Publications by authors named "Hannes Devos"

75 Publications

Frailty and falls in people living with multiple sclerosis.

Arch Phys Med Rehabil 2021 Nov 24. Epub 2021 Nov 24.

Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States; Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA. Electronic address:

Objective: To explore the association between frailty and history of falls in people living with multiple sclerosis (MS).

Design: Secondary analysis.

Setting: University research laboratories in the United States and Israel.

Participants: 118 people with relapsing-remitting MS [age=48.9 years (SD=10.0); 74.6% female; expanded disability status scale (EDSS) range=1.0-6.0] were studied in this cross-sectional analysis.

Intervention: Not applicable.

Main Outcomes: A frailty index was calculated from 40 health deficits by following standard validated procedures. The number of falls (12-month history) was recorded.

Results: Overall, 33.9%, 29.7%, and 36.4% of participants were classified as non-frail, moderately frail, and severely frail, respectively. The frailty index was significantly correlated (ρ=0.37, p<0.001) with higher scores on the EDSS. In univariable negative binomial regression analysis, the frailty index was associated with a higher number of falls (IRR=3.33, 95%CI[1.85-5.99], p<0.001). After adjustment for age, gender and EDSS, frailty remained strongly associated with history of falls (IRR=2.78, 95%CI[1.51-5.10], p=0.001).

Conclusion: The current study identifies a significant relationship between frailty and history of falls in MS, independent of age, gender, and disease severity. These findings support the notion that frailty is a syndrome related to, but independent of, disability in MS.
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http://dx.doi.org/10.1016/j.apmr.2021.10.025DOI Listing
November 2021

Prevalence and Disease Spectrum of Extracoronary Arterial Abnormalities in Spontaneous Coronary Artery Dissection.

JAMA Cardiol 2021 Nov 24. Epub 2021 Nov 24.

Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.

Importance: Spontaneous coronary artery dissection (SCAD) has been associated with fibromuscular dysplasia (FMD) and other extracoronary arterial abnormalities. However, the prevalence, severity, and clinical relevance of these abnormalities remain unclear.

Objective: To assess the prevalence and spectrum of FMD and other extracoronary arterial abnormalities in patients with SCAD vs controls.

Design, Setting, And Participants: This case series included 173 patients with angiographically confirmed SCAD enrolled between January 1, 2015, and December 31, 2019. Imaging of extracoronary arterial beds was performed by magnetic resonance angiography (MRA). Forty-one healthy individuals were recruited to serve as controls for blinded interpretation of MRA findings. Patients were recruited from the UK national SCAD registry, which enrolls throughout the UK by referral from the primary care physician or patient self-referral through an online portal. Participants attended the national SCAD referral center for assessment and MRA.

Exposures: Both patients with SCAD and healthy controls underwent head-to-pelvis MRA (median time between SCAD event and MRA, 1 [IQR, 1-3] year).

Main Outcome And Measures: The diagnosis of FMD, arterial dissections, and aneurysms was established according to the International FMD Consensus. Arterial tortuosity was assessed both qualitatively (presence or absence of an S curve) and quantitatively (number of curves ≥45%; tortuosity index).

Results: Of the 173 patients with SCAD, 167 were women (96.5%); mean (SD) age at diagnosis was 44.5 (7.9) years. The prevalence of FMD was 31.8% (55 patients); 16 patients (29.1% of patients with FMD) had involvement of multiple vascular beds. Thirteen patients (7.5%) had extracoronary aneurysms and 3 patients (1.7%) had dissections. The prevalence and degree of arterial tortuosity were similar in patients and controls. In 43 patients imaged with both computed tomographic angiography and MRA, the identification of clinically significant remote arteriopathies was similar. Over a median 5-year follow-up, there were 2 noncardiovascular-associated deaths and 35 recurrent myocardial infarctions, but there were no primary extracoronary vascular events.

Conclusions And Relevance: In this case series with blinded analysis of patients with SCAD, severe multivessel FMD, aneurysms, and dissections were infrequent. The findings of this study suggest that, although brain-to-pelvis imaging allows detection of remote arteriopathies that may require follow-up, extracoronary vascular events appear to be rare.
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http://dx.doi.org/10.1001/jamacardio.2021.4690DOI Listing
November 2021

Impact of vascular morphology and plaque characteristics on computed tomography derived fractional flow reserve in early stage coronary artery disease.

Int J Cardiol 2021 Nov 26;343:187-193. Epub 2021 Aug 26.

Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.

Background: Computed-tomography (CT) derived fractional-flow-reserve (FFR) gradually may decrease from proximal to distal vessels even without apparent coronary artery disease (CAD). It may be unclear whether the decrease in FFR at the distal coronal artery is physiological or due to stenosis. We decided to study predictive factors of an FFR decline below the pathological value of 0.80 in no-apparent CAD.

Methods: A total of 150 consecutive patients who had both CT angiography coupled to FFR analysis and invasive angiogram showing < 20% coronary stenosis were included. Vessels were divided into two groups according to FFR at the distal vessel: FFR > 0.80 (n = 317) and FFR ≤ 0.80 (n = 114). ΔFFR was defined as the change in FFR from proximal to distal vessel. Vessel morphology (vessel length and lumen volume) and plaque characteristics [low-attenuation plaque volume, intermediate-attenuation (IAP) plaque volume, and calcified plaque volume] were evaluated.

Results: FFR decreased from proximal to distal for the three major vessels in both FFR > 0.80 and FFR ≤ 0.80. Compared to FFR > 0.80, IAP volume was significantly higher in all three major vessels in FFR ≤ 0.80. ΔFFR was correlated with vessel length and lumen volume in FFR > 0.80, whereas ΔFFR was correlated with IAP volume in FFR ≤ 0.80. IAP volume above 44.8 mm was the strongest predictor of distal FFR of ≤ 0.80.

Conclusions: The presence of IAP is a major predictor of gradual decrease of FFR below 0.80 in no-apparent CAD vessels. Vessel morphology and plaque characteristics should be considered when interpreting FFR.
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http://dx.doi.org/10.1016/j.ijcard.2021.08.036DOI Listing
November 2021

Proof-of-Concept of the Virtual Reality Comprehensive Balance Assessment and Training for Sensory Organization of Dynamic Postural Control.

Front Bioeng Biotechnol 2021 29;9:678006. Epub 2021 Jul 29.

Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, United States.

Accurate quantification of the impact of visual, somatosensory, and vestibular systems on postural control may inform tailor-made balance intervention strategies. The aim of this proof-of-concept study was to determine the safety, sense of presence, system usability, and face validity of a newly developed Virtual Reality Comprehensive Balance Assessment and Training (VR-ComBAT) in healthy young individuals. The VR-ComBAT included six balance condition: (1) stable surface with fixed virtual reality (VR) surroundings; (2) stable surface with blacked out VR surroundings; (3) stable surface with VR visual conflict; (4) unstable surface with fixed VR surroundings; (5) unstable surface with blacked out VR surroundings; and (6) unstable surface with VR visual conflict. Safety was evaluated using the number of adverse events, including scores on the Simulator Sickness Questionnaire. Sense of presence was evaluated using the igroup Presence Questionnaire (iPQ). System usability was assessed using the Systems Usability Scale (SUS). Friedman analyses with Wilcoxon Signed Rank tests were employed to demonstrate face validity by quantifying center of pressure (COP) changes in mean distance, mean velocity, and mean frequency in the anteroposterior (AP) and mediolateral (ML) direction across the six conditions. Twenty-three participants (27.4 ± 8.0 years old; 13 women) reported no adverse events. Participants scores on average 44.9 ± 9.6 on the iPQ and 79.7 ± 9.9 on the SUS. analyses showed significant changes in COP-based measures when compared to baseline. The mean frequency change of COP showed direction-dependence in which increased frequency change in AP was observed while decreased change in ML was noted. The VR-ComBAT provides a safe, feasible, and cost-effective VR environment that demonstrates consistent sensory re-weighting between visual, somatosensory, and vestibular systems. Future studies should investigate whether VR-ComBAT can be used to inform precision rehabilitation of balance and fall prevention in older adults without and with neurological conditions.
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http://dx.doi.org/10.3389/fbioe.2021.678006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8358300PMC
July 2021

Oculomotor Deficits and Symptom Severity Are Associated With Poorer Dynamic Mobility in Chronic Mild Traumatic Brain Injury.

Front Neurol 2021 26;12:642457. Epub 2021 Jul 26.

Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States.

Oculomotor deficits, vestibular impairments, and persistent symptoms are common after a mild traumatic brain injury (mTBI); however, the relationship between visual-vestibular deficits, symptom severity, and dynamic mobility tasks is unclear. Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after mTBI, who were between 3 months to 2 years post-injury were compared with 23 age and sex-matched controls. Oculomotor deficits [depth perception, near-point convergence, baseline visual acuity (BLVA), perception time], vestibular deficits (dynamic visual acuity in the pitch and yaw planes), dynamic mobility measured by the Functional Gait Assessment (FGA), and symptoms measured by the Post-Concussion Symptom Scale (PCSS) and Dizziness Handicap Inventory (DHI) were compared between groups. Participants with mTBI had poorer performance on the FGA ( < 0.001), higher symptom severity on the PCSS ( < 0.001), and higher DHI scores ( < 0.001) compared to controls. Significant differences were seen on specific items of the FGA between individuals with mTBI and controls during walking with horizontal head turns ( = 0.002), walking with vertical head tilts ( < 0.001), walking with eyes closed ( = 0.003), and stair climbing ( = 0.001). FGA performance was correlated with weeks since concussion ( = -0.67, < 0.001), depth perception ( = -0.5348, < 0.001), near point convergence ( = -0.4717, = 0.001), baseline visual acuity ( = -0.4435, = 0.002); as well as with symptoms on the PCSS ( = -0.668, < 0.001), and DHI ( = -0.811, < 0.001). Dynamic balance deficits persist in chronic mTBI and may be addressed using multifaceted rehabilitation strategies to address oculomotor dysfunction, post-concussion symptoms, and perception of handicap due to dizziness.
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http://dx.doi.org/10.3389/fneur.2021.642457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350131PMC
July 2021

Fibromuscular dysplasia: its various phenotypes in everyday practice in 2021.

Kardiol Pol 2021;79(7-8):733-744. Epub 2021 Jun 24.

Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique and Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.

Fibromuscular dysplasia (FMD) is a non-atherosclerotic vascular disease that may involve medium-sized muscular arteries throughout the body. The pathogenesis of FMD remains poorly understood, but a combination of genetic and environmental factors may be involved. The majority of FMD patients are women, but men may have a more progressive disease, especially when smoking. Besides the classical phenotype of string of beads or focal stenosis, arterial aneurysms, dissections, and tortuosity are frequent manifestations of the disease. However, the differential diagnosis of FMD is extensive and includes imaging artefacts as well as other arterial diseases. Diagnosis is based on CT-, MR-, or conventional catheter-based angiography during work-up of clinical manifestations, but clinically silent lesions may be found incidentally. Arterial hypertension and neurological symptoms are the most frequent clinical presentations, as renal and cerebrovascular arteries are the most commonly involved. However, involvement of most arteries throughout the body has been reported, resulting in a variety of clinical symptoms. The management of FMD depends on the vascular phenotype as well on the clinical picture. Ongoing FMD-related research will elaborate in depth the current progress in improved understandings of the disease's clinical manifestations, epidemiology, natural history and pathogenesis. This review is focused on the clinical management of adult FMD in daily practice.
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http://dx.doi.org/10.33963/KP.a2021.0040DOI Listing
September 2021

Effectiveness of Brain Gaming in Older Adults With Cognitive Impairments: A Systematic Review and Meta-Analysis.

J Am Med Dir Assoc 2021 Nov 16;22(11):2281-2288.e5. Epub 2021 Jun 16.

Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.

Objective: This systematic review and meta-analysis evaluates the evidence from randomized clinical trials (RCTs) that designed brain gaming interventions to improve cognitive functions of older adults with cognitive impairments, including mild cognitive impairments and dementia.

Design: Systematic review and meta-analysis.

Setting And Participants: N/A.

Measures: N/A.

Methods: Data sources-relevant randomized control trials (RCTs) were identified by a systematic search of databases including Medline, PubMed, PsycINFO, Embase, CINAHL, Web of Science, and Cochrane. RCTs were selected first based on title and abstract review and then on full-text review by independent reviewers using predefined eligibility criteria. Risk of bias (RoB) was assessed using the Cochrane RoB tool and funnel plots. The primary outcome variable was the composite score of global cognitive function.

Results: A total of 909 participants with mild cognitive impairment or dementia from 16 RCTs were included in the systematic review. The study quality was modest, and the RoB assessment showed bias in blinding the participants and personnel. Funnel plots showed no evidence of publication bias. The meta-analysis of 14 RCTs revealed no superior effect of brain gaming compared to other interventions on global cognitive function (pooled standardized mean difference = 0.08, 95% confidence interval -0.24, 0.41, P = .61, I = 77%). Likewise, no superior effects were found on the cognitive domains of memory, executive function, visuospatial skills, and language.

Conclusion And Implications: The findings of this meta-analysis suggest that brain gaming compared with the control intervention does not show significant improvement in standardized tests of cognitive function. Because of considerable heterogeneity in sample size, gaming platform, cognitive status, study design, assessment tools, and training prescription, we cannot confidently refute the premise that brain gaming is an effective cognitive training approach for older adults with cognitive impairments. Recommendations for future research are included.
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http://dx.doi.org/10.1016/j.jamda.2021.05.022DOI Listing
November 2021

Pupillary Response to Postural Demand in Parkinson's Disease.

Front Bioeng Biotechnol 2021 27;9:617028. Epub 2021 Apr 27.

Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States.

Individuals with Parkinson's disease (PD) may need to spend more mental and physical effort (i.e., cognitive workload) to maintain postural control. Pupillary response reflects cognitive workload during postural control tasks in healthy controls but has not been investigated as a measure of postural demand in PD. To compare pupillary response during increased postural demand using vision occlusion and dual tasking between individuals with PD and healthy controls. Thirty-three individuals with PD and thirty-five healthy controls were recruited. The four conditions lasted 60 s and involved single balance task with eyes open; single balance task with eyes occluded; dual task with eyes open; dual task with eyes occluded. The dual task comprised the Auditory Stroop test. Pupillary response was recorded using an eye tracker. The balance was assessed by using a force plate. Two-way Repeated Measures ANOVA and LSD tests were employed to compare pupillary response and Center of Pressure (CoP) displacement across the four conditions and between individuals with PD and healthy controls. Pupillary response was higher in individuals with PD compared to healthy controls ( = 0.009) and increased with more challenging postural conditions in both groups ( < 0.001). The analysis demonstrated increased pupillary response in the single balance eyes occluded ( < 0.001), dual task eyes open ( = 0.01), and dual task eyes occluded ( < 0.001) conditions compared to single task eyes open condition. Overall, the PD group had increased pupillary response with increased postural demand compared to the healthy controls. In the future, pupillary response can be a potential tool to understand the neurophysiological underpinnings of falls risk in the PD population.
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http://dx.doi.org/10.3389/fbioe.2021.617028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111006PMC
April 2021

Exercise interventions for older adults with Alzheimer's disease: a systematic review and meta-analysis protocol.

Syst Rev 2021 01 4;10(1). Epub 2021 Jan 4.

Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, USA.

Background: The growing societal and economic impact of Alzheimer's disease (AD) is further compounded by the present lack of disease-modifying interventions. Non-pharmacological intervention approaches, such as exercise, have the potential to be powerful approaches to improve or mitigate the symptoms of AD without added side effects or financial burden associated with drug therapies. Various forms and regiments of exercise (i.e., strength, aerobic, multicomponent) have been reported in the literature; however, conflicting evidence obscures clear interpretation of the value and impact of exercise as an intervention for older adults with AD. The primary objective of this review will be to evaluate the effects of exercise interventions for older adults with AD. In addition, this review will evaluate the evidence quality and synthesize the exercise training prescriptions for proper clinical practice guidelines and recommendations.

Methods: This systematic review and meta-analysis will be carried out by an interdisciplinary collective representing clinical and research stakeholders with diverse expertise related to neurodegenerative diseases and rehabilitation medicine. Literature sources will include the following: Embase, PsychINFO, OVID Medline, and Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily. Inclusion criteria are participants with late onset AD and structured exercise interventions with prescribed duration, frequency, and intensity. The primary outcome of this study will center on improved or sustained cognitive functioning. Secondary outcomes will include institutionalization-related outcomes, ability in activities of daily living, mood and emotional well-being, quality of life, morbidity, and mortality. Analysis procedures to include measurement of bias, data synthesis, sensitivity analysis, and assessment of heterogeneity are described in this protocol.

Discussion: This review is anticipated to yield clinically meaningful insight on the specific value of exercise for older adults with AD. Improved understanding of diverse exercise intervention approaches and their specific impact on various health- and function-related outcomes is expected to guide clinicians to more frequently and accurately prescribe meaningful interventions for those affected by AD.

Systematic Review Registration: PROSPERO CRD42020175016 .
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http://dx.doi.org/10.1186/s13643-020-01555-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779651PMC
January 2021

Changes in Prefrontal Cortical Activity During Walking and Cognitive Functions Among Patients With Parkinson's Disease.

Front Neurol 2020 10;11:601686. Epub 2020 Dec 10.

TS2-LESCOT, Univ Gustave Eiffel, IFSTTAR, Univ Lyon, Lyon, France.

Walking becomes more and more degraded as Parkinson's Disease (PD) progresses. Previous research examined factors contributing to this deterioration. Among them, changes in brain cortical activity during walking have been less studied in this clinical population. This study aimed to: (1) investigate changes in dorsolateral prefrontal cortex (DLPFC) activation during usual walking and dual-task walking conditions in patients with PD; (2) examine the association between cortical activity and behavioral/cognitive outcomes; and (3) explore which factors best predict increased activation of the DLPFC during usual walking. Eighteen patients with early stage PD and 18 controls performed 4 conditions: (1) standing while subtracting, (2) usual walking, (3) walking while counting forward, and (4) walking while subtracting. Cortical activity in DLPFC, assessed by changes in oxy-hemoglobin (ΔHbO) and deoxy-hemoglobin (ΔHbR), was measured using functional near infrared spectroscopy (fNIRS). Gait performance was recorded using wearables sensors. Cognition was also assessed using neuropsychological tests, including the Trail Making Test (TMT). DLPFC activity was higher in patients compared to controls during both usual walking and walking while subtracting conditions. Patients had impaired walking performance compared to controls only during walking while subtracting task. Moderate-to-strong correlations between ΔHbO and coefficients of variation of all gait parameters were found for usual walking and during walking while counting forward conditions. Part-B of TMT predicted 21% of the variance of ΔHbO during usual walking after adjustment for group status. The increased DLPFC activity in patients during usual walking suggests a potential compensation for executive deficits. Understanding changes in DLPFC activity during walking may have implications for rehabilitation of gait in patients with PD.
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http://dx.doi.org/10.3389/fneur.2020.601686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758480PMC
December 2020

Psychometric Properties of NASA-TLX and Index of Cognitive Activity as Measures of Cognitive Workload in Older Adults.

Brain Sci 2020 Dec 16;10(12). Epub 2020 Dec 16.

Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA.

Cognitive workload is increasingly recognized as an important determinant of performance in cognitive tests and daily life activities. Cognitive workload is a measure of physical and mental effort allocation to a task, which can be determined through self-report or physiological measures. However, the reliability and validity of these measures have not been established in older adults with a wide range of cognitive ability. The aim of this study was to establish the test-retest reliability of the National Aeronautics and Space Administration Task Load Index (NASA-TLX) and Index of Cognitive Activity (ICA), extracted from pupillary size. The convergent validity of these measures against event-related potentials (ERPs) was also investigated. A total of 38 individuals with scores on the Montreal Cognitive Assessment ranging between 17 and 30 completed a working memory test (-back) with three levels of difficulty at baseline and at a two-week follow-up. The intraclass correlation coefficients (ICC) values of the NASA-TLX ranged between 0.71 and 0.81, demonstrating good to excellent reliability. The mean ICA scores showed fair to good reliability, with ICCs ranging between 0.56 and 0.73. The mean ICA and NASA-TLX scores showed significant and moderate correlations (Pearson's r ranging between 0.30 and 0.33) with the third positive peak of the ERP at the midline channels. We conclude that ICA and NASA-TLX are reliable measures of cognitive workload in older adults. Further research is needed in dissecting the subjective and objective constructs of cognitive workload.
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http://dx.doi.org/10.3390/brainsci10120994DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766152PMC
December 2020

Reliability of P3 Event-Related Potential During Working Memory Across the Spectrum of Cognitive Aging.

Front Aging Neurosci 2020 19;12:566391. Epub 2020 Oct 19.

University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, KS, United States.

Event-related potentials (ERPs) offer unparalleled temporal resolution in tracing distinct electrophysiological processes related to normal and pathological cognitive aging. The stability of ERPs in older individuals with a vast range of cognitive ability has not been established. In this test-retest reliability study, 39 older individuals (age 74.10 (5.4) years; 23 (59%) women; 15 non β-amyloid elevated, 16 β-amyloid elevated, 8 cognitively impaired) with scores on the Montreal Cognitive Assessment (MOCA) ranging between 3 and 30 completed a working memory (-back) test with three levels of difficulty at baseline and 2-week follow-up. The main aim was to evaluate stability of the ERP on grand averaged task effects for both visits in the total sample ( = 39). Secondary aims were to evaluate the effect of age, group (non β-amyloid elevated; β-amyloid elevated, cognitively impaired), cognitive status (MOCA), and task difficulty on ERP reliability. P3 peak amplitude and latency were measured in predetermined channels. P3 peak amplitude at Fz, our main outcome variable, showed excellent reliability in 0-back (intraclass correlation coefficient (ICC), 95% confidence interval = 0.82 (0.67-0.90) and 1-back (ICC = 0.87 (0.76-0.93), however, only fair reliability in 2-back (ICC = 0.53 (0.09-0.75). Reliability of P3 peak latencies was substantially lower, with ICCs ranging between 0.17 for 2-back and 0.54 for 0-back. Generalized linear mixed models showed no confounding effect of age, group, or task difficulty on stability of P3 amplitude and latency of Fz. By contrast, MOCA scores tended to negatively correlate with P3 amplitude of Fz ( = 0.07). We conclude that P3 peak amplitude, and to lesser extent P3 peak latency, provide a stable measure of electrophysiological processes in older individuals.
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http://dx.doi.org/10.3389/fnagi.2020.566391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604307PMC
October 2020

Real-time assessment of daytime sleepiness in drivers with multiple sclerosis.

Mult Scler Relat Disord 2021 Jan 31;47:102607. Epub 2020 Oct 31.

Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City KS, United States.

Background: Daytime sleepiness is a common symptom of multiple sclerosis (MS) that may jeopardize safe driving. Our aim was to compare daytime sleepiness, recorded in real-time through eyelid tracking, in a simulated drive between individuals with MS (iwMS) and healthy controls.

Methods: Fifteen iwMS (age = median (Q1 - Q3), 55 (50 - 55); EDSS = 2.5 (2 - 3.5); 12 (80%) female) were matched for age, sex, education, and cognitive status with 15 controls. Participants completed self-reported fatigue and sleepiness scales including the Modified Fatigue Impact Scale (MFIS), Pittsburg Sleep Quality Inventory (PSQI), and Epworth Sleepiness Scale (ESS). Percentage of eyelid closure (PERCLOS) was extracted from a remote eye tracker while completing a simulated drive of 25 min.

Results: Although iwMS reported more symptoms of fatigue (MFIS, p = 0.003) and poorer sleep quality (PSQI, p = 0.008), they did not report more daytime sleepiness (ESS, p = 0.45). Likewise, there were no differences between groups in real-time daytime sleepiness, indexed by PERCLOS (p = 0.82). Both groups exhibited more real-time daytime sleepiness as they progressed through the drive (time effect, p < 0.0001). The interaction effect of group*time (p = 0.05) demonstrated increased symptoms of daytime sleepiness towards the end of the drive in iwMS compared to controls. PERCLOS correlated strongly (Spearman ρ = 0.76, p = 0.001) with distance out of lane in iwMS.

Conclusion: IwMS show exacerbated symptoms of daytime sleepiness during a monotonous, simulate drive. Future studies should investigate the effect of MS on daytime sleepiness during real-world driving.
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http://dx.doi.org/10.1016/j.msard.2020.102607DOI Listing
January 2021

Vision Problems in Multiple Sclerosis.

Arch Phys Med Rehabil 2020 12 25;101(12):2263-2265. Epub 2020 Sep 25.

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http://dx.doi.org/10.1016/j.apmr.2020.08.003DOI Listing
December 2020

Slowed driving-reaction time following concussion-symptom resolution.

J Sport Health Sci 2021 03 19;10(2):145-153. Epub 2020 Sep 19.

UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30602, USA. Electronic address:

Background: Concussed patients have impaired reaction time (RT) and cognition following injury that may linger and impair driving performance. Limited research has used direct methods to assess driving-RT post-concussion. Our study compared driving RT during simulated scenarios between concussed and control individuals and examined driving-RT's relationship with traditional computerized neurocognitive testing (CNT) domains.

Methods: We employed a cross-sectional study among 14 concussed (15.9 ± 9.8 days post-concussion, mean ± SD) individuals and 14 healthy controls matched for age, sex, and driving experience. Participants completed a driving simulator and CNT (CNS Vital Signs) assessment within 48 h of symptom resolution. A driving-RT composite (ms) was derived from 3 simulated driving scenarios: stoplight (green to yellow), evasion (avoiding approaching vehicle), and pedestrian (person running in front of vehicle). The CNT domains included verbal and visual memory; CNT-RT (simple-, complex-, Stroop-RT individually); simple and complex attention; motor, psychomotor, and processing speed; executive function; and cognitive flexibility. Independent t tests and Hedge d effect sizes assessed driving-RT differences between groups, Pearson correlations (r) examined driving RT and CNT domain relationships among cohorts separately, and p values were controlled for false discovery rate via Benjamini-Hochberg procedures (α = 0.05).

Results: Concussed participants demonstrated slower driving-RT composite scores than controls (mean difference = 292.86 ms; 95% confidence interval (95%CI): 70.18-515.54; p = 0.023; d = 0.992). Evasion-RT (p = 0.054; d = 0.806), pedestrian-RT (p = 0.258; d = 0.312), and stoplight-RT (p = 0.292; d = 0.585) outcomes were not statistically significant after false-discovery rate corrections but demonstrated medium to large effect sizes for concussed deficits. Among concussed individuals, driving-RT outcomes did not significantly correlate with CNT domains (r-range: -0.51 to 0.55; p > 0.05). No correlations existed between driving-RT outcomes and CNT domains among control participants either (r-range: -0.52 to 0.72; p > 0.05).

Conclusion: Slowed driving-RT composite scores and large effect sizes among concussed individuals when asymptomatic signify lingering impairment and raise driving-safety concerns. Driving-RT and CNT-RT measures correlated moderately but not statistically, which indicates that CNT-RT is not an optimal surrogate for driving RT.
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http://dx.doi.org/10.1016/j.jshs.2020.09.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987557PMC
March 2021

Reliability and Validity of Pupillary Response During Dual-Task Balance in Parkinson Disease.

Arch Phys Med Rehabil 2021 03 18;102(3):448-455. Epub 2020 Sep 18.

Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS.

Objective: To investigate the reliability and validity of pupillary response during dual-task balance conditions in individuals with Parkinson disease (PD).

Design: Cross-sectional study.

Setting: University of Kansas Medical Center Parkinson's Disease and Movement Disorder Center.

Participants: Participants (N=68) included individuals with PD (n=33) and healthy controls (n=35).

Interventions: Not applicable.

Main Outcome Measures: Pupillary response was the main outcome measure that was measured during the following conditions: single-task balance eyes open, single-task balance eyes occluded, dual-task eyes open, and dual-task eyes occluded. After each condition, the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) was administered to assess self-reported cognitive workload. To examine the test-retest reliability of the pupillary response, the conditions were administered twice for each individual within 2 hours. Intraclass correlation coefficients (ICC) were used to analyze the test-retest reliability of pupillary response in each condition for both groups. Pearson's r correlation was used to assess the convergent validity of pupillary response against the NASA-TLX.

Results: The test-retest reliability was excellent for both groups in almost all conditions (ICC>0.75). There were no correlations between pupillary response and the NASA-TLX. However, increased mental demand (a subitem of the NASA-TLX) significantly correlated with increased pupillary response in individuals with PD (r=0.38; P=.03).

Conclusions: Pupillary response showed excellent test-retest reliability and validity during dual-task balance for individuals with PD and healthy controls. Overall, these results suggest that pupillary response represents a stable index of cognitive workload during dual-task balance in individuals with PD.
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http://dx.doi.org/10.1016/j.apmr.2020.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914127PMC
March 2021

Classification of Parkinson's disease and essential tremor based on balance and gait characteristics from wearable motion sensors via machine learning techniques: a data-driven approach.

J Neuroeng Rehabil 2020 09 11;17(1):125. Epub 2020 Sep 11.

Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.

Background: Parkinson's disease (PD) and essential tremor (ET) are movement disorders that can have similar clinical characteristics including tremor and gait difficulty. These disorders can be misdiagnosed leading to delay in appropriate treatment. The aim of the study was to determine whether balance and gait variables obtained with wearable inertial motion sensors can be utilized to differentiate between PD and ET using machine learning. Additionally, we compared classification performances of several machine learning models.

Methods: This retrospective study included balance and gait variables collected during the instrumented stand and walk test from people with PD (n = 524) and with ET (n = 43). Performance of several machine learning techniques including neural networks, support vector machine, k-nearest neighbor, decision tree, random forest, and gradient boosting, were compared with a dummy model or logistic regression using F1-scores.

Results: Machine learning models classified PD and ET based on balance and gait characteristics better than the dummy model (F1-score = 0.48) or logistic regression (F1-score = 0.53). The highest F1-score was 0.61 of neural network, followed by 0.59 of gradient boosting, 0.56 of random forest, 0.55 of support vector machine, 0.53 of decision tree, and 0.49 of k-nearest neighbor.

Conclusions: This study demonstrated the utility of machine learning models to classify different movement disorders based on balance and gait characteristics collected from wearable sensors. Future studies using a well-balanced data set are needed to confirm the potential clinical utility of machine learning models to discern between PD and ET.
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http://dx.doi.org/10.1186/s12984-020-00756-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488406PMC
September 2020

Gaze stability in young adults with previous concussion history.

J Vestib Res 2020 ;30(4):259-266

Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.

Background: Disruption of visual-vestibular interaction after concussion can cause gaze instability with head movements. The long-term impact of concussion on gaze stability is unknown.

Objective: This cross-sectional comparative pilot study examined gaze stability in the chronic stage after concussion (greater than one year). A secondary objective was to examine the relationship between gaze stability and sleep.

Methods: Outcome measures included: 1. Gaze stability in logMAR (mean loss of dynamic visual acuity (DVA) in the yaw and pitch planes); 2. Pittsburgh Sleep Quality Index (PSQI); 3. Epworth Sleepiness Scale (ESS). Post-Concussion Symptom Scale (PCSS), time since injury, and number of concussions were collected for the people with concussion.

Results: The study sample included thirty-four adults (mean age 23.35±1.3 years). Seventeen had a history of 1-9 concussions, with a mean duration of 4.4±1.9 years since last concussion; and 17 were age and sex-matched controls. Mean pitch plane DVA loss was greater in the concussion group compared to the control group (p = 0.04). Participants with previous concussion had lower sleep quality based on the PSQI (p = 0.01) and increased daytime sleepiness based on the ESS (p = 0.01) compared to healthy controls. Mean DVA loss in the pitch plane was significantly correlated with the PSQI (r = 0.43, p = 0.01) and the ESS (r = 0.41, p = 0.02).

Conclusion: Significant differences in dynamic visual acuity may be found in young adults long after a concussion, compared with those who have no concussion history. Furthermore, loss of dynamic visual acuity was associated with poorer sleep quality and higher daytime sleepiness.
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http://dx.doi.org/10.3233/VES-200706DOI Listing
October 2021

Prevalence of chondrocalcinosis in the temporomandibular joint in patients with chondrocalcinosis of the knee or wrist.

Dentomaxillofac Radiol 2020 Oct 18;49(7):20190450. Epub 2020 Jun 18.

Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium.

Objective: The aim of this study was to investigate the prevalence of TMJ chondrocalcinosis on head CT scans in patients with chondrocalcinosis of the knee or wrist.

Methods And Materials: 227 patients with radiological evidence of calcifications on knee or wrist radiographs had a head CT scan obtained for unrelated purposes. CT scans were retrospectively reviewed for the presence of temporomandibular crystal deposition. Prevalence, bilaterality, age and gender distribution were determined.

Results: 41 of 227 (18%) of patients had TMJ chondrocalcinosis. TMJ chondrocalcinosis was more common in females (17%) than males (1%). It was more commonly unilateral (68%) than bilateral (32%).

Conclusion: In patients with peripheral calcific disease, the TMJ is more commonly involved than previously reported and this is more common in females compared to males.
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http://dx.doi.org/10.1259/dmfr.20190450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549530PMC
October 2020

Artificial neural networks in neurorehabilitation: A scoping review.

NeuroRehabilitation 2020 ;46(3):259-269

Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.

Background: Advances in medical technology produce highly complex datasets in neurorehabilitation clinics and research laboratories. Artificial neural networks (ANNs) have been utilized to analyze big and complex datasets in various fields, but the use of ANNs in neurorehabilitation is limited.

Objective: To explore the current use of ANNs in neurorehabilitation.

Methods: PubMed, CINAHL, and Web of Science were used for the literature search. Studies in the scoping review (1) utilized ANNs, (2) examined populations with neurological conditions, and (3) focused on rehabilitation outcomes. The initial search identified 1,136 articles. A total of 19 articles were included.

Results: ANNs were used for prediction of functional outcomes and mortality (n = 11) and classification of motor symptoms and cognitive status (n = 8). Most ANN-based models outperformed regression or other machine learning models (n = 11) and showed accurate performance (n = 6; no comparison with other models) in predicting clinical outcomes and accurately classifying different neurological impairments.

Conclusions: This scoping review provides encouraging evidence to use ANNs for clinical decision-making of complex datasets in neurorehabilitation. However, more research is needed to establish the clinical utility of ANNs in diagnosing, monitoring, and rehabilitation of individuals with neurological conditions.
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http://dx.doi.org/10.3233/NRE-192996DOI Listing
October 2020

Cognitive workload during verbal abstract reasoning in Parkinson's disease: a pilot study.

Int J Neurosci 2021 May 7;131(5):504-510. Epub 2020 Apr 7.

Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.

Background: Pupillary response reflects cognitive workload during processing speed, working memory, and arithmetic tasks in Parkinson's disease (PD). Abstract reasoning, a higher-order cognitive function that relates different objects, events, or thoughts in a similar manner, may also be compromised in PD. The aim of this study was to compare pupillary response as a measure of cognitive workload while completing a verbal abstract reasoning test between patients with PD and age-matched controls.

Methods: Nineteen non-demented individuals with PD (66.6 ± 8.9 years) and 10 healthy controls (65.3 ± 7.3 years) were recruited. A remote eye tracker recorded the pupillary response at 60 Hz, while the participants were performing the Similarities test of Wechsler Adult Intelligence Scale-IV. Outcome measures included pupillary response, evaluated by the Index of Cognitive Activity (ICA), and behavioral responses of the Similarities test.

Results: The PD group (scaled scores = 8.9 ± 2.2) did not show impairment in behavioral performance on Similarities test compared with healthy controls (scaled scores = 8.8 ± 2.3; = .91). However, the PD group (ICA = .32 ± .09) demonstrated significantly greater cognitive workload during the Similarities test compared to controls (ICA = .24 ± .08; = .03).

Conclusions: Non-demented individuals with PD exerted greater cognitive workload to complete a verbal abstract reasoning task despite similar behavioral performance compared to healthy controls. Clinical utilities of pupillary response to detect and monitor early impairment in higher-order executive function will be the subject of further study in the PD population.
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http://dx.doi.org/10.1080/00207454.2020.1746309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541427PMC
May 2021

Fat misbehaving in the abdominal cavity: a pictorial essay.

Pol J Radiol 2020 21;85:e32-e38. Epub 2020 Jan 21.

UZ Brussel, Belgium.

Intra-abdominal fat is abundantly present in both the peritoneum and retroperitoneum. Fat necrosis or inflammation are common findings in abdominal imaging. The most common pathologies that we encounter are epiploic appendagitis, omental infarction, mesenteric panniculitis, and encapsulated fat necrosis. Less common entities that can occur are pancreatic saponification, heterotopic mesenteric ossification, and pseudolipoma of the capsule of Glisson. These entities can mimic more urgent pathologies such as appendicitis, diverticulitis, or malignancies.
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http://dx.doi.org/10.5114/pjr.2020.93070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064015PMC
January 2020

A wearable sensor identifies alterations in community ambulation in multiple sclerosis: contributors to real-world gait quality and physical activity.

J Neurol 2020 Jul 12;267(7):1912-1921. Epub 2020 Mar 12.

Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.

People with multiple sclerosis (pwMS) often suffer from gait impairments. These changes in gait have been well studied in laboratory and clinical settings. A thorough investigation of gait alterations during community ambulation and their contributing factors, however, is lacking. The aim of the present study was to evaluate community ambulation and physical activity in pwMS and healthy controls and to compare in-lab gait to community ambulation. To this end, 104 subjects were studied: 44 pwMS and 60 healthy controls (whose age was similar to the controls). The subjects wore a tri-axial, lower back accelerometer during usual-walking and dual-task walking in the lab and during community ambulation (1 week) to evaluate the amount, type, and quality of activity. The results showed that during community ambulation, pwMS took fewer steps and walked more slowly, with greater asymmetry, and larger stride-to-stride variability, compared to the healthy controls (p < 0.001). Gait speed during most of community ambulation was significantly lower than the in-lab usual-walking value and similar to the in-lab dual-tasking value. Significant group (pwMS /controls)-by-walking condition (in-lab/community ambulation) interactions were observed (e.g., gait speed). Greater disability was associated with fewer steps and reduced gait speed during community ambulation. In contrast, physical fatigue was correlated with sedentary activity, but was not related to any of the measures of community ambulation gait quality including gait speed. This disparity suggests that more than one mechanism contributes to community ambulation and physical activity in pwMS. Together, these findings demonstrate that during community ambulation, pwMS have marked gait alterations in multiple gait features, reminiscent of dual-task walking measured in the laboratory. Disease-related factors associated with these changes might be targets of rehabilitation.
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http://dx.doi.org/10.1007/s00415-020-09759-7DOI Listing
July 2020

Pilot Feasibility Study Examining Pupillary Response During Driving Simulation as a Measure of Cognitive Load in Breast Cancer Survivors.

Oncol Nurs Forum 2020 03;47(2):203-212

University of Kansas Medical Center.

Objectives: To test the feasibility of adding driving simulation tasks to measure visuospatial ability and processing speed to an existing neurocognitive battery for breast cancer survivors (BCSs).

Sample & Setting: 38 BCSs and 17 healthy controls from a cross-sectional pilot study conducted at the University of Kansas Medical Center.

Methods & Variables: Exploratory substudy measuring pupillary response, visuospatial ability, and processing speed during two 10-minute driving simulations (with or without n-back testing) in a sample of BCSs with self-reported cognitive complaints and healthy controls.

Results: Feasibility of measurement of pupillary response during driving simulation was demonstrated. No between-group differences were noted for pupillary response during driving simulation. BCSs had greater visuospatial ability and processing speed performance difficulties than healthy controls during driving simulation without n-back testing and slower n-back response time.

Implications For Nursing: Preliminary evidence showed a possible link between cancer/treatment on visuospatial ability and processing speed in BCSs.
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http://dx.doi.org/10.1188/20.ONF.203-212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057397PMC
March 2020

Cognitive performance and cognitive workload in multiple sclerosis: Two different constructs of cognitive functioning?

Mult Scler Relat Disord 2020 Feb 6;38:101505. Epub 2019 Nov 6.

Multiple Sclerosis Clinic, Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.

Background: Cognitive impairment in individuals with Multiple Sclerosis (iwMS) is traditionally diagnosed using performance measures on cognitive tests. Yet, performance on cognitive tests does not convey the amount of mental effort or cognitive workload it takes to complete the task. The main aim was to evaluate whether cognitive performance and cognitive workload are two different constructs of cognitive functioning in iwMS.

Methods: IwMS were categorized into cognitive impairments (iwMS+, n = 10) and no cognitive impairments (iwMS-, n = 12) using their performance on Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Their scores on BICAMS, Stroop, and trail making tests were compared to age- and education-matched controls (n = 22). Cognitive workload was assessed using the self-reported NASA Task Load Index and the Index of Cognitive Activity, derived from pupillary response.

Results: IwMS+ performed worse on most cognitive tests compared to iwMS- and controls. However, iwMS+ did not report or exhibit greater cognitive workload compared to the other groups. Potential confounding variables, such as sex, use of antidepressants, and symptoms of depression, fatigue, and dysautonomia did not influence the lack of correlation between cognitive performance and cognitive workload in all three groups.

Conclusion: Cognitive performance and cognitive workload seem to measure different cognitive constructs of cognitive functioning in MS. Our results suggest that iwMS+ do not show effective allocation of cognitive resources to compensate for deteriorated performance in cognitive tests.
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http://dx.doi.org/10.1016/j.msard.2019.101505DOI Listing
February 2020

Driving in Parkinson Disease.

Clin Geriatr Med 2020 02 6;36(1):141-148. Epub 2019 Sep 6.

Department of Neurology, University of Iowa, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA; Neurology Service, Veterans Affairs Medical Center, 601 Highway 6 W, Iowa City, IA 52246, USA. Electronic address:

Driving is impaired in most patients with Parkinson disease because of motor, cognitive, and visual dysfunction. Driving impairments in Parkinson disease may increase the risk of crashes and result in early driving cessation with loss of independence. Drivers with Parkinson disease should undergo comprehensive evaluations to determine fitness to drive with periodic follow-up evaluations as needed. Research in rehabilitation of driving and automation to maintain independence of patients with Parkinson disease is in progress.
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http://dx.doi.org/10.1016/j.cger.2019.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8550265PMC
February 2020

Brain activity during dual task gait and balance in aging and age-related neurodegenerative conditions: A systematic review.

Exp Gerontol 2019 12 22;128:110756. Epub 2019 Oct 22.

Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA. Electronic address:

The aims of this systematic review were to investigate (1) real-time brain activity during DT gait and balance, (2) whether changes in brain activity correlate with changes in behavioral outcomes in older adults and people with age-related neurodegenerative conditions. PubMed, PsycINFO, and Web of Science were searched from 2009 to 2019 using the keywords dual task, brain activity, gait, balance, aging, neurodegeneration, and other related search terms. A total of 15 articles were included in this review. Functional near-infrared spectroscopy and electroencephalogram measures demonstrated that older adults had higher brain activity, particularly in the prefrontal cortex (PFC), compared to young adults during dual task gait and balance. Similar neurophysiological results were observed in people with age-related neurodegenerative conditions. Few studies demonstrated a relationship between increased brain activity and better behavioral outcomes. This systematic review supports the notion that aging and age-related neurodegenerative conditions are associated with neuronal network changes, resulting in increased brain activity specifically in the PFC. Further studies are warranted to assess the relationship between increased PFC activation during dual task gait and balance and behavioral outcomes to better optimize the rehabilitation interventions.
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http://dx.doi.org/10.1016/j.exger.2019.110756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876748PMC
December 2019

Post-concussion driving management among athletic trainers.

Brain Inj 2019 16;33(13-14):1652-1659. Epub 2019 Sep 16.

Department of Kinesiology, University of Georgia, Athens, GA, USA.

: To describe and compare athletic trainer (AT) post-concussion driving management practices and opinions.: Cross-sectional.: A survey was sent via email to 8,723 ATs (10.8% response rate[945/8723]) to capture demographics, management practices, and opinions (agreement on a seven-point Likert scale). We used Kruskal-Wallis tests to compare the percentage of patients instructed to refrain from driving across the highest earned a degree, setting, and years certified (alpha = 0.05).: When asked whether they recommended patients with concussion refrain from driving, 58.5%(n = 553/945) of ATs responded "sometimes", 37.9%(n = 358/945) responded "always", and 3.6%(n = 34/945) responded "never". ATs responding "sometimes" or "always" estimated that they instruct 57.6 ± 37.6% of patients with concussion to refrain from driving. ATs most commonly: recommended that patients refrain from driving until symptom resolution(44.7%,n = 399/892); utilized their clinical exam (patient interview/history) to determine when a patient could resume driving(64.9%,n = 579/892); and provided instructions verbally(94.2%,n = 840/892). High school(60.5 ± 37.6%) and clinical ATs(66.5 ± 31.2%) trended toward higher percentages of patients they instruct to refrain from driving relative to college(52.3 ± 38.2%; χ(2) = 5.92, = .052).: ATs recommend driving restrictions to some, but not all, patients with concussion. Overall, ATs recognize post-concussion driving dangers, but do not strongly endorse refraining from driving after a concussion. High school and clinical ATs may manage more adolescent novice drivers and, therefore, act more conservatively.
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http://dx.doi.org/10.1080/02699052.2019.1664765DOI Listing
September 2020

Classification of Mild Stroke: A Mapping Review.

PM R 2019 09 28;11(9):996-1003. Epub 2019 May 28.

B.R.A.I.N. Laboratory (Better Rehabilitation and Assessment for Improved Neurorecovery); Division of Occupational Therapy, The Ohio State University, Columbus, OH.

Persons with mild stroke experience motor and cognitive impairments that negatively affect their health and quality of life. To address these deficits, it is essential for clinicians and researchers to precisely identify mild stroke survivors. Despite the fact that half of all strokes are categorized as mild, no standards exist on what constitutes a "mild" stroke. The purpose of this study is to summarize the current classification of mild stroke using a mapping review approach. Strategies to categorize "mild stroke" severity were explored in 188 papers indexed in the PubMed database. The results indicate that there was substantial variability in the procedures and scoring criteria used to determine mild stroke. To identify persons with mild stroke, researchers have largely applied assessment instruments developed to inform acute stroke care (eg, National Institutes of Health Stroke Scale, Modified Rankin Scale, Barthel Index). Unfortunately, these approaches demonstrate floor effects and fail to detect the long-term disabling impairments that often limit the outcomes of mild stroke survivors. Additional research is warranted to suggest an evidence-based mild stroke categorization strategy that enhances diagnosis, treatment, and referral decisions to the benefit of mild stroke survivors.
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http://dx.doi.org/10.1002/pmrj.12142DOI Listing
September 2019
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