scholarly journals Locomotor Training in People With Parkinson Disease

2006 ◽  
Vol 86 (10) ◽  
pp. 1426-1435 ◽  
Author(s):  
Meg E Morris
Keyword(s):  
Parkinson Disease ◽  
Clinical Decision Making ◽  
Physical Therapist ◽  
Clinical Decision ◽  
Gait Training ◽  
International Classification Of Functioning ◽  
Locomotor Training ◽  
Participation Restrictions ◽  
End Stage ◽  
And Function

Abstract The purpose of this article is to consider the role of the physical therapist in locomotor training for people with Parkinson disease. The ways in which disease progression, medication status, environmental conditions, individual factors, and the goals of locomotor tasks contribute to clinical decision making are explored. Using the International Classification of Functioning, Disability and Health, gait training will be considered in relation to impairments of body structure and function, activity limitations, and participation restrictions in people who are newly diagnosed through to those with end-stage disease. Based on the principles of neural adaptation and clinical research findings, practical suggestions are made on how to provide the most efficient and effective physical therapy services at different stages of Parkinson disease.

scholarly journals A practical approach to detection and treatment of depression in Parkinson disease and dementia

2017 ◽  
Vol 7 (2) ◽  
pp. 128-140 ◽  
Author(s):  
Zahra Goodarzi ◽  
Zahinoor Ismail
Keyword(s):  
Parkinson Disease ◽  
Clinical Decision Making ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Clinical Decision ◽  
Geriatric Depression ◽  
Late Life Depression ◽  
Treatment Of Depression ◽  
Pharmacologic Management ◽  
Severity Of Depression

AbstractPurpose of review:To review the available evidence for the detection and management of depression in Parkinson disease (PD) and dementia.Recent findings:Depression is a common comorbidity in those with PD or dementia, and leads to increased morbidity. There are several available and accurate tools for the detection of depression in PD (e.g., Geriatric Depression Scale) and dementia (e.g., Cornell Scale for Depression in Dementia). Treatment of depression depends on patient preference, severity of depression, comorbidities, and available resources. Despite variable evidence, the use of nonpharmacologic strategies to manage depression is suggested. Pharmacologic management is guided by modest evidence in PD and dementia, but also informed by the management of late-life depression (LLD).Summary:There is evidence to guide the diagnosis and management of depression in PD or dementia. However, more research is required in this field to better inform clinical decision-making.

Right ventricle and pulmonary arterial pressure

2016 ◽  
Author(s):  
Annemien E. van den Bosch ◽  
Luigi P. Badano ◽  
Julia Grapsa
Keyword(s):  
Clinical Decision Making ◽  
Complex Geometry ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Prognostic Information ◽  
Recent Developments ◽  
And Function

Right ventricular (RV) performance plays an important role in the morbidity and mortality of patients with left ventricular dysfunction, congenital heart disease, and pulmonary hypertension. Assessment of RV size, function, and haemodynamics has been challenging because of its complex geometry. Conventional two-dimensional echocardiography is the modality of choice for assessment of RV function in clinical practice. Recent developments in echocardiography have provided several new techniques for assessment of RV dimensions and function, include tissue Doppler imaging, speckle-tracking imaging, and volumetric three-dimensional imaging. However, specific training, expensive dedicated equipment, and extensive clinical validation are still required. Doppler methods interrogating tricuspid inflow and pulmonary artery flow velocities, which are influenced by changes in pre- and afterload conditions, may not provide robust prognostic information for clinical decision-making. This chapter addresses the role of the various echocardiographic modalities used to assess the RV and pulmonary circulation. Special emphasis has been placed on technical considerations, limitations, and pitfalls of image acquisition and analysis.

scholarly journals Measuring Work-Related Functioning Using the Work Rehabilitation Questionnaire (WORQ)

2019 ◽  
Vol 16 (15) ◽  
pp. 2795 ◽  
Author(s):  
Finger ◽  
Escorpizo ◽  
Tennant
Keyword(s):  
Clinical Decision Making ◽  
Injury Severity ◽  
Clinical Decision ◽  
International Classification Of Functioning ◽  
Minimal Detectable Change ◽  
Work Rehabilitation ◽  
French Version ◽  
Work Related ◽  
Item Functioning ◽  
Operational Range

The assessment of work-related functioning is a key process in vocational rehabilitation to identify specific domains of disability that can be considered within return to work strategies. The Work Rehabilitation Questionnaire (WORQ) was developed to evaluate work-related functioning based on the International Classification of Functioning, Disability, and Health (ICF) framework and is available in different languages. The aim of this study was to assess the French version of the WORQ using item response theory to further validate the scale. Rasch analysis of WORQ and the WORQ-BRIEF (a brief version of the WORQ) was performed using a calibration sample of 221 persons with musculoskeletal injuries. A four-testlet solution indicated the unidimensionality of WORQ, with no differential item functioning for age, education, physical job demands, and injury severity. Reliability was 0.969 and 0.918 for WORQ and WORQ-BRIEF, respectively. The minimal detectable change was calculated to be 4.2% of its operational range for WORQ and 8.5% for WORQ-BRIEF. Consequently, the French version of WORQ can be considered a good measure of work-related functioning in musculoskeletal conditions. WORQ can be used in rehabilitation practice to comprehensively identify the disability and guide clinical decision making and intervention planning. Further studies are needed to evaluate the psychometric properties of WORQ in other health conditions.

How Do Physical Therapists Approach Management of People With Early Knee Osteoarthritis? A Qualitative Study

2019 ◽  
Vol 100 (2) ◽  
pp. 295-306 ◽  
Author(s):  
Crystal MacKay ◽  
Gillian A Hawker ◽  
Susan B Jaglal
Keyword(s):  
Knee Osteoarthritis ◽  
Weight Management ◽  
Clinical Decision Making ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Continuing Professional Development ◽  
Clinical Decision ◽  
Therapeutic Interventions ◽  
Evidence Based ◽  
Knee Oa

Abstract Background Knee osteoarthritis (OA) is a leading cause of disability. There is increasing emphasis on initiating treatment earlier in the disease. Physical therapists are central to the management of OA through the delivery of exercise programs. There is a paucity of research on physical therapists’ perceptions and clinical behaviors related to early knee OA management. Objective The study aimed to explore how physical therapists approached management of early knee OA, with a focus on evidence-based strategies. This is an important first step to begin to optimize care by physical therapists for this population. Design We used a qualitative, descriptive research design. Methods Semistructured interviews were conducted with 33 physical therapists working with people with knee symptoms and/or diagnosed knee OA in community or outpatient settings in Canada. Data were analyzed using thematic analysis. Results Five main themes were constructed: (1) Physical therapists’ experience and training: clinical experiences and continuing professional development informed clinical decision-making. (2) Tailoring treatment from the physical therapist “toolbox:” participants described their toolbox of therapeutic interventions, highlighting the importance of tailoring treatments to people. (3) The central role of exercise and physical activity in management: exercise was consistently recommended by participants. (4) Variability in support for weight management: there was variation related to how participants addressed weight management. (5) Facilitating “buy-in” to management: physical therapists used a range of strategies to gain “buy-in.” Limitations Participants were recruited through a professional association specializing in orthopedic physical therapy and worked an average of 21 years. Conclusions Participants’ accounts emphasized tailoring of interventions, particularly exercises, which is an evidence-based strategy for OA. Findings illuminated variations in management that warrant further exploration to optimize early intervention (eg, weight management, behavior change techniques).

scholarly journals Acute Rehabilitation of a Patient With COVID-19 Myocarditis: A Case Report

2020 ◽  
Author(s):  
Kelly Butler ◽  
Malachy J Clancy ◽  
Joe Adler ◽  
Michael A Tevald
Keyword(s):  
Case Report ◽  
Clinical Decision Making ◽  
Care Delivery ◽  
Prolonged Mechanical Ventilation ◽  
Virus Transmission ◽  
Clinical Decision ◽  
Patient Specific ◽  
Timed Up And Go ◽  
And Function ◽  
Acute Rehabilitation

Abstract Objective The purpose of this case report is to describe the acute rehabilitation of an individual with severe COVID-19 complicated by myocarditis, focusing on both facility-wide and patient-specific strategies. Methods A 50-year-old male presented to the emergency department with progressive dyspnea and confirmed COVID-19. He developed hypoxic respiratory failure and heart failure, requiring prolonged mechanical ventilation. Mobility was limited by severe impairments in strength, endurance, balance, and cognition. The referral, screening, and rehabilitation of this patient was guided by a COVID-19 Service Delivery Plan designed to maximize the effectiveness and efficiency of care delivery while minimizing staff exposure to the virus. Coordinated physical and occupational therapy sessions focused on progressive mobility and cognitive retraining. Progress was monitored using a series of standardized outcome measures, including the Activity Measure for Post-Acute Care (AMPAC), Timed “Up and Go” (TUG), and the Saint Louis University Mental Status (SLUMS) examination. Results Rehabilitation was initiated on day 18, and the patient participated in 19 treatment sessions, each approximately 30 minutes, over the remaining 30 days of his hospital stay. His AM-PAC mobility and function scores both improved from 100% to 0% disability, he experienced substantial improvements in both TUG (Δ = 4.2 s) and SLUMS (discharge score = 25), and there were no adverse events. He was discharged to home with his family and home rehabilitation services. Conclusion COVID-19 contributed to severe declines in mobility and function in this middle-aged man. He experienced substantial gains in his function, mobility, and cognition during his in-hospital rehabilitation, which was guided by a facility-wide plan to prevent virus transmission. Impact The rehabilitation of individuals with severe COVID-19 presents significant challenges, both at the level of the individual patient and the whole facility. This report describes clinical decision making required to manage these individuals in the setting of a global pandemic.

scholarly journals Emergency department-based 3D echocardiogram use: a case series

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Sajith Matthews ◽  
Phillip D. Levy
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Clinical Decision Making ◽  
Three Dimensional ◽  
Case Series ◽  
Clinical Decision ◽  
Volumetric Imaging ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography ◽  
And Function

Abstract Background Three-dimensional echocardiography (3DE) with real-time volumetric imaging can be a vital modality in clinical practice. Despite its potential, it remains underutilized in the acute care setting. Case presentation We present two cases describing the use of 3DE in the emergency department (ED) for acute heart failure (AHF) and discuss the potential benefits of routine use in acute care settings. Conclusions Three-dimensional echocardiography offers unique information as it relates to cardiac structure and function, and can be valuable for diagnosis and clinical decision-making in the ED.

scholarly journals Economic burden of prescriptive inadequacy in the management of osteoarthritis in Italy

2020 ◽  
Vol 7 (1) ◽  
pp. 101-108
Author(s):  
Michele Basile ◽  
Filippo Rumi ◽  
Marco Palmeri ◽  
Ivano Mattozzi ◽  
Lamberto Manzoli ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Economic Burden ◽  
Clinical Decision Making ◽  
Integrated Management ◽  
Clinical Decision ◽  
Joint Disease ◽  
Italian Population ◽  
International Guidelines ◽  
Quality Healthcare ◽  
And Function

Introduction: Osteoarthritis (OA) is a common chronic joint disease characterized by pain, deformity, instability, reduction of motion and function. It is one of the main causes of disability in older adults, affecting about 10% of men and 18% of women over the age of sixty. There are several Guidelines that support the general clinical decision-making process. However, it is necessary to define an integrated management model for patients with OA to ensure an appropriate and quality healthcare. Methods: The objective of the analysis is to determine the economic burden linked to the prevalence and incidence of OA in the acute and chronic phases from the perspective of the National Health Service (NHS) and the entire society. A comparison was made between the management according to the clinical practice and the appropriate management according to National and International Guidelines, determining for each scenario the level of resources absorbed. Results: Patients who started a nonsteroidal anti-inflammatory drug (NSAID)-based therapy in clinical practice resulted in a higher absorption of resources of €363.87 than the same patient managed by referring to National and International Guidelines. Conclusions: OA is associated with a high economic burden and it is a priority problem for public health internationally. The savings resulting from our research, if generalized to the entire Italian population, would lead to a significant reduction of OA economic burden, thus allowing a reallocation of the available resources to other NHS’ sectors.

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