Increasing Physical Activity in Multiple Sclerosis Using a Behavioral Intervention Internet intervention for increasing physical activity in persons with multiple sclerosis Observation and execution of upper-limb movements as a tool for rehabilitation of motor deficits in paretic stroke patients: protocol of a randomized clinical trial INVITED COMMENTARY: Rating the Quality of Trials in Systematic Reviews of Physical Therapy Interventions Toward Automated, At-Home Assessment of Mobility Among Patients With Parkinson Disease, Using a Body-Worn Accelerometer The Development of a Mobile Monitoring and Feedback Tool to Stimulate Physical Activity of People With a Chronic Disease in Primary Care: A User-Centered Design Feasibility of home-based automated Parkinson's disease motor assessment Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Physical activity for the prevention and treatment of major chronic disease: an overview of systematic reviews Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Supplementary motor area stimulation for Parkinson disease Upper limb rehabilitation after spinal cord injury: a treatment based on a data glove and an immersive virtual reality environment Randomized controlled trial of a behavioral intervention targeting symptoms and physical activity in multiple sclerosis Ambulatory Monitoring of Physical Activities in Patients With Parkinson's Disease Physiological improvement with moderate exercise in type II diabetic neuropathy. Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. Controlled Study of 50-Hz Repetitive Transcranial Magnetic Stimulation for the Treatment of Parkinson Disease
The present study adopted an interrupted time-series design for identifying the possibility of behavioral reactivity and examining the effect of an Internet-delivered behavioral intervention for increasing self-reported and objective ly-measured physical activity among persons with multiple sclerosis ( MS ) . Participants ( n = 18 ) wore an accelerometer for 7 days and completed a battery of question naires to measure  physical activity  at 3 time points ( before and after a 3-month period of no treatment and again after a 3-month period of treatment ) . There was a small change in objective ly-measured , but not self-reported , physical activity in the period of no treatment , whereas there was a large increase in self-reported and objective ly-measured physical activity in the period of treatment . These findings both complement and extend previous research and further support the efficacy of the current Internet behavioral intervention for increasing physical activity in persons with MS Background : Physical activity has been associated with improvements in walking mobility and quality of life in persons with multiple sclerosis ( MS ) , and yet this population is largely sedentary and inactive compared with the general population . Objectives : We conducted a pilot , r and omized controlled trial ( RCT ) for examining the effect of an Internet intervention based on social cognitive theory ( SCT ) for favorably increasing physical activity among persons with MS . We further examined variables from SCT as possible mediators of the Internet intervention . Methods : We r and omly allocated 54 persons with MS into either an Internet intervention condition or a waitlist control condition .  The participants completed measures of physical activity , self-efficacy , outcome expectations , functional limitations , and goal setting before and after the 12-week period . Results : The intervention group reported a statistically significant ( p = 0.01 ) and large increase in physical activity over time ( d = 0.72 ) , whereas the control group had a small ( d = 0.04 ) and non-significant change in physical activity ( p = 0.71 ) . The intervention group further reported a statistically significant ( p = 0.001 ) and large increase in goal setting over time ( d = 0.97 ) , whereas the control group had a small ( d = −0.13 ) and non-significant change ( p = 0.17 ) . The change in goal setting over time mediated the effect of the Internet intervention on physical activity behavior . Conclusions : This pilot study sets the stage for a subsequent RCT that includes a larger sample of persons with MS , longer intervention period along with a follow-up , objective measure of physical activity , and secondary outcomes of walking mobility and QOL Background Evidence exist that motor observation activates the same cortical motor areas that are involved in the performance of the observed actions . The so called “ mirror neuron system ” has been proposed to be responsible for this phenomenon . We employ this neural system and its capability to re-enact stored motor representations as a tool for rehabilitating motor control . In our new neurorehabilitative schema ( videotherapy ) we combine observation of daily actions with concomitant physical training of the observed actions focusing on the upper limbs . Following a pilot study in chronic patients in an ambulatory setting , we currently design ed a new multicenter clinical study dedicated to patients in the sub-acute state after stroke using a home-based self-induced training .  Within our protocol we assess 1 ) the capability of action observation to elicit rehabilitational effects in the motor system , and 2 ) the capacity of this schema to be performed by patients without assistance from a physiotherapist . The results of this study would be of high health and economical relevance . Methods / design A controlled , r and omized , multicenter , paralleled , 6 month follow-up study will be conducted on three groups of patients : one group will be given the experimental treatment whereas the other two will participate in control treatments .  All patients will undergo their usual rehabilitative treatment beside participation in the study . The experimental condition consists in the observation and immediate imitation of common daily h and and arm actions . The two parallel control groups are a placebo group and a group receiving usual rehabilitation without any trial-related treatment . Trial r and omization is provided via external data management . The primary efficacy endpoint is the improvement of the experimental group in a st and ardized motor function test ( Wolf Motor Function Test ) relative to control groups . Further assessment s refer to subjective and qualitative rehabilitational scores . This study has been review ed and approved by the ethics committee of Aachen University . Discussion This therapy provides an extension of therapeutic procedures for recovery after stroke and emphasizes the importance of action perception in neurorehabilitation The results of the study could become implemented into the wide physiotherapeutic practice , for example as an ad on and individualized therapy & NA ; Physical therapists seeking to use evidence to guide their practice may have limited time to read research reports . One way to reduce the time required to identify and read about the research that is relevant to a particular clinical question is to read a systematic review that summarizes multiple studies . This paper explains the process that is used to conduct systematic review s , which includes the establishment of a protocol , comprehensive search ing , appraisal of the quality of the included studies , data extraction and meta analysis , and consideration of the clinical and research implication s of the findings . We also consider how the reader of a systematic review can determine whether the review is likely to provide an unbiased ( believable ) estimate of the treatment effect . A systematic review of r and omized trials of a  cardiopulmonary physical therapy intervention is used as an example . The issue of appraisal of quality is then discussed further , with a demonstration of how one vali date d tool for quality appraisal ‐‐the PEDro scale‐‐can be used to evaluate a r and omized trial in cardiopulmonary physical therapy Objective . To develop an automated and objective method to assess mobility in Parkinson disease ( PD ) patients in daily-life setting s and to investigate whether accelerometer-derived measures discriminate between PD and healthy controls as they walk and simulate activities of daily living ( ADL ) . Methods . Healthy older adults ( 17 ) and patients with PD ( 22 ) wore a triaxial accelerometer on their lower back during short walks ( validation study ) and during a walk around the medical center to simulate daily activities ( ADL simulation ) . The variability ( consistency and rhythmicity ) of stepping was assessed . The patients completed the walks before and after taking their anti-Parkinsonian medications .  Frequency-based acceleration measures included dominant frequency , amplitude ( strength of signal frequency ) , width ( frequency dispersion ) , and slope ( a combination reflecting amplitude and width ) of the main frequency of the power spectral density in the 0.5- to 3.0-Hz b and . A subset of the Unified Parkinson-Disease Rating Scale provided a clinical measure of gait impairment ( UPDRS-Gait5 ) . A PD patient and control wore the sensors for 3 days at home . Results . The width was larger , and the amplitude and slope were smaller in the PD patients compared to the controls in the validation study and ADL simulation ( P < .02 ) . The width decreased , and the amplitude and slope increased when patients took anti-Parkinsonian medications ( P < .007 ) . Significant correlations were observed between acceleration-derived measures and UPDRS-Gait5 . The data obtained at home was similar to the clinic data . Conclusions . Frequency-derived measures are valid and sensitive estimates of stride-to-stride variability that can be used to assess the quality and consistency of walking in patients with PD in real-life setting Background  Physical activity  is an important aspect in the treatment of patients with chronic obstructive pulmonary disease or type-2 diabetes . A monitoring and feedback tool combined with guidance by a primary care provider might be a successful method to enhance the level of physical activity in these patients . As a prerequisite for useful technology , it is important to involve the end-users in the design process from an early stage . Objective The aim of this study was to investigate the user requirements for a tool to stimulate physical activity  , embedded in primary care practice . The leading principle of this tool is to change behavior by self-monitoring , goal - setting , and feedback . Methods The research team collected qualitative data among 15 patients , 16 care professionals , and several experts . A prototype was developed in three stages . In stage 1 , the literature was search ed to identify end-users and context . In stage 2 , the literature , experts and patient representatives were consulted to set up a use case with the general idea of the innovation . In stage 3 , individual interviews and focus groups were held to identify the end-user requirements . Based on these requirements a prototype was built by the engineering team . Results The development process has led to a tool that generally meets the requirements of the end-users . A tri-axial activity sensor  , worn on the hip , is connected by Bluetooth to a smartphone . In an app , quantitative feedback is given about the amount of activity and goals reached by means of graphical visualization , and an image shows a sun when the goal is reached . Overviews about activity per half an hour , per day , week , and month are provided . In the menu of the app and on a secured website , patients can enter information in individual sessions or read feedback messages generated by the system . The practice nurse can see the results of all patients on a secure webpage and can then discuss the results and set personalized goals in consultation with the patient . Conclusions This study demonstrates that a user-centered approach brings in valuable details ( such as the requirements for feedback in activity minutes per day ) to improve the fit between the user , technology , and the organization of care , which is important for the usability and acceptability of the tool . The tool embedded in primary care will be evaluated in a r and omized controlled trial Patients with Parkinson 's disease ( PD ) receive therapies aim ed at addressing a diverse range of motor symptoms . Motor complications in the form of symptom fluctuations and dyskinesias that commonly occur with chronic PD medication use may not be effectively captured by Unified Parkinson 's Disease Rating Scale ( UPDRS ) assessment s performed in the clinic . Therefore , home monitoring may be a viable adjunct tool to provide insight into PD motor symptom response to treatment . In this pilot study , we sought to evaluate the feasibility of capturing PD motor symptoms at home using a computer-based assessment system .  Ten subjects diagnosed with idiopathic PD used the system at home and ten non-PD control subjects used the system in a laboratory . The Kinesia system consists of a wireless finger-worn motion sensor and a laptop computer with software for automated tremor and bradykinesia severity score assessment s. Data from control subjects were used to develop compliance algorithms for rejecting motor tasks performed incorrectly . These algorithms were then applied to data collected from the PD subjects who used the Kinesia system at home to complete motor exams 3 - 6 times per day over 3 - 6 days . Motor tasks not rejected by the compliance algorithms were further processed for symptom severity . PD subjects successfully completed motor assessment s at home , with approximately 97 % of all motor task data files ( 1222/1260 ) accepted . These findings suggest that objective home monitoring of PD motor fluctuations is feasible BACKGROUND Multiple sclerosis ( MS ) is a major cause of chronic , neurological disability , with a significant long-term disability burden , often requiring comprehensive rehabilitation . OBJECTIVES To systematic ally evaluate evidence from published Cochrane Review s of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS ( pwMS ) , to improve patient outcomes , and to highlight current gaps in knowledge . METHODS We search ed the Cochrane Data base of Systematic Review s up to December 2017 , to identify Cochrane Review s that assessed the effectiveness of organised rehabilitation interventions for pwMS . Two review ers independently assessed the quality of included review s , using the Revised Assessment of Multiple Systematic Review s ( R-AMSTAR ) tool , and the quality of the evidence for reported outcomes , using the GRADE framework . MAIN RESULTS Overall , we included 15 review s published in the Cochrane Library , comprising 164 r and omised controlled trials ( RCTs ) and four controlled clinical trials , with a total of 10,396 participants . The included review s evaluated a wide range of rehabilitation interventions , including : physical activity and exercise therapy , hyperbaric oxygen therapy ( HBOT ) , whole-body vibration , occupational therapy , cognitive and psychological interventions , nutritional and dietary supplements , vocational rehabilitation , information provision , telerehabilitation , and interventions for the management of spasticity . We assessed all review s to be of high to moderate method ological quality , based on R-AMSTAR criteria .Moderate- quality evidence suggested that physical therapeutic modalities ( exercise and physical activities ) improved functional outcomes ( mobility , muscular strength ) , reduced impairment ( fatigue ) , and improved participation ( quality of life ) . Moderate- quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation , and interventions that provided information improved patient knowledge . Low-qualitty evidence suggested that neuropsychological interventions , symptom-management programmes ( spasticity ) , whole body vibration , and telerehabilitation improved some patient outcomes . Evidence for other rehabilitation modalities was inconclusive , due to lack of robust studies . AUTHORS ' CONCLUSIONS The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit , although the certainty of evidence varies across the different types of interventions evaluated by the review s. Structured , multidisciplinary rehabilitation programmes and physical therapy ( exercise or physical activities ) can improve functional outcomes ( mobility , muscle strength , aerobic capacity ) , and quality of life . Overall , the evidence for many rehabilitation interventions should be interpreted cautiously , as the majority of included review s did not include data from current studies . More studies , with appropriate design , which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge Background The evidence that higher levels of physical activity and /or lower levels of physical inactivity are associated with beneficial health-related outcomes stems mainly from observational studies . Findings from these studies often differ from r and omised controlled trials and systematic review s currently demonstrate mixed results , due partly to heterogeneity in physical activity interventions , method ologies used and population s studied . As a result , translation into clinical practice has been difficult . It is therefore essential that an overview is carried out to compare and contrast systematic review s , and to identify those physical activity interventions that are the most effective in preventing and /or treating major chronic disease . This protocol has been registered on PROSPERO 2013 : CRD42013003523 . Methods We will carry out an overview of Cochrane systematic review s. We will search the Cochrane Data base of Systematic Review s for systematic review s of r and omised controlled trials that have a primary focus on disease-related outcomes . We will restrict review s to those in selected major chronic diseases . Two authors will independently screen search outputs , select studies , extract data and assess the quality of included review s using the assessment of multiple systematic review s tool ; all discrepancies will be resolved by discussing and reaching a consensus , or by arbitration with a third author . The data extraction form will summarise key information from each review , including details of the population ( s ) ( for example , disease condition ) , the context ( for example , prevention , treatment or management ) , the participants , the intervention(s ) , the comparison(s ) and the outcomes . The primary outcomes of interest are the prevention of chronic disease and /or improved outcomes , in the treatment or management of chronic disease . These outcomes will be summarised and presented for individual chronic diseases ( for example , any change in blood pressure in hypertension or glucose control in diabetes ) . Secondary outcomes of interest are to describe the structure and delivery of physical activity interventions  across chronic disease conditions and adverse events associated with physical activity . Discussion We anticipate that our results could inform research ers , guideline groups and policymakers of the most efficacious physical activity interventions in preventing and /or managing major chronic disease Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 Objective : To explore the efficacy and stimulation frequency dependence of repetitive transcranial magnetic stimulation ( rTMS ) over the supplementary motor area ( SMA ) in Parkinson disease ( PD ) . Methods : In this r and omized , double-blind , sham-controlled , multicenter study with a parallel design , a weekly intervention was performed 8 times . The effects were monitored up to 20 weeks . By central registration , participants were assigned to 1 of 3 arms of the study : low-frequency ( 1-Hz ) rTMS , high-frequency ( 10-Hz ) rTMS , and realistic sham stimulation . The primary end point was the score change of the Unified Parkinson 's Disease Rating Scale ( UPDRS ) part III from the baseline . Several nonmotor symptom scales such as the Hamilton Rating Scale for Depression , apathy score , and nonmotor symptoms question naire were defined as secondary end points . Results : Of the 106 patients enrolled , 36 were allocated to 1-Hz rTMS , 34 to 10-Hz rTMS , and 36 to realistic sham stimulation . Results show 6.84-point improvement of the UPDRS part III in the 1-Hz group at the last visit of the 20th week . Sham stimulation and 10-Hz rTMS improved motor symptoms transiently , but their effects disappeared in the observation period . Changes in nonmotor symptoms were not clear in any group . No severe adverse event was reported . Conclusions : The 1-Hz rTMS over the SMA was effective for motor , but not nonmotor , symptoms in PD . Level of evidence : This study provides Class I evidence that 1-Hz rTMS over the SMA is effective for motor symptoms in PD Abstract Purpose state : The aim of this preliminary study was to test a data glove , CyberTouch ™ , combined with a virtual reality ( VR ) environment , for using in therapeutic training of reaching movements after spinal cord injury ( SCI ) . Method : Nine patients with thoracic SCI were selected to perform a pilot study by comparing two treatments : patients in the intervention group ( IG ) conducted a VR training based on the use of a data glove , CyberTouch ™ for 2 weeks , while patients in the control group ( CG ) only underwent the traditional rehabilitation . Furthermore , two functional parameters were implemented in order to assess patient ’s performance of the sessions : normalized trajectory lengths and repeatability . Results : Although no statistical significance was found , the data glove group seemed to obtain clinical changes in the muscle balance ( MB ) and functional parameters , and in the dexterity , coordination and fine grip tests . Moreover , every patient showed variations in at least one of the functional parameters , either along Y-axis trajectory or Z-axis trajectory . Conclusions : This study might be a step forward for the investigation of new uses of motion capture systems in neurorehabilitation , making it possible to train activities of daily living ( ADLs ) in motivational environments while measuring objective ly the patient ’s functional evolution . Implication s for Rehabilitation Key findings : A motion capture application based on a data glove is presented , for being used as a virtual reality tool for rehabilitation . This application has provided objective data about patient ’s functional performance . What the study has added : ( 1 ) This study allows to open new areas of research based on the use of different motion capture systems as rehabilitation tools , making it possible to train Activities of Daily Living in motivational environments . ( 2 ) Furthermore , this study could be a contribution for the development of clinical protocol s to identify which types of patients will benefit most from the VR treatments , which interfaces are more suitable to be used in neurorehabilitation , and what types of virtual exercises will work best Background : Exercise training is beneficial , but most persons with multiple sclerosis ( MS ) are sedentary and physically inactive . This has prompted a new focus on the promotion of lifestyle physical activity in MS . We previously design ed , tested , and refined a behavioral intervention delivered through the Internet that successfully increased lifestyle physical activity in MS , but have not evaluated the effects on secondary symptomatic and health-related quality of life ( HRQOL ) outcomes . Objective : We conducted a 6-month r and omized controlled trial ( RCT ) that examined the efficacy of an Internet-delivered , behavioral intervention for improving outcomes of fatigue , depression , anxiety , pain , sleep quality , and HRQOL in 82 ambulatory persons with MS . The secondary aim was to replicate previous results regarding change in free-living physical activity . Results : There was a significant and positive effect of the intervention on fatigue severity ( p=.001 , ηρ2=.15 ) and its physical impact ( p=.008 , ηρ2=.09 ) , depression ( p=.006 , ηρ2=.10 ) , and anxiety ( p=.006 , ηρ2=.10 ) . There were non-significant improvements in pain ( p=.08 , ηρ2=.04 ) , sleep quality ( p=.06 , ηρ2=.05 ) , and physical HRQOL ( p=.06 , ηρ2=.05 ) . We replicated our previous results by demonstrating an increase in self-reported physical activity ( p=.001 , ηρ2=.13 ) . Conclusions : Our results support behavioral interventions targeting lifestyle physical activity as an alternative approach for managing symptoms in MS A new ambulatory method of monitoring physical activities in Parkinson 's disease ( PD ) patients is proposed based on a portable data -logger with three body-fixed inertial sensors . A group of ten PD patients treated with subthalamic nucleus deep brain stimulation ( STN-DBS ) and ten normal control subjects followed a protocol of typical daily activities and the whole period of the measurement was recorded by video . Walking periods were recognized using two sensors on shanks and lying periods were detected using a sensor on trunk . By calculating kinematics features of the trunk movements during the transitions between sitting and st and ing postures and using a statistical classifier , sit-to-st and ( SiSt ) and st and -to-sit ( StSi ) transitions were detected and separated from other body movements . Finally , a fuzzy classifier used this information to detect periods of sitting and st and ing . The proposed method showed a high sensitivity and specificity for the detection of basic body postures allocations : sitting , st and ing , lying , and walking periods , both in PD patients and healthy subjects . We found significant differences in parameters related to SiSt and StSi transitions between PD patients and controls and also between PD patients with and without STN-DBS turned on . We concluded that our method provides a simple , accurate , and effective means to objective ly quantify physical activities in both normal and PD patients and may prove useful to assess the level of motor functions in the latter OBJECTIVE The objective of this study was to demonstrate improvement in nerve function with moderate exercise in patients with type II diabetic neuropathies . RESEARCH DESIGN AND METHODS Fives subjects with type II diabetes mellitus and distal , predominantly sensory polyneuropathies were studied . The subjects completed an 8-week program of a supervised moderate exercise program ( 40 - 75 % of maximal 02 uptake reserve ) with a subsequent 16-week program of monitored similar exercise . The same experienced electrophysiologist performed the electrodiagnostic studies both before and after the 24-week exercise period . These studies monitored physiological changes ( conduction velocities , response amplitudes ) in motor and sensory fibers as well as F-wave latencies . RESULTS The exercise program produced a documented increase in aerobic exercise capacity . Despite the small number of subjects studied and the relatively short exercise period , there was a statistically significant improvement in nearly all electrophysiological parameters evaluated post exercise including motor conduction velocities and amplitudes , sensory conduction velocities , and F-wave latencies . This improvement included a statistically significant improvement in absolute median motor evoked response amplitudes as well as the recording of sensory nerve action potentials not present prior to exercise . There were no adverse effects from the exercise . CONCLUSIONS This study supports the hypothesis that exercise can be performed safely in patients with type II diabetic neuropathies and can produce improvement in their nerve function . This study also supports the hypothesis that ischemia may have a meaningful role in the pathogenesis of neuropathies in patients with type II diabetes mellitus OBJECTIVE Changes in physical activity are thought to play an important role in maintaining symptoms in chronic fatigue syndrome ( CFS ) . The aim of this study was to describe intraindividual physical activity patterns in more detail and to identify pervasively passive patients . METHODS With help of a movement-sensing device , physical activity levels were registered continuously over a 12-day period in 277 CFS patients . Within this registration period , the 10 largest activity peaks were computed . The intensity and duration of these activity peaks and their subsequent rest periods were described and compared to those of 47 healthy controls . In addition , the patients ' 12 daily activity scores were used to identify patients who were characterised by low levels of physical activity throughout the registration period . RESULTS The CFS sample had less intense and shorter activity peaks , while the average rest periods that followed these peaks lasted longer . Approximately one-fourth of the CFS sample differed distinctly from the control group and was labelled as pervasively passive . CONCLUSION The measurements and classification of actual physical activity levels were found to reduce heterogeneity in the CFS population and therefore could provide the opportunity to optimise behavioural intervention protocol s for CFS Objective . To investigate the safety and efficacy of 50-Hz repetitive transcranial magnetic stimulation ( rTMS ) in the treatment of motor symptoms in  Parkinson disease ( PD ) . Background . Progression of PD is characterized by the emergence of motor deficits that gradually respond less to dopaminergic therapy . rTMS has shown promising results in improving gait , a major cause of disability , and may provide a therapeutic alternative . Prior controlled studies suggest that an increase in stimulation frequency might enhance therapeutic efficacy . Methods . In this r and omized , double blind , sham-controlled study , the authors investigated the safety and efficacy of 50-Hz rTMS of the motor cortices in 8 sessions over 2 weeks . Assessment of safety and clinical efficacy over a 1-month period included timed tests of gait and bradykinesia , Unified Parkinson ’s Disease Rating Scale ( UPDRS ) , and additional clinical , neurophysiological , and neuropsychological parameters . In addition , the safety of 50-Hz rTMS was tested with electromyography-electroencephalogram ( EMG-EEG ) monitoring during and after stimulation . Results . The authors investigated 26 patients with mild to moderate PD : 13 received 50-Hz rTMS and 13 sham stimulation . The 50-Hz rTMS did not improve gait , bradykinesia , and global and motor UPDRS , but there appeared a short-lived “ on”-state improvement in activities of daily living ( UPDRS II ) . The 50-Hz rTMS lengthened the cortical silent period , but other neurophysiological and neuropsychological measures remained unchanged . EMG/EEG recorded no pathological increase of cortical excitability or epileptic activity . There were no adverse effects . Conclusion . It appears that 50-Hz rTMS of the motor cortices is safe , but it fails to improve motor performance and functional status in PD . Prolonged stimulation or other techniques with rTMS might be more efficacious but need to be established in future research
Physical activity levels measured by remote monitoring are consistently low in people with MS , stroke and dementia , and patterns of physical activity are altered in PD .
In MS , decreased ambulatory activity assessed via remote monitoring is associated with greater disability and lower quality of life .
In stroke , remote measures of upper limb function and ambulation are associated with functional recovery following rehabilitation and goal -directed interventions .
In PD , remote monitoring may help to predict falls .
In dementia , remote physical activity measures correlate with disease severity and can detect w and ering .
Conclusions These studies show that remote physical activity monitoring is feasible in neurological diseases , including in people with moderate to severe neurological disability .
Remote monitoring can be a psychometrically sound and responsive way to assess physical activity in neurological disease .
Objective To perform a systematic review of studies using remote physical activity monitoring in neurological diseases , highlighting advances and determining gaps .