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Background Parkinson’s disease (PD) is associated with motor impairments that negatively impact functional mobility (Armstrong & Okun, 2020). Functional mobility is “a person’s ability to move to accomplish activities of daily living” (Bouça-Machado et al., 2020). Whilst several assessment scales exist to evaluate PD, many focus on symptom severity or use speed as a proxy for quality of movement (e.g. Timed Up and Go; Buckley et al., 2019; Mirelman et al., 2019). Here we share the development of an integrated motion capture and pressure-sensitive gait mat sequence to assess functional mobility. Design/Methods To capture aspects of functional mobility accurately, we developed a new assessment protocol (FMA-P) to measure which aspects of movement differed between people with (n = 12) and without (n = 12) PD. The sequence involved rising from a chair, locomotion, turning, bending, picking up and placing an object (keys), and returning to sit down on the chair (mean of three trials). Results The mean age of our participants was 65.25 ± 7.8 years, 46% females. We found significant differences in locomotion such as a lower step ratio (p = 0.023), stride length (p < 0.001), and stride velocity (p = 0.019), as well as a higher double support time (p = 0.004), and stride length variability (p = 0.004) in people with PD (PwP) compared to aged-matched healthy participants. PwP showed a lower toe-off set angle (p = 0.042), lower foot height (p = 0.007), and a lower heel strike angle (p = 0.006) during locomotion. Further, a lower shoulder-elbow arm swing angular velocity (p=0.042), and a higher elbow-wrist arm swing angular velocity (p = 0.054) were observed in PwP compared to controls. Getting up from a chair was associated with a lower inclination amplitude in PwP compared to healthy controls (p = 0.047). In the turning section, we found a later onset of pelvis rotation in PwP (p = 0.034). More time was required for PwP to pick the keys up from the floor compared to controls (p = 0.002). Discussion The new measurement protocol could contribute to early diagnosis of PD, offering a quantitative evaluation of functional mobility. For example, reduced toe and heel offset angles may be early determinants of developing shuffling in later disease stages. Moreover, our findings provide objective and precise information about a variety of qualitative aspects of functional mobility. This approach can therefore be used to evaluate change over time thereby improving the evidence base of outcome variables for intervention studies. The FMA-P is of high clinical relevance to aid in the quantitative evaluation of clinical measures of motor impairment. References Armstrong, M. J., & Okun, M. S. (2019). Diagnosis and treatment of Parkinson disease. A review. JAMA, 232(6), 548-560. https://doi.org/10.1001/jama.2019.22360 Bouça-Machado, R., Duarte, G. S., Patriarca, M., Castro Caldas, A., Alarcão, J., Fernandes, R. M., Mestre, T. A.,, Matias, R., & Ferreira, J. J. (2020). Measurement instruments to assess functional mobility in Parkinson’s disease: A systematic review. Movement Disorders Clinical Practice, 7(2), 129-139. https://doi.org/10.1002/mdc3.12874 Buckely, C., Alcock, L., McArdle, R., Rana Zia Ur Rehman, R. Z. U., Del Din, S., Mazzà, C., Yarnall, A.J., & Rochester, L. (2019). The role of movement analysis in diagnosing and monitoring neurodegenerative conditions: Insights from gait and postural control. Brain Sciences, 9(2), Article 34. https://doi.org/10.3390/brainsci9020034 Mirelman, A., Bonato, P., Cmicioli, R., Ellis, T. D., Giladi, N., Hamilton, J. L., Hass, C. J., Hausdorff, J. M., Pelosin, E., & Almeida Q. J. (2019). Gait impairments in Parkinson’s disease. The Lancet Neurology, 18(7), 697-708. https://doi.org/10.1016/s1474-4422(19)30044-4

This study presents an audio stimulus set of 40 drum patterns from Western popular music with empirical measurements of perceived complexity. The audio stimuli are meticulous reconstructions of drum patterns found in commercial recordings; they are based on careful transcriptions (carried out by professional musicians), drum stroke loudness information, and highly precise onset timing measurements. The 40 stimuli are a subset selected from a previously published larger corpus of reconstructed Western popular music drum patterns (Lucerne Groove Research Library). The patterns were selected according to two criteria: a) they only feature the bass drum, snare drum, and one or more cymbals, and b) they plausibly cover the complexity range of the corpus. Perceived stimulus complexity was measured in a listening experiment using a pairwise comparison design with 220 participants (4,400 trials). In each trial, participants were presented with two stimuli, and they stated which of the two sounded more complex to them. The comparison data then served to calculate complexity estimates using the Bradley–Terry probability model. The complexity estimates have an intuitive interpretation: they allow calculation of the probability that one pattern is considered more complex than another pattern in a pairwise comparison. To our knowledge, this is the first set of naturalistic music stimuli with meaningful perceived complexity estimates. The drum pattern stimuli and complexity measurements can be used for listening experiments in music psychology. The stimuli will further allow measures and models of drum pattern complexity to be assessed.

Background Parkinson’s disease (PD) is a neurodegenerative brain disorder associated with early-onset functional motor impairments (Rana et al., 2012). There are several assessment scales for the evaluation of PD, but many motor measurement protocols lack reference to the qualitative assessment of functional mobility in everyday life (Opara et al., 2017). Moreover, previous studies have shown that pharmaceutical treatments in combination with physical therapy play an important role in improving motor symptoms, but the benefits do not seem to extend to mental well-being (Fox et al., 2018). Growing evidence suggest that an interdisciplinary approach by integrating musical activity with exercises may have the potential to improve both functional mobility and psychological wellbeing (Barnish & Barran, 2020). Methods The first phase of this mixed methods study includes a Patient and Public Involvement (PPI) consultation process (workshops and interviews; Rose et al., 2022) to develop a context-appropriate new group-based intervention program for and with PwP and health professionals. The focus will lie on music activity and the use music imagery to develop individual jukeboxes of musical cues to combat motor symptoms such as rigidity and freeze of gait. To evaluate the efficacy and the generalisability of the program, a 12-week within-subject repeated measures controlled trial will be conducted in Switzerland and the UK. An accurate and reliable quantitative measurement protocol will be developed to enable assessment of disease progression, and evaluation of interventions alongside qualitative observations of mobility in PwP. Moreover, we aim to provide fine-grained assessment of clinical measures (such as the Timed Up and Go) using an integrated motion capture (MoCap) and gait mat analysis system. Expected Outcomes and Perspectives This project lays the foundation for the development of non-pharmaceutical and low-cost intervention programs. Our PPI approach will provide better individualised and targeted prevention strategies to counteract the increasing financial and personal burden of PD worldwide. A unique aspect of the study is to develop a new quantitative functional mobility measurement protocol to assess PwP over time. This research approach will contribute to our understanding of functional mobility symptoms and the use of music in PD to reduce symptom severity and improve quality of life. References Barnish, M. S., & Barran, S. M. (2020). A systematic review of active group-based dance, singing, music therapy and theatrical interventions for quality of life, functional communication, speech, motor function and cognitive status in people with Parkinson’s disease. BMC Neurology, 20(1), Article 371. https://doi.org/10.1186/s12883-020-01938-3 Fox, S. H., Katzenschlager, R., Lim, S. Y., Barton, B., de Bie, R. M. A., Seppi, K., Coelho, M., & Sampaio, C. (2018). International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson’s disease. Movement Disorders, 33(8),1248-1266. https://doi.org/10.1002/mds.27372 Opara, J., Małecki, A., Małecka, E., & Socha, T. (2017). Motor assessment in Parkinson’s disease. Annals of Agricultural and Environment Medicine, 24(3), 411-415. https://doi.org/10.5604/12321966.1232774 Rana, A. Q., Siddiqui, I., & Yousuf, M. S. (2012). Challenges in diagnosis of young onset Parkinson’s disease. Journal of the Neurological Sciences, 323(1-2), 113-116. https://doi.org/10.1016/j.jns.2012.08.029 Rose, D. C., Poliakoff, E., Hadley, R., Guérin, S. M. R., Phillips, M., & Young, W. R. (2022) Levelling the playing field: The role of workshops to explore how people with Parkinson’s use music for mood and movement management as part of a patient and public involvement strategy. Frontiers in Rehabilitation Sciences, 3, Article 873216. https://doi.org/10.3389/fresc.2022.873216

Abstract Finger-tapping tasks are classically used to investigate sensorimotor synchronization in relation to neutral auditory cues, such as metronomes. However, music is more commonly associated with an entrained bodily response, such as toe tapping, or dancing. Here we report an experimental procedure that was designed to bridge the gap between timing and intervention studies by directly comparing the effects of metronome and musical cue types on motor timing abilities across the three naturalistic voluntary actions of finger tapping, toe tapping, and stepping on the spot as a simplified case of whole body movement. Both pacing cues were presented at slow, medium, and fast tempi. The findings suggested that the task of stepping on the spot enabled better timing performances than tapping both in younger and older adults (75+). Timing performances followed an inverse U shape with best performances observed in the medium tempi that were set close to the spontaneous motor tempo in each movement type. Finally, music provided an entrainment effect in addition to pace setting that enabled better motor timing and greater stability than classically reported using a metronome. By applying time-stamp analyses to kinetic data, we demonstrate that tapping and stepping engage different timing modes. This work details the importance of translational research for a better understanding of motor timing. It offers a simple procedure that strengthens the validity of applying academic work and contributes in knowledge towards a wide range of therapeutic interventions.

Objective Spontaneous motor tempo (SMT), observed in walking, tapping and clapping, tends to occur around 2 Hz. Initiating and controlling movement can be difficult for people with Parkinson’s (PWP), but studies have not identified whether PWP differ from controls in SMT. For community-based interventions, e.g. dancing, it would be helpful to know a baseline SMT to optimize the tempi of cued activities. Therefore, this study compared finger tapping (FT), toe tapping (TT) and stepping ‘on the spot’ (SS) in PWP and two groups of healthy controls [age-matched controls (AMC) and young healthy controls (YHC)], as SMT is known to change with age. Methods Participants (PWP; n = 30, AMC; n = 23, YHC; n = 35) were asked to tap or step on the spot at a natural pace for two trials lasting 40 seconds. The central 30 seconds were averaged for analyses using mean inter-onset intervals (IOI) and coefficient of variation (CoV) to measure rate and variability respectively. Results PWP had faster SMT than both control groups, depending on the movement modality: FT, F(2, 87) = 7.92, p < 0.01 (PWP faster than YHC); TT, F(2, 87) = 4.89, p = 0.01 (PWP faster than AMC); and SS, F(2, 77) = 3.26, p = 0.04 (PWP faster than AMC). PWP had higher CoV (more variable tapping) than AMC in FT only, F(2, 87) = 4.10, p = 0.02. Conclusion This study provides the first direct comparison of SMT between PWP and two control groups for different types of movements. Results suggest SMT is generally faster in PWP than control groups, and more variable when measured with finger tapping compared to stepping on the spot.

Evidence indicates that bodily perception is negatively related to Parkinson’s disease (PD); in particular, people with Parkinson’s (PwP) feel dissatisfaction in their physical abilities and appearance. While established treatments exist to ameliorate motor symptoms in PD, research has yet to explore the effects of well-being-focused interventions in relation to the subjective experience of bodily concerns of PwP. This mixed methods exploratory study investigated the constructs of body appreciation in relation to well-being in PwP and the impact of participation in a dance class on body appreciation and well-being, comparing PwP with age-matched controls. Participants (n = 27 PwP, n = 14 controls) completed the Warwick Edinburgh Mental Well-Being Scale and the Body Appreciation Scale before and after taking part in a dance class. Well-being was positively associated with body appreciation in PwP (rs = 0.64, p < 0.001) but not in controls. Following participation in a dance class, all participants’ well-being scores increased; a greater increase in well-being scores was observed for controls. A pilot qualitative study explored bodily awareness with PwP who attended dance classes (n = 4) and other movement-based activities (n = 4). Analysis of the interview data indicated that PwP who danced showed heightened bodily awareness, including bodily limitations, in comparison with PwP who did not dance. These preliminary findings provide initial insight explaining the lack of improvements in body appreciation in PwP following a dance class. The current study highlights the need for dance interventions for PwP to consider incorporating elements that encourage a body positive attitude alongside fostering perceived well-being.

Students in Higher Education report high levels of mental health issues and psychological distress. Paradoxical findings on performance-orientated students, such as athletes and musicians, suggest that the demands of highly skilled vocations may enhance wellbeing while being detrimental to physical and mental health. To provide timely and appropriate help, institutions need to understand what areas of health and wellbeing are compromised in different student groups. In this study, we compared performance-orientated (music and sport) students to other students and the general population on a selection of wellbeing (WHO5, PWS, and WEMWBS), mental and physical health (K10, SF12, and PHQ9), and trait measures (TIPI, LOT-R, and PCS). Through an online survey (N = 273), data were collected from bachelor and master students (n = 135 music, n = 67 sport, n = 71 controls). Students’ scores were compared to the general population, where norm values were available, and analyzed within and between groups. Multiple regression was performed to investigate trait measures as predictors of wellbeing. All groups scored significantly below population norms for wellbeing and mental health. One third were classed as having moderate to severe depression. Musicians scored higher openness to experience than athletes. While sport students showed a highly homogenous within-group profile, music students’ scores differed significantly across study courses (e.g., performance and composition). Predictors for wellbeing were: optimism and emotional stability (all students); additionally conscientiousness (sport and music); and perceived competence (music only). As expected, students reported more health and wellbeing issues than general population. Distinct profiles of wellbeing were apparent for performance-orientated students. Results are in line with Self Determination Theory and suggest the need for institutions to embed health and wellbeing into a ‘living curriculum’ to accommodate the needs of different student groups. The WHO5 emerged as a parsimonious yet sensitive measure for mental health and wellbeing in student populations.

Introduction Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in the intensive care unit (ICU). Probiotics are defined as live microorganisms that may confer health benefits when ingested. Prior randomised trials suggest that probiotics may prevent infections such as VAP and Clostridioides difficile–associated diarrhoea (CDAD). PROSPECT (Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial) is a multicentre, double-blinded, randomised controlled trial comparing the efficacy of the probiotic Lactobacillus rhamnosus GG with usual care versus usual care without probiotics in preventing VAP and other clinically important outcomes in critically ill patients admitted to the ICU.Methods and analysis The objective of E-PROSPECT is to determine the incremental cost-effectiveness of L. rhamnosus GG plus usual care versus usual care without probiotics in critically ill patients. E-PROSPECT will be performed from the public healthcare payer’s perspective over a time horizon from ICU admission to hospital discharge.We will determine probabilities of in-ICU and in-hospital events from all patients alongside PROSPECT. We will retrieve unit costs for each resource use item using jurisdiction-specific public databases, supplemented by individual site unit costs if such databases are unavailable. Direct costs will include medications, personnel costs, radiology/laboratory testing, operative/non-operative procedures and per-day hospital ‘hoteling’ costs not otherwise encompassed. The primary outcome is the incremental cost per VAP prevented between the two treatment groups. Other clinical events such as CDAD, antibiotic-associated diarrhoea and in-hospital mortality will be included as secondary outcomes. We will perform pre-specified subgroup analyses (medical/surgical/trauma; age; frailty status; antibiotic use; prevalent vs no prevalent pneumonia) and probabilistic sensitivity analyses for VAP, then generate confidence intervals using the non-parametric bootstrapping approach.Ethics and dissemination Study approval for E-PROSPECT was granted by the Hamilton Integrated Research Ethics Board of McMaster University on 29 July 2019. Informed consent was obtained from the patient or substitute decision-maker in PROSPECT. The findings of this study will be published in peer-reviewed journals.Trial registration number NCT01782755; Pre-results.

Music criticism has a long tradition as a leading agent in the classical music discourse. However, some people question its function in the contemporary music market. We explored the topicality of classical music critique by asking: Who reads professional reviews today? And what do readers expect from review? Through an online survey (English/German), we profiled the listening habits of classical music listeners ( N = 1200) and their engagement with professional reviews. Our participants were more actively engaged with music, but contrary to the ‘highbrow’ stereotype, not more highly musically trained than the general population. They consumed music and opinion sources in a variety of ways. Approximately two-thirds ( n = 741) of the participants had recently engaged with professional reviews, which were perceived as the most useful form of opinion, followed by short written commentaries and, lastly, ratings. A multiple logistic regression model suggested that the typical consumer of professional music critique was older with higher levels of musical engagement and education, had a higher inclination to purchase music and lower usage of streaming services, and had a preference for detailed reviews from traditional sources (e.g. newspapers). According to review readers, reviews should cover a variety of topics and offer evaluations underpinned with reasons. Reviewers should be constructive, open-minded, respectful, and well informed; their professional background was less relevant. Professional reviews should not necessarily provide a recommendation on what to buy, but rather guide listeners’ musical appreciation and understanding. Professional criticism still has an audience, although more so among older, musically educated listeners. Critics need to explore various channels in order to connect to a new generation of classical music listeners.

Objectives. Although many studies have shown that psychosocial interventions, such as dance classes, can improve quality of life for people with Parkinson’s disease (PD): few have addressed the role of, and potential benefits to, the caregivers in such activities. This mixed methods study explored the reasons for caregiver participation in a variety of activities and considered whether participation in, or abstention from these, affected the wellbeing of the caregivers. Method. Transcriptions of a focus group (two people with PD, two caregivers) and eight semistructured interviews (caregivers) were analysed using Grounded Theory (GT). To test the hypotheses derived from the GT, caregivers (n = 75) completed an online survey about activities they and the person they care for participated in, alongside the PDQ-Carer questionnaire, to establish the caregiver’s levels of wellbeing. Results. Qualitative findings suggested that caregivers tried to find a balance between caring for the person with PD and participating in activities to attend to their own needs. Reasons for participating in activities for people with PD included being able to socialise in an empathetic safe space, alongside engaging in physical activity that provided some respite distraction, such as dancing with others to music. Reasons for not participating included generating time for oneself and increasing the independence of the person with PD. Quantitative results suggested that most of the participants’ wellbeing was not compromised, although this was gendered: female caregivers reported lower wellbeing scores than male caregivers. Overall, 62% of caregivers participated in joint activities. Linear regression revealed a significant relationship between nonparticipation in daily activities and stress levels for female caregivers only, whereby the more independent the person with PD was, the lower the stress of the caregiver. Conclusion. This study suggests that caregivers of people with PD can find a healthy balance in terms of their own wellbeing by jointly participating in two-thirds of activities while ensuring the remaining third is time reserved for themselves.

Introduction. Rhythmic auditory stimulation (RAS) has successfully helped regulate gait for people with Parkinson’s disease. However, the way in which different auditory cues and types of movements affect entrainment, synchronization, and pacing stability has not been directly compared in different aged people with and without Parkinson’s. Therefore, this study compared music and metronomes (cue types) in finger tapping, toe tapping, and stepping on the spot tasks to explore the potential of RAS training for general use. Methods. Participants (aged 18–78 years) included people with Parkinson’s (n = 30, Hoehn and Yahr mean = 1.78), older (n = 26), and younger adult controls (n = 36), as age may effect motor timing. Timed motor production was assessed using an extended synchronization-continuation task in cue type and movement conditions for slow, medium, and fast tempi (81, 116, and 140 mean beats per minute, respectively). Results. Analyses revealed main effects of cue and movement type but no between-group interactions, suggesting no differences in motor timing between people with Parkinson’s and controls. Music supported entrainment better than metronomes in medium and fast tempi, and stepping on the spot enabled better entrainment and less asynchrony, as well as more stable pacing compared to tapping in medium and fast tempi. Age was not confirmed as a factor, and no differences were observed in slow tempo. Conclusion. This is the first study to directly compare how different external auditory cues and movement types affect motor timing. The music and the stepping enabled participants to maintain entrainment once the external pacing cue ceased, suggesting endogenous mechanisms continued to regulate the movements. The superior performance of stepping on the spot suggests embodied entrainment can occur during continuous movement, and this may be related to emergent timing in tempi above 600 ms. These findings can be applied therapeutically to manage and improve adaptive behaviours for people with Parkinson’s.

Byline: Ravi. Yadav, Mahendra. Ramdas, N. Karthik, Girish. Kulkarni, Rose. Dawn, M. Kumar, D. Nagaraja Sir, Hot cross bun (HCB) sign is a cruciform hyperintensity in the pons best seen [...]

Byline: A. Nalini, N. Gayathri, Rose. Dawn Background: Distal myopathy with rimmed vacuoles (DMRV) is an autosomal recessive (AR) myopathy characterized clinically by the preferential involvement of the tibialis anterior [...]

Byline: A. Nalini, Jerry. Kovoor, Rose. Dawn, Kumar. Kallur We report two patients with Marchiafava-Bignami disease (MBD). A 38-year-old male with chronic alcohol abuse developed acute onset cerebellar ataxia and [...]

Introduction The commensal bacterium Faecalibacterium prausnitzii is a prominent member of the microbiome of animals and humans, and it plays an important role in several physiological processes. Numerous studies have correlated the reduction of F. prausnitzii abundance with many disease states, including irritable bowel syndrome, Crohn’s disease, obesity, asthma, major depressive disorder, and metabolic diseases in humans. Studies have also correlated F. prausnitzii with diseases in humans involved in altered glucose metabolism, including diabetes.Research design and methods The aim of this study was to investigate the effects of compositions derived from three strains of F. prausnitzii (coined FPZ) on glucose metabolism in diet-induced obese male C57BL/6J prediabetic and type 2 diabetic mice. The primary endpoints of these studies were measuring changes in fasting blood glucose, glucose tolerance (as measured by a glucose tolerance test), and percent hemoglobin A1c (HbA1c) with longer term treatment. Two placebo-controlled trials were carried out using both live cell FPZ and killed cell FPZ and extracts. Two additional placebo-controlled trials were carried out in non-diabetic mice and mice that previously had type 2 diabetes (T2D).Results Both trials in prediabetic and diabetic mice revealed that peroral administration of live FPZ or extracts from FPZ lowered fasting blood glucose levels and improved glucose tolerance compared with control mice. A trial administering longer FPZ treatment also resulted in lowered percent HbA1c compared with control mice. Additionally, trials in non-diabetic mice treated with FPZ demonstrated that FPZ treatment does not lead to hypoglycemia.Conclusions The trial results have shown that treatment with different formulations of FPZ result in lower blood glucose levels, lower percent HbA1c, and improved glucose response in mice compared with control prediabetic/diabetic mice. FPZ is a promising candidate as an orally administered probiotic or postbiotic to manage and improve pre-diabetes and T2D.