Journal of Neurologic Physical Therapy最新文献

{"title":"Reflections and Aspirations: Shaping the Future of Neurologic Physical Therapy.","authors":"Lori Quinn","doi":"10.1097/NPT.0000000000000503","DOIUrl":"10.1097/NPT.0000000000000503","url":null,"abstract":"","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"1-3"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733721","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":"Utilization of Neurology and Allied Health Services by People With Parkinson's Disease in Israel: A Retrospective Observational Study.","authors":"Badera Naamneh-Abuelhija, Michal Kafri, Meir Kestenbaum, Efrat Shadmi, Igor Mintz, Sarit Shved, Shmuel Giveon, Sharon Kamah, Galit Yogev-Seligmann","doi":"10.1097/NPT.0000000000000502","DOIUrl":"10.1097/NPT.0000000000000502","url":null,"abstract":"<p><strong>Background: </strong>Sustainable utilization of neurology and allied health professions' services is pivotal for effective management of Parkinson disease (PD) and is correlated with positive health-related outcomes.</p><p><strong>Objectives: </strong>(1) To describe the utilization of neurology and allied health services by people with PD (PwP); (2) to explore the associations between demographic and structural variables and utilization; and (3) to test associations between utilization and unplanned hospitalizations.</p><p><strong>Methods: </strong>A retrospective observational cohort study of 1761 PwP in the years 2014-2019 was conducted. Utilization of neurology and allied health services was mapped. Regression models were examined to test associations between demographic and structural variables, utilization of neurology and physical therapy (PT), and unplanned hospitalizations.</p><p><strong>Results: </strong>Approximately 50% of the study population utilized neurology services. Utilization rate of allied health services ranged between 0% and 19%. The likelihood of utilizing neurology services increased for people with extended health insurance and people with more years since diagnosis and decreased for women and for people living at a great distance from a neurology service. The likelihood of utilizing PT increased for Jews and people with extended health insurance and decreased for people with more years since diagnosis and for people living at a great distance from a PT service. Among patients with fewer years since diagnosis (<5 years), those who utilized PT had a higher likelihood of unplanned hospitalization.</p><p><strong>Conclusions: </strong>Neurology and allied health services are underutilized by PwP, particularly by minorities and women. Policymakers should take proactive steps to increase utilization.</p><p><strong>Video abstract available: </strong>for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A496 ).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733725","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 as a Mediator Between Strength and Health-Related Quality of Life in Multiple Sclerosis.","authors":"Laura B Simaitis, Elizabeth S Gromisch, Alyssa Demeule, Rhiannon Murphy, Corinne Palumbo, Heather M DelMastro","doi":"10.1097/NPT.0000000000000505","DOIUrl":"10.1097/NPT.0000000000000505","url":null,"abstract":"<p><p>Background and Purpose: Lower limb (LL) weakness and gait impairment are prevalent among persons with multiple sclerosis (PwMS) and can impede functional independence and impact health-related quality of life (HR-QoL). The purpose of this study was to examine the mediation effect of walking speed and perceived walking ability on the relationship between LL weakness and HR-QoL in ambulatory PwMS.</p><p><strong>Methods: </strong>Participants (n = 175) were PwMS in this secondary analysis of a cross-sectional study. Demographics, pain (visual analog scale), fatigue (5-item Modified Fatigue Impact Scale), LL strength (hip extensors [HE] and flexors [HF], knee extensors [KE] and flexors [KF], and ankle plantarflexors [APF] and dorsiflexors [ADF]), Timed 25-Foot Walk, 12-item MS Walking Scale, and HR-QoL (MS Impact Scale-Physical [MSIS-29-Phys] and Psychological [MSIS-29-Psych]) were collected. Bivariate and mediation analyses using Hayes' PROCESS were performed to determine if LL strength had an indirect effect through walking speed or perceived walking ability on physical and psychological HR-QoL while controlling for fatigue and pain.</p><p><strong>Results: </strong>There were significant ( P < 0.01) correlations for all strength measures with the MSIS-29-Phys and for HF, KE, KF, and APF with the MSIS-29-Psych. In the mediation analyses, LL strength indirectly influenced PwMS' MSIS-29-Phys through walking speed and perceived walking ability. There was only partial mediation between HE, HF, KF, ADF, and MSIS-29-Phy when walking speed was in the model. LL strength did not influence MSIS-29-Psych.</p><p><strong>Discussion and conclusions: </strong>LL strength impacts physical HR-QoL through walking but does not indirectly affect PwMS' perceived psychological HR-QoL. These findings may prompt physical therapists to create individualized care plans that address LL weakness and walking impairments with the goal of promoting optimal outcomes and improving HR-QoL.</p><p><strong>Video abstract available: </strong>for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A504 ).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717511","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":"Proximal Muscle Resistance Training to Improve Walking in People With Multiple Sclerosis: A Pilot Study.","authors":"Mark M Mañago, Jeri E Forster, Eliza Biondi, Margaret Schenkman, Michelle H Cameron, Cory L Christiansen","doi":"10.1097/NPT.0000000000000504","DOIUrl":"10.1097/NPT.0000000000000504","url":null,"abstract":"<p><strong>Background and purpose: </strong>This pilot study examined the feasibility of a proximal muscle resistance training program to improve walking in people with multiple sclerosis using a combination of in-person, virtual, and independent exercise sessions.</p><p><strong>Methods: </strong>People with multiple sclerosis (Expanded Disability Status Scale Score is <6.0) were recruited to a study of resistance training exercises targeting hip abduction and trunk muscles for 10 weeks. Feasibility criteria were: enrolling 40 participants, retaining ≥80%, ≥80% visit adherence, no serious intervention-related adverse events, and ≥80% satisfaction. The 6-Minute Walk Test, Timed 25-Foot Walk Test, muscle performance (hip abduction and lateral trunk flexion strength, and trunk flexion endurance), patient-reported outcomes, daily step count, and pelvis and trunk kinematics were measured before and after intervention. Patient-reported outcomes and step count were measured again 12 weeks after intervention.</p><p><strong>Results: </strong>Twenty-eight people (median Expanded Disability Status Scale is 3.5) enrolled and 92.8% were retained. Visit adherence was 86.5% (96% for virtual visits, 74% for in-person visits), and 48% of participants preferred virtual visits, while 20% preferred in-person visits. There were no serious intervention-related adverse events, and there was 100% satisfaction. Following intervention, 6-Minute Walk Test distance increased 29.6 m (95% confidence interval [CI], 12.2-47.0), Timed 25-Foot Walk Test decreased by 0.57 seconds (95% CI, -0.85 to -0.29), and all muscle performance outcomes improved. Patient-reported outcomes also improved immediately following intervention. There were no changes in average daily step count or trunk and pelvis kinematics.</p><p><strong>Discussion and conclusions: </strong>This proximal muscle resistance training program was feasible, with benefits in walking and muscle strength, warranting a future efficacy study.</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/A499 ).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examination of Proprioceptive Reliance During Backward Walking in Individuals With Multiple Sclerosis.","authors":"Michael VanNostrand, Patrick G Monaghan, Nora E Fritz","doi":"10.1097/NPT.0000000000000497","DOIUrl":"10.1097/NPT.0000000000000497","url":null,"abstract":"<p><strong>Background: </strong>Slowed somatosensory conduction in multiple sclerosis (MS) increases postural instability and decreases proprioception. Despite these delays, individuals with MS rely more on proprioception for balance compared to controls. This heightened reliance, combined with slowed signal transduction, increases fall risk. Backward walking (BW) increases proprioceptive reliance by reducing visual cues. However, no study has conclusively linked proprioception to BW. This study aims to assess proprioception's role in BW compared to forward walking (FW) in MS and to compare differences in proprioception between MS fallers and non-fallers.</p><p><strong>Methods: </strong>Fifty participants (average age: 50.34 ± 11.84, median Patient Determined Disease Steps [PDDS]: 2) completed the study. Participants completed BW and FW at comfortable and fast speeds. We have previously established vibration sensation as a proxy measure for proprioception. Vibration thresholds were quantified at the great toe bilaterally using a 2-alternative forced-choice procedure.</p><p><strong>Results: </strong>Significant correlations were seen for vibration sensation and FW comfortable ( ρ  = 0.35), FW fast ( ρ  = 0.34), BW comfortable ( ρ  = 0.46), and BW fast ( ρ  = 0.46). After controlling for age, sex, and PDDS, vibration sensation significantly predicted performance during all walking tasks, with larger beta coefficients seen during BW (comfortable β  = 0.57; fast β  = 0.58) compared to FW (comfortable β  = 0.41; fast β  = 0.45). Fallers performed significantly worse than non-fallers for vibration sensation ( P = 0.04).</p><p><strong>Discussion and conclusions: </strong>Considering the notable decrease in proprioception in participants with MS and the clear distinction between fallers and non-fallers, it is crucial to conduct fall risk assessments and interventions focusing on proprioception. With its heightened reliance on proprioception, BW offers a promising method for assessing fall risk and could be an effective exercise intervention.</p><p><p>Video Abstract available for more insights from the authors (see the Supplemental Digital Content available at: http://links.lww.com/JNPT/A490 ).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773868","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":"Vagus Nerve Stimulation Paired With Rehabilitation for Chronic Stroke: Characterizing Responders.","authors":"Alexa Beovich, Jessica Boose, Rachana Patel, Steven L Wolf","doi":"10.1097/NPT.0000000000000488","DOIUrl":"10.1097/NPT.0000000000000488","url":null,"abstract":"<p><strong>Background and purpose: </strong>Implantable vagus nerve stimulation (VNS) paired with volitional upper extremity rehabilitation can improve impairment and function among moderately to severely impaired, chronic stroke survivors. This study is a retrospective analysis of the in-clinic rehabilitation phase of the blinded, placebo-controlled, randomized pivotal VNS-REHAB trial to determine whether dosing parameters during in-clinic paired VNS therapy were associated with responder status and whether covariates might impact that determination.</p><p><strong>Methods: </strong>Data were limited to 53 participants in the active VNS group who had received VNS implants prior to undergoing 6 weeks of in-clinic rehabilitation paired with VNS. Tasks were standardized across all participants. Dosing parameters included number of stimulations and task time. The primary outcome was the Fugl-Meyer Upper Extremity Assessment (FMA-UE), evaluated at the end of 6 weeks (Post-1). Participants were classified a priori as responders based on an improvement of ≥6 points on the FMA-UE from baseline to Post-1.</p><p><strong>Results: </strong>Dosing parameters were not associated with FMA-UE responder status at the end of 6 weeks. Covariates including age, gender, paretic hand, baseline severity, and chronicity of stroke were also not significant associations of response.</p><p><strong>Discussion and conclusions: </strong>While responders to VNS could be defined, therapy dosing and participant attributes did not provide greater specification for association of responder status. Limitations of this study include small sample size and non-linearity of the FMA-UE. Future studies will include reassessing responder categorization using more linear scales and examining stroke lesion characteristics to determine whether these measures are more sensitive to dosing parameters.</p><p><strong>Video abstract available: </strong>for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://www.w3.org/1999/xlink ).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"217-223"},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727932","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":"Grateful for the Opportunity.","authors":"George Fulk","doi":"10.1097/NPT.0000000000000493","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000493","url":null,"abstract":"","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":"48 4","pages":"177"},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330679","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":"The Role of the Cervical Spine in Dizziness.","authors":"Julia Treleaven","doi":"10.1097/NPT.0000000000000491","DOIUrl":"10.1097/NPT.0000000000000491","url":null,"abstract":"<p><p>The neck can be implicated in dizziness via several, separate, discreet mechanisms. Proprioceptive cervicogenic dizziness (CGD) is the most common and reflects the cervical spine's important role, along with visual and vestibular input, for sensorimotor control. Impaired cervical proprioception can lead to symptoms such as dizziness, unsteadiness, visual disturbances, and altered sensorimotor control, and treatment directed toward cervical musculoskeletal and sensorimotor control is efficacious to improve this in individuals with cervical musculoskeletal disorders. Despite this, CGD is difficult to diagnose. Many people present with both neck pain and dizziness, and often the onset of both follows head and neck trauma, but neither necessarily implicate the neck as the cause of dizziness. Further, people often present with mixed forms of dizziness. Thus, rather than diagnosing CGD, it might be more important to consider the potential for the neck to have no (nil, co-morbid cervical condition) or some (minor, major, or compensatory) role in dizziness. Determining the precise role of the cervical spine role in dizziness requires a skilled interview and examination for cervical musculoskeletal and related sensorimotor impairments and relevant testing of other potential causes. A combination and cluster of test outcomes in addition to comparing responses to specific tests when the cervical afferents are stimulated and not stimulated will be important. Considering the role of the neck in dizziness will allow a balanced approach in assessment and management to allow timely, effective intervention to be provided to the large number of individuals presenting with neck pain and dizziness (Supplemental Digital Content, available at: http://links.lww.com/JNPT/A484 ).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"1-10"},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989287","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":"International Neurological Physical Therapy Association: Best Abstracts.","authors":"","doi":"10.1097/NPT.0000000000000492","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000492","url":null,"abstract":"","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":"48 4","pages":"232-233"},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136473","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":"Implementation and Clinical Outcomes of Blood Flow Restriction Training on Adults With Cerebral Palsy: A Case Series.","authors":"Christopher Joyce, Brendan Aylward, Nicholas Rolnick, Steven Lachowski","doi":"10.1097/NPT.0000000000000475","DOIUrl":"10.1097/NPT.0000000000000475","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cerebral palsy (CP) is a congenital neurological disorder that causes musculoskeletal weakness and biomechanical dysfunctions. Strength training guidelines recommend at least 70% of 1-repetition maximum to increase muscle strength and mass. However, individuals with CP may not tolerate such high exercise intensity. Blood flow restriction (BFR) can induce similar gains in strength and muscle mass using loads as low as 20% to 30% 1-repetition maximum. This case series described the safety, feasibility, and acceptability of BFR in adults with CP and examined changes in muscle mass and strength.</p><p><strong>Case description: </strong>Three male participants with gross motor function classification system level 3 CP underwent strength training using a periodized 8-week BFR protocol. Outcomes included: Safety via blood pressure during and post-BFR exercises in addition to adverse event tracking; Feasibility via number of support people and time-duration of BFR exercises; Acceptability via rate of perceived discomfort (0-10) and qualitative interviews; Muscle Mass via ultrasonographic cross-sectional area of the quadriceps and hamstring; and Strength via (1) 3-repetition maximum in the leg press and knee extension, (2) isometric knee flexor and extensor muscle force measured with a hand-held dynamometer, and (3) 30-second sit-to-stand test.</p><p><strong>Intervention: </strong>Participants replaced 2 exercises from their current regimen with seated knee extension and leg press exercises using progressively higher limb occlusion pressure and exercise intensity. Limb occlusion pressure started at 60%, by week 4 progressed to 80%, and then remained constant. The exercise repetition scheme progressed from fixed nonfailure repetition sets to failure-based repetition sets.</p><p><strong>Outcomes: </strong>Blood pressure never exceeded safety threshold, and no adverse events were reported. The BFR training was time-consuming and resource-intensive, but well-tolerated by participants (rate of perceived discomfort with a mean value of 5.8, 100% protocol adherence). Strength, as measured by 3-repetition maximum testing and 30-second sit-to-stand test, increased, but isometric muscle force and muscle mass changes were inconsistent.</p><p><strong>Discussion: </strong>Blood flow restriction may be an effective means to increase strength in adults with CP who cannot tolerate high-intensity resistance training. Future research should compare BFR to traditional strength training and investigate mediators of strength changes in this population.</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/A473 ).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"224-231"},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960465","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}