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Consciousness has intrigued philosophers and scholars for millennia and has been the topic of considerable scientific investigation in recent decades. Despite its importance, there is no unifying definition of the term, nor are there widely accepted measures of consciousness. Indeed, it is likely that consciousness—by its very nature—eludes measurement. It is, however, possible to measure how consciousness manifests as a lived experience. Yet here, too, holistic measures are lacking. This investigation describes the development and validation of the Awareness Atlas, a measure of the manifestation of consciousness. The scale was informed by heart-based contemplative practices and the resulting lived experience with a focus on the impacts of manifestation of consciousness on daily life. Four hundred forty-nine individuals from the USA, Canada, India, and Europe participated in psychometric testing of the scale. Exploratory and confirmatory factor analyses were used for validation, demonstrating excellent validity in measuring manifestation of consciousness. The final model fit exceeded all required thresholds, indicating an excellent fitted model with a single dimensionality to measure the manifestation of consciousness comprised of four subscales: Relationship to Others; Listening to the Heart; Connection with Higher Self; and Acceptance and Letting Go. Number of years meditating and practicing Heartfulness meditation were positively related to the total and subscale scores. Test–retest reliability was excellent for the total scale, and good to excellent for the four subscales. Findings demonstrate that the Awareness Atlas is a well-constructed tool that will be useful in examining changes in manifestation of consciousness with various experiences (e.g., meditation, lifealtering conditions). [ABSTRACT FROM AUTHOR]

When designing repeated measures studies, both the amount and the pattern of missing outcome data can affect power. The chance that an observation is missing may vary across measurements, and missingness may be correlated across measurements. For example, in a physiotherapy study of patients with Parkinson's disease, increasing intermittent dropout over time yielded missing measurements of physical function. In this example, we assume data are missing completely at random, since the chance that a data point was missing appears to be unrelated to either outcomes or covariates. For data missing completely at random, we propose noncentral F power approximations for the Wald test for balanced linear mixed models with Gaussian responses. The power approximations are based on moments of missing data summary statistics. The moments were derived assuming a conditional linear missingness process. The approach provides approximate power for both complete-case analyses, which include independent sampling units where all measurements are present, and observed-case analyses, which include all independent sampling units with at least one measurement. Monte Carlo simulations demonstrate the accuracy of the method in small samples. We illustrate the utility of the method by computing power for proposed replications of the Parkinson's study. [ABSTRACT FROM AUTHOR]

The benefits of meditation have been effectively documented. Neural correlates demonstrating different areas of the brain affected by meditation practice have contributed to our understanding of its multifarious effects. What is lacking are theories of meditation that help elucidate and map the effects of meditation on consciousness. This article seeks to contribute to this research employing phenomenological enquiry into the lived experience of thirteen Heartfulness meditation practitioners who have been meditating from four to forty-four years. Heartfulness is a spiritual practice originating from the teachings of Ram Chandra seeking to bring balance between the inner field of the heart and the outer world of relationships and work. Interviews with participants from Europe, the USA, and India focused on the question, 'How does Heartfulness meditation practice affect or permeate your daily life? Following a hermeneutically informed phenomenological approach, attention was given to the existential dimensions of lived relationality, space, time and embodiment. Phenomenological accounts of emergent meaning and experience are offered, which illuminate some of the changes participants find from their meditation practice in everyday life. These findings suggest that further qualitative enquiry may shed light on what one participant described as 'living at the cusp of two opposite things and you are living at a slightly higher plane, and the more I plunge into this deep silence, into this not knowing, there is this consciousness that expands". [ABSTRACT FROM AUTHOR]

Objective: he purpose of the study was to determine the impact of novel coronavirus 2019 (COVID-19) restrictions on community-based exercise classes for people with Parkinson disease (PD) and their instructors. Methods: Data were collected via custom-designed electronic surveys for people with PD and class instructors who reported attending or teaching PD-specific exercise class ≥1 time/week for ≥3 months prior to pandemic restrictions (March 2020). The PD group also completed the Godin Leisure-Time Questionnaire, Self-Efficacy for Exercise scale, Schwab-England scale, and Parkinson's Disease Questionnaire 8. Results: Eighty-seven people with PD (mean = 70 [7.3] years old) and 43 instructors (51 [12.1] years old) from the United States completed surveys (October 2020 to February 2021). Mean Schwab-England (84 [16]) and Parkinson's Disease Questionnaire 8 (21 [15]) scores indicated low-to-moderate disability in the PD group. Ninety-five percent of the PD group had COVID-19 exposure concerns, and 54% reported leaving home ≤1 time/week. Although 77% of the PD group scored "active" on the Godin Leisure-Time Questionnaire, the mean Self-Efficacy for Exercise Scale score (55 [24]) indicated only moderate exercise self-efficacy, and >50% reported decreased exercise quantity/intensity compared with pre-COVID. There was decreased in-person and increased virtual class participation for both groups. The top in-person class barrier for the PD (63%) and instructor (51%) groups was fear of participant COVID-19 exposure. The top virtual class barriers were lack of socialization (20% of PD group) and technology problems (74% of instructor group). Conclusion: During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and decreased exercise quantity and intensity. Virtual classes may not fully meet the needs of people with PD, and primary barriers include technology and lack of socialization. Impact: As COVID-19 restrictions wane, it is imperative to help people with PD increase exercise and activity. The barriers, needs, and facilitators identified in this study might help inform approaches to increase participation in exercise and activity for people with PD. Lay Summary: During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and a decrease in exercise quantity and intensity. If you have PD, virtual classes might not fully meet your needs. Primary barriers may include technology problems and lack of social interaction. [ABSTRACT FROM AUTHOR]

Background: The Movement Disorder Society revision of the Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) was designed to be more sensitive to mild motor severity than the Unified Parkinson's Disease Rating Scale (UPDRS). Objective: To test whether MDS‐UPDRS Part III items provide increased sensitivity to mild motor severity when compared to the same items of the UPDRS in de novo PD patients. Method: Using a sample of 129 de novo PD patients assessed at one time point simultaneously with both scales, we compared the scale's scores on the 17 items measuring the same motor function. The scaling anchors for the MDS‐UPDRS were Slight, Mild, Moderate and Severe, and for the UPDRS were Mild, Moderate, Severe and Marked. Using Classical Test Theory (CTT) we compared the distributions of the scaling anchors from the individual items. Using Item Response Theory (IRT), we examined the sensitivity of the scaling anchors from each scale to the latent‐trait measurement of overall parkinsonian motor severity. Results: There was 2193 observations of individual scaling anchors from the 17 items in both scales. The CTT approach revealed frequent floor effects with only the item assessing Gait demonstrating a significance difference in the scaling distribution between the scales (P = 0.005). The IRT analyses revealed similar levels of sensitivity to the latent trait of PD motor function. Conclusion: These results do not support increased sensitivity of MDS‐UPDRS over the UPDRS for assessing mild motor severity in de novo PD patients, with significant difference in the scaling only for the item assessing gait. [ABSTRACT FROM AUTHOR]

Background: Physical function is a common target of rehabilitation intervention to improve disability and physical activity after dysvascular lower‐limb amputation (LLA); yet, the influence of psychosocial factors on physical activity is unclear. Objective: To identify psychosocial factors with potential to influence clinically relevant measures of physical activity, physical function, and disability in light of participants' narratives. Design Convergent mixed‐methods. Setting: General community. Participants: Twenty participants with dysvascular LLA were enrolled if their most recent LLA was at least 1 year prior, they were ambulating independently with a prosthesis, and were between 45 and 88 years old. Intervention: Not applicable. Main Outcome Measures: Quantitative data included physical activity (activPAL; steps/d), physical function (Timed Up‐and‐Go; TUG), and disability (World Health Organization Disability Assessment Schedule 2.0; WHODAS 2.0). Qualitative data were collected via semistructured interviews. Results: Higher steps/d was moderately correlated with better TUG time (r = −.58, P <.01), but was not correlated with WHODAS 2.0 score (r = −0.18; P >.10). Qualitative analysis of interviews, using an inductive, team‐based, phenomenological approach, identified four themes: (1) perceptions of their prosthesis, (2) fear during mobility, (3) influence of LLA on life activities, and (4) positive outlook within social interactions. Mixed‐methods analysis used an iterative approach to interpret and describe how psychosocial factors influence physical activity in four exemplar cases. Conclusions: Physical activity in people with dysvascular LLA results from an interaction among perceptions of their prosthesis, fear during mobility, influence of LLA on life activities, and positive outlook within social interactions. The overlapping nature of these themes suggests that interventions targeting psychosocial factors may be associated with improved physical activity, physical function, and subsequent disability after dysvascular LLA. [ABSTRACT FROM AUTHOR]

Background: Interventions targeting psychosocial factors may improve rehabilitation outcomes for prosthesis users after lower‐limb amputation (LLA), but there is a need to identify targeted factors for minimizing disability. Objective: To identify psychosocial factors related to disability for prosthesis users after LLA in middle age or later. Design: Cross‐sectional study. Setting: General community. Participants: Participants with LLA (N = 122) were included in this cross‐sectional study if their most recent LLA was at least 1 year prior, they were ambulating independently with a prosthesis, and they were between 45 and 88 years old. Interventions: Not applicable. Main Outcome Measures: Disability, the primary outcome, was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS). Candidate psychosocial variables included self‐efficacy, social support, and motivation, measured using the Self‐Efficacy of Managing Chronic Disease questionnaire (SEMCD), Multidimensional Scale of Perceived Social Support questionnaire (MSPSS), and modified contemplation ladder (mCL), respectively. The hypothesis was that greater self‐efficacy, social support, and motivation would be associated with lower disability when controlling for covariates. Results: The covariate model, including etiology, age, sex, U.S. military veteran status, LLA characteristics, time since LLA, medical complexity, and perceived functional capacity, explained 66.1% of disability variability (WHODAS 2.0). Backward elimination of candidate psychosocial variables stopped after removal of motivation (P =.10), with self‐efficacy (P <.001) and social support (P =.002) variables remaining in the final model. The final model fit was statistically improved (P <.001) and explained an additional 6.1% of disability variability when compared to the covariate model. Conclusions: Greater self‐efficacy and social support are related to lower disability after LLA. Findings suggest there may be a role for interventions targeting increased physical function, self‐efficacy, and social support for ambulatory prosthesis users after LLA in middle age or later, especially when complicated by multiple chronic conditions. [ABSTRACT FROM AUTHOR]

Background and purpose: This study examined the association of a commonly used gait assessment, the Dynamic Gait Index, with falls and lower extremity and trunk muscle function in people with multiple sclerosis. Materials and methods: Cross-sectional data from 72 people with multiple sclerosis (Expanded Disability Status Scale 3.5 ± 1.14) were used. The ability of the Dynamic Gait Index to identify fallers was evaluated using the receiver operating characteristic curve. Multiple linear regression determined contributions of muscle function variables to Dynamic Gait Index scores. Results: Thirty-seven participants reported at least one fall in the previous 3 months (51%). The area under the curve for the Dynamic Gait Index was 0.80 (95% CI: 0.69–0.90), indicating a good ability to identify fallers with a cutoff of ≤19/24. After adjusting for age, sex, and disability level, a one standard deviation increase in ankle plantarflexion (15.2 repetitions) and trunk flexion (15.1 repetitions) endurance were associated with an increase in Dynamic Gait Index score of 0.73 (95% CI: 0.07–1.39) and 0.62 (95% CI: 0.002–1.25), respectively. Conclusions: The Dynamic Gait Index may be a useful tool to identify fallers, and was associated with ankle plantarflexion and trunk flexion endurance. The Dynamic Gait Index appears to be a useful tool to identify people with multiple sclerosis at increased risk for falls using a cutoff score of ≤19/24. The ability to do fewer than 13 single leg heel raises had a moderate ability to identify fallers in this study. Out of 11 lower extremity and trunk muscles, only ankle plantarflexion and trunk flexion muscle endurance were significant predictors of Dynamic Gait Index scores. Clinicians may consider targeting ankle plantarflexion and trunk muscle endurance to improve dynamic gait and fall risk in patients with multiple sclerosis. [ABSTRACT FROM AUTHOR]

Disturbances in the visual, vestibular, and oculomotor systems have been identified in Parkinson's disease (PD). Patients' perspectives regarding these symptoms remain unexplored and may provide insights on functional implications of these symptoms and guide future interventions. The goal of this study is to elicit perceptions of individuals with PD with respect to visual, vestibular, and oculomotor deficits. Methods: Twenty-nine individuals with PD participated in focus group discussions. Participants discussed visual, vestibular, and oculomotor deficits they experience and how these deficits affect function. Discussions were recorded, transcribed, and coded. Inductive qualitative data analysis techniques were used to interpret responses. Results: Four themes emerged: 1) participants perceived visual, vestibular, and oculomotor deficits and related these deficits to their PD diagnosis; 2) participants perceive that these deficits affect function; 3) participants suggested these deficits are not recognized by healthcare providers; and 4) participants indicated they receive limited treatment for these deficits. Conclusions: Visual, vestibular, and oculomotor deficits are under-reported and under-assessed symptoms, which have a significant impact on the lives of people with PD. Healthcare providers should be aware of such deficits. The findings suggest that the healthcare team can better identify these deficits and identify important future areas of research. [ABSTRACT FROM AUTHOR]

Background: Early Intervention (EI) is a federally mandated, state-administered system of care for children with developmental delays and disabilities under the age of three. Gaps exist in the process of accessing EI through pediatric primary care, and low rates of EI access are well documented and disproportionately affect poor and minority children. The aims of this paper are to examine child characteristics associated with gaps in EI (1) referral, (2) access and (3) service use. To our knowledge, this is the first study to leverage linked safety net health system pediatric primary care and EI records data to follow EI-referred children longitudinally to understand EI service use gaps from EI referral to EI service utilization.Methods: In a retrospective cohort design (14,710 children with developmental disability or delay), we linked pediatric primary care records between a large, integrated safety net health system in metro Denver and its corresponding EI program (2014-2016). Using adjusted marginal effects [ME, (95% CI)], we estimated gaps in EI referral, access, and service type (i.e., physical [PT], occupational [OT], speech therapy [ST] and developmental intervention [DI]). Analyses accounted for child characteristics including socio-demographics, diagnosis, condition severity, and baseline function.Results: Only 18.7% of EI-eligible children (N = 2726) received a referral; 26% of those (N = 722) received services for a net enrollment rate of 5% among EI-eligible children. Having the most severe developmental condition was positively associated with EI referral [ME = 0.334 [0.249, 0.420]) and Individualized Family Services Plan (IFSP) receipt [ME = 0.156 [0.088, 0.223]). Children less likely to be EI-referred were Black, non-Hispanic (BNH) [ME = -0.029 (- 0.054, - 0.004)] and had a diagnosed condition ([ME = - 0.046 (- 0.087, - 0.005)]. Children with a diagnosis and those with higher income were more likely to receive PT or OT. Higher baseline cognitive and adaptive skills were associated with lower likelihood of PT [ME = -0.029 (- 0.054, - 0.004)], OT [ME = -0.029 (- 0.054, - 0.004)], and ST [ME = -0.029 (- 0.054, - 0.004)].Conclusions: We identified and characterized gaps in EI referral, access, and service use in an urban safety-net population of children with high rates of developmental delay. Interventions are needed to improve integrated systems of care affecting primary care and EI processes and coordination. [ABSTRACT FROM AUTHOR]

In health care, "person centeredness" is a valued (though nebulous) concept. In physical therapy, clinical interactions often strive to be person-centered, for example, by focusing on participation and valuing patient empowerment. However, the available evidence has mostly been constructed around populations (or study samples) rather than individuals. In this perspective, an alternative evidence framework is described, constructed around measurements in routine practice. Specifically, the authors propose developing "people-like-me" reference charts, generated with historical outcomes data, to provide real-time information on an individual's status relative to similar people. The authors present an example of how this could work using their experience with people rehabilitating after total knee arthroplasty. They also describe several challenges that must be addressed to bring this innovation into practice. First, the most important outcome measures for stakeholders (eg, patients, clinicians) need to be identified and monitored longitudinally to ensure that "people-like-me" estimates are useful and support the goals of person-centered care. Statistical methods for selecting "people-like-me" need to be examined and refined. Finally, the "people-like-me" information needs to be packaged in such a way that it is accessible, intuitive, and helpful at the point of care. Ideally, the entire process should recognize from the outset that practice patterns evolve, so databases, statistical models, and decision tools should be dynamic by design. Ultimately, the authors propose this framework as a practical mechanism to advance person-centered decisions in physical therapy according to the ideals of evidence-based practice. [ABSTRACT FROM AUTHOR]

Background: Family‐centred care (FCC) is an approach to paediatric rehabilitation service delivery endorsing shared decision making and effective communication with families. There is great need to understand how early intervention (EI) programmes implement these processes, how EI caregivers perceive them, and how they relate to EI service use. Therefore, the purpose of this study is to examine (a) parent and provider perceptions about EI FCC processes and (b) the association between FCC perceptions and EI service intensity. Methods: In this cross‐sectional study, parent perceptions of EI FCC were measured using the electronically administered Measures of Processes of Care (MPOC‐56 and MPOC‐SP; using 7‐point scales). Participants included EI parents (n = 29) and providers (n = 9) from one urban EI programme (1/1/18–6/1/18). We linked survey responses with child characteristics and service use ascertained through EI records. We estimated parent–provider MPOC score correlations and the association between EI service intensity (hr/month) and parent MPOC scores using adjusted linear regression accounting for child characteristics. Results: Parents (M = 4.2, SD = 1.1) and providers (M = 5.8, SD = 1.3) reported low involvement related to general information exchange. Parent and provider subscale scores were not correlated except that parent‐reported receipt of specific information was inversely associated with provider‐reported provision of general information (r = −0.4, P <.05). In adjusted models, parent perceptions related to respectful and supportive (b = 1.57, SE = 0.56) and enabling (b = 1.42, SE = 0.67) care were positively associated with EI intensity, whereas specific information exchange and general information exchange were not associated with intensity. Conclusion: We found that EI parents and providers reported high levels of investment in the family centredness of their EI care, with the exception of information sharing. Greater EI service intensity was associated with higher perception of involvement with some metrics of family centredness. [ABSTRACT FROM AUTHOR]

Getting older adults to initiate and maintain long-term exercise is an important public health mandate. This study is an analysis of a clinical trial of 112 sedentary adults, age 65-90 years, randomly assigned to 1 of 2 exercise interventions. We examined predictors and patterns of adherence of the 6-month home-based component of the trial. Telephone follow-up and diaries were used to assess adherence. Adherence to weekend exercise during the supervised phase of the program was the strongest predictor of subsequent home-based adherence. Adherence appeared stable throughout the intervention, indicating that adherence or nonadherence was established from the outset. The authors conclude that nonadherence can be identified early in the behavioral-change process. Future studies should focus on developing strategies for adults with chronic illnesses, depressive symptoms, and functional limitations who are nonadherent early on as they initiate and attempt to maintain exercise. [ABSTRACT FROM AUTHOR]

Background: Timely initiation of physical, occupational, and speech therapy in critically ill patients is crucial to reduce morbidity and improve outcomes. Over a 5-year time interval, we sought to determine the utilization of these rehabilitation therapies in the USA.Methods: We performed a retrospective cohort study utilizing a large, national administrative database including ICU patients from 591 hospitals. Patients over 18 years of age with acute respiratory failure requiring invasive mechanical ventilation within the first 2 days of hospitalization and for a duration of at least 48 h were included.Results: A total of 264,137 patients received invasive mechanical ventilation for a median of 4.0 [2.0-8.0] days. Overall, patients spent a median of 5.0 [3.0-10.0] days in the ICU and 10.0 [7.0-16.0] days in the hospital. During their hospitalization, 66.5%, 41.0%, and 33.2% (95% CI = 66.3-66.7%, 40.8-41.2%, 33.0-33.4%, respectively) received physical, occupational, and speech therapy. While on mechanical ventilation, 36.2%, 29.7%, and 29.9% (95% CI = 36.0-36.4%, 29.5-29.9%, 29.7-30.1%) received physical, occupational, and speech therapy. In patients receiving therapy, their first physical therapy session occurred on hospital day 5 [3.0-8.0] and hospital day 6 [4.0-10.0] for occupational and speech therapy. Of all patients, 28.6% (95% CI = 28.4-28.8%) did not receive physical, occupational, or speech therapy during their hospitalization. In a multivariate analysis, patients cared for in the Midwest and at teaching hospitals were more likely to receive physical, occupational, and speech therapy (all P < 0.05). Of patients with identical covariates receiving therapy, there was a median of 61%, 187%, and 70% greater odds of receiving physical, occupational, and speech therapy, respectively, at one randomly selected hospital compared with another (median odds ratio 1.61, 2.87, 1.70, respectively).Conclusions: Physical, occupational, and speech therapy are not routinely delivered to critically ill patients, particularly while on mechanical ventilation in the USA. The utilization of these therapies varies according to insurance coverage, geography, and hospital teaching status, and at a hospital level. [ABSTRACT FROM AUTHOR]

Background: There are mixed reports on the effectiveness of strength training to improve gait performance in people with multiple sclerosis (MS), yet the reasons for these inconsistent results are not clear. Therefore, a critical review was conducted to explore dosage, frequency, mode, position, and muscle targets of studies that have included strength training in people with MS. Methods: An electronic search was conducted through July 2017. Randomized controlled trials involving people with MS were included that implemented strength training with or without other interventions and assessed 1) strength in the lower extremities and/or trunk and 2) gait speed and/or endurance. Strength and gait results were extracted, along with exercise frequency, intensity, duration, mode, position, and muscle targets. Results: Thirteen trials met the inclusion criteria; nine used dosing consistent with recommended guidelines. Overall, six studies reported significant between-group strength improvements, and four reported within-group changes. Four studies reported significant between-group gait improvements for gait speed and/or endurance, and two reported within-group changes. Most exercises were performed on exercise machines while sitting, supine, or prone. The most common intervention target was knee extension. Conclusions: Studies generally improved strength, yet only two studies reported potentially meaningful between-group changes in gait. Future strength intervention studies designed to improve gait might consider dosing beyond that of the minimum intensity to improve strength and explore muscles targets, positions, and modes that are task-specific to walking. [ABSTRACT FROM AUTHOR]

Background. The relative importance of lower extremity and trunk muscle function to gait in people with multiple sclerosis (MS) is unknown. Objective. This study aimed to investigate the association of lower extremity and trunk muscle function with gait performance in people who have MS and mild-to-moderate disability. Design. This was a cross-sectional, observational study. Methods. Participants were people who had an Expanded Disability Status Scale score of ≤5.5. Eleven lower extremity and trunk muscles were assessed using handheld dynamometry or endurance tests. Gait performance was assessed with the Timed 25-Foot (7.62 m) Walk (T25FW) and 6-Minute Walk Test (6MWT). Regression analysis was used to quantify the association between gait outcomes and muscle variables. Results. Seventy-two participants with MS and a mean Expanded Disability Status Scale score of 3.5 (SD = 1.14) were enrolled. Adjusted for age and sex, the multivariate model including hip abduction, ankle plantar flexion, trunk flexion, and knee flexion explained 57% of the adjusted variance in the T25FW; hip abduction, ankle plantar flexion, and trunk flexion explained 61% of the adjusted variance in the 6MWT. The strongest predictors were ankle plantar flexion endurance for the T25FW and hip abduction strength for the 6MWT: a 1-SD increase in ankle plantar flexion (15.2 heel-raise repetitions) was associated with a 0.33-second reduction in the T25WT (95% CI = -0.71 to -0.14 seconds); a 1-SD increase in normalized hip abduction strength (0.14 kg/body mass index) was associated with a 54.4-m increase in the 6MWT (28.99 to 79.81 m). Limitations. Different measurement scales for independent variables were included because the muscle function assessment used either force or endurance. Conclusions. For the major muscles in the lower extremity and trunk, hip abduction, ankle plantar flexion, trunk flexion, and knee flexion were the strongest predictors of gait performance. [ABSTRACT FROM AUTHOR]

Background: Strength training in people with multiple sclerosis (MS) is an important component of rehabilitation, but it can be challenging for clinicians to quantify strength accurately and reliably. This study investigated the psychometric properties of a clinical strength assessment protocol using handheld dynamometry and other objective, quantifiable tests for the lower extremities and trunk in people with MS. Methods: This study determined discriminant validity between 25 participants with MS and 25 controls and between participants with MS who had higher versus lower disability; test-retest reliability across 7 to 10 days; and response stability. The protocol included handheld dynamometry measurements of ankle dorsiflexion, knee flexion and extension; hip flexion, extension, abduction, and adduction; and trunk lateral flexion. Muscular endurance tests were used to measure trunk extension, trunk flexion, and ankle plantarflexion. Results: The protocol discriminated between participants with MS and controls for all muscles tested (P < .001-.003). The protocol also discriminated between low- and moderate-disability groups (P = .001-.046) for 80% of the muscles tested. Test-retest reliability intraclass correlation coefficients were high (0.81-0.97). Minimal detectable change as a percentage of the mean was 13% to 36% for 85% of muscles tested. Conclusions: This study provides evidence for the discriminant validity, test-retest reliability, and response stability of a strength assessment protocol in people with MS. This protocol may be useful for tracking outcomes in people with MS for clinical investigations and practice. [ABSTRACT FROM AUTHOR]

Background: The proportion of survivors of acute respiratory failure is growing; yet, many do not regain full function and require prolonged admission in an acute or post-acute care facility. Little is known about their trajectory of functional recovery. We sought to determine whether prolonged admission influenced the trajectory of physical function recovery and whether patient age modified the recuperation rate.Methods: We performed a secondary analysis of a randomized clinical trial of intensive physical therapy for patients with acute respiratory failure requiring mechanical ventilation for ≥4 days. The primary outcome was Continuous Scale Physical Functional Performance, short form (CS-PFP-10), score. Predictor variables included prolonged admission in an acute or post-acute care facility at 1 month, time, and patient age. To determine whether the association between admission and functional outcome varied over time, a multivariable mixed effects linear regression model was fit using an interaction between prolonged admission and time with a primary outcome of total CS-PFP-10 score.Results: Of the 89 patients included, 56% (50 of 89) required prolonged admission. At 1 month, patients who remained admitted had CS-PFP-10 scores that were 20.1 (CI 10.4-29.8) points lower (p < 0.0001) than patients who were discharged to home. However, there was no difference in the rate at which physical function improved from 3 to 6 months for patients who required prolonged admission compared with those who returned home (p = 0.24 for interaction between prolonged admission and time). Adjusted for age, Acute Physiology and Chronic Health Evaluation II score, and sex, both groups had CS-PFP-10 scores that were 8.2 (CI 4.5-12.0) points higher at 6 months than at 3 months (p < 0.0001). For each additional year in patient age, CS-PFP-10 recovered 0.36 points slower (95% CI 0.12-0.61; p = 0.004).Conclusions: Patients who require prolonged admission after acute respiratory failure have significantly lower physical functional performance than patients who return home. However, the rates of physical functional recovery between the two groups do not differ. The majority of survivors do not recover sufficiently to achieve functional independence by 6 months. Older age negatively influences the trajectory of functional recovery.Trial Registration: ClinicalTrials.gov, NCT01058421 . Registered on 26 January 2010. [ABSTRACT FROM AUTHOR]

BACKGROUND: The functional capacity of the vestibulo-ocular reflex (VOR) is not well understood in people with multiple sclerosis (MS). OBJECTIVE: To determine the psychometric properties of computerized Gaze Stabilization Test (GST) and Dynamic Visual Acuity Test (DVAT) in people with MS. METHODS: This cross-sectional study determined discriminant validity of the GST and DVAT between 15 healthy controls and 30 participants with MS, and between participants with MS who had higher versus lower disability. This study also determined same-day and between-session test-retest reliability, and concurrent validity with patient-reported outcomes (PROs) of balance, dizziness, and fatigue. RESULTS: GST (p < 0.001) and DVAT (p = 0.001) scores were lower in participants with MS compared to controls. GST (p = 0.035) but notDVAT (p = 0.313) scores were lower in those with higher compared to lower disability. Test-retest reliability intraclass correlation coefficients (ICC (2,1)) were fair-to-good for the GST (0.48 to 0.74) and DVAT (0.47 to 0.60). PROs correlated significantly with GST, but not DVAT scores. CONCLUSIONS: This study provides initial evidence that the functional capacity of the VOR is impaired in people with MS as measured by the GST and DVAT. Further investigation is warranted to determine usefulness of both measures as outcomes for people with MS. [ABSTRACT FROM AUTHOR]

Rationale: Early physical therapy (PT) interventions may benefit patients with acute respiratory failure by preventing or attenuating neuromuscular weakness. However, the optimal dosage of these interventions is currently unknown.Objectives: To determine whether an intensive PT program significantly improves long-term physical functional performance compared with a standard-of-care PT program.Methods: Patients who required mechanical ventilation for at least 4 days were eligible. Enrolled patients were randomized to receive PT for up to 4 weeks delivered in an intensive or standard-of-care manner. Physical functional performance was assessed at 1, 3, and 6 months in survivors who were not currently in an acute or long-term care facility. The primary outcome was the Continuous Scale Physical Functional Performance Test short form (CS-PFP-10) score at 1 month.Measurements and Main Results: A total of 120 patients were enrolled from five hospitals. Patients in the intensive PT group received 12.4 ± 6.5 sessions for a total of 408 ± 261 minutes compared with only 6.1 ± 3.8 sessions for 86 ± 63 minutes in the standard-of-care group (P < 0.001 for both analyses). Physical function assessments were available for 86% of patients at 1 month, for 76% at 3 months, and for 60% at 6 months. In both groups, physical function was reduced yet significantly improved over time between 1, 3, and 6 months. When we compared the two interventions, we found no differences in the total CS-PFP-10 scores at all three time points (P = 0.73, 0.29, and 0.43, respectively) or in the total CS-PFP-10 score trajectory (P = 0.71).Conclusions: An intensive PT program did not improve long-term physical functional performance compared with a standard-of-care program. Clinical trial registered with www.clinicaltrials.gov (NCT01058421). [ABSTRACT FROM AUTHOR]

Background. Early rehabilitation improves outcomes, and increased use of physical therapist services in the intensive care unit (ICU) has been recommended. Little is known about the implementation of early rehabilitation programs or physical therapists' preparation and perceptions of care in the United States. Objective. A national survey was conducted to determine the current status of physical therapist practice in the ICU. Design. This study used a cross-sectional, observational design. Methods. Self-report surveys were mailed to members of the Acute Care Section of the American Physical Therapy Association. Questions addressed staffing, training, barriers, and protocols, and case scenarios were used to determine perceptions about providing rehabilitation. Results. The response rate was 29% (667/2,320). Staffing, denned as the number of physical therapists per 100 ICU beds, was highest in community hospitals (academic: median=5.4 [range=3-6-9.2]; community: median=6.7 [range=4.4-10.0]) and in the western United States (median=7.5 [range=4.2-12.9]). Twelve percent of physical therapists reported no training. Barriers to providing ICU rehabilitation included insufficient staffing and training, departmental prioritization policies, and inadequate consultation criteria. Responses to case scenarios demonstrated differences in the likelihood of consultation and physical therapists' prescribed frequency and intensity of care based on medical interventions rather than characteristics of patients. Physical therapists in academic hospitals were more likely to be involved in the care of patients in each scenario and were more likely to perform higher-intensity mobilization. Limitations. Members of the Acute Care Section of the American Physical Therapy Association may not represent most practicing physical therapists, and the 29% return rate may have contributed to response bias. Conclusions. Although staffing was higher in community hospitals, therapists in academic and community hospitals cited insufficient staffing as the most common barrier to providing rehabilitation in the ICU. Implementing strategies to overcome barriers identified in this study may improve the delivery of ICU rehabilitation services. [ABSTRACT FROM AUTHOR]

Background. Although studies have established the safety and feasibility of physical therapy in the critical care setting, minimal information about physical therapist practice in the neurological intensive care unit (NICU) is available. Objective. This study describes physical therapists' treatment of people admitted to a NICU. Design. People admitted to the NICU with a diagnosis of subarachnoid hemorrhage, subdural hematoma, intracranial hemorrhage, or trauma were retrospectively studied. Methods. Data on patient demographics, use of mechanical ventilation, and intracranial pressure (ICP) monitoring were collected. For each physical therapy session, the length of the session, the location (NICU or post-NICU setting), and the presence of mechanical ventilation or ICP monitoring were recorded. Data on safety parameters, including vital sign response, falls, and dislodgement of lines, were collected. Results. Over 1 year, 180 people were admitted to the NICU; 86 were evaluated by a physical therapist, for a total of 293 physical therapy sessions in the NICU (n=132) or post-NICU setting (n=161). Only one session (0.3%) was stopped, secondary to an increase in ICP. The first physical therapy session occurred on NICU day 3-0 (25%-75% interquartile range=2.0-6.0). Patients received a median of 3.4 sessions per week (25%-75% interquartile range= 1.8-5.9). Patients with mechanical ventilation received less frequent physical therapy sessions than those without mechanical ventilation. Patients with ICP monitoring received less frequent sessions than those without ICP monitoring. However, after multivariate analysis, only the admission Glasgow Coma Score was independently associated with physical therapy frequency in the NICU. Patients were more likely to stand, transfer, and walk in the post-NICU setting than in the NICU. Limitations. The results are limited by the retrospective, single-center nature of the study. There is inherent bias of evaluating only those patients who had physical therapy, and therapists were unable to completely adjust for the severity of illness of a given patient. Conclusions. Physical therapy was performed safely in the NICU. Patients who required invasive support received less frequent physical therapy. [ABSTRACT FROM AUTHOR]

The article discusses a Cochrane review that focuses on an adult patient with early Parkinson Disease (PD). Topics discussed include a comparison between physical therapist interventions with either placebo or no intervention, the case of a 54-year old financial planner diagnosed with Parkinson Disease (PD) and findings that people with PD gain greater short-term improvements in gait and balance with physical therapist intervention than with placebo or no physical therapist intervention.

Background: Previous investigation of the relationship between physical performance and patient self-report physical function (PF) measures in intensive care unit (ICU) survivors have not been performed. Objectives: To (1) analyze the extent to which other activity-based measures of physical performance may serve as proxies for the 6-min walk test (6MWT); (2) determine the extent to which the Short Form (SF) 36 domain of PF and physical component summary (PCS) score, reflect components of physical performance and (3) examine the relationship between demographic and ICU variables and the 6MWT. Design: Cross-sectional data from two clinical trials. Setting: Two acute care hospitals (Melbourne, Australia and Denver, USA). Patients: A total of 177 survivors of ICU. Measurements: Were evaluated at 3 months. Performance-based measures were: 6MWT, timed up and go test (TUG), the five times sit to stand test (5×STS), the Berg balance scale (BBS) and two self-report measures: the SF-36 PF domain and the PCS score. Main results: 6MWT showed excellent correlation with the TUG (rho = −0.79) and BBS (rho = 0.80); and good correlation with 5×STS (rho = −0.69) and SF-36 PF scores (rho = 0.69). 6MWT explained 54 and 33 % of variance in SF-36 PF and PCS scores respectively. No variables were clinically important in predicting 6MWT. Conclusions: The 6MWT and TUG may both be acceptable measures of PF performance 3 months after ICU. Performance-based tests measure different constructs than self-report measures and choice of outcome variables should be aligned with study aims to ensure the most appropriate measure is used. [ABSTRACT FROM AUTHOR]

Background Parkinson disease (PD) may lead to functional limitations through both motor and nonmotor symptoms. Although patients with advanced disease have well-documented and profound functional limitations, less is known about the determinants of function in early to mid-stage disease where interventions may be more likely to benefit and preserve function. Objective The objective of the current study was to identify motor, cognitive, and gait determinants of physical functional performance in patients with early to mid-stage PD. Design This was a secondary analysis of cross-sectional baseline data from a randomized clinical trial of exercise. Setting The study was performed at a tertiary academic medical center. Participants The study included 121 patients with early to mid-stage PD. Methods Our functional performance outcomes included the following: the Continuous Scale Physical Functional Performance Test (CS-PFP; primary outcome); the Timed Up and Go test (TUG); and Section 2 (Activities of Daily Living) of the Unified Parkinson's Disease Rating Scale (UPDRS). Explanatory variables included measures of disease severity, motor function, cognitive function, balance, and gait. Stepwise linear regression models were used to determine correlations between explanatory variables and outcome measures. Results In our regression models, the CS-PFP significantly correlated with walking endurance (Six-Minute Walk Test; r 2 = 0.12, P < .0001), turning ability (360° Turn Test; r 2 = 0.03, P = .002), attention (Brief Test of Attention; r 2 = 0.01, P = .03), overall cognitive status (Mini–Mental State Examination; r 2 = 0.01, P = .04), and bradykinesia (timed tapping; r 2 = 0.02, P = .02). The TUG significantly correlated with walking speed (5-Meter Walk Test; r 2 = 0.33, P < .0001), stride length (r 2 = 0.25, P < .0001), turning ability (360° turn, r 2 = 0.05, P = .0003), and attention (r 2 = 0.016, P = .03). Section 2 of the UPDRS was significantly correlated with endurance (r 2 = 0.09, P < .0001), turning ability (r 2 = 0.03, P = .001), and attention (r 2 = 0.01, P = .03). Conclusions Gait, motor, and cognitive function all contribute to objectively measured global functional ability in mild to moderate PD. Subjectively measured functional activity outcomes may underestimate the impact of both motor and nonmotor symptoms. [ABSTRACT FROM AUTHOR]

Background. Recent studies have demonstrated safety, feasibility, and decreased hospital length of stay for patients with weakness acquired in the intensive care unit (ICU) who receive early physical rehabilitation. The scored Physical Function in Intensive Care Test (PFIT-s) was specifically designed for this population and demonstrated excellent psychometrics in an Australian ICU population. Objective. The purpose of this study was to determine the responsiveness and predictive capabilities of the PFIT-s in patients in the United States admitted to the ICU who required mechanical ventilation (MV) for 4 days or longer. Methods. This nested study within a randomized trial administered the PFIT-s, Medical Research Council (MRC) sum score, and grip strength test at ICU recruitment and then weekly until hospital discharge, including at ICU discharge. Spearman rho was used to determine validity. The effect size index was used to calculate measurement responsiveness for the PFIT-s. The receiver operating characteristic curve was used in predicting participants’ ability to perform functional components of the PFIT-s. Results. From August 2009 to July 2012, 51 patients were recruited from 4 ICUs in the Denver, Colorado, metro area. At ICU discharge, PFIT-s scores were highly correlated to MRC sum scores (rho=.923) and grip strength (rho=.763) (P<.0005). Using baseline test with ICU discharge (26 pairs), test responsiveness was large (1.14). At ICU discharge, an MRC sum score cut-point of 41.5 predicted participants’ ability to perform the standing components of the PFIT-s. Limitations. The small sample size was a limitation. However, the findings are consistent with those in a larger sample from Australia. Conclusions. The PFIT-s is a feasible and valid measure of function for individuals who require MV for 4 days or longer and who are alert, able to follow commands, and have sufficient strength to participate. [ABSTRACT FROM AUTHOR]

Patients admitted to the intensive care unit (ICU) can develop a condition referred to as "ICU-acquired weakness." This condition is characterized by profound weakness that is greater than might be expected to result from prolonged bed rest. Intensive are unit-acquired weakness often is accompanied by dysfunction of multiple organ systems. Individuals with ICU-acquired weakness typically have significant activity limitations, often requiring physical assistance for even the most basic activities associated with bed mobility. Many of these individuals have activity limitations months to years after hospitalization. The purpose of this article is to review evidence that guides physical rehabilitation of people with ICU-acquired weakness. Included are diagnostic criteria, medical management, and prognostic indicators, as well as criteria for beginning physical rehabilitation, with an emphasis on patient safety. Data are presented indicating that rehabilitation can be implemented with very few adverse effects. Evidence is provided for appropriate measurement approaches and for physical intervention strategies. Finally, some of the key issues are summarized that should be investigated to determine the best intervention guidelines for individuals with ICU-acquired weakness. [ABSTRACT FROM AUTHOR]

Background. Exercise confers short-term benefits for individuals with Parkinson disease (PD). Objective. The purpose of the study was to compare short- and long-term responses among 2 supervised exercise programs and a home-based control exercise program. Design. The 16-month randomized controlled exercise intervention investigated 3 exercise approaches: flexibility/balance/function exercise (FBF), supervised aerobic exercise (AE), and home-based exercise (control). Setting. This study was conducted in outpatient clinics. Patients. The participants were 121 individuals with PD (Hoehn & Yahr stages 1-3). Interventions. The FBF program (individualized spinal and extremity flexibility exercises followed by group balance/functional training) was supervised by a physical therapist. The AE program (using a treadmill, bike, or elliptical trainer) was supervised by an exercise trainer. Supervision was provided 3 days per week for 4 months, and then monthly (16 months total). The control group participants exercised at home using the National Parkinson Foundation Fitness Counts program, with 1 supervised, clinic-based group session per month. Measurements. Outcomes, obtained by blinded assessors, were determined at 4, 10, and 16 months. The primary outcome measures were overall physical function (Continuous Scale-Physical Functional Performance [CS-PFP]), balance (Functional Reach Test [FRT]), and walking economy (oxygen uptake [mL/kg/min]). Secondary outcome measures were symptom severity (Unified Parkinson's Disease Rating Scale [UPDRS] activities of daily living [ADL] and motor subscales) and quality of life (39-item Parkinson's Disease Quality of Life Scale [PDQ-39D- Results. Of the 121 participants, 86.8%, 82.6%, and 79.3% completed 4, 10, and 16 months, respectively, of the intervention. At 4 months, improvement in CS-PFP scores was greater in the FBF group than in the control group (mean difference=4.3, 95% confidence interval [CI] = 1.2 to 7.3) and the AE group (mean difference = 3.1, 95% CI=0.0 to 6.2). Balance was not different among groups at any time point. Walking economy improved in the AE group compared with the FBF group at 4 months (mean difference =-1.2, 95% CI=-1.9 to -0.5), 10 months (mean differ- ence=-1.2, 95% CI=-1.9 to -0.5), and 16 months (mean difference=-1.7, 95% CI = - 2.5 to -1.0). The only secondary outcome that showed significant differences was UPDRS ADL subscale scores: the FBF group performed better than the control group at 4 months (mean difference = - 1.47, 95% CI=-2.79 to -0.15) and 16 months (mean difference=-1.95, 95% CI=-3.84 to -0.08). Limitations. Absence of a non-exercise control group was a limitation of the study. Conclusions. Findings demonstrated overall functional benefits at 4 months in the FBF group and improved walking economy (up to 16 months) in the AE group. [ABSTRACT FROM AUTHOR]

Background. Neuromuscular electrical stimulation (NMES) can facilitate the recovery of quadriceps muscle strength after total knee arthroplasty (TKA), yet the optimal intensity (dosage) of NMES and its effect on strength after TKA have yet to be determined. Objective. The primary objective of this study was to determine whether the intensity of NMES application was related to the recovery of quadriceps muscle strength early after TKA. A secondary objective was to quantify quadriceps muscle fatigue and activation immediately after NMES to guide decisions about the timing of NMES during rehabilitation sessions. Design. This study was an observational experimental investigation. Methods. Data were collected from 30 people who were 50 to 85 years of age and who received NMES after TKA. These people participated in a randomized controlled trial in which they received either standard rehabilitation or standard rehabilitation plus NMES to the quadriceps muscle to mitigate strength loss. For the NMES intervention group, NMES was applied 2 times per day at the maximal tolerable intensity for 15 contractions beginning 48 hours after surgery over the first 6 weeks after TKA. Neuromuscular electrical stimulation training intensity and quadriceps muscle strength and activation were assessed before surgery and 35 and 6.5 weeks after TKA. Results. At 3.5 weeks, there was a significant association between NMES training intensity and a change in quadriceps muscle strength ( R2 = .68) and activation < R2=.22). At 6.5 weeks, NMES training intensity was related to a change in strength ( R2 = .25) but not to a change in activation ( R2=.00). Furthermore, quadriceps muscle fatigue occurred during NMES sessions at 3-5 and 6.5 weeks, whereas quadriceps muscle activation did not change. Limitations. Some participants reached the maximal stimulator output during at least 1 treatment session and might have tolerated more stimulation. Conclusions. Higher NMES training intensities were associated with greater quadriceps muscle strength and activation after TKA. INSET: The Bottom Line. [ABSTRACT FROM AUTHOR]

Background. People with Parkinson disease (PD) typically have complaints of weakness. The mechanisms underlying this deficit have not been well established, although many factors may contribute. Objective. This investigation aimed to characterize quadriceps muscle weakness and activation failure in people with PD and explore whether these deficits were related to disease severity. The authors further sought to examine quadriceps muscle fatigability. Methods. This was a cross-sectional comparison of 17 people with mild-severe PD and 17 healthy adults matched by age, sex, and body mass index (BMI). The Unified Parkinson’s Disease Rating Scale motor score (UPDRS motor) ranged from 9.5 to 61.0. Participants were divided into those with low-PD motor signs (UPDRS motor < 31.7) and high-PD motor signs (UPDRS motor ≥ 31.7). Measures of quadriceps performance included isometric torque, central activation using doublet interpolation, and an isokinetic fatigue test. Results. Participants with high-PD motor signs had significantly more quadriceps weakness and central activation deficits than those with low-PD motor signs or healthy controls. Strength and activation deficits correlated strongly with UPDRS motor score. Quadriceps muscle fatigue was present in healthy controls and in those with low-PD motor signs but not in those with high-PD motor signs. Conclusions. These findings provide additional evidence for lower-extremity strength loss with PD; central activation deficits may account for some of the strength deficits, especially with increased PD motor signs. Also, muscle fatigue did not occur in individuals with a greater degree of PD motor signs, most likely because of insufficient central activation to allow for muscle overload to induce metabolic fatigue. [ABSTRACT FROM PUBLISHER]

The article describes the case of a 48-year-old woman who was admitted to a hospital with several medical complications associated with anorexia nervosa (AN). Information on the patient's medical history is provided. Based on her initial clinical assessment, the patient was unable to complete basic activities of daily living (ADLs) independently. Also included are information on the patient's physical therapy goals, plan of care and intervention.

Background. Overall functional ability declines over time in people with Parkinson disease (PD). Established benchmarks are needed to allow clinicians and researchers to facilitate meaningful interpretation of data. Objective. The purposes of this study were: (1) to report typical values for standard measures of functional ability commonly used in intervention studies and clinical practice with individuals in the early and middle stages of PD and (2) to describe the profile of functional limitations using the Hoehn and Yahr (H&Y) stages of disease and Unified Parkinson's Disease Rating Scale (UPDRS) motor scores. Design. Cross-sectional data were obtained from 5 different studies. Methods. Three hundred thirty-nine patients were evaluated for disease severity (UPDRS motor score); functional capacity (Continuous Scale Physical Functional Performance Test [CS-PFP]); balance and gait (Functional Reach Test [FRT], Timed "Up & Go" Test [TUG], 360-degree turn, Six-Minute Walk Test [6MWT], and Two- Minute Walk Test); and basic functional activities (supine-to-stand task, stand-to-supine task, and functional axial rotation [FAR]). Results. The mean UPDRS motor score for the sample was 39.2 (SD= 12.93). At each stage of PD (from least to most involved), scores on functional measures indicated a significant and progressively reduced functional status. Limitations began early in the disease for the CS-PFP and FAR. Losses in performance were consistent across all stages of disease for the CS-PFP, FRT, 6MWT, and FAR. Several measures demonstrated meaningful losses of function only in later stages of disease. Findings extend current appreciation of functional limitations that begin early in PD and can guide the choice of functional outcome measures at different stages of disease severity. Limitations. Data were obtained only from participants in H&Y stages 1 through 3 and only for some of the performance measures typically used. Conclusions. The findings demonstrate that functional loss occurs at different points in the disease process, depending on the task under consideration. The resulting profile of functional limitations provides benchmarks that clinicians and researchers can use to interpret and monitor status of patients. INSET: The Bottom Line. [ABSTRACT FROM AUTHOR]

Background. Fatigue and impaired upright postural control (balance) are the 2 most common findings in people with multiple sclerosis (MS), with treatment approaches varying greatly in effectiveness. Objectives. The aim of this study was to investigate the benefits of implementing a vestibular rehabilitation program for the purpose of decreasing fatigue and improving balance in patients with MS. Design. The study was a 14-week, single-blinded, stratified blocked randomized controlled trial. Setting. Measurements were conducted in an outpatient clinical setting, and interventions were performed in a human performance laboratory. Patients. Thirty-eight patients with MS were randomly assigned to an experimental group, an exercise control group, or a wait-listed control group. Intervention. The experimental group underwent vestibular rehabilitation, the exercise control group underwent bicycle endurance and stretching exercises, and the wait-listed control group received usual medical care. Measurements. Primary measures were a measure of fatigue (Modified Fatigue Impact Scale), a measure of balance (posturography), and a measure of walking (Six-Minute Walk Test). Secondary measures were a measure of disability due to dizziness or disequilibrium (Dizziness Handicap Inventory) and a measure of depression (Beck Depression Inventory-II). Results. Following intervention, the experimental group had greater improvements in fatigue, balance, and disability due to dizziness or disequilibrium compared with the exercise control group and the wait-listed control group. These results changed minimally at the 4-week follow-up. Limitations. The study was limited by the small sample size. Further investigations are needed to determine the underlying mechanisms associated with the changes in the outcome measures due to the vestibular rehabilitation program. Conclusion. A 6-week vestibular rehabilitation program demonstrated both statistically significant and clinically relevant change in fatigue, impaired balance, and disability due to dizziness or disequilibrium in patients with MS. INSET: The Bottom Line. [ABSTRACT FROM AUTHOR]

Objective: To characterize patient outcomes after total knee arthroplasty (TKA) by (1) examining changes in self-report measures (Knee Injury and Osteoarthritis Outcome Score [KOOS]) and performance measures over the first 6 months after TKA, (2) evaluating correlations between changes in KOOS self-report function (activities of daily living [ADL] subscale) and functional performance (6-minute walk [6MW]), and (3) exploring how changes in pain correlate with KOOS ADL and 6MW outcomes. Design: Retrospective cohort evaluation. Setting: Clinical research laboratory. Patients (or Participants): Thirty-nine patients scheduled for a unilateral, primary TKA for end-stage unilateral knee osteoarthritis. Methods: Patients were evaluated 2 weeks before surgery and 1, 3, and 6 months after surgery. Main Outcome Measurements: KOOS, 6MW, timed-up-and-go (TUG), and stair climbing tests (SCT), quadriceps strength. Results: Three of 5 KOOS subscales significantly improved by 1 month after TKA. All 5 KOOS subscales significantly improved by 3 and 6 months after TKA. In contrast, performance measures (6MW, TUG, SCT, and quadriceps strength) all significantly declined from preoperative values by 1 month after TKA and significantly improved from preoperative values by 3 and 6 months after TKA; yet, improvements from preoperative values were not clinically meaningful. Pearson correlations between changes in the KOOS ADL subscale and 6MW from before surgery were not statistically significant at 1, 3, or 6 months after TKA. In addition, KOOS Pain was strongly correlated with KOOS ADL scores at all times, but KOOS Pain was not correlated with 6MW distance at any time. Conclusions: Patient self-report by using the KOOS did not reflect the magnitude of performance deficits present after surgery, especially 1 month after TKA. Self-report KOOS outcomes closely paralleled pain relief after surgery, whereas performance measures were not correlated with pain. These results emphasize the importance of including performance measures when tracking recovery after TKA as opposed to solely relying on self-reported measures. [Copyright &y& Elsevier]

Although Parkinson disease (PD) is common throughout the world, the evidence for physical therapy interventions that enable long-term improvement in walking is still emerging. This article critiques the major physical therapy approaches related to gait rehabilitation in people with PD: compensatory strategies, motor skill learning, management of secondary sequelae, and education to optimize physical activity and reduce falls. The emphasis of this review is on gait specifically, although balance and falls are of direct importance to gait and are addressed in that context. Although the researchers who have provided the evidence for these approaches grounded their studies on different theoretical paradigms, each approach is argued to have a valid place in the comprehensive management of PD generally and of gait in particular. The optimal mix of interventions for each individual varies according to the stage of disease progression and the patient's preferred form of exercise, capacity for learning, and age. [ABSTRACT FROM AUTHOR]

Gait dysfunction is an early problem identified by patients with Parkinson's disease (PD). Alterations in gait may result in an increase in the energy cost of walking (i.e., walking economy). The purpose of this study was to determine whether walking economy is atypical in patients with PD when compared with healthy controls. A secondary purpose was to evaluate the associations of age, sex, and level of disease severity with walking economy in patients with PD. The rate of oxygen consumption (V̇O2) and other responses to treadmill walking were compared in 90 patients (64.4 ± 10.3 years) and 44 controls (64.6 ± 7.3 years) at several walking speeds. Pearson correlation coefficients (r) were calculated to determine relationships of age, sex, and disease state with walking economy in PD patients. Walking economy was significantly worse in PD patients than in controls at all speeds above 1.0 mph. Across all speeds, V̇O2 was 6 to 10% higher in PD patients. Heart rate, minute ventilation, respiratory exchange ratio, and rating of perceived exertion were correspondingly elevated. No significant relationship of age, sex, or UPDRS score with V̇O2 was found for patients with PD. The findings suggest that the physiologic stress of daily physical activities is increased in patients with early to mid-stage PD, and this may contribute to the elevated level of fatigue that is characteristic of PD. © 2009 Movement Disorder Society [ABSTRACT FROM AUTHOR]