NeuroRehabilitation - Volume 20, issue 3

Authors: Seel, Ronald T. | Cifu, David X.

Article Type: Introduction

DOI: 10.3233/NRE-2005-20301

Citation: NeuroRehabilitation, vol. 20, no. 3, pp. 151-152, 2005

Authors: Diaz, Natalie | Bronstein, Jeff M.

Article Type: Research Article

Abstract: Parkinson's disease (PD) afflicts more than 1,000,000 people in the United States and over 50,000 veterans obtain their medical care for PD within the Veterans Health Care System. In an effort to improve care for this growing population of veterans suffering from PD, the Veteran's Health Administration established 6 Parkinson's disease Research, Education, and Clinical Centers (PADRECC) based on merit. These 6 centers offer state of the art diagnosis and treatment of PD and other movement disorders. The PADRECC also provide education for both the professional community and patients not only at the 6 sites, but also throughout the VA …system through the development of a national consortium. Improving veterans' health care through research is also a priority for the PADRECC. All 6 PADRECC are participating in the largest surgical trial for the treatment of PD ever performed. Heath service researchers have already identified quality of care indicators that are now being used to evaluate care for veterans with PD. Basic researchers at the PADRECC are studying the cause of PD and are developing new therapies including stem cells. The development of the PADRECC has created an important infrastructure and attracted expertise into the VA system. They have already made great improvements in caring for veterans with PD and promises to push the field further with their research efforts. Show more

DOI: 10.3233/NRE-2005-20302

Citation: NeuroRehabilitation, vol. 20, no. 3, pp. 153-160, 2005

Authors: Carne, William | Cifu, David | Marcinko, Paul | Pickett, Treven | Baron, Mark | Qutubbudin, Abu | Calabrese, Vincent | Roberge, Peggy | Holloway, Kathryn | Mutchler, Brian

Article Type: Research Article

Abstract: The efficacy of the multidisciplinary treatment approach to the management of Parkinson's disease (PD) was examined at a regional Veteran's Administration Parkinson's Disease Research, Education and Clinical Center (PADRECC). The records of 43 consecutive individuals with PD were examined. The Unified Parkinson's Disease Rating Scale (UPDRS) was employed to assess disease progression. Changes between initial and one-year follow-up UPDRS motor functioning (Part III) scores were compared to expected disease progression from prior research. In this cohort, thirty patients (69.8%) had improved, 2 were unchanged (4.7%) and 11 patients (25.6%) had worsened at the mean 12.2-month follow-up period. The range of …multidisciplinary interventions included neurology (100%), physiatrist (93%), and psychology (41.9%) visits, medication changes (60.5%), rehabilitation therapy (62.8%), functional diagnostic testing (16.3%), support group (9.3%), home exercise programs (86%), and disease and wellness education (83.7%). Statistical analyses of the individual components of the program did not demonstrate significant differences between improvers and non-improvers. Clinical implications and study limitations are discussed. Show more

Keywords: Disease progression, outcomes, Parkinson's disease, UPDRS, multidisciplinary team

DOI: 10.3233/NRE-2005-20303

Citation: NeuroRehabilitation, vol. 20, no. 3, pp. 161-167, 2005

Authors: Robinson, Keith | Dennison, Andrew | Roalf, David | Noorigian, Joseph | Cianci, Heather | Bunting-Perry, Lisette | Moberg, Paul | Kleiner-Fisman, Galit | Martine, Rebecca | Duda, John | Jaggi, Jurg | Stern, Matthew

Article Type: Research Article

Abstract: Objective: to identify falling risk factors that are potentially modifiable among individuals who have idiopathic Parkinson's disease. Design: a between group comparison of 19 fallers and 21 nonfallers who have Parkinson's disease, across an array of variables that have been identified as falling risk factors among the elderly and among those who have Parkinson's disease. Results: several variables were demonstrated significantly to distinguish fallers: disease duration and severity; dyskinesias associated with the use of dopaminergic agents; freezing; postural instability; depression; fear of falling; impaired fine motor control and motor planning in the feet; decreased …proximal strength and muscular endurance in the legs; and a higher level of disability. Conclusions: several of these variables can be viewed a potentially modifiable during a future intervention trial that aims to reduce falls in those who have Parkinson's disease using multidimensional risk factor modification. Show more

Keywords: Falling, risk factors, Parkinson's disease

DOI: 10.3233/NRE-2005-20304

Citation: NeuroRehabilitation, vol. 20, no. 3, pp. 169-182, 2005

Authors: Protas, Elizabeth J. | Mitchell, Katy | Williams, Amanda | Qureshy, Huma | Caroline, Kavitha | Lai, Eugene C.

Article Type: Research Article

Abstract: Introduction: Frequent falls and risk of injury are evident in individuals with Parkinson's disease (PD) as the disease progresses. There have been no reports of any interventions that reduce the incidence of falls in idiopathic PD. Purpose: Assess the benefit of gait and step perturbation training in individuals with PD. Design: Randomized, controlled trial. Setting: Outpatient research, education and clinical center in a tertiary care Veterans Affairs Medical Center. Outcome measures: Gait parameters, 5-step test, report of falls. Subjects: Eighteen men with idiopathic PD in stage 2 or 3 …of the Hoehn and Yahr staging. Methods: Subjects were randomly assigned to a trained or control group. They were asked about any falls 2 weeks prior to and after an 8 week period. Gait speed, cadence, and step length were tested on an instrumented walkway. Subjects were timed while stepping onto and back down from an 8.8 cm step for 5 consecutive steps. Gait training consisted of walking on a treadmill at a speed greater than over ground walking speed while walking in 4 directions and while supported in a harness for safety. Step training consisted of suddenly turning the treadmill on and off while the subject stood in the safety harness facing either forwards, backwards, or sideways. Training occurred 1 hour per day, three times per week for 8 weeks. A two-factor (time and group) analysis of variance with repeated measures was used to compare the groups. Results: Substantial reduction occurred in falls in the trained group, but not in the control group. Gait speed increased in the trained group from 1.28±0.33 meters/sec to 1.45±0.37 meters/sec, but not in the control group (from 1.26 to 1.27 m/s). The cadence increased for both groups: from 112.8 to 120.3 steps/min for the trained group and 117.7 to 124.3 steps/min for the control group. Stride lengths increased for the trained group, but not the control group. The 5-step test speed increased in the trained group from 0.40±0.08 steps/sec to 0.51±0.12 steps/sec, and in the control group (0.36±0.11 steps/sec to 0.42±0.11 steps/sec). Conclusion: Gait and step perturbation training resulted in a reduction in falls and improvements in gait and dynamic balance. This is a promising approach to reduce falls for patients with PD. Show more

Keywords: Parkinson's disease, falls, gait training, rehabilitation

DOI: 10.3233/NRE-2005-20305

Citation: NeuroRehabilitation, vol. 20, no. 3, pp. 183-190, 2005

Authors: Ong, Jason C. | Seel, Ronald T. | Carne, William F. | Brown, Rashelle | Pegg, Phillip O. | Jehle, Patrick J.

Article Type: Research Article

Abstract: Mild to severe cognitive impairment and depression are common among patients with Parkinson's disease (PD) and play a significant role in disability. Effective treatment planning requires a holistic assessment of cognitive and emotional difficulties. A brief neuropsychological protocol was developed to examine the pattern of cognitive and emotional functioning of patients with idiopathic PD. Data was retrospectively analyzed for the first 61 male veterans who were evaluated at an interdisciplinary movement disorders clinic. The most frequently observed cognitive impairments were in the areas of auditory learning, delayed recall memory, and visual motor functioning that required alternating tracking and sequencing. Executive …dysfunction was marked by the inability of 60% of the sample to complete the Wisconsin Card Sorting Test, a measure of non-verbal reasoning with a cognitive flexibility component. Clinical interviews revealed that 28% of the sample met DSM-IV Criterion A for a Major Depressive Episode. The findings suggested that this brief neuropsychological protocol established cognitive and emotional profiles of patients with PD, consistent with other samples of patients with Parkinson's Disease. Clinical uses of the brief neuropsychological protocol are detailed. Selection of an alternative executive function measure with a lower “floor” that minimizes patient fatigue and frustration is recommended. Show more

Keywords: Parkinson's disease, neuropsychological assessment, depression, neurobehavioral symptoms, clinical assessment

DOI: 10.3233/NRE-2005-20306

Citation: NeuroRehabilitation, vol. 20, no. 3, pp. 191-203, 2005

Authors: Trail, Marilyn | Fox, Cynthia | Ramig, Lorraine Olson | Sapir, Shimon | Howard, Julia | Lai, Eugene C.

Article Type: Research Article

Abstract: Researchers estimate that 89% of people with Parkinson's disease (PD) have a speech or voice disorder including disorders of laryngeal, respiratory, and articulatory function. Despite the high incidence of speech and voice impairment, studies suggest that only 3–4% of people with PD receive speech treatment. The authors review the literature on the characteristics and features of speech and voice disorders in people with PD, the types of treatment techniques available, including medical, surgical, and behavioral therapies, and provide recommendations for the current efficacy of treatment interventions and directions of future research.

Keywords: Parkinson's disease, speech and voice disorders, speech and voice treatment, hypokinetic dysarthria, hypophonia

DOI: 10.3233/NRE-2005-20307

Citation: NeuroRehabilitation, vol. 20, no. 3, pp. 205-221, 2005

Authors: Piper, Melinda | Abrams, Gary M. | Marks Jr., William J.

Article Type: Research Article

Abstract: Abnormality in gait is a cardinal feature of Parkinson's disease. Walking is characterized by relatively preserved sequencing of trunk and limb movements, but diminished velocity, shortened stride length, increased base, and diminished double stance support time. The principle problem producing the gait abnormalities is dopamine deficiency, which is hypothesized to disrupt pallido-thalamic modulation of cortical motor regions that automatically regulate walking. Deep brain stimulation currently is directed at either the globus pallidum internus (GPi) or subthalamic nucleus (STN) and improves many of the abnormal characteristics of parkinsonian gait with efficacy similar to dopamine replacement. The optimal target for stimulation remains …uncertain and is currently being addressed in a large VA cooperative study. Our studies show that unilateral stimulation of GPi or STN improves gait to a similar extent. Functional and quantitative gait analyses confirm sustained improvement in gait dynamics with bilateral stimulation for periods for more than several years. Parkinsonian gait is also improved with rehabilitation training, primarily using external visual or auditory cues. The combination of deep brain stimulation, pharmacotherapy, and rehabilitation training may result in more effective comprehensive approaches to the reduced mobility associated with Parkinson's disease. Show more

Keywords: Parkinson's disease, gait, gait analysis, deep brain stimulation, rehabilitation

DOI: 10.3233/NRE-2005-20308

Citation: NeuroRehabilitation, vol. 20, no. 3, pp. 223-232, 2005

Authors: Fillmore, Helen L. | Holloway, Kathryn L. | Gillies, George T.

Article Type: Research Article

Abstract: Much has been learned from recent clinical trials exploring cell transplantation as a means to treat Parkinson's disease. Additionally, much information is being gathered in the science arena on the method of cultivation and expansion of neural stem/progenitor cells as well as catheter and cell delivery methodology. Cell replacement remains a potential promising treatment option for Parkinson's disease, however several obstacles must be overcome in order to achieve successful outcomes in future clinical trials. Hurdles include but are not limited to the identification of a reliable method of cultivation and expansion of neural stem/progenitor cells, the optimization of methods for …cell delivery and the optimization of location or locations for transplantation. Show more

Keywords: Neural stem/progenitor cell isolation, adult neural stem cell, cell delivery, catheter design, Parkinson's disease, neural transplantation

DOI: 10.3233/NRE-2005-20309

Citation: NeuroRehabilitation, vol. 20, no. 3, pp. 233-242, 2005