigated.

Lower limb activity and its determinants in COPD

Background:Patients with chronic obstructive pulmonary disease (COPD) walk less than healthy older people and their self-reported activity predicts exacerbation risk. The relationship between lower limb activity and total daily activity...

Shoe Modification and the Use of Orthoses in the Treatment of Foot and Ankle Pathology

Shoe modification and foot orthoses can play an important role in the nonsurgical management of foot and ankle pathology. Therapeutic footwear may be used to treat patients with diabetes, arthritis, neurologic conditions, traumatic injuries, congenital deformities, and sports-related injuries. These modalities may improve patient gait and increase the level of ambulation. They also may be used to treat acute problems such as plantar fasciitis or metatarsalgia and as preventive tools in patients with diabetic neuropathy. Shoe selection is primarily based on the condition of the patient, the foot shape and type, and the patient's daily activities. Modifications include flares, which provide stability; extended shanks to reduce bending stresses; rocker soles to rock the foot from heel strike to toe-off; and relasting, or reshaping, shoes to accommodate deformities. The four main types of custom orthoses are the accommodative, which cushions and protects the foot; the semi-rigid, which cushions and protects as well as provides support, control, and weight redistribution; the rigid, which offers arch support; and the partial foot prosthesis, which addresses partial amputations and helps protect the foot.

Neuromodulators for Migraine Prevention

Migraine is a debilitating condition characterized by a cycle of painful headaches and headache-related symptoms interspersed with periods of worry, distress, and apprehension. The negative impact of migraine on patient functioning, workplace productivity, and other daily activities has been demonstrated through the use of a variety of clinician- and patient-reported assessment tools, including the Migraine-Specific Questionnaire and the Migraine Disability Assessment questionnaire. In addition to considering the frequency and severity of migraine, clinicians need to encourage more open dialogue with their patients about the impact of this disorder on daily activities and productivity. Only then can the most appropriate course of treatment be determined. Appropriately prescribed acute and preventive therapies should break the cycle of migraine and improve the daily activities of patients with this chronic condition. Divalproex sodium and topiramate are neuromodulators that are approved by the US Food and Drug Administration (FDA) for the prophylaxis (prevention) of migraine headache in adults. Non-FDA-approved neuromodulators sometimes used in the management of migraine headache include gabapentin, lamotrigine, levetiracetam, and zonisamide. All medications need to be titrated, and treatment-related adverse events need to be managed appropriately. Preventive medications should be taken for at least 2-3 months to ascertain their therapeutic effect.

Five‐Year Follow‐Up of a Cordotomy

Percutaneous cervical cordotomy is an invasive procedure to treat severe, opioid-resistant cancer pain. It is usually proposed for patients with a limited life expectancy. As a consequence, objective quantification of the long-term effects of this procedure is lacking. The present report describes a patient who was treated with a right-sided percutaneous cervical cordotomy for refractory cancer pain. Afterward, disseminated seminoma was diagnosed, which was cured with chemotherapy. Five years after the procedure, a qualitative and quantitative evaluation of the long-term effects was performed. Sensory dysfunction was observed in the left side of the body, but no motor neuron or autonomic dysfunction was observed. The influence of these long-term effects on the patient's daily activities was limited.

Sclerotherapy of Lower Extremity Varices: Optimal Cosmetic Results

Today sclerotherapy is superior than surgical and non-surgical treatments to relieve the symptoms and to reach the optimal cosmetic result for small, localized, primary varices of lower extremity. This article reviews the indications, application methods and complications for sclerotherapy of the lower extremity varices. Sclerotherapy has the advantage of not requiring general or regional anesthesia and takes much less time than equivalent surgical techniques. It is more cheaper than surgery,does not limit patient's daily activities and if successful has the best cosmetic appearance with asymptomatic life. If the procedure is performed in the hands of experts the risk and secondary side effects of the treatment are minimal and rates of success should approach 100%.

Effects of modified constraint-induced movement therapy on reach-to-grasp movements and functional performance after chronic stroke: a randomized controlled study

Objective: To evaluate changes in (1) motor control characteristics of the hemiparetic hand during the performance of a functional reach-to-grasp task and (2) functional performance of daily activities in patients with stroke treated with modified constraint-induced movement therapy. Design: Two-group randomized controlled trial with pretreatment and posttreatment measures. Setting: Rehabilitation clinics. Subjects: Thirty-two chronic stroke patients (21 men, 11 women; mean age=57.9 years, range=43—81 years) 13—26 months (mean 16.3 months) after onset of a first-ever cerebrovascular accident. Intervention: Thirty-two patients were randomized to receive modified constraint-induced movement therapy (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for three weeks. Main measures: Kinematic analysis was used to assess motor control characteristics as patients reached to grasp a beverage can. Functional outcomes were evaluated using the Motor Activity Log and Functional Independence Measure. Results: There were moderate and significant effects of modified constraint-induced movement therapy on some aspects of motor control of reach-to-grasp and on functional ability. The modified constraint-induced movement therapy group preplanned reaching and grasping (P=0.018) more efficiently and depended more on the feedforward control of reaching (P=0.046) than did the traditional rehabilitation group. The modified constraint-induced movement therapy group also showed significantly improved functional performance on the Motor Activity Log (P<0.0001) and the Functional Independence Measure (P=0.016). Conclusions: In addition to improving functional use of the affected arm and daily functioning, modified constraint-induced movement therapy improved motor control strategy during goal-directed reaching, a possible mechanism for the improved movement performance of stroke patients undergoing this therapy.

Measurement of daily activity in restrictive type anorexia nervosa

The assessment of daily activity in patients with restrictive type anorexia nervosa is limited by an absence of accurate and precise technology. We wanted to test a daily activity detecting device named, the physical activity monitoring system (PAMS). Women participants with restrictive type anorexia nervosa (n = 8, 36 +/- 11 years, 17 +/- 2 kg/m(2)) and healthy women participants (n = 8, 30 +/- 11 years, 27 +/- 7 kg/m(2)) were asked to lie, sit, and stand motionless, and walk at 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 mph while wearing PAMS. For all restrictive type anorexia nervosa and healthy participants, body posture was correctly detected for all measurements (300/300). There was excellent correlation of an individual's body acceleration with walking velocity and walking energy expenditure (r(2) > .99). The PAMS technology could serve as a tool for lending insight into the pathophysiology of restrictive type anorexia nervosa; and potentially measuring compliance with activity recommendations for medical professionals treating individuals with restrictive type anorexia nervosa.

The Impact of Topiramate on Health‐Related Quality of Life Indicators in Chronic Migraine

Chronic migraine is a disabling primary chronic daily headache disorder that significantly impacts the daily activities of patients with this disorder. To our knowledge, this is the first report of a large, randomized, double-blind, placebo-controlled trial that assessed the impact of topiramate on the daily activities, emotional distress, headache-related disability, and global impression of change in patients with chronic migraine. To assess whether topiramate 100 mg/day reduces migraine-related disability and limitations of daily activities in patients with chronic migraine. Patients aged > or =18 years with chronic migraine were randomized 1 : 1 ratio to topiramate 100 mg/day or placebo. The double-blind period lasted 16 weeks. Three patient-reported outcome measures were administered: Migraine Disability Assessment, Migraine-Specific Quality of Life Questionnaire (Domains: Role Function Restrictive and Preventive and Emotional Function), and Subject's Global Impression of Change. Investigators completed a Physician's Global Impression of Change for each patient. Subject's Global Impression of Change and Physician's Global Impression of Change were completed one time, at the end of study, and measured on a 7-point scale (1 = very much improved to 7 = very much worse). The Migraine-Specific Quality of Life Questionnaire was analyzed using analysis of covariance (last observation carried forward) approach. Results were not adjusted for multiplicity. A total of 328 patients were randomized (topiramate, n = 165; placebo, n = 163), and 306 patients were included in the intent-to-treat population. Mean age was 38.2 years, and a majority of the patients were female (85.3%). Fifty-six percent of topiramate-treated patients vs 45% of placebo-treated patients reported >50% improvement from baseline in Migraine Disability Assessment scores (P = .074). The Migraine-Specific Quality of Life Questionnaire analysis demonstrated significant improvements at week 4 in all 3 domains, and at weeks 8 and 16 in both Role Function-Restrictive and Emotional Function domains (P < .05). Role Function-Preventive approached, but did not reach significance, at week 8 (P = .053). Seventy-five percent and 72% of topiramate-treated patients vs 61% and 59% of placebo-treated patients reported improvements on the Subject and Physician's Global Impression of Change scales (P = .025 and P = .037, respectively). Compared with placebo-treated patients, topiramate 100 mg/day appears to contribute to reductions in migraine-related limitations on daily activities and emotional distress beginning as early as week 4 and continuing up to week 16 after treatment. Physician's Global Impression of Change results are very similar with Subject's Global Impression of Change, indicating concordance between the physician's and the subject's assessment of improvement.

Isquemia silenciosa na doença coronariana estável em vigência de tratamento medicamentoso

Few data are available on the behavior of myocardial ischemia during daily activities in patients with coronary artery disease receiving antianginal drug therapy. To study the mechanism generating myocardial ischemia by evaluating blood pressure and heart rate changes in patients with stable atherosclerotic disease receiving drug therapy and with evidence of myocardial ischemia. Fifty non-hospitalized patients (40 males) underwent 24-hour electrocardiographic monitoring synchronized with blood pressured monitoring. Thirty five episodes of myocardial ischemia were detected in 17 patients, with a total duration of 146.3 minutes; angina was reported in five cases. Twenty nine episodes (100.3 minutes) occurred during wakefulness, with 11 episodes (35.3 + 3.7 min) in the period from 11 a.m. to 3 p.m. Blood pressure and heart rate evaluation in the three ten-minute intervals following the ischemic episodes showed a statistically significant difference (p< 0.05), unlike that shown for the three intervals preceding the episodes. However, during the ischemic episode, a higher than 10-mmHg elevation in blood pressure and 5 beats per minute in heart rate were observed when compared with the time interval between 20 and 10 minutes before the episode. The mean heart rate at the onset of ischemia during the exercise test performed before the study was 118.2 + 14.0, and 81.1 + 20.8 beats per minute on the 24-hour electrocardiogram (p < 0.001). The incidence of silent myocardial ischemia is high in stable coronary artery disease and is related to alterations in blood pressure and heart rate, with different thresholds for ischemia for the same patient.

Measuring Perceived Harmfulness of Physical Activities in Patients With Chronic Low Back Pain: The Photograph Series of Daily Activities—Short Electronic Version

Cognitive-behavioral models of chronic low back pain (CLBP) predict that dysfunctional assumptions about the harmfulness of activities may maintain pain-related fear and disability levels. The Photograph Series of Daily Activities (PHODA) is an instrument to determine the perceived harmfulness of daily activities in patients with CLBP. This study examined the psychometric properties of a short electronic version of the PHODA (PHODA-SeV). The results show that the PHODA-SeV measures a single factor and has a high internal consistency. The test-retest reliability and stability of the PHODA-SeV over a 2-week time interval are good, with discrepancies between 2 measurements over 20 points suggesting true change. The construct validity is supported by the finding that both self-reported pain severity and fear of movement/(re)injury were uniquely related to the PHODA-SeV. Validity is further corroborated by the finding that patients who have received exposure in vivo, that aimed to systematically reduce the perceived harmfulness of activities, had significantly lower PHODA-SeV scores after treatment than patients receiving graded activity that did not address these assumptions. The findings support the PHODA-SeV as a valid and reliable measure of the perceived harmfulness of activities in patients with CLBP. Preliminary normative data of the PHODA-SeV are presented. This article describes a pictorial measurement tool (PHODA-SeV) for the assessment of the perceived harmfulness of activities in patients with chronic low back pain. The PHODA-SeV has good psychometric properties and can be used to elaborate on the contribution of beliefs about harmful consequences of activities to pain and disability.

Self‐administered acupressure reduces the symptoms that limit daily activities in bronchiectasis patients: pilot study findings

To examine and compare the effects of acupressure on the perceived health-related quality of life of the participants with bronchiectasis. In an attempt to offer comfort, pain control and symptom management, nursing is becoming increasingly involved in offering complementary-alternative medicine as part of its caring-healing focus in comprehensive patient care. Acupressure is one such modality that is being increasingly used by both medical and nursing professionals. While acupressure has been reported to have beneficial effects in patients with respiratory disease, the benefits to bronchiectasis patients have remained uncertain. A randomized, partially blinded study consisting of three groups. Thirty-five out-patients of both genders, aged 59.46 SD 11.52 years, who were suffering from bronchiectasis, were randomly split into one of three groups: standard care with supplemental acupressure for eight weeks (11 participants); standard care with supplemental sham acupressure for eight weeks (11 participants); and standard care alone (13 participants). Outcomes were determined by changes in daily sputum amounts, sputum self-assessment, six-minute walking distance, breathing difficulty (measured on the dyspnea visual analogue scale) and health-related quality of life (measured by the Saint George Respiratory Questionnaire). The sputum self-assessment score improved over time for the sham acupressure participants (P = 0.03), when compared with the controls. For acupressure participants, the Saint George respiratory questionnaire activity component scores also improved over time, compared with controls (P = 0.01) after adjustment for covariates (treatment, time, age, sex and baseline values). Other variables did not differ between the standard care alone group and the other two groups. Eight weeks of self-administered acupressure could be useful in reducing the effects of bronchiectasis on a patient's daily activities. Acupressure may be regarded as a viable nursing intervention.

Vaginal pressure during daily activities before and after vaginal repair

The objective of the study was to measure vaginal pressure during various daily activities in patients before and after vaginal surgery for pelvic organ prolapse, searching data for evidence-based activity guidelines. Vaginal pressure (VP) was studied in 23 patients during activities such as rest, pelvic floor contraction (PFC), coughing, Valsalva, rising from sitting to standing and lifting 2 and 5 kg with four different lifting techniques. VP was measured before, 1-5 days and 4-6 weeks after vaginal repair. Mean VP was four to five times higher during coughing and Valsalva compared to PFC and lifting 2 and 5 kg. Lifting in the walking position created a slightly higher VP compared to other lifting techniques, which did not differ. The VP did not increase when lifting 5 kg compared to 2 kg. Mean VP during coughing and Valsalva were significantly lower 1-5 days after the operation. VP was not related to the type of vaginal repair. The results imply that post-operative counselling should concentrate more on treating chronic cough and constipation than restrictions of moderate physical activities.

Correlation between the shuttle walking distance and daily activities in patients with COPD

Correlation between the shuttle walking distance and daily activities in patients with COPD

Clinical outcomes of wrist arthrodeses with wrist fusion plate

目的 评价腕关节融合钢板内固定术的临床疗效.方法 2000年7月-2004年12月,采用腕关节融合钢板内固定术治疗创伤性腕关节炎21例.随访内容包括腕关节疼痛程度、手指关节活动度、握力和X线片.根据Buck-Gramcko/Lohmannn评分表评价腕关节总体功能,DASH调查表评价腕关节融合术对患者日常活动及生活质量的影响.结果 术后21例获得随访,平均随访时间为20个月.术后患侧腕部疼痛值平均为1.5(术前4.5),12例掌指关节和10例拇指指间关节出现轻微背伸功能障碍,腕部握力为30 kg(健侧为38 kg).X线片示腕关节全部骨性融合.Buck-Gramcko/Lohmannn评分值为8.7,其中优5例、良10例,中6例.DASH值为32,DASH调查表结果表明腕关节融合术后部分日常活动受限.结论 腕关节融合钢板内固定成功率高,腕关节疼痛明显减轻,但术后腕关节部分功能丧失。

Assessing the Ability of Topiramate to Improve the Daily Activities of Patients With Migraine

To assess the impact of topiramate on the daily activities of patients with migraine. We performed a randomized, double-blind, placebo-controlled multicenter trial Initiated on March 1, 2001, and completed on April 4, 2002. Patient-reported data from the Migraine Specific Questionnaire (MSQ) and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) were collected at baseline and at weeks 8, 16, and 26 from an intent-to-treat population receiving either topiramate, 50, 100, or 200 mg/d, or placebo. Two activity-related MSQ domains (role restrictive [MSQ-RR] and role prevention [MSQ-RP]) and 2 activity-related SF-36 domains (role physical [SF36-RP] and vitality [SF36-VT]) were the prospectively designated secondary outcome measures. The changes in MSQ and SF-36 scores for each treatment group were calculated by measuring the area under the curve from week 8 (the beginning of the maintenance period) through week 26 of the double-blind phase, relative to the prospective baseline. A mixed-effect piecewise linear regression model was used to estimate average domain score over time. Patients receiving topiramate, 100 or 200 mg/d, had significantly reduced mean monthly (28-day) migraine frequency (P = .008 and P < .001, respectively) compared with placebo, but not patients receiving topiramate, 50 mg/d (P = .48). Topiramate significantly improved mean MSQ-RR domain scores (50 mg/d [P = .02], 100 mg/d [P< .001], and 200 mg/d [P < .001]) and mean MSQ-RP domain scores (50 mg/d [P = .007], 100 mg/d [P = .001], and 200 mg/d [P= .002]) vs placebo. Topiramate, 100 and 200 mg/d, significantly improved mean SF36-RP domain scores vs placebo (P = .02). Topiramate (all doses) improved SF36-VT domain scores, although not significantly vs placebo. Changes in prospectively designated domain scores were significantly correlated with changes in mean monthly migraine frequency (P < or = .001 [MSQ domains], P < or = .002 [SF-36 domains]). Patient-reported migraine-specific outcomes measured by the MSQ-RR and MSQ-RP domains improved significantly for those receiving topiramate (all doses) vs placebo. The SF36-RP domain scores improved significantly for patients receiving 100 or 200 mg/d of topiramate. Improvements in all 4 prospectively selected MSQ and SF-36 domains were significantly correlated with decreases in mean monthly migraine frequency.

403: Recovery and Return to Daily Activities of Patients After Discharge From Procedural Sedation: A Prospective Telephone Questionnaire

Emergency department (ED) patients who receive procedural sedation and analgesia (PSA) are frequently discharged home and may require additional care or support as a result of the medical illness, the procedure, or the PSA. Limited data supports any specific follow-up; there has been no extensive data on the functional status of patients after they leave the emergency department after PSA.

Treatment with Certolizumab Pegol 400 mg Improves Work Productivity and Daily Activities in Patients with Crohnʼs Disease

Treatment with Certolizumab Pegol 400 mg Improves Work Productivity and Daily Activities in Patients with Crohnʼs Disease

Adjunct armodafinil improves wakefulness and memory in obstructive sleep apnea/hypopnea syndrome

Armodafinil is the R-enantiomer of racemic modafinil and has a significantly longer half-life than the S-enantiomer. This study evaluated armodafinil 150 mg/day as an adjunct treatment for residual excessive sleepiness in patients with obstructive sleep apnea/hypopnea syndrome (OSA/HS) who were otherwise well controlled with nasal continuous positive airway pressure (nCPAP). We assessed the ability of armodafinil to improve wakefulness and cognition and reduce fatigue in this population. In this 12-week, randomized, double-blind study, patients (n=259) received armodafinil (150 mg) or placebo once daily. Efficacy assessments at baseline and weeks 4, 8, and 12 included the Maintenance of Wakefulness Test (MWT), Clinical Global Impression of Change (CGI-C), Cognitive Drug Research battery, Epworth Sleepiness Scale, and Brief Fatigue Inventory. At final visit, mean (SD) MWT sleep latency increased from baseline by 2.3 (7.8) min with armodafinil and decreased by 1.3 (7.1) min in the placebo group (P=0.0003). Armodafinil improved clinical condition (CGI-C, 71% vs. 53% for armodafinil and placebo, respectively; P=0.0069). Armodafinil significantly improved episodic secondary memory (P=0.0102) and patient-estimated wakefulness (P<0.01) and reduced fatigue (P<0.05) compared with placebo. Armodafinil did not adversely affect nCPAP use. The most common adverse event associated with armodafinil was headache. Sleep macroarchitecture was not altered by armodafinil. Adjunct treatment with armodafinil significantly improved alertness, overall clinical condition, and long-term memory. Armodafinil also reduced fatigue and the impact of sleepiness on daily activities in patients with OSA/HS who have residual excessive sleepiness notwithstanding regular use of nCPAP. Armodafinil was well tolerated.