Nervous System Diseases Commons^™

Sedentary Behavior Modifies The Effect Of Balance Rehabilitation On Balance Discordance In Parkinson’S Disease, Franziska Albrecht, Sarah J. Conklin, Andrew Hooyman, Daniel S. Peterson, Jason K. Longhurst, Erika Franzén

Physical Therapy Faculty Articles and Research

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Individuals with Parkinson’s disease (PD) often experience a misalignment between their perceived and actual balance ability, known as balance discordance, which has been associated with falls. We examined whether high-intensity balance and gait training (HiBalance) alters balance discordance in individuals with PD, and whether baseline sedentary behavior influences these changes. A secondary analysis examining pre- to post-intervention discordance changes of two HiBalance clinical trials (N = 97) using linear regression with interactions between sedentary behavior and pre-intervention discordance. The sample included two cohorts: one clinical and one research based. The model including sedentary behavior and its interaction with pre-intervention …

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Using Diffusion Mri To Relate Hippocampal Subfield Microstructure To Delayed Verbal Memory In Cognitively Intact Individuals At Genetic Risk For Developing Alzheimer's Disease, Jennapher Lingo Vangilder, Andrew Hooyman, Sasha Hakhu, Kurt G. Schilling, Leland S. Hu, Yuxiang Zhou, Richard J. Caselli, Leslie C. Baxter, Scott C. Beeman

Physical Therapy Faculty Articles and Research

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Intervention to delay the onset of Alzheimer's disease (AD) is an important treatment strategy but detecting at-risk individuals before significant disease progression remains challenging. This study evaluates the relationship between hippocampal microstructure and verbal cognition in cognitively intact older adults, focusing on the differences between APOΕ ε4 allele carriers and noncarriers. Participants (n = 41 noncarriers, 33 carriers) over 60 years old (mean ± SD: carriers 71 ± 6.6; noncarriers 71 ± 6.4 years) underwent diffusion-weighted magnetic resonance imaging (dMRI) and volumetric assessments. We assessed hippocampal structure, including microstructure, using Neurite Orientation Dispersion and Density Imaging (NODDI), diffusion tensor …

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Discordance Between Actual And Perceived Balance Ability Relates To Quality Of Life And Global Cognition In A Clinical Sample Of Parkinson Patients, Daniel S. Peterson, Jason K. Longhurst, Franziska Albrecht, Joanna Weller, Jennifer Vasquez, Myassar Zarif, Mark Gudesblatt, Andrew Hooyman

Physical Therapy Faculty Articles and Research

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Background

Misalignment between actual and perceived balance ability provides relevant information to understand functional deficits and fall risk. However, few studies have provided a continuous quantification of misalignment in neurological populations such as people with Parkinson's disease (PD).

Objective

Determine whether a continuous quantification of misalignment between actual and perceived balance ability, discordance, relates to functional outcomes such as quality of life and cognition.

Methods

Actual (gait velocity), and perceived (Activities of Balance Confidence) balance, cognition (measured via a computer-based cognitive assessment), and mobility-related quality of life were captured in a clinical sample of 95 people with PD. Primary outcomes …

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Biomarkers In Alzheimer's Disease Clinical Trials: 2025, Amanda M. Leisgang Osse, Yadi Zhou, Jefferson W. Kinney, Andrew Hooyman, Ayan Sengupta, Jorge Fonseca, Aaron H. Burstein, Laura Nisenbaum, Howard M. Fillit, Feixiong Cheng, Jeffrey L. Cummings

Physical Therapy Faculty Articles and Research

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Biomarkers play an important role in Alzheimer's disease (AD) clinical trials in several contexts of use, including defining trial eligibility and serving as outcome measures. Utilizing clinicaltrials.gov, a registry of clinical trials, we assessed biomarker usage across all active AD disease-targeted therapeutic (DTT) trials. Biomarkers are widely used in AD DTT trials, with 84% including a fluid, imaging, and/or digital biomarker, either as an inclusion criterion or as an outcome measure. In DTT trials, biomarkers were included in 83% of Phase 3 trials, 91% of Phase 2 trials, and 72% of Phase 1 trials. Biomarkers were used for trial inclusion …

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Evaluating The Effect Of Ethnicity And Amyloid On Gait Speed In The Healthy Aging Brain Study-Health Disparities Study, Alexandra M. Reed, Andrew Hooyman, Edward Ofori, Sydney Y. Schaefer

Physical Therapy Faculty Articles and Research

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Background

Many novel Alzheimer's disease (AD) biomarkers have been studied in non-Hispanic White populations, despite Hispanic/Latino adults being 1.5 times more likely to develop AD and receiving a later diagnosis. Equitable, accessible assessments are needed to identify individuals at risk earlier. While cognitive screening monitors early AD signs, neuropsychological tests are often inequitable across ethnicity, race, and other social determinants of health. However, we have shown that performance-based motor assessments may be less susceptible to demographic factors than memory tests, and may be more equitable for screening older adults. Gait speed has been linked to elevated amyloid in non-Hispanic White …

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Twenty Minutes Of Corsi Block Tapping Task Training Does Not Improve Mental Rotation In Adults With Stroke, Sarah A. Kettlety, Giuliet L. Kibler, Andrew Hooyman, Christina K. Holl, Sydney Y. Schaefer, Kristan A. Leech

Physical Therapy Faculty Articles and Research

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Background: Visuospatial function is commonly impaired post-stroke and is associated with motor learning and recovery. A single, twenty-minute Corsi Block Tapping Task (CBTT) training session improved visuospatial function in young neurotypical adults; however, it is unclear whether this training would improve visuospatial function in adults with stroke.

Objective: To understand if a single, twenty-minute CBTT training session improved visuospatial function in adults with stroke compared to a no-training control group of adults with stroke.

Methods: Participants post-stroke were assigned to one of two groups. The training group completed twenty minutes of computerized CBTT training. The control group completed a survey …

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Two-Year Follow-Up Of Gait And Postural Control Following Initiation Of Recombinant Human Tripeptidyl Intracerebroventricular Enzyme Replacement Therapy In Two Atypical Cln2 Patients, Rahul Soangra, Marybeth Grant-Beuttler, Harriet Chang, Raymond Y. Wang

Physical Therapy Faculty Articles and Research

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Neuronal ceroid lipofuscinosis type 2 (CLN2) is a rapidly progressive neurodegenerative disorder leading to premature mortality. Ambulatory CLN2 patients typically receive standard of care treatment through biweekly intracerebroventricular (ICV) enzyme replacement therapy (ERT) involving recombinant human tripeptidyl peptidase 1, known as cerliponase alfa (Brineura^®, Biomarin Pharmaceuticals). This study longitudinally assessed the impact of ICV cerliponase alfa ERT on gait, and postural control across a two-year span in two siblings diagnosed with atypical CLN2 disease. Both participants, ID01 (18 years and 8 months old at enrollment) and ID02 (13 years and 3 months old at enrollment), exhibited symptomatic characteristics …

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Discordance Between Balance Ability And Perception Is Associated With Falls In Parkinson’S Disease: A Coordinated Analysis, Jason K. Longhurst, Andrew Hooyman, Merrill R. Landers, Martina Mancini, Erika Franzén, Breiffni Leavy, Hanna Johansson, Daniel Peterson

Physical Therapy Faculty Articles and Research

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Background: The congruence or discordance between actual and perceived balance ability has been proposed to be linked to functional outcomes such as falls. However, gaps remain in our ability to quantify discordance, and its relationship to relevant outcomes.

Objective: To investigate a novel quantification of concordance/discordance between balance performance and perception and determine the relationship to falls among people with Parkinson’s disease (PwPD).

Methods: Data from 244 PwPD were aggregated from 5 previously conducted studies. Variables extracted included age, sex, Activities-Specific Balance Confidence scale (ABC; perceived balance), Timed Up and Go (TUG; balance performance), Movement Disorder Society Unified Parkinson Disease …

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A Single-Center, Assessor-Blinded, Randomized Controlled Clinical Trial To Test The Safety And Efficacy Of A Novel Brain-Computer Interface Controlled Functional Electrical Stimulation (Bci-Fes) Intervention For Gait Rehabilitation In The Chronic Stroke Population, Piyashi Biswas, Lucy Dodakian, Po T. Wang, Christopher A. Johnson, Jill See, Vicky Chan, Cathy Chou, Wendy Lazouras, Alison L. Mckenzie, David J. Reinkensmeyer, Danh V. Nguyen, Steven C. Cramer, An H. Do, Zoran Nenadic

Physical Therapy Faculty Articles and Research

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Background

In the United States, there are over seven million stroke survivors, with many facing gait impairments due to foot drop. This restricts their community ambulation and hinders functional independence, leading to several long-term health complications. Despite the best available physical therapy, gait function is incompletely recovered, and this occurs mainly during the acute phase post-stroke. Therapeutic options are limited currently. Novel therapies based on neurobiological principles have the potential to lead to long-term functional improvements. The Brain-Computer Interface (BCI) controlled Functional Electrical Stimulation (FES) system is one such strategy. It is based on Hebbian principles and has shown promise …

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Examining The Diagnostic Accuracy Of A Novel Performance-Based Test For Alzheimer's Disease Screening, A. M. Reed, K. Duff, L. E. Dibble, S. S. Paul, Andrew Hooyman, S. Y. Schaefer

Physical Therapy Faculty Articles and Research

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Affordable, rapid methods for identifying mild Alzheimer’s disease (AD) are needed. A simple, brief performance-based test involving the learning of functional upper-extremity movements has been developed and is associated with AD pathology and functional decline. However, its specificity to AD relative to other neurodegenerative diseases that present with motor impairment is unknown. This study examined whether this novel test could distinguish between 34 participants diagnosed with mild AD (Clinical Dementia Rating Scale = 0.5-1) from 23 participants with mild-to-moderate Parkinson’s disease (PD) (Hoehn & Yahr = 2-3) using Receiver Operating Characteristic analysis of secondary data from two separate clinical trials. …

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Multi-Site Identification And Generalization Of Clusters Of Walking Behaviors In Individuals With Chronic Stroke And Neurotypical Controls, Natalia Sánchez, Nicolas Schweighofer, Sara J. Mulroy, Ryan T. Roemmich, Trisha M. Keshar, Gelsy Torres-Oviedo, Beth E. Fisher, James M. Finley, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

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Background

Walking patterns in stroke survivors are highly heterogeneous, which poses a challenge in systematizing treatment prescriptions for walking rehabilitation interventions.

Objectives

We used bilateral spatiotemporal and force data during walking to create a multi-site research sample to: (1) identify clusters of walking behaviors in people post-stroke and neurotypical controls and (2) determine the generalizability of these walking clusters across different research sites. We hypothesized that participants post-stroke will have different walking impairments resulting in different clusters of walking behaviors, which are also different from control participants.

Methods

We gathered data from 81 post-stroke participants across 4 research sites and …

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Age And Sex Effects On Superg Performance Are Consistent Across Internet Devices, Andrew Hooyman, Sidney Y. Schaefer

Physical Therapy Faculty Articles and Research

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There have been recent advances in the application of online games that assess motor skill acquisition/learning and its relationship to age and biological sex, both of which are associated with dementia risk. While this online motor learning assessment (called Super G), along with other computer-based cognitive tests, was originally developed to be completed on a computer, many people (including older adults) have been shown to access the internet through a mobile device. Thus, to improve the generalizability of our online motor skill learning game, it must not only be compatible with mobile devices but also yield replicable effects of various …

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Identifying The Neural Correlates Of Anticipatory Postural Control: A Novel Fmri Paradigm, Jo Armour Smith, Rongwen Tain, Kelli G. Sharp, Laura M. Glynn, Linda R. Van Dillen, Korinne Henslee, Jesse V. Jacobs, Steven C. Cramer

Physical Therapy Faculty Articles and Research

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Altered postural control in the trunk/hip musculature is a characteristic of multiple neurological and musculoskeletal conditions. Previously it was not possible to determine if altered cortical and subcortical sensorimotor brain activation underlies impairments in postural control. This study used a novel fMRI-compatible paradigm to identify the brain activation associated with postural control in the trunk and hip musculature. BOLD fMRI imaging was conducted as participants performed two versions of a lower limb task involving lifting the left leg to touch the foot to a target. For the supported leg raise (SLR) the leg is raised from the knee while the …

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Using The Instrumented Sway System (Isway) To Identify And Compare Balance Domain Deficits In People With Multiple Sclerosis, Patrick G. Monaghan, Andrew S. Monaghan, Andrew Hooyman, Brett W. Fling, Jessie M. Huisinga, Daniel S. Peterson

Physical Therapy Faculty Articles and Research

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Objective
To develop a multiple sclerosis (MS)-specific model of balance and examine differences between (1) MS and neurotypical controls and (2) people with MS (PwMS) with (MS-F) and without a fall history (MS-NF).

Design and Setting
A cross-sectional study was conducted at the Gait and Balance Laboratory at the University of Kansas Medical Center. Balance was measured from the instrumented sway system (ISway) assessment.

Participants
In total, 118 people with relapsing-remitting MS (MS-F=39; MS-NF=79) and 46 age-matched neurotypical controls.

Intervention
Not applicable.

Outcome Measures
A total of 22 sway measures obtained from the ISway were entered into an exploratory factor …

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Improving Prediction Of Amyloid Deposition In Mild Cognitive Impairment With A Timed Motor Task, Sydney Y. Schaefer, Kevin Duff, Andrew Hooyman, John M. Hoffman

Physical Therapy Faculty Articles and Research

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Cortical amyloid deposition is one of the hallmark biomarkers of Alzheimer’s disease (AD). However, given how cost- and time-intensive amyloid imaging can be, there is a continued need for a low-cost, non-invasive, and accessible enrichment strategy to pre-screen individuals for their likelihood of amyloid prior to imaging. Previous work supports the use of coordinated limb movement as a potential screening tool, even after controlling for cognitive and daily function. Thirty-six patients diagnosed with amnestic mild cognitive impairment over the age of 65 underwent 18F-Flutemetamol amyloid-positron emission tomography Cortical amyloid deposition is one of the hallmark biomarkers of Alzheimer’s disease (AD). …

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Kinematic Assessment Of Turning And Walking Tasks Among Stroke Survivors By Employing Wearable Sensors And Pressure Platform, Masoud Abdollahi, Pranav Madhav Kuber, Christopher Hoang, Michael Shiraishi, Rahul Soangra, Ehsan Rashedi

Physical Therapy Faculty Articles and Research

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Stroke survivors often experience reduced movement capabilities due to alterations in their neuromusculoskeletal systems. Modern sensor technologies and motion analyses can facilitate the determination of these changes. Our work aims to assess the potential of using wearable motion sensors to analyze the movement of stroke survivors and identifying the affected functions. We recruited 10 participants (5 stroke survivors, 5 healthy individuals) and conducted a controlled laboratory evaluation for two of the most common daily activities: turning and walking. Among the extracted kinematic parameters, range of trunk and sacrum lateral bending in turning were significantly larger in stroke survivors (p-value<0.02). However, no statistical difference in mean angular velocity and range of motion for trunk/sacrum/shank flexion-extension were obtained in the turning task. Our results also indicated that during walking, while there was no difference in swing time, double support portion of gait among the stroke group was significantly larger (p-value = 0.001). Outcomes of this investigation may help in designing new rehabilitation programs for stroke and other neurological disorders and/or in improving the efficacy of such programs.Clinical Relevance— This study may provide a better insight on the detailed functional differences between stroke survivors and healthy individuals which in turn could be used to develop a more efficient rehabilitation program for stroke community.

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Self-Paced Treadmills Do Not Allow For Valid Observation Of Linear And Nonlinear Gait Variability Outcomes In Patients With Parkinson’S Disease, Maryam Rohafza, Rahul Soangra, Jo Armour Smith, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

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Background

Due to the imposed constant belt speed, motorized treadmills are known to affect linear and nonlinear gait variability outcomes. This is particularly true of patients with Parkinson’s Disease where the treadmill can act as an external pacemaker. Self-paced treadmills update the belt speed in response to the subject's walking speed and might, therefore, be a useful tool for measurement of gait variability in this patient population. This study aimed to compare gait variability during walking at self-paced and constant treadmill speeds with overground walking in individuals with PD and individuals with unimpaired gait.

Methods

Thirteen patients with Parkinson’s Disease …

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Does Subthalamic Deep Brain Stimulation Impact Asymmetry And Dyscoordination Of Gait In Parkinson’S Disease?, Deepak K. Ravi, Christian R. Baumann, Elena Bernasconi, Michelle Gwerder, Niklas K. Ignasiak, Mechtild Uhl, Lennart Stieglitz, William R. Taylor, Navrag B. Singh

Physical Therapy Faculty Articles and Research

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Background. Subthalamic deep brain stimulation (STN-DBS) is an effective treatment for selected Parkinson’s disease (PD) patients. Gait characteristics are often altered after surgery, but quantitative therapeutic effects are poorly described. Objective. The goal of this study was to systematically investigate modifications in asymmetry and dyscoordination of gait 6 months postoperatively in patients with PD and compare the outcomes with preoperative baseline and to asymptomatic controls without PD. Methods. A convenience sample of thirty-two patients with PD (19 with postural instability and gait disorder (PIGD) type and 13 with tremor dominant disease) and 51 asymptomatic controls participated. Parkinson patients …

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Gains Across Who Dimensions Of Function After Robot-Based Therapy In Stroke Subjects, Jennifer Wu, Lucy Dodakian, Jill See, Erin Burke Quinlan, Lisa Meng, Jeby Abraham, Ellen C. Wong, Vu Le, Alison Mckenzie, Steven C. Cramer

Physical Therapy Faculty Articles and Research

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Background

Studies examining the effects of therapeutic interventions after stroke often focus on changes in loss of body function/structure (impairment). However, improvements in activities limitations and participation restriction are often higher patient priorities, and the relationship that these measures have with loss of body function/structure is unclear.

Objective

This study measured gains across WHO International Classification of Function (ICF) dimensions and examined their interrelationships.

Methods

Subjects were recruited 11 to 26 weeks after hemiparetic stroke. Over a 3-week period, subjects received 12 sessions of intensive robot-based therapy targeting the distal arm. Each subject was assessed at baseline and at 1 …

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Using A Timed Motor Task To Predict One-Year Functional Decline In Amnestic Mild Cognitive Impairment, Sydney Y. Schaefer, Andrew Hooyman, Kevin Duff

Physical Therapy Faculty Articles and Research

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Affordable, noninvasive methods of predicting functional decline are needed for individuals at risk for Alzheimer’s disease. This study tested whether a timed upper-extremity motor task predicted functional decline over one year in 79 adults diagnosed with amnestic mild cognitive impairment. Participants completed subjective and objective measures of daily functioning at baseline and one year later. Motor task performance and delayed memory were also evaluated at baseline. Motor task performance was a significant predictor of one-year follow-up daily functioning, improving model fits by 18– 35%. Thus, motor behavior has potential to be an affordable enrichment strategy that is sensitive to functional …

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Predicting Gains With Visuospatial Training After Stroke Using An Eeg Measure Of Frontoparietal Circuit Function, Robert J. Zhou, Hossein M. Hondori, Maryam Khademi, Jessica M. Cassidy, Katherine M. Wu, Derek Z. Yang, Nikhita Kathuria, Fareshte R. Erani, Lucy Dodakian, Alison Mckenzie, Cristina V. Lopes, Walt Scacchi, Ramesh Srinivasan, Steven C. Cramer

Physical Therapy Faculty Articles and Research

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The heterogeneity of stroke prompts the need for predictors of individual treatment response to rehabilitation therapies. We previously studied healthy subjects with EEG and identified a frontoparietal circuit in which activity predicted training-related gains in visuomotor tracking. Here we asked whether activity in this same frontoparietal circuit also predicts training-related gains in visuomotor tracking in patients with chronic hemiparetic stroke. Subjects (n = 12) underwent dense-array EEG recording at rest, then received 8 sessions of visuomotor tracking training delivered via home-based telehealth methods. Subjects showed significant training-related gains in the primary behavioral endpoint, Success Rate score on a standardized test …

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Motor Subtypes Of Parkinson’S Disease Can Be Identified By Frequency Component Of Postural Stability, Saba Rezvanian, Thurmon Lockhart, Christopher Frames, Rahul Soangra, Abraham Lieberman

Physical Therapy Faculty Articles and Research

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Parkinson’s disease (PD) can be divided into two subtypes based on clinical features—namely tremor dominant (TD) and postural instability and gait difficulty (PIGD). This categorization is important at the early stage of PD, since identifying the subtypes can help to predict the clinical progression of the disease. Accordingly, correctly diagnosing subtypes is critical in initiating appropriate early interventions and tracking the progression of the disease. However, as the disease progresses, it becomes increasingly difficult to further distinguish those attributes that are relevant to the subtypes. In this study, we investigated whether a method using the standing center of pressure (COP) …

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Biomarkers Of Rehabilitation Therapy Vary According To Stroke Severity, Erin Burke Quinlan, Lucy Dodakian, Jill See, Alison Mckenzie, Jill Campbell Stewart, Steven C. Cramer

Physical Therapy Faculty Articles and Research

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Biomarkers that capture treatment effects could improve the precision of clinical decision making for restorative therapies. We examined the performance of candidate structural, functional,and angiogenesis-related MRI biomarkers before and after a 3-week course of standardized robotic therapy in 18 patients with chronic stroke and hypothesized that results vary significantly according to stroke severity. Patients were 4.1 ± 1 months poststroke, with baseline arm Fugl-Meyer scores of 20–60. When all patients were examined together, no imaging measure changed over time in a manner that correlated with treatment-induced motor gains. However, when also considering the interaction with baseline motor status, treatment-induced motor …

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Can Gait Signatures Provide Quantitative Measures For Aiding Clinical Decision-Making? A Systematic Meta-Analysis Of Gait Variability Behavior In Patients With Parkinson’S Disease, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

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A disturbed, inconsistent walking pattern is a common feature of patients with Parkinson's disease (PwPD). Such extreme variability in both temporal and spatial parameters of gait has been associated with unstable walking and an elevated prevalence of falls. However, despite their ability to discretise healthy from pathological function, normative variability values for key gait parameters are still missing. Furthermore, an understanding of each parameter's response to pathology, as well as the inter-parameter relationships, has received little attention. The aim of this systematic literature review and meta-analysis was therefore to define threshold levels for pathological gait variability as well as to …

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Revealing The Quality Of Movement: A Meta-Analysis Review To Quantify The Thresholds To Pathological Variability During Standing And Walking, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

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Neuromotor processes are inherently noisy, which results in variability during movement and fluctu-ations in motor control. Although controversial, low levels of variability are traditionally considered healthy, while increased levels are thought to be pathological. This systematic review and meta-analysisof the literature investigates the thresholds between healthy and pathological task variability.

After examining 13,195 publications, 109 studies were included. Results from over 3000 healthy sub-jects and 2775 patients revealed an overall positive effect size of pathology on variability of 0.59 forwalking and 0.80 for sway. For the coefficient of variation of stride time (ST) and sway area (SA), upperthresholds of 2.6% …

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Connectivity Measures Are Robust Biomarkers Of Cortical Function And Plasticity After Stroke, Jennifer Wu, Erin Burke Quinlan, Lucy Dodakian, Alison Mckenzie, Nikhita Kathuria, Robert J. Zhou, Renee Augsburger, Jill See, Vu H. Lee, Ramesh Srinivasan, Steven C. Cramer

Physical Therapy Faculty Articles and Research

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Valid biomarkers of motor system function after stroke could improve clinical decision-making. Electroencephalography-based measures are safe, inexpensive, and accessible in complex medical settings and so are attractive candidates. This study examined specific electroencephalography cortical connectivity measures as biomarkers by assessing their relationship with motor deficits across 28 days of intensive therapy. Resting-state connectivity measures were acquired four times using dense array (256 leads) electroencephalography in 12 hemiparetic patients (7.3 ± 4.0 months post-stroke, age 26–75 years, six male/six female) across 28 days of intensive therapy targeting arm motor deficits. Structural magnetic resonance imaging measured corticospinal tract injury and infarct volume. …

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