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P2.067 Tandem gait performance in Parkinson's disease patients reveals a distinct variability
S60
Poster Session II
P2.065 Falls prevention in frail cognitively impaired elderly: design of a single blinded randomized controlled trial
P2.067 Tandem gait performance in Parkinson’s disease patients reveals a distinct variability
M.C. Faes1° , M.F. Reelick1 , R.A.J. Esselink2 , J.G.W.M. Joosten1,3 , Y. Schoon1 , N. van Schuylenborgh1,4 , M.G.M. Olde Rikkert1 Nijmegen, The Netherlands
A. Fleiner° , M.H. Strothjohann, D. Djundja, G.A. Fuchs Wolfach, Germany
Background and Aims: Frail cognitively impaired elderly living in the community are at risk for accidental falls. So far no secondary prevention program proved efficacy in these patients. Aim of this paper is to present the design of a trial evaluating a complex multifactorial falls prevention program for frail cognitively impaired elderly living in the community and their informal caregivers. Methods: A two-group single blinded randomized controlled trial was developed to evaluate the intervention. Frail community dwelling elders of 70 years and over, referred to the geriatric falls clinic, and who have an informal caregiver fulfilling the criteria (visit the patient once a week and willing to practice with the patient twice a week) were eligible. Dyads of patients and informal caregivers were measured at baseline and subsequently randomly allocated to the intervention or to the control group (no treatment). The intervention comprises ten sessions (2 sessions per week) of 2 hours each and a booster session at 3 months after intervention. The primary outcome measures are falls incidence rate, fear of falling and mental well-being. Secondary outcome measures are fall risk, quality of life, fear related to balance, depression, general anxiety and functional performance in activities of daily living. Secondary outcomes measures of the informal caregiver are depression and burden. Cost-effectiveness analysis will be carried out alongside the evaluation of the clinical results. Follow-up measurements will be collected directly after the intervention, and at 3 and 6 months after randomization. Process parameters will be measured to evaluate the intervention. P2.066 Development of a complex multifactorial falls prevention program for frail cognitively impaired elderly and their informal caregivers M.C. Faes° , M.F. Reelick, R.A.J. Esselink, J.G.W.M. Joosten, Y. Schoon, N. van Schuylenborgh, M.G.M. Olde Rikkert Nijmegen, The Netherlands Background and Aims: Frail cognitively impaired elderly are at risk for accidental falls with far reaching consequences. Aim of this paper is to describe the development of a complex multifactorial falls prevention program for frail elderly and their informal caregivers living in the community. Methods: The first three Phases of the Medical Research Council (MRC) framework for the development and evaluation of complex interventions for randomized control trials (RCT) were used to design the intervention. The Preclinical Phase included a review of the literature relating to accidental falls, fear of falling and falls prevention in frail elderly and the consequences and impact of falls on informal caregivers. In Phase 1 the theoretical background and the qualitative data from two focus groups and two Delphi surveys were combined to define the main components of the intervention. In Phase 2 a pilot study was conducted amongst four frail elders with their informal caregivers. Results: As a result of the Preclinical Phase and Phase 1, key-concepts of the intervention were identified. They are: 1 ten group sessions of physical training with cognitive behavioural elements; 2. addressing dyads of patients and informal caregivers; 3. support for caregivers; 4. applicability of training in daily life; 5. booster session after three months. The preliminary intervention was implemented in Phase 2. Findings from this phase allow further modeling of the intervention. Conclusions: The MRC framework yields an efficient methodology to develop complex multifactorial falls prevention interventions in frail cognitively impaired elderly and their informal caregivers.
Introduction: Tandem gait performance in Parkinson’s Disease (PD) patients is known to reflect balance impairment as a frequently encountered problem. Balance impairment leads to recurrent falls, which are a disabling feature. Objective: To assess Tandem gait performance in patients with PD according to Hoehn and Yahr (H&Y) stages. Methods: UPDRS motor score and Tandem gait performance (8 consecutive tandem steps) were assessed in 75 PD patients (42 men, 33 women, mean age 70.6, range 46−88), H&Y stages II: 5; II−III: 19; III: 24; III−IV: 13; IV: 14. Results: Not as a surprise the mean UPDRS motor score (MUPS) increased according to H&Y stage, reflecting the disease’s progress: Total: N = 75; MUPS = 37,866±12,031. Mean Tandem steps (MTS) decreases according to H&Y stages: Total: N = 75; MTS: 4,053±3,448. Mean values of Tandem gait performance decreased almost linearly, but with marked interindividual differences and with considerable interindividual variation in range. A distinct decrease while reaching H&Y III stage was not detected, and the range was the broadest. Conclusions: During the disease progress mean Tandem gait performance in Parkinson’s Disease patients decreases, but with wide individual variability. No clear cut step was detected clearly defining H&Y stage III, and no absolute values were associated with the H&Y stage III, the decrease instead seems linear. Other factors, maybe subtypes of PD yet to be detected, may play a role in the variability of stance and gait.
P2.068 The influence of stabilo-training on restoration of pose control and cognition in brain-injury patients L.A. Zhavoronkova, O.A. Maksakova, I.S. Flerov° Moscow, Russia Outcomes of sustained unconscious states after severe brain injury appear as stable disorder of motor and cognitive functions. Recovery then require special set of rehabilitation measures. Stabilography (SG) used as stabilotraining with biofeedback (ST) facilitates functional restoration. Research purpose was estimation of treatment response and detection of restoration features when stabilo-training was used as part of rehabilitation program. We examined 34 patients surviving severe brain injury who underwent early rehabilitation treatment (under 6 months after injury). 19 of them received ST as part of rehabilitation program yet 15 others had not. Stabilograph with biofeedback and special programmed set of tasks (“MBNBiomechanica”, Russia) was used for estimation and improvement of pose control. ST courses consisted of 8−12 sessions. Realization of several static and dynamic tasks was accompanied with quantitative assessment. All patients passed SG and EEG before and after rehabilitation course as well as neurological examination and rehabilitation scaling (Functional Independence Measure and Mayo-Portland Adaptability Inventory). Stabilography data were compared with ones of control group (18 healthy volunteers). Analysis of results demonstrated positive effect of ST application to rehabilitation program. It facilitated not only pose control restoration, but disordered cognition too, including memory in patients with posttraumatic amnesia. Cognitive improvement correlated with SG indices of “opened eyes”-test whereas motor function improved with SG indices of “closed eyes”-test. Nonlinear changing of stabilographic parameters in both tests was shown. This may indicate different dynamics of movement and cognitive restoration. ST may operate as multimodal integrator of brain activity thus elevating efficiency of rehabilitation.
Poster Session II
P2.065 Falls prevention in frail cognitively impaired elderly: design of a single blinded randomized controlled trial
P2.067 Tandem gait performance in Parkinson’s disease patients reveals a distinct variability
M.C. Faes1° , M.F. Reelick1 , R.A.J. Esselink2 , J.G.W.M. Joosten1,3 , Y. Schoon1 , N. van Schuylenborgh1,4 , M.G.M. Olde Rikkert1 Nijmegen, The Netherlands
A. Fleiner° , M.H. Strothjohann, D. Djundja, G.A. Fuchs Wolfach, Germany
Background and Aims: Frail cognitively impaired elderly living in the community are at risk for accidental falls. So far no secondary prevention program proved efficacy in these patients. Aim of this paper is to present the design of a trial evaluating a complex multifactorial falls prevention program for frail cognitively impaired elderly living in the community and their informal caregivers. Methods: A two-group single blinded randomized controlled trial was developed to evaluate the intervention. Frail community dwelling elders of 70 years and over, referred to the geriatric falls clinic, and who have an informal caregiver fulfilling the criteria (visit the patient once a week and willing to practice with the patient twice a week) were eligible. Dyads of patients and informal caregivers were measured at baseline and subsequently randomly allocated to the intervention or to the control group (no treatment). The intervention comprises ten sessions (2 sessions per week) of 2 hours each and a booster session at 3 months after intervention. The primary outcome measures are falls incidence rate, fear of falling and mental well-being. Secondary outcome measures are fall risk, quality of life, fear related to balance, depression, general anxiety and functional performance in activities of daily living. Secondary outcomes measures of the informal caregiver are depression and burden. Cost-effectiveness analysis will be carried out alongside the evaluation of the clinical results. Follow-up measurements will be collected directly after the intervention, and at 3 and 6 months after randomization. Process parameters will be measured to evaluate the intervention. P2.066 Development of a complex multifactorial falls prevention program for frail cognitively impaired elderly and their informal caregivers M.C. Faes° , M.F. Reelick, R.A.J. Esselink, J.G.W.M. Joosten, Y. Schoon, N. van Schuylenborgh, M.G.M. Olde Rikkert Nijmegen, The Netherlands Background and Aims: Frail cognitively impaired elderly are at risk for accidental falls with far reaching consequences. Aim of this paper is to describe the development of a complex multifactorial falls prevention program for frail elderly and their informal caregivers living in the community. Methods: The first three Phases of the Medical Research Council (MRC) framework for the development and evaluation of complex interventions for randomized control trials (RCT) were used to design the intervention. The Preclinical Phase included a review of the literature relating to accidental falls, fear of falling and falls prevention in frail elderly and the consequences and impact of falls on informal caregivers. In Phase 1 the theoretical background and the qualitative data from two focus groups and two Delphi surveys were combined to define the main components of the intervention. In Phase 2 a pilot study was conducted amongst four frail elders with their informal caregivers. Results: As a result of the Preclinical Phase and Phase 1, key-concepts of the intervention were identified. They are: 1 ten group sessions of physical training with cognitive behavioural elements; 2. addressing dyads of patients and informal caregivers; 3. support for caregivers; 4. applicability of training in daily life; 5. booster session after three months. The preliminary intervention was implemented in Phase 2. Findings from this phase allow further modeling of the intervention. Conclusions: The MRC framework yields an efficient methodology to develop complex multifactorial falls prevention interventions in frail cognitively impaired elderly and their informal caregivers.
Introduction: Tandem gait performance in Parkinson’s Disease (PD) patients is known to reflect balance impairment as a frequently encountered problem. Balance impairment leads to recurrent falls, which are a disabling feature. Objective: To assess Tandem gait performance in patients with PD according to Hoehn and Yahr (H&Y) stages. Methods: UPDRS motor score and Tandem gait performance (8 consecutive tandem steps) were assessed in 75 PD patients (42 men, 33 women, mean age 70.6, range 46−88), H&Y stages II: 5; II−III: 19; III: 24; III−IV: 13; IV: 14. Results: Not as a surprise the mean UPDRS motor score (MUPS) increased according to H&Y stage, reflecting the disease’s progress: Total: N = 75; MUPS = 37,866±12,031. Mean Tandem steps (MTS) decreases according to H&Y stages: Total: N = 75; MTS: 4,053±3,448. Mean values of Tandem gait performance decreased almost linearly, but with marked interindividual differences and with considerable interindividual variation in range. A distinct decrease while reaching H&Y III stage was not detected, and the range was the broadest. Conclusions: During the disease progress mean Tandem gait performance in Parkinson’s Disease patients decreases, but with wide individual variability. No clear cut step was detected clearly defining H&Y stage III, and no absolute values were associated with the H&Y stage III, the decrease instead seems linear. Other factors, maybe subtypes of PD yet to be detected, may play a role in the variability of stance and gait.
P2.068 The influence of stabilo-training on restoration of pose control and cognition in brain-injury patients L.A. Zhavoronkova, O.A. Maksakova, I.S. Flerov° Moscow, Russia Outcomes of sustained unconscious states after severe brain injury appear as stable disorder of motor and cognitive functions. Recovery then require special set of rehabilitation measures. Stabilography (SG) used as stabilotraining with biofeedback (ST) facilitates functional restoration. Research purpose was estimation of treatment response and detection of restoration features when stabilo-training was used as part of rehabilitation program. We examined 34 patients surviving severe brain injury who underwent early rehabilitation treatment (under 6 months after injury). 19 of them received ST as part of rehabilitation program yet 15 others had not. Stabilograph with biofeedback and special programmed set of tasks (“MBNBiomechanica”, Russia) was used for estimation and improvement of pose control. ST courses consisted of 8−12 sessions. Realization of several static and dynamic tasks was accompanied with quantitative assessment. All patients passed SG and EEG before and after rehabilitation course as well as neurological examination and rehabilitation scaling (Functional Independence Measure and Mayo-Portland Adaptability Inventory). Stabilography data were compared with ones of control group (18 healthy volunteers). Analysis of results demonstrated positive effect of ST application to rehabilitation program. It facilitated not only pose control restoration, but disordered cognition too, including memory in patients with posttraumatic amnesia. Cognitive improvement correlated with SG indices of “opened eyes”-test whereas motor function improved with SG indices of “closed eyes”-test. Nonlinear changing of stabilographic parameters in both tests was shown. This may indicate different dynamics of movement and cognitive restoration. ST may operate as multimodal integrator of brain activity thus elevating efficiency of rehabilitation.