<b><i>Introduction:</i></b> Motor dysfunction is an important feature of early-stage dementia. Gait provides a non-invasive biomarker across the dementia continuum. Gait speed and rhythm aid risk stratification of incident dementia in subjective cognitive impairment (SCI) and are associated with cognitive domains in mild cognitive impairment (MCI) and dementia. However, hand movement analysis, which may be more accessible, has never been undertaken in SCI and rarely in MCI or dementia. We aimed to address this gap and improve understanding of hand motor-cognitive associations across the dementia continuum. <b><i>Methods:</i></b> A total of 208 participants were recruited: 50 with dementia, 58 MCI, 40 SCI, and 60 healthy controls. Consensus diagnoses were made after comprehensive gold-standard assessments. A computer key-tapping test measured frequency, dwell-time, rhythm, errors, and speed. Associations between key-tapping and cognitive domains and diagnoses were analysed using regression. Classification accuracy was measured using area under receiver operating characteristic curves. <b><i>Results:</i></b> Hand frequency and speed were associated with memory and executive domains (<i>p</i> ≤ 0.001). Non-dominant hand rhythm was associated with all cognitive domains. Frequency, rhythm, and speed were associated with SCI, MCI, and dementia. Frequency and speed classified ≥94% of dementia and ≥88% of MCI from controls. Rhythm of the non-dominant hand classified ≥86% of dementia and MCI and 69% of SCI. <b><i>Conclusion:</i></b> Our findings show hand motor dysfunction occurs across the dementia continuum and, similar to gait, is associated with executive and memory domains and with cognitive diagnoses. Key-tapping performance differentiated dementia and MCI from healthy controls. More research is required before recommending key-tapping as a non-invasive motor biomarker of cognitive impairment.
Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected ‘Restraint’ as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the ‘last resort’. To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, doctors, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified during the study: 1. Understanding of restraint; 2. Support for Legislation; 3. Restraint-free environments are not possible; 4. Low-level restraint, and 5. Restraint in the community is uncharted. Although most staff, health practitioners and relatives have a basic understanding of restraint, more education is needed at a conceptual level to enable them to identify and avoid restraint practice, particularly ‘low-level’ forms and chemical restraint. There was strong support for the new restraint regulations, but most interviewees admitted they were unsure what the legislation entailed. With regards to resources, stakeholders wanted recognition that there were times when restraint was necessary and advice on what to do in these situations, as opposed to unrealistic aspirations for restraint-free care. Stakeholders reported greater oversight of restraint in residential aged care but stated that community restraint use was largely unknown. Research is needed to investigate the extent and types of restraint practice in community aged care.
With populations ageing, the number of people with dementia worldwide is expected to triple to 152 million by 2050. Seventy percent of cases are due to Alzheimer's disease (AD) pathology and there is a 10-20 year 'pre-clinical' period before significant cognitive decline occurs. We urgently need, cost effective, objective methods to detect AD, and other dementias, at an early stage. Risk factor modification could prevent 40% of cases and drug trials would have greater chances of success if participants are recruited at an earlier stage. Currently, detection of dementia is largely by pen and paper cognitive tests but these are time consuming and insensitive to pre-clinical phases. Specialist brain scans and body fluid biomarkers can detect the earliest stages of dementia but are too invasive or expensive for widespread use. With the advancement of technology, Artificial Intelligence (AI) shows promising results in assisting with detection of early-stage dementia. Existing AI-aided methods and potential future research directions are reviewed and discussed.
Purpose: We explored physiotherapists' perceptions of clinical supervision. Method: Individual semi-structured interviews were conducted with a purposive sample of 21 physiotherapists from a public hospital. Qualitative analysis was undertaken using an interpretive description approach. The Manchester Clinical Supervision Scale (MCSS-26) was administered to evaluate the participants' perceptions of the effectiveness of the clinical supervision they had received and to establish trustworthiness in the qualitative data by means of triangulation. Results: The major theme was that the content of clinical supervision should focus on professional skill development, both clinical and non-clinical. Four subthemes emerged as having an influence on the effectiveness of supervision: the model of clinical supervision, clinical supervision processes, supervisor factors, and supervisee factors. All sub-themes had the potential to act as either a barrier to or a facilitator of the perception that clinical supervision was effective. Conclusions: Physiotherapists reported that clinical supervision was most effective when it focused on their professional skill development. They preferred a direct model of supervision, whereby their supervisor directly observed and guided their professional skill development. They also described the importance of informal supervision in which guidance is provided as issues arise by supervisors who value the process of supervision. Physiotherapists emphasized that supervision should be driven by their learning needs rather than health organization processes.Objectif : explorer les perceptions des physiothérapeutes à l’égard de la supervision clinique. Méthodologie : entrevues individuelles semi-structurées réalisées auprès d’un échantillon choisi de 21 physiothérapeutes d’un hôpital public. Les chercheurs ont procédé à une analyse qualitative au moyen d’une description interprétative. Ils ont utilisé l’échelle de supervision clinique de Manchester (MCSS–26) pour évaluer les points de vue des participants à l’égard de l’efficacité de la supervision et pour établir la fiabilité des données qualitatives par triangulation. Résultats : un thème majeur est ressorti : la supervision clinique devrait être axée sur le perfectionnement d’habiletés professionnelles cliniques et non cliniques. Il a été établi que quatre sous-thèmes avaient une influence sur l’efficacité de la supervision : le modèle de supervision clinique, les processus de supervision clinique, les facteurs liés au superviseur et ceux liés au supervisé. Ces sous-thèmes avaient tous le potentiel d’être un obstacle ou un incitatif à la perception d’efficacité de la supervision clinique. Conclusion : selon les physiothérapeutes, la supervision clinique la plus efficace était axée sur le perfectionnement de leurs habiletés professionnelles. Ils préféraient un modèle de supervision directe, selon lequel leur superviseur observait directement et orientait le perfectionnement de leurs habiletés professionnelles. Ils ont également insisté sur l’importance de la supervision informelle, c’est-à-dire que les superviseurs qui adhèrent à l’importance du processus de supervision donnent des conseils à mesure que des problèmes surgissent. Ils ont souligné que la supervision devrait être dictée par leurs besoins d’apprentissage plutôt que par les processus de l’organisation hospitalière.
Abstract Background Dementia prevention and drug development is hindered by the lack of low‐cost population‐level tests to help identify preclinical Alzheimer’s disease (AD) in the community. Recent evidence suggests that precise analysis of hand movements may detect motor changes indicative of preclinical AD. The objective was to evaluate how TAS Test, a new online automated hand movement test, predicts preclinical AD biomarkers (plasma ptau181 and subtle episodic memory decline) in a cognitively asymptomatic cohort of older adults. Method Participants completed TAS Test online at home using their own computer without researcher assistance: a series of 10‐30 second index finger‐key and index finger‐thumb tapping tests recorded with a keyboard and/or webcam. Movement features including frequency, rhythm, pauses and accuracy were extracted. Participants also completed online tests of episodic memory, CANTAB Paired Associate Learning (CANTAB). A subset provided blood samples for ptau181 analysis. Accuracy of linear regression models comprising hand motor features to predict PAL scores and ptau181 levels, adjusted for confounding, was compared to null models (with only confounders: age, gender, education level, anxiety and depression) using R2adj and AIC. ΔAIC > 2 denotes statistical difference. Result 1,228 adults (mean (SD) age, 65.8 (7.4) years; 73.0% female) completed TAS Test and CANTAB; 459 underwent ptau181 analysis. All keyboard tests improved prediction of asymptomatic episodic memory decline; the 3 step‐ (ΔAIC = 11.2; R2adj = 8.1%) and alternate‐ key (ΔAIC = 3.3; R2adj = 7.5%) tests ranked highest and were the only keyboard tests to improve prediction of ptau181 (3 step ΔAIC = 7.0; R2adj = 17.8%; alternate key ΔAIC = 3.4; R2adj = 17.4%). All finger‐thumb motor measures improved predictions of CANTAB scores and ptau181 levels; the highest performing tests were dominant hand tapping (CANTAB ΔAIC = 2.9; R2adj = 8.2%; ptau181 ΔAIC = 2.4; R2adj = 12.9%) and both hands dual‐task tapping (CANTAB ΔAIC = 3.0; R2adj = 6.8%; ptau181 ΔAIC = 8.7; R2adj = 11.9%). Conclusion TAS Test provides an accessible brief home‐based test for identifying preclinical AD risk. This novel approach holds potential as a pre‐screening/enrichment tool for identifying at risk cohorts for further investigation.
To explore the literature on carer-supported home-based exercise programs for people after stroke, as a form of physical activity. The review focus was to examine the training carers receive, the content of programs, and investigate the physical activity levels and functional mobility of people after stroke.
Abstract INTRODUCTION Finding low‐cost methods to detect early‐stage Alzheimer's disease (AD) is a research priority for neuroprotective drug development. Presymptomatic Alzheimer's is associated with gait impairment but hand motor tests, which are more accessible, have hardly been investigated. This study evaluated how home‐based Tasmanian (TAS) Test keyboard tapping tests predict episodic memory performance. METHODS 1169 community participants (65.8 ± 7.4 years old; 73% female) without cognitive symptoms completed online single‐key and alternate‐key tapping tests and episodic memory, working memory, and executive function cognitive tests. RESULTS All single‐key ( R 2 adj = 8.8%, ΔAIC = 5.2) and alternate‐key ( R 2 adj = 9.1%, ΔAIC = 8.8) motor features predicted episodic memory performance relative to demographic and mood confounders only ( R 2 adj = 8.1%). No tapping features improved estimation of working memory. DISCUSSION Brief self‐administered online hand movement tests predict asymptomatic episodic memory impairment. This provides a potential low‐cost home‐based method for stratification of enriched cohorts. Highlights We devised two brief online keyboard tapping tests to assess hand motor function. 1169 cognitively asymptomatic adults completed motor‐ and cognitive tests online. Impaired hand motor function predicted reduced episodic memory performance. This brief self‐administered test may aid stratification of community cohorts.
Abstract Background Clinical care for people with dementia as a primary diagnosis, or as a co‐morbidity, can be complex. Physiotherapists play a key role in the care of people living with dementia in multiple settings. The aim of this systematic review was to understand the attitudes, beliefs, knowledge and confidence of physiotherapists and physiotherapy students when working with people living with dementia. Methods This was a mixed‐methods systematic review that included qualitative and quantitative studies. Participants were physiotherapists working in any clinical specialty (e.g. gerontology, orthopaedic, neurological), and physiotherapy students who had completed at least 5 weeks of clinical placement. The phenomena of interest were attitudes, beliefs, knowledge and confidence when working with people with dementia in any setting. Eleven databases were searched. Data synthesis followed a convergent integrated approach according to Joanna Briggs Institute methodology for mixed methods systematic reviews. Results Fifteen studies were included (9 quantitative and 6 qualitative studies). Seven key themes evolved. Five related to the belief that (1) working with people with dementia is complex and challenging; (2) opportunities for education in dementia care are lacking; (3) working with people with dementia is a specialized area of practice; (4) there are unsupportive systems for working with people with dementia; and (5) people with dementia deserve rehabilitation, but their potential to improve is less certain. One theme related to knowledge (lack of knowledge in some areas of dementia care), and one theme related to confidence (lack of confidence in working with people with dementia). Discussion/Conclusion Physiotherapists and physiotherapy students have low levels of knowledge and confidence in areas including cognition, communication and management of behavioural symptoms. Given that higher levels of knowledge and confidence may be associated with more positive attitudes and beliefs, dementia education needs of physiotherapists at all levels needs to be addressed.
There are no low-cost population-level tests to help identify preclinical Alzheimer's disease (AD); this hinders drug development and targeted dementia prevention. New evidence suggests that hand movements change in preclinical AD. We evaluated the predictive accuracy of TAS Test (new online hand movement analysis website) for detecting preclinical AD biomarkers (plasma ptau181 and subtle episodic memory impairment) in cognitively asymptomatic adults.
Methods
Participants completed TAS Test online at home: 10–30 second finger-tapping tests recorded with a keyboard and/or webcam. Movement features (frequency, rhythm, pauses etc) were extracted. Participants also completed online episodic memory tests (CANTAB) and some provided blood samples for ptau181 analysis. Linear regression models comprising hand movement features to predict CANTAB scores and ptau181 levels, adjusted for confounding, was compared to null models (with only confounders: age, gender, education level, anxiety and depression) using R2adj and AIC. ΔAIC > 2 denotes statistical difference.
Results
1,228 adults (mean (SD) age, 65.8 (7.4) years; 73.0% female) completed TAS Test and CANTAB; 459 underwent ptau181 analysis. The 3 step-key and alternate-key tapping tests improved prediction of asymptomatic episodic memory impairment; (ΔAICs=11.2 and 3.3; R2adjs=8.1% and 7.5% respectively) and ptau181 (3 step ΔAIC=7.0; R2adj=17.8%; alternate key ΔAIC=3.4; R2adj=17.4%). The highest performing webcam tests were dominant hand tapping (CANTAB ΔAIC= 2.9; R2adj=8.2%; ptau181 ΔAIC=2.4; R2adj=12.9%) and both hands dual-task tapping (CANTAB ΔAIC=3.0; R2adj=6.8%; ptau181 ΔAIC=8.7; R2adj=11.9%).
Conclusions
TAS Test provides a home-based test for identifying preclinical AD risk and holds potential as a pre-screening tool for identifying cohorts for further investigation.
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