Objective: To determine whether a programme of multidisciplinary rehabilitation and group support achieves sustained benefit for people with Parkinson’s disease or their carers. Methods: The study ...was a randomised controlled crossover trial comparing patients and carers who had received rehabilitation four months before assessment with those who had not. Patients were recruited from a neurology clinic, attended a day hospital from home weekly for six weeks using private car or hospital transport, and received group educational activities and individual rehabilitation from a multidisciplinary team. Patients were assessed at entry and at six months using a 25 item self assessment Parkinson’s disease disability questionnaire, Euroqol-5d, SF-36, PDQ-39, hospital anxiety and depression scale, and timed stand-walk-sit test. Carers were assessed using the carer strain index and Euroqol-5d. Results: 144 people with Parkinson’s disease without severe cognitive losses and able to travel to hospital were registered (seven were duplicate registrations); 94 had assessments at baseline and six months. Repeated measures analysis of variance comparing patients at the 24 week crossover point showed that those receiving rehabilitation had a trend towards better stand-walk-sit score (p = 0.093) and worse general and mental health (p = 0.002, p = 0.019). Carers of treated patients had a trend towards more strain (p = 0.086). Analysis comparing patients before and six months after treatment showed worsening in disability, quality of life, and carer strain. Conclusions: Patients with Parkinson’s disease decline significantly over six months, but a short spell of multidisciplinary rehabilitation may improve mobility. Follow up treatments may be needed to maintain any benefit.
Background: Neurofilament phosphoforms (Nf) are principal components of the axoskeleton released during axonal injury. Cerebrospinal fluid (CSF) levels of Nf phosphoforms might be useful surrogate ...markers for disability in multiple sclerosis (MS), aid in distinguishing clinical subtypes, and provide valuable prognostic information. Method: Thirty four patients with MS were included in a three year follow up study along with 318 controls with other non-inflammatory neurological diseases. CSF levels of two Nf heavy chain (NfH) phosphoforms (NfHSMI35, NfHSMI34) were quantified at baseline and three year follow up using new ELISA techniques. Levels of NfH phosphoforms, the degree of phosphorylation (NfHSMI34:NfHSMI35 ratio), and changes in NfH levels between baseline and follow up (ΔNfH) were related to the clinical phenotype (RR or SP/PP), to three clinical scales (Kurtzke’s EDSS, ambulation index (AI), and nine hole peg test (9HPT)), and to progression of disability. Results: A significantly higher proportion (59%) of patients with SP/PPMS experienced an increase in NfHSMI35 levels between baseline and follow up compared with those with RRMS (14%, p<0.05). CSF NfHSMI34 levels at baseline were higher in patients with SP/PP (11 pg/ml) compared with RR (7 pg/ml, p<0.05) and NfHSMI35 levels were higher at follow up in SP/PP (129 pg/ml) compared with levels below assay sensitivity in RR (p<0.05). NfHSMI35 correlated with the EDSS (rs = 0.54, p<0.01), the AI (rs = 0.42, p<0.05), and the 9HPT (rs = 0.59, p<0.01) at follow up. Conclusion: The increase in NfH during the progressive phase of the disease together with the correlation of NfHSMI35 with all clinical scales at follow up suggests that cumulative axonal loss is responsible for sustained disability and that high NfHSMI35 levels are a poor prognostic sign.
Highlights • We examine the validity of the squares test as a measure of hand function in MS. • The test is compared to the 9-hole peg test, a standard in the MSFC. • The ST shows high correlation ...with the 9HPT and comparable discriminatory power. • The ST is a good candidate for use in composite measures of functional deficits
The dorsal premotor cortex (PMd) is abnormally active in patients with idiopathic Parkinson's disease. This has been interpreted as a functional correlate of adaptive plasticity within the motor ...system to compensate for deficient activation of striato-mesial–frontal projections in these patients. Whether abnormal PMd activity influences excitability in the primary motor cortex (M1) in untreated Parkinson's disease patients and how this premotor–motor interaction might be altered by l-dopa is unclear. To this end, we studied the effects of 1 Hz premotor repetitive transcranial magnetic stimulation (rTMS) on M1 excitability in 10 previously untreated non-tremulous Parkinson's disease patients before (day 1) and after (day 8) their first ever l-dopa treatment and compared the results with those of a group of nine age- and sex-matched healthy controls. In each rTMS session, 1200 pulses of 1 Hz rTMS were applied at an intensity of 80% active motor threshold (AMT) to the PMd contralateral to the clinically more affected side in Parkinson's disease patients and to the left PMd in healthy controls. Intracortical paired pulse excitability of ipsilateral M1 was probed using a TMS paired pulse paradigm where subthreshold conditioning pulses (80% of AMT) were given 2–15 ms prior to a suprathreshold test pulse. In Parkinson's disease patients, abnormal baseline intracortical excitability at an interstimulus interval (ISI) of 5 ms was normalized by premotor rTMS. In contrast, rTMS led to an increased excitability at an ISI of 5 ms in healthy controls. Premotor rTMS effects lasted longer (for at least a week) in patients. These results show that the modifiability of premotor–motor connections is abnormal in untreated Parkinson's disease. A single dose of l-dopa reversed, i.e. normalized, the direction of excitability changes in M1 following premotor rTMS in Parkinson's disease patients, suggesting that dopamine depletion directly or indirectly influences premotor–motor interactions in Parkinson's disease. The rTMS conditioning approach described here provides a promising tool to delineate further the excitability changes in frontal motor areas in response to progressive degeneration of nigrostriatal dopaminergic neurons and also to chronic l-dopa treatment in Parkinson's disease.
Abstract. Purpose The aim of this study was to study manual dexterity levels provided by the type of compression garment and compression bandages of patients with breast cancer-related lymphedema ...(BCRL). Methods Twenty-six BCRL patients formed experimental group and 32 healthy volunteers who were matched to the experimental subjects were in the control group. Grip strength and manual dexterity were tested under the three conditions (the no compression condition, the garment condition, and the bandage condition) using the Nine-Hole Peg Test (NHPT), the Box and Block Test (B&BT) and a hand-held Jamar dynamometer. Results The comparison showed significant differences of grip strength between the experimental group and the control group under the bandage condition. Both groups' performance abilities decreased as the thickness of the compression materials increased. The correlations between the grip strength and dexterity scores tended to be low to moderate, ranging from 0.407 (Box and Block Test) to -0.550 (Nine-Hole Peg Test) under the bandage condition. Conclusion The result of this study suggest that the grip strength and manual dexterity scores in patients with BCRL are influenced by the characteristics of the compression type. A wider choice of compression materials would improve on hand function in activities of daily living.
Background and Aim: Hand writing is one of the most important abilities that children can gain and use as one part of their duties during their schooling. Students should write fluently and fast to ...have good connection with school works and gain good grades in exams. It is clear that hand writing problems can influence on children’s other abilities, because this skill is declared often as a reflection of intelligence and although what they write is the same, students with bad hand writing gain lower grades than students with nice hand writing. Recognition of sub base items in this problem will be affective in assessment, intermediation and prevention programs for children who are suffering from this problem. This study is designed to appoint the relation between in hand manipulation skills and visual-motor integration skills with hand writing skills of students of grade one of primary schools in Tehran.Material & Methods: This study was a descriptive-analytic (sectional) investigation. 139 students had been chosen by accident. Instruments which had been used in this study consisted of visual-motor integration test, hand writing quality checklist, chronometer and nine hole PEG test. After data collection, the results were analyzed.Results: The results indicate that visual- motor integration and in hand manipulation skills both are affective in children’s hand writing skills. Grades of girls and boys in visual-motor integration were significantly different. Mean grade of girls in this test was higher than boys, but these variants in hand manipulation skills were not significantly different. Also there was no significant different in handwriting speed and quality between boys and girls.Conclusion: The results indicate that by assessment of visual- motor integration skills and in hand manipulation skills we may be able to find more exact ways to prevent and treat children who are suffering from hand writing problems.
Purpose The aim of this study was to study manual dexterity levels provided by the type of compression garment and compression bandages of patients with breast cancer-related lymphedema (BCRL). ...Methods Twenty-six BCRL patients formed experimental group and 32 healthy volunteers who were matched to the experimental subjects were in the control group. Grip strength and manual dexterity were tested under the three conditions (the no compression condition, the garment condition, and the bandage condition) using the Nine-Hole Peg Test (NHPT), the Box and Block Test (B&BT) and a hand-held Jamar dynamometer. Results The comparison showed significant differences of grip strength between the experimental group and the control group under the bandage condition. Both groups’ performance abilities decreased as the thickness of the compression materials increased. The correlations between the grip strength and dexterity scores tended to be low to moderate, ranging from 0.407 (Box and Block Test) to - 0.550 (Nine-Hole Peg Test) under the bandage condition. Conclusion The result of this study suggest that the grip strength and manual dexterity scores in patients with BCRL are influenced by the characteristics of the compression type. A wider choice of compression materials would improve on hand function in activities of daily living.
Virtual reality based 9 Hole Peg Test Tufekci, Pinar; Gungor, Halil Ibrahim; Yilmaz, Alican
2018 26th Signal Processing and Communications Applications Conference (SIU)
Conference Proceeding
A physical test called the "9-Hole Peg Test" (9-HPT) is being used to measure progress in neurological disease, physiotherapy and rehabilitation treatment processes. During the application of this ...test, possible physical errors, which may be caused by the patient or the specialist, can affect the measurement results. In this study, an application was developed to bring the 9-HPT physical test to the virtual reality environment in order to minimize the most possible errors. For the user to be included in the 9-HPT environment created in the virtual environment, the Leap Motion touchless sensor was used, which enabled the user to interact with the virtual environment and easily perform this test in the virtual environment. With the developed application, it is ensured that the patients can measure their measurements easily by themselves when necessary with minimum losses.
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