Exploratory study of different doses of endurance exercise in people with Parkinson's disease.
Schenkman, M (PI); Corcos, D (Co-PI)
This exploratory Phase II clinical trial is a multi-center, randomized, controlled (no-exercise arm), evaluator-blinded study of two intensities of endurance exercise over six months. The two levels of exercise are moderate (4 days/wk at mean 60-65% HRmax) and vigorous (4 days/wk at mean 80-85% HRmax). The first aim is to find out if patients can exercise at the higher level of intensity. The second aim is to find out if either or both of the exercise intensities yield benefits consistent with meaningful clinical change in the Unified Parkinson's Disease Rating Scale (UPDRS). The third aim is to document key responses associated with clinical trials, such as adverse events and attrition across the different treatments and the 3 different sites. This study is being conducted in collaboration with colleagues at the University of Illinois, Chicago, Rush Medical Center in Chicago, and the University of Pittsburgh.
Vestibular rehabilitation for persons with multiple sclerosis: who benefits the most?
Hebert, J (PI); Schenkman, M (Co-PI)
This 16-week, two-group, stratified-blocked randomized controlled trial is designed to determine if vestibular rehabilitation for persons with MS is more effective in improving balance for those who have brainstem and/or cerebellar involvement compared to persons with MS who do not. In addition, because eye movement exercises are an important part of the proposed vestibular rehabilitation program, we will determine if significant changes in visual stability for persons with MS who present with abnormal eye movements are possible following participation in this program. Lastly, we will expand our knowledge of the benefits of vestibular rehabilitation on fatigue.
Exercise, Physical Function, and Parkinson’s Disease
This study compared benefits of three different exercise interventions for people who have Parkinson’s disease. The interventions included the following: 1) usual care, in which the participant performs exercises recommended by the National Parkinson’s Foundation; 2) aerobic conditioning in which the participant exercises on a treadmill, bicycle, or elliptical trainer; 3) flexibility and function in which the participant first learned specific exercises (one-on-one with the physical therapist) to improve axial flexibility and then participated in a group exercise with exercises designed to incorporate flexibility in the context of balance and function.
Participants exercised in a supervised setting for four months and then exercised on their own (with once monthly sessions) for an additional year (16 months total). Our primary outcomes were at 10 months and our goal was to determine which of these three exercise approaches best improved balance, economy of movement and overall functional ability. In addition, our secondary goals were to examine specificity of treatment at 4 months and to determine which exercise the participants can continue with on their own for best outcomes at 16 months.
We have completed enrollment and analysis of the primary questions. Participants in the flexibility and function group showed greater functional improvement at four months compared with the other groups. Those in the aerobic conditioning group showed improvements in economy of movement at all three time points compared to the other groups. (Phys Ther 2012;92:1395-1410). Secondary analyses are ongoing.
Economy of Movement in People who have Parkinson’s Disease
People with Parkinson’s disease (PD) have increased energy expenditure during walking (i.e., poor walking economy) compared to similarly aged healthy adults. The implication of poor walking economy for individuals with PD is that the relative intensity of walking is high. This high intensity of walking could contribute to excessive fatigue, a major problem that develops early in the disease process.
The goal of this research is to determine the extent to which factors specific to PD explain variability in walking economy above and beyond typical aging.
Critical Illness Weakness
Moss M, (PI), Nordon-Craft A, Schenkman M, Quan D
This investigation is designed to diagnose and characterize individuals who are critically ill and require mechanical ventilation for at least seven days. An important part of the investigation is designed to characterize impairments and functional limitations of these individuals and to determine the benefits of physical therapy intervention.
Participants are randomly assigned to a physical intervention program, specifically tailored to individuals in the ICU, or to usual care. They are treated for a month, beginning in the ICU and continuing on the medical ward and / or home, depending on their length of hospital stay. The goal is to determine whether the physical intervention improves outcomes, both immediately and after six months.