Improvement In Timed Up And Go Research Articles

IS EDUCATION ENOUGH? SEATED YOGA AND FALLS PREVENTION FOR OLDER ADULTS

Abstract Falls impact 25% of older adults 65+ annually (Bergen et al., 2016) with 1 in 5 falls resulting in trauma (CDC, 2020). Standing yoga can reduce falls by 48% (Hamrick et al., 2017), but some older adults cannot participate in these poses/inversions due to pain, lack of balance, and endurance. Seated yoga can reduce pain, fear of falling, mobility, and balance ( Yao & Tseng, 2019). Ong et al. (2021) found that falls education improves intention to engage in prevention. Although CDC (2022) suggests multi-modal interventions , no known research compares a combination of falls prevention education and seated yoga intervention with an education-only control group. This controlled study compared fifteen older adults living in HUD housing who received both an 8-week “Get Fit While You Sit” seated yoga (LVSY, 2021) and falls prevention education to those who only received falls prevention education. Physical testing (Timed Up and Go (TUG), chair stand test, 4-point balance test) and attitude/participation measures were measured in both groups. Wilcoxon signed rank and Kruskal-Wallis were used to compare pre-to-post and between groups. Results suggest that the multi-modal intervention (combined education and chair yoga) resulted in improvements in TUG and chair stand test but other measures (e.g. self-efficacy for falls) did not change over time. The education-alone group did not improve over time. Between groups, a sig. difference was found in TUG and Chair stand. More research is needed but older adults in LTC settings may benefit from combining seated yoga with prevention education.

Is walking maintained following discharge from prosthetic rehabilitation?

PURPOSE: To determine if people who walked with a lower limb prosthesis on discharge from rehabilitation continued to 20 weeks after discharge. MATERIALS AND METHODS: An observational cohort study design. People with major lower extremity amputation (LEA) who were discharged from rehabilitation using a prosthesis to walk and were due for prosthetic review appointment (20 weeks following discharge) during the period of data collection were eligible to be included. The primary outcome was the continuation of walking with a lower limb prosthesis at this time point (T2). Secondary outcome measures were: Timed Up and Go (TUG), Two Minute Walk Test (2MWT), SIGAM score, Locomotor Capability Index-5 (LCI-5), and Orthotic Prosthetic User Survey- Quality of Life (OPUS-QOL). Secondary outcomes were assessed at time of discharge from rehabilitation (T1) and repeated at T2. Statistical analysis was carried out comparing the results of the secondary outcome measures at T1 and T2. RESULTS: 22/28 participants were still walking with their prostheses at T2. Five of the six who abandoned walking with their prostheses did so because of issues with the skin on their residuum or contralateral foot. Participants who continued to walk with their prostheses demonstrated a statistically significant improvement in TUG (5.01 seconds, p < 0.01) and 2MWT (11.35 metres, p < 0.01) between the two time points. No statistically significant difference was found in LCI-5 or OPUS QOL scores between the two time points. CONCLUSION: Most participants continued to walk with their prosthesis and experienced further improvements in their exercise tolerance and decrease in their risk of falls after discharge.

Favorable Effects of 24-Week Whole-Body Vibration on Glycemic Control and Comprehensive Diabetes Therapy in Elderly Patients with Type 2 Diabetes.

BackgroundElderly patients with type 2 diabetes (T2DM) are vulnerable to treatment-inducible hypoglycemia, falls, and depressive symptoms. Although it is challenging for elderly patients to adhere to regular exercise, its positive effect on functional ability, glycemic control, and mental wellness offers comprehensive diabetes treatment. In the present study, we aimed to investigate a novel exercise approach for the elderly, focusing on whole-body vibration (WBV).MethodsThis retrospective cohort study was conducted in a primary-care setting at a medical fitness center affiliated with the incorporated medical institution of THY (TOTAL HEALTH YARD). Fourteen (WBV group) and 12 (control group) elderly patients with T2DM undergoing and not undergoing our WBV program, respectively, for > 6 months were analyzed. Primary endpoints were the functional ability changes, evaluated by Timed Up and Go (TUG), Sit-to-Stand test (SST), gait length, and grip test. Secondary endpoints were global glycemic control and questionnaires, namely the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and Geriatric Depression Scale (GDS). All records of exercise adherence and any adverse events were followed.ResultsSignificant improvements in TUG and SST were found only in the WBV group [TUG: 7.1 ± 0.9, 7.1 ± 0.8 to 7.0 ± 1.0, 6.6 ± 0.9 (s), P = 0.63, 0.01; SST: 10.4 ± 1.9, 11.3 ± 2.4 to 9.7 ± 2.3, 9.5 ± 2.1 (s), P = 0.62, P < 0.01, control vs. WBV group, respectively]. The WBV group demonstrated significant improvement of hemoglobin A1C levels (7.2 ± 0.8 to 6.9 ± 0.5, P < 0.01) and DTSQ and GDS scores, while the control group did not. There were no hypoglycemic events during the study. The WBV program adherence was 93.3 ± 8.0%.ConclusionWe demonstrated the favorable effect of WBV training on balance, diabetes treatment, and mood. Therefore, WBV training can be proposed as comprehensive therapy in a safe manner and potentially has a positive effect on health-related quality of life in elderly patients with T2DM.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01068-0.

Improved function and strength in patients with knee osteoarthritis as a result of adding a two-day educational program to usual care. Prospective randomized trial

ObjectiveThe primary aim was to quantify the improvements on function and pain of patients with knee osteoarthritis (KOA), short education and low income by a two-day self-management program. Secondary aims were verifying if the program improves clinically relevant measures of weight and strength. DesignA prospective randomized clinical trial was conducted in a tertiary hospital in Brazil with 191 patients with Kellgren & Lawrence grades II and III KOA who were allocated to two groups: control (usual care- CG) and intervention (usual care and two days of an OA self-management program with a multiprofessional team - IG). Western Ontario and McMaster Universities Index (WOMAC), weight, body mass index (BMI), Timed up and go (TUG) and five Times Sit to Stand Test (FTSST) were assessed at baseline, six, 12 and 24 months. ResultsGroups were similar at baseline (p ​> ​0.05). Both groups exhibited improved WOMAC total and subsets scores throughout the study (p ​< ​0.001). However, only IG improved WOMAC total and subsets in all follow-ups above 20% (minimally clinically important difference), with differences in WOMAC pain, function and total scores (p ​= ​0.001, p ​< ​0.001, and p ​< ​0.001, respectively) and best effect sizes at 1 year (0.355, 0.651 and 0.770, respectively). IG group lost weight (p ​< ​0.001) and BMI (p ​< ​0.01). Both groups exhibited improvements in TUG and FTSST (p ​< ​0.001) that remained in all evaluations. FTSST results favored the IG, p ​= ​0.032. ConclusionsAn educational program to patients with KOA, short schooling and low income improves clinically important measures of pain and function.

Enhancing sensory acuity and balance function using near-sensory biofeedback-based perturbation intervention for individuals with traumatic brain injury.

Interventions addressing balance dysfunction after traumatic brain injury (TBI) only target compensatory aspects and do not investigate perceptual mechanisms such as sensory acuity. To evaluate the efficacy of a novel intervention that integrates sensory acuity with a perturbation-based approach for improving the perception and functional balance after TBI. A two-group design was implemented to evaluate the effect of a novel, perturbation-based balance intervention. The intervention group (n = 5) performed the intervention with the sinusoidal (0.33, 0.5, and 1 Hz) perturbations to the base of support with amplitudes derived using our novel outcome of sensory acuity - perturbation perception threshold (PPT). The efficacy is evaluated using changes in PPT and functional outcomes (Berg Balance Scale (BBS), Timed-up and Go (TUG), 5-meter walk test (5MWT), and 10-meter walk test (10MWT)). There was a significant post-intervention change in PPT for 0.33 Hz (p = 0.021). Additionally, clinically and statistically significant improvements in TUG (p = 0.03), 5MWT (p = 0.05), and 10MWT (p = 0.04) were observed. This study provides preliminary efficacy of a novel, near-sensory balance intervention for individuals with TBI. The use of PPT is suggested for a comprehensive understanding and treatment of balance dysfunction. The promising results support the investigation in a larger cohort.

Locomotor Function and Pain in Total Ankle Arthroplasty Patients at Six Months’ Follow-Up

Category:Ankle; Ankle ArthritisIntroduction/Purpose:Outcomes following total ankle arthroplasty (TAA) are largely positive, with high levels of patient satisfaction, but residual pain has been identified in up to 60% of cases. While associations between implant kinematics and pain following TAA have been found in a study of walking gait, there have been no studies to date of pain and function during more challenging locomotor tasks. The purposes of this study were (1) to examine pre- to post-operative (6 months) changes in function along with comparisons to healthy controls, and (2) to determine how functional changes are related to pain. We hypothesized that following TAA, function would improve but would not match that of healthy controls. We further hypothesized that improvements in function would be related to reductions in pain.Methods:Complete data sets were obtained for 11 TAA patients (age: 64.04 +- 9.26 y, height: 1.71 +- 0.07 m, body mass: 98.55+- 20.07 kg; 3 implant designs) and 15 age-matched control subjects (age: 63.14 +- 7.95 y, height: 1.68 +- 0.10 m, body mass: 75.57+- 13.66 kg). All procedures involving testing of human subjects were approved by the PSU HMC Institutional Review Board. Patients performed all tasks pre-operatively and six months post-operatively in a motion laboratory. Participants completed the RAND 36-Item Health Survey 1.0 (SF-36), whose global pain score was used in our analysis. Each patient and control participant performed three tasks to assess their locomotor function: Single-Leg Balance Test (SLBT); Timed Up-and-Go (TUG) Test, and Six- Minute Walk (6MW). Linear regression analysis incorporating covariates of change in pain (delta-pain) and BMI was performed to investigate how change in performance on these tests depended on these variables.Results:For 6MW velocity (r = 0.653, p = 0.030), normalized 6MW velocity (r = 0.624, p = 0.040), and SLBT (r = 0.695, p = 0.018) pre-operative scores were correlated with post-operative function. TUG performance had a very weak correlation (r = 0.226, p = 0.504) and pain levels had a moderate correlation (r = 0.646, p = 0.032). Linear regression did not predict change in function from delta-pain alone, but when BMI and the interaction of BMI with delta-pain were included, moderate to good fits for change in function were obtained (Table 1). Improvements in pain (when accounting for BMI) accounted for the majority of improvement in average walking velocity, and up to half of the variation in improvement in TUG.Conclusion:This is the first study relating changes in locomotor function to changes in pain following TAA. Our first hypothesis that performance on the three tests would be improved over pre-operative function, but without reaching that of healthy controls, was supported. Contrary to our second hypothesis, we found that pain improvement assessed using the pain score from the SF-36 did not explain variation in observed improvements in function. When we included the interaction between pain and BMI in our models, 80% of the changes in 6MW average velocity was explained, and approximately 50% of TUG time change was explained.

Effects of training with nintendo wii on balance and mobility in institutionalized elderly

Background: One of the consequences of the institutionalization of the elderly is the increased risk of falls. Games of video games have shown ability to improve balance in the elderly population, but there is no data on their use in institutionalized elderly. Objective: To evaluate the effects of training with Nintendo Wii on static balance and functional mobility in elderly living in Long-Term Care Facilities for Elderly. Methods: Participated in the research 10 institutionalized elderly, who underwent training with Nintendo Wii for eight weeks, twice a week. Functional mobility was assessed by the Timed Up and Go (TUG) test and the static balance by a force platform. Results: Significant improvement in TUG was observed (17.65 ± 4.38s pre-treatment and 15.30 ± 3.70s p= 0.03). There was no significant improvement in the static equilibrium variables, but there was a tendency for improvement. Conclusion: The results demonstrated that the intervention with Nintendo Wii significantly improved the functional mobility, but with no improvement in the static balance in the institutionalized elderly.

Multi-session anodal transcranial direct current stimulation enhances lower extremity functional performance in healthy older adults.

The aim of this study was to examine the effects of 5days of anodal-transcranial direct current stimulation (a-tDCS) over the primary motor cortex (M1) on lower extremity functional performance in healthy elderly people. This was a randomized, double-blinded, sham-controlled study whereby 32 healthy older individuals participated in two groups. The intervention group received 20min of a-tDCS (1mA) over the M1 on five consecutive days. The sham group received the same stimulation, but the tDCS device was turned off after 30s of stimulation. Participants were asked to perform the Timed Up and Go (TUG), 30-s Chair Stand Test (30-s CST), and a Modified Figure of Eight Walk Test (MFEWT) on the first day before tDCS application, immediately, 30min, and 1week after the last session of stimulation. Results of the a-tDCS group showed that most of the test values had significant changes in post-test assessments compared to the pre-test (p < 0.05). When comparing the anodal and sham tDCS groups, the results showed a significant improvement in TUG and time-MFEWT immediately after (p = 0.02, p = 0.01), 30min after (p = 0.04, p = 0.01) and 1week after the last session of stimulation (p = 0.01, p = 0.01). Improvements in performance of the 30-s CST and the number of steps-MFEWT were not significant, except at 1week after the last session for the steps-MFEWT (p = 0.04). The application of 20min a-tDCS over the M1 for 5 consecutive days improves lower extremity functional performance in the healthy older participants.

EFFECT OF MOTOR IMAGERY TRAINING IN COMBINATION WITH ELECTROMYOGRAPHY-TRIGGERED ELECTRICAL STIMULATION IN STROKE WITH HEMIPLEGIA PATIENTS: A RANDOMIZED CONTROLLED STUDY

Recently, motor imagery training combined with electromyography-triggered electrical stimulation (MIT EMG-ES) has been reported as a remedial treatment for stroke patients. However, the clinical evidence of the effect is still lacking. To investigate the effect of MIT EMG-ES on lower extremities and activities of daily of living (ADL) in patients with stroke, the participants were randomly assigned to an experimental group ([Formula: see text]) or control group ([Formula: see text]). The experimental group underwent MIT EMG-ES, whereas the control group performed underwent motor imagery training. In addition, both groups received the same conventional rehabilitation therapy. All participants underwent treatment for 30[Formula: see text]min a day, 5 sessions per week, for 4 weeks. Lower extremities function was measured by the Fugl–Meyer Assessment Lower Extremity (FMA-LE), Timed Up-and-Go (TUG) test and 10 m Walk (10[Formula: see text]MW) test. ADL were measured by the Korea version of the Modified Barthel Index (K-MBI). The experimental group except for the FMA-LE group showed more improvement in TUG and 10[Formula: see text]MW test scores than the control group ([Formula: see text]). The effect size showed FMA-LE, TUG, and 10[Formula: see text]MW test (0.7, 1.0, 0.7, respectively). However, there was no statistically significant difference between the two groups in K-MBI ([Formula: see text]). Our findings suggest that MIT EMG-ES may be a novel treatment for lower extremities function in patients with stroke better than MIT alone.

Use of home neuromuscular electrical stimulation in the first 6 weeks improves function and reduces pain after primary total knee arthroplasty: a matched comparison.

The use of neuromuscular electrical stimulation (NMES) after total knee arthroplasty (TKA) has been demonstrated to facilitate quadriceps muscle recovery and to reduce pain. However, to our knowledge, this therapeutic modality has not been directly tested in patients who receive muscle stimulators for home use immediately after surgery. Therefore, the purpose of this study was to assess the effect of NMES use at home in addition to standard therapy program in patients after primary TKA surgery, and to compare the early functional results to a matching group of post TKA patients who did not receive home NMES units. A total of 41 patients scheduled for a primary TKA during April 1st, 2017 to January 31st, 2018 were identified as being eligible for the study. There were 15 patients deemed ineligible to be part of the study, resulting in 26 patients who were fitted either 1 week before or within 1 week of surgery a home NMES device. The device was controlled by a smart phone. Patients were asked to use the NMES device daily for 20 minutes, 3 times a day, for 6 weeks after surgery. As their ability to activate their quadriceps muscle improved, patients were encouraged to increase their exercise regimens. The NMES patients were compared to a matched cohort of 26 patients who had a TKA performed between June 1st, 2015 and July 31st, 2016, but did not receive home an NMES device. Comparative outcomes included: timed up and go (TUG) test, single limb stance (SLS) time, time to ascend and descend one flight of stairs, quadriceps lag, active and passive range of motion (ROM), 2-minute walking distance, and pain rating on a visual analog scale (VAS). A P value of 0.05 was set as the threshold for statistical significance for the matched comparison. Patients in the home NMES had significantly better scores for quadriceps lag (P<0.001), TUG (P<0.001), time to ascend and descend one flight of stairs (P=0.001), SLS time (P<0.001). They also experienced significantly lower resting pain (P<0.001) and lower worst reported pain scores (P<0.001) compared to the control cohort. Additionally, there were a higher percentage of patients in the control cohort that could not use stairs reciprocally compared to the home NMES group (53.85% vs. 23.08%). Furthermore, passive range of motion for flexion was statistically better in the home NMES group (P=0.037). This matched comparison of primary TKA patients demonstrated significant pain reductions both at rest and lower worst reported pain scores and improved function with use of the home-based NMES units for the sub-acute phase of recovery. Patients walked longer distances safely as shown by improvements in TUG, quadriceps lag, and single limb support time. Larger proportions of patients in home NMES group were able to negotiate stairs reciprocally and faster than the matched control group. These findings may have important economic and functional implications for the post-operative care of TKA patient.

Effect of a high-speed bodyweight resistance training on timed up and go and one leg stance in older women

High-speed resistance training programs aiming to increase muscle power have beneficial effects on balance. To compare the effect of high-speed bodyweight resistance training and normal-speed bodyweight resistance training on the static and dynamic balance in community-dwelling older women. Thirty-five non-disabled community-dwelling women aged 65 to 80 years were trained for 12 weeks using a high-speed bodyweight resistance training (HS-BT) or a normal-speed bodyweight resistance training (NS-BT). At baseline and after the intervention, One Leg Stance (OLS) and Timed Up and Go (TUG) tests were measured. Participants with an attendance to training sessions of less than 70% were excluded from the final analysis. Data from 26 participants were analyzed, 14 women aged 71 ± 4 years who received HS-BT and 12 women aged 73 ± 4 years who received NS-BT. After 12 weeks of training, a significant improvement in TUG was observed in women receiving HS-BT (ΔTUG -1.07 sec, p < 0.01), but without changes in the OLS test. No significant changes were observed in any of the tests in the NS-BT group. High-speed bodyweight resistance training for 12 weeks improved TUG in these women.

Outcomes of Participation in a Community-Based Physical Activity Program.

Fit and Fall ProofTM (FFP) program, established in 2004, is a peer volunteer-led collaboration between state and local public health organizations. The goal is to bring sustainable physical activity programs to underserved populations, including those in rural and frontier communities. FFP program is designed to help older adults maintain independence by improving mobility and function and providing opportunities for social engagement. The aim of this study was to evaluate the impact of participation in the program. A 6-month longitudinal study evaluated physical, social, and emotional outcomes among participants. The FES-I, SF-36v2, and Timed Up and Go (TUG) were collected. A convenience sample of new participants (n = 120, mean age = 75) representing rural and urban communities were recruited. FFP produced results similar to programs using physiotherapists or athletic trainers. Significant improvements were seen in TUG and SF-36v2 measures of physical, social, and emotional health. Participants completing at least one 10-week session (66%) demonstrated sustained improvements on these measures. While the average change in TUG between baseline and 10 weeks was statistically significant (p = 0.003), improvement in TUG was dependent on age and attendance. For participants <75 years, all attendance levels resulted in similar improvements in TUG. However, for those ≥75, improvements were strongly associated with the number of classes attended. Both the raw data and the model-based estimates of TUG times demonstrated that as age and attendance increase, greater improvements in TUG times were observed. The FFP program promotes health equity by reaching community-dwelling, underserved senior populations. The FFP program is in its 15th year and serves as an example of a sustainable collaboration between state and local public health organizations that is translatable to both urban and rural settings.

Effectiveness of robotics fall prevention program among elderly in senior housings, Bangkok, Thailand: a quasi-experimental study.

ObjectiveThis study aimed at investigating the effectiveness of a robotic fall prevention program on knowledge, exercises, balance, and incidence of falls among elderly in senior housings.Patients and methodsThis is a quasi-experimental study. Sixty-four elderly in two senior housings in Bangkok with Barthel Index scale ≥12, who had either at least one fall experience in the past 12 months and/or had Timed Up and Go (TUG) test ≥20 seconds were recruited and purposively assigned to the intervention group (received a small robot-installed fall prevention software, personal coaching, and handbook, n=32) and control group (received only handbook, n=32). Outcomes were knowledge score evaluated by structured questionnaire through face-to-face interviews, number of exercises measured by self-recorded diary, and balance score assessed by TUG and Berg Balance Scale (BBS). The incidence of falls was assessed by face-to-face interviews. Both groups were assessed at baseline, 3rd, and 6th month after the intervention.ResultsThere was a statistically significant improvement in knowledge mean score at 6th month in both the groups. However, the intervention group showed faster increase in knowledge mean score than the control group at 3rd month (P<0.01). The intervention group showed a statistically significant higher number of exercises than the control group at 3rd and 6th month (P<0.05). There was no statistically significant difference on TUG and BBS mean scores between the two groups at baseline, 3rd, and 6th month. However, the intervention group showed a statistically significant improvement in TUG and BBS at 6th month post-intervention (P<0.01). There was one fall reported in the control group.ConclusionThe robotic fall prevention program increased knowledge on fall prevention and promoted exercises and balance among elderly in senior housings.

Feasibility of a community-based Functional Power Training program for older adults

PurposeCommunity-based programs can increase and sustain physical activity participation in older adults, even for those who are physically frail. We studied the feasibility and potential effect of a 12-week structured Functional Power Training (FPT) program involving high velocities and low loads for older adults conducted in a common area of their housing estate.Patients and methodsThe structured FPT program was conducted in collaboration with a health promotion social enterprise and a community service provider based in a public housing site. We recruited nine inactive residents as participants to the single, group-based, twice-weekly program. Attendance and adverse event(s) were recorded throughout the program. The Short Physical Performance Battery, Timed Up and Go (TUG), and 30s Sit-to-Stand tests were used to assess functional outcomes pre- and postprogram. The FRAIL Scale was used to assess their frailty status, and a postprogram experience survey was conducted.ResultsEight subjects (aged 74±10 years) completed the program with an average overall attendance of 90.3%, with at least five participants present for each session. Changes in functional outcomes showed a moderate-to-large effect with significant improvement in TUG (p<0.01). In addition, participants either reversed or maintained their frailty status (p<0.01). Overall, the program was perceived to be well structured, engaging, as well as providing physical and psychosocial benefits. No exercise-related adverse events occurred during the program, and participants were keen to recommend this program to others.ConclusionCommunity-based structured FPT is safe and feasible for frail older adults, with the potential to improve function and reverse frailty status.

Safety and efficacy of ADS-5102 (amantadine) extended release capsules to improve walking in multiple sclerosis: A randomized, placebo-controlled, phase 2 trial

Background: Walking impairment causes disability and reduced quality of life in patients with multiple sclerosis (MS). Objective: Characterize the safety and efficacy of ADS-5102 (amantadine) extended release capsules, 274 mg administered once daily at bedtime in patients with MS with walking impairment. Methods: This randomized, double-blind, placebo-controlled, 4-week study was conducted at 14 trial sites in the United States. Study objectives included safety and tolerability of ADS-5102, and efficacy assessments (Timed 25-Foot Walk (T25FW), Timed Up and Go (TUG), 2-Minute Walk Test, and Multiple Sclerosis Walking Scale-12). Fatigue, depression, and cognition also were assessed. Results: A total of 60 patients were randomized (30 to ADS-5102 and 30 to placebo); 59 of whom were treated. The most frequent adverse events (AEs) were dry mouth, constipation, and insomnia. Five ADS-5102 patients and no placebo patients discontinued treatment due to AEs. One patient in the ADS-5102 group experienced a serious AE—suspected serotonin syndrome. A 16.6% placebo-adjusted improvement was seen in the T25FW test (p < 0.05). A 10% placebo-adjusted improvement in TUG was also observed. No changes in fatigue, depression, or cognition were observed. Conclusion: ADS-5102 was generally well tolerated. These data demonstrate an effect of ADS-5102 on walking speed. Further studies are warranted to confirm these observations.

Improving Strength and Mobility of Adults with Multiple Sclerosis Through a 16-week Exercise Program

Canada has the highest prevalence rate of multiple sclerosis (MS) globally (291 per 100,000). People with MS often experience intense fatigue, muscle weakness, decreased aerobic endurance, loss of flexibility, and impaired balance and gait. To mitigate these symptoms, which negatively affect quality of life, physical activity is often recommended. PURPOSE: To examine the effectiveness of a 16-week exercise program on improving common symptoms of MS. METHODS: Nine adults diagnosed with MS (Mage: 51.3 years; range: 42-65 years, 1 male) completed a progressive exercise program including cardiovascular, strength, flexibility, balance, and proprioception exercises (60 minutes, twice a week for 16 weeks). General measurements of health, physical fitness, functional movement, cognitive function, and quality of life were collected pre-, mid-, and post-program. A one-way ANOVA with repeated measures (Session: pre-, mid-, post-program) was performed on all dependent measures (α = 0.05). Effect sizes were calculated using the partial omega-squared (ω2p) test. RESULTS: Collectively, participants showed significant (p < 0.05) improvements from pre- to post-program on the timed up-and-go (TUG) (ω2p = 0.21) and wall push-up tests (ω2p = 0.45). Strong trends (p < 0.1) toward improvement were shown for flexibility (ω2p = 0.19), comfortable walking speed (CWS) (ω2p = 0.28), gait cadence (ω2p = 0.20), vitality (ω2p = 0.26), fatigue (ω2p = 0.17), and mental health (ω2p = 0.18). Individually, five participants showed improvement in mental health, six showed improvement in cadence, and seven showed improvement in one or more of TUG, wall push-ups, flexibility, CWS, vitality, and fatigue (all pre- to post-program). CONCLUSIONS: The progressive exercise program was successful in providing significant improvement in mobility (TUG) and upper body strength (wall push-ups). Although not statistically significant, strong trends were recognized in the areas of gait (CWS and cadence, which support the significant improvement in TUG) and quality of life (vitality, fatigue, and mental health), which may be functionally meaningful. Future research could investigate the possibility of using exercise to slow the progression of the degenerative effects of the disease. Supported by the University of Windsor Strategic Priority Fund.

P029 Effects of dual-mode non-invasive brain stimulation on freezing of gait in patients with Parkinson’s disease

Purpose Our previous study demonstrated the favorable effect of repetitive transcranial magnetic stimulation (rTMS) over both the dominant primary motor cortex of lower leg (M1-LL) and the left dorsolateral prefrontal cortex (DLPFC). The aim of this study was to investigate the effects of dual-mode non-invasive brain stimulation (NBS) on FOG using both rTMS and tDCS in patients with PD. Methods This study was a randomized controlled double-blind study comparing the effect of single vs. dual-mode stimulation. Thirty-two patients with PD that featured FOG were included and divided into two groups. For the dual-mode stimulation, 10 Hz rTMS over the dominant M1-LL and the anodal tDCS over the left DLPFC were simultaneously applied for 20 min per session, 5 sessions in a week. For the single stimulation, rTMS were applied at the same manner. Behavioral, neurophysiologic and cognitive outcomes were measured before, after, and 1 week after the intervention by the Timed Up and Go (TUG) test, Standing Start 180° Turn (SS-180° Turn Step/Time) test, Unified Parkinson’s Disease Rating Scale (UPDRS) part III, FOG Questionnaire (FOG-Q), motor evoked potential, Korean version of Montreal Cognitive Assessment (K-MOCA), Digit span-Forward/Back and Trail Making-A/B. Results There were significant improvements in TUG, SS-180° Turn Step, UPDRS part III and FOG-Q in both the dual-mode and the single stimulation group (p 0.05). The dual-mode stimulation also resulted in significant improvements in SS-180° Turn Time (p = 0.008), K-MOCA (p = 0.004), Digit span-Forward (p = 0.015) and Trail making-B test (p = 0.010), whereas single stimulation did not. Furthermore, improvement of Trail making-B test was significantly greater after the dual-mode stimulation than the single stimulation (p = 0.024). Conclusion The dual-mode stimulation using the 10 Hz rTMS over the dominant M1-LL and the anodal tDCS over the left DLPFC was more effective than single stimulation for improving FOG in combination with cognitive improvement in patients with PD.

Impact of hyponatremia on nerve conduction and muscle strength.

Hyponatremia is associated with unstable gait and propensity to falls. The potential contribution of peripheral nervous system dysfunction induced by hyponatremia has not yet been addressed by prospective studies. In the first part of this prospective study, we performed two tests evaluating muscle strength (grip test and quadriceps isometric contraction test) together with a timed up and go (TUG) test in 11 patients with chronic mild-to-moderate hyponatremia before and after the normalization of natremia. In the second part, we measured nerve conduction velocities and F-wave latencies in nine patients with profound hyponatremia (< 125 mmol/L) before and after the normalization of natremia. No significant change in muscle strength was observed when natremia was corrected from 127·7 ± 2·5 to 136·1 ± 1·8 mmol/L, contrary to a significant improvement in TUG from 14·9 ± 5·1 to 12·5 ± 4·7 s (P = 0·006). Nerve conduction velocities and F-wave latencies showed significant improvement in most of the studied nerves when natremia was corrected from 121·9 ± 2·4 to 135·5 ± 3·4 mmol/L (e.g. mean increase of 14·3% for motor nerve conduction and mean decrease of 21·6% for F-wave latency of left peroneal nerve). Whereas chronic mild-to-moderate hyponatremia has no impact on muscle strength, we demonstrate for the first time an impact of profound hyponatremia on nerve conduction studies. Further studies are needed to ascertain the contribution of these latter results on gait disturbances, propensity to falls and attention deficits associated with hyponatremia.

Effects of thai foot massage on balance performance in diabetic patients with peripheral neuropathy: a randomized parallel-controlled trial.

BackgroundPeripheral neuropathy is the most common complications of diabetic patients and leads to loss of plantar cutaneous sensation, movement perception, and body balance. Thai foot massage is an alternative therapy to improve balance. Therefore, the purpose of this study was to investigate the effects of Thai foot massage on balance performance in diabetic patients with peripheral neuropathy.Material/MethodsSixty patients with type-2 diabetes were recruited and randomly assigned into either the Thai foot massage or control groups. The Thai foot massage group received a modified Thai traditional foot massage for 30 min, 3 days per week for 2 weeks. We measured timed up and go (TUG), one leg stance: OLS), the range of motion (ROM) of the foot, and foot sensation (SWMT) before treatment, after the first single session, and after the 2-week treatment.ResultsAfter the single treatment session, only the Thai foot massage group showed a significant improvement in TUG. After the 2-week treatment, both Thai foot massage and control groups showed a significant improvement of TUG and OLS (P<0.05); however, when comparing between 2 groups, the Thai foot massage group showed better improvement in TUG than the control group (p<0.05). The Thai foot massage group also showed significant improvements in ROM and SWMT after the 2-week treatment.ConclusionsThe results of this study suggest that Thai foot massage is a viable alternative treatment for balance performance, ROM of the foot, and the foot sensation in diabetic patients with peripheral neuropathy.

Wii Fit and Balance

Computer-based active gaming has recently gained in popularity as an intervention in physical therapy clinics. However, little evidence exists supporting its effectiveness especially in the elderly population. The purpose of this pilot study was to determine whether a 4-week, computer-based balance intervention using the Wii Fit is effective as an intervention to improve balance in community-dwelling older adults. Community-dwelling adults aged 65 to 80 years were recruited from 2 local community centers. Sixteen older adults participated in a balance exercise program utilizing the Wii Fit 2 times a week for 4 weeks. Changes in balance were assessed by comparing preintervention and postintervention measures using the Timed Up and Go (TUG) and Functional Reach Test (FRT). The Activities-specific Balance Confidence Scale was used to determine the participants' perceived confidence in specific activities. Participants demonstrated improvements in balance as indicated by statistically significant changes in TUG and FRT (P < .05). The data from this pilot study showed improvements in TUG and FRT scores, suggesting that Wii Fit balance games may be used as a clinical intervention to improve balance in community-dwelling adults aged 65 to 80 years. The positive data outcomes warrant further investigation in using the Wii Fit as a balance intervention in a larger target population.