Background and Purpose: Fear of falling (FoF) avoidance behavior (FFAB) is common in Parkinson disease (PD) and contributes to reduced activity, deconditioning, and functional decline. Although depression, anxiety, fatigue, cognition, balance, and motor severity have been examined in relation to FoF, few studies have evaluated them simultaneously. The purpose of this exploratory study was to identify the relative contributions of affective, cognitive, fatigue-related, balance, and motor factors associated with FFAB in individuals with early-stage PD and to generate hypotheses for future investigation. Methods: A cross-sectional secondary analysis was conducted in mild to moderate PD (Hoehn and Yahr stages 1-3, n = 35). Participants completed measures of FFAB (modified FFAB Questionnaire), fatigue (Movement Disorder Society Unified Parkinson Disease Rating Scale [MDS-UPDRS] Part I, item 13), mood (Parkinson Anxiety Scale and Geriatric Depression Scale), cognition (Mini-Mental State Exam, Trail Making Test Parts A and B, and Symbol Digit Modalities Test), balance (MiniBESTest [MBT]), and motor severity (MDS-UPDRS Part III). Bivariate correlations were computed between FFAB and candidate predictors, followed by Elastic Net regression. Results: Modified FFAB Questionnaire scores were strongly correlated with depressive symptoms and balance. Elastic Net regression retained 11 variables, including Geriatric Depression Scale ( β = 616), MBT ( β = −0.469), MDS-UPDRS Part III ( β = 0.156), sex ( β = 0.183), Trail Making Test Part A ( β = 0.115), and fatigue ( β = 0.050). Bootstrap confidence intervals indicated that MBT demonstrated the most stable association with FFAB (95% confidence interval: −0.703, −0.169). Discussion and Conclusions: FFAB in early-stage PD appears strongly associated with depressive symptoms and balance impairment, with modest contributions from motor severity. These exploratory findings identify affective and physical factors as promising targets for research aimed at understanding FFAB.
Background and purpose: There is a need for new and inexpensive methods for the maximum inspiratory and expiratory pressures (MIP/MEP) test. The one-repetition maximum (1RM) test is an easy and cost-effective method to measure maximal strength. The purpose of this study was to validate a MIP/MEP test protocol based on the 1RM test, its test–retest reliability, and minimal detectable change (MDC) in individuals with multiple sclerosis. Methods: Fifty-two individuals (53.6 ± 10 years; 5.7 ± 1.8 points on Expanded Disability Status Scale) (46% relapsing–remitting; 23% primary progressive; 31% secondary progressive) attended two appointments 7 to 10 days apart. MIP/MEP tests were performed using a threshold valve device (1RM-based protocol) and a digital manometer (reference test). The 1RM-based protocol included an incremental phase (load increase [30 cmH 2 O] to achieve task failure) and a halving phase (load halfway between the lowest failed attempt and the last valid attempt was prescribed). Results: The concurrent validity of the 1RM-based protocol was good to excellent with respect to the reference test (MIP: day 1, n = 49, intraclass correlation coefficient [ICC (95% confidence intervals)] = 0.87 (0.78-0.93); day 2, n = 48, ICC = 0.91 (0.82-0.95); MEP: day 1, n = 49, ICC = 0.82 (0.60-0.91); day 2, n = 49, ICC = 0.88 (0.64-0.95)). The test–retest reliability was good for MIP [n = 46, ICC = 0.88 (0.79-0.93)] and excellent for MEP [n = 48, ICC = 0.90 (0.83-0.94)]. The MDC (90-95) for MIP ranged from 23.7 to 28.2 cmH 2 O, and for MEP ranged from 19 to 22.5 cmH 2 O. Discussion and Conclusion: This study validated a new 1RM-based protocol for the MIP/MEP tests using a respiratory muscle training threshold valve device in individuals with multiple sclerosis, showing good to excellent concurrent validity compared with the reference test, as well as good to excellent test–retest reliability. The MDC reported can be interpreted and applied in the clinical setting.
Background and Purpose: The vestibulo-ocular reflex (VOR) contributes to gaze stabilization after head movement, but its independent prognostic value for return-to-play (RTP) after sport-related concussion (SRC) is unclear. This systematic review and meta-analysis examined associations between early vestibular-ocular motor screening (VOMS) assessment and RTP duration following SRC. Methods: Searches of PubMed, CINAHL, Scopus, PEDro, and Cochrane Library to March 2025 identified studies assessing within 14 days of SRC and reporting RTP outcomes. Two reviewers extracted data and assessed the risk of bias. Random-effects meta-analysis was performed for studies reporting prolonged recovery (≥28–30 days). Results: Twelve studies (N = 3297 athletes) met inclusion criteria. Meta-analysis of four studies (n = 968) found a positive VOMS screen was associated with increased odds of prolonged recovery (odds ratio 2.39; 95% confidence interval, 1.82–3.13; P < 0.00001; I 2 =0%). Among nine studies of isolated VOR gain, eight reported significant univariate associations with longer RTP, but only two retained significance after multivariable adjustment. VOMS reliably identifies athletes at risk for protracted recovery, but isolated VOR measures show inconsistent independent predictive value after adjustment. Discussion and Conclusions: Objective VOR gain quantification (eg, vHIT, caloric) is needed to clarify whether physiological VOR dysfunction independently affects recovery. Clinicians should interpret VOR findings within a multimodal assessment.
Background and Purpose: Individuals with vestibular hypofunction (VH) report low levels of physical activity (PA), corresponding with restrictions when performing activities of daily living. However, a clear association between physical function and self-reported dizziness handicap and measures of vestibular function has not been established. Our purpose is to investigate whether functional aerobic capacity and PA are related to dizziness handicap and objective assessments of the vestibulo-ocular reflex in participants with VH. Methods: A total of 36 participants (14 males, 22 females; 70.11 ± 12.2 years) with evidence of VH of peripheral origin were included. Self-reported measures of dizziness handicap and impairment included the Dizziness Handicap Inventory and Visual Analogue Scale of dizziness. Objective measures included the Video Head Impulse Test and computerized Dynamic Visual Acuity. Outcomes of interest included the 2-minute walk test, average daily steps, light PA, and moderate-to-vigorous PA. Multiple linear regression models were built, controlling for age and sex, and adjusted using the Benjamini–Hochberg. Significance was set at alpha = 0.05. Results: Self-reported measures of dizziness handicap and impairment were significantly associated with the 2-minute walk test ( P ≤ 0.05). No significant associations between PA and the independent variables were found. Discussion and Conclusions: Greater dizziness handicap was associated with lower functional aerobic capacity when adjusting for age and sex. Interestingly, this relation was not observed when examining objective measures of vestibular function. After adjusting for age and sex, age was associated with reduced moderate-to-vigorous PA time, whereas the vestibular-related measures were not.
Background and Purpose: Functional neurological disorder (FND) is increasingly recognized as a disorder of brain network dysfunction with neuroimaging studies demonstrating altered communication among neural circuits involved in movement, attention, and self-agency. The Optimizing Performance Through Intrinsic Motivation and Attention for Learning (OPTIMAL) theory of motor learning is centered on the three constructs: external focus of attention, enhanced expectancies, and autonomy. This article explores the potential alignment between the pathophysiology underlying FND and the constructs proposed by the OPTIMAL theory and hypothesizes that OPTIMAL offers a promising, pathophysiology-informed framework for the physical therapy management of FND across varied practice settings. Summary of Key Points • FND is characterized by disrupted brain network communication, particularly in circuits related to motor learning, attention, and self-agency. • Physical therapy is supported by evidence as a first-line treatment for motor symptoms in FND; however, existing consensus guidelines do not identify an explicit motor learning framework to guide PT intervention • The OPTIMAL theory of motor learning emphasizes external focus of attention, enhanced expectancies, and autonomy, constructs that align with the neural networks implicated in FND and have demonstrated efficacy to improve motor learning when applied to healthy and neurological populations. Recommendations for Clinical Practice • Applying motor learning constructs from OPTIMAL offers a practical and evidence-aligned approach to treating motor learning deficits in FND across care settings and age groups. • Therapists may improve motor outcomes in FND by incorporating external cueing, success-oriented feedback, and patient choice.
