Journal of Neurologic Physical Therapy最新文献

{"title":"Physical Therapy and Deep Brain Stimulation in Parkinson Disease: Safety, Feasibility, and Preliminary Efficacy.","authors":"Lauren E Tueth, Kerri S Rawson, Linda R Van Dillen, Gammon M Earhart, Joel S Perlmutter, Ryan P Duncan","doi":"10.1097/NPT.0000000000000519","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000519","url":null,"abstract":"<p><strong>Background and purpose: </strong>Subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats some of the motor manifestations of Parkinson disease (PD). However, previous work suggests STN-DBS may lead to worsening of balance and gait in some people with PD. Physical therapy (PT) is often used to improve balance and gait in PD, but its safety, feasibility, and efficacy have not been tested in people with STN-DBS. The purpose of this study was to test the safety, feasibility, and preliminary efficacy of PT for improving gait and balance in persons with PD and STN-DBS.</p><p><strong>Methods: </strong>This randomized pilot study compared the effects of an 8-week PT intervention (n = 15) on balance and gait to a usual care control group (n = 14) among people with PD with STN-DBS. Individuals were evaluated in the on medication/on stimulation state as well as off medication/off stimulation state.</p><p><strong>Results: </strong>PT was safe as there were no serious adverse events during treatment. PT was feasible as the average percentage of session attendance was 93%. PT significantly improved balance as measured by the Balance Evaluation Systems Test (BESTest) in the on medication/on stimulation state but did not significantly improve gait. No significant differences between groups were found in the off medication/off stimulation state.</p><p><strong>Discussion and conclusions: </strong>PT was safe, feasible, and may improve balance for individuals with PD with STN-DBS. Further work is needed to understand how modifying the frequency and intensity of PT interventions may impact balance and gait in individuals with STN-DBS.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Research to the Clinic: Using Technology to Measure Gait in Neurorehabilitation.","authors":"Amelia R Cain, Kristan A Leech","doi":"10.1097/NPT.0000000000000523","DOIUrl":"10.1097/NPT.0000000000000523","url":null,"abstract":"<p><strong>Background and purpose: </strong>Neurorehabilitation research utilizes wearable technology (WT) and mobile phone apps (MPA) to measure gait and walking activity in people with various neurological conditions. Despite physical therapists' perceptions that WT is useful, the reported use of WT in clinical practice remains low. The purpose of this brief review is to discuss the advantages of WT and MPA for gait assessment in the clinical setting, highlight WT and MPA that are available for clinical use, and acknowledge the limitations and future potential of these technologies in patient care.</p><p><strong>Summary of key points: </strong>WT and MPA provide objective assessments of gait characteristics or physical activity that is low-cost, easy to use, and a beneficial adjunct to traditional clinical methods. There are several WT and MPA that have been validated in persons with neurological conditions and help identify gait impairments and discriminate fallers from non-fallers. Although additional research is needed to overcome continued barriers to use in clinical practice, WT and MPA have potential as tools to provide objective feedback to patients and influence clinical decision making.</p><p><strong>Recommendations for clinical practice: </strong>There are many advantages to using WT or MPA to measure gait and walking activity in persons with neurologic conditions. We anticipate that these technologies will only become more pervasive in research and practice and recommend that clinicians consider applying these technologies in their own practice.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State of the Academy.","authors":"Nancy Fell","doi":"10.1097/NPT.0000000000000522","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000522","url":null,"abstract":"","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fusing GPS, Activity Monitors, and Self-Report to Improve Assessment of Walking Activity and Community Participation After Stroke.","authors":"George D Fulk, Karen Klingman, Emily N Peterson","doi":"10.1097/NPT.0000000000000518","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000518","url":null,"abstract":"<p><strong>Background and purpose: </strong>Walking and participation in the community are important goals for people post-stroke (PPS). These constructs are challenging to measure given limitations in current data collection methodologies. The purpose of this study was to (1) develop a data fusion approach that combined data from global positioning system (GPS), activity monitor (AM), and daily trip log to identify walking activity and participation in the community, and (2) to examine the construct validity of the data fusion method.</p><p><strong>Methods: </strong>At 60 days post-stroke, PPS wore a GPS and AM and completed a daily trip log for 7 days. Using a combination of a density-based spatial clustering algorithm and geocoding GPS, AM, and daily trip log data were time synched and fused to identify total trips taken outside the home; locations visited per trip; number of steps taken in the home, in the community, at each location visited, and in total. Associations between stroke outcomes and the data fusion metrics were determined to support the construct validity of the data fusion method.</p><p><strong>Results: </strong>Forty-four PPS took a mean of 2,541 steps/day, of which 56% were in the community, and took a mean of 0.39 trips/day outside the home and visited a mean of 0.42 locations. A social visit was the most common reason for going into the community. There were fair associations between number of trips outside the home and gait speed (GS), r = 0.49, Berg Balance Scale (BBS), r = 0.48, modified Rankin Scale (mRS), r = -0.47, and Stroke Impact Scale participation subscale (SIS-P) (0.45). There were moderate associations between steps taken in the community and GS, r = 0.63, BBS, r = 0.51, mRS, r = -0.61, and SIS-P, r = 0.43.</p><p><strong>Discussion and conclusions: </strong>Participants did not often access their community. Fusing GPS, AM, and trip log data may provide a comprehensive method to identify walking activity and community participation in PPS.</p><p><strong>Video abstract available: </strong>for more insights from the authors (see the Video, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A529).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measurement Properties of a Virtually Administered 30-Second Chair Stand Test in People With Stroke.","authors":"Kenneth S Noguchi, Allison Liang, Elise Wiley, Sarah Park, Brodie M Sakakibara, Ada Tang","doi":"10.1097/NPT.0000000000000520","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000520","url":null,"abstract":"<p><strong>Background and purpose: </strong>Muscle strength is important for functional independence after a stroke. Given the rise in telerehabilitation, there is a need to study the measurement properties of virtually administered performance-based measures. The purpose of this study was to assess the validity and responsiveness of a virtually administered 30-second chair stand test (30sCST-Virtual) in people with stroke.</p><p><strong>Methods: </strong>Thirty-two hypotheses were generated about construct validity and responsiveness using several outcome measures (Stroke Impact Scale, strength domain [SIS-S], Timed Up and Go [TUG], Activities-Specific Balance Confidence Scale, Fugl-Meyer Lower Extremity Assessment, Functional Reach Test, and SIS cognition domain). Hypotheses were tested using Spearman's correlations. Scores on the 30sCST-Virtual were compared between higher- and lower-functioning participants using the modified Rankin Scale (mRS) and NIH Stroke Scale (NIHSS) with Wilcoxon rank-sum tests to assess known-groups validity.</p><p><strong>Results: </strong>Sixty-seven participants (n = 19 female, 9.3 months post-stroke) with mild to moderate stroke were included. The 30sCST-Virtual demonstrated acceptable construct validity and responsiveness, as 14 (82%) and 12 (80%) hypotheses were confirmed, respectively. Its baseline scores were most highly correlated with the TUG (r = - 0.64) and change scores with the SIS-S (r = 0.35). The 30sCST-Virtual scores were also lower in those with lower function using the mRS (median difference [MD] = 4.0 repetitions, P < 0.001) and NIHSS (MD = 3.5 repetitions, P = 0.003), meeting our hypotheses for known-groups validity.</p><p><strong>Discussion and conclusions: </strong>The 30sCST-Virtual demonstrated acceptable construct validity and responsiveness, as well as adequate known-groups validity. It was also moderately correlated with other measures of physical function, indicating that the 30sCST-Virtual may measure the construct of functional strength.</p><p><strong>Video abstract available: </strong>For more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A526).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Walking Forward: Advances in Mobility for People with Neurological Disorders.","authors":"George Fulk, Merrill Landers, Michelle Ploughman, Dorian Rose, Gavin Williams","doi":"10.1097/NPT.0000000000000521","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000521","url":null,"abstract":"","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving Sounds Increase Postural Visual Dependence in Adults With Chronic Traumatic Brain Injury.","authors":"Daniel Humphrey, Jennifer Kelly, Emily R Rosario, Tammie Keller Johnson, Anat V Lubetzky","doi":"10.1097/NPT.0000000000000515","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000515","url":null,"abstract":"<p><strong>Background and purpose: </strong>This cross-sectional study aimed to (1) establish the safety and tolerability of head-mounted display (HMD) assessment of sensory integration for postural control in participants with chronic traumatic brain injury (TBI); (2) investigate whether responses to visual and auditory cues differ between persons with TBI and healthy controls; and (3) evaluate the relationship between postural responses, postural visual dependence, and self-reported perception of disability.</p><p><strong>Methods: </strong>20 healthy adults and 19 participants with TBI completed an HMD assessment of with visual and auditory perturbations. Head sway was quantified as a directional path in the anteroposterior and mediolateral directions. Participants also completed the Simulator Sickness Questionnaire (SSQ) and the Dizziness Handicap Inventory (DHI).</p><p><strong>Results: </strong>All participants completed testing. The average change in SSQ scores from pre to post postural control assessment was 0.8 points for healthy controls and 3.2 points for participants with TBI. Head sway in the TBI group was consistently higher in both directions, especially with dynamic visuals. In addition, a significant sound by visual by group interaction in the mediolateral direction indicates that participants with TBI responded more to the visual perturbations when sounds were present. Under the most challenging conditions, people with mild-to-moderate dizziness handicap showed little head sway, while those with severe symptoms were more variable.</p><p><strong>Discussion and conclusions: </strong>HMD assessment of participants with TBI is feasible and provides a clinic-based assessment of postural visual dependence in this population. This assessment carries the potential to evaluate postural control and monitor progress of participants with TBI.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Individual Factors on Exercise Dose During a Walking Intervention in People With Stroke.","authors":"Kiersten M McCartney, Ryan T Pohlig, Duncan Thibodeau Tulimieri, Pierce Boyne, Susanne M Morton, Darcy S Reisman","doi":"10.1097/NPT.0000000000000517","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000517","url":null,"abstract":"<p><strong>Background and objective: </strong>There has been a substantial increase in the number of studies demonstrating improvements in walking capacity in people with chronic stroke following moderate-to-high intensity walking exercise interventions. Yet, there is significant variability in response to these interventions. This is likely due to the heterogeneity in this population and the variability in the exercise dose parameters actually attained within these walking interventions. Exercise prescription can be optimized by understanding how individual variables impact walking exercise dose. This study leveraged a large, clinical dataset to classify people with chronic stroke into homogeneous groups (called classes) and compare classes on the walking exercise dose achieved in a walking intervention.</p><p><strong>Methods: </strong>One hundred sixty-nine people with chronic (>6-Months) stroke completed clinical evaluations and a 12-week high-intensity treadmill intervention. Baseline measures of walking capacity, physical health, and psychosocial factors were used in a latent variable mixture model to assess if latent, homogeneous classes existed within the dataset. Objective criteria determined the optimal number of classes, which were compared to the walking exercise dose attained across the intervention.</p><p><strong>Results: </strong>Four homogeneous classes were distinguished by differences in baseline walking capacity, steps-per-day, comorbidity burden, and balance self-efficacy. Despite clear \"clinical profiles\" of people with chronic stroke, these classes did not differ on the walking exercise dose attained.</p><p><strong>Discussion and conclusions: </strong>Prior literature and clinical intuition suggest individuals with lower baseline walking capacity, physical health, and self-efficacy are less likely to tolerate high-intensity exercise, however our results demonstrate this is not true for people with chronic stroke.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A524.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustained Attention and Gait Pattern Changes During the 6-minute Walk Test in Persons With Multiple Sclerosis.","authors":"Zuhal Abasıyanık, Turhan Kahraman, Renee Veldkamp, Özge Ertekin, Alon Kalron, Serkan Özakbaş, Peter Feys","doi":"10.1097/NPT.0000000000000514","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000514","url":null,"abstract":"<p><strong>Background and purpose: </strong>It is unknown whether persons with multiple sclerosis (pwMS) can retain sustained attention and gait quality during long-distance walking tests. This study aimed to investigate changes in sustained attention and gait parameters during prolonged walking in pwMS with different levels of disability and healthy controls (HCs) and correlations of these changes with self-reported daily life difficulties.</p><p><strong>Methods: </strong>The 6-Minute Walk Test was performed with an auditory sustained attention task while wearing inertial measurement sensors. Participants were asked to respond verbally as quickly as possible to randomly presented auditory stimuli during 6 minutes of walking. The accuracy of answers, average reaction time, and gait parameters per minute were determined.</p><p><strong>Results: </strong>Thirty pwMS with mild disability (Expanded Disease Status Scale [EDSS] < 4.0), 16 pwMS with moderate-to-severe disability (EDSS 4.0 to 6.5), and 27 age-gender matched HCs were included. A significant group-by-time interaction effect as found for reactions times, which increased in mild and moderate-to-severe disability groups but not in HCs. Gait parameters deteriorated over time in all groups, but no significant group-by-time interaction was found. The decrease in sustained attention was not related to changes in gait or clinical outcomes, while deterioration in gait parameters was associated with perceived walking disability and dual-task difficulties in daily life.</p><p><strong>Discussion and conclusions: </strong>Sustained attention during walking declined over time in pwMS, but not in HCs. However, gait parameters deteriorated in all groups. Worsening gait during simultaneous cognitive task execution may contribute to walking and dual-task difficulties in pwMS.</p><p><p>Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A520.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatigue Is Associated With Perceived Effort and 2-Dimensional Reach Performance After Stroke.","authors":"Hui-Ting Goh, Jill Stewart, Kevin Becker","doi":"10.1097/NPT.0000000000000483","DOIUrl":"10.1097/NPT.0000000000000483","url":null,"abstract":"<p><strong>Background and purpose: </strong>Poststroke fatigue (PSF) is prevalent and often manifests as high perceived effort during activities. Little is known about how PSF influences goal-directed reaching after stroke. The purpose of this study was 2-fold (1) to evaluate how perceived effort changed when individuals with stroke performed a reaching task with various demands and (2) to determine whether PSF was associated with perceived effort during reaching and reach performance.</p><p><strong>Methods: </strong>Thirty-six individuals with chronic stroke performed 2-dimensional reach actions under varied conditions with the more and less affected arms. Perceived effort during reaching was assessed using rating of perceived exertion (RPE) and Paas Mental Effort Rating Scale (MERS). Derived reach kinematics were used to quantify reach performance. The Fatigue Severity Scale (FSS) was administered to assess fatigue severity.</p><p><strong>Results: </strong>Perceived effort was higher when participants reached with the more affected arm, reached toward far and small targets, and performed memory-guided reaching. Both RPE and MERS significantly correlated with the FSS score ( r = 0.50 and 0.35, respectively, P < 0.05). Further, FSS correlated with movement time during the more affected arm reaching (ρ = 0.40, p < 0.05) and reach performance discrepancy between the fast and self-selected speed conditions when participants performed with the less affected arm (ρ = 0.36, P < 0.05). Exploratory analysis revealed that the relationship between fatigue and reach control appeared to be modulated by task demand.</p><p><strong>Discussion and conclusions: </strong>PSF is associated with perceived effort during reaching and reach performance after stroke. These relationships might offer insights into arm performance in the real world after stroke.</p><p><strong>Video abstract: </strong>for more insights from the authors Supplemental Digital Content available at http://links.lww.com/JNPT/A476.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"90-98"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}