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  1. Article ; Online: Stroboscopic visual training: The potential for clinical application in neurological populations.

    Das, Julia / Walker, Richard / Barry, Gill / Vitório, Rodrigo / Stuart, Samuel / Morris, Rosie

    PLOS digital health

    2023  Volume 2, Issue 8, Page(s) e0000335

    Abstract: Visual problems are common in people who have neurological injury or disease, with deficits linked to postural control and gait impairment. Vision therapy could be a useful intervention for visual impairment in various neurological conditions such as ... ...

    Abstract Visual problems are common in people who have neurological injury or disease, with deficits linked to postural control and gait impairment. Vision therapy could be a useful intervention for visual impairment in various neurological conditions such as stroke, head injury, or Parkinson's disease. Stroboscopic visual training (SVT) has been shown to improve aspects of visuomotor and cognitive performance in healthy populations, but approaches vary with respect to testing protocols, populations, and outcomes. The purpose of this structured review was to examine the use of strobe glasses as a training intervention to inform the development of robust protocols for use in clinical practice. Within this review, any studies using strobe glasses as a training intervention with visual or motor performance-related outcomes was considered. PubMed, Scopus, and ProQuest databases were searched in January 2023. Two independent reviewers (JD and RM) screened articles that used strobe glasses as a training tool. A total of 33 full text articles were screened, and 15 met inclusion/exclusion criteria. Reported outcomes of SVT included improvements in short-term memory, attention, and visual response times, with emerging evidence for training effects translating to balance and physical performance. However, the lack of standardisation across studies for SVT protocols, variation in intervention settings, duration and outcomes, and the limited evidence within clinical populations demonstrates that further work is required to determine optimal strobe dosage and delivery. This review highlights the potential benefits, and existing research gaps regarding the use of SVT in clinical practice, with recommendations for clinicians considering adopting this technology as part of future studies in this emerging field.
    Language English
    Publishing date 2023-08-23
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2767-3170
    ISSN (online) 2767-3170
    DOI 10.1371/journal.pdig.0000335
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: The integration of technology into a home-based visuo-cognitive training intervention for people with Parkinson's: Is the future digital?

    Das, Julia / Barry, Gill / Walker, Richard / Vitorio, Rodrigo / Morris, Rosie / Stuart, Samuel

    PloS one

    2023  Volume 18, Issue 6, Page(s) e0285100

    Abstract: Background: Mobile applications and technology (e.g., stroboscopic glasses) are increasingly being used to deliver combined visual and cognitive (termed visuo-cognitive) training that replaces standard pen and paper-based interventions. These ' ... ...

    Abstract Background: Mobile applications and technology (e.g., stroboscopic glasses) are increasingly being used to deliver combined visual and cognitive (termed visuo-cognitive) training that replaces standard pen and paper-based interventions. These 'technological visuo-cognitive training' (TVT) interventions could help address the complex problems associated with visuo-cognitive dysfunction in people with long term neurological conditions such as Parkinson's disease. As data emerges to support the effectiveness of these technologies, patient perspectives offer an insight into how novel TVT is received by people living with long term neurological conditions.
    Objective: To explore experiences of people with Parkinson's in using technology as part of a home-based visuo-cognitive training programme compared to traditional approaches to rehabilitation.
    Methods: Eight people with Parkinson's who took part in a pilot randomised cross-over trial, investigating the efficacy and feasibility of TVT compared to standard care, were interviewed to explore their experiences of each arm of the training they received. Integration of Normalisation Process Theory (NPT) into the analysis enabled examination of the potential to embed novel TVT into a home-based rehabilitation intervention for people with Parkinson's disease.
    Results: Three key themes emerged from the thematic analysis as factors influencing the implementation potential of TVT for people with Parkinson's disease: perceived value of technology, perceived ease of use and support mechanisms. Further examination of the data through the lens of NPT revealed that the implantation and embedding of novel technology was dependent on positive user experience, individual disease manifestation and engagement with a professional.
    Conclusions: Our findings provide insights into the challenges of engaging with technology-based interventions while living with a progressive and fluctuating disease. When implementing technology-based interventions for people with Parkinson's, we recommend that patients and clinicians collaborate to determine whether the technology fits the capacity, preference, and treatment needs of the individual patient.
    MeSH term(s) Humans ; Parkinson Disease/psychology ; Cognitive Training ; Cognitive Dysfunction/rehabilitation ; Occupational Therapy
    Language English
    Publishing date 2023-06-15
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0285100
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Understanding the challenges and impact of training on referral of postnatal women to a community physical activity programme by health professionals: A qualitative study using the COM-B model.

    Allin, Linda / Haighton, Catherine / Dalkin, Sonia / Das, Julia / Allen, Georgia

    Midwifery

    2022  Volume 116, Page(s) 103516

    Abstract: Objective: To understand the value of training for health professionals for improving their ability to effectively refer postnatal women to a targeted community physical activity programme. The study also sought to understand challenges to effective ... ...

    Abstract Objective: To understand the value of training for health professionals for improving their ability to effectively refer postnatal women to a targeted community physical activity programme. The study also sought to understand challenges to effective referral of postnatal women from deprived areas.
    Design, setting and participants: Semi-structured interviews were conducted in January-February 2020 with early years practitioners (n = 4), health visitors (n = 1) and community midwives (n = 2) who had participated in a training workshop implemented as part of a targeted community physical activity referral programme for postnatal women from deprived areas in the North East of England. Two follow up interviews were also conducted with one midwife and one early years practitioner during the Covid-19 pandemic. Data were analysed thematically and the Capability, Opportunity, Motivation, Behaviour (COM-B) model was employed to facilitate identification of the impact of training and the challenges in referral from the health professionals' perspective.
    Findings: The training increased capability to refer by improving knowledge and confidence of health professionals in being able to give appropriate guidance to postnatal women about physical activity without having to refer to other professionals. Health professionals reported adequate opportunities to engage with postnatal women, were motivated to refer and perceived this to be part of their role. The timing and method of message delivery were key contexts for perceived successful referral, particularly for midwives who wanted to ensure the messaging began in the antenatal period. Low staffing levels, limited interprofessional collaboration and finding strategies to engage women from deprived areas were key challenges to effective delivery of physical activity messages. These challenges were exacerbated during Covid-19, with increased mental health issues amongst postnatal women.
    Key conclusions and implications for practice: Training health professionals for physical activity messaging can be a useful way to increase capability, opportunity, and motivation to refer to physical activity interventions for postnatal women in deprived areas to potentially increase physical wellbeing and reduce postnatal depression. The COM-B is a relevant framework to underpin training. A clearly identified referral pathway and staffing issues need to be addressed to improve referrals by health professionals.
    Language English
    Publishing date 2022-10-17
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 1036567-9
    ISSN 1532-3099 ; 0266-6138
    ISSN (online) 1532-3099
    ISSN 0266-6138
    DOI 10.1016/j.midw.2022.103516
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  4. Article ; Online: Brain activity response to cues during gait in Parkinson's disease: A study protocol.

    Vitório, Rodrigo / Morris, Rosie / Das, Julia / Walker, Richard / Mancini, Martina / Stuart, Samuel

    PloS one

    2022  Volume 17, Issue 11, Page(s) e0275894

    Abstract: Various cueing strategies (internal and external) have been used to alleviate gait deficits in Parkinson's disease (PD). However, it remains unclear which type of cueing strategy is most effective at different disease stages or with more severe walking ... ...

    Abstract Various cueing strategies (internal and external) have been used to alleviate gait deficits in Parkinson's disease (PD). However, it remains unclear which type of cueing strategy is most effective at different disease stages or with more severe walking impairment, such as freezing of gait (FOG). The underlying neural mechanisms of response to cueing are also unknown. This trial aims to: (i) determine brain activity response to cue stimulus (internal, visual, auditory or tactile) when walking in PD and; (ii) examine changes in brain activity to cues at different stages of PD. This ongoing single-site study uses an exploratory observational design, with laboratory application of cues for gait deficit. A total of 80 people with PD who meet the inclusion criteria will be enrolled. Participants are split into groups dependent on their disease stage (classified with the Hoehn and Yahr (H&Y) scale); n = 20 H&YI; n = 30 H&YII; n = 30 H&YIII. Within the H&Y stage II and III groups, we will also ensure recruitment of a sub-group of 15 individuals with FOG within each group. Participants perform walking tasks under several conditions: baseline walking without cues; randomized cued walking conditions [internal and external (visual, auditory and tactile) cues]. A combined functional near-infrared spectroscopy and electroencephalography system quantifies cortical brain activity while walking. Inertial sensors are used to assess gait. Primary outcome measures are cue-related changes in cortical brain activity while walking, including the relative change in cortical HbO2 and the power spectral densities at alpha (8-13Hz), beta (13-30Hz), delta (0.5-4Hz), theta (4-8Hz) and gamma (30-40Hz) frequency bandwidths. Secondary outcome measures are cue-related changes in spatiotemporal gait characteristics. Findings will enhance our understanding about the cortical responses to different cueing strategies and how they are influenced by PD progression and FOG status. This trial is registered at clinicaltrials.gov (NCT04863560; April 28, 2021, https://clinicaltrials.gov/ct2/show/NCT04863560).
    MeSH term(s) Humans ; Cues ; Parkinson Disease ; Gait Disorders, Neurologic ; Gait/physiology ; Brain ; Observational Studies as Topic
    Language English
    Publishing date 2022-11-17
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0275894
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Technological solution for the assessment and rehabilitation of visuo-cognition in Parkinson's disease.

    Das, Julia / Morris, Rosie / Barry, Gill / Celik, Yunus / Godfrey, Alan / McDonald, Claire / Walker, Richard / Vitorio, Rodrigo / Stuart, Samuel

    Expert review of medical devices

    2023  Volume 20, Issue 4, Page(s) 253–257

    MeSH term(s) Humans ; Parkinson Disease ; Cognition ; Cognition Disorders ; Medicine
    Language English
    Publishing date 2023-03-23
    Publishing country England
    Document type Editorial
    ZDB-ID 2250857-0
    ISSN 1745-2422 ; 1743-4440
    ISSN (online) 1745-2422
    ISSN 1743-4440
    DOI 10.1080/17434440.2023.2192869
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Ocular microtremor: a structured review.

    Graham, Lisa / Das, Julia / Vitorio, Rodrigo / McDonald, Claire / Walker, Richard / Godfrey, Alan / Morris, Rosie / Stuart, Samuel

    Experimental brain research

    2023  Volume 241, Issue 9, Page(s) 2191–2203

    Abstract: Ocular microtremor (OMT) is the smallest of three involuntary fixational micro eye movements, which has led to it being under researched in comparison. The link between OMT and brain function generates a strong rationale for further study as there is ... ...

    Abstract Ocular microtremor (OMT) is the smallest of three involuntary fixational micro eye movements, which has led to it being under researched in comparison. The link between OMT and brain function generates a strong rationale for further study as there is potential for its use as a biomarker in populations with neurological injury and disease. This structured review focused on populations previously studied, instrumentation used for measurement, commonly reported OMT outcomes, and recommendations concerning protocol design and future studies. Current methods of quantifying OMT will be reviewed to analyze their efficacy and efficiency and guide potential development and understanding of novel techniques. Electronic databases were systematically searched and compared with predetermined inclusion criteria. 216 articles were identified in the search and screened by two reviewers. 16 articles were included for review. Findings showed that piezoelectric probe is the most common method of measuring OMT, with fewer studies involving non-invasive approaches, such as contact lenses and laser imaging. OMT frequency was seen to be reduced during general anesthesia at loss of consciousness and in neurologically impaired participants when compared to healthy adults. We identified the need for a non-invasive technique for measuring OMT and highlight its potential in clinical applications as an objective biomarker for neurological assessments. We highlight the need for further research on the clinical validation of OMT to establish its potential to identify or predict a meaningful clinical or functional state, specifically, regarding accuracy, precision, and reliability of OMT.
    MeSH term(s) Adult ; Humans ; Consciousness ; Eye ; Face ; Reproducibility of Results
    Language English
    Publishing date 2023-08-26
    Publishing country Germany
    Document type Journal Article ; Systematic Review
    ZDB-ID 1201-4
    ISSN 1432-1106 ; 0014-4819
    ISSN (online) 1432-1106
    ISSN 0014-4819
    DOI 10.1007/s00221-023-06691-w
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  7. Article ; Online: Gait Impairment in Traumatic Brain Injury: A Systematic Review.

    Dever, Anthony / Powell, Dylan / Graham, Lisa / Mason, Rachel / Das, Julia / Marshall, Steven J / Vitorio, Rodrigo / Godfrey, Alan / Stuart, Samuel

    Sensors (Basel, Switzerland)

    2022  Volume 22, Issue 4

    Abstract: Introduction: Gait impairment occurs across the spectrum of traumatic brain injury (TBI); from mild (mTBI) to moderate (modTBI), to severe (sevTBI). Recent evidence suggests that objective gait assessment may be a surrogate marker for neurological ... ...

    Abstract Introduction: Gait impairment occurs across the spectrum of traumatic brain injury (TBI); from mild (mTBI) to moderate (modTBI), to severe (sevTBI). Recent evidence suggests that objective gait assessment may be a surrogate marker for neurological impairment such as TBI. However, the most optimal method of objective gait assessment is still not well understood due to previous reliance on subjective assessment approaches. The purpose of this review was to examine objective assessment of gait impairments across the spectrum of TBI.
    Methods: PubMed, AMED, OVID and CINAHL databases were searched with a search strategy containing key search terms for TBI and gait. Original research articles reporting gait outcomes in adults with TBI (mTBI, modTBI, sevTBI) were included.
    Results: 156 citations were identified from the search, of these, 13 studies met the initial criteria and were included into the review. The findings from the reviewed studies suggest that gait is impaired in mTBI, modTBI and sevTBI (in acute and chronic stages), but methodological limitations were evident within all studies. Inertial measurement units were most used to assess gait, with single-task, dual-task and obstacle crossing conditions used. No studies examined gait across the full spectrum of TBI and all studies differed in their gait assessment protocols. Recommendations for future studies are provided.
    Conclusion: Gait was found to be impaired in TBI within the reviewed studies regardless of severity level (mTBI, modTBI, sevTBI), but methodological limitations of studies (transparency and reproducibility) limit clinical application. Further research is required to establish a standardised gait assessment procedure to fully determine gait impairment across the spectrum of TBI with comprehensive outcomes and consistent protocols.
    MeSH term(s) Adult ; Brain Concussion ; Brain Injuries, Traumatic ; Gait ; Humans ; Reproducibility of Results
    Language English
    Publishing date 2022-02-14
    Publishing country Switzerland
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 2052857-7
    ISSN 1424-8220 ; 1424-8220
    ISSN (online) 1424-8220
    ISSN 1424-8220
    DOI 10.3390/s22041480
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  8. Article ; Online: Exploring the feasibility of technological visuo-cognitive training in Parkinson's: Study protocol for a pilot randomised controlled trial.

    Das, Julia / Morris, Rosie / Barry, Gill / Vitorio, Rodrigo / Oman, Paul / McDonald, Claire / Walker, Richard / Stuart, Samuel

    PloS one

    2022  Volume 17, Issue 10, Page(s) e0275738

    Abstract: Visual and cognitive dysfunction are common in Parkinson's disease and relate to balance and gait impairment, as well as increased falls risk and reduced quality of life. Vision and cognition are interrelated (termed visuo-cognition) which makes ... ...

    Abstract Visual and cognitive dysfunction are common in Parkinson's disease and relate to balance and gait impairment, as well as increased falls risk and reduced quality of life. Vision and cognition are interrelated (termed visuo-cognition) which makes intervention complex in people with Parkinson's (PwP). Non-pharmacological interventions for visuo-cognitive deficits are possible with modern technology, such as combined mobile applications and stroboscopic glasses, but evidence for their effectiveness in PwP is lacking. We aim to investigate whether technological visuo-cognitive training (TVT) can improve visuo-cognitive function in PwP. We will use a parallel group randomised controlled trial to evaluate the feasibility and acceptability of TVT versus standard care in PwP. Forty PwP who meet our inclusion criteria will be randomly assigned to one of two visuo-cognitive training interventions. Both interventions will be carried out by a qualified physiotherapist in participants own homes (1-hour sessions, twice a week, for 4 weeks). Outcome measures will be assessed on anti-parkinsonian medication at baseline and at the end of the 4-week intervention. Feasibility of the TVT intervention will be assessed in relation to safety and acceptability of the technological intervention, compliance and adherence to the intervention and usability of equipment in participants homes. Additionally, semi structured interviews will be conducted to explore participants' experience of the technology. Exploratory efficacy outcomes will include change in visual attention measured using the Trail Making Test as well as changes in balance, gait, quality of life, fear of falling and levels of activity. This pilot study will focus on the feasibility and acceptability of TVT in PwP and provide preliminary data to support the design of a larger, multi-centre randomised controlled trial. This trial is registered at isrctn.com (ISRCTN46164906).
    MeSH term(s) Accidental Falls/prevention & control ; Cognition ; Fear ; Feasibility Studies ; Humans ; Multicenter Studies as Topic ; Pilot Projects ; Quality of Life ; Randomized Controlled Trials as Topic ; Technology
    Language English
    Publishing date 2022-10-07
    Publishing country United States
    Document type Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0275738
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  9. Article ; Online: Combination of Clinical and Gait Measures to Classify Fallers and Non-Fallers in Parkinson's Disease.

    Araújo, Hayslenne A G O / Smaili, Suhaila M / Morris, Rosie / Graham, Lisa / Das, Julia / McDonald, Claire / Walker, Richard / Stuart, Samuel / Vitório, Rodrigo

    Sensors (Basel, Switzerland)

    2023  Volume 23, Issue 10

    Abstract: Although the multifactorial nature of falls in Parkinson's disease (PD) is well described, optimal assessment for the identification of fallers remains unclear. Thus, we aimed to identify clinical and objective gait measures that best discriminate ... ...

    Abstract Although the multifactorial nature of falls in Parkinson's disease (PD) is well described, optimal assessment for the identification of fallers remains unclear. Thus, we aimed to identify clinical and objective gait measures that best discriminate fallers from non-fallers in PD, with suggestions of optimal cutoff scores.
    Methods: Individuals with mild-to-moderate PD were classified as fallers (n = 31) or non-fallers (n = 96) based on the previous 12 months' falls. Clinical measures (demographic, motor, cognitive and patient-reported outcomes) were assessed with standard scales/tests, and gait parameters were derived from wearable inertial sensors (Mobility Lab v2); participants walked overground, at a self-selected speed, for 2 min under single and dual-task walking conditions (maximum forward digit span). Receiver operating characteristic curve analysis identified measures (separately and in combination) that best discriminate fallers from non-fallers; we calculated the area under the curve (AUC) and identified optimal cutoff scores (i.e., point closest-to-(0,1) corner).
    Results: Single gait and clinical measures that best classified fallers were foot strike angle (AUC = 0.728; cutoff = 14.07°) and the Falls Efficacy Scale International (FES-I; AUC = 0.716, cutoff = 25.5), respectively. Combinations of clinical + gait measures had higher AUCs than combinations of clinical-only or gait-only measures. The best performing combination included the FES-I score, New Freezing of Gait Questionnaire score, foot strike angle and trunk transverse range of motion (AUC = 0.85).
    Conclusion: Multiple clinical and gait aspects must be considered for the classification of fallers and non-fallers in PD.
    MeSH term(s) Humans ; Gait Disorders, Neurologic/diagnosis ; Parkinson Disease/diagnosis ; Gait ; Walking ; Lower Extremity
    Language English
    Publishing date 2023-05-11
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2052857-7
    ISSN 1424-8220 ; 1424-8220
    ISSN (online) 1424-8220
    ISSN 1424-8220
    DOI 10.3390/s23104651
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  10. Article ; Online: Visual Exploration While Walking With and Without Visual Cues in Parkinson's Disease: Freezer Versus Non-Freezer.

    Graham, Lisa / Armitage, Jordan / Vitorio, Rodrigo / Das, Julia / Barry, Gill / Godfrey, Alan / McDonald, Claire / Walker, Richard / Mancini, Martina / Morris, Rosie / Stuart, Samuel

    Neurorehabilitation and neural repair

    2023  Volume 37, Issue 10, Page(s) 734–743

    Abstract: Background: Visual cues can improve gait in Parkinson's disease (PD), including those experiencing freezing of gait (FOG). However, responses are variable and underpinning mechanisms remain unclear. Visuo-cognitive processing (measured through visual ... ...

    Abstract Background: Visual cues can improve gait in Parkinson's disease (PD), including those experiencing freezing of gait (FOG). However, responses are variable and underpinning mechanisms remain unclear. Visuo-cognitive processing (measured through visual exploration) has been implicated in cue response, but this has not been comprehensively examined.
    Objective: To examine visual exploration and gait with and without visual cues in PD who do and do not self-report FOG, and healthy controls (HC).
    Methods: 17 HC, 21 PD without FOG, and 22 PD with FOG walked with and without visual cues, under single and dual-task conditions. Visual exploration (ie, saccade frequency, duration, peak velocity, amplitude, and fixation duration) was measured via mobile eye-tracking and gait (ie, gait speed, stride length, foot strike angle, stride time, and stride time variability) with inertial sensors.
    Results: PD had impaired gait compared to HC, and dual-tasking made gait variables worse across groups (all
    Conclusion: Visual cues improved visual exploration and gait outcomes in HC and PD, with similar responses in freezers and non-freezers. Freezer and non-freezer specific associations between cue-related changes in visual exploration and gait indicate different underlying visuo-cognitive processing within these subgroups for cue response.
    MeSH term(s) Humans ; Cues ; Parkinson Disease/complications ; Gait Disorders, Neurologic/etiology ; Walking/physiology ; Gait/physiology
    Language English
    Publishing date 2023-09-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1491637-x
    ISSN 1552-6844 ; 1545-9683 ; 0888-4390
    ISSN (online) 1552-6844
    ISSN 1545-9683 ; 0888-4390
    DOI 10.1177/15459683231201149
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