Chad Swank Ph.D.

Criminger, C. and C. Swank (2019). “Impact of dual-tasking on mobility tasks in Parkinson’s disease as described through 2D kinematic analysis.” Aging Clin Exp Res Jul 3. [Epub ahead of print].

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BACKGROUND: Walking for people with Parkinson’s disease (PD) degrades during motor-cognitive interplay (i.e., dual task conditions). Declining gait mechanics and turning ability result in more frequent falls and an interruption of daily activities in persons with PD. AIMS: To determine the impact of dual-tasking on key mobility elements during a walking task in people with PD with 2D motion analysis. METHODS: Participants performed Timed Up and Go (TUG) single, dual task conditions (TUGalone, TUGmotor, and TUGcognitive). 2D motion analysis application was used to quantify seven key mobility elements including: sit-to-walk (STW) (s), walking turn time (WTT) (s), number of turn steps, turn-to-sit (TTS) (s), total number of TUG steps, total TUG time and turn strategy (on-the-spot or u-shaped). RESULTS: Thirty-one participants with PD completed this study [age M= 69 +/- 8.19, UPDRSm M= 23.21 +/- 10.03, HY MED= 2 (range 1-4)]. All key elements were significantly different between TUG conditions with the exception of sit-to-walk and turn strategy. Turn strategy was consistent across TUG tasks despite added cognitive loading. Repeated-measures MANOVA differences were observed in WTT (p = 0.01), number of turn steps (p = 0.03), TTS (p < 0.001), total number of TUG steps (p = 0.01), and total TUG time (p = 0.01). No significant relationships were found between disease severity (HY/UPDRSm) and turn strategy. DISCUSSION/CONCLUSION: Key mobility elements were significantly affected across dual task walking conditions in persons with PD. The use of 2D motion analysis assisted with identification of key mobility elements impacted during the single and dual task conditions.

Swank, C., S. Sikka, S. Driver, M. Bennett and L. Callender (2019). “Feasibility of integrating robotic exoskeleton gait training in inpatient rehabilitation.” Disabil Rehabil Assist Technol Mar 19: 1-9. [Epub ahead of print].

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OBJECTIVE: Learning to walk is a major goal of inpatient rehabilitation and robotic exoskeletons may provide a new gait training approach. Our purpose was to determine the feasibility of integrating the Ekso Gait Training device into inpatient rehabilitation in a neurologic population. DESIGN: Longitudinal cohort design and convenience sample including physical therapists trained to use the Ekso Bionics Ekso GT robotic exoskeleton or inpatients with stroke or SCI. Therapists completed a focus group and survey at baseline and 6 months after initial Ekso training. Patients completed a survey indicating their satisfaction with using the Ekso. RESULTS: Twenty-five patients used the Ekso an average of 4.5 sessions during their 38.5-day rehabilitation stay. Survey and focus group feedback revealed that therapists encountered measurement difficulties with the Ekso and limited treatment time influencing effectiveness of usage. After 6 months, therapists reported an improvement in feasibility. Patients tolerated Ekso sessions well, without any complications or adverse incidents, and reported improved mobility post session. CONCLUSION: Integrating Ekso gait training into clinical practice was not seamless but appears feasible. Barriers were addressed within the rehabilitation team and received administrative support in a process lasting several months. Patients enjoyed walking in Ekso and felt secure within the device. Implications for rehabilitation Integrating Ekso gait training into clinical practice during inpatient rehabilitation is feasible. Overcoming barriers to implementation required administrative support and clinician persistence over several months. Patients tolerated Ekso sessions well, without any complications or adverse incidents.

Cookinham, B. and C. Swank (2019). “Concussion History and Career Status Influence Performance on Baseline Assessments in Elite Football Players.” Arch Clin Neuropsychol Mar 30. [Epub ahead of print].

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OBJECTIVE: To determine if concussion history and career status is associated with neurocognitive performance in elite football players. METHODS: The study design was a cross-sectional single assessment. Fifty-seven elite football players (age 29.39 +/- 7.49 years) categorized as draft prospects, active professional players, and retired professional players were assessed on the Sport Concussion Assessment Tool – third edition (SCAT-3), in an outpatient therapy setting. RESULTS: Common symptoms were the following: fatigue (45.6%), trouble falling asleep (35.1%), difficulty remembering (33.3%) and irritability (22.8%); 36.8% reported no symptoms. The low concussion (0-1) group reported fewer symptoms (U = 608.50, p < .001), less symptom severity (U = 598.00, p = -.001), and produced greater scores on the Standardized Assessment of Concussion (SAC) total scores compared to the multiple concussion (2+) group (U = 253.00, p = .024), but no differences were observed on modified Balance Error Scoring System (m-BESS) scores (U = 501.50, p = .066) on the Mann-Whitney U test. The Kruskal-Wallis test and post-hoc analysis indicated retired players were significantly different from draft prospects and current professional players for total symptom scores (p < .001), total symptom severity (p < .001), SAC total scores (p = .030), and m-BESS (p < .001). CONCLUSIONS: Concussion history and career status appear associated with total symptoms, symptom severity, performance on the SAC, and the m-BESS in elite football players. With this in mind, future research is recommended to determine longitudinal impact for elite football players.