Identifying noninvasive treatments to alleviate the symptoms of Parkinson's disease (PD) is important to improving the quality of life for those with PD. Several studies have explored the effects of visual, auditory, and vibratory cueing to improve gait in PD patients. Here, we present a wireless vibratory feedback system, called the PDShoe, and an associated intervention study with four subjects. The PDShoe was used on two control subjects, one subject with PD who experienced freezing of gait (FOG), and one subject with PD with an implanted deep brain stimulator (DBS). This short intervention study showed statistically significant improvements in peak heel pressure timing, peak toe pressure timing, time on the heel sensor, and stance to swing ratio after just one week of twice-daily therapy. Thus, step-synchronized vibration applied to the feet of patients with PD may be an effective way to improve gait in those subjects.
Aims:We present retrospective analysis of patients of glioblastoma multiforme (GBM) and discuss clinical characteristics, various treatment protocols, survival outcomes, and prognostic factors influencing survival.Materials and Methods:From January 2002 to June 2009, 439 patients of GBM were registered in our department. The median age of patients was 50 years, 66.1% were males, and 75% underwent complete or near-total excision. We evaluated those 360 patients who received radiotherapy (RT). Radiotherapy schedule was selected depending upon pre-RT Karnofsky Performance Status (KPS). Patients with KPS < 70 (Group I, n = 48) were planned for RT dose of 30-35 Gy in 10-15 fractions, and patients with KPS ≥ 70 (Group II, n = 312) were planned for 60 Gy in 30 fractions. In group I, six patients and in group II, 89 patients received some form of chemotherapy (lomustine or temozolomide).Statistical Analysis Used:Statistical analysis was done using Statistical Package for Social Sciences, version 12.0. Overall survival (OS) was calculated using Kaplan-Meier method, and prognostic factors were determined by log rank test. The Cox proportional hazards model was used for multivariate analysis.Results:The median follow-up was 7.53 months. The median and 2-year survival rates were 6.33 months and 2.24% for group I and 7.97 months and 8.21% for group II patients, respectively (P = 0.001). In multivariate analysis, site of tumor (central vs. others; P = 0.006), location of tumor (parietal lobe vs. others; P = 0.003), RT dose (<60 Gy vs. 60 Gy; P = 0.0001), and use of some form of chemotherapy (P = 0.0001) were independent prognostic factors for survival.Conclusions:In patients with GBM, OS and prognosis remains dismal. Whenever possible, we should use concurrent and/or adjuvant chemotherapy to maximize the benefits of post-operative radiotherapy. Patients with poor performance status may be considered for hypofractionated RT schedules, which have similar median survival rates as conventional RT.
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