Evidence-Based Research Project on Multiple Sclerosis With Patient and Physician Perspectives

Description
The demyelinating and degenerating disease, multiple sclerosis, is the highlight of this evidence-based research project. A set of questions were created specifically to the patients and physicians. I conducted interviews with patients and physician to gather relevant data. The results were qualitatively analyzed and reported in the project.
Date Created
2023-12
Agent

Understanding the Effect of Epidural Steroid Injection in Lower Back Pain Using Inertial Measurement Unit Wearable Device

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Description
Low back pain (LBP) is the most common symptom leading to hospitalization and medical assistance. In the US, LBP is the fifth most prevalent case for visiting hospitals. Approximately 2.06 million LBP incidents were reported during the timeline between 2004

Low back pain (LBP) is the most common symptom leading to hospitalization and medical assistance. In the US, LBP is the fifth most prevalent case for visiting hospitals. Approximately 2.06 million LBP incidents were reported during the timeline between 2004 and 2008. Globally, LBP occurrence increased by almost 200 million from 1990 to 2017. This problem is further implicated by physical and financial constraints that impact the individual’s quality of life. The medical cost exceeded $87.6 billion, and the lifetime prevalence was 84%. This indicates that the majority of people in the US will experience this symptom. Also, LBP limits Activities of Daily Living (ADL) and possibly affects the gait and postural stability. Prior studies indicated that LBP patients have slower gait speed and postural instability. To alleviate this symptom, the epidural injection is prescribed to treat pain and improve mobility function. To evaluate the effectiveness of LBP epidural injection intervention, gait and posture stability was investigated before and after the injection. While these factors are the fundamental indicator of LBP improvement, ADL is an element that needs to be significantly considered. The physical activity level depicts a person’s dynamic movement during the day, it is essential to gather activity level that supports monitoring chronic conditions, such as LBP, osteoporosis, and falls. The objective of this study was to assess the effects of Epidural Steroid Injection (ESI) on LBP and related gait and postural stability in the pre and post-intervention status. As such, the second objective was to assess the influence of ESI on LBP, and how it influences the participant’s ADL physical activity level. The results indicated that post-ESI intervention has significantly improved LBP patient’s gait and posture stability, however, there was insufficient evidence to determine the significant disparity in the physical activity levels. In conclusion, ESI depicts significant positive effects on LBP patients’ gait and postural parameters, however, more verification is required to indicate a significant effect on ADL physical activity levels.
Date Created
2023
Agent

Quantification of Bilateral Ankle Stiffness in the Frontal Plane during Standing for Varying Weight Distributions

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Description
Chronic ankle instability (CAI) is caused by the failure to seek treatment and rehabilitation after an acute ankle sprain. Typically, clinical assessment of ankle sprains is done under unloaded conditions, despite the fact that ankle sprains occur during weight loading.

Chronic ankle instability (CAI) is caused by the failure to seek treatment and rehabilitation after an acute ankle sprain. Typically, clinical assessment of ankle sprains is done under unloaded conditions, despite the fact that ankle sprains occur during weight loading. Characterization of ankle stiffness, a representation of ankle stability during weight loading, is crucial to quantify ankle stability. Patients with CAI suffer from gait asymmetry, and the descriptions of the asymmetry ratio vary widely throughout the research community. Bilateral ankle stiffness could be a systematic metric to describe the gait asymmetry of CAI patients. Additionally, women generally have higher ankle joint and ligamentous laxity than men, and lower ankle stiffness, which has been thoroughly investigated in previous literature. However, differences in bilateral ankle stiffness between sexes still need to be investigated. Using twin dual-axis robotic platforms, this study investigated the weight loading effect on ankle stiffness in the frontal plane during standing, the bilateral difference in stiffness between the dominant and non-dominant ankle, and the sex difference in bilateral ankle stiffness during standing for varying weight distribution. The group average results of 20 healthy subjects showed that ankle stiffness increased with increasing weight loading on the ankle, which is speculated to be caused by active muscle contraction and changes in passive structure due to weight loading. For the bilateral difference of the group, the statistical analysis showed that there was no significant difference between dominant and non-dominant ankle stiffness for all the weight distributions considered. Although the group average result of the difference in bilateral ankle stiffness was statistically insignificant, individual analysis confirmed the importance of subject-specific investigation of bilateral ankle stiffness, as there were more cases of dominant ankle stiffness being larger than non-dominant ankle stiffness, and the bilateral difference was subject-specific. Investigations into sex differences in bilateral ankle stiffness showed that ankle stiffness in males is significantly greater than in females, even after normalizing the stiffness by weight, which is speculated to be caused by higher joint and ligamentous laxity in females regardless of laterality.
Date Created
2023
Agent

Gait Changes in Male RBD Patients with Abnormal DAT Scan and Confirmed Synucleinopathy

Description

While REM Sleep Behavior disorder (RBD) has been linked with synucleinopathies, difficulties persist in clinically convenient diagnostic tools which can differentiate between underlying diseases. Identifying markers in the gait of RBD patients may ease the diagnostic process and indicate potential

While REM Sleep Behavior disorder (RBD) has been linked with synucleinopathies, difficulties persist in clinically convenient diagnostic tools which can differentiate between underlying diseases. Identifying markers in the gait of RBD patients may ease the diagnostic process and indicate potential or status for developing more severe disorders. Individuals were referred to Movement Disorders Center of Arizona (MDCA) by a sleep specialist with a confirmed diagnosis of RBD, or those who were clinically indicated after questioning. All participants underwent a skin-biopsy test for α-synuclein, I-ioflupane dopamine transporter(DAT) scan, and had their gait velocity, cadence and stride dynamics assessed by an automated gait analysis system.

Date Created
2023-05
Agent

Characterizing Reactive Lateral Stepping in People with PD

Description

Introduction: Lateral reactive stepping is correlated with impairment in people with Parkinson’s Disease (PwPD). Despite this, there is little known of lateral stepping strategies and performance of these strategies in reactive stepping. Objective: To characterize step strategy in people with

Introduction: Lateral reactive stepping is correlated with impairment in people with Parkinson’s Disease (PwPD). Despite this, there is little known of lateral stepping strategies and performance of these strategies in reactive stepping. Objective: To characterize step strategy in people with PD, characterize changes in these stepping strategies through training, and identify performance improvements in the lateral step strategies. Methods: A total of 31 PwPd who are currently at risk for falls took part in an 18-week various background reactive stepping intervention. The stepping strategies were assessed on two baseline assessments (B1 and B2) immediately followed by a 6- session step training intervention occurring over two weeks. Step strategies were again assessed immediately after training (P1) and two months later (P2). Initial outcomes were characterized step strategies, changes in step strategies, and improvement in performance of step strategies. Results: Three step strategies were established and split into two groups (no cross and cross). Changes in step strategies did not occur significantly both before and after training. Improvement in performance of the step strategies occurred at a significant amount (p=0.05) via a decrease in use of support after training occurred for any step strategies utilized. Conclusion: Step strategies were characterized, and performance of strategies was improved upon following the 2-week training. Lateral step strategies are defined and repeated throughout reactive step training with potential for improvement.

Date Created
2023-05
Agent

Do Cognitive Tests Within the Same Domain Similarly Affect Freezing of Gait Status in People with Parkinson’s Disease?

Description

Parkinson’s Disease (PD) is characterized by involuntary tremors, muscle rigidity, slowed movement, and cognitive impairments. Some people with PD experience “Freezing of Gait” (FOG), which is an acute inability to release effective stepping. The severity of Freezing of Gait can

Parkinson’s Disease (PD) is characterized by involuntary tremors, muscle rigidity, slowed movement, and cognitive impairments. Some people with PD experience “Freezing of Gait” (FOG), which is an acute inability to release effective stepping. The severity of Freezing of Gait can be influenced by disease duration, disease severity, and medication. Freezing of Gait can lead to an increased risk of falls, mood disorders, reduced quality of life, poorer cognition, and executive function impairments (Morris et. al.). It is important to understand how Freezing of Gait can affect cognition, as this can alter the plan of cognitive rehabilitation that the patient receives in order to improve their cognition. Within each of these domains, are a variety of tests that all claim to measure the same cognition the same way and achieve similar results. A recent meta analysis assessed this hypothesized effect. However, to best understand this relationship, it is important to assess whether the effects of FOG status on cognition are similar across cognitive tests of the same domain. This research was performed by using a previously completed meta analysis on PD tests and the domains that tests fall into. Each of the domains were analyzed individually, and the most common tests used within each domain were compared to determine their effect sizes. The effect sizes were then compared to determine which tests have a greater influence on cognition, and if the effect sizes of each test within the same domain are similar, showing that FOG affects cognition to a similar degree.

Date Created
2023-05
Agent