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Surasa Khongprasert - One of the best experts on this subject based on the ideXlab platform.
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109 Thai Traditional Game-Based Exercise for Gait and Balance of People with Parkinson's Disease
Age and Ageing, 2019Co-Authors: Surasa KhongprasertAbstract:Abstract Falls and recurrent falls are serious complications for people with PD. Poor standing balance, Impaired Ambulation, Impaired lower-limb motor planning, postural instability and falling in previous year are associated with falling in PD. Exercise based computer game (Exergaming) have been used for motor rehabilitation to promote gait and balance and can encourage therapeutic activity. However, many commercially available games are not affordable for some people with Parkinson ’s disease. The aim of this study was to evaluate the effectiveness of Thai Traditional game (TTG) based exercise on gait and balance in people with Parkinson ’s disease. A total of 22 participants with PD (mild –moderate severity) were randomly assigned to either a TTG group or a control group. Participants in TTG completed 1 hour, 3 sessions a week for 10 weeks. The TTG comprises 10 games involved instruction in sit to standing, slow and fast walking speed, turning, weight shifting, reaching, obstacle stepping, cognition, clapping and singing. Gait and balance were assessed before and after the training sessions. Measures included the Berg Balance Scale (BBS), Balance platform, Timed Up and Go (TUG) and The GaitRite walkway. Participants in TTG groups showed significantly improved BBS, TUG, gait velocity and sagittal mean sway with eyes open (p <0.05). Thai Traditional Game based exercise incorporated therapeutic movement could lead improvement in gait and balance and participants seem to enjoy playing as an activity while maintaining their functionality. Future studies should incorporate larger groups and focus on long-term compliance and follow-up.
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163 Thai Traditional Game-Based Exercise for Gait and Balance of People with Parkinson's Disease
Age and Ageing, 2019Co-Authors: Surasa Khongprasert, Keerati SooksaiAbstract:Abstract Falls and recurrent falls are serious complications for people with PD. Poor standing balance, Impaired Ambulation, Impaired lower-limb motor planning, postural instability and falling in previous year are associated with falling in PD. Exercise based computer game (Exergaming) have been used for motor rehabilitation to promote gait and balance and can encourage therapeutic activity. However, many commercially available games are not affordable for some people with Parkinson’s Disease. The aim of this study was to evaluate the effectiveness of Thai Traditional game (TTG) based exercise on gait and balance in people with Parkinson’s Disease. A total of 22 participants with PD (mild –moderate severity) were randomly assigned to either a TTG group or a control group. Participants in TTG completed 1 hour, 3 sessions a week for 10 weeks. The TTG comprises 10 games involved instruction in sit to standing, slow and fast walking speed, turning, weight shifting, reaching, obstacle stepping, cognition, clapping and singing. Gait and balance were assessed before and after the training sessions. Measures included the Berg Balance Scale (BBS), Balance platform, Timed Up and Go (TUG) and The GaitRite walkway. Participants in TTG groups showed significantly improved BBS, TUG, gait velocity and sagittal mean sway with eyes open (p <0.05). Thai Traditional Game based exercise incorporated therapeutic movement could lead improvement in gait and balance and participants seem to enjoy playing as an activity while maintaining their functionality. Future studies should incorporate larger groups and focus on long-term compliance and follow-up.
Keerati Sooksai - One of the best experts on this subject based on the ideXlab platform.
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163 Thai Traditional Game-Based Exercise for Gait and Balance of People with Parkinson's Disease
Age and Ageing, 2019Co-Authors: Surasa Khongprasert, Keerati SooksaiAbstract:Abstract Falls and recurrent falls are serious complications for people with PD. Poor standing balance, Impaired Ambulation, Impaired lower-limb motor planning, postural instability and falling in previous year are associated with falling in PD. Exercise based computer game (Exergaming) have been used for motor rehabilitation to promote gait and balance and can encourage therapeutic activity. However, many commercially available games are not affordable for some people with Parkinson’s Disease. The aim of this study was to evaluate the effectiveness of Thai Traditional game (TTG) based exercise on gait and balance in people with Parkinson’s Disease. A total of 22 participants with PD (mild –moderate severity) were randomly assigned to either a TTG group or a control group. Participants in TTG completed 1 hour, 3 sessions a week for 10 weeks. The TTG comprises 10 games involved instruction in sit to standing, slow and fast walking speed, turning, weight shifting, reaching, obstacle stepping, cognition, clapping and singing. Gait and balance were assessed before and after the training sessions. Measures included the Berg Balance Scale (BBS), Balance platform, Timed Up and Go (TUG) and The GaitRite walkway. Participants in TTG groups showed significantly improved BBS, TUG, gait velocity and sagittal mean sway with eyes open (p <0.05). Thai Traditional Game based exercise incorporated therapeutic movement could lead improvement in gait and balance and participants seem to enjoy playing as an activity while maintaining their functionality. Future studies should incorporate larger groups and focus on long-term compliance and follow-up.
Armin Curt - One of the best experts on this subject based on the ideXlab platform.
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Ankle dexterity remains intact in patients with incomplete spinal cord injury in contrast to stroke patients
Experimental Brain Research, 2008Co-Authors: Brigitte Wirth, Hubertus J. A. Hedel, Armin CurtAbstract:Patients with either incomplete spinal cord injury (iSCI) or stroke suffer from muscle weakness in the lower limb and Impaired Ambulation. The assessment of motor function in iSCI has so far focused on measures of muscle strength, while in stroke extensive research has been directed towards upper limb motor control. Slowness of movements was reported to be a common motor impairment of patients with lesions of the central nervous system (CNS). It may result from muscle weakness and deficits in dexterity, which is two aspects of motor control that are dependent on cortico-spinal tract (CST) integrity and are crucial to Ambulation. Thus, this study investigated the impact of CST damage either at spinal (iSCI) or cortical level (stroke) on ankle dexterity and maximal movement velocity (MMV). Twelve iSCI, stroke and control subjects were tested. The patients were matched for gender, age and maximal voluntary contraction (MVC) in ankle dorsi- and plantar-flexion muscles. Dexterity and MMV were tested in the supine position. CST function was assessed by motor evoked potentials (MEPs). In both groups of patients, MMV and MEP latencies were comparably deteriorated. However, dexterity was preserved in iSCI, but Impaired in the hemiparetic stroke leg. Therefore, iSCI patients showed a high dexterity within the preserved muscle strength, but suffered primarily from reduced MMV. In stroke patients, both dexterity and MMV were reduced. These differences might be considered in rehabilitation programs and regeneration therapies.
Ls. Schwartzberg - One of the best experts on this subject based on the ideXlab platform.
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Abstract P5-12-04: Symptom Burden Declines When Breast Cancer Patients Treated with Adjuvant Trastuzumab/Combination Chemotherapy Regimens Enter Trastuzumab Monotherapy Follow-Up
Poster Session Abstracts, 2010Co-Authors: Arthur C. Houts, Deepa Lalla, Walker, E. J. Stepanski, M Brammer, Jf Doan, Ls. SchwartzbergAbstract:Background: Trastuzumab (T) is indicated for the adjuvant treatment of HER2-overexpressing breast cancer (BC). We report the results of a retrospective study of patient-reported outcomes (PROs) for patients who received T plus chemotherapy followed by T monotherapy or T as a single-agent. Methods: Included in this analysis were 210 patients with early HER2+ BC treated in community oncology practices affiliated with ACORN Research, who completed a 38-item symptom assessment scale, the Patient Care Monitor (PCM). Treatment regimens were classified as: combination chemotherapy followed by T monotherapy: doxorubicin, cyclophosphamide, paclitaxel [n=74] or docetaxel [n=18] and T (AC→TH/ACTH) (n=92); docetaxel, carboplatin, and T (TCH) (n = 38); or “Other” chemotherapy/T (n=47); or T only (n=33). Medical records were abstracted and symptom burden was measured by PCM index scores for: Physical Symptoms, Treatment Side Effects, Distress, Despair, Impaired Ambulation, and Impaired Performance. Linear mixed models were used to examine change in PCM index scores over time, controlling for first line chemotherapy group and relevant covariates. Results: Patients were 66% Caucasian and 28% African American. The mean age of, this cohort was 56.0 years (range=31-85 years). Demographic and disease characteristic s did not differ among the four treatment regimens except patients treated with AC→TH/ACTH tended to have higher stage of disease at time of diagnosis. Among patients on combination chemotherapy, median time on active chemotherapy was 3.5 months. Patients were observed for a median of 12.5 months. Impaired Ambulation, Impaired Performance, and General Physical Symptoms worsened over the course of active chemotherapy (p Discussion: Functioning and physical symptom burden tended to worsen during active chemotherapy and to improve when active chemotherapy stopped. TCH was associated with more gradual improvement in symptom burden than AC→TH/ACTH and the “Other” combination group. Most patients treated with combination chemotherapy showed symptom burden similar to those treated with T only once they transitioned to T monotherapy as follow-up treatment. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-12-04.
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The Effect of Disease Progression on Patient Reported Outcomes in HER-2 Negative Metastatic Breast Cancer Patients.
Poster Session Abstracts, 2009Co-Authors: M. Hasan, E. J. Stepanski, Mark S. Walker, Yeun Mi Yim, Ls. SchwartzbergAbstract:Background: Patients with HER-2 neg metastatic breast cancer (MBC) often experience a wide range of cancer related symptoms, which may impact their quality of life (QoL). We conducted a retrospective analysis to characterize the differences between patient-reported outcomes (PROs) of MBC patients prior to progression of disease (PD) and following PD, and examined the effect of metastases in bone, lung, liver, peritoneum and central nervous system (CNS) on PROs.Methods: 102 HER-2 neg MBC patients were enrolled from 7 community oncology practices within the U.S. The source data comprised data abstracted from medical records and PROs from the 38-item Patient Care Monitor (PCM). The PCM consists of 6 indices including Impaired Ambulation, Impaired performance, general physical symptoms, treatment-related side effects, despair and depression, and acute distress. Linear mixed-effect models were used to analyze change in PCM index scores over time, controlling for individual, disease, and treatment characteristics. Minimum important difference for PCM index scores was estimated to be 1.5 to 3 points (Ringash 2000).Results: The sample (n=102) consists of 72% Caucasian, 25% African American, 3% other race patients, with mean age of 57 years. The ECOG performance status (PS) was unknown in 58% of the cases. Among those with known PS, 79% had a status of 0 or 1. Most patients (87%) had previous surgery, and 62% had received adjuvant chemotherapy. The mean time from metastatic diagnosis to first PD was 14 months. The predominant sites of metastasis were bone (66%), lung (35%), and liver (33%). First line treatment was hormone therapy only for 29%, no treatment recorded for 4%, taxane based for 42%, and non-taxane based for 25%. Linear mixed-effect model results showed modest but statistically significant (p Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5050.
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Symptom Burden in Patients with Follicular Lymphoma Undergoing Maintenance Treatment with Rituxan Compared with Observation.
Blood, 2009Co-Authors: Mark Walker, E. J. Stepanski, Carolina Reyes, Murad Hasan, Ls. SchwartzbergAbstract:Abstract 2498 Poster Board II-475 Background: The use of rituximab maintenance after front line chemotherapy has been shown superior to observation in the treatment of follicular lymphoma (FL). However, the impact of rituximab maintenance (R-M) vs. observation (OBS) on symptom burden has not been thoroughly examined. This study examined treatment patterns and self reported symptom burden among patients who received either R-M or OBS after front line chemotherapy. Methods: This was a retrospective review of existing data drawn from 7 community oncology practices within the U.S. Eligible patients had a diagnosis of FL, were ≥ 18 years of age, had received monotherapy or combination chemotherapy front line, and had received either R-M therapy or OBS following front line therapy. Patients were excluded if they had progressed during front line therapy. Patients had completed ≥ 1 Patient Care Monitor (PCM) surveys, a 38-item self report measure of symptom burden and quality of life collected as a routine part of clinical care. The PCM produces index scores in areas of physical symptoms (General Physical Symptoms, Treatment Side Effects), psychological symptoms (Distress, Despair), and physical functioning (Impaired Ambulation, and Impaired Performance). Linear mixed models were used to examine change in PCM index scores over time, across R-M vs. OBS treatment groups, controlling for propensity to be in the OBS groups, and for other relevant covariates. Results: The sample (n=137) was 53% female, 87% Caucasian, 7% African American, with mean age of 61.0 years (range: 33 - 88). Fewer patients received R-M (n = 53) than OBS (n = 84) during the post-front line period. Stage of disease at diagnosis was: 34% stage IV, 31% stage III, 15% stage II, 9% stage I, and 11% missing. FLIPI risk class was: 29% low, 23% intermediate, 48% high. The most common front line regimens were R-CHOP (34%), R-CVP (18%), and rituximab monotherapy (26%). A total of 960 PCM surveys were completed by 112 of the 137 patients during the front line and post-front line period. Linear mixed model results showed that General Physical Symptom and Treatment Side Effect index scores worsened during front line therapy. Other index scores were stable or nominally improved during front line therapy. Symptom burden during the maintenance period was generally stable. However, there was a significant interaction involving treatment group, showing that Impaired Performance index scores improved during the maintenance period for R-M patients, but not for OBS patients. The pattern of Impaired Performance Index scores, across R-M and OBS groups, is shown in Figure 1. Subset analysis on maintenance patients during maintenance therapy showed no effect of different schedules of R-M. Physical symptoms were unchanged during the active phase of R-M. However, psychological symptoms significantly improved during active rituximab therapy relative to the intervening non-treatment months of R-M. Conclusions: In this retrospective study of symptom burden, physical symptoms among patients undergoing treatment of FL tend to worsen during front line therapy. Physical and psychological symptoms, and functional impairment appear to stabilize after front line therapy. Among R-M patients, active receipt of rituximab was associated with improved psychological symptoms relative to the intervening period between doses of R-M. Overall, patients on R-M show symptoms that are generally equal to or better than those for patients on OBS. Disclosures: Off Label Use: Rituximab, indicated for use in treatment of NHL. Reyes:Genentech Inc: Employment.
Steven R. Messé - One of the best experts on this subject based on the ideXlab platform.
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Predictors of Outcome in Patients with Spinal Cord Ischemia after Open Aortic Repair
Neurocritical Care, 2013Co-Authors: Danielle A. Becker, Michael L. Mcgarvey, Catherine Rojvirat, Joseph E. Bavaria, Steven R. MesséAbstract:Introduction Spinal cord ischemia is a potentially devastating complication of thoracic aortic surgery. However, predictors of outcome have not been well characterized. The study objective was to generate a prognostic score that accurately stratifies patient outcomes, aiding in future management and planning. Methods A retrospective review of 224 consecutive open thoracic aortic surgeries identified patients with spinal cord ischemia, defined as changes on intraoperative somatosensory evoked potentials (SSEP) and/or paraparesis/paraplegia postoperatively. The outcome of interest was poor outcome, defined as death or discharge with a lower extremity motor score ≤40, indicating Impaired Ambulation. Demographic and clinical characteristics were tested in univariate analyses and significant factors were incorporated in multivariate modeling to determine independent predictors of poor outcome. Results Seventy-five patients were identified with spinal cord ischemia, of which 43(57 %) had poor outcomes including 28(37 %) that died prior to discharge. Factors associated with poor outcome in univariate analysis included absent lumbar CSF drain ( p = 0.03), surgical repair that crossed the diaphragm ( p = 0.002), permanent intraoperative SSEP change ( p = 0.02), postoperative renal failure ( p = 0.004), paraplegia ( p = 0.001), and concomitant stroke ( p = 0.04). In multivariable analysis, surgical repair crossing the diaphragm (OR 4.8, CI 1.4–16.7, p = 0.02), paraplegia (OR 4.5, CI 1.4–14.0, p = 0.01), and renal failure (OR 6.1, CI 1.7–21.2, p = 0.005) were independently associated with poor outcome. Patients with transient intraoperative neurophysiologic changes were least likely to have poor outcome when compared to patients with no or permanent SSEP changes, and those not monitored ( p = 0.03). Conclusion Development of spinal cord ischemia with thoracic aortic repair often leads to death or disability. Characteristics known at the time of event can accurately predict the likelihood of poor outcome.
