Tinetti Balance Scale Research Articles

Vestibular rehabilitation has positive effects on balance, fatigue and activities of daily living in highly disabled multiple sclerosis people: A preliminary randomized controlled trial.

Balance disorders are present in patients with Multiple Sclerosis and part of these disorders could be of vestibular origin. Vestibular Rehabilitation was found to be effective in improving balance in patients with central vestibular dysfunction. To investigate the clinical effects of vestibular rehabilitation on balance skills and secondly on fatigue and activity of daily living in highly disabled multiple sclerosis people. Thirty hospitalized participants with severe multiple sclerosis (EDSS 6-7) were randomly assigned to the experimental group (15 patients -9F-; mean age 50.64±11.73) and the control group (15 patients -8F-; mean age 45.77±10.91). All patients were evaluated before and after treatment with the Expanded Disability Status Scale, Barthel Index Tinetti Balance and Gait scale, Berg Balance Scale, Fatigue Severity Scale, Two Minute Walking Test and Timed 25-foot walk test. Two follow-ups (i.e., at 30 and 60 days after treatment) were carried out with Barthel Index. Significant improvement was found in the experimental group with respect to the control group (p < 0,05) in balance, fatigue perception, activities of daily living and short distance gait. No significant improvements were found for gait endurance as measured by Two Minute Walking Test. Four weeks of Vestibular Rehabilitation training results in less fatigue, improved balance and performance of the activities of daily living in patients with severe Multiple Sclerosis.

The role of robotic gait training coupled with virtual reality in boosting the rehabilitative outcomes in patients with multiple sclerosis

Motor impairment is the most common symptom in multiple sclerosis (MS). Thus, a variety of new rehabilitative strategies, including robotic gait training, have been implemented, showing their effectiveness. The aim of our study was to investigate whether an intensive robotic gait training, preceding a traditional rehabilitative treatment, could be useful in improving and potentiating motor performance in MS patients. Forty-five patients, who fulfilled the inclusion criteria, were enrolled in this study and randomized into either the control group (CG) or the experimental group (EG). A complete clinical evaluation, including the Expanded Disability Severity Scale, the Functional Independence Measure, the Hamilton Rating Scale for Depression, the time up and go test (TUG), and the Tinetti balance scale, was performed at baseline (T0), after 6 week (T1), at the end of rehabilitative training (T2), and 1 month later (T3). A significant improvement was observed in the EG for all the outcome measures, whereas the CG showed an improvement only in TUG. In contrast, from T1 to T2, only CG significantly improved in all outcomes, whereas the EG had an improvement only regarding TUG. From T2 to T3, no significant differences in Functional Independence Measure scores emerged for both the groups, but a significant worsening in Tinetti balance scale and TUG was observed for the CG and in TUG for the EG. Our study provides evidence that robotic rehabilitationn coupled with two-dimensional virtual reality may be a valuable tool in promoting functional recovery in patients with MS.

The Effect of a Physical Training with the Use of an Exoskeleton on Depression Levels in Institutionalized Elderly Patients: A Pilot Study.

The Human Body Posturizer (HBP) is an exoskeleton used in the neurorehabilitation. The HBP may improve motor control by stimulating the pre-frontal cortex, a brain region involved also in the inhibitory modulation of the amygdala whose hyperactivity is involved in the mechanisms of depression. The aim of the study was to investigate in institutionalized elderly patients the effects on depression of a physical training with the use of the HBP compared to a traditional training. Randomized controlled trial. 20 institutionalized patients (mean age = 88, ds = ± 5, 3 males) with moderate depression levels. The participants were randomly assigned to: a) HBP Group, which carried out physical training using the HBP; b) Excercise Group, which carried out a training without the use of the orthosis. The training was conducted for 6 months (3 sessions each week), with the same kind of exercises with or without the HBP according to the assignment group. Participants were evaluated at baseline using the Tinetti balance and Gait scale, the Mini Mental State Examination and the Geriatric Handicap Scale. The Geriatric Depression Scale was administered to the participants before and after the period of training. The two groups were homogeneous for age, baseline motor ability (risk falls), handicap score, cognitive functioning and depression levels. After 6 months of exercise training a significant reduction in depression levels was reported only in the HBP Group (p <.01). A positive effect of the HBP in the modulation of mood in institutionalized elderly subjects was found. It is possible to hypothesis that a traditional training without the HBP may require more time to achieve significant results. Clinical implications will be discussed.

Validity and Reliability Study of the Korean Tinetti Mobility Test for Parkinson's Disease.

Objective Postural instability and gait disturbance are the cardinal symptoms associated with falling among patients with Parkinson’s disease (PD). The Tinetti mobility test (TMT) is a well-established measurement tool used to predict falls among elderly people. However, the TMT has not been established or widely used among PD patients in Korea. The purpose of this study was to evaluate the reliability and validity of the Korean version of the TMT for PD patients.Methods Twenty-four patients diagnosed with PD were enrolled in this study. For the interrater reliability test, thirteen clinicians scored the TMT after watching a video clip. We also used the test-retest method to determine intrarater reliability. For concurrent validation, the unified Parkinson’s disease rating scale, Hoehn and Yahr staging, Berg Balance Scale, Timed-Up and Go test, 10-m walk test, and gait analysis by three-dimensional motion capture were also used. We analyzed receiver operating characteristic curve to predict falling.Results The interrater reliability and intrarater reliability of the Korean Tinetti balance scale were 0.97 and 0.98, respectively. The interrater reliability and intra-rater reliability of the Korean Tinetti gait scale were 0.94 and 0.96, respectively. The Korean TMT scores were significantly correlated with the other clinical scales and three-dimensional motion capture. The cutoff values for predicting falling were 14 points (balance subscale) and 10 points (gait subscale).Conclusion We found that the Korean version of the TMT showed excellent validity and reliability for gait and balance and had high sensitivity and specificity for predicting falls among patients with PD.

Tools for assessing fall risk in the elderly: a systematic review and meta-analysis.

The prevention of falls among the elderly is arguably one of the most important public health issues in today's aging society. The aim of this study was to assess which tools best predict the risk of falls in the elderly. Electronic searches were performed using Medline, EMBASE, the Cochrane Library, CINAHL, etc., using the following keywords: "fall risk assessment", "elderly fall screening", and "elderly mobility scale". The QUADAS-2 was applied to assess the internal validity of the diagnostic studies. Selected studies were meta-analyzed with MetaDisc 1.4. A total of 33 studies were eligible out of the 2,321 studies retrieved from selected databases. Twenty-six assessment tools for fall risk were used in the selected articles, and they tended to vary based on the setting. The fall risk assessment tools currently used for the elderly did not show sufficiently high predictive validity for differentiating high and low fall risks. The Berg Balance scale and Mobility Interaction Fall chart showed stable and high specificity, while the Downton Fall Risk Index, Hendrich II Fall Risk Model, St. Thomas's Risk Assessment Tool in Falling elderly inpatients, Timed Up and Go test, and Tinetti Balance scale showed the opposite results. We concluded that rather than a single measure, two assessment tools used together would better evaluate the characteristics of falls by the elderly that can occur due to a multitude of factors and maximize the advantages of each for predicting the occurrence of falls.

Positive Effects of Specific Exercise and Novel Turning-based Treadmill Training on Turning Performance in Individuals with Parkinson's disease: A Randomized Controlled Trial.

Two different training strategies to improve turning performance in individuals with Parkinson’s disease (PD) were designed and investigated in this study. Subjects were randomly assigned to a specific exercise group, turning-based training group, or control group to receive training that emphasized balance and strengthening, turning-based treadmill training, and general exercise training, respectively. A total of 12 30-min training sessions followed by 10 min of turning training on a level surface were administered over 4 to 6 weeks. The results (n = 12 for each group) showed that both the specific exercise and turning-based training group experienced improved turning performance, the primary outcome, compared with the control group (specific exercise, 33% change, p = 0.016; turning-based training, 35% change, p = 0.021). For the secondary outcomes, the specific exercise group performed better than the control group on the Tinetti balance scale, limit of stability test and lower extremity extensor and abductor strength. The turning-based training groups performed better than the control group in sensory organization and ankle plantar flexor strength. In summary, specific exercise training and turning-based treadmill training were both effective in improving turning performance in participants with PD. However, the improvements in turning performance of these two groups resulted from improving different aspects of impairment in individuals with PD.

Motor performance differentiates individuals with Lewy body dementia, Parkinson’s and Alzheimer’s disease

IntroductionDifferential diagnosis of dementia with Lewy bodies (DLB), Parkinson’s disease with dementia (PDD), Parkinson’s disease (PD) and Alzheimer’s disease (AD) is challenging. Comparative motor profiles of these neurodegenerative disorders may aid in earlier diagnosis but have not been extensively studied. MethodsGroups were rigorously matched by age, education, and sex. DLB/PDD participants were matched by Mini-Mental State Examination Score to individuals with AD and by Unified Parkinson’s Disease Rating Scale motor scores to individuals with PD. Gait, balance, dual task walking and hand dexterity measures were compared between a combined group (n=21) of individuals with Lewy body dementia (LBD) consisting of those with DLB (n=11) and PDD (n=10) to individuals with PD (n=21) or AD (n=21). ResultsIndividuals at the same disease stage with LBD walked significantly slower with shorter stride lengths (p<0.05), demonstrated poorer balance on both the Tinetti and Berg Balance Scale, and poorer performance on dual-task and figure-of-eight walking compared to PD and AD (p<0.05 for all) groups. Upper extremity coordination on the 9-hole peg test differentiated LBD from both PD and AD and was the only motor test in which individuals with AD performed worse than those with PD. Tinetti balance subscores were significantly lower in PDD compared to DLB participants (10.4±2.3 versus 12.8±2.3; p=0.027). ConclusionsMotor features distinguish individuals with LBD from those with AD and PD. Measures of gait, balance and finger dexterity provide an additional means of differentiating individuals with LBD from those with AD and PD.

Measurement instruments to assess posture, gait, and balance in Parkinson's disease: Critique and recommendations.

Disorders of posture, gait, and balance in Parkinson's disease (PD) are common and debilitating. This MDS-commissioned task force assessed clinimetric properties of existing rating scales, questionnaires, and timed tests that assess these features in PD. A literature review was conducted. Identified instruments were evaluated systematically and classified as "recommended," "suggested," or "listed." Inclusion of rating scales was restricted to those that could be used readily in clinical research and practice. One rating scale was classified as "recommended" (UPDRS-derived Postural Instability and Gait Difficulty score) and 2 as "suggested" (Tinetti Balance Scale, Rating Scale for Gait Evaluation). Three scales requiring equipment (Berg Balance Scale, Mini-BESTest, Dynamic Gait Index) also fulfilled criteria for "recommended" and 2 for "suggested" (FOG score, Gait and Balance Scale). Four questionnaires were "recommended" (Freezing of Gait Questionnaire, Activities-specific Balance Confidence Scale, Falls Efficacy Scale, Survey of Activities, and Fear of Falling in the Elderly-Modified). Four tests were classified as "recommended" (6-minute and 10-m walk tests, Timed Up-and-Go, Functional Reach). We identified several questionnaires that adequately assess freezing of gait and balance confidence in PD and a number of useful clinical tests. However, most clinical rating scales for gait, balance, and posture perform suboptimally or have been evaluated insufficiently. No instrument comprehensively and separately evaluates all relevant PD-specific gait characteristics with good clinimetric properties, and none provides separate balance and gait scores with adequate content validity for PD. We therefore recommend the development of such a PD-specific, easily administered, comprehensive gait and balance scale that separately assesses all relevant constructs. © 2016 International Parkinson and Movement Disorder Society.

Fall prevention in the young old using an exoskeleton human body posturizer: a randomized controlled trial.

Fall risk in elderly has been related with physical decline, low quality of life and reduced survival. To evaluate the impact of exoskeleton human body posturizer (HBP) on the fall risk in the elderly. 150 subjects (mean age 64.85; 79M/71 F) with mild fall risk were randomized into two groups: 75 for group treated with human body posturizer (HBP group) and 75 for physical training without HBP group (exercise group). The effects of interventions were assessed by differences in tests related to balance and falls. Medically eligible patients were screened with Tinetti balance and Gait evaluation scale, short physical performance battery and numeric pain rating scale to determine fall risk in elderly people. In the HBP group there was a significant improvement in short physical performance battery, Tinetti scale and Pain Numeric rating scale with a significant reduction in fall risk (p<0.05). In the exercise group we observed only minimal variations in the test scores. The results at the sixth and twelfth months show a twofold positive effect in the HBP group reducing fall risk and improving quality of life by reducing pain. The use of exoskeleton human body posturizer seems to be a new significant device for prevention of fall in elderly patients. Further research should be carried out to obtain more evidence on effects of robotic technology for fall prevention in the elderly.

Strategies for obstacle crossing in older adults with high and low risk of falling.

[Purpose] Tripping is a frequent cause of falls among aging adults. Appropriate limb movements while negotiating obstacles are critical to trip avoidance. The aim of our study was to investigate the mechanics of obstacle crossing in older adults at low or high risk of falling. [Subjects and Methods] Twenty community-dwelling adults aged ≥55 years, were evaluated with the Tinetti Balance and Gait scale and classified as being at high or low risk of falling. Between-group comparisons of kinematics were evaluated for obstacle heights of 10%, 20%, and 30% of leg length. [Results] The high-risk group demonstrated greater toe-obstacle clearance of the leading leg. Increasing obstacle height led to increased maximal toe-obstacle clearance, toe-obstacle distance, and shortened swing phase of the leading limb. Adaptation of clearance height was greater for the trailing leg. Individuals at high risk of falling demonstrated less symmetry between the leading and trailing legs and a narrower step width, features that increase the likelihood of tripping. [Conclusion] Kinematic parameters of obstacle clearance, including the symmetry index described in our study, could provide clinicians with a quick screening tool to identify patients at risk of falling and to evaluate outcomes of training programs.

A New Therapeutic Strategy and Rehabilitation in Hereditary Collagen Diseases: Case Report

The Ehlers-Danlos syndrome (EDS) is the most common hereditary disorder of connective tissue, with main manifestations in skin, joints and cardiovascular system. Hyperelasticity of skin, joint hypermobility and fragility of vessels and internal organs are responsible for severe physical disability and loss of autonomy in ADL (activities of daily life). Aim of the Study: To demonstrate efficacy in patients with hereditary disorders of connective tissue of dietary supplements based on collagen hydrolyzate in association with proprioceptive rehabilitation, by Prokin system, in improving postural stability, osteo-articular painful symptoms and bone density for the recovery of autonomy in ADL. Materials and Methods: A patient of 53 years with genetic diagnosis of Ehlers-Danlos Syndrome type Classic (mutation COL1A1) who had several sprains in the lower limbs, complained pain syndrome in the left ankle and right knee, associated with postural instability. We assessed him by WOMAC, VAS pain scale and Tinetti Balance Scale; by proprioceptive multiaxial test of Prokin; and by bone densitometry. Then he underwent 2 cycles of 10 sessions of proprioceptive rehabilitation with Prokin. In addition, he was prescribed therapy for one month with the PROTOCOL dietary supplement of collagen hydrolyzate 1 flc / day. At the end of the 2 cycles, all the previous tests and evaluations were repeated. Results: The comparison between the scores at T0 (one day before treatment) and T1 (one day after treatment) showed a reduction of pain and stiffness and an improvement of physical function (WOMAC scale from 26/96 to 0/96, VAS of pain from "intense" to "no pain". Postural instability measured by Tinetti balance scale reduced at time t1 compared to t0; This finding has been confirmed by proprioceptive test of prokin, with a reduction in the percentage of error (ATE) from 34% to 20%, and the index of instability from 1.2 to 0.80. After a month of therapy PROTOCOL, dietary supplement of hydrolyzed collagen 1 flc / day, a reduction in the T-score at DEXA from -2.6 to -1.6 was documented. Also at clinical examination at T1, we found reduced postural instability in monopodalic standing, and less critical postural changes, with significant improvement of functional independence and quality of life of the patient. Conclusions: The preliminary results show how the integration of a proprioceptive rehabilitation, such as Prokin exercises, with dietary supplementation of collagen can lead to a reduction (in this case a resolution) in pain and a functional improvement and recovery of autonomy in ADL. Keywords: Collagen supplements, Ehlers-Danlos syndrome, hereditary disorders, Prokin, rehabilitation, Tinetti Balance Scale.

Functional electrical stimulation may reduce bradykinesia in Parkinson's disease: A feasibility study.

ObjectivesThis feasibility study investigated the effect of combined upper and lower limb functional electrical stimulation (FES) to reduce bradykinesia in Parkinson’s disease (PD).MethodEleven people with PD and Hoehn and Yahr score 2–3 used FES to assist dorsiflexion and hand opening or fine hand movements for 2 weeks. Outcome measures were the nine-hole peg test, box and block test, 10 m walking test, Tinetti balance scale, modified Parkinson’s disease quality of life questionnaire (PDQL), SPES/SCOPA scale, and compliance. All tests were carried out without FES. Comparisons were tested using the Student paired t-test.ResultsTwo participants dropped out due to difficulty in using the equipment. Mean walking speed increased by 0.29 m s−1 (p = 0.002), step length by 0.09 m (p = 0.007), and cadence by 19.8 steps min−1 (p = 0.045). Tinetti balance score increased by 2.9 (p = 0.006). There was an increase in the box and block test of 5.1 (p = 0.025). The PD symptoms score of the PDQL improved by 4.9 (p = 0.013) and a reduction in SPES/SCOPA score of 5.7 (p = 0.005) indicated a reduced impact of PD.ConclusionsFES produced clinically meaningful improvements in gait and upper limb function. Some participants found using both interventions challenging and we would recommend that their introduction be staggered.

Optimizing Eating Performance for Long-Term Care Residents With Dementia: Testing the Impact of Function-Focused Care for Cognitively Impaired

ObjectivesThe objective of this study was to evaluate the impact of a well-developed theory-based function-focused care for cognitively impaired (FFC-CI) intervention on eating performance among long-term care (LTC) residents with moderate-to-severe cognitive impairment. DesignA secondary analysis of longitudinal data from 2 cluster-randomized controlled trials that originally tested the impact of FFC-CI on all function and physical activities. Participants and SettingParticipants were 199 residents with moderate-to-severe cognitive impairment from 4 nursing homes and 4 assisted living facilities. MeasurementsData at baseline, and 3 and 6 months were used. Resident outcome data used in this analysis included eating performance conceptualized using the single self-care “feeding” item in the Barthel Index, cognitive function by Mini-Mental State Examination, sitting balance conceptualized using the single “chair sit-sitting balance” item in the Tinetti Gait and Balance scale, physical capability by Physical Capability Scale, depression by Cornell Scale for Depression in Dementia, and agitation by Cohen-Mansfield Agitation Inventory (short form). ResultsAt baseline, almost one-third (32.2%) of the 199 residents needed help with eating. There was no significant change with regard to eating performance over time in both groups, and no significant treatment by time difference between groups in eating performance (P = .195). ConclusionCurrent findings support a need to revise the FFC-CI to better address eating performance. Future work may benefit from a stronger focus on eating performance rather than the more commonly addressed functional tasks, such as bathing, dressing, and ambulation. In addition, the inclusion of a more heterogeneous group of LTC residents with regard to eating performance is needed to test the impact of the revised approach on eating performance.

Working on asymmetry in Parkinson's disease: randomized, controlled pilot study.

Posture, gait and balance problems are very disabling symptoms in Parkinson's disease (PD). An increased stride-to-stri de variability, reduction of automaticity and asymmetry of lower limbs function characterize parkinsonian gait. These features predispose to freezing of gait (FOG), which often leads to falls. The aim of this study was to evaluate how the modulation of asymmetry through physiotherapy might improve gait and reduce FOG, thus preventing falls. Twenty-eight PD patients entered a double-blind pilot feasibility controlled study and were evaluated at baseline and after 3 months of a rehabilitative program (performed twice a week) by means of the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS-III), Gait and Falls Questionnaire, Tinetti balance and gait scale, Short Physical Performance Battery (SPPB), European Quality of Life questionnaire. Patients were randomly assigned to three treatment arms: (1) worst side improvement; (2) best side improvement; (3) standard therapy. All study arms showed a significant improvement of the Tinetti and SPPB scores. BSI led to a greater improvement than ST in terms of UPDRS-III (p = 0.01); Tinetti total score (p = 0.05) and Tinetti gait subscore (p = 0.01). Our study confirms the efficacy of physical therapy in the treatment of PD and, more importantly, suggests that specific intervention tailored on individual feature (e.g., asymmetry of motor condition) might be even more effective than standard rehabilitative programs.

Neurocognitive rehabilitation in Parkinson's disease with motor imagery: a rehabilitative experience in a case report.

A 50-year-old female with Parkinson's disease underwent a neurocognitive rehabilitation program consisting of one-hour-lasting sessions attended twice a week for three months. The balance and the risk of falls were determined using the Tinetti Balance and Gait Evaluation Scale. The pain was determined using the Visual Analog Scale and the course of the disease was examined using the Unified Parkinson's Disease Rating Scale (UPDRS). Endpoints were before the treatment, at the end of the treatment, and at a 12-week follow-up. The aim of this study is to evaluate the efficacy of neurocognitive rehabilitation in PD with motor imagery. Primary outcome is the improvement in balance and the falls risk reduction; secondary outcome is lower limb pain reduction.

Correlation of Foot Posture, Foot Function with Balance and Gait in Patients with Diabetic Neuropathy

Objective : To assess foot posture, foot function and correlate it with balance in patients with diabetic neuropathy. Materials and Method : The presence of neuropathy was evaluated using a clinical scale. Foot posture was evaluated using foot posture index. Foot function was evaluated using foot function index. Balance was evaluated using Tinetti's Balance Scale (POMA) and Bergs Balance Scale (BBS). Results : There is significant correlation of FFI and POMA with BBS with r value of 0.7028 and p value of 0.0008. There is a significant correlation of FFI, POMA and BBS with r value of -0.4491, - 0.4547 and -0.5892 and p value of 0.0188, 0.0172 and 0.0012.there is a significant correlation of duration of diabetes with POMA, BBS with r value of -0.3394 and -0.3504 and p value of 0.0159 and 0.0126. There is a significant correlation of severity of neuropathy with POMA and BBS with r value of - 0.2901 and -0.3165 and p value of 0.0410 and 0.0251. Conclusion: In this study thus there was a positive correlation of pronated foot with balance, duration of diabetes with balance and severity of neuropathy with balance.

Percepção Fisioterapêutica de Indivíduos Parkinsonianos Correlacionando Escalas de Avaliação

ABSTRACT Introduction: Parkinson’s disease is characterized by tremor, bradykinesia, rigid muscles, and postural instability. It may lead to neurological, cognitive, and respiratory alterations, causing functional limitations that vary according to the level of symptomatic severity. As a result, daily life and labour activities may be decreased, in addition to gradual self-removal from social life. Objective: To correlate assessment scales from the kinetic functional state, cognitive impairment, and quality of life in three individuals living with Parkinson’s disease. Material and Methods: Three patients were involved in the study, two female and one male, age group varying between 51 and 61 years and educational level varying since completed elementary school up to graduate degree in the educational area. In order to characterize the study subjects as to Parkinson’s disease staging, before starting the physiotherapeutic treatment, the following questionnaires were used: Mini-Mental State Examination (MEEM), Functional Independence Measure (FIM), Parkinson’s Disease Questionnaire (PDQ-39), and Tinetti Mobility and Balance Scale / Gait Scale. Results: The three patients presented deficit in both balance and gait analyses, with distinct walking movements, such as idling, short steps and asymmetrical steps. All patients also showed moderate risk of falls. Conclusion: There was a correlation as to the application of the assessment scales of the kinetic-functional state, given that the three patients showed balance and gait deficits detected in the Tinetti’s Mobility and Balance Scale and in the Gait test. DESCRIPTORS Parkinson’s Disease. Disability Assessment. Quality of Life.

Correlation of trunk impairment with balance in patients with chronic stroke

To evaluate the correlation between the trunk impairment and balance in patients with chronic stroke. Thirty subjects with chronic stroke participated in the study. The subjects were evaluated with the trunk impairment scale (TIS) and Tinetti balance scale (TBS). Spearman's correlation showed highly significant correlation between TIS and TBS scores (rho = 0.911). The study reveals that the trunk impairment and balance in subjects with stroke are positively correlated with each other.

19 Working on asymmetry in Parkinson’s disease: A double-blind, randomized, controlled rehabilitation trial

Background Posture, gait and balance problems are very disabling symptoms in Parkinson’s disease (PD). Gait cycle in PD shows increased stride-to-stride variability because of the reduction of gait automaticity and asymmetry of lower limbs function. These feature predispose to freezing of gait (FOG) and recurrent falls. Aim of the study was to evaluate how the modulation of asymmetry through physiotherapy might improve gait and FOG preventing falls. Methods Twenty-eight PD patients entered the study and were evaluated at baseline and after three months of rehabilitative program (performed twice a week) by means of the motor part of the Unified Parkinson’s Disease Rating Scale (UPDRS-III), Gait and Falls Questionnaire (GFQ), Tinetti balance and gait scale, Short Physical Performance Battery (SPPB), European Quality of Life questionnaire (EQ-5D). Patients were randomly assigned to (1) physiotherapy for worst side improvement (WSI), (2) physiotherapy for best side improvement (BSI), and (3) standard physical therapy (SPT). Patients were unaware of study’s aim and evaluations were carried out by blinded physiotherapist and doctor. Results After three months, all three groups showed a significant improvement at the Tinetti and SPPB scores. The magnitude of change (end of treatment compared to baseline) was analyzed among groups: BSI led to a greater improvement than SPT in terms of UPDRS-III ( p = 0.01), Tinetti total score ( p = 0.05) and Tinetti gait subscore ( p = 0.01). No other significant differences arose. Conclusions Our study confirms the usefulness of physical therapy in the treatment of PD and, more importantly, suggests that specific intervention tailored on individual feature (e.g. asymmetry of motor condition) might be even more effective than standard rehabilitative programs. The impact of such approach on the benefit duration and rate of falls should be prospectively assessed by future trials.

Functional Decline in Hospitalized Older Adults: Can Nursing Make a Difference?

Function-focused care (FFC) is an approach to care in which nurses help patients engage in activities of daily living (ADL) and physical activity, with the goal of preventing avoidable functional decline. This prospective, observational study, conducted with hospitalized older adults (N = 93) examined: 1) the demographic and clinical characteristics of patients who were provided FFC activity, and 2) the relationship between change in physical activity and FFC activities. Patients who received FFC were more likely: to be younger (P = .028); had one or more falls during the hospitalization (P = .048); had demonstrated better functional performance at admission (P = .004) and better physical capability, measured by the Tinetti gait and balance scale (P = .004). FFC was associated with less decrement in ADL function, admission to discharge, while considering patient characteristics (t = 7.6; P < .008). Results suggest that hospitalized older persons can benefit from FFC.