Amplitude-Based Interventions Reducing Falls in Parkinson S Patients

Amplitude-Based Interventions Reducing Falls in Parkinson S Patients



Amplitude-Based Interventions Reducing Falls in Parkinson’s Patients

Rehab & DisabilityPostersIntermediate

By viewing this poster and interacting with the presenters, participants will be able to: 1. Describe the procedure of completing evidence based practice literature review on available interventions to promote safety and reduce falls in individuals with Parkinson’s disease. 2. Describe the current research literature on the effectiveness of amplitude-based movement interventions and rhythmic auditory stimulation interventions in promoting safety in occupations and reducing falls in individuals with Parkinson’s disease. 3. Recognize the stronger, higher-quality, and more current evidence for the effectiveness of amplitude based movement interventions in reducing falls and promoting safety in occupations over rhythmic auditory stimulation interventions for individuals with Parkinson’s disease.

This poster is designed to provide an overview of the current evidence-based research concerning interventions for individuals with Parkinson’s disease to answer the following question: Are amplitude-based movement interventions more effective in promoting safety in occupations and reducing falls in individuals with Parkinson’s disease than interventions using rhythmic auditory stimulation (RAS)? Amplitude-based movement interventions include repetitive, high amplitude, and intensive movements to improve motor outputs and consequently, occupational performance. Rhythmic auditory stimulation interventions include an individual to match his/her steps and other body movements to a beat provided by a metronome to produce smoother movements and improve his/her ability to perform occupations.

The following methodology was applied to evaluate the available evidence: 1) description of practice scenario, 2) development a clinical question, 3) systematic review of the current literature, 4) synthesis of findings, and 5) clinical implications for occupational therapy. While there is strong evidence in the literature to support both RAS and amplitude-based movement interventions, there is not enough evidence available to conclusively determine if one is superior to the other. The literature suggests RAS may act to override the impaired motor loop, producing smoother and more normalized movements (Nombela et al., 2013). However, it was found that while metronomes can improve gait patterns, they ultimately did not result in any significant improvement in quality of life or reduction in the number of falls (Elston et al., 2010). Amplitude-based movement interventions were shown to be associated with not only improved movement patterns and fewer falls, but also improved functional performance and longer carryover of gains post-treatment (Janssens et al., 2014; Morris et al., 2015).

1. Ebersbach, G., Ebersbach, A., Edler, D., Kaufhold, O., Kusch, M., Kupsch, A., Wissel, J. (2010). Comparing exercise in Parkinson’s disease- The Berlin BIG study.Movement Disorders, 25, 1902-1908. doi: 10.1002/mds.23212.

2. Elston, J., Honan, W., Powell, R., Gormley, J., & Stein, K. (2010). Do metronomes improve the quality of life in people with Parkinson’s disease? A pragmatic, single-blind, randomized controlled trial.Clinical Rehabilitation, 24, 523-532. doi: 10.1177/0269215509360646.

3. Ford, M., Malone, L., Nyikos, I., Yelisetty, R., & Bickel, C. S. (2010). Gait training with progressive external auditory cueing in persons with Parkinson’s disease. Archives of Physical Medical and Rehabilitation, 91, 1255-1261. doi: 10.1016/j.apmr.2010.04.012.

4. Janssens, J., Malfroid, K., Nyffeler, T., Bohlhalter, S., & Vanbellingen, T. (2014). Application of LSVT BIG intervention to address gait, balance, bed mobility, and dexterity in people with Parkinson’s disease: A case series. Physical Therapy, 94, 1014-1023.

5. Kadivar, Z., Corcos, D., Foto, J., & Hondzinski. (2011). Effect of step training and rhythmic auditory stimulation on functional performances in Parkinson’s patients.Neurorehabilitation and Neural Repair, 25, 626-635. doi: 10.1177/1545968311401627.

6. Lowry, K., Carrel, A., McIlrath, J., & Smiley-Oyen, A. (2010) Use of harmonic ratios to examine the effects of cueing strategies on gait stability in persons with Parkinson’s disease. Archives of Physical Medicine and Rehabilitation, 91, 632-638. doi: 10.1016/j.apmr.2009.12.016.

7. Morris, M., Menz, H., McGinley, J., Watts, J., Huxham, F. Murphy, A., Iansek, R. (2015). A randomized controlled trial to reduce falls in people with Parkinson’s disease. Neurorehabilitation and Neural Repair, 29, 777-785. doi: 10.1177/1545968314565511.

8. Rochester, L., Burns, D., Woods, G., Godwin, J., & Nieuwboer, A. (2009). Does auditory rhythmical cueing improve gait in people with Parkinson’s disease and cognitive impairment? A feasibility study.Movement Disorders, 24, 839-845. doi: 10.1002/mds.22400.

An evidence-based study of amplitude-based movement interventions compared to rhythmic auditory stimulation in reducing falls and increasing participation in occupations in individuals with Parkinson’s disease. Interventions were most effective when applied within the context of functional or occupational performance.


Anatomy, Kinesiology and Taping as an Evaluation and Treatment Tool

Rehab & Disability2 hour 50 minute Institutes


Demonstrate the ability to integrate anatomy and kinesiology to evaluate movement and function. Demonstrate the ability to integrate anatomy and kinesiology to treat movement and function. Demonstrate the ability to develop an individualize treatment plan utilizing Kinesio Tex Taping to facilitate movement and function.

This program will include an overview of anatomy and kinesiology of the upper quadrant. Participants will perform palpation skills to identify upper quadrant structures and joints. Participants will perform palpation skills to identify normal and dysfunctional movement patterns affecting function.This session will utilize a variety of case studies to apply anatomy, kinesiology, and Kinesio Tex Taping methods in the evaluation and treatment of patients. Pre-treatment and post-treatment outcomes of a variety of case studies will be reviewed.

Biel, A. (2014) Trail guide to the body: A hands-on guide to locating muscles, bones and more (5th ed.). Boulder, CO: Books ofDiscovery.

Neumann, D.A. (2010) Kinesiology of the musculoskeletal system:Foundations for rehabilitation (2nd ed.). St. Louis, MO: Mosby

Elsevier. Norkin, C.C., White, D.J. (2009) Measurement of joint motion: A guide to goniometry (4th ed.). Philadelphia, PA: F.A. Davis Company

This session will utilize a variety of case studies to apply anatomy, kinesiology, and Kinesio Tex Taping methods in the evaluation and treatment of patients. Pre-treatment and post-treatment outcomes of a variety of case studies will be reviewed.


Can Occupational Therapists Utilize the BIMS to Effectively Screen for Cognitive Deficits in Short-Term SNF Residents?

Rehab & Disability50 minute sessions


1) Understand the scopes of the BIMS, MMSE and MoCA. 2) Compare the scores and levels of cognitive deficit identified by the BIMS to those of the MMSE and the MoCA. 3) Determine if the BIMS is an effective cognitive screening tool or if there is a cutoff score for the BIMS that indicates the need for a more detailed cognitive evaluation by an occupational therapist.

The purpose of this study is to determine if the BIMS is as sensitive as the MoCA and the MMSE in identifying cognitive deficits requiring occupational therapy intervention in short-term SNF residents. This presentation will review the targeted areas of cognition for each screen, administration methods, scoring, and interpretation of scores for the BIMS, MMSE and MoCA.

A literature review was performed to understand the scope of the BIMS. The BIMS is a short performance-based cognitive screen designed specifically to facilitate cognitive screening in MDS assessments for residents of skilled nursing facilities, but it does not have to be administered by a skilled professional. More than 50% of SNF residents are reported to have some level of cognitive impairment, which is associated with poorer functional outcomes and requires increased resources and individualized care planning. The BIMS provides information on a resident’s performance in the following cognitive domains: attention, temporal orientation and item recall. Results provide a distribution that includes cognitively intact, moderately impaired and severe impairment(7). The literature review was also conducted in order to understand the correlation between the scores of the MMSE and MoCA (2, 6, 9).

In this study, 67 short-term SNF residents were randomly assigned to two different test groups upon admission to a SNF for short-term inpatient rehabilitation: Group 1) the BIMS and MMSE were administered and scored separately; Group 2) the BIMS and the MoCA were administered and scored separately. Numeric scores and interpreted results were analyzed to determine if there is any correlation between levels of cognitive impairment identified by the BIMS and MMSE, as well as the BIMS and MoCA.

1. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198.

2. Mace, R. A., Mansbach, W. E., & Gever, J. MoCA beats MMSE to assess dementia. Retrieved 3/31, 2016, from 3.

3. Clark, K. M. (2016). Rapid cognitive assessment of nursing home residents: A comparison of the brief interview for mental status (BIMS) and brief cognitive assessment tool-short form (BCAT-SF). Research in Gerontological Nursing, 9(1), 35-44.

4. McDougall, G. J. (1990). A review of screening instruments for assessing cognition and mental status in older adults.Nurse Practitioner, 15(11), 18.

5. Nasreddine, Z. S., Phillips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V., Collin, I., et al. (2005). The montreal cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699.

6. Saczynski, J. S., Inouye, S. K., Guess, J., Jones, R. N., Fong, T. G., Nemeth, E., et al. (2015). The montreal cognitive assessment: Creating a crosswalk with the mini-mental state examination. Journal of the American Geriatrics Society, 63(11), 2370-2374.

7. Saliba, D., Buchanan, J., Edelen, M. O., Streim, J., Ouslander, J., Berlowitz, D., et al. (2012). MDS 3.0: Brief interview for mental status. Journal of the American Medical Directors Association, 13(7),611-617.

8. Teng, E. L., & Chui, H. C. (1987). The modified mini-mental state (3MS) examination.The Journal of Clinical Psychiatry, 48(8), 314-318.

9. Velayudhan, L., Ryu, S. H., Raczek, M., Philpot, M., Lindesay, J., Critchfield, M., et al. (2014). Review of brief cognitive tests for patients with suspected dementia. International Psychogeriatrics / IPA, 26(8), 1247-1262.

The Brief Interview for Mental Status (BIMS) is a short performance-based cognitive screen designed specifically to facilitate cognitive screening in MDS assessments for residents of skilled nursing facilities. The ability and sensitivity of the BIMS in determining level of cognitive deficit is explored by comparing the interpreted results of the BIMS to those of the more widely known and recognized cognitive screening tools, the Mini-Mental State Exam (MMSE) and Montreal Cognitive Assessment (MoCA).


Constructing A Sensory Environment

Rehab & DisabilityPostersIntroductory

Understand common participation challenges for adults with moderate to profound intellectual disability. Recognize ways occupational therapy can play a role in improving quality of life for this population through program development.

This poster presents the development and outcomes of "Constructing A Sensory Environment," a sensory-based leisure group for adults with moderate to profound intellectual disabilities. It intends to convey the potential for OT to enhance quality of life for this population, and demonstrate a program that was found effective during Level II Fieldwork at a day center for adults with intellectual disabilities. An area of need observed at the center was the disengagement of clients with more severe performance skill challenges. Activities were seldom graded to a level facilitating their participation. These observations correspond with research findings that adults with intellectual disabilities spend more time in passive rather than active activities (Crowe, Sedillo, Kertcher, & LaSalle, 2015), and those with more severe disabilities are often unoccupied for large portions of the day (Mansell & Beadle-Brown, 2012). This group operated at the Parallel or Project Level, according to Mosey’s five developmental group types (Cole, 2012). It provided opportunity for participants to make choices, interact with peers and the environment, experience intrinsic gratification, and reduce self-harming behaviors. Its development drew on the Developmental Model, the Lifestyle Performance Model, and Dunn’s Sensory Processing Model.

Group participants collaboratively constructed a small-scale multisensory space using a PVC pipe framework and fastening an assortment of objects to it. These materials elicited sensory exploration and a range of motor responses, in the context of group interaction and collaboration.

The presentation will describe the area of need and target population, outline the theoretical basis for group development, explain the format of group sessions, present the Likert Scale developed for use with the group, and provide the group’s outcomes.

Cole, M. B. (2012). Group dynamics in occupational therapy (4th ed.). Thorofare, NJ: SLACK Incorporated.

Crowe, T. K., Sedillo, J. S., Kertcher, E. F., & LaSalle, J. H. (2015). Time and space use of adults withintellectual disabilities. The Open Journal of Occupational Therapy, 3(2). Retrieved from

Mansell, J., & Beadle-Brown, J. (2012). Active support: Enabling and empowering people with intellectual disabilities. Philadelphia, PA: Jessica Kingsley Publishers.

The development and outcomes of a sensory-based leisure group for adults with significant intellectual disabilities are presented. Occupational therapy’s potential to enhance this population’s quality of life is explored through description of this program implemented during Level II Fieldwork.


Coordiated Rhythmic Movement on Parkinson's disease Symptoms

Rehab & DisabilityPostersIntroductory

Objective 1: Explore how current evidence of coordinated rhythmical based movement interventions can apply to occupational therapy practice. Objective 2: Understand the current evidence available to support the use of coordinated rhythmical based movement to decrease the severity of symptoms in individuals with Parkinson’s disease. Objective 3: Apply the knowledge learned and the results to current occupational therapy practice.

Parkinson’s Disease is a neurodegenerative disorder that affects over 1 million people in the United States. It affects an individual’s ability to function in everyday activities and impacts their functional mobility, balance, and potentially quality of life. The purpose of this literature synthesis is to determine if rhythmic coordinated movements is an effective intervention to decrease symptoms of Parkinson’s disease.

To conduct the literature synthesis, the databases ProQuest, CINAHAL, and PubMed were utilized. Search terms included: Parkinson’s disease, occupational therapy, movement, intervention, postural stability, movement based therapy, and tai chi (to get more specific when searching the database). After articles were retrieved, eight were critically analyzed and synthesized for the literature synthesis.

Of the articles reviewed, there was statistical significant in most of the interventions involving rhythmic coordinated movement showed an improvement in decreasing Parkinson’s disease symptoms. In the available research articles pertaining to rhythmic coordinated movements and Parkinson’s disease symptoms there is limited significant evidence in the improvement of symptoms in individuals with Parkinson’s disease as compared to traditional rehabilitation interventions. Utilizing different rhythmic coordinated movements as a preparatory technique could improve participation of activities of daily living in individuals with Parkinson’s disease. Occupational therapists could allow the individuals with Parkinson’s disease to perform these movements to decrease the symptoms. Once symptoms are decreased, the occupational therapists could engage the individual in their daily tasks. The tasks will be easier to complete if the individual has decrease symptoms.

De Dreu, M. J., van der Wilk, A. D., Poppe, E., Kwakkel, G., & van Wegen, E. H. (2012). Rehabilitation, exercise therapy and music in patients with Parkinson's disease: a meta-analysis of the effects of music-based movement therapy on walking ability, balance and quality of life. Parkinsonism & Related Disorders, 18(s), S114-9 1p.

Fong Mei Toh, S. (2013). A Systematic Review on the Effectiveness of Tai Chi Exercise in Individuals with Parkinson's Disease from 2003 to 2013. Hong Kong Journal Of Occupational Therapy, 23(2), 69-81 13p. doi:10.1016/j.hkjot.2013.11.001

Giese, Terry. (2005). Complementary and alternative medicine (CAM) position paper. American Journal of Occupational Therapy.59(6) 653-655p. doi:10.5014/ajot.59.6.653

Hashimoto, H., Takabatake, S., Miyaguchi, H., Nakanishi, H., & Naitou, Y. (2015). Effects of dance on motor functions, cognitive functions, and mental symptoms of parkinson's disease: A quasi- randomized pilot trial. Complementary Therapies in Medicine, 23(2), 210-219. doi:

Hackney, E., M., & Earhart, M., G. (2009). Effects of dance on movement control in parkinson’s disease: a comparison of argentine tango and American ballroom. J Rehabil Medical, 41(6): 475-481. doi: 10.2340/16501977-0362.

Hackney, E., M., & Earhart, M., G.. (2009). Health-related quality of life and alternative forms of exercise in parkinson disease. Parkinsonism related Disorder, 15(9), 644-648p. doi: 0.1016/j.parkreldis.2009.03.003.

Li, F., Harmer, P., Fitzgerald, K., Eckstrom, E., Stock, R., Galver, J., & ... Batya, S. (2012). Tai chi and postural stability in patients with Parkinson's disease.New England Journal Of Medicine, 366(6), 511-519 9p.

McNeely ME, Mai MM, Duncan RP and Earhart GM (2015) Differential Effects of Tango Versus Dance for PD in Parkinson Disease. Front. Aging Neurosci. 7:239. doi: 10.3389/fnagi.2015.00239

Pompeu, E., J, Arduini, A., L, Botelho, R., A, Fonseca, M., Pompeu, S., Torriani-Pasin, C., & Deutsch, E., J. (2013). Feasibility, safety and outcomes of playing kinect adventures for people with parkinson’s disease: a pilot study. Physiotherapy, 100(2): 162-168). doi:


The purpose of this session is to determine the effectiveness of rhythmic coordinated movement interventions compared to traditional rehabilitation interventions on Parkinson’s disease symptoms. A decrease in symptoms will allow individual to participate in daily tasks with more ease.


Decreasing Pain in Adolescents with Complex Regional Pain Syndrome

Rehab & DisabilityPostersIntroductory

Develop an awareness of the prevalence of pediatric Complex Regional Pain Syndrome and the importance of finding effective interventions for decreasing pain in this population • Interpret the current literature to demonstrate an understanding of the effectiveness of an interdisciplinary, biopsychosocial approach to treatment for decreasing pain among adolescents/young adults with Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS), an amplified musculoskeletal pain syndrome that typically affects one extremity or limb, is characterized by pain that is disproportionate to the inciting event. Although CRPS was previously considered rare among adolescents, as it most commonly affects middle-aged adults, it has been increasingly recognized in pediatric patients and can result in significant disability. Occupational Therapy can provide client-centered interventions to facilitate decreased pain in order to improve daily functioning and increase quality of life. For these reasons, it is imperative to determine which occupational therapy interventions are effective in decreasing pain among adolescents/young adults with CRPS.

The purpose of this presentation is to disseminate the current research on this topic in order to encourage the best treatment for this population. Articles were obtained from PubMed, PsychINFO, CINAHL, OVID, and OTSearch for the purposes of this literature synthesis. After an extensive literature search and retrieving about twenty results from each research database, eight articles from the last five to seven years were selected to critically review. Following a critique of each article, the lack of research on specific occupational therapy interventions for this population became evident. Rather, the evidence suggests that intensive rehabilitation programs, consisting of physical therapy, occupational therapy, and cognitive-behavioral therapy, are most effective in decreasing pain and increasing the overall functional abilities of the adolescents/young adults. Thus, this literature synthesis concludes that an interdisciplinary approach to rehabilitation produces the best outcomes in decreasing pain and increasing overall function in adolescents/young adults with CRPS.