Evaluating a Speech-Specific and a Computerized Step-Training-Specific Rhythmic Intervention in Parkinson's Disease: A Cross-Over, Multi-Arms Parallel Study

Background:Recent studies suggest movements of speech and gait in patients with Parkinson's Disease (PD) are impaired by a common underlying rhythmic dysfunction. If this being the case, motor deficits in speech and gait should equally benefit from rhythmic interventions regardless of whether it is a speech-specific or step-training-specific approach.Objective:In this intervention trial, we studied the effects of two rhythmic interventions on speech and gait. These rhythmic intervention programs are similar in terms of intensity and frequency (i.e., 3x per week, 45 min-long sessions for 4 weeks in total), but differ regarding therapeutic approach (rhythmic speech vs. rhythmic balance-mobility training).Methods:This study is a cross-over, parallel multi-arms, single blind intervention trial, in which PD patients treated with rhythmic speech-language therapy (rSLT; N = 16), rhythmic balance-mobility training (rBMT; N = 10), or no therapy (NT; N = 18) were compared to healthy controls (HC; N = 17; matched by age, sex, and education: p > 0.82). Velocity and cadence in speech and gait were evaluated at baseline (BL), 4 weeks (4W-T1), and 6 months (6M-T2) and correlated.Results:Parameters in speech and gait (i.e., speaking and walking velocity, as well as speech rhythm with gait cadence) were positively correlated across groups (p < 0.01). Statistical analyses involved repeated measures ANOVA across groups and time, as well as independent and one-samples t-tests for within groups analyses. Statistical analyses were amplified using Reliable Change (RC) and Reliable Change Indexes (RCI) to calculate true clinically significant changes due to the treatment on a patient individual level. Rhythmic intervention groups improved across variables and time (total Mean Difference: 3.07 [SD 1.8]; 95% CI 0.2–11.36]) compared to the NT group, whose performance declined significantly at 6 months (p < 0.01). HC outperformed rBMT and NT groups across variables and time (p < 0.001); the rSLT performed similarly to HC at 4 weeks and 6 months in speech rhythm and respiration.Conclusions:Speech and gait deficits in PD may share a common mechanism in the underlying cortical circuits. Further, rSLT was more beneficial to dysrhythmic PD patients than rBMT, likely because of the nature of the rhythmic cue.

Investigating the Development of Individuals with Mental and Physical Problems Receiving Water Therapy in a Special Education and Rehabilitation Center

Investigation of the physical and psychological development challenged individuals receiving water therapy in a private education rehabilitation center. The aim of this study is to investigate the physical and psychological development challenged individuals receiving water therapy in a private education rehabilitation center.5 children with mentally and physically problems who took water therapy in the Special Education Rehabilitation Center participated in the study. Children aged between 3-8. Children who have mentally problematic, who have participated in the research, have severe, moderate and mild mental problems and who have problems physically also have placenta, quatri plaque, spina bifida etc. children with orthopedic insufficiency.Special mobility training program was prepared for the children to be able to make joint problems for children with mental problems and physical problems. While the program was being prepared, support was received from special educator, water therapist and repertoire people.The study was administered 4 months, 2 days a week and 60-90 minutes. At the beginning of the research, the children who had mental problems were afraid of entering the water, they did not comply with the commands, they did not want to be separated from the mother and father.At the end of the research process, children with mental problems enter the water comfortably and even hurry to enter, they are not afraid of water, they are more adaptable to the commands, they continue to work separately from their parents, they are more willing to enter the water in children who have problems with orthopedic problems. It was observed that most of the children who wanted to move in the water, they were mostly able to perform the movements, and the majority of the children (90%) who had walking pants had walking exercises.

Pediatric Powered Mobility Training: Powered Wheelchair Versus Simulator-Based Practice

Background: Many children with physical disabilities lack independent mobility. Powered wheelchair mobility can be a viable option, but users must be proficient drivers to ensure safety. To become a proficient driver, children need opportunities to practice. As is often the case, powered wheelchairs are scarce and direct therapy hours dedicated to powered mobility are often limited. Alternative options are needed to enable safe, unsupervised practice. Simulator-based learning has been shown to be an effective training method for powered mobility and other skill-based tasks for adults. The goal of this study was to compare two training methods of powered mobility, powered wheelchair practice (control group) versus simulator-based (experimental group) practice to determine whether simulation is a feasible and effective method for children and adolescents. The hypothesis was that children practicing on either modality at home supervised by a caregiver would similarly improve their powered mobility skills. Method: Participants included 36 children and adolescents (23 males, 13 females) with cerebral palsy and neuromuscular diseases, aged 6-18 years (mean age: 10 y, 7 mo, SD: 3y, 7 mo). Data were collected and compared at baseline and after 12 weeks of home based practice of powered mobility via a powered wheelchair or a simulator. Thirty participants completed the study and were included in the analysis Powered mobility ability was determined by the Powered Mobility Program (PMP), the Israeli Ministry of Health’s Powered Mobility Proficiency Test (PM-PT) and the Assessment of Learning Powered Mobility use (ALP). Participants (21/30) were interviewed after study completion by an independent researcher concerning the child’s and parent’s experiences regarding practice time and user experience (e.g., satisfaction with training program, views of its importance). Results: Both the powered wheelchair and simulator-based practice groups achieved significant improvement following the practice period as assessed by the PMP and PM-PT assessments, with no significant difference between them. A significant improvement was found in the ALP assessment outcomes for the powered wheelchair group only. All participants practiced for the required amount of time and both groups reported a similar user experience. Conclusions: The results demonstrate that simulator-based practice is an effective training option for powered mobility for children aged 6-18 years old with physical disabilities. Simulator-based practice can provide a safe environment to practice driving skills that could endanger the child (e.g., out of doors). This is the first study, to our knowledge, that compares two different wheelchair training methods. Trial Registration: The study protocol for this clinical trial was registered at ClinicalTrials.gov under the ID NCT04531488 and the title “ Simulator Based Powered Mobility Training of Children With Special Needs ”(Protocol ID: 004-17, URL: https://rb.gy/dfeslr).

Effects of Rhythmic Interventions on Cognitive Abilities in Parkinson’s Disease

<b><i>Objective:</i></b> The objective of this study is to compare 2 different rhythmic, high-intensive interventions, that is, rhythmic speech-language therapy (rSLT) versus rhythmic balance-mobility training (rBMT), against a no-therapy (NT) condition in patients with Parkinson’s disease and against healthy controls (HCs) with regard to the change in or enhancement of cognitive abilities. <b><i>Methods:</i></b> The 4 groups (rSLT: <i>N</i> = 16; rBMT: <i>N</i> = 10; NT: <i>N</i> = 18; and HC: <i>N</i> = 17) were matched for age, sex, and educational level and were tested in 6 cognitive domains: working memory, executive function, visuo-construction, episodic memory, attention, and word retrieval. Assessments took place at baseline, at 4 weeks (T1), and at 6 months (T2). Rhythmic interventions were provided 3 times per week for 4 weeks in total. To analyze true intervention effects between groups and across time, statistical analyses included <i>reliable change index.</i> Intergroup differences were assessed with multivariate assessment of variance, while differences within groups were assessed with 95% confidence intervals of mean difference. <b><i>Results:</i></b> The rSLT improved <i>working memory</i> and <i>word retrieval</i> (<i>p</i> &#x3c; 0.05), possibly a beneficial transfer effect of the training method per se. In contrast, the NT group worsened in <i>phonemic</i> and <i>semantic shifting</i> (<i>p</i> &#x3c; 0.01). Observed improvements in <i>flexibility</i> and in <i>episodic memory</i> in the HC may be linked to training effects of retesting. <b><i>Conclusions:</i></b> Rhythmic cues are resistant to neurodegeneration and have a strong motivating factor. As thus, these may facilitate high-intensive and demanding training. Although both trainings were superior to NT, the improvement of cognitive abilities depends on the specific training method. Further, therapy may be more effective when delivered by a therapist rather than by an impersonal computer program.

Seamless Wayfinding by a Deafblind Adult on an Urban College Campus: A Case Study on Wayfinding Performance, Information Preferences, and Technology Requirements

This article reports on an empirical evaluation of the experience, performance, and perception of a deafblind adult participant in an experimental case study on pedestrian travel in an urban environment. The case study assessed the degree of seamlessness of the wayfinding experience pertaining to routes that traverse both indoor and outdoor spaces under different modalities of technology-aided pedestrian travel. Specifically, an adult deafblind pedestrian traveler completed three indoor/outdoor routes on an urban college campus using three supplemental wayfinding support tools: a mobile application, written directions, and a tactile map. A convergent parallel mixed-methods approach was used to synthesize insights from a pre-travel questionnaire, route travel video recordings, post-travel questionnaire, and post-travel interview. Our results indicate that wayfinding performance and confidence differed considerably between the three wayfinding support tools. The tactile map afforded the most successful wayfinding and highest confidence. Wayfinding performance and confidence were lowest for the mobile application modality. The simplicity of use of a wayfinding tool is paramount for reducing cognitive load during wayfinding. In addition, information that does not match individual, user-specific information preferences and needs inhibits wayfinding performance. Current practice pertaining to the representation of digital spatial data only marginally accounts for the complexity of pedestrian human wayfinding across the gamut of visual impairment, blindness, and deafblindness. Robust orientation and mobility training and skills remain key for negotiating unexpected or adverse wayfinding situations and scenarios, irrespective of the use of a wayfinding tool. A substantial engagement of the deafblind community in both research and development is critical for achieving universal and equitable usability of mobile wayfinding technology.

Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial

Introduction: Mobility impairments are among the main causes of falls in older adults and patients with neurological diseases, leading to functional dependence and substantial health care costs. Feedback-based interventions applied in controlled, laboratory environments have shown promising results for mobility rehabilitation, enhancing the benefits of standard therapy. However, the effectiveness of sensor-based feedback to improve gait in actual outpatient physical therapy settings is unknown. The proposed trial examines the effectiveness of a physical therapist-assisted, visual feedback system using wearable inertial sensors, Mobility Rehab, for mobility training in older adults with gait disturbances in an outpatient clinic.Methods: The study is a single site, pragmatic clinical trial in older adults with gait disturbances. Two hundred patients undergoing their outpatient rehabilitation program are assigned, by an independent assistant, for screening by one of four therapists, and assigned to either a standard physical therapy or therapist-assisted feedback therapy. Both groups train twice a week for 6 weeks. Four physical therapists were randomized and stratified by years of experience to deliver standard therapy or therapist-assisted feedback rehabilitation. Each session is 45 min long. Gait is trained for 30 min. The additional 15 min include exercises for endurance, strength, and static and dynamic balance in functional tasks. Mobility Rehab uses unobtrusive, inertial sensors on the feet and belt with real-time algorithms to provide real-time feedback on gait metrics (i.e., gait speed, double support time, foot clearance, angle at foot strike, and arm swing), which are displayed on a hand-held monitor. Blinded assessments are carried out before and after the intervention. The primary outcome measure is subjects' perception of balance as measured by the Activities-specific Balance Confidence scale. Gait speed, as measured with wearable inertial sensors during walking, is the secondary outcome measure.Discussion: We hypothesize that therapist-assisted feedback rehabilitation will be more effective than standard rehabilitation for gait. Feedback of motor performance plays a crucial role in rehabilitation and objective characterization of gait impairments by Mobility Rehab has the potential to improve the accuracy of patient-specific gait feedback.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03869879.

Business Strategies in HR in Times of Crisis: The Case of Agri-Food Industry in Central Greece

Crisis, in whatever form it takes, is a challenge for modern business. The challenge lies in the fact that a company is prepared to balance the difficult conditions that are created, while preserving their business interest and efficiency. Thus, companies focus only on their perceived fixed bases, those that are in the internal environment such as the human capital. The need for better human resource management is more urgent than ever, and the burden on the business department is particularly great. The aim of this qualitative research is to highlight the strategies that were developed by agri-food companies in Greece and contribute to the maintenance and motivation of employees in the context of economic crisis. The methodology of this study is based on in depth interviews that were conducted in focus group discussion. Eleven companies from the agri-food sector in the region of Central Greece participated in the research. The executives highlighted three different strategies that were developed by agri-food companies in Greece, which focused on internal mobility, training and appraisal performance. Companies had to face different difficulties to use these strategies, but most of them proved that they can face their weaknesses and apply these strategies in a turbulent period like a financial crisis.