Semi-supervised home-based treadmill training is a feasible and safe form of exercise for cognitively intact people with mild Parkinson's disease. Further investigation regarding the effectiveness of home-based treadmill training is warranted.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the benefits and harms of rigid dressings versus soft dressings for treating transtibial amputations. B A C K G R O U N D Description of the condition Lower limb amputation can result from non-traumatic causes (e.g. dysvascular disease, malignancy and congenital deficiencies) or traumatic causes (e.g. war injuries and work accidents) (Varma 2014; Ziegler-Graham 2008). Amongst these causes, dysvascular disease is most common and includes diseases such as diabetes and peripheral vascular disease (Varma 2014; Ziegler-Graham 2008). The incidence of lower limb amputation is estimated to be 24 per 100,000 in the USA (Moxey 2011), and 26 per 100,000 in the UK (Ahmad 2014). These estimates increase in people with diabetes, and estimates range from 410 to 3100 per 100,000 in the USA and from 147 to 248 per 100,000 in the UK (Moxey 2011). Trauma is the second most common cause of limb loss (Varma 2014; Ziegler-Graham 2008), and accounts for 16% of amputations in the USA (Tintle 2010), and 7% to 9% of amputations 1 Rigid dressings versus soft dressings for transtibial amputations (Protocol)
Background Despite optimal medical and surgical intervention, freezing of gait commonly occurs in people with Parkinson disease. Action observation via video self-modeling, combined with physical practice, has potential as a noninvasive intervention to reduce freezing of gait. Objective The aim of this study is to determine the feasibility and acceptability of a home-based, personalized video self-modeling intervention delivered via a virtual reality head-mounted display (HMD) to reduce freezing of gait in people with Parkinson disease. The secondary aim is to investigate the potential effect of this intervention on freezing of gait, mobility, and anxiety. Methods The study was a single-group pre-post mixed methods pilot trial for which 10 participants with Parkinson disease and freezing of gait were recruited. A physiotherapist assessed the participants in their homes to identify person-specific triggers of freezing and developed individualized movement strategies to overcome freezing of gait. 180° videos of the participants successfully performing their movement strategies were created. Participants watched their videos using a virtual reality HMD, followed by physical practice of their strategies in their own homes over a 6-week intervention period. The primary outcome measures included the feasibility and acceptability of the intervention. Secondary outcome measures included freezing of gait physical tests and questionnaires, including the Timed Up and Go Test, 10-meter walk test, Goal Attainment Scale, and Parkinson Anxiety Scale. Results The recruitment rate was 24% (10/42), and the retention rate was 90% (9/10). Adherence to the intervention was high, with participants completing a mean of 84% (SD 49%) for the prescribed video viewing and a mean of 100% (SD 56%) for the prescribed physical practice. One participant used the virtual reality HMD for 1 week and completed the rest of the intervention using a flat-screen device because of a gradual worsening of his motion sickness. No other adverse events occurred during the intervention or assessment. Most of the participants found using the HMD to view their videos interesting and enjoyable and would choose to use this intervention to manage their freezing of gait in the future. Five themes were constructed from the interview data: reflections when seeing myself, my experience of using the virtual reality system, the role of the virtual reality system in supporting my learning, developing a deeper understanding of how to manage my freezing of gait, and the impact of the intervention on my daily activities. Overall, there were minimal changes to the freezing of gait, mobility, or anxiety measures from baseline to postintervention, although there was substantial variability between participants. The intervention showed potential in reducing anxiety in participants with high levels of anxiety. Conclusions Video self-modeling using an immersive virtual reality HMD plus physical practice of personalized movement strategies is a feasible and acceptable method of addressing freezing of gait in people with Parkinson disease.
Objective The purpose of this study was to determine interrater and test–retest reliability of the Ziegler test to measure freezing of gait (FOG) severity in people with Parkinson disease. Secondary aims were to evaluate test validity and explore Ziegler test duration as a proxy FOG severity measure. Methods Physical therapists watched 36 videos of people with Parkinson disease and FOG perform the Ziegler test and rated FOG severity using the rating scale in real time. Two researchers rated 12 additional videos and repeated the ratings at least 1 week later. Interrater and test–retest reliability were calculated using intraclass correlation coefficients (ICCs). Bland–Altman plots were used to visualize agreement between the researchers for test–retest reliability. Correlations between the Ziegler scores, Ziegler test duration, and percentage of time frozen (based on video annotations) were determined using Pearson r. Results Twenty-four physical therapists participated. Overall, the Ziegler test showed good interrater (ICC2,1 = 0.80; 95% CI = 0.65 to 0.92) and excellent test–retest (ICC3,1 = 0.91; 95% CI = 0.82 to 0.96) reliability when used to measure FOG. It was also a valid measure, with a high correlation (r = 0.72) between the scores and percentage of time frozen. Ziegler test duration was moderately correlated (r = 0.67) to percentage of time frozen and may be considered a proxy FOG severity measure. Conclusion The Ziegler test is a reliable and valid tool to measure FOG when used by physical therapists in real time. Ziegler test duration may be used as a proxy for measuring FOG severity.
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