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      Patient Companionship in a Movement Disorders Clinic: Outside Assistance Inside the Office

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          Abstract

          Objective: We (1) report whether a companion (i.e., spouse, relative, aide) accompanied our consecutive outpatients with a range of movement disorders, (2) identified the set of patient characteristics that was associated with the need for a visit companion, and (3) characterized the role(s) of these companions during the visit. Our overarching goals were to further understand patient needs and the extent of their support networks, and to enrich the clinician-patient interface.

          Methods: Two-hundred consecutive patients were enrolled from the Movement Disorders Clinic at Yale School of Medicine. We noted whether patients were accompanied by another person during the visit and documented the role of the visit companion during the encounter.

          Results: One-hundred-twenty-eight of 200 patients (64.0%) brought a companion, with these being spouses (44.8%), adult children (24.1%) or an aide, nurse or social worker (14.5%). Patients who were unemployed (odds ratio [OR] = 5.32, p = 0.019), had a diagnosis of Parkinson's disease or other Parkinsonian syndromes (OR = 10.61, p = 0.001), or were dependent in any instrumental activities of daily living (iADLs) (OR = 4.99, p = 0.005) or basic activities of daily living (bADLs) (OR = 5.81, p = 0.02), had increased odds of presenting to the clinical visit with a visit companion. Visit companions' main roles involved communication (86.7%) and transportation (84.4%).

          Conclusion: Visit companions were commonly present during movement disorders outpatient visits–two-thirds of patients were accompanied. A number of factors increased the odds of requiring such a companion by 4- or 5-fold.

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          Most cited references19

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          Gait disorders and balance disturbances in Parkinson's disease: clinical update and pathophysiology.

          Gait disorders and balance impairments are one of the most incapacitating symptoms of Parkinson's disease. Here, we discuss the latest findings regarding epidemiology, assessment, pathophysiology and treatment of gait and balance impairments in Parkinson's disease. Recent studies have confirmed the high rate and high risk of falls of patients with Parkinson's disease. Therefore, it is crucial to detect patients who are at risk of falling and how to prevent falls. Several studies have shown that multiple balance tests improve the prediction of falls in Parkinson's disease. Difficulty turning may be caused by axial rigidity, affected interlimb coordination and asymmetries. Turning difficulties are easily assessed by timed performance and the number of steps during a turn. Impaired sensorimotor integration, inability of switching between sensory modalities and lack of compensatory stepping may all contribute to the high incidence of falls in patients with Parkinson's disease. Similarly, various studies highlighted that pharmacotherapy, neurosurgery and physiotherapy may adversely affect balance and gait in Parkinson's disease. Insights into the pathophysiology of Parkinson's disease continue to grow. At the same time, it is becoming clear that some patients may in fact deteriorate with treatment. Future research should focus on the development and evaluation of multifactorial fall prevention strategies.
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            Measuring the activities of daily living: comparisons across national surveys.

            The "activities of daily living," or ADLs, are the basic tasks of everyday life, such as eating, bathing, dressing, toileting, and transferring. Reported estimates of the size of the elderly population with ADL disabilities differ substantially across national surveys. Differences in which ADL items are being measured and in what constitutes a disability account for much of the variation. Other likely explanations are differences in sample design, sample size, survey methodology, and age structure of the population to which the sample refers. When essentially equivalent ADL measures are compared, estimates for the community-based population vary by up to 3.1 percentage points; and for the institutionalized population, with the exception of toileting, by no more than 3.2 percentage points. As small as these differences are in absolute terms, they can be large in percent differences across surveys. For example, the National Medical Expenditure Survey estimates that there are 60 percent more elderly people with ADL problems than does the Supplement on Aging.
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              Tremor-related quality of life: A comparison of essential tremor vs. Parkinson's disease patients.

              Tremor-related quality of life is a multi-dimensional concept that reflects the physical, emotional and other health effects of tremor. Curiously, tremor-related quality of life has never been directly compared in patients with the two major tremor disorders, essential tremor (ET) and Parkinson's disease (PD). We performed a head-to-head comparison of ET with PD patients.
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                Author and article information

                Contributors
                Journal
                Front Neurol
                Front Neurol
                Front. Neurol.
                Frontiers in Neurology
                Frontiers Media S.A.
                1664-2295
                05 March 2019
                2019
                : 10
                : 182
                Affiliations
                [1] 1Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University , New Haven, CT, United States
                [2] 2Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University , New Haven, CT, United States
                [3] 3Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University , New Haven, CT, United States
                Author notes

                Edited by: Huifang Shang, Sichuan University, China

                Reviewed by: Giovanni Pellegrino, Montreal Neurological Institute and Hospital, McGill University, Canada; Athanasios Alexiou, Novel Global Community Educational Foundation (NGCEF), Hebersham, Australia; Richard B. Reilly, Trinity College Dublin, Ireland

                *Correspondence: Elan D. Louis elan.louis@ 123456yale.edu

                This article was submitted to Movement Disorders, a section of the journal Frontiers in Neurology

                Article
                10.3389/fneur.2019.00182
                6411683
                d18d7351-d568-43f5-ab04-52e045a4130f
                Copyright © 2019 Vives-Rodriguez, Trujillo Diaz and Louis.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 27 September 2018
                : 13 February 2019
                Page count
                Figures: 0, Tables: 3, Equations: 0, References: 24, Pages: 7, Words: 5263
                Categories
                Neurology
                Original Research

                Neurology
                movement disorders,visit companions,caregiver,parkinson's disease,essential tremor
                Neurology
                movement disorders, visit companions, caregiver, parkinson's disease, essential tremor

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