Dalfampridine for Mobility Limitations in People With Multiple Sclerosis May Be Augmented by Physical Therapy: A Non-randomized Two-Group Proof-of-Concept Pilot Study

Purpose: To demonstrate proof-of-concept for a combined physical therapy and pharmacological intervention and obtain preliminary estimates of the therapeutic efficacy of a motor-relearning physical therapy intervention with and without concurrent dalfampridine treatment on gait speed in people with mobility limitations due to multiple sclerosis (MS).Methods: Using a non-randomized, two-group design, 4 individuals with MS newly prescribed dalfampridine as part of their routine medical care, and 4 individuals with MS not taking dalfampridine completed a 3-week drug run-in or no-treatment baseline, respectively. After 3 weeks, all participants commenced physical therapy twice weekly for 6 weeks. Participants taking dalfampridine took the medication for the study duration. The physical therapy program comprised functional strengthening, gait training, balance training, and dual-task training. The primary outcome was Timed 25-foot Walk (T25FW) at the end of the 6-week physical therapy program.Results: For the 4 participants taking dalfampridine, average improvement in T25FW on drug only was 12.8% (95% CI 1.2 to 24.4%). During the 6-week physical therapy phase, both groups significantly improved T25FW, but the effect tended to favor the group taking dalfampridine (mean difference = −0.93 s, 95% CI −1.9 to 0.07 s, p = 0.064, d = 1.6). Whereas the physical therapy group had average T25FW improvement of 10.8% (95% CI 1.0 to 20.5%), the physical therapy plus dalfampridine group demonstrated average improvement of 20.7% (95% CI 3.8 to 37.6%).Conclusions: Further research is warranted to examine whether dalfampridine for mobility impairment may be augmented by physical therapy in people with MS.

Multimorbidity Patterns and the Disablement Process among Public Long-Term Care Insurance Claimants in the City of Yiwu (Zhejiang Province, China)

This study aimed to identify multimorbidity patterns and explore the disablement process by utilizing the model raised by Verbrugge and Jette as a theoretical framework. This cross-sectional study used public Long-term Care Insurance (LTCI) claimants’ assessment data of Yiwu city in Zhejiang Province, China, for 2604 individuals aged 60 years and older, from September through December 2018. Latent Class Analysis (LCA) was conducted using 10 common chronic conditions. Structural Equation Modeling was used to examine the disablement process. The latent classes of multimorbidity patterns were the “coronary atherosclerotic heart disease” class (19.0%), the “lower limb fractures” class (26.4%), and the “other diseases” class (54.6%). The structural model results show that coronary atherosclerotic heart disease had a significant influence on incontinence, but it was not statistically significant in predicting vision impairment and mobility impairment. Lower limb fractures had significant effects on vision impairment, incontinence, and mobility impairment. Vision impairment, incontinence, and mobility impairment had significant effects on physical activities of daily living (ADLs). Our findings suggest that different impairments exist from specific patterns of multimorbidity to physical ADL disability, which may provide insights for researchers and policy makers to develop tailored care and provide support for physically disabled older people.

Acceptability and deliverability of an auditory rhythmical cueing (ARC) training programme for use at home and outdoors to improve gait and physical activity post-stroke

Background Although laboratory studies demonstrate that training programmes using auditory rhythmical cueing (ARC) may improve gait post-stroke, few studies have evaluated this intervention in the home and outdoors where deployment may be more appropriate. This manuscript reports stakeholder refinement of an ARC gait and balance training programme for use at home and outdoors, and a study which assessed acceptability and deliverability of this programme. Methods Programme design and content were refined during stakeholder workshops involving physiotherapists and stroke survivors. A two-group acceptability and deliverability study was then undertaken. Twelve patients post-stroke with a gait related mobility impairment received either the ARC gait and balance training programme or the gait and balance training programme without ARC. Programme provider written notes, participant exercise and fall diaries, adverse event monitoring and feedback questionnaires captured data about deliverability, safety and acceptability of the programmes. Results The training programme consisted of 18 sessions (six supervised, 12 self-managed) of exercises and ARC delivered by a low-cost commercially available metronome. All 12 participants completed the six supervised sessions and 10/12 completed the 12 self-managed sessions. Provider and participant session written records and feedback questionnaires confirmed programme deliverability and acceptability. Conclusion An ARC gait and balance training programme refined by key stakeholders was feasible to deliver and acceptable to participants and providers. Trial registration ISCTRN 12/03/2018.

Wheelchair Skills Test Outcomes across Multiple Wheelchair Skills Training Bootcamp Cohorts

User training is a critical component of wheelchair service delivery to ensure individuals with a mobility impairment can negotiate environmental barriers and promote their social participation. A wheelchair “bootcamp”, delivered during professional preparation education, is one strategy to better prepare occupational therapists for clinical rehabilitation practice by developing their own wheelchair skills. The purpose of this study was a retrospective review of a large dataset of student cohorts from a single site and delineate bootcamp effects on the Wheelchair Skills Test-Questionnaire (WST-Q) scores. Participant data from eight cohorts was consolidated (n = 307). Comparison of two WST-Q scoring formats revealed significantly lower scores for cohorts using the 4-point version, which was subsequently standardized to the other 3-point version. WST-Q change scores were similar between cohorts, and differences were more reflective of variability in skill level prior to bootcamp than post-bootcamp scores. Students were able to master most basic and intermediate level skills, while advanced skill acquisition was much more variable. This study provides more precise point estimates of wheelchair skill acquisition among occupational therapy students than previous studies. While confirming the benefits of bootcamp education, recommendations for further investigation were identified.

Penerapan Latihan ROM (RANGE OF MOTION) Terhadap Rentang Gerak Ekstremitas Pada Pasien Stroke

Stroke is a disease caused by an acute neurological deficit in blood vesseldisorders leading to the brain that occur suddenly and can cause physical disability or death.The common complain are mobility impairment or decreased range of movement of the extremities.This study aimed to increase the range of movement of the extremities by doing Range on Motion exercises in families who have a history of stroke.There are two post-stroke patients involved in this study and give the Range of Motion exercise.The method used is to measure the degree of joint range of motion before performing ROM exercises then ROM exercises ranging from flexion, extension, hyperextension, adduction, abduction, and so on then measure the degree of joint range of motion with a goniometer measuring instrument and the results are recorded on the observation sheet.Goniometer was used to measurement the range of movement of the extremities.Range of Motion was performed for 7 days, each movement of 10 seconds duration.The results show that the range of movement increased in both patients. Accordingly, the Range of Motion exercises proved can increase the range of movement of the extremities in stroke patients.Families are expected to doing the Range of Motion exercise independently at home.Keywords:Range of motion; Range of movement; Stroke. AbstrakStroke adalah penyakit yang disebabkan oleh defisit neurologis akut pada gangguan pembuluh darah menuju otak yang terjadi secara tiba-tiba dan dapat menyebabkan kecacatan fisik atau kematian.Keluhan yang sering dikeluhkan adalah gangguan mobilitas atau penurunan jangkauan gerak ekstremitas. Penelitian ini bertujuan untuk meningkatkan jangkauan gerak ekstremitas dengan melakukan latihan Range on Motion pada keluarga yang memiliki riwayat stroke.Ada dua pasien pasca stroke yang terlibat dalam penelitian ini dan memberikan latihan Range of Motion.Metode yang dilakukan mengukur derajat rentang gerak sendi sebelum dilakukan latihan ROM kemudian latihan ROM mulai dari gerakan fleksi, ekstensi, hiperekstensi, addukksi, abduksi, dan lain sebagainya kemudian mengukur kembali derajat rentang gerak sendi dengan alat ukur goniometer dan hasilnya catat dilembar observasi.Goniometer digunakan untuk mengukur jangkauan gerakan ekstremitas.ROM dilakukan selama 7 hari, setiap gerakan durasi 10 detik.Hasil penelitian menunjukkan bahwa rentang gerak meningkat pada kedua pasien. Dengan demikian, latihan Range of Motion terbukti dapat meningkatkan jangkauan gerak ekstremitas pada pasien stroke. Keluarga diharapkan melakukan latihan Range of Motion secara mandiri di rumah.Kata kunci:Range of motion; Rentang gerak; Stroke.

Gait Speed Maintenance Is Associated With Sensorimotor and Frontoparietal Network Connectivity Among Older Adults

Mobility impairment is a geriatric giant. Particularly, slow gait is associated with elevated risk for cognitive decline, disabilities and dementia. Gait is the product of complex neural network interactions and changes in their connectivity pattern may negatively impact gait speed. However, mechanistic neural correlates for gait speed maintenance and decline remained unclear. As such, the aim of this study is to investigate differences in neural network connectivity in older adults with and without gait speed decline over 24 months. This sub-analysis included 35 community-dwelling older adults age >70 years from the MOBILIZE Boston Study. Baseline assessments included four-meter gait speed test and resting-state fMRI. Gait speed was reassessed at a 24-month follow-up. Participants were stratified to “Maintainer” and “Decliner” groups based upon a cut-off of >0.05 m/s decline in gait speed from baseline to follow-up. A priori selected functional network included sensori-motor network (SMN) and frontoparietal network (FPN). Multivariate analysis of variance was performed to determine between group differences in network connectivity. Discriminant analysis was conducted to identify relative contribution of network connectivity to group classification. Between the 14 Maintainers and 21 Decliners (mean age 83.9 years), Maintainers were younger (p=0.088). After adjusting for age, Maintainers exhibited lower SMN premotor-precentral gyrus connectivity (p=0.023), greater FPN ventral visual-supramarginal gyrus connectivity (p=0.025), and trend level greater SMN-FPN cerebellum-occipital connectivity (p=0.053). Premotor-precentral gyrus connectivity showed greatest contribution to discriminant function. These preliminary findings suggest aberrant connectivity patterns of the SMN and FPN may be predictive of older adults’ ability to maintain gait speed.

Longitudinal changes of frailty in 8 years: comparisons between physical frailty and frailty index

Background Few studies have made longitudinal comparisons between frailty phenotype (FP) and frailty index (FI) changes. We aimed to investigate frailty status changes defined by FP and FI concurrently, and to compare the associated factors and incident disability among different combination of FI and FP trajectory groups. Methods Data on respondents aged over 50 who completed the 1999, 2003 and 2007 Taiwan Longitudinal Study on Aging (TLSA) surveys (n = 2807) were excerpted. Changes of FI, FP and major time-dependent variables were constructed by group-based trajectory modeling. Logistic regression was used to investigate the associated factors and relationships with incident disability among different frailty trajectories. Results We identified four FP trajectories – stably robust, worsened frailty, improved frailty, and stably frail and three FI trajectories – stable FI, moderate increase FI and rapid increase FI. Lower self-rated health, mobility impairment, and depressed mood were associated with unfavorable FP and FI changes (all p < 0.001). Regardless of FP trajectory groups, the moderate and rapid increase FI group had significantly more comorbidities than the stable FI group, and more visual, hearing, oral intake impairment, more difficulty in meeting living expenses, and poorer cognitive function in ≥65-year-olds (all p < 0.05). In addition, the worsened frailty, improved frailty, and stably frail groups had ORs for incident disability of 10.5, 3.0, and 13.4, respectively, compared with the stably robust group (all p < 0.01); the moderate and rapid increase FI groups had 8.4-fold and 77.5-fold higher risk than the stable FI group (both p < 0.001). When combining FI and FP trajectories, risk increased with FI trajectory steepness, independent of FP change (all p < 0.01 in rapid increase FI vs stable FI). Conclusions Four FP trajectories (stably robust, worsened frailty, improved frailty, and stably frail) and three FI trajectories (stable FI, moderate increase FI and rapid increase FI) were identified. Lower self-rated health, mobility impairment, and depressed mood were associated with both unfavorable FP and FI trajectories. Nevertheless, even for individuals in stably robust or improved frailty FP groups, moderate or rapid increase in FI, either due to comorbidities, sensory impairment, cognitive deficits, or financial challenges, may still increase the risk of incident disability.

Energy Decline May Predict Mild Parkinsonian Signs in Community-Dwelling Older Adults

Mild Parkinsonian Signs (MPS) are common in older adults without overt neurological disease. MPS are often progressive and predict disability and dementia, yet little is known about predictors for MPS. Low self-reported energy is associated with mobility impairment, which is a hallmark of MPS. Yet whether self-reported energy relates to MPS is unknown. We explored the association of changes in self-reported energy with MPS in 293 participants (aged 83 ± 2.8 years, 58% women, 61% White) free of dementia and Parkinson’s Disease in the Health, Aging and Body Composition Study. Self-reported energy was assessed on a 0-10 scale annually between Year 2 and Year 10 (mean follow-up: 8 years) and its slope was estimated via linear mixed effects models. MPS were evaluated at Year 10 based on the Unified Parkinson Disease Rating Scale motor component. On average, self-reported energy declined 0.06 points per year. In a linear regression model adjusted for age, fatigue, and comorbidities, those with MPS had steeper SEL decline (β [Standard Error] = -0.358 [0.119]) in the prior eight years than those without MPS. Thus, declining self-reported energy may be a risk factor for MPS. Self-reported energy is easily evaluated in routine clinic visits, and may be a modifiable risk factor that can be targeted to reduce the incidence of MPS.

Disability Profile and Accessibility Limitations among Persons with Physical Disability in Nigeria

Purpose: To evaluate disability profile and accessibility limitations among Persons Living with Disabilities (PLWDs) in Nigeria. Methods: 61 PLWDs (44 men, 17 women) consented for this study. World Health Organization Disability Assessment Schedule 2.0, Facilitators and Barriers Survey for People with Mobility Limitations version 2, Barthel Index, and Medical Expenditure Panel Survey Questionnaires were used to obtain data on physical disability profile, level of access barriers, activities of daily living and quality of access to health care respectively. A proforma was used to collect information on socio-demographic characteristics. Data were analyzed using descriptive and inferential statistics. Alpha level set at p< 0.05. Results: Prevalence of mobility, visual and hearing impairments were 60.7%, 21.3% and 6.6% respectively, There was a 11.5% rate of functional limitation while mild difficulty with ‘cognition’ and ‘life activities’ were reported among 96.7% and 65.6% of the respondents. 24.6% of the respondents had partial mobility dependence. There was low quality of access to health care (67.2%), high access barrier to home environment (73.8%) and transportation (93.4%). Conclusion: The PLWDs have high mobility impairment and face barriers in accessing healthcare, transportation and environment.

Relationship Between Cognition and Gait at 2- and 12-Months Post-Traumatic Brain Injury

Background: A common and debilitating challenge experienced by people with TBI is gait-associated mobility impairment and persisting cognitive impairments. Cognitive and physical impairments are often addressed independently during rehabilitation, however, increasing evidence links cognitive and motor processes more closely.Objectives: (1) To determine if correlations exist between measures of cognitive and gait recovery, post-TBI. (2) To investigate the predictive power of cognition at 2-months on gait outcomes at 12-months post-TBI.Methods: In this secondary, longitudinal study of cognitive and neural recovery, data from 93 participants admitted to an inpatient neurorehabilitation program were analyzed. Spatiotemporal gait variables [velocity, step time variability (STV), step length variability (SLV)] were collected along with cognitive variables [Trail Making Test-B (TMT-B), Digit Span-Forward (DS-F)]. Spearman's correlation coefficients were calculated between gait and cognitive variables. Multilinear and step wise regression analyses were calculated to determine predictive value of cognitive variables at 2-months on gait performance at 12-months-post TBI.Results: At 2-months post-injury, TMT-B was significantly correlated with gait velocity and STV; and DS-F was significantly correlated with velocity. At 12-months post-injury, TMT-B and DS-F was still significant correlated with velocity. TMT-B at 2-months was correlated with SLV and STV at 12-months; and DS-F correlated significantly with velocity. Regression models showed TMT-B at 2-months predicting STV, SLV, and velocity at 12-months.Conclusions: Significant associations and predictions between physical and cognitive recovery post-TBI were observed in this study. Future directions may consider a “neural internetwork” model as a salient rehabilitation approach in TBI that integrates physical and cognitive functions.