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Barbosa M, de Melo CA, Torres R. The effects of adding a six-month Pilates exercise program to three months of traditional community-based pulmonary rehabilitation in individuals with COPD: a prospective cohort study. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2024; 60:68-85. [PMID: 38828206 PMCID: PMC11144029 DOI: 10.29390/001c.117966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024]
Abstract
Introduction Pilates exercise may complement traditional pulmonary rehabilitation in individuals with chronic obstructive pulmonary disease (COPD). The objective was to analyze the effects of adding a six-month Pilates exercise program to a three-month pulmonary rehabilitation for individuals with COPD. Methods Thirty-five participants with COPD (GOLD B) were assigned to the intervention (n=14) or control (n=21) group. Both groups received an initial three months of a pulmonary rehabilitation program. The intervention group further underwent six months of pilates. Participants were evaluated at baseline and at three, six, and nine months. Lung function and strength of respiratory muscles were defined as primary outcomes. Secondary outcomes included cardiac, physical function, and exacerbation episodes. Results There were no consistent statistically significant differences between groups for the lung function outcomes (p\<0.05). Maximal inspiratory and expiratory pressure increased significantly at three months in both groups (p\<0.05). It was significantly superior in the intervention group at nine months for maximal inspiratory pressure (p=0.005) and six and nine months for maximal expiratory pressure (p=0.027 and p\<0.001, respectively). Changes in muscle strength (knee extension and handgrip) were comparable between groups (p>0.05), but exercise-induced fatigue and balance were significantly superior in the intervention group at the six- and nine-month follow-ups (p\<0.05). Discussion Pilates exercise programs may be implemented to augment traditional pulmonary rehabilitation with the goal of improving the strength of respiratory muscles. Conclusion Adding a Pilates exercise program to pulmonary rehabilitation resulted in superior strength of respiratory muscles, higher resistance to exercise-induced fatigue, and improved balance.
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Affiliation(s)
- Marisela Barbosa
- PhysiotherapyCentro Hospitalar do Baixo Vouga Aveiro - Unidade Local de Saúde da Região de Aveiro, Aveiro, Portugal
- PhysiotherapyEscola Superior de Saúde Norte da Cruz Vermelha Portuguesa, Oliveira de Azeméis, Portugal
| | - Cristina A. de Melo
- PhysiotherapySchool of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal (retired)
| | - Rui Torres
- PhysiotherapyCESPU, North Polytechnic Institute of Health, Paredes, Portugal
- PhysiotherapyCIR, Center for Rehabilitation Research, Polytechnic Institute of Porto, Porto, Portugal
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Buekers J, Delgado-Ortiz L, Megaritis D, Polhemus A, Breuls S, Buttery SC, Chynkiamis N, Demeyer H, Gimeno-Santos E, Hume E, Koch S, Williams P, Wuyts M, Hopkinson NS, Vogiatzis I, Troosters T, Frei A, Garcia-Aymerich J. Gait differences between COPD and healthy controls: systematic review and meta-analysis. Eur Respir Rev 2024; 33:230253. [PMID: 38657998 PMCID: PMC11040389 DOI: 10.1183/16000617.0253-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/06/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Despite the importance of gait as a determinant of falls, disability and mortality in older people, understanding of gait impairment in COPD is limited. This study aimed to identify differences in gait characteristics during supervised walking tests between people with COPD and healthy controls. METHODS We searched 11 electronic databases, supplemented by Google Scholar searches and manual collation of references, in November 2019 and updated the search in July 2021. Record screening and information extraction were performed independently by one reviewer and checked for accuracy by a second. Meta-analyses were performed in studies not considered at a high risk of bias. RESULTS Searches yielded 21 085 unique records, of which 25 were included in the systematic review (including 1015 people with COPD and 2229 healthy controls). Gait speed was assessed in 17 studies (usual speed: 12; fast speed: three; both speeds: two), step length in nine, step duration in seven, cadence in six, and step width in five. Five studies were considered at a high risk of bias. Low-quality evidence indicated that people with COPD walk more slowly than healthy controls at their usual speed (mean difference (MD) -19 cm·s-1, 95% CI -28 to -11 cm·s-1) and at a fast speed (MD -30 cm·s-1, 95% CI -47 to -13 cm·s-1). Alterations in other gait characteristics were not statistically significant. CONCLUSION Low-quality evidence shows that people with COPD walk more slowly than healthy controls, which could contribute to an increased falls risk. The evidence for alterations in spatial and temporal components of gait was inconclusive. Gait impairment appears to be an important but understudied area in COPD.
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Affiliation(s)
- Joren Buekers
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laura Delgado-Ortiz
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Dimitrios Megaritis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Ashley Polhemus
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sara C Buttery
- National Lung and Heart Institute, Imperial College London, London, UK
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
- Thorax Research Foundation and First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria General Chest Hospital, Athens, Greece
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Elena Gimeno-Santos
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Hospital Clinic of Barcelona - August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Sarah Koch
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Parris Williams
- National Lung and Heart Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, London, UK
| | - Marieke Wuyts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
- Thorax Research Foundation and First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria General Chest Hospital, Athens, Greece
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Brandenbarg P, Hoekstra F, Barakou I, Seves BL, Hettinga FJ, Hoekstra T, van der Woude LHV, Dekker R, Krops LA. Measurement properties of device-based physical activity instruments in ambulatory adults with physical disabilities and/or chronic diseases: a scoping review. BMC Sports Sci Med Rehabil 2023; 15:115. [PMID: 37735403 PMCID: PMC10512652 DOI: 10.1186/s13102-023-00717-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND People with physical disabilities and/or chronic diseases tend to have an inactive lifestyle. Monitoring physical activity levels is important to provide insight on how much and what types of activities people with physical disabilities and/or chronic diseases engage in. This information can be used as input for interventions to promote a physically active lifestyle. Therefore, valid and reliable physical activity measurement instruments are needed. This scoping review aims 1) to provide a critical mapping of the existing literature and 2) directions for future research on measurement properties of device-based instruments assessing physical activity behavior in ambulant adults with physical disabilities and/or chronic diseases. METHODS Four databases (MEDLINE, CINAHL, Web of Science, Embase) were systematically searched from 2015 to April 16th 2023 for articles investigating measurement properties of device-based instruments assessing physical activity in ambulatory adults with physical disabilities and/or chronic diseases. For the majority, screening and selection of eligible studies were done in duplicate. Extracted data were publication data, study data, study population, device, studied measurement properties and study outcome. Data were synthesized per device. RESULTS One hundred three of 21566 Studies were included. 55 Consumer-grade and 23 research-grade devices were studied on measurement properties, using 14 different physical activity outcomes, in 23 different physical disabilities and/or chronic diseases. ActiGraph (n = 28) and Fitbit (n = 39) devices were most frequently studied. Steps (n = 68) was the most common used physical activity outcome. 97 studies determined validity, 11 studies reliability and 6 studies responsiveness. CONCLUSION This scoping review shows a large variability in research on measurement properties of device-based instruments in ambulatory adults with physical disabilities and/or chronic diseases. The variability highlights a need for standardization of and consensus on research in this field. The review provides directions for future research.
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Affiliation(s)
- Pim Brandenbarg
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
| | - Femke Hoekstra
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, V1V 1V7, Canada
| | - Ioulia Barakou
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Bregje L Seves
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Florentina J Hettinga
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, NE1 8ST, UK
| | - Trynke Hoekstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 BT, The Netherlands
| | - Lucas H V van der Woude
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Leonie A Krops
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
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Buekers J, Megaritis D, Koch S, Alcock L, Ammour N, Becker C, Bertuletti S, Bonci T, Brown P, Buckley E, Buttery SC, Caulfied B, Cereatti A, Chynkiamis N, Demeyer H, Echevarria C, Frei A, Hansen C, Hausdorff JM, Hopkinson NS, Hume E, Kuederle A, Maetzler W, Mazzà C, Micó-Amigo EM, Mueller A, Palmerini L, Salis F, Scott K, Troosters T, Vereijken B, Watz H, Rochester L, Del Din S, Vogiatzis I, Garcia-Aymerich J. Laboratory and free-living gait performance in adults with COPD and healthy controls. ERJ Open Res 2023; 9:00159-2023. [PMID: 37753279 PMCID: PMC10518872 DOI: 10.1183/23120541.00159-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/29/2023] [Indexed: 09/28/2023] Open
Abstract
Background Gait characteristics are important risk factors for falls, hospitalisations and mortality in older adults, but the impact of COPD on gait performance remains unclear. We aimed to identify differences in gait characteristics between adults with COPD and healthy age-matched controls during 1) laboratory tests that included complex movements and obstacles, 2) simulated daily-life activities (supervised) and 3) free-living daily-life activities (unsupervised). Methods This case-control study used a multi-sensor wearable system (INDIP) to obtain seven gait characteristics for each walking bout performed by adults with mild-to-severe COPD (n=17; forced expiratory volume in 1 s 57±19% predicted) and controls (n=20) during laboratory tests, and during simulated and free-living daily-life activities. Gait characteristics were compared between adults with COPD and healthy controls for all walking bouts combined, and for shorter (≤30 s) and longer (>30 s) walking bouts separately. Results Slower walking speed (-11 cm·s-1, 95% CI: -20 to -3) and lower cadence (-6.6 steps·min-1, 95% CI: -12.3 to -0.9) were recorded in adults with COPD compared to healthy controls during longer (>30 s) free-living walking bouts, but not during shorter (≤30 s) walking bouts in either laboratory or free-living settings. Double support duration and gait variability measures were generally comparable between the two groups. Conclusion Gait impairment of adults with mild-to-severe COPD mainly manifests during relatively long walking bouts (>30 s) in free-living conditions. Future research should determine the underlying mechanism(s) of this impairment to facilitate the development of interventions that can improve free-living gait performance in adults with COPD.
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Affiliation(s)
- Joren Buekers
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Dimitrios Megaritis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Sarah Koch
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Health and Care Research Newcastle Biomedical Research Centre, Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nadir Ammour
- Clinical Science and Operations, GlobalDevelopment, Sanofi R&D, Chilly-Mazarin, France
| | - Clemens Becker
- Robert Bosch Gesellschaft für Medizinische Forschung, Stuttgart, Germany
| | - Stefano Bertuletti
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Tecla Bonci
- Department of Mechanical Engineering and INSIGNEO Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Philip Brown
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ellen Buckley
- Department of Mechanical Engineering and INSIGNEO Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Sara C. Buttery
- National Lung and Heart Institute, Imperial College, London, UK
| | - Brian Caulfied
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Andrea Cereatti
- Polytechnic University of Torino, Department of Electronics and Telecommunications, Turin, Italy
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
- Thorax Research Foundation and First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria General Chest Hospital, Athens, Greece
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences and Pulmonary Rehabilitation, Respiratory Division, University Hospital Gasthuisberg, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Carlos Echevarria
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience and Department of Physical Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Arne Kuederle
- Machine Learning and Data Analytics Lab, Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Claudia Mazzà
- Department of Mechanical Engineering and INSIGNEO Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Encarna M. Micó-Amigo
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Arne Mueller
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Luca Palmerini
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, University of Bologna, Bologna, Italy
| | - Francesca Salis
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Kirsty Scott
- Department of Mechanical Engineering and INSIGNEO Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences and Pulmonary Rehabilitation, Respiratory Division, University Hospital Gasthuisberg, Leuven, Belgium
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Health and Care Research Newcastle Biomedical Research Centre, Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Health and Care Research Newcastle Biomedical Research Centre, Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
- Thorax Research Foundation and First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria General Chest Hospital, Athens, Greece
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
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Kaya M, Gurses HN, Ucgun H, Okyaltirik F. Effects of creative dance on functional capacity, pulmonary function, balance, and cognition in COPD patients: A randomized controlled trial. Heart Lung 2023; 58:13-20. [PMID: 36335909 DOI: 10.1016/j.hrtlng.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Exercise training is key to the comprehensive management of patients with chronic obstructive pulmonary disease (COPD). Creative dance can be an innovative approach as effective as traditional exercise training. OBJECTIVES This study aimed to investigate effect of creative dance-based exercise (CDE) training on functional capacity, postural stability and balance, pulmonary and cognitive functions, respiratory and peripheral muscle strength in COPD patients. METHODS Twenty-four patients with COPD were randomly allocated to either "chest physiotherapy and home-based walking program" (PT) or "CDE alongside home-based chest physiotherapy group" (PT+CDE). Both groups performed chest PT program twice a day for 5 days per week for 8 weeks. PT+CDE group received CDE training 2 days a week for 8 weeks. Primary outcome was six minute walk test (6MWT). Secondary outcomes were postural stability and balance, pulmonary function, maximum inspiratory (MIP) and expiratory (MEP) pressure, peripheral muscle strength, Montreal Cognitive Assessment (MoCA), COPD Assessment Test (CAT), and BODE index. Outcome measures were assessed at baseline and after 8 weeks of training. RESULTS Both groups showed statistically significant improvements in 6MWT distance, MIP, MEP, MoCA score, CAT, and BODE index (p < 0.05). Only with CDE training was achieved improvements in postural stability and balance scores, pulmonary function, and peripheral muscle strength (p < 0.05). The improvements in 6 MWT distance, MEP, MoCA score, and CAT were greater in PT+CDE group (p < 0.05). CONCLUSION Use of creative dance training in addition to home-based chest PT program was more effective than chest PT program regarding primary and secondary outcomes in COPD patients.
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Affiliation(s)
- Meltem Kaya
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Institute of Health Sciences, Bezmialem Vakif University, Istanbul 34093, Turkey; Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Atlas University, Istanbul 34408, Turkey
| | - Hulya Nilgun Gurses
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Silahtaraga St. No: 189, Istanbul 34060, Turkey; Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul 34060, Turkey.
| | - Hikmet Ucgun
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Biruni University, Istanbul 34010, Turkey
| | - Fatmanur Okyaltirik
- Department of Chest Diseases, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
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Gore S, Blackwood J, Ziccardi T. Associations Between Cognitive Function, Balance, and Gait Speed in Community-Dwelling Older Adults with COPD. J Geriatr Phys Ther 2023; 46:46-52. [PMID: 34334706 DOI: 10.1519/jpt.0000000000000323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Older adults with chronic obstructive pulmonary disease (COPD) are at risk for physical and cognitive impairment. Cognitive function is associated with falls in older adults. However, it is unknown whether a relationship exists between cognitive function and falls in patients with COPD. The aim of this study was to examine the relationships between cognitive function, balance, and gait speed in older adults with COPD. PATIENTS AND METHODS A secondary analysis was performed using data from the 2010 wave of the Health and Retirement Study (HRS). Cognitive (immediate and delayed recall, executive function) and physical (gait speed, tandem balance time) measure data were extracted for older adults with COPD (n = 382) and an age-matched control group without COPD (n = 382) who met inclusion/exclusion criteria. Multivariate linear regression modeling was performed to examine associations between cognitive function and mobility or balance while controlling for age, gender, body mass index, grip strength, and education. RESULTS In older adults with COPD, delayed recall was significantly associated with tandem balance performance (β= 1.42, P < .05). Other cognitive measures were not associated with gait speed or balance. CONCLUSION In older adults with COPD, one of four cognitive functions was associated with a static standing balance task. Screening of cognitive function, specifically delayed recall, should be a part of the management of falls in this population.
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Affiliation(s)
- Shweta Gore
- Physical Therapy Department, MGH Institute of Health Professionals, Boston, Massachusetts
| | | | - Tyler Ziccardi
- Department of Physical Therapy, University of Michigan-Flint, Flint
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Rassam P, Pazzianotto-Forti EM, Matsumura U, Orchanian-Cheff A, Aliabadi S, Kulkarni M, Fat Fur RL, Rodrigues A, Langer D, Rozenberg D, Reid WD. Impact of cognitive capacity on physical performance in chronic obstructive pulmonary disease patients: A scoping review. Chron Respir Dis 2023; 20:14799731231163874. [PMID: 37029090 PMCID: PMC10087654 DOI: 10.1177/14799731231163874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is often accompanied by impaired cognitive and physical function. However, the role of cognitive function on motor control and purposeful movement is not well studied. The aim of the review was to determine the impact of cognition on physical performance in COPD. Methods: Scoping review methods were performed including searches of the databases: MEDLINE, EMBASE, Cochrane Systematic Reviews, Cochrane (CENTRAL), APA PsycINFO, and CINAHL. Two reviewers independently assessed articles for inclusion, data abstraction, and quality assessment. Results: Of 11,252 identified articles, 44 met the inclusion criteria. The review included 5743 individuals with COPD (68% male) with the forced expiratory volume in one second range of 24-69% predicted. Cognitive scores correlated with strength, balance, and hand dexterity, while 6-min walk distance (n = 9) was usually similar among COPD patients with and without cognitive impairment. In 2 reports, regression analyses showed that delayed recall and the trail making test were associated with balance and handgrip strength, respectively. Dual task studies (n = 5) reported impaired balance or gait in COPD patients compared to healthy adults. Cognitive or physical Interventions (n = 20) showed variable improvements in cognition and exercise capacity. Conclusions: Cognition in COPD appears to be more related to balance, hand, and dual task function, than exercise capacity.
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Affiliation(s)
- Peter Rassam
- Rehabilitation Sciences Institute, School of Graduate Studies, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, 7938University of Toronto, Toronto, ON, Canada
| | | | - Umi Matsumura
- Department of Health Sciences, Graduate School of Biomedical Sciences, 12961Nagasaki University, Nagasaki, Japan
| | - Ani Orchanian-Cheff
- Library and Information Services, 7989University Health Network, Toronto, ON, Canada
| | - Saina Aliabadi
- Rehabilitation Sciences Institute, School of Graduate Studies, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, 7989University Health Network, Toronto, ON, Canada
| | - Manjiri Kulkarni
- Rehabilitation Sciences Institute, School of Graduate Studies, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, 7938University of Toronto, Toronto, ON, Canada
| | | | - Antenor Rodrigues
- Department of Critical Care, St Michael's Hospital, Toronto, ON, Canada
| | - Daniel Langer
- Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, 26657Katholieke Universiteit Leuven, Leuven, Belgium
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Dmitry Rozenberg
- Division of Respirology, Temerty Faculty of Medicine, 7938University of Toronto, University Health Network, Toronto, ON, Canada
- Toronto General Hospital Research Institute, Toronto, ON, Canada
| | - W Darlene Reid
- Department of Physical Therapy, 7938University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, 7989University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, 7938University of Toronto, Toronto, ON, Canada
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Yentes JM, Liu WY, Zhang K, Markvicka E, Rennard SI. Updated Perspectives on the Role of Biomechanics in COPD: Considerations for the Clinician. Int J Chron Obstruct Pulmon Dis 2022; 17:2653-2675. [PMID: 36274993 PMCID: PMC9585958 DOI: 10.2147/copd.s339195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) demonstrate extra-pulmonary functional decline such as an increased prevalence of falls. Biomechanics offers insight into functional decline by examining mechanics of abnormal movement patterns. This review discusses biomechanics of functional outcomes, muscle mechanics, and breathing mechanics in patients with COPD as well as future directions and clinical perspectives. Patients with COPD demonstrate changes in their postural sway during quiet standing compared to controls, and these deficits are exacerbated when sensory information (eg, eyes closed) is manipulated. If standing balance is disrupted with a perturbation, patients with COPD are slower to return to baseline and their muscle activity is differential from controls. When walking, patients with COPD appear to adopt a gait pattern that may increase stability (eg, shorter and wider steps, decreased gait speed) in addition to altered gait variability. Biomechanical muscle mechanics (ie, tension, extensibility, elasticity, and irritability) alterations with COPD are not well documented, with relatively few articles investigating these properties. On the other hand, dyssynchronous motion of the abdomen and rib cage while breathing is well documented in patients with COPD. Newer biomechanical technologies have allowed for estimation of regional, compartmental, lung volumes during activity such as exercise, as well as respiratory muscle activation during breathing. Future directions of biomechanical analyses in COPD are trending toward wearable sensors, big data, and cloud computing. Each of these offers unique opportunities as well as challenges. Advanced analytics of sensor data can offer insight into the health of a system by quantifying complexity or fluctuations in patterns of movement, as healthy systems demonstrate flexibility and are thus adaptable to changing conditions. Biomechanics may offer clinical utility in prediction of 30-day readmissions, identifying disease severity, and patient monitoring. Biomechanics is complementary to other assessments, capturing what patients do, as well as their capability.
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Affiliation(s)
- Jennifer M Yentes
- Department of Kinesiology & Sport Management, Texas A&M University, College Station, TX, USA
| | - Wai-Yan Liu
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, the Netherlands
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, the Netherlands
| | - Kuan Zhang
- Department of Electrical & Computer Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
| | - Eric Markvicka
- Department of Electrical & Computer Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
- Department of Mechanical & Materials Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
| | - Stephen I Rennard
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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9
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Zucchelli A, Pancera S, Bianchi LNC, Marengoni A, Lopomo NF. Technologies for the Instrumental Evaluation of Physical Function in Persons Affected by Chronic Obstructive Pulmonary Disease: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22176620. [PMID: 36081078 PMCID: PMC9459845 DOI: 10.3390/s22176620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 05/17/2023]
Abstract
Several systems, sensors, and devices are now available for the instrumental evaluation of physical function in persons with Chronic Obstructive Pulmonary Disease (COPD). We aimed to systematically review the literature about such technologies. The literature search was conducted in all major scientific databases, including articles published between January 2001 and April 2022. Studies reporting measures derived from the instrumental assessment of physical function in individuals with COPD were included and were divided into application and validation studies. The quality of validation studies was assessed with the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) risk of bias tool. From 8752 articles retrieved, 21 application and 4 validation studies were included in the systematic review. Most application studies employed accelerometers, gait analysis systems, instrumented mattresses, or force plates to evaluate walking. Surface electro-myography or near-infrared spectroscopy were employed in four studies. Validation studies were heterogeneous and presented a risk of bias ranging from inadequate to doubtful. A variety of data regarding physical function can be retrieved from technologies used in COPD studies. However, a general lack of standardization and limitations in study design and sample size hinder the implementation of the instrumental evaluation of function in clinical practice.
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Affiliation(s)
- Alberto Zucchelli
- Department of Information Engineering, Università degli Studi di Brescia, Brescia 25123, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna SE-171 65, Sweden
| | - Simone Pancera
- IRCCS Fondazione Don Carlo Gnocchi, Milan 20148, Italy
- Correspondence: (S.P.); (N.F.L.); Tel.: +39-030-29881 (S.P. & N.F.L.)
| | | | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna SE-171 65, Sweden
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia 25123, Italy
| | - Nicola Francesco Lopomo
- Department of Information Engineering, Università degli Studi di Brescia, Brescia 25123, Italy
- Correspondence: (S.P.); (N.F.L.); Tel.: +39-030-29881 (S.P. & N.F.L.)
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10
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Giardini M, Arcolin I, Godi M, Guglielmetti S, Maretti A, Capelli A, Corna S. The Coronavirus Footprint on Dual-Task Performance in Post-Acute Patients after Severe COVID-19: A Future Challenge for Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10644. [PMID: 36078366 PMCID: PMC9518102 DOI: 10.3390/ijerph191710644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
Recent studies suggest that also the non-critical form of COVID-19 infection may be associated with executive function impairments. However, it is not clear if they result from cognitive impairments or by COVID-19 infection per se. We aimed to investigate if patients in the post-acute stage of severe COVID-19 (PwCOVID), without manifest cognitive deficits, reveal impairments in performing dual-task (DT) activities compared to healthy controls (HS). We assessed balance in 31 PwCOVID vs. 30 age-matched HS by stabilometry and the Timed Up and Go (TUG) test with/without a cognitive DT. The DT cost (DTC), TUG test time and sway oscillations were recorded; correct cognitive responses (CCR) were calculated to evaluate cognitive performance. Results show a significant difference in overall DT performance between PwCOVID and HS in both stabilometry (p < 0.01) and the TUG test (p < 0.0005), although with similar DTCs. The main difference in the DTs between groups emerged in the CCR (effect size > 0.8). Substantially, PwCOVID gave priority to the motor task, leaving out the cognitive one, while HS performed both tasks simultaneously. Our findings suggest that PwCOVID, even without a manifest cognitive impairment, may present a deficit in executive function during DTs. These results encourage the use of DTs and CCR in PwCOVID.
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Affiliation(s)
- Marica Giardini
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Ilaria Arcolin
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Marco Godi
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Simone Guglielmetti
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Alessandro Maretti
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Armando Capelli
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Pulmonary Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Stefano Corna
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
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11
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Pichon R, Van Hove O, Ménard M, Hearing D, Crétual A. Impairment and characteristics of postural control sub-components in people with COPD: a scoping review. Disabil Rehabil 2022:1-16. [PMID: 36000464 DOI: 10.1080/09638288.2022.2107083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose: Impairment of postural control is common in people with COPD. However, the precise characteristics of this alteration are not clearly known. The "Systems Framework for Postural Control" which define postural control sub-components, represents an interesting tool to explore this field. The main aim of this review was to identify which postural control sub-components are impaired in people with COPD and to summarise characteristics for each sub-component. A secondary aim was to precise the relation between postural control and activities of daily living (ADL).Materials and methods: A scoping review was conducted, according to the JBI methodology. Medline, Cochrane Library, Scielo, Google Scholar, OpenGrey, and HAL were searched from inception to May 2022. The search was performed in English and French.Results: Eighty-nine articles were included. There was evidence of a potential impairment for most of the postural control sub-components. Characteristics of every sub-component alteration were heterogeneous. Reduced postural control could be associated with difficulties in ADL.Conclusions: People with COPD may have impairment in a wide range of postural control sub-components. Further research is needed to clarify if a common pattern of modification exits for this alteration and to precise the link with ADL.Implications for rehabilitationImpairment of postural control is a common extra-respiratory manifestation in people with COPD and so clinicians must include it in their clinical reasoning.Numerous postural control sub-components could be altered in people with COPD, suggesting that postural control assessment must be holistic.This scoping review shows that characteristics of postural control impairment are varied and that there may be no common pattern at the COPD population level.The relationship between impaired postural control and activities of daily living remains unclear, but clinicians should be alert to potential negative interactions between these two areas.
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Affiliation(s)
- Romain Pichon
- Institut de Formation en Pédicurie-Podologie, Ergothérapie et Kinésithérapie (IFPEK), Rennes, France.,M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
| | | | - Mathieu Ménard
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France.,Institut d'Ostéopathie de Rennes - Bretagne (IO-RB), Bruz, France
| | - Diane Hearing
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
| | - Armel Crétual
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
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12
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Ozcan EB, Saglam M, Vardar-Yagli N, Calik-Kutukcu E, Inal-Ince D, Altinsoy M, Kaya EB. Impaired Balance and Gait Characteristics in Patients With Chronic Heart Failure. Heart Lung Circ 2022; 31:832-840. [PMID: 35177316 DOI: 10.1016/j.hlc.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Heart failure affects most systems of the body and causes various problems in patients. Balance deficits and gait deviations can be a result of these effects. There is little information in the literature about balance and gait parameters in chronic heart failure (CHF). This study aimed to investigate balance abnormalities together with gait deficits for possible associations in patients with CHF and compare them to healthy controls. METHODS Twenty-two (22) patients with CHF (59±2.5 years) and 22 age- and gender-matched healthy subjects (59.4±6.8 years) participated in the study. This study is a cross-sectional/comparison study. Balance was evaluated using the Activity-Specific Balance Confidence Scale (ABC) and the Mini-Balance Evaluation Systems Test (Mini-BESTest) balance battery, which includes the timed up-and-go test (TUG) and dual-task TUG. Gait analysis was performed using a Biodex Gait Trainer. Peripheral muscle strength (quadriceps muscle and handgrip strength) was assessed using a hand dynamometer and exercise capacity using the six-minute walk test (6MWT). RESULTS The CHF patients had significantly lower Mini-BESTest total, reactive postural control, and gait stability scores, significantly longer TUG/dual-task TUG time, and lower ABC score compared to the healthy control group (p<0.05). Chronic heart failure patients also showed significantly lower gait speed, stride length, gait cycle and step length (p<0.05). Dominant-side quadriceps muscle and handgrip strength and 6MWT distance were significantly reduced in CHF (p<0.05). Anticipatory postural adjustments and sensory orientation did not differ between groups. CONCLUSIONS Our study demonstrated impaired balance and gait performance and reduced muscle strength and exercise capacity in patients with CHF. Cardiac rehabilitation including balance and walking training should be planned for CHF patients to eliminate balance disorders, gait impairment and prevent falls in this patient group.
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Affiliation(s)
- Emine Burcu Ozcan
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Melda Saglam
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | - Naciye Vardar-Yagli
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Deniz Inal-Ince
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Meltem Altinsoy
- Saglik Bilimleri University, Gulhane Training and Research Hospital Cardiology Clinic, Ankara, Turkey
| | - Ergun Baris Kaya
- Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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13
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Giardini M, Arcolin I, Guglielmetti S, Godi M, Capelli A, Corna S. Balance performance in patients with post-acute COVID-19 compared to patients with an acute exacerbation of chronic obstructive pulmonary disease and healthy subjects. Int J Rehabil Res 2022; 45:47-52. [PMID: 34860732 PMCID: PMC8828308 DOI: 10.1097/mrr.0000000000000510] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/03/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 leaves important sequelae in patients, not only in those who had the experience of a critical illness but also in patients with severe form. Understanding the impairments allows us to target rehabilitation to patients' real needs; balance impairments are an assumed sequela of COVID-19, but no study has specifically evaluated balance performance in these patients. Their performance was compared to that of patients with a pulmonary disease that leads to systemic diseases, such as patients with an acute exacerbation of chronic obstructive pulmonary disease (PwAECOPD), and of healthy subjects. A total of 75 subjects were assessed: 25 patients with COVID-19 (PwCOVID) with a severe form in the acute phase, 25 PwAECOPD and 25 healthy subjects sex- and age-matched. A stabilometric platform was used to evaluate static balance, both with eyes open and closed, while the dynamic balance was assessed with the Mini-BESTest and the Timed Up and Go test. When compared to healthy subjects, results showed that PwCOVID had worse performance in both static (P < 0.005) and dynamic (P < 0.0001) balance, with a large effect size in all measures (>0.8). Moreover, PwCOVID showed similar results to those of PwAECOPD. In conclusion, PwCOVID showed a balance deficit in both dynamic and static conditions. Therefore, as for PwAECOPD, they should require not only respiratory rehabilitation but also balance and mobility physiotherapy to prevent today's PwCOVID from becoming tomorrow's fallers.
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Affiliation(s)
| | | | | | - Marco Godi
- Department of Physical Medicine and Rehabilitation
| | - Armando Capelli
- Department of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, Gattico-Veruno (NO), Italy
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14
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Morelli N, Parry SM, Steele A, Lusby M, Montgomery-Yates AA, Morris PE, Mayer KP. Patients Surviving Critical COVID-19 have Impairments in Dual-task Performance Related to Post-intensive Care Syndrome. J Intensive Care Med 2022; 37:890-898. [PMID: 35072548 PMCID: PMC9160440 DOI: 10.1177/08850666221075568] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective The purpose was to examine Dual Task (DT) performance in patients surviving
severe and critical COVID-19 compared to patients with chronic lung disease
(CLD). Secondarily, we aimed to determine the psychometric properties of the
Timed Up and Go (TUG) test in patients surviving COVID-19. Design Prospective, cross-sectional, observational study. Setting Academic medical center within United States. Patients Ninety-two patients including 36 survivors of critical COVID-19 that required
mechanical ventilation (critical-COVID), 20 patients recovering from
COVID-19 that required supplemental oxygen with hospitalization
(severe-COVID), and 36 patients with CLD serving as a control group. Measurements and Main Results Patients completed the TUG, DT-TUG, Short Physical Performance Battery
(SPPB), and Six Minute Walk Test (6MWT) 1-month after hospital discharge. A
subset of patients returned at 3-months and repeated testing to determine
the minimal detectable change (MDC). Critical-COVID group (16.8 ± 7.3)
performed the DT-TUG in significantly slower than CLD group (13.9 ± 4.8 s;
P = .024) and Severe-COVID group (13.1 ± 5.1 s;
P = .025). Within-subject difference between TUG and
DT-TUG was also significantly worse in critical-COVID group (−21%) compared
to CLD (−10%; P = .012), even despite CLD patients having a
higher comorbid burden (P < .003) and older age
(P < .001). TUG and DT-TUG demonstrated strong to
excellent construct validity to the chair rise test, gait speed, and 6MWT
for both COVID-19 groups (r = −0.84to 0.73, P < .05).
One- and 3-months after hospital discharge there was a floor effect of 14%
(n = 5/36) and 5.2% (n = 1/19), respectively for patients in the
critical-COVID group. Ceiling effects were noted in four (11%)
critical-COVID, six (30%) severe-COVID patients for the TUG and DT-TUG at
1-month. Conclusion The ability to maintain mobility performance in the presence of a cognitive
DT is grossly impaired in patients surviving critical COVID-19. DT
performance may subserve the understanding of impairments related to
Post-intensive care syndrome (PICS) for survivors of critical illness.
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Affiliation(s)
- Nathan Morelli
- Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Selina M. Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Angela Steele
- Pulmonary Rehabilitation Center, Therapeutic Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Megan Lusby
- Pulmonary Rehabilitation Center, Therapeutic Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Ashley A. Montgomery-Yates
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Research Alliance for Lung Disease, University of Kentucky, Lexington, Kentucky, USA
| | - Peter E. Morris
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Research Alliance for Lung Disease, University of Kentucky, Lexington, Kentucky, USA
| | - Kirby P. Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Research Alliance for Lung Disease, University of Kentucky, Lexington, Kentucky, USA
- Center for Muscle Biology, University of Kentucky, Lexington, Kentucky, USA
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15
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McCrum C, Vaes AW, Delbressine JM, Koopman M, Liu WY, Willems P, Meijer K, Spruit MA. A pilot study on the feasibility and effectiveness of treadmill-based perturbations for assessing and improving walking stability in chronic obstructive pulmonary disease. Clin Biomech (Bristol, Avon) 2022; 91:105538. [PMID: 34823220 DOI: 10.1016/j.clinbiomech.2021.105538] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Falls risk is elevated in chronic obstructive pulmonary disease (COPD). However, there is a lack of evidence regarding the contributing factors. Here, we examined the feasibility of, and initial responses to, large walking perturbations in COPD, as well as the adaptation potential of people with COPD to repeated walking perturbations that might indicate potential for perturbation-based balance training in COPD. METHODS 12 participants with COPD undergoing inpatient pulmonary rehabilitation and 12 age-gender-matched healthy control participants walked on an instrumented treadmill and experienced repeated treadmill-belt acceleration perturbations (leading to a forward balance loss). Three-dimensional motion capture was used to quantify the stability of participants body position during perturbed walking. Feasibility, stability following the initial perturbations and adaptation to repeated perturbations were assessed. FINDINGS Using perturbations in this manner was feasible in this population (no harness assists and participants completed the minimum number of perturbations). No clear, specific deficit in reactive walking stability in COPD was found (no significant effects of participant group on stability or recovery step outcomes). There were mixed results for the adaptability outcomes which overall indicated some adaptability to repeated perturbations, but not to the same extent as the healthy control participants. INTERPRETATION Treadmill-based perturbations during walking are feasible in COPD. COPD does not appear to result in significant deficits in stability following sudden perturbations and patients do demonstrate some adaptability to repeated perturbations. Perturbation-based balance training may be considered for fall prevention in research and practice in people with COPD.
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Affiliation(s)
- Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Anouk W Vaes
- Research and Development, CIRO, Horn, the Netherlands
| | | | - Maud Koopman
- Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Wai-Yan Liu
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands; Research and Development, CIRO, Horn, the Netherlands; Department of Orthopaedic Surgery, Máxima Medical Center, Eindhoven, the Netherlands; Department of Orthopaedic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Paul Willems
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Martijn A Spruit
- Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
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16
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Paixão C, Rebelo P, Oliveira A, Jácome C, Cruz J, Martins V, Simão P, Marques A. Responsiveness and Minimal Clinically Important Difference of the Brief-BESTest in People With COPD After Pulmonary Rehabilitation. Phys Ther 2021; 101:6365141. [PMID: 34499161 DOI: 10.1093/ptj/pzab209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/21/2021] [Accepted: 07/11/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE he Brief-Balance Evaluation Systems Test (Brief-BESTest) is a comprehensive, reliable, and valid balance test that provides valuable information to guide balance training in people with chronic obstructive pulmonary disease (COPD). Its clinical interpretability is, however, currently limited, because cutoff points to identify clinically relevant changes in people with COPD after pulmonary rehabilitation are still lacking. This study aimed to establish the responsiveness and minimal clinically important difference (MCID) for the Brief-BESTest in people with COPD after pulmonary rehabilitation (PR). METHODS A secondary analysis of data from 2 previous studies was conducted. The modified British Medical Research Council (mMRC) dyspnea scale, the 6-Minute Walk Test (6-MWT), and the Brief-BESTest (0-24 points) were collected in people with COPD pre/post a 12-week PR program including balance training. The MCID was computed using anchor- and distribution-based methods. Changes in the 6-MWT and the mMRC were assessed and used as anchors. The pooled MCID was computed using the arithmetic weighted mean (2/3 anchor- and 1/3 distribution-based methods). RESULTS Seventy-one people with COPD (69 years [SD = 8]; 76% male; FEV1 = 49.8%predicted [SD = 18%]) were included. There was a significant improvement in the Brief-BESTest after PR (mean difference = 3 points [SD = 3]). Significant correlations were found between the Brief-BESTest and the mMRC (r = -.31) and the 6-MWT (r = .37). The pooled MCID was 3.3 points. CONCLUSION An improvement of at least 3 points in the Brief-BESTest in people with COPD will enhance the interpretability of PR effects on balance performance of this population and guide tailored interventions. IMPACT The Brief-BESTest outcome measure is comprehensive, easily administered, and simple to interpret in clinical practice. This study represents a significant contribution toward the clinical interpretation of changes in balance in people with COPD following PR.
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Affiliation(s)
- Cátia Paixão
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- iBiMED-Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
- Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Patrícia Rebelo
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- iBiMED-Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
- Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Ana Oliveira
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Cristina Jácome
- CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Cruz
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- ciTechCare-Center for Innovative Care and Health Technology, School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
| | - Vitória Martins
- Pulmonology Department, Hospital Distrital da Figueira da Foz, Figueira da Foz, Portugal
| | - Paula Simão
- Pulmonology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Alda Marques
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- iBiMED-Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
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17
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Kaul M, Sunkara S, Major MJ, Gordon KE, Rubinstein I. Proposed novel treatment paradigm of aberrant gait and balance kinematics in patients with severe COPD. Respirology 2021; 26:914-916. [PMID: 34382283 DOI: 10.1111/resp.14126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Malvika Kaul
- Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Medical Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Research Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Sai Sunkara
- Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Medical Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Research Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Matthew J Major
- Research Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Keith E Gordon
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Edward Hines, Jr. VA Medical Center, Chicago, Illinois, USA
| | - Israel Rubinstein
- Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Medical Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Research Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
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Tanrıverdi A, Özcan Kahraman B, Acar S, Özsoy İ, Özpelit E, Şentürk B, Akdeniz B, Savcı S. Determinants of gait speed in patients with heart failure with reduced ejection fraction. Anatol J Cardiol 2021; 25:617-622. [PMID: 34498592 DOI: 10.5152/anatoljcardiol.2021.17735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Given the prognostic significance of gait speed, there is insufficient evidence about possible functional determinants of gait speed in patients with heart failure with reduced ejection fraction (HFrEF). Therefore, the objective of this study was to investigate the functional determinants of gait speed in patients with HFrEF. METHODS Fifty-nine patients with HFrEF participated in this cross-sectional study. Demographic and clinical characteristics were recorded. The gait speed was determined with a 4-meter walking test. Dyspnea perception was assessed with the modified medical research council (mMRC) scale. Functional capacity was evaluated with a 6-minute walk test (6MWT). The five times sit-to-stand (5-STS) test and the Berg Balance Scale (BBS) were used to measure functional mobility and balance. Physical activity was evaluated with the International Physical Activity Questionnaire (IPAQ) Short-Form. RESULTS Gait speed was correlated with age (r=-0.368, p=0.004), NYHA functional class (r=-0.438, p=0.001), mMRC score (r=-0.422, p=0.001), 6MWT (r=0.650, p<0.001), 5STS (r=-0.506, p<0.001), BBS (r=0.586, p<0.001), IPAQ (r=0.305, p=0.019) and IPAQ-Sitting time (r=-0.327, p=0.011). On multiple linear regression analysis, the 6MWT distance and BBS were independent determinants of the usual gait speed in patients with HFrEF, accounting for 44.4% of the variance. CONCLUSION This study indicates that functional capacity and balance are independent functional determinants of gait speed in patients with HFrEF.
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Affiliation(s)
- Aylin Tanrıverdi
- Department of Institute of Health Sciences, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Buse Özcan Kahraman
- Department of School of Physical Therapy and Rehabilitation, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Serap Acar
- Department of School of Physical Therapy and Rehabilitation, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - İsmail Özsoy
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Selçuk University; Konya-Turkey
| | - Ebru Özpelit
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Bihter Şentürk
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Bahri Akdeniz
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Sema Savcı
- Department of School of Physical Therapy and Rehabilitation, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
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Karege G, Zekry D, Allali G, Adler D, Marti C. Gait speed is associated with death or readmission among patients surviving acute hypercapnic respiratory failure. BMJ Open Respir Res 2021; 7:7/1/e000542. [PMID: 32561512 PMCID: PMC7304813 DOI: 10.1136/bmjresp-2019-000542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives Death or hospital readmission are frequent among patients surviving acute hypercapnic respiratory failure (AHRF). Severity scores are not valid to predict death or readmission after AHRF. Gait speed, a simple functional parameter, has been associated with hospital admission and death in the general population. The purpose of this study is to highlight an association between gait speed at hospital discharge and death or readmission among AHRF survivors. Design Secondary analysis of a prospective cohort study. Settings Single Swiss tertiary hospital, pulmonary division. Participants Patients were prospectively recruited to form a cohort of patients surviving AHRF in the intensive care unit between January 2012 and May 2015. Outcome measure Gait speed was derived from a 6 min walking test (6MWT) before hospital discharge. All predictive variables were prospectively collected. Death or hospital readmission were recorded for 6 months. Univariate and multivariate analyses were performed to evaluate the association between predictive variables and death or hospital readmission. Results 71 patients performed a 6MWT. 34/71 (48%) patients died or were readmitted to the hospital during the observation period. Median gait speed was 0.7 (IQR 0.3–1.0) m/s. At 6 months, 66% (25/38) of slow walkers (gait speed <0.7 m/s) and 27% (9/33) of non-slow walkers died or were readmitted to the hospital (p=0.002). In univariate analysis, gait speed was associated with death or readmission (HR 0.41; 95% CI 0.19 to 0.90, p=0.025). In a multivariate model adjusted for age, gender, body mass index, forced expired volume, heart failure and home mechanical ventilation, gait speed remained the only variable associated with death or readmission (multivariate HR: 0.35; 95% CI 0.14 to 0.88, p=0.025). Conclusion This study suggests that a simple functional parameter such as gait speed is associated with death or hospital readmission in patients surviving AHRF. Trial registration number NCT02111876.
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Affiliation(s)
- Gatete Karege
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Dina Zekry
- Division of Internal Medicine for the Aged, Geneva University Hospitals, Geneva, Switzerland
| | - Gilles Allali
- Division of Neurology, Geneva University Hospitals, Geneve, Switzerland.,Division of Neurology, Yeshiva University, New York, New York, USA
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Marti
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
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20
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Van Hove O, Cebolla AM, Andrianopoulos V, Leduc D, Guidat PA, Feipel V, Deboeck G, Bonnechère B. The influence of cognitive load on static balance in chronic obstructive pulmonary disease patients. CLINICAL RESPIRATORY JOURNAL 2020; 15:351-357. [PMID: 33217122 DOI: 10.1111/crj.13307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/13/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients with chronic obstructive pulmonary disease (COPD) may demonstrate cognitive function and balance deterioration. These two phenomena are often realized simultaneously during daily living activities, where the risk of falling may be increased due to possible postural disturbance when focusing on a cognitive task during motion. Despite the high rate of falls in COPD, there is currently a lack of affordable clinical instruments to quantify the interaction between cognitive tasks and static balance in these patients. Therefore, this study aims to assess the balance perturbation induced by cognitive tasks using a new cost-effective protocol which can easily be implemented in clinical settings. METHOD A total of 21 COPD patients (Age: 64 ± 8 yrs, Forced Expiratory Volume in one second = 41 ± 17%, Women: 7) and 21 matched healthy controls participated in the study. They performed two cognitive tasks (counting backward by 3s and naming animals) with eyes open and with eyes closed. Each trial lasted 60 s, with balance-related parameters recorded and quantified using a Wii Balance Board. A three-way ANOVA (cognitive task, eyes action, and health status) for balance-related parameters derived from the center of pressure displacement was performed. RESULTS COPD, vision, and cognitive tasks altered the balance; no interaction between conditions was observed. There was no correlation between cognitive ability, respiratory function, and the balance-related parameters. CONCLUSION Compared to healthy controls, the COPD patients had impaired balance. Cognitive tasks altered postural control in both COPD and controls, where this alteration was more pronounced with eyes closed.
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Affiliation(s)
| | - Ana Maria Cebolla
- Laboratory of Neurophysiology and Movement Biomechanics, Université Libre de Bruxelles, Brussels, Belgium
| | - Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Dimitri Leduc
- Department of Pneumology, Erasme Hospital, Brussels, Belgium.,Laboratory of Cardiorespiratory Physiology, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Véronique Feipel
- Laboratory of Functional Anatomy, Université Libre de Bruxelles, Brussels, Belgium
| | - Gaël Deboeck
- Research Unit in Rehabilitation, Université Libre de Bruxelles, Brussels, Belgium
| | - Bruno Bonnechère
- Department of Psychiatry and Behavioural and Clinical Neurosciences, University of Cambridge, Cambridge, UK
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21
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Cognitive and motor performances in dual task in patients with chronic obstructive pulmonary disease: a comparative study. Ir J Med Sci 2020; 190:723-730. [PMID: 32885377 DOI: 10.1007/s11845-020-02357-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) may display a motor and/or cognitive disadvantage during dual tasking. However, studies investigating dual task are quite limited in patients with COPD. AIMS To compare cognitive and motor performances (i.e., muscle force production and functional balance/mobility together with a cognitive task) in dual task between patients with COPD and healthy controls. METHODS Thirty-five clinically stable patients with COPD and 27 age- and sex-matched healthy controls participated in this cross-sectional controlled study. The muscle force production (knee extension muscle strength assessed with an isokinetic strength dynamometer) and functional balance/mobility (Timed Up and Go (TUG) test) were performed with and without a cognitive task. Dual-task interference (DTI) was assessed. Additionally, the rate of correct responses per second (RCR) was calculated to evaluate cognitive performance. RESULTS The decrease in RCRmuscle force production values was greater in the COPD group compared with the control group (p = 0.045). Similarly, the cognitive DTI in muscle force production test was higher in the control group than in the COPD group (p < 0.001). There was no significant difference in other outcome measures between the two groups (p > 0.05). CONCLUSION The study results indicate that in individuals with COPD, cognitive performance deteriorations are more pronounced than motor performance defects during dual tasking. Further studies are needed to investigate the effects of dual task taking into account this disadvantage in patients with COPD rather than focusing solely on motor performance.
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Abstract
Balance problems and an increased rate and risk of falls are common in people
with chronic obstructive pulmonary disease (COPD). Although a balance assessment
is now recommended by clinical practice guidelines for pulmonary rehabilitation,
specific tests have yet to be suggested. The purpose of this review is to
provide an evidence-based synthesis of balance measurement in older adults and
in people with COPD, to guide practice in this area. An overview of best
practices for assessing balance and fall risk in older adults is provided along
with a practical synthesis of evidence to date on common balance measures used
in people with COPD such as the Timed Up and Go, Single Leg Stance, Berg
Balance, and Mini and Full Balance Evaluation Systems Tests. Finally, two
clinical scenarios are described to illustrate the process of evidence-based
clinical decision-making with respect to balance assessment in people with COPD.
Ultimately, the selection of balance test and its interpretation will depend on
the purpose of the assessment, available data on psychometric properties, the
patient’s individual characteristics, and the resources available to the
clinician.
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Affiliation(s)
- Marla K Beauchamp
- 1 School of Rehabilitation Science and Department of Medicine, McMaster University, Hamilton, ON, Canada.,2 West Park Healthcare Centre, Toronto, ON, Canada
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23
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Loughran KJ, Atkinson G, Beauchamp MK, Dixon J, Martin D, Rahim S, Harrison SL. Balance impairment in individuals with COPD: a systematic review with meta-analysis. Thorax 2020; 75:539-546. [PMID: 32409612 DOI: 10.1136/thoraxjnl-2019-213608] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 01/29/2020] [Accepted: 03/06/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND People with chronic obstructive pulmonary disease (COPD) are four times more likely to fall than healthy peers, leading to increased morbidity and mortality. Poor balance is a major risk factor for falls. This review aims to quantify the extent of balance impairment in COPD, and establish contributing clinical factors, which at present are sparse. METHODS Five electronic databases were searched, in July 2017 and updated searches were performed in March 2019, for studies comparing balance in COPD with healthy controls. Meta-analyses were conducted on sample mean differences (MD) and reported correlations between balance and clinical factors. Meta-regression was used to quantify the association between mean difference in percentage predicted forced expiratory volume in 1 s (FEV1) and mean balance impairment. Narrative summaries were provided where data were insufficient for meta-analysis. RESULTS Twenty-three studies were included (n=2751). Meta-analysis indicated COPD patients performed worse than healthy controls on timed up and go (MD=2.77 s, 95% CI 1.46 s to 4.089 s, p=<0.005), single leg stance (MD=-11.75 s, 95% CI -15.12 s to -8.38 s, p=<0.005) and berg balance scale (MD=-6.66, 95% CI -8.95 to -4.37, p=<0.005). The pooled correlation coefficient between balance and reduced quadriceps strength was weak-moderate (r=0.37, 95% CI 0.23 to 0.45, p=<0.005). The relationship between differences in percentage predicted FEV1 and balance were negligible (r2 =<0.04). CONCLUSIONS Compared with healthy controls, people with COPD have a clinically meaningful balance reduction, which may be related to reduced muscle strength, physical activity and exercise capacity. Our findings support a need to expand the focus of pulmonary rehabilitation to include balance assessment and training, and further exploration of balance impairment in COPD. PROSPERO registration number CRD4201769041.
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Affiliation(s)
| | - Greg Atkinson
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Marla K Beauchamp
- School of Rehabilitation Science, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - John Dixon
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Shaera Rahim
- School of Rehabilitation Science, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Bordoni B, Simonelli M. Chronic Obstructive Pulmonary Disease: Proprioception Exercises as an Addition to the Rehabilitation Process. Cureus 2020; 12:e8084. [PMID: 32542139 PMCID: PMC7292710 DOI: 10.7759/cureus.8084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Respiratory rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is recognized as a cornerstone for the therapeutic path. Physiotherapy involves physical activity with aerobic and anaerobic exercises, which can improve the patient's symptomatic picture, such as motor function, emotional status (depression and anxiety), and improve the pain perception. The training of proprioception is not included in the structure of the exercises proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The training of proprioception is a very useful strategy for stimulating the cerebellum, a neurological suffering area in patients with COPD. The cerebellum sorts information about pain and emotions, as well as motor stimuli. The article discusses the need to introduce proprioception in respiratory rehabilitation protocols, highlighting the neurological relationships with the management of comorbidities.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Marta Simonelli
- Integrative/Complimentary Medicine, French-Italian School of Osteopathy, Pisa, ITA
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25
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Godi M, Giardini M, Arcolin I, Ferrante S, Nardone A, Corna S, Colombo R. Is the Brief-BESTest Brief Enough? Suggested Modifications Based on Structural Validity and Internal Consistency. Phys Ther 2019; 99:1562-1573. [PMID: 31348513 DOI: 10.1093/ptj/pzz103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Brief Balance Evaluation Systems Test (Brief-BESTest) could be a useful tool for balance assessment. Although some psychometric characteristics have been examined, others still need to be clarified. OBJECTIVE The objective was to assess the structural validity, convergent validity, discriminant validity, and internal consistency of the Brief-BESTest in neurological patients. DESIGN This was a cross-sectional study. METHODS Data were from 416 patients with neurological disease and related balance disorders. Patients were assessed with the 5-levels Activities-Specific Balance Confidence Scale (ABC 5-levels), Brief-BESTest, and some simple balance tests (ie, 1-leg stance, Timed "Up & Go" test, functional reach, and a fall history questionnaire). Three Brief-BESTest models were examined through confirmatory factor analysis, and the following indexes were calculated: Comparative Fit Index, Tucker-Lewis Index, and root-mean-square error of approximation. Convergent validity was assessed by calculating the correlation between Brief-BESTest and ABC 5-levels total scores. Receiver operating characteristics assessed the ability of each model to differentiate between people with falls and those without falls. Internal consistency was measured with Cronbach α and coefficient ω. RESULTS Confirmatory factor analysis showed model 3 (Comparative Fit Index = 0.97; Tucker-Lewis Index = 0.95; root-mean-square error of approximation = 0.05), with item 1 removed and error covariance between items 3 and 4 and between items 5 and 6, to have a significantly better structure than models 1 and 2. The correlation between Brief-BESTest and ABC 5-levels was 0.61 (Spearman ρ) for all 3 models. The area under the curve of the receiver operating characteristics showed an acceptable accuracy (0.72) in distinguishing patients with a history of falls from those without a history of falls (95% confidence interval = 0.66-0.78) for all models and was superior to the areas under the curve of other simple balance tests (1-leg stance, Timed "Up & Go" test, functional reach). Cronbach α was good for Brief-BESTest models 1 (0.92) and 3 (0.92), but ω was greater than 0.80 only for model 3. LIMITATIONS The sample was heterogeneous. CONCLUSIONS The Brief-BESTest, after some changes, shows good validity and internal consistency in patients affected by different balance disorders.
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Affiliation(s)
- Marco Godi
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Simona Ferrante
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
| | - Antonio Nardone
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Stefano Corna
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Roberto Colombo
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
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Gait characteristics and their associations with clinical outcomes in patients with chronic obstructive pulmonary disease. Gait Posture 2019; 74:60-65. [PMID: 31470225 DOI: 10.1016/j.gaitpost.2019.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 05/19/2019] [Accepted: 08/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Abnormalities of spatiotemporal gait parameters are frequently observed in chronic obstructive pulmonary disease (COPD). However, associations of gait parameters with clinical outcomes and their implementation into clinical practice have not been established. RESEARCH QUESTION To investigate gait abnormalities and their association with clinical outcomes of COPD. METHODS This study included 34 male outpatients with COPD and 16 community-dwelling healthy men aged ≥65 years. The subjects underwent a ten-metre walk test wearing an accelerometer. Data on gait speed, step length, cadence, walk ratio, acceleration magnitude, and standard deviation of step time (step time SD) were collected. Forced expiratory volume in 1-second, modified Medical Research Council dyspnoea score, six-minute walk distance (6MWD), quadriceps muscle strength (QMVC), and physical activity (daily steps and time spent in moderate to vigorous physical activity per day) were measured in the COPD group as clinical outcomes of COPD. We tested group differences in gait parameters, associations between gait parameters and COPD clinical outcomes, and predictive capability of gait parameters for reductions in 6MWD, QMVC, and daily steps in COPD. RESULTS All gait parameters except walk ratio deteriorated in COPD. Step time SD and gait speed were significant independent predictors of 6MWD in COPD (B=-0.440, p = 0.001, B = 0.339, p = 0.007, respectively). Step length was a significant independent predictor of QMVC (B=-0.609, p < 0.001) and daily steps (B=-0.453, p = 0.006). Step length was a significant predictor of muscle weakness and physical inactivity, and step time SD was significant in predicting poor 6MWD in COPD. SIGNIFICANCE Significant associations between gait abnormalities measured by an accelerometer and deficits in extra-pulmonary features of COPD were observed. An accelerometer-based gait analysis could be an alternative approach to assessing gait abnormalities and screening of functional decline in COPD.
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27
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Heraud N, Alexandre F, Gueugnon M, Davy C, Tremey E, Oliver N, Varray A. Impact of Chronic Obstructive Pulmonary Disease on Cognitive and Motor Performances in Dual-Task Walking. COPD 2018; 15:277-282. [PMID: 29799281 DOI: 10.1080/15412555.2018.1469607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
When two tasks are performed simultaneously, they compete for attentional resources, resulting in a performance decrement in one or both tasks. Patients with attention disorders have a reduced ability to perform several tasks simultaneously (e.g., talking while walking), which increases the fall risk and frailty. This study assessed the cognitive and motor performances of patients with COPD and healthy controls within a dual-task walking paradigm. A subobjective was to assess the impact of a pulmonary rehabilitation program on the dual-task performances in COPD. Twenty-five patients with COPD and 20 controls performed a cognitive task (subtraction) and a 15-m walking test separately (single-task; ST) and jointly (dual-task; DT). In addition, a subsample of 10 patients performed the same evaluations 5 weeks later after a pulmonary rehabilitation program following current recommendations. Cognitive and gait performances in ST showed no differences between patients with COPD and controls (all p > 0.05). However, COPD patients exhibited a greater increase in gait variability than controls in DT (4.07 ± 1.46% vs. 2.17 ± 0.7%, p < 0.001). The pulmonary rehabilitation program had no effect on the dual-task impairment for the subsample of patients (p = 0.87). This study provides evidence of insufficient attentional resources to successfully deal with DT in patients with COPD, and this was expressed through an exaggerated increase in gait variability in DT walking. Given the high risk of falls and disability associated with altered gait variability, dual-task training interventions should be considered in pulmonary rehabilitation programs.
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Affiliation(s)
- Nelly Heraud
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France
| | - François Alexandre
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France
| | - Mathieu Gueugnon
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France
| | - Corentin Davy
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France
| | - Emilie Tremey
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France
| | - Nicolas Oliver
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France
| | - Alain Varray
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France.,b Euromov, University of Montpellier , Montpellier , France
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28
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Turcato AM, Godi M, Giardini M, Arcolin I, Nardone A, Giordano A, Schieppati M. Abnormal gait pattern emerges during curved trajectories in high-functioning Parkinsonian patients walking in line at normal speed. PLoS One 2018; 13:e0197264. [PMID: 29750815 PMCID: PMC5947908 DOI: 10.1371/journal.pone.0197264] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/30/2018] [Indexed: 12/22/2022] Open
Abstract
Background Several patients with Parkinson´s disease (PD) can walk normally along straight trajectories, and impairment in their stride length and cadence may not be easily discernible. Do obvious abnormalities occur in these high-functioning patients when more challenging trajectories are travelled, such as circular paths, which normally implicate a graded modulation in the duration of the interlimb gait cycle phases? Methods We compared a cohort of well-treated mildly to moderately affected PD patients to a group of age-matched healthy subjects (HS), by deliberately including HS spontaneously walking at the same speed of the patients with PD. All participants performed, in random order: linear and circular walking (clockwise and counter-clockwise) at self-selected speed. By means of pressure-sensitive insoles, we recorded walking speed, cadence, duration of single support, double support, swing phase, and stride time. Stride length-cadence relationships were built for linear and curved walking. Stride-to-stride variability of temporal gait parameters was also estimated. Results Walking speed, cadence or stride length were not different between PD and HS during linear walking. Speed, cadence and stride length diminished during curved walking in both groups, stride length more in PD than HS. In PD compared to HS, the stride length-cadence relationship was altered during curved walking. Duration of the double-support phase was also increased during curved walking, as was variability of the single support, swing phase and double support phase. Conclusion The spatio-temporal gait pattern and variability are significantly modified in well-treated, high-functioning patients with PD walking along circular trajectories, even when they exhibit no changes in speed in straight-line walking. The increased variability of the gait phases during curved walking is an identifying characteristic of PD. We discuss our findings in term of interplay between control of balance and of locomotor progression: the former is challenged by curved trajectories even in high-functioning patients, while the latter may not be critically affected.
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Affiliation(s)
- Anna Maria Turcato
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Marco Godi
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
- * E-mail:
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Antonio Nardone
- Centro Studi Attività Motorie, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Neurorehabilitation and Spinal Units, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Giordano
- Unit of Bioengineering, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Marco Schieppati
- Department of Exercise & Sports Science, International University of Health, Exercise and Sports, LUNEX University, Differdange, Luxembourg
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Giardini M, Nardone A, Godi M, Guglielmetti S, Arcolin I, Pisano F, Schieppati M. Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson's Disease. Neural Plast 2018; 2018:5614242. [PMID: 29706993 PMCID: PMC5863303 DOI: 10.1155/2018/5614242] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/14/2018] [Indexed: 12/19/2022] Open
Abstract
We hypothesised that rehabilitation specifically addressing balance in Parkinson's disease patients might improve not only balance but locomotion as well. Two balance-training protocols (standing on a moving platform and traditional balance exercises) were assessed by assigning patients to two groups (Platform, n = 15, and Exercises, n = 17). The platform moved periodically in the anteroposterior, laterolateral, and oblique direction, with and without vision in different trials. Balance exercises were based on the Otago Exercise Program. Both platform and exercise sessions were administered from easy to difficult. Outcome measures were (a) balancing behaviour, assessed by both Index of Stability (IS) on platform and Mini-BESTest, and (b) gait, assessed by both baropodometry and Timed Up and Go (TUG) test. Falls Efficacy Scale-International (FES-I) and Parkinson's Disease Questionnaire (PDQ-8) were administered. Both groups exhibited better balance control, as assessed both by IS and by Mini-BESTest. Gait speed at baropodometry also improved in both groups, while TUG was less sensitive to improvement. Scores of FES-I and PDQ-8 showed a marginal improvement. A four-week treatment featuring no gait training but focused on challenging balance tasks produces considerable gait enhancement in mildly to moderately affected patients. Walking problems in PD depend on postural instability and are successfully relieved by appropriate balance rehabilitation. This trial is registered with ClinicalTrials.gov NCT03314597.
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Affiliation(s)
- Marica Giardini
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Antonio Nardone
- Centro Studi Attività Motorie, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Neurorehabilitation and Spinal Units, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Marco Godi
- Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Italy
| | - Simone Guglielmetti
- Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Italy
| | - Ilaria Arcolin
- Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Italy
| | - Fabrizio Pisano
- Neurorehabilitation Division, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Italy
| | - Marco Schieppati
- Department of Exercise and Sport Science, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
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Sozzi S, Crisafulli O, Schieppati M. Haptic Cues for Balance: Use of a Cane Provides Immediate Body Stabilization. Front Neurosci 2017; 11:705. [PMID: 29311785 PMCID: PMC5735113 DOI: 10.3389/fnins.2017.00705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/01/2017] [Indexed: 11/13/2022] Open
Abstract
Haptic cues are important for balance. Knowledge of the temporal features of their effect may be crucial for the design of neural prostheses. Touching a stable surface with a fingertip reduces body sway in standing subjects eyes closed (EC), and removal of haptic cue reinstates a large sway pattern. Changes in sway occur rapidly on changing haptic conditions. Here, we describe the effects and time-course of stabilization produced by a haptic cue derived from a walking cane. We intended to confirm that cane use reduces body sway, to evaluate the effect of vision on stabilization by a cane, and to estimate the delay of the changes in body sway after addition and withdrawal of haptic input. Seventeen healthy young subjects stood in tandem position on a force platform, with eyes closed or open (EO). They gently lowered the cane onto and lifted it from a second force platform. Sixty trials per direction of haptic shift (Touch → NoTouch, T-NT; NoTouch → Touch, NT-T) and visual condition (EC-EO) were acquired. Traces of Center of foot Pressure (CoP) and the force exerted by cane were filtered, rectified, and averaged. The position in space of a reflective marker positioned on the cane tip was also acquired by an optoelectronic device. Cross-correlation (CC) analysis was performed between traces of cane tip and CoP displacement. Latencies of changes in CoP oscillation in the frontal plane EC following the T-NT and NT-T haptic shift were statistically estimated. The CoP oscillations were larger in EC than EO under both T and NT (p < 0.001) and larger during NT than T conditions (p < 0.001). Haptic-induced effect under EC (Romberg quotient NT/T ~ 1.2) was less effective than that of vision under NT condition (EC/EO ~ 1.5) (p < 0.001). With EO cane had little effect. Cane displacement lagged CoP displacement under both EC and EO. Latencies to changes in CoP oscillations were longer after addition (NT-T, about 1.6 s) than withdrawal (T-NT, about 0.9 s) of haptic input (p < 0.001). These latencies were similar to those occurring on fingertip touch, as previously shown. Overall, data speak in favor of substantial equivalence of the haptic information derived from both “direct” fingertip contact and “indirect” contact with the floor mediated by the cane. Cane, finger and visual inputs would be similarly integrated in the same neural centers for balance control. Haptic input from a walking aid and its processing time should be considered when designing prostheses for locomotion.
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Affiliation(s)
- Stefania Sozzi
- Centro Studi Attività Motorie, Istituti Clinici Scientifici Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
| | - Oscar Crisafulli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Marco Schieppati
- Department of Exercise and Sport Science, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
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