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Individuals with Parkinson's disease (PD) have shown deficits in the ability to recognize emotion. However, these results have been inconsistent. In addition, questions remain about whether any deficit in PD is secondary to depression and broader cognitive impairments, and the effects of stimulus modality, task type, and specific emotion remain unclear. A meta-analysis of 34 comparisons, using data from 1,295 individual participants, was conducted to (a) provide a reliable estimate of the magnitude of the purported deficit in emotion recognition and (b) examine the influence of several potential moderators of emotion recognition abilities in PD. Results show a robust link between PD and specific deficits in recognizing emotion, from both the face and the voice (overall effect size g ϭ 0.52). The deficit extends across stimulus modalities and task types and is particularly acute with respect to negative emotions. Although this deficit does not appear to be secondary to comorbid depression or visuospatial impairments, the potential role of working memory constraints warrants further investigation. We highlight the potential implications of these findings for communication abilities in PD.

Many factors can affect the successful implementation and validity of intervention studies. A primary purpose of feasibility and pilot studies is to assess the potential for successful implementation of the proposed main intervention studies and to reduce threats to the validity of these studies. This article describes a typology to guide the aims of feasibility and pilot studies designed to support the development of randomized controlled trials and provides an example of the studies underlying the development of one rehabilitation trial. The purpose of most feasibility and pilot studies should be to describe information and evidence related to the successful implementation and validity of a planned main trial. Null hypothesis significance testing is not appropriate for these studies unless the sample size is properly powered. The primary tests of the intervention effectiveness hypotheses should occur in the main study, not in the studies that are serving as feasibility or pilot studies. P lanning intervention research takes creativity and innovation, a bit like building castles in the air. Feasibility studies are studies designed to build the foundation for the planned intervention study. For several reasons, it is challenging to define feasibility studies for occupational therapy research. Although many types of feasibility studies could be applicable to intervention research in occupational therapy, no typology has been developed specifically for the research done in our field. Published feasibility study typologies are rare and typically focus on preparing for drug trials in which a single "active" ingredient is being tested, such as a chemical that is posited to be the causal effect of intervention outcomes.As we know, occupational therapy is not implemented with the assumption of a single active factor inducing change in our clients. Our intervention outcomes are derived from "blended" active agents. Person, environment, and occupation factors compose an interactional network of potential agents that create the quality of occupational performance and health outcomes (Law et al., 1996). Moreover, our outcomes are often theoretical constructs (e.g., occupational performance, quality of life) rather than direct observables (e.g., cure of disease or a change in bodily function), and they generally are measured along a conceptual continuum that is not a true count (e.g., cell counts, tumor size). Our interventions in actual practice are client centered and highly individualized as opposed to highly standardized.Feasibility studies in occupational therapy must build the foundations that support intervention trials that involve a blending of active agents; a theoretical perspective that reflects an understanding of occupational performance and outcomes as being at the intersection of person, environment, and occupation; a measurement paradigm based on constructs and continua; and client-centered, individualized intervention. Feasibility studies are rare in our field. Many, if not

The purpose of this randomized controlled trial was to determine if increasing hours of selfmanagement rehabilitation had increasing benefits for health-related quality of life (HRQOL) in Parkinson's disease beyond best medical treatment, if effects persisted at two and six months follow-up, and if targeted compared to non-targeted HRQOL domains responded more to rehabilitation. Participants on best medication therapy were randomized to one of three conditions for six weeks intervention: 0 hrs of rehabilitation; 18 hrs of clinic group rehabilitation plus 9 hrs of attention control social sessions; and 27 hrs of rehabilitation, with 18 in clinic group rehabilitation and 9 hrs of rehabilitation designed to transfer clinic training into home and community routines. Results (N = 116) showed that at six weeks there was a beneficial effect of increased rehabilitation hours on HRQOL measured with the Parkinson's Disease Questionnaire-39 summary index (eta = .23, CI = .05 -.40, p =.01). Benefits persisted at follow-up. The difference between 18 and 27 hrs was not significant. Clinically relevant improvement occurred at a greater rate for 18 and 27 hrs (54% improved) than for 0 hrs (18% improved), a significant 36% difference in rates (95% CI = 20% to 52% difference). Effects were largest in two targeted domains: communication and mobility. More concerns with mobility and activities of daily living at baseline predicted more benefit from rehabilitation. KeywordsClinical trials Randomized controlled (CONSORT agreement); Health-related Quality of life; Parkinson's disease/Parkinsonism; Rehabilitation Health-related quality of life (HRQOL) is one's perceived health and well-being in personally valued domains of daily life.1 , 2 Parkinson's disease (PD) symptoms compromise HRQOL by making it difficult to participate in valued activities and roles of home and NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript community life. Yet individuals who feel mastery over life activities and maintain participation in them experience less depression and more well-being.3 , 4 Effective management of PD begins with considering the person's HRQOL and promoting a sense of control in valued life domains that realistically are within the person's capacity to influence. 5 , 6 Our meta-analyses of previous studies found rehabilitation to improve performance in mobility and self-care activities in 25% more individuals with PD compared to control conditions.7 -9 Recent studies have strengthened the evidence that rehabilitation benefits HRQOL.10 -12 Few of these studies implemented well-defined interventions and tested effects with randomized controlled trials, and fewer yet attempted to test varying intensities of rehabilitation.13 Consequently we developed a specific, best practice rehabilitation intervention and used a randomized-controlled trial to test the effects of differing rehabilitation intensities on health-related quality of life.An interdisciplinary team of physical, occupational, and speech therapists ...

One clinical implication is that internally focused instructions can contribute to slower and less forceful reach in adults with and without CVA. This research reinforces the need for therapists to consider their use of instruction during the evaluation and treatment of movement disorders.