The Influence of Dopaminergic Medication on Regularity and Determinism of Gait and Balance in Parkinson's Disease: A Pilot Analysis.

: Understanding how dual-tasking and Parkinson's disease medication affect gait and balance regularity can provide valuable insights to patients, caregivers, and clinicians regarding frailty and fall risk. However, dual-task gait and balance studies in PD most often only employ linear measures to describe movement regularity. Some have used nonlinear techniques to analyze PD performances, but only in the on-medication state.

Practical approaches for supporting informed consent in neonatal clinical trials.

The survival and health of preterm and critically ill infants have markedly improved over the past 50  years, supported by well-conducted neonatal research. However, newborn research is difficult to undertake for many reasons, and obtaining informed consent for research in this population presents several unique ethical and logistical challenges. In this article, we explore methods to facilitate the consent process, including the role of checklists to support meaningful informed consent for neonatal clinical trials.

Recent-Onset Altered Mental Status: Evaluation and Management.

Potential precipitating factors for the recent onset of altered mental status (AMS) include primary central nervous system insults, systemic infections, metabolic disturbances, toxin exposure, medications, chronic systemic diseases, and psychiatric conditions. Delirium is also an important manifestation of AMS, especially in older people who are hospitalized. Clinicians should identify and treat reversible causes of the AMS, some of which require urgent intervention to minimize morbidity and mortality.

Distribution, Dynamics, and Diversity of Questing Ticks in the Lower Midwest.

We investigated the spatiotemporal patterns of medically important tick species in southcentral Indiana in 2018 and 2019. In recent decades, both Amblyomma americanum (Acari: Ixodidae) (Linnaeus) and Ixodes scapularis (Acari: Ixodidae) (Say) have been expanding their ranges into the Midwest. We report updates to the status of A.

Evaluation of Motor and Cognitive Performance in People with Parkinson's Disease Using Instrumented Trail-Making Test.

Introduction: Parkinson's disease (PD) progressively impairs motor and cognitive performance. The current tools to detect decline in motor and cognitive functioning are often impractical for busy clinics and home settings. To address the gap, we designed an instrumented trail-making task (iTMT) based on a wearable sensor (worn on the shin) with interactive game-based software installed on a tablet.

'Medical Clearance' of Patients With Acute Mental Health Needs in the Emergency Department: A Literature Review and Practice Recommendations.

Introduction: Emergency departments have seen increasing numbers of patients presenting with acute mental illness. Currently, there is not a standard for assessing the medical stability of these patients prior to transfer to inpatient psychiatric services, which causes unnecessary delays in patient care.

Objective: Provide a literature review and multidisciplinary expert consensus recommendations to simplify and expedite the medical evaluation of patients requiring admission to inpatient psychiatric facilities.

The influence of dopaminergic medication on gait automaticity in Parkinson's disease.

Dual-tasking studies have shown that gait automaticity in Parkinson's disease (PD) is significantly diminished. Additionally, it's well accepted that dopaminergic medication improves single-task gait. But, how dopaminergic medication influences gait automaticity in PD has not been sufficiently understood.

The influence of dopaminergic medication on balance automaticity in Parkinson's disease.

Background: Studies have shown that dual-task standing balance in Parkinson's disease (PD) is significantly diminished. Additionally, it is well accepted that dopaminergic medication improves dynamic balance (Berg Balance Scale, mini-BESTest), but standing balance (force platform posturography) may suffer. What remains unknown is how dopaminergic medication influences standing balance automaticity in PD.

A new fall-inducing technology platform: Development and assessment of a programmable split-belt treadmill.

Typical technologies for fall reduction/prevention training incorporate mechanical obstacles or cables/pulleys to induce trip or slip perturbations. This paper proposes a technology platform that uses a split-belt treadmill equipped with one force plate underneath each belt and a real-time gait phase detection algorithm. A proof-of-concept study validates the method for inducing trip perturbations in healthy young adults (n=10) by using kinematic measures from a full body motion capture system to characterize the effects of the perturbations.

The Effects of Coding Schemes on Vibrotactile Biofeedback for Dynamic Balance Training in Parkinson's Disease and Healthy Elderly Individuals.

Coding scheme for earlier versions of vibrotactile biofeedback systems for balance-related applications was primarily binary in nature, either on or off at a given threshold (range of postural tilt), making it unable to convey information about error magnitude. The purpose of this paper was to explore the effects of two coding schemes (binary versus continuous) for vibrotactile biofeedback during dynamic weight-shifting exercises that are common physical therapists' recommended balance exercises used in clinical settings. Nine individuals with idiopathic Parkinson's disease and nine healthy elderly individuals participated in this paper.

The Effect of Vibrotactile Cuing on Recovery Strategies From a Treadmill-Induced Trip.

Effective fall prevention technologies need to detect and transmit the key information that will alert an individual in advance about a potential fall. This study investigated advanced vibrotactile cuing that may facilitate trip recovery for balance-impaired individuals who are prone to falling. A split-belt treadmill that simulated unpredictable trip perturbations was developed to compare balance recovery without and with cuing.

Vibrotactile cuing revisited to reveal a possible challenge to sensorimotor adaptation.

Motor responses to unexpected external perturbations require the adjustment of the motor commands driving the ongoing activity. Strategies can be learned with practice to compensate for these unpredictable perturbations (e.g.

Respiratory Protection Toolkit: Providing Guidance Without Changing Requirements-Can We Make an Impact?

International travel and infectious respiratory illnesses worldwide place health care workers (HCWs) at increasing risk of respiratory exposures. To ensure the highest quality safety initiatives, one health care system used a quality improvement model of Plan-Do-Study-Act and guidance from Occupational Safety and Health Administration's (OSHA) May 2015 Hospital Respiratory Protection Program (RPP) Toolkit to assess a current program. The toolkit aided in identification of opportunities for improvement within their well-designed RPP.

Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD), the hepatic manifestation of the metabolic syndrome, is the leading cause of chronic liver disease. Treatments target lifestyle modification and improvement of underlying risk factors. Noninvasive biomarkers for diagnosis and staging of NAFLD and safe, cost-effective treatments for patients with nonalcoholic steatohepatitis (NASH) and/or NASH-related cirrhosis are currently under investigation.

Validity and reliability of two protocols for measuring Reachable Workspace Volume in able-bodied and stroke subjects.

Background: Researchers are measuring Reachable Workspace Volume (RWV) to assess the effects of various interventions on impaired upper extremity function. These measurement protocols have not been validated.

Objective: Assess the validity and reliability of two RWV protocols.

The effects of different sensory augmentation on weight-shifting balance exercises in Parkinson's disease and healthy elderly people: a proof-of-concept study.

Background: Earlier versions of biofeedback systems for balance-related applications were intended primarily to provide "alarm" signals about body tilt rather than to guide rehabilitation exercise motion. Additionally, there have been few attempts to evaluate guidance modalities for balance rehabilitation exercises. The purpose of this proof-of-concept study is to evaluate the effects of guidance modalities during common dynamic weight-shifting exercises used in clinical settings.

Strength and endurance adaptations to functional electrical stimulation leg cycle ergometry in spinal cord injury.

Objectives: To describe adaptations in power output, quadriceps muscle strength, and fatigability that occur during a 13-week regimen of Functional Electrical Stimulation Leg Cycle Ergometry (FES-LCE) in Spinal Cord Injury (SCI). To identify differences in outcomes between individuals with complete and incomplete motor impairment.

Design: Observational and longitudinal.

Societal costs of intrathecal drug delivery systems--an administrative analysis based on patient claims.

Objectives: To quantify the overall and disaggregated societal costs of intrathecal drug delivery systems (IDDSs) in the treatment of pain and spasticity in the United States.

Materials And Methods: A retrospective review of medical and pharmacy claims was performed on patients with IDDS. Patients were divided into three cohorts according to the conditions that their IDDSs were intended to treat pain, spasticity, or both.

Evaluation of muscle fatigue of wheelchair basketball players with spinal cord injury using recurrence quantification analysis of surface EMG.

Wheelchair basketball is the most popular exercise activity among individuals with spinal cord injury (SCI). The purpose of this study was to investigate muscular endurance and fatigue in wheelchair basketball athletes with SCI using surface electromyography (SEMG) and maximal torque values. SEMG characteristics of 10 wheelchair basketball players (WBP) were compared to 13 able-bodied basketball players and 12 sedentary able-bodied subjects.

A comprehensive three-dimensional dynamic model of the human head and trunk for estimating lumbar and cervical joint torques and forces from upper body kinematics.

Linked-segment representations of human body dynamics have been used extensively in biomechanics, ergonomics, and rehabilitation research to systemize thinking, make predictions, and suggest novel experiments. In the scope of upper body biomechanics, these models play an even more essential role as the human spine dynamics are difficult to study in vivo. No study exists to date, however, that specifically disseminates the technical details of a comprehensive three-dimensional model of the upper body for the purpose of estimating spinal joint torques and forces for a wide range of scenarios.

Classification of rhythmic locomotor patterns in electromyographic signals using fuzzy sets.

Background: Locomotor control is accomplished by a complex integration of neural mechanisms including a central pattern generator, spinal reflexes and supraspinal control centres. Patterns of muscle activation during walking exhibit an underlying structure in which groups of muscles seem to activate in united bursts. Presented here is a statistical approach for analyzing Surface Electromyography (SEMG) data with the goal of classifying rhythmic "burst" patterns that are consistent with a central pattern generator model of locomotor control.

Robot-assisted gait training for patients with hemiparesis due to stroke.

Robot-assisted devices are becoming a popular alternative to manual facilitation in stroke rehabilitation. These devices have the potential to reduce therapist burden and treatment costs; however, their effectiveness in terms of functional recovery remains in question. This pilot study compared the outcomes of a stroke rehabilitation program that incorporates robot-assisted gait training (RAGT) with a more traditional therapy program that does not.

A complete, non-lumped, and verifiable set of upper body segment parameters for three-dimensional dynamic modeling.

Dynamic models of the human trunk have been extensively used to investigate the biomechanics of lower back pain and postural instability in different populations. Despite their diverse applications, previous models rely on intrinsic upper body segment parameters (UBSP), e.g.