Volume 13:1


Longitudinal Assessments of Gait in Participants Receiving an Investigational Peripheral-Nerve-Cell Therapy and Deep Brain Stimulation in Parkinson's Disease

 

Tuftee T1, Taylor T1, Tarrants W1, McCowan W1, Trenary T, van Horne CG2,3, Quintero JE2,3, Gera G1,2

1Physical Therapy, 2Brain Restoration Center, 3Neurosurgery University of Kentucky, Lexington, KY, USA


Abstract

Study Design: Pilot Study

Purpose: The objective of this pilot feasibility study is to determine how gait is affected in people with Parkinson's disease (PwPD) who received a peripheral nerve tissue (PNT) delivery to the substantia nigra as an adjuvant to deep brain stimulation (DBS) and levodopa therapy.

Methods: Gait parameters measured using the GAITrite software included cadence, gait, velocity, and step length for more and less affected sides. Clinical assessment incorporated Unified Parkinson's Disease Rating Scale (UPDRS) part III and Hoehn and Yahr. Data for 10 participants [7M/3F, 60(8) yr.], were collected in the practically defined OFF state and the ON state at baseline, 6 and 24 months. At baseline, the OFF state received no treatment and the ON state received levodopa only. At 6 and 24 months, the OFF state was a 12+ hour therapy washout where the principal influence would be the PNT only, and the ON state was the best medical therapy, which included levodopa, DBS, and the PNT.

Results: All gait measures including cadence, velocity, and step length for more and less affected sides increased from baseline to six months in both OFF and ON states. Similar improvements were observed from baseline to six months in the clinical measures of UPDRS III and Hoehn and Yahr scores.

Conclusion: Over the course of two years, participants with PNT did not show worsening gait and/or clinical outcome measures. Our data provides preliminary evidence for the further examination of PNT in conjunction with DBS and levodopa to provide long-term improvements in gait. In a population with a progressive degenernative disease, even maintaining gait parameters may be helpful.




Applying a Biopsychosocial Treatment Approach to an Adolescent with a Centralized Pain State

Carlie Austin Kennon, PT, DPT & Leslie Taylor, PT, PhD, MS
Mercer University, College of Health Professions, Department of Physical Therapy, Atlanta, GA

Abstract 
Study Design: Case Study
Background: Amplified musculoskeletal pain syndrome (AMPS) is characterized by perceptions of intense physical pain without a clear etiology and is often associated with psychosocial contributors. Patients may present with multiple painful points, with or without autonomic signs, and hypervigilance. Traditional treatment involves psychological counseling as an adjunct to intensive physical therapy. Children and adolescents with untreated chronic pain have a high risk of developing pain syndromes later in life.

Purpose:The purpose of this case study is to demonstrate the importance of applying a biopsychosocial treatment approach into the physical therapy plan of care to improve tolerance to physical activity and functional capacity in an adolescent patient presenting with a centralized pain state. 

Case Description: A 13-year-old male presented to an outpatient physical therapy clinic with widespread constant pain and weakness. The patient’s pain began as migraines that progressed to diffuse pain, allodynia, and an eventual inability to continue attending school. The patient demonstrated fear avoidant and hypervigilant behaviors.

Outcomes: After 12 weeks of treatment, activity tolerance increased from 15 minutes to 34 minutes. At 17 weeks, the patient’s Two Minute Walk Test increased from 405’ to 900’.

Discussion: Outcomes for this patient suggest that incorporating a biopsychosocial approach to physical therapy for a child with AMPS is beneficial in improving activity tolerance and gait speed. Cognitive restructuring and enhancing self-efficacy augment physical interventions when underlying psychosocial factors and familial dynamics are involved.

Conclusion: It is imperative that physical therapists consider ways to address the myriad of contributing factors to pediatric pain syndromes, including cognitive behavior therapy in practice with pain science education. Early recognition of these conditions and access to multimodal treatment is crucial to reduce the risk of developing chronic pain conditions as adults.


Targeted strength training using sling suspension exercises for total knee arthroplasty rehabilitation in a patient with relapsing-remitting MS: A case report
Caroline Esposito Seethaler, PT, DPT & Leslie Taylor, PT, PhD, MS 
Mercer University, College of Health Professions, Department of Physical Therapy, Atlanta, GA 

Abstract
Background and Purpose: Relapsing-remitting multiple sclerosis (RRMS) is a progressive neurologic disorder which can lead to fatigue, muscular weakness, and other symptoms ultimately decreasing the patient’s functional mobility. The purpose of this case report is to evaluate the effectiveness of targeted strength training using sling suspension exercises (SSEs) to address specific muscular weakness in a patient with RRMS following a total knee arthroplasty (TKA).  

Case Description: A 74-year-old female with a 43-year history of RRMS underwent a TKA. The patient’s prior level of function included community ambulation with use of a front-wheeled walker (FWW) and independent performance of activities of daily living (ADLs). Comorbidities include anxiety, asthma, fibromyalgia, osteoarthritis, osteoporosis, and scoliosis. Physical therapy (PT) intervention began on the first postoperative day and included standard knee range of motion (ROM) exercises, general lower extremity (LE) strengthening exercises, and functional retraining including gait and stair training. After three months of PT, the patient experienced a RRMS relapse, leading to functional decline.  Secondary to the RRMS relapse, the patient was unable to ambulate, required a wheelchair for community mobility and needed maximum assistance to complete ADLs. She presented with new-onset dynamic genu valgum due to decreased gluteal activation and lack of knee extension during gait secondary to decreased quadriceps activation. Sling suspension (redcord®) was incorporated to facilitate activation of these specific muscle groups, as it can be used to target specific muscle groups for neuromuscular re-education and strength training. The SSEs included double-leg bridging, single-leg bridging, and terminal knee extension.  

Outcome Measures: The patient demonstrated increased strength as evidenced by decreased assistance from redcord® bungie cords to perform LE strengthening, increased manual muscle testing (MMT) scores on a 0-5 scale, improved timed up and go (TUG) completion time, and decreased percent dysfunction on the LE Functional Scale (LEFS).  

Conclusions: Low-load exercise training is indicated for patients with RRMS post-surgery to mitigate fatigue and disease exacerbation, and SSEs were found to increase LE strength in a patient with RRMS post-TKA.