Background: Scapular dyskinesis is considered a risk factor for the shoulder pain that may warran... more Background: Scapular dyskinesis is considered a risk factor for the shoulder pain that may warrant screening for prevention. Clinicians of all experience screen scapular dyskinesis using the scapular dyskinesis test yes-no classification (Y-N), yet its reliability in asymptomatic individuals is unknown. We aimed to establish Y-N’s intra- and inter-reliability between students and expert physical therapists.Methods: We utilized a cross-sectional design using consecutive asymptomatic subjects. Six students and two experts rated 100 subjects using the Y-N. Cohen’s kappa (κ) and Krippendorff’s alpha (K-α) were calculated to determine intra- and inter-rater reliability.Results: Intra- and inter-rater values for experts were κ=0.92 (95% confidence interval [CI], 0.91–0.93) and 0.85 (95% CI, 0.84–0.87) respectively; students were κ=0.77 (95% CI, 0.75–0.78) and K-α=0.63 (95% CI, 0.58–0.67).Conclusions: The Y-N is reliable in detecting scapular dyskinesis in asymptomatic individuals regardle...
<p>Sleep Efficiency, ratio of actual sleep divided by total attempted sleep. Actual Sleep, ... more <p>Sleep Efficiency, ratio of actual sleep divided by total attempted sleep. Actual Sleep, total duration spent sleeping (not including Wake and Time to Z). Total Attempted Sleep, from time to bed to morning rise. Times Woken, number of times subject awaken during night-sleep. Wake Duration, total duration of time spent awake during night-sleep. Light Sleep, light sleep stage. Deep Sleep, deep sleep stage. REM Sleep, rapid eye movement sleep stage. Time to Sleep, the time it takes to fall asleep (a.k.a. sleep latency). *<i>p</i><0.05 between the PD and Older groups. (Young group's data are shown in order to visualize normative values.) Numbers are the effect sizes between the Older and PD groups, based on Cohen's <i>d</i> using averaged standard deviation <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109818#pone.0109818-Cohen1" target="_blank">[25]</a>.</p
A six-month double-blind, placebo-controlled randomized study was conducted to ascertain whether ... more A six-month double-blind, placebo-controlled randomized study was conducted to ascertain whether low-dose daily niacin supplementation would improve motor symptoms in Parkinson’s disease (PD) patients. A total of 47 PD patients were assigned to receive low-dose niacin or a placebo. At the end of the double-blind phase, all participants received open-label niacin for the next six months. All patients were evaluated at baseline, after six months, and after one year of treatment. The primary outcome measure was the Unified Parkinson’s Disease Rating Scale III (UPDRS III) scores. Secondary outcome measures were depression, sleep quality, mental flexibility and cognition, and physical fatigue. Niacin treatment was well-tolerated by forty-five subjects. The mean [95% CI] change in UPDRS III scores at six months of placebo was −0.05 [95% CI, −2.4 to 2.32], and niacin was −1.06 [95% CI, −3.68 to 1.57]. From six to twelve months when both groups received open-label niacin supplementation, th...
<p>Values represent good to excellent coefficient of correlations (<i>p</i><... more <p>Values represent good to excellent coefficient of correlations (<i>p</i><0.05 for all). Empty cells indicate moderate or low correlations (<i>p</i>>0.05).</p><p>Abbreviations are the same as <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109818#pone-0109818-t001" target="_blank">Table 1</a>.</p><p>*Sleep4 (PD Sleep questionnaire item 4), restlessness of legs or arms at night or in the evening causing disruption of sleep <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109818#pone.0109818-Chaudhuri1" target="_blank">[69]</a>.</p>§<p>PDQ1 (PD Quality of Life questionnaire item 1), difficulty getting around in public.</p>§<p>PDQ3, feeling depressed.</p>§<p>PDQ7, painful muscle cramps or spasms.</p><p>Times woken, number of times woken during EEG night-sleep assessment.</p><p>Actual sleep, sum of EEG light sleep, deep sleep and REM sleep durations.</p><p>Carbidopa, prescribed with dopamine (as Sinemet) to minimize breakdown of levodopa before it crosses the blood brain barrier.</p><p>*High scores indicate less problems.</p>§<p>High scores indicate more problems.</p><p>Subject characteristics.</p
Background Parkinson's Disease (PD) patients have lower niacin levels compared to their spous... more Background Parkinson's Disease (PD) patients have lower niacin levels compared to their spouses. The main objective was to study low-dose daily niacin supplementation on motor symptoms in Parkinson's disease subjects. Methods Forty-Seven PD patients were randomly assigned to receive low-dose niacin or placebo in a randomized, double-blind study for the first six months. After the double-blind phase, all participants received open-label niacin for the next six months. All patients were evaluated at baseline, six months, and one year of treatment. The main outcome measure was the Unified Parkinson's Disease Rating Scale III (UPDRS III) scores. Secondary outcome measures were depression, sleep quality, mental flexibility and cognition, and physical fatigue. Results Niacin treatment was tolerated well by 45 subjects. The baseline mean UPDRS III score was 21.3 ± 15.8 for the niacin group and 22.4 ± 11.8 for placebo. The change with six months of placebo was 1.5 [95% CI, -0.73...
We previously reported that individuals with Parkinson’s disease (PD) present with lower vitamin ... more We previously reported that individuals with Parkinson’s disease (PD) present with lower vitamin B3 levels compared to controls. It may be related to carbidopa interaction, defective tryptophan metabolism, and stresses of night sleep disorder. Vitamin B3 is the energy source for all cells by producing NAD+ and NADP+ in redox reactions of oxidative phosphorylation. Thus, some symptoms of PD such as fatigue, sleep dysfunction, and mood changes may be related to the deficiency of vitamin B3. Here, we conducted an effectiveness trial to determine the effect of 12 months of low-dose niacin (a vitamin B3 derivative) enhancement in PD individuals. An average of 9 ± 6-point improvement in the Unified Parkinson’s Disease Rating Scale (UPDRS) III (motor) score was observed after 12 months of daily niacin compared to the expected decline in score (effect size = 0.78, 95% CI = 7–11). Additionally, secondary outcome measures improved. Notably, handwriting size increased, fatigue perception decre...
In this study, we used macrophage RAW264.7 cells to elucidate the molecular mechanism underlying ... more In this study, we used macrophage RAW264.7 cells to elucidate the molecular mechanism underlying the anti-inflammatory actions of niacin. Anti-inflammatory actions of niacin and a possible role of its receptor GPR109A have been studied previously. However, the precise molecular mechanism of niacin’s action in reducing inflammation through GPR109A is unknown. Here we observed that niacin reduced the translocation of phosphorylated nuclear kappa B (p-NF-κB) induced by lipopolysaccharide (LPS) in the nucleus of RAW264.7 cells. The reduction in the nuclear translocation in turn decreased the expression of pro-inflammatory cytokines IL-1β, IL-6 in RAW264.7 cells. We observed a decrease in the nuclear translocation of p-NF-κB and the expression of inflammatory cytokines after knockdown of GPR109A in RAW264.7 cells. Our results suggest that these molecular actions of niacin are mediated via its receptor GPR109A (also known as HCAR2) by controlling the translocation of p-NF-κB to the nucleu...
Orientation of posture relative to the environment depends on the contributions from the somatose... more Orientation of posture relative to the environment depends on the contributions from the somatosensory, vestibular, and visual systems mixed in varying proportions to produce a sensorimotor set. Here, we probed the sensorimotor set composition using a postural adaptation task in which healthy adults stood on an inclined surface for 3 min. Upon returning to a horizontal surface, participants displayed a range of postural orientations - from an aftereffect that consisted of a large forward postural lean to an upright stance with little or no aftereffect. It has been hypothesized that the post-incline postural change depends on each individual's sensorimotor set: whether the set was dominated by the somatosensory or vestibular system: Somatosensory dominance would cause the lean aftereffect whereas vestibular dominance should steer stance posture toward upright orientation. We investigated the individuals who displayed somatosensory dominance by manipulating their attention to spat...
Fatigue is a common problem among individuals with Parkinson's disease (PD). It may occur bef... more Fatigue is a common problem among individuals with Parkinson's disease (PD). It may occur before the overt symptoms of bradykinesia, rigidity and tremor. Little is understood about how to measure fatigue in PD. Here we determined the dimensionality of the constructs of fatigue. Four recommended scales, the Fatigue Severity Scale, Functional Assessment of Chronic Illness Therapy-Fatigue, Parkinson Fatigue Scale and Visual Analog Fatigue Scale (VAFS) were tested against quality of life measures including cognition, depression, sleep, life orientation, physical activity and PD symptoms in 22 PD subjects and 15 caregivers. Fatigue was associated with many quality of life variables, with the PDQ-39 summary index showing the strongest association. PD subjects agreed more strongly than caregivers that they experienced higher levels of fatigue. 27% of PD subjects rated fatigue as one of their top three most bothersome symptoms. The constructs of fatigue was captured within one dimension...
Neuroinflammation remains a central piece in Parkinson's disease (PD) pathophysiology. Howeve... more Neuroinflammation remains a central piece in Parkinson's disease (PD) pathophysiology. However, mechanisms by which PD links to the neuroinflammation remain elusive. Here, for the first time, we report that lower dose of niacin in PD patients may affect macrophage polarization from M1 (pro-inflammatory) to M2 (counter-inflammatory) profile through the niacin receptor GPR109A. Skew in the peripheral macrophages were accompanied by improved quality of life assessments in patients. Low dose niacin supplementation may be beneficial in PD, boosting anti-inflammatory processes and suppressing inflammation. Varied niacin dosages for longer durations may further reveal the potential role of anti-inflammatory interventions in PD progression.
Achieving a soft landing during walking can be quantified by analyzing changes in the vertical ve... more Achieving a soft landing during walking can be quantified by analyzing changes in the vertical velocity of the body center of mass (CoM) just prior to the landing of the swing limb. Previous research suggests that walking speed and step length may predictably influence the extent of this CoM control. Here we ask how stable this control is. We altered treadmill walking speed by systematically increasing or decreasing it at fixed intervals. We then reversed direction. We hypothesized that the control of the CoM vertical velocity during the late stance of the walking gait may serve as an order parameter which has an attribute of hysteresis. The presence of hysteresis implies that the CoM control is not based on simply knowing the current input conditions to predict the output response. Instead, there is also the influence of previous speed conditions on the ongoing responses. We found that the magnitudes of CoM control were different depending on whether the treadmill speed (as the con...
A 65-year-old male, Parkinson's disease patient, was evaluated for GPR109A expression, niacin... more A 65-year-old male, Parkinson's disease patient, was evaluated for GPR109A expression, niacin index, UPDRS scale, handwriting test, and quality of sleep with and without niacin treatment. The evaluation was repeated 3 months after niacin was stopped. Niacin modulated the abovementioned parameters and showed the overall improvement without side effects.
Previous work has shown that individuals with Parkinson’s disease affecting the basal ganglia hav... more Previous work has shown that individuals with Parkinson’s disease affecting the basal ganglia have difficulty in adapting the amplitude of ankle muscle responses to changes in balance conditions. The purpose of this investigation was to test the hypothesis that this inflexibility is the result of a deficit in the ability to quickly change from one behavioral set to another compared to healthy young, healthy older adults, and individuals with dementia of the Alzheimer type (AD). The ability to change set quickly was inferred by comparing ankle muscle responses when balance conditions were changed from one context to another. Balance conditions were specifically chosen to influence different kinds of set: (1) Postural set - responses to backward translations or toes up rotations of the support surface under free stance versus holding onto a stable frame; responses to surface translations when standing versus when sitting; rapid rise-to-toes action during free stance versus holding ont...
Background: Scapular dyskinesis is considered a risk factor for the shoulder pain that may warran... more Background: Scapular dyskinesis is considered a risk factor for the shoulder pain that may warrant screening for prevention. Clinicians of all experience screen scapular dyskinesis using the scapular dyskinesis test yes-no classification (Y-N), yet its reliability in asymptomatic individuals is unknown. We aimed to establish Y-N’s intra- and inter-reliability between students and expert physical therapists.Methods: We utilized a cross-sectional design using consecutive asymptomatic subjects. Six students and two experts rated 100 subjects using the Y-N. Cohen’s kappa (κ) and Krippendorff’s alpha (K-α) were calculated to determine intra- and inter-rater reliability.Results: Intra- and inter-rater values for experts were κ=0.92 (95% confidence interval [CI], 0.91–0.93) and 0.85 (95% CI, 0.84–0.87) respectively; students were κ=0.77 (95% CI, 0.75–0.78) and K-α=0.63 (95% CI, 0.58–0.67).Conclusions: The Y-N is reliable in detecting scapular dyskinesis in asymptomatic individuals regardle...
<p>Sleep Efficiency, ratio of actual sleep divided by total attempted sleep. Actual Sleep, ... more <p>Sleep Efficiency, ratio of actual sleep divided by total attempted sleep. Actual Sleep, total duration spent sleeping (not including Wake and Time to Z). Total Attempted Sleep, from time to bed to morning rise. Times Woken, number of times subject awaken during night-sleep. Wake Duration, total duration of time spent awake during night-sleep. Light Sleep, light sleep stage. Deep Sleep, deep sleep stage. REM Sleep, rapid eye movement sleep stage. Time to Sleep, the time it takes to fall asleep (a.k.a. sleep latency). *<i>p</i><0.05 between the PD and Older groups. (Young group's data are shown in order to visualize normative values.) Numbers are the effect sizes between the Older and PD groups, based on Cohen's <i>d</i> using averaged standard deviation <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109818#pone.0109818-Cohen1" target="_blank">[25]</a>.</p
A six-month double-blind, placebo-controlled randomized study was conducted to ascertain whether ... more A six-month double-blind, placebo-controlled randomized study was conducted to ascertain whether low-dose daily niacin supplementation would improve motor symptoms in Parkinson’s disease (PD) patients. A total of 47 PD patients were assigned to receive low-dose niacin or a placebo. At the end of the double-blind phase, all participants received open-label niacin for the next six months. All patients were evaluated at baseline, after six months, and after one year of treatment. The primary outcome measure was the Unified Parkinson’s Disease Rating Scale III (UPDRS III) scores. Secondary outcome measures were depression, sleep quality, mental flexibility and cognition, and physical fatigue. Niacin treatment was well-tolerated by forty-five subjects. The mean [95% CI] change in UPDRS III scores at six months of placebo was −0.05 [95% CI, −2.4 to 2.32], and niacin was −1.06 [95% CI, −3.68 to 1.57]. From six to twelve months when both groups received open-label niacin supplementation, th...
<p>Values represent good to excellent coefficient of correlations (<i>p</i><... more <p>Values represent good to excellent coefficient of correlations (<i>p</i><0.05 for all). Empty cells indicate moderate or low correlations (<i>p</i>>0.05).</p><p>Abbreviations are the same as <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109818#pone-0109818-t001" target="_blank">Table 1</a>.</p><p>*Sleep4 (PD Sleep questionnaire item 4), restlessness of legs or arms at night or in the evening causing disruption of sleep <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109818#pone.0109818-Chaudhuri1" target="_blank">[69]</a>.</p>§<p>PDQ1 (PD Quality of Life questionnaire item 1), difficulty getting around in public.</p>§<p>PDQ3, feeling depressed.</p>§<p>PDQ7, painful muscle cramps or spasms.</p><p>Times woken, number of times woken during EEG night-sleep assessment.</p><p>Actual sleep, sum of EEG light sleep, deep sleep and REM sleep durations.</p><p>Carbidopa, prescribed with dopamine (as Sinemet) to minimize breakdown of levodopa before it crosses the blood brain barrier.</p><p>*High scores indicate less problems.</p>§<p>High scores indicate more problems.</p><p>Subject characteristics.</p
Background Parkinson's Disease (PD) patients have lower niacin levels compared to their spous... more Background Parkinson's Disease (PD) patients have lower niacin levels compared to their spouses. The main objective was to study low-dose daily niacin supplementation on motor symptoms in Parkinson's disease subjects. Methods Forty-Seven PD patients were randomly assigned to receive low-dose niacin or placebo in a randomized, double-blind study for the first six months. After the double-blind phase, all participants received open-label niacin for the next six months. All patients were evaluated at baseline, six months, and one year of treatment. The main outcome measure was the Unified Parkinson's Disease Rating Scale III (UPDRS III) scores. Secondary outcome measures were depression, sleep quality, mental flexibility and cognition, and physical fatigue. Results Niacin treatment was tolerated well by 45 subjects. The baseline mean UPDRS III score was 21.3 ± 15.8 for the niacin group and 22.4 ± 11.8 for placebo. The change with six months of placebo was 1.5 [95% CI, -0.73...
We previously reported that individuals with Parkinson’s disease (PD) present with lower vitamin ... more We previously reported that individuals with Parkinson’s disease (PD) present with lower vitamin B3 levels compared to controls. It may be related to carbidopa interaction, defective tryptophan metabolism, and stresses of night sleep disorder. Vitamin B3 is the energy source for all cells by producing NAD+ and NADP+ in redox reactions of oxidative phosphorylation. Thus, some symptoms of PD such as fatigue, sleep dysfunction, and mood changes may be related to the deficiency of vitamin B3. Here, we conducted an effectiveness trial to determine the effect of 12 months of low-dose niacin (a vitamin B3 derivative) enhancement in PD individuals. An average of 9 ± 6-point improvement in the Unified Parkinson’s Disease Rating Scale (UPDRS) III (motor) score was observed after 12 months of daily niacin compared to the expected decline in score (effect size = 0.78, 95% CI = 7–11). Additionally, secondary outcome measures improved. Notably, handwriting size increased, fatigue perception decre...
In this study, we used macrophage RAW264.7 cells to elucidate the molecular mechanism underlying ... more In this study, we used macrophage RAW264.7 cells to elucidate the molecular mechanism underlying the anti-inflammatory actions of niacin. Anti-inflammatory actions of niacin and a possible role of its receptor GPR109A have been studied previously. However, the precise molecular mechanism of niacin’s action in reducing inflammation through GPR109A is unknown. Here we observed that niacin reduced the translocation of phosphorylated nuclear kappa B (p-NF-κB) induced by lipopolysaccharide (LPS) in the nucleus of RAW264.7 cells. The reduction in the nuclear translocation in turn decreased the expression of pro-inflammatory cytokines IL-1β, IL-6 in RAW264.7 cells. We observed a decrease in the nuclear translocation of p-NF-κB and the expression of inflammatory cytokines after knockdown of GPR109A in RAW264.7 cells. Our results suggest that these molecular actions of niacin are mediated via its receptor GPR109A (also known as HCAR2) by controlling the translocation of p-NF-κB to the nucleu...
Orientation of posture relative to the environment depends on the contributions from the somatose... more Orientation of posture relative to the environment depends on the contributions from the somatosensory, vestibular, and visual systems mixed in varying proportions to produce a sensorimotor set. Here, we probed the sensorimotor set composition using a postural adaptation task in which healthy adults stood on an inclined surface for 3 min. Upon returning to a horizontal surface, participants displayed a range of postural orientations - from an aftereffect that consisted of a large forward postural lean to an upright stance with little or no aftereffect. It has been hypothesized that the post-incline postural change depends on each individual's sensorimotor set: whether the set was dominated by the somatosensory or vestibular system: Somatosensory dominance would cause the lean aftereffect whereas vestibular dominance should steer stance posture toward upright orientation. We investigated the individuals who displayed somatosensory dominance by manipulating their attention to spat...
Fatigue is a common problem among individuals with Parkinson's disease (PD). It may occur bef... more Fatigue is a common problem among individuals with Parkinson's disease (PD). It may occur before the overt symptoms of bradykinesia, rigidity and tremor. Little is understood about how to measure fatigue in PD. Here we determined the dimensionality of the constructs of fatigue. Four recommended scales, the Fatigue Severity Scale, Functional Assessment of Chronic Illness Therapy-Fatigue, Parkinson Fatigue Scale and Visual Analog Fatigue Scale (VAFS) were tested against quality of life measures including cognition, depression, sleep, life orientation, physical activity and PD symptoms in 22 PD subjects and 15 caregivers. Fatigue was associated with many quality of life variables, with the PDQ-39 summary index showing the strongest association. PD subjects agreed more strongly than caregivers that they experienced higher levels of fatigue. 27% of PD subjects rated fatigue as one of their top three most bothersome symptoms. The constructs of fatigue was captured within one dimension...
Neuroinflammation remains a central piece in Parkinson's disease (PD) pathophysiology. Howeve... more Neuroinflammation remains a central piece in Parkinson's disease (PD) pathophysiology. However, mechanisms by which PD links to the neuroinflammation remain elusive. Here, for the first time, we report that lower dose of niacin in PD patients may affect macrophage polarization from M1 (pro-inflammatory) to M2 (counter-inflammatory) profile through the niacin receptor GPR109A. Skew in the peripheral macrophages were accompanied by improved quality of life assessments in patients. Low dose niacin supplementation may be beneficial in PD, boosting anti-inflammatory processes and suppressing inflammation. Varied niacin dosages for longer durations may further reveal the potential role of anti-inflammatory interventions in PD progression.
Achieving a soft landing during walking can be quantified by analyzing changes in the vertical ve... more Achieving a soft landing during walking can be quantified by analyzing changes in the vertical velocity of the body center of mass (CoM) just prior to the landing of the swing limb. Previous research suggests that walking speed and step length may predictably influence the extent of this CoM control. Here we ask how stable this control is. We altered treadmill walking speed by systematically increasing or decreasing it at fixed intervals. We then reversed direction. We hypothesized that the control of the CoM vertical velocity during the late stance of the walking gait may serve as an order parameter which has an attribute of hysteresis. The presence of hysteresis implies that the CoM control is not based on simply knowing the current input conditions to predict the output response. Instead, there is also the influence of previous speed conditions on the ongoing responses. We found that the magnitudes of CoM control were different depending on whether the treadmill speed (as the con...
A 65-year-old male, Parkinson's disease patient, was evaluated for GPR109A expression, niacin... more A 65-year-old male, Parkinson's disease patient, was evaluated for GPR109A expression, niacin index, UPDRS scale, handwriting test, and quality of sleep with and without niacin treatment. The evaluation was repeated 3 months after niacin was stopped. Niacin modulated the abovementioned parameters and showed the overall improvement without side effects.
Previous work has shown that individuals with Parkinson’s disease affecting the basal ganglia hav... more Previous work has shown that individuals with Parkinson’s disease affecting the basal ganglia have difficulty in adapting the amplitude of ankle muscle responses to changes in balance conditions. The purpose of this investigation was to test the hypothesis that this inflexibility is the result of a deficit in the ability to quickly change from one behavioral set to another compared to healthy young, healthy older adults, and individuals with dementia of the Alzheimer type (AD). The ability to change set quickly was inferred by comparing ankle muscle responses when balance conditions were changed from one context to another. Balance conditions were specifically chosen to influence different kinds of set: (1) Postural set - responses to backward translations or toes up rotations of the support surface under free stance versus holding onto a stable frame; responses to surface translations when standing versus when sitting; rapid rise-to-toes action during free stance versus holding ont...
Uploads
Papers by Raymond Chong