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Objective To characterise specific measures of neurologic dysfunction and recovery associated with concussion in student-athletes using the clinical examination and Cleveland Clinic Concussion application (C3 app). Design Retrospective... more
Objective To characterise specific measures of neurologic dysfunction and recovery associated with concussion in student-athletes using the clinical examination and Cleveland Clinic Concussion application (C3 app). Design Retrospective observational study Setting Tertiary sports concussion clinic Participants 181 student-athletes aged 14-20 diagnosed with concussion by a Cleveland Clinic physician were included. Interventions C3 data were collected pre-season, and at least once post-injury, along with a physician clinical examination. Individuals were stratified into two groups based on recovery time: typical <21 days (n=97) or protracted 21+ days (n=84). Outcome measures Near point convergence (NPC) and the following modules of the C3 app were administered: 1) Graded symptom checklist (GSC); 2) Standardised Assessment of Concussion (SAC); 3) Trail Making Test (TMT); 4) Simple and Choice Reaction Time; 5) Processing Speed Test (PST); 6) Biomechanical quantification of balance dur...
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OBJECTIVE: To determine patient satisfaction with the Multiple Sclerosis Performance Test (MSPT). BACKGROUND: The MSPT is an iPad-based neuroperformance assessment tool that was designed to simulate the Multiple Sclerosis Functional... more
OBJECTIVE: To determine patient satisfaction with the Multiple Sclerosis Performance Test (MSPT). BACKGROUND: The MSPT is an iPad-based neuroperformance assessment tool that was designed to simulate the Multiple Sclerosis Functional Composite (MSFC). The MSTP has the potential to provide reliable MS-specific neuroperformance data at lower cost, at more frequent intervals, in the patient’s home environment. Knowledge of patients’ opinions about the usability of the application during in-center testing can provide insight into patients’ acceptance of using this application in the home setting. DESIGN/METHODS: A usability questionnaire regarding the MSPT app was administered to 51 MS patients representing a range of MS severity and 40 age and gender-matched healthy controls (HC) who completed the cross-sectional validation phase of this app’s development. RESULTS: The majority of study participants agreed it was easy to read the applications in the iPad screen (MS=96 % agreed or strong...
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Objective To characterise neurologic impairment and recovery associated with concussion in youths and young adults using the Cleveland Clinic Concussion application (C3 app). Design Retrospective observational study Setting Concussion... more
Objective To characterise neurologic impairment and recovery associated with concussion in youths and young adults using the Cleveland Clinic Concussion application (C3 app). Design Retrospective observational study Setting Concussion clinic at an academic medical centre Participants 181 student-athletes aged 14–20 diagnosed with concussion by a Cleveland Clinic physician were included. Intervention C3 data were collected pre-season and at least once post-injury. At least one clinical examination by a physician was obtained to characterise clinical impairments. Individuals were stratified into two groups based on recovery time: typical <21 days (n=97) or protracted 21+ days (n=84). Outcome measures The following modules of the C3 app were administered across groups: 1) Graded symptom checklist (GSC); 2) Standardised Assessment of Concussion (SAC); 3) Trail Making Test; 4) Simple and Choice Reaction Time; 5) Processing Speed Test; 6) Biomechanical quantification of balance during ...
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Biomechanical measures are the gold standard in the assessment of gait in healthy and chronic disease populations. Augmented reality (AR) systems represent an opportunity to evaluate human movement under more realistic and interactive... more
Biomechanical measures are the gold standard in the assessment of gait in healthy and chronic disease populations. Augmented reality (AR) systems represent an opportunity to evaluate human movement under more realistic and interactive conditions. A barrier to integrating AR into healthcare is the unknown accuracy of systems in the quantification of human movement. This project aimed to determine the accuracy of the HoloLens relative to three-dimensional motion capture (MoCap) in quantifying gait. Ten healthy adults completed nine walking trials (n = 3 for slow, medium, and fast speed, respectively). Outcome measures included: cumulative walking distance, number of steps, step length, and speed. Statistical equivalence testing, using an a priori threshold of five percent, confirmed biomechanical measures derived from the HoloLens was equivalent to MoCap. Cumulative walking distance from the HoloLens was within 1.5–2.1% of the MoCap system for all walking speeds. Difference between systems in terms of movement accuracy was less than 3.7 cm across trials. Equivalence in outcomes makes the HoloLens appropriate for the quantification of frequently used gait variables to characterize walking performance. Future AR applications have the potential to deliver digital therapeutics to patient populations under more real-world conditions and monitor performance using objective and quantitative outcomes.
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Objective To develop and utilise a custom mobile application to provide a portable yet systematic method to characterise injury demographics, post-injury disposition, and immediate medical care of sport-related concussion in youth, high... more
Objective To develop and utilise a custom mobile application to provide a portable yet systematic method to characterise injury demographics, post-injury disposition, and immediate medical care of sport-related concussion in youth, high school and college settings. Design Retrospective observational study. Setting Academic medical centre. Participants Athletes under the care of Cleveland Clinic Concussion Centre clinicians from August 5, 2014-March 1, 2016. The sample included youth (n=110), high school (n=1175) and college (n=309) athletes; approximately 35% of the sample were female. Intervention Electronic incident reports were completed on all student-athletes with suspected concussion to triage injury severity, document injury-related demographics along with immediate medical management. Total time to complete the incident report was less than three minutes. Outcome measures Sport, mechanism of injury, red flags, immediate symptoms, and post-injury disposition were recorded for all participants. Main results Football and soccer represented the greatest frequency of injury across males and females respectively. Despite significantly fewer red flags in youth, they were sent to the emergency department four times more frequently (22%) than high school or college athletes (5%). Conclusions The systematic characterisation of injury profiles indicates athletes across the continuum of age share general characteristics in terms of incidence as a function of sport and setting (practice vs. competition). The disproportional disposition to emergency departments, despite the absence of red flags, indicates a more conservative approach to youth concussion triage compared to high school and college athletes. Competing interests None.
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Date Presented 4/18/2015 Stroke survivors in rural areas lack access to the specialized occupational therapy needed for functional gains in the upper extremity (UE). The Home Arm Assistance Progression Initiative (HAAPI) trial... more
Date Presented 4/18/2015 Stroke survivors in rural areas lack access to the specialized occupational therapy needed for functional gains in the upper extremity (UE). The Home Arm Assistance Progression Initiative (HAAPI) trial demonstrates robotic-assisted telerehabilitation as a viable means to deliver occupational therapy remotely, maintain a client-centered relationship, improve quality of life (QoL), and promote UE neuromotor recovery.
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OBJECTIVE: To examine the relationship between performance on the Processing Speed Test (PST), an iPad®-based app for measuring cognition in MS, and self-reported fatigue, employment, and cognitive status. BACKGROUND: Cognitive... more
OBJECTIVE: To examine the relationship between performance on the Processing Speed Test (PST), an iPad®-based app for measuring cognition in MS, and self-reported fatigue, employment, and cognitive status. BACKGROUND: Cognitive dysfunction occurs in >50% of MS patients but is infrequently assessed in the clinic setting. The PST app is a self-administered test of information processing speed that simulates the technician-administered Symbol Digit Modalities Test (SDMT). The purpose of this study was to examine the validity of the PST in comparison to the SDMT. DESIGN/METHODS: Self-administered PST and technician-administered SDMT scores were derived from 51 MS patients representing a range of MS severity, and 40 age and gender-matched healthy controls (HC). Test-retest reliability, concurrent validity between PST and SDMT, sensitivity in distinguishing MS from HC participants, and relationship between PST and SDMT scores and self-reports of fatigue, work status, and cognitive perf...
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Introduction A multi-domain approach to concussion assessment has been recommended that includes self-reported symptom severity in addition to neurocognitive tests and measures of postural stability. The relationship between subjective... more
Introduction A multi-domain approach to concussion assessment has been recommended that includes self-reported symptom severity in addition to neurocognitive tests and measures of postural stability. The relationship between subjective self-reported symptoms and objective measures of cognitive function in the post-injury state is not well understood. The aims of the study were to determine symptom severity throughout the post-injury continuum of care and the association between symptom severity and performance on measures of neurocognitive function. Methods An observational cohort study was conducted on 1257 high school and collegiate athletes (67% male and 33% female) who had sustained a concussion. Student-athletes were included in the study if they had a healthy baseline assessment and at least one follow-up injury assessment utilizing the Cleveland Clinic Concussion Application (C3 App). Symptom severity was assessed during the acute (0–7 days post-injury), subacute (8–20 days p...
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Parkinson’s disease is a neurodegenerative disease that has traditionally been treated with anti-parkinsonian medication. There is increasing evidence that exercise is beneficial to those with PD, therefore, it is necessary to validate a... more
Parkinson’s disease is a neurodegenerative disease that has traditionally been treated with anti-parkinsonian medication. There is increasing evidence that exercise is beneficial to those with PD, therefore, it is necessary to validate a measure of exertion that can be implemented across exercise settings that may not have the capability to actively monitor heart rate. The aim of this project was to determine the validity of the Borg RPE scale in individuals with PD undergoing a maximal progressive cycling exercise test. Thirty-eight males and females (58.5 ± 8.1 yrs) with a clinical diagnosis of idiopathic PD, Hoehn and Yahr stage II–III, completed a maximal exercise test. Heart rate was monitored continuously, with RPE being recorded during the last minute of each stage of the test. Correlation analysis was used to evaluate the relationship between RPE and continuous heart rate monitoring. A significant, positive correlation was present between RPE and heart rate and RPE and workl...
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INTRODUCTION Parkinson's disease (PD) disrupts the control and coordination of grasping forces, likely due to a disruption in basal ganglia circuitry and diminished activity within the supplementary motor area (SMA). High intensity... more
INTRODUCTION Parkinson's disease (PD) disrupts the control and coordination of grasping forces, likely due to a disruption in basal ganglia circuitry and diminished activity within the supplementary motor area (SMA). High intensity aerobic exercise has been shown to enhance connectivity between basal ganglia nuclei and cortical areas, including the SMA. The aim of this project was to determine the effects of high intensity lower extremity exercise on motor control patterns underlying a manual dexterity task. METHODS PD participants completed eight weeks of high intensity aerobic exercise under forced or voluntary exercise (FE or VE) modalities. Grasping forces for each limb were quantified during a functional bimanual dexterity task. Data were collected while OFF antiparkinsonian medication at baseline, end of treatment (EOT), and eight weeks after exercise cessation (EOT+8). RESULTS Eight weeks of high intensity exercise improved MDS-UPDRS Motor III clinical ratings by more than 4 points (~15%) for the FE and VE groups. Time to complete the task decreased nearly 30% across both groups as well. The control and coordination of grasping forces, simultaneity of force initiation, and rate of grip and load force exhibited significant improvements following exercise. In general, improvements in biomechanical outcomes were sustained following exercise cessation. CONCLUSION High intensity aerobic exercise, achieved via a forced or voluntary mode, improved PD symptoms and bimanual dexterity. Sustained improvement of upper extremity motor control following exercise cessation indicates high intensity exercise enhances CNS functioning and suggests exercise may be a candidate for altering PD progression.
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Introduction Although concussion continues to be a major source of acute and chronic injuries, concussion injury mechanisms and risk functions are ill-defined. This lack of definition has hindered efforts to develop standardized... more
Introduction Although concussion continues to be a major source of acute and chronic injuries, concussion injury mechanisms and risk functions are ill-defined. This lack of definition has hindered efforts to develop standardized concussion monitoring, safety testing, and protective countermeasures. To overcome this knowledge gap, we have developed, tested, and deployed a head impact monitoring mouthguard (IMM) system. Materials and Methods The IMM system was first calibrated in 731 laboratory tests. Versus reference, Laboratory IMM data fit a linear model, with results close to the ideal linear model of form y = x + 0, R2 = 1. Next, during on-field play involving n = 54 amateur American athletes in football and boxing, there were tens of thousands of events collected by the IMM. A total of 890 true-positive head impacts were confirmed using a combination of signal processing and National Institute of Neurological Disorders and Stroke/National Institutes of Health Common Data Element...
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Introduction Military personnel and civilian athletes are both at risk for mild traumatic brain injury. However, these groups are unique in their training and typical daily activities. A fundamental gap in the evaluation of military... more
Introduction Military personnel and civilian athletes are both at risk for mild traumatic brain injury. However, these groups are unique in their training and typical daily activities. A fundamental gap in the evaluation of military personnel following mild traumatic brain injury is the lack of military-specific normative reference data. This project aimed to determine if a separate normative sample should be used for military personnel on their performance of the Cleveland Clinic Concussion application and a recently developed dual-task module. Methods Data were collected from healthy military personnel (n = 305) and civilians (n = 281) 18 to 30 years of age. Participants completed the following assessments: simple and choice reaction time, Trail Making tests A&B, processing speed test, single-task postural stability, single-task cognitive assessment, and dual-task assessment. Results Civilian participants outperformed military service members on all cognitive tasks under single- a...
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Background: Parkinson’s disease (PD) results in a global decrease in information processing, ultimately resulting in dysfunction executing motor-cognitive tasks. Motor-cognitive impairments contribute to postural instability, often... more
Background: Parkinson’s disease (PD) results in a global decrease in information processing, ultimately resulting in dysfunction executing motor-cognitive tasks. Motor-cognitive impairments contribute to postural instability, often leading to falls and decreased physical activity. The aim of this study was to determine the effects of a multimodal training (MMT) versus single-modal (SMT) training on motor symptoms, fall frequency, and physical activity in patients with PD classified as fallers. Methods: Individuals with PD were randomized into SMT (n = 11) or MMT (n = 10) and completed training 3 times per week for 8 weeks. The SMT completed gait and cognitive training separately, whereas MMT completed gait and cognitive training simultaneously during each 45-minute session. Physical activity, 30-day fall frequency, and PD motor symptoms were assessed at baseline, posttreatment, and during a 4-week follow-up. Results: Both groups exhibited significant (P < .05) improvements in cli...
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Background: In order to provide patient center care, our multiple sclerosis (MS) clinic assesses patient concerns before clinical encounters, first by asking the optional qualitative question “What is the most important thing you what... more
Background: In order to provide patient center care, our multiple sclerosis (MS) clinic assesses patient concerns before clinical encounters, first by asking the optional qualitative question “What is the most important thing you what your health-care provider to know today” (most important concern of the patient [MIPC]) and then completing quantitative patient-reported outcome measures (PROMs) including Quality of Life in Neurological Disorders (Neuro-QoL). Both sets of questions are designed to facilitate encounters that address patients’ values and preferences. Objective: Determine whether the qualitative MIPC responses provided unique information not included in PROMs or clinical assessments. Methods: We randomly selected 400 first-time MIPC responders and 400 first-time MIPC nonresponders from 2788 participants in our database. We categorized MIPC responses by content and number of unique concerns and appended them to the Neuro-QoL framework. Nonresponders were compared to thos...
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Background/Aims: Traditionally, physical therapy for gait and balance training takes place in a gym setting, which may not fully reproduce situations in everyday activities. The Computer Assisted Rehabilitation ENvironment system provides... more
Background/Aims: Traditionally, physical therapy for gait and balance training takes place in a gym setting, which may not fully reproduce situations in everyday activities. The Computer Assisted Rehabilitation ENvironment system provides an immersive virtual environment, allowing a simulation of complex conditions conducive to gait and balance training. The purpose of this study was to determine: (1) the feasibility and safety of using the Computer Assisted Rehabilitation ENvironment system for physical therapy sessions with multiple sclerosis patients, and (2) pre-post treatment changes observed with the Computer Assisted Rehabilitation ENvironment system compared to traditional physical therapy. Findings: Data from functional outcome measures Berg Balance Scale, Timed Up and Go test, Timed 25-Foot Walk, and 6-Minute Walk Test were extracted from the medical records of 62 patients with multiple sclerosis who had at least three physical therapy sessions in either environment. Stati...
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Emerging literature indicates aerobic exercise improves the motor symptoms associated with Parkinson's disease (PD). However, the impact of aerobic exercise on functional locomotor performance has not been evaluated systematically.... more
Emerging literature indicates aerobic exercise improves the motor symptoms associated with Parkinson's disease (PD). However, the impact of aerobic exercise on functional locomotor performance has not been evaluated systematically. The aim of this project was to determine the impact of an 8-week high intensity aerobic exercise intervention on Timed Up and Go (TUG) performance in PD. Fifty-nine participants with idiopathic PD completed 24 aerobic exercise sessions over 8 weeks. Two modes of exercise were utilized: forced (FE) and voluntary (VE). A mobile application was used to gather biomechanical data for the characterization of the TUG subtasks: Sit-Stand, Gait, Turning, and Stand-Sit. Participants were assessed in an off medication state at: 1) baseline, prior to any exercise intervention, and 2) after completion of exercise treatment. At baseline, the VE group completed the TUG in 9.41 s, while the FE group completed the TUG significantly faster in 8.0 s. Following the exercise intervention, the VE group decreased TUG time to 8.9 s (p < .01). Both exercise groups demonstrated significant improvements in Turning Velocity, time of Gait phase and Stand-Sit duration. Overall mobility in participants with PD was significantly improved after high intensity aerobic exercise training. Improvements in turning and gait speed, and in Stand-Sit times indicate exercise is effective in improving functional aspects of mobility that are often associated with falls and quality of life measures. These results support the use of high intensity aerobic exercise for improvements in functional lower extremity performance in a PD population.
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The acute and long-term effects of concussive and subconcussive head impacts on brain health have gained tremendous attention over the past five years. The treatment and management of concussion involves multiple providers from multiple... more
The acute and long-term effects of concussive and subconcussive head impacts on brain health have gained tremendous attention over the past five years. The treatment and management of concussion involves multiple providers from multiple disciplines and backgrounds. Varied backgrounds and approaches to assessing cognitive and motor function before and post-concussion are limiting factors in the efficient and effective management of concussion as discipline-specific rating scales and assessments serve as a barrier to effective patient hand-offs between providers. Combining principles of motor behavior with biomechanical approaches to data analysis has the potential to improve the continuity of care across the multiple providers managing athletes with concussion. Biomechanical measures have been developed and validated using mobile devices to provide objective and quantitative assessments of information processing, working memory, set switching, and postural stability. These biomechani...
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OBJECTIVE. To understand how two types of aerobic exercise affect upper-extremity motor recovery post-stroke. Our aims were to (1) evaluate the feasibility of having people who had a stroke complete an aerobic exercise intervention and... more
OBJECTIVE. To understand how two types of aerobic exercise affect upper-extremity motor recovery post-stroke. Our aims were to (1) evaluate the feasibility of having people who had a stroke complete an aerobic exercise intervention and (2) determine whether forced or voluntary exercise differentially facilitates upper-extremity recovery when paired with task practice. METHOD. Seventeen participants with chronic stroke completed twenty-four 90-min sessions over 8 wk. Aerobic exercise was immediately followed by task practice. Participants were randomized to forced or voluntary aerobic exercise groups or to task practice only. RESULTS. Improvement on the Fugl-Meyer Assessment exceeded the minimal clinically important difference: 12.3, 4.8, and 4.4 for the forced exercise, voluntary exercise, and repetitive task practice–only groups, respectively. Only the forced exercise group exhibited a statistically significant improvement. CONCLUSION. People with chronic stroke can safely complete...
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Augmented reality (AR) may be a useful tool for the delivery of dual-task training. This manuscript details the development of the Dual-task Augmented Reality Treatment (DART) platform for individuals with Parkinson’s disease (PD) and... more
Augmented reality (AR) may be a useful tool for the delivery of dual-task training. This manuscript details the development of the Dual-task Augmented Reality Treatment (DART) platform for individuals with Parkinson’s disease (PD) and reports initial feasibility, usability, and efficacy of the DART platform in provoking dual-task interference in individuals with PD. The DART platform utilizes the head-mounted Microsoft HoloLens2 AR device to deliver concurrent motor and cognitive tasks. Biomechanical metrics of gait and cognitive responses are automatically computed and provided to the supervising clinician. To assess feasibility, individuals with PD (N = 48) completed a bout of single-task and dual-task walking using the DART platform. Usability was assessed by the System Usability Scale (SUS). Dual-task interference was assessed by comparing single-task walking and walking during an obstacle course while performing a cognitive task. Average gait velocity decreased from 1.06 to 0.8...
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BACKGROUND Globally, postural stability and cognitive performance are intimately linked in Parkinson's disease (PD). However, a fundamental gap exists in understanding the precise relationship between a disruption in executive... more
BACKGROUND Globally, postural stability and cognitive performance are intimately linked in Parkinson's disease (PD). However, a fundamental gap exists in understanding the precise relationship between a disruption in executive function and its impact on postural stability. OBJECTIVE This project aimed to determine the precise effects of cognitive errors on postural stability under dual-task conditions in participants with PD and controls. METHODS Twenty-eight individuals with PD and 27 healthy controls completed a series of postural stability tests under single- and dual-tasks. The dual-task required maintenance of balance while performing an audio number discrimination task. RESULTS In general, postural stability in PD and control subjects was similar across single-task conditions. In controls, an error in the cognitive task during dual-task conditions did not impact measures of postural sway. In contrast, in PD, postural sway increased in epochs surrounding cognitive errors relative to epochs without errors. CONCLUSIONS Postural task selection plays a critical role when testing for balance deficits in PD compared to healthy controls. Furthermore, time synchronized analysis of cognitive and balance data revealed the greatest episodes of postural instabilities occurred around cognitive errors. The measurement and evaluation of cognitive-motor linkages, relative to postural stability, could provide a patient-specific fingerprint of balance function and provide more sensitive measures for fall risk in PD.
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Introduction: Aerobic exercise (AE) has been shown to improve cardiovascular health in individuals with stroke; however, the potential role of AE in enhancing neuroplasticity after stroke has not been systematically studied. We have... more
Introduction: Aerobic exercise (AE) has been shown to improve cardiovascular health in individuals with stroke; however, the potential role of AE in enhancing neuroplasticity after stroke has not been systematically studied. We have implemented a forced exercise (FE) cycling intervention, initially developed for individuals with Parkinson’s disease, with a cohort of individuals with chronic stroke. We hypothesize that intensive AE training, when paired with repetitive task practice (RTP), will “prime” the central nervous system, to exploit the motor learning effects of task practice. Hypothesis: Individuals who perform FE followed by RTP will demonstrate greater improvements in motor and non-motor function compared to the voluntary rate aerobic exercise (VE) + RTP and RTP only groups. Individuals in both AE groups (FE and VE) will demonstrate greater improvements in VO2peak compared to the RTP only group. Methods: Fifteen individuals 6-12 months post-stroke were enrolled into one of...
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ABSTRACT Non-human primate models are extensively being used to study and understand biomechanical mechanisms of various neuro-motor pathological conditions such as Parkinson’s disease. However, collecting full body 3D kinematics using... more
ABSTRACT Non-human primate models are extensively being used to study and understand biomechanical mechanisms of various neuro-motor pathological conditions such as Parkinson’s disease. However, collecting full body 3D kinematics using current technologies for obtaining reliable objective biomechanical measures to precisely characterize gait mechanics in non-cooperating primates is laborious and daunting task. We developed a method to reduce data collection and analyses time by using retro-reflective paint, a mixture of reflective powder and petroleum jelly that was applied directly on the primate’s skin. 3D kinematic data from three treadmill walking female rhesus primates (one normal and two MPTP treated) was collected using a four infrared camera system. Bilateral joint angle trajectories of hip, knee, ankle, shoulder and elbow for normal primate show 180 degrees out of phase. Step cycle duration and percentage stance are significantly different between the normal (F(9,62)=128.2) and MPTP (F(9,62)=143.1) treated primates. Step cycle duration between forelimb and hindlimb is not significantly different in all primates. However, percentage stance in less affected limbs of both MPTP treated primates is significantly higher in forelimb than hindlimb. Gait pattern of normal primate is diagonal symmetrical gait, one MPTP treated primate showed lateral symmetrical gait and other showed a non-standard gait pattern.
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Over the past two decades, aerobic exercise has emerged as a mainstream recommendation to aid in treating Parkinson’s disease (PD). Despite the acknowledgement of the benefits of exercise for people with PD (PwPD), frequently, exercise... more
Over the past two decades, aerobic exercise has emerged as a mainstream recommendation to aid in treating Parkinson’s disease (PD). Despite the acknowledgement of the benefits of exercise for people with PD (PwPD), frequently, exercise recommendations lack specificity in terms of frequency, intensity and duration. Additionally, conflating physical activity with exercise has contributed to providing vague exercise recommendations to PwPD. Therefore, the beneficial effects of exercise may not be fully realized in PwPD. Data provided by animal studies and select human trials indicate aerobic exercise may facilitate structural and functional changes in the brain. Recently, several large human clinical trials have been completed and collectively support the use of aerobic exercise, specifically high-intensity aerobic exercise, in improving PD motor symptoms. Data from these and other studies provide the basis to include aerobic exercise as an integral component in treating PD. Based on p...
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Bilateral subthalamic stimulation impairs cognitive^motor performance in Parkinson’s
Introduction. To overcome travel restrictions during the COVID-19 pandemic, consumer-based technology was rapidly deployed to the smartphones of individuals with Parkinson’s disease (PD) participating in a 12-month exercise trial. The aim... more
Introduction. To overcome travel restrictions during the COVID-19 pandemic, consumer-based technology was rapidly deployed to the smartphones of individuals with Parkinson’s disease (PD) participating in a 12-month exercise trial. The aim of the project was to determine the feasibility of utilizing a combined synchronous and asynchronous self-administered smartphone application to characterize PD symptoms. Methods. A synchronous video virtual visit was completed for the administration of virtual Movement Disorder Society-Unified Parkinson’s Disease Rating Scale III (vMDS-UPDRS III). Participants asynchronously completed a mobile application consisting of a measure of upper extremity bradykinesia (Finger Tapping Test) and information processing. Results. Twenty-three individuals completed the assessments. The mean vMDS-UPDRS III was 23.65 ± 8.56 points. On average, the number of taps was significantly greater for the less affected limb, 97.96 ± 17.77 taps, compared to the more affect...
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http://ptjournal.apta.org/content/90/4/493 found online at: The online version of this article, along with updated information and services, can be Collections Work and Community Reintegration Stroke (Neurology) Stroke (Geriatrics)... more
http://ptjournal.apta.org/content/90/4/493 found online at: The online version of this article, along with updated information and services, can be Collections Work and Community Reintegration Stroke (Neurology) Stroke (Geriatrics) Self-Care and Home Management Randomized Controlled Trials Injuries and Conditions: Hand Adaptive/Assistive Devices in the following collection(s): This article, along with others on similar topics, appears
Objective Collect head impact dose data in young athletes, using an instrumented mouthguard validated per NFL specification. Compare theses doses with published concussive head impact data. Design Prospective, cross-sectional Setting... more
Objective Collect head impact dose data in young athletes, using an instrumented mouthguard validated per NFL specification. Compare theses doses with published concussive head impact data. Design Prospective, cross-sectional Setting Calibrate an instrumented mouthguard head impact dosimeter in laboratory on Hybrid III (HIII) dummy. Collect young athlete non-concussive head impacts on playing field using this dosimeter. Compare these doses to published concussion doses from adult American footballers. Participants Young American footballers and boxers, n=12, ages 10–21. IRB #13–899. Assessment of risk factors Single head impact doses, signs/symptoms of concussion. Outcome measures National Football League (NFL) validity specifications for laboratory testing, head kinematics, presence/absence of concussion. Main results 177 non-concussive head impact doses were identified. Apparent overlap between non-concussive mouthguard doses and published concussion helmet doses from Rowson et al...
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Background: The accumulation of subconcussive impacts has been implicated in permanent neurological impairment. A gap in understanding the relationship between head impacts and neurological function is the lack of precise characterization... more
Background: The accumulation of subconcussive impacts has been implicated in permanent neurological impairment. A gap in understanding the relationship between head impacts and neurological function is the lack of precise characterization and quantification of forces that individuals experience during sports training and competition. Purpose: To characterize impact exposure during training and competition among male and female athletes participating in boxing and mixed martial arts (MMA) via an instrumented custom-fit Impact Monitoring Mouthguard (IMM). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty-three athletes (n = 4 women) were provided a custom-fit IMM. The IMM monitored impacts during sparring and competition. All training and competition sessions were videotaped. Video and IMM data were synchronized for post hoc data verification of true positives and substantiation of impact location. IMM data were collected from boxing and MMA athletes at a coll...
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Objective: To study performance characteristics of sleep apnea screening instruments for predicting the respiratory event index (REI) in former professional athletes Background: Prevalence of obstructive sleep apnea (OSA) in the general... more
Objective: To study performance characteristics of sleep apnea screening instruments for predicting the respiratory event index (REI) in former professional athletes Background: Prevalence of obstructive sleep apnea (OSA) in the general population is influenced independently by age, sex and BMI. The influence of BMI on performance characteristics of screening instruments in professional male athletes is unknown Design/Methods: STOPBANG and home sleep apnea tests (HSAT) were performed in former professional male athletes. Spearman correlation evaluated relationships between REI and STOP, STOPBANG, STOPBAG and STOPBAG 2 (continuous variable for BMI/age; Katzan, 2016) scores. Comparison of scores between REI groups (cutoffs 5, 15, 30) was performed by Wilcoxon sum rank test and Chi-square test on prevalence of elevated STOP≥2, STOPBANG≥3, STOPBAG≥2 and STOPBAG 2 ≥0.395. Logistic regression and ROC analysis investigated optimal cutoffs for REI groups. Results: Among 68 subjects (age 37....
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L'invention porte sur un systeme et sur un procede destines a mener une stimulation de regions anatomiques afin de traiter un trouble neuromoteur, neurocognitif ou neuromoteur et neurocognitif, au moyen de laquelle stimulation on... more
L'invention porte sur un systeme et sur un procede destines a mener une stimulation de regions anatomiques afin de traiter un trouble neuromoteur, neurocognitif ou neuromoteur et neurocognitif, au moyen de laquelle stimulation on stimule les regions motrices, tout en minimisant les fuites de courant vers les regions non motrices. On peut selectionner les parametres de stimulation sur la base de tests de fonctions motrices, de tests de fonctions cognitives, et de tests d'une combinaison de fonctions motrices et cognitives.
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Parkinson's disease (PD) adversely affects information processing and motor performance. The impact of aerobic exercise on modifying the deleterious effects of PD underlying information and motor control processes is not well... more
Parkinson's disease (PD) adversely affects information processing and motor performance. The impact of aerobic exercise on modifying the deleterious effects of PD underlying information and motor control processes is not well established. The primary aim of this project was to determine the effects of an 8-week high intensity exercise intervention on information processing and movement execution in individuals with PD. A secondary aim sought to understand the effects of antiparkinsonian medication relative to exercise on motor control processes. Data were collected at baseline (on- and off-medication) and upon completion of the exercise intervention (off-medication). Information processing and motor execution were evaluated via simple and choice reaction time paradigms (SRT and CRT) performed on a mobile device. Neither exercise nor medication impacted information processing or movement execution under the SRT paradigm. However, under CRT, exercise improved movement execution and information processing: total time was significantly reduced from 814 to 747 ms (p < 0.001), reaction time improved from 543 to 502 ms (p < 0.001), movement time improved from 270 to 246 ms (p = 0.01), and movement velocity improved from 28 cm/sec to 30 cm/sec (p = 0.01). Improvements in total time and reaction time in the CRT paradigm persisted 4 and 8 weeks following exercise cessation. Antiparkinsonian medication improved motor execution, but not information processing. The improvement in information processing following aerobic exercise, but not levodopa administration, suggests high intensity exercise may be enhancing neural processing and non-motor pathways outside those impacted by medication. The persistence of symptom improvement despite exercise intervention cessation indicates exercise is a candidate for disease modification. Trial registration: The trial was first registered at ClinicalTrials.gov on 7/10/2012 under registration number NCT01636297.