Background and Purpose. The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities. The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults. Subjects. Ninety-six community-dwelling elderly people (61–89 years of age) with independent functioning performed 4 clinical tests. Methods. Data were collected on the Six-Minute Walk Test (6MW), Berg Balance Scale (BBS), and Timed Up & Go Test (TUG) and during comfortable- and fast-speed walking (CGS and FGS). Intraclass correlation coefficients (ICCs) were used to determine the test-retest reliability for the 6MW, TUG, CGS, and FGS measurements. Data were analyzed by gender and age (60–69, 70–79, and 80–89 years) cohorts, similar to previous studies. Means, standard deviations, and 95% confidence intervals for each measurement were calculated for each cohort. Results. The 6MW, TUG, CGS, and FGS measurements showed high test-retest reliability (ICC [2,1]=.95–.97). Mean test scores showed a trend of age-related declines for the 6MW, BBS, TUG, CGS, and FGS for both male and female subjects. Discussion and Conclusion. Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW, BBS, TUG, CGS and FGS. Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons.

/pdf/age-and-gender-related-test-performance-in-community-428kc3iw0l.pdf

Age- and Gender-Related Test Performance in Community-Dwelling Elderly People: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and Gait Speeds

Falls and freezing of gait are two "episodic" phenomena that are common in Parkinson's disease. Both symptoms are often incapacitating for affected patients, as the associated physical and psychosocial consequences have a great impact on the patients' quality of life, and survival is diminished. Furthermore, the resultant loss of independence and the treatment costs of injuries add substantially to the health care expenditures associated with Parkinson's disease. In this clinically oriented review, we summarise recent insights into falls and freezing of gait and highlight their similarities, differences, and links. Topics covered include the clinical presentation, recent ideas about the underlying pathophysiology, and the possibilities for treatment. A review of the literature and the current state-of-the-art suggests that clinicians should not feel deterred by the complex nature of falls and freezing of gait; a careful clinical approach may lead to an individually tailored treatment, which can offer at least partial relief for many affected patients.

https://reylab.bidmc.harvard.edu/pubs/2004/md-2004-19-871.pdf

Falls and freezing of gait in Parkinson's disease : a review of two interconnected, episodic phenomena

We studied prospectively the epidemiology, clinical impact and prediction of falls in 59 moderately affected patients with Parkinson's disease (PD) (mean UPDRS motor score 31.5; mean age 61 years) and 55 controls (mean age 60 years). At baseline, balance and gait were evaluated extensively. The retropulsion test (response to sudden shoulder pull) was executed first unexpectedly and five more times following prior warning. All persons used standardised scoring forms to document their falls during six months. Thirty patients (50.8 %) and eight controls (14.5%) fell at least once (relative risk [RR] 6.1; 95% confidence interval [CI] 2.5-15.1, p or = 2) falls occurred in 15 patients (25.4%), but in only two controls (RR 9.0; 95 % CI 2.0-41.7; p=0.001). Recurrent falls were more common among persons taking benzodiazepines (RR 5.0; 95% CI 1.6-15.5; p 100; 95% CI 3.1-585) and asking for prior falls (RR 5.0; 95% CI 1.2-20.9). We conclude that falls are common and disabling, even in relatively early stage PD. Recurrent fallers were best predicted by disease severity and presence of prior falls. Strategies to prevent falls in PD should particularly focus at intrinsic (patient-related) factors, such as minimising the use of benzodiazepines.

Prospective assessment of falls in Parkinson's disease

Background and Purpose. The Timed “Up & Go” Test (TUG) is used to measure the ability of patients to perform sequential locomotor tasks that incorporate walking and turning. This study investigated the retest reliability, interrater reliability, and sensitivity of TUG scores in detecting changes in mobility in subjects with idiopathic Parkinson disease (PD). Subjects. The performance of 12 people with PD was compared with that of 12 age-matched comparison subjects without PD. Methods. The subjects with PD completed 5 trials of the TUG after withdrawal of levodopa for 12 hours (“off” phase of the medication cycle) as well as an additional 5 trials 1 hour after levodopa was administered (“on” phase of the medication cycle). They were scored on the Modified Webster Scale at both sessions. The comparison subjects also performed 5 TUG trials. All trials were videotaped and timed by 2 experienced raters. The videotape was later rated by 3 experienced clinicians and 3 inexperienced clinicians. Results. For the subjects with PD, within-session performance was highly consistent, with correlations ( r ) ranging from .80 to .98 for the “off” phase and from .73 to .99 for the “on” phase. The performance of the comparison subjects across the 5 trials was also highly consistent ( r =.90–.97). Comparisons showed differences between trials 1 and 2 on the TUG for both groups. Removal of data for trial 1 (the practice trial) further enhanced retest reliability. There was close agreement in TUG scores among raters despite different levels of experience (intraclass correlation coefficient [3,1]=.87–.99). Mean TUG scores were different between the “on” and “off” phases of the levodopa cycle and between subjects with PD and comparison subjects during the “on” phase. Conclusion and Discussion. Retest reliability and interrater reliability of the TUG measurements were high, and the measurements reflected changes in performance according to levodopa use. The TUG can also be used to detect differences in performance between people with PD and elderly people without PD.

/pdf/reliability-of-measurements-obtained-with-the-timed-up-go-pc31ym8pi7.pdf

Reliability of Measurements Obtained With the Timed “Up & Go” Test in People With Parkinson Disease

Timed Up and Go (TUG) test is a widely used clinical paradigm to evaluate balance and mobility. Although TUG includes several complex subcomponents, namely: sit-to-stand, gait, 180° turn, and turn-to-sit; the only outcome is the total time to perform the task. We have proposed an instrumented TUG, called iTUG, using portable inertial sensors to improve TUG in several ways: automatic detection and separation of subcomponents, detailed analysis of each one of them and a higher sensitivity than TUG. Twelve subjects in early stages of Parkinson's disease (PD) and 12 age matched control subjects were enrolled. Stopwatch measurements did not show a significant difference between the two groups. The iTUG, however, showed a significant difference in cadence between early PD and control subjects (111.1 ± 6.2 versus 120.4 ± 7.6 step/min, p <; 0.006) as well as in angular velocity of arm-swing (123 ± 32.0 versus 174.0 ± 50.4°/s, p <; 0.005), turning duration (2.18 ± 0.43 versus 1.79 ± 0.27 s, p <; 0.023), and time to perform turn-to-sits (2.96 ± 0.68 versus 2.40 ± 0.33 s, p <; 0.023). By repeating the tests for a second time, the test-retest reliability of iTUG was also evaluated. Among the subcomponents of iTUG, gait, turning, and turn-to-sit were the most reliable and sit-to-stand was the least reliable.

https://www.researchgate.net/profile/Kamiar_Aminian/publication/224130667_iTUG_a_Sensitive_and_Reliable_Measure_of_Mobility/links/0deec521f1ace67625000000.pdf

iTUG, a Sensitive and Reliable Measure of Mobility

SummaryThis study was devised to check the feasibility and validity of a rating scale specifically designed to evaluate gait impairment in Parkinson's disease (RSGE). Demographic data, a brief questionnaire on general aspects influencing gait and mobility, a battery of scales (Barthel Index; Hoehn a

A new clinical tool for gait evaluation in Parkinson's disease

Parkinsonism is a well-known side effect of some calcium channel blockers (CCB). Its long-term evolution, however, is unknown. To clarify this issue, we performed a prospective follow-up study involving 32 patients diagnosed with CCB-induced parkinsonism. After the baseline examination, the CCB were discontinued and serial evaluations were carried out according to the same protocol. Despite a global improvement, cognitive and mood disturbances subsided slowly, and tremor persisted in most patients. After 18 months of CCB withdrawal, 44% of patients had depression, 88% had tremor, and 33% still had criteria for diagnosis of parkinsonism. During the survey, only three patients were found to be fully recovered. The improvement of some clinical symptoms was related to age: Patients younger than 73 years recovered better than older patients did. Our data indicate that CCB-induced parkinsonism is not the benign condition previously thought, and suggest an age-related prognosis of this entity.

Parkinsonism associated with calcium channel blockers: a prospective follow-up study.

Calcium channel blockers can act on dopaminergic systems, and some reports suggest that they could be useful for the treatment of several movement disorders. In order to assess the efficacy of nicardipine in tics disorders we performed a prospective open non-controlled study which included 10 previously untreated patients. Our results suggest that nicardipine could be a useful and safe treatment for tics.

Nicardipine improves motor tics

Anticonvulsants and osteopenia

Seven patients carriers of a disease capable of provoking immunodeficiency (six of them suffering AIDS and one case of Hodgkin type lymphoma) are reported. All of them presented neurological complications consisting of toxoplasma Gondii infection of the Central Nervous System. We summarize their evolution and the diagnostic and therapeutical approaches.

D. Garcia Urra

Papers

A new clinical tool for gait evaluation in Parkinson's disease

Parkinsonism associated with calcium channel blockers: a prospective follow-up study.

Nicardipine improves motor tics

Anticonvulsants and osteopenia

Toxoplasmosis of the central nervous system in immunodepressed patients. Our experience