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Langer A, Hansen C, Roth D, Santer A, Flotz A, Gruber J, Wizany L, Hasenauer S, Pokan R, Dabnichki P, Treven M, Zimmel S, Schmoeger M, Willinger U, Gassner L, Brücke C, Maetzler W, Zach H. Vertical locomotion improves horizontal locomotion: effects of climbing on gait and other mobility aspects in Parkinson's disease. A secondary analysis from a randomized controlled trial. J Neuroeng Rehabil 2024; 21:63. [PMID: 38678241 PMCID: PMC11055236 DOI: 10.1186/s12984-024-01363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND In the Climb Up! Head Up! trial, we showed that sport climbing reduces bradykinesia, tremor, and rigidity in mildly to moderately affected participants with Parkinson's disease. This secondary analysis aimed to evaluate the effects of sport climbing on gait and functional mobility in this cohort. METHODS Climb Up! Head Up! was a 1:1 randomized controlled trial. Forty-eight PD participants (Hoehn and Yahr stage 2-3) either participated in a 12-week, 90-min-per-week sport climbing course (intervention group) or were engaged in regular unsupervised physical activity (control group). Relevant outcome measures for this analysis were extracted from six inertial measurement units placed on the extremities, chest, and lower back, that were worn during supervised gait and functional mobility assessments before and after the intervention. Assessments included normal and fast walking, dual-tasking walking, Timed Up and Go test, Instrumented Stand and Walk test, and Five Times Sit to Stand test. RESULTS Compared to baseline, climbing improved gait speed during normal walking by 0.09 m/s (p = 0.005) and during fast walking by 0.1 m/s. Climbing also reduced the time spent in the stance phase during fast walking by 0.03 s. Climbing improved the walking speed in the 7-m- Timed Up and Go test by 0.1 m/s (p < 0.001) and the turning speed by 0.39 s (p = 0.052), the speed in the Instrumented Stand and Walk test by 0.1 m/s (p < 0.001), and the speed in the Five Times Sit to Stand test by 2.5 s (p = 0.014). There was no effect of sport climbing on gait speed or gait variables during dual-task walking. CONCLUSIONS Sport climbing improves gait speed during normal and fast walking, as well as functional mobility in people with Parkinson's disease. Trial registration This study was registered within the U.S. National Library of Medicine (No: NCT04569981, date of registration September 30th, 2020).
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Affiliation(s)
- Agnes Langer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, 24105, Kiel, Germany
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, 1090, Vienna, Austria
| | - Agnes Santer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Anna Flotz
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Jakob Gruber
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Laurenz Wizany
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Sebastian Hasenauer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Rochus Pokan
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, 1090, Vienna, Austria
| | - Peter Dabnichki
- School of Engineering, RMIT University, 3000, Melbourne, VIC, Australia
| | - Marco Treven
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Sarah Zimmel
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Michaela Schmoeger
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Ulrike Willinger
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Lucia Gassner
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, 1090, Vienna, Austria
- School of Engineering, RMIT University, 3000, Melbourne, VIC, Australia
| | - Christof Brücke
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, 24105, Kiel, Germany
| | - Heidemarie Zach
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria.
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Pappas MC, Baudendistel ST, Schmitt AC, Au KLK, Hass CJ. Acclimatization of force production during walking in persons with Parkinson's disease. J Biomech 2023; 148:111477. [PMID: 36739723 PMCID: PMC10851883 DOI: 10.1016/j.jbiomech.2023.111477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
Individuals with Parkinson's disease walk slowly, with short strides resulting in decreased mobility. Treadmill walking assessments are utilized to understand gait impairment in persons with Parkinson's disease and treadmill-based interventions to mobility have become increasingly popular. While walking on a treadmill, there is a reported initial acclimatization period where individuals adjust to the speed and dynamics of the moving belt before producing consistent walking patterns. It is unknown how much walking time is required for individuals with Parkinson's disease to acclimate to the treadmill. We investigated how spatiotemporal parameters and ground reaction forces changed during treadmill acclimatization. Twenty individuals with idiopathic Parkinson's (15 Males, 5 Females) walked for a five-minute treadmill session on an instrumented treadmill while motion capture data were collected. The measures of interest included ground reaction force measures (peak propulsive force, peak braking force, propulsive impulse, and braking impulse) and spatiotemporal measures (stride length, stride time, or double support time). Analyses demonstrated significantly increased propulsive impulse (p <.001) after the first minute, with no significant difference for the remaining minutes (p ≥ 0.395). There were no significant changes in the spatiotemporal measures (P =.065). These results quantify the stabilization of ground reaction force during the treadmill acclimatization period. Based on our findings, if steady-state gait is desired, we recommend participants walk for at least two minutes before data collection. Future clinical investigations should consider ground reaction force as sensitive parameters for evaluating gait in persons with Parkinson's disease in treadmill-based assessments or interventional therapies.
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Affiliation(s)
- Marc C Pappas
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Sidney T Baudendistel
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, FL, USA; Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | - Abigail C Schmitt
- Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR, USA
| | | | - Chris J Hass
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, FL, USA; Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Carmignano SM, Fundarò C, Bonaiuti D, Calabrò RS, Cassio A, Mazzoli D, Bizzarini E, Campanini I, Cerulli S, Chisari C, Colombo V, Dalise S, Gazzotti V, Mazzoleni D, Mazzucchelli M, Melegari C, Merlo A, Stampacchia G, Boldrini P, Mazzoleni S, Posteraro F, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Andrenelli E. Robot-assisted gait training in patients with Parkinson's disease: Implications for clinical practice. A systematic review. NeuroRehabilitation 2022; 51:649-663. [PMID: 35570502 DOI: 10.3233/nre-220026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Gait impairments are common disabling symptoms of Parkinson's disease (PD). Among the approaches for gait rehabilitation, interest in robotic devices has grown in recent years. However, the effectiveness compared to other interventions, the optimum amount of training, the type of device, and which patients might benefit most remains unclear. OBJECTIVE To conduct a systematic review about the effects on gait of robot-assisted gait training (RAGT) in PD patients and to provide advice for clinical practice. METHODS A search was performed on PubMed, Scopus, PEDro, Cochrane library, Web of science, and guideline databases, following PRISMA guidelines. We included English articles if they used a robotic system with details about the intervention, the parameters, and the outcome measures. We evaluated the level and quality of evidence. RESULTS We included twenty papers out of 230 results: two systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies, and 5 descriptive reports. Nine studies used an exoskeleton device and the remainders end-effector robots, with large variability in terms of subjects' disease-related disability. CONCLUSIONS RAGT showed benefits on gait and no adverse events were recorded. However, it does not seem superior to other interventions, except in patients with more severe symptoms and advanced disease.
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Affiliation(s)
- Simona Maria Carmignano
- Centro Terapeutico Riabilitativo (CTR), Potenza, Italy.,University of Salerno, Salerno, Italy
| | - Cira Fundarò
- Neurophysiopatology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Pavia, Italy
| | | | | | - Anna Cassio
- Spinal Cord Unit and Intensive Rehabilitation Medicine, Ospedale di Fiorenzuola d'Arda, AUSL Piacenza, Piacenza, Italy
| | - Davide Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | - Emiliana Bizzarini
- Department of Rehabilitation Medicine, Spinal Cord Unit, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Isabella Campanini
- Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Cerulli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmelo Chisari
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | | | - Stefania Dalise
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | - Valeria Gazzotti
- Centro Protesi Vigorso di Budrio, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Bologna, Italy
| | - Daniele Mazzoleni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | - Andrea Merlo
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy.,Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy
| | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | | | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
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Yakşi E, Yaşar MF, Türel CA, Balcı M. Are static posturography-assisted biofeedback exercises effective in Parkinson's disease? ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:935-943. [PMID: 36351419 PMCID: PMC9770088 DOI: 10.1055/s-0042-1755325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Parkinson disease (PD) is a progressive condition that causes disorders in movement and balance. OBJECTIVE To evaluate the effectiveness of static posturography-assisted biofeedback exercises in PD-related balance disorder. METHODS We screened 83 patients, 48 of whom were enrolled, and 41 completed the study. The sample was randomized into two groups, one submitted to static posturography-assisted biofeedback exercises and the other, to a conventional exercise program. The patients in the biofeedback group (n = 20) performed biofeedback exercises in addition to conventional balance exercises. Those in the conventional exercise group (n = 21) performed classic balance exercises. Both groups were treated for 20 minutes per session 3 times a week for 6 weeks. The patients were evaluated using the Hoehn and Yahr Scale, the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the Berg Balance Scale (BBS), the Tinetti Gait and Balance Assessment (TGBA), the Timed Up and Go Test (TUG), the Tandem Stance Test (TST), a Turkish version of the Stanford Health Assessment Questionnaire (HAQ), and the Beck Depression Inventory (BDI) before and at the end of the treatment. RESULTS No statistically significant differences were observed between the two groups in terms of the MDS-UPDRS, BBS, TGBA, TST, TUG, HAQ, or BDI measurements before and after the treatment (p > 0.05). CONCLUSIONS Improved balance parameters were observed following balance training in the patients with PD, although static posturography-assisted biofeedback exercises appeared to provide no additional benefit. However, larger, randomized controlled trials are needed to investigate their effectiveness.
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Affiliation(s)
- Elif Yakşi
- Abant Izzet Baysal University, Medical Faculty, Department of Physical Medicina and Rehabilitation, Bolu, Turkey.,Address for correspondence Elif Yakşi
| | - Mustafa Fatih Yaşar
- Abant Izzet Baysal University, Medical Faculty, Department of Physical Medicina and Rehabilitation, Bolu, Turkey.
| | - Canan Akünal Türel
- Abant Izzet Baysal University, Medical Faculty, Department of Neurology, Bolu, Turkey.
| | - Muhammed Balcı
- Abant Izzet Baysal University, Medical Faculty, Department of Physical Medicina and Rehabilitation, Bolu, Turkey.
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Effects of Ten Different Exercise Interventions on Motor Function in Parkinson’s Disease Patients—A Network Meta-Analysis of Randomized Controlled Trials. Brain Sci 2022; 12:brainsci12060698. [PMID: 35741584 PMCID: PMC9221238 DOI: 10.3390/brainsci12060698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/22/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The aim of this study was to evaluate ten exercise interventions (YOGA: yoga training, RT: resistance training, AQU: aquatic training, TAI: Taiji Qigong training, TRD: treadmill training, VR: virtual reality training, DANCE: musical dance training, WKT: walking training, CYC: cycling training, BDJ: Baduanjin Qigong training) on motor function in Parkinson’s disease (PD) patients. Design: Through searching PubMed, Embase, Cochrane Library, Web of Science, and CNKI, only randomized controlled trials (RCTs) were collected to study the effects of the ten exercise interventions on motor function in patients with Parkinson’s disease. The included studies were evaluated for methodological quality by the Cochrane bias risk assessment tool. Results: The RCTs were collected between the earliest available date and April 2022. Sixty RCTs were included and the total sample size used in the study was 2859. The results of the network meta-analysis showed that DANCE can significantly improve patients’ Berg Balance Scale (BBS) (SUCRA = 78.4%); DANCE can significantly decline patients’ Unified Parkinson’s Disease Rating Scale score (UPDRS) (SUCRA = 72.3%) and YOGA can significantly decline patients’ Timed-Up-and-Go score (TUGT) (SUCRA = 78.0%). Conclusion: Based on the network meta-analysis and SUCRA ranking, we can state that dance, yoga, virtual reality training and resistance training offers better advantages than other exercise interventions for patients’ motor function.
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Ma CZH, Bao T, DiCesare CA, Harris I, Chambers A, Shull PB, Zheng YP, Cham R, Sienko KH. Reducing Slip Risk: A Feasibility Study of Gait Training with Semi-Real-Time Feedback of Foot-Floor Contact Angle. SENSORS (BASEL, SWITZERLAND) 2022; 22:3641. [PMID: 35632054 PMCID: PMC9144019 DOI: 10.3390/s22103641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022]
Abstract
Slip-induced falls, responsible for approximately 40% of falls, can lead to severe injuries and in extreme cases, death. A large foot-floor contact angle (FFCA) during the heel-strike event has been associated with an increased risk of slip-induced falls. The goals of this feasibility study were to design and assess a method for detecting FFCA and providing cues to the user to generate a compensatory FFCA response during a future heel-strike event. The long-term goal of this research is to train gait in order to minimize the likelihood of a slip event due to a large FFCA. An inertial measurement unit (IMU) was used to estimate FFCA, and a speaker provided auditory semi-real-time feedback when the FFCA was outside of a 10-20 degree target range following a heel-strike event. In addition to training with the FFCA feedback during a 10-min treadmill training period, the healthy young participants completed pre- and post-training overground walking trials. Results showed that training with FFCA feedback increased FFCA events within the target range by 16% for "high-risk" walkers (i.e., participants that walked with more than 75% of their FFCAs outside the target range) both during feedback treadmill trials and post-training overground trials without feedback, supporting the feasibility of training FFCA using a semi-real-time FFCA feedback system.
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Affiliation(s)
- Christina Zong-Hao Ma
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Tian Bao
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
| | - Christopher A. DiCesare
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
| | - Isaac Harris
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
| | - April Chambers
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA; (A.C.); (R.C.)
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Peter B. Shull
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Rakie Cham
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA; (A.C.); (R.C.)
| | - Kathleen H. Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
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Bishnoi A, Lee R, Hu Y, Mahoney JR, Hernandez ME. Effect of Treadmill Training Interventions on Spatiotemporal Gait Parameters in Older Adults with Neurological Disorders: Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052824. [PMID: 35270516 PMCID: PMC8909968 DOI: 10.3390/ijerph19052824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 12/07/2022]
Abstract
Objective: Treadmill interventions have been shown to promote ‘normal’ walking patterns, as they facilitate the proper movement and timing of the lower limbs. However, prior reviews have not examined which intervention provides the most effective treatment of specific gait impairments in neurological populations. The objective of this systematic review was to review and quantify the changes in gait after treadmill interventions in adults with neurological disorders. Data Sources: A keyword search was performed in four databases: PubMed, CINAHL, Scopus, and Web of Science (January 2000−December 2021). We performed the search algorithm including all possible combinations of keywords. Full-text articles were examined further using forward/backward search methods. Study Selection: Studies were thoroughly screened using the following inclusion criteria: study design: Randomized Controlled Trial (RCT); adults ≥55 years old with a neurological disorder; treadmill intervention; spatiotemporal gait characteristics; and language: English. Data Extraction: A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, and spatiotemporal gait parameters including stride length, stride time, step length, step width, step time, stance time, swing time, single support time, double support time, or cadence. Data Synthesis: We found a total of 32 studies to be included in our systematic review through keyword search, out of which 19 studies included adults with stroke and 13 studies included adults with PD. We included 22 out of 32 studies in our meta-analysis that examined gait in adults with neurological disorders, which only yielded studies including Parkinson’s disease (PD) and stroke patients. A meta-analysis was performed among trials presenting with similar characteristics, including study population and outcome measure. If heterogeneity was >50% (denoted by I2), random plot analysis was used, otherwise, a fixed plot analysis was performed. All analyses used effect sizes and standard errors and a p < 0.05 threshold was considered statistically significant (denoted by *). Overall, the effect of treadmill intervention on cadence (z = 6.24 *, I2 = 11.5%) and step length (z = 2.25 *, I2 = 74.3%) in adults with stroke was significant. We also found a significant effect of treadmill intervention on paretic step length (z = 2.34 *, I2 = 0%) and stride length (z = 6.09 *, I2 = 45.5%). For the active control group, including adults with PD, we found that overground physical therapy training had the largest effect on step width (z = −3.75 *, I2 = 0%). Additionally, for PD adults in treadmill intervention studies, we found the largest significant effect was on step length (z = 2.73 *, I2 = 74.2%) and stride length (z = −2.54 *, I2 = 96.8%). Conclusion: Treadmill intervention with sensory stimulation and body weight support treadmill training were shown to have the largest effect on step length in adults with PD and stroke.
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Affiliation(s)
- Alka Bishnoi
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
| | - Rachel Lee
- Department of Solid Organ Transplant, University of Chicago Medical Center, Chicago, IL 60637, USA;
| | - Yang Hu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
| | - Jeannette R. Mahoney
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Manuel E. Hernandez
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
- Correspondence:
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Is treadmill walking biomechanically comparable to overground walking? A systematic review. Gait Posture 2022; 92:249-257. [PMID: 34890914 DOI: 10.1016/j.gaitpost.2021.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The equivalency of treadmill and overground walking has been investigated in a large number of studies. However, no systematic review has been performed on this topic. RESEARCH QUESTION The aim of this study was to compare the biomechanical, electromyographical and energy consumption outcomes of motorized treadmill and overground walking. METHODS Five databases, ScienceDirect, SpringerLink, Web of Science, PubMed, and Scopus, were searched until January 13, 2021. Studies written in English comparing lower limb biomechanics, electromyography and energy consumption during treadmill and overground walking in healthy young adults (20-40 years) were included. RESULTS Twenty-two studies (n = 409 participants) were included and evaluated via the Cochrane Collaboration's tool. These 22 studies showed that some kinematic (reduced pelvic ROM, maximum hip flexion angle for females, maximum knee flexion angle for males and cautious gait pattern), kinetic (sagittal plane joint moments: dorsiflexor moments, knee extensor moments and hip extensor moments and sagittal plane joint powers at the knee and hip joints, peak backwards, lateral and medial COP velocities and propulsive forces during late stance) and electromyographic (lower limbs muscles activities) outcome measures were significantly different for motorized treadmill and overground walking. SIGNIFICANCE Spatiotemporal, kinematic, kinetic, electromyographic and energy consumption outcome measures were largely comparable for motorized treadmill and overground walking. However, the differences in kinematic, kinetic and electromyographic parameters should be taken into consideration by clinicians, trainers, and researchers when working on new protocols related to patient rehabilitation, fitness rooms or research as to be as close as possible to the outcome measures of overground walking. The protocol registration number is CRD42021236335 (PROSPERO International Prospective Register of Systematic Reviews).
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Osborne JA, Botkin R, Colon-Semenza C, DeAngelis TR, Gallardo OG, Kosakowski H, Martello J, Pradhan S, Rafferty M, Readinger JL, Whitt AL, Ellis TD. Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association. Phys Ther 2021; 102:6485202. [PMID: 34963139 PMCID: PMC9046970 DOI: 10.1093/ptj/pzab302] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
A clinical practice guideline on Parkinson disease was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists and a neurologist. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for management of Parkinson disease. The Spanish version of this clinical practice guideline is available as a supplement (Suppl. Appendix 1).
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Affiliation(s)
- Jacqueline A Osborne
- Brooks Rehabilitation Hospital, Brooks Institute of Higher Learning, Jacksonville, Florida, USA
| | - Rachel Botkin
- Botkin Rehab Services, Physical Therapy, Columbus, Ohio, USA
| | - Cristina Colon-Semenza
- Department of Kinesiology, Doctor of Physical Therapy Program, University of Connecticut, Storrs, Connecticut, USA
| | - Tamara R DeAngelis
- Boston University Sargent College of Health and Rehabilitation Services, Physical Therapy and Athletic Training, Boston, Massachusetts, USA
| | - Oscar G Gallardo
- Rancho Los Amigos National Rehabilitation Center, Physical Therapy, Downey, California, USA
| | - Heidi Kosakowski
- Address all correspondence to Dr Kosakowski care of the Department of Practice of the American Physical Therapy Association at:
| | | | - Sujata Pradhan
- University of Washington, Rehabilitation Medicine, Seattle, Washington, USA
| | - Miriam Rafferty
- Northwestern University, Center for Education in Health Sciences, Chicago, Illinois, USA
| | | | | | - Terry D Ellis
- Boston University Sargent College of Health and Rehabilitation Services, Physical Therapy and Athletic Training, Boston, Massachusetts, USA
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Callais Franco do Nascimento T, Martins Gervásio F, Pignolo A, Augusto Santos Bueno G, Araújo do Carmo A, Martins Ribeiro D, D’Amelio M, Augusto dos Santos Mendes F. Assessment of the Kinematic Adaptations in Parkinson's Disease Using the Gait Profile Score: Influences of Trunk Posture, a Pilot Study. Brain Sci 2021; 11:1605. [PMID: 34942907 PMCID: PMC8699192 DOI: 10.3390/brainsci11121605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Postural abnormalities are common in patients with Parkinson's disease (PD) and lead to gait abnormalities. Relationships between changes in the trunk posture of PD patients and gait profile score (GPS) and gait spatiotemporal parameters are poorly investigated. The aim of the current study was to investigate the relationships between trunk posture, GPS, and gait spatiotemporal parameters, in patients with PD. MATERIALS AND METHODS Twenty-three people with PD and nineteen age-matched healthy people participated in this study. A 3D gait kinematical analysis was applied to all participants using the Plug-In Gait Full BodyTM tool. Trunk and limb kinematics patterns and gait spatio-temporal parameters of patients with PD and the control group were compared. Additionally, correlations between trunk kinematics patterns, gait spatio-temporal parameters, and GPS of the PD group were tested. RESULTS Cadence, opposite foot off, step time, single support, double support, foot off, gait speed, trunk kinematics, and GPS showed significant differences between the two groups (p ≤ 0.05). Posture of the trunk during gait was not related to the spatio-temporal parameters and gait profile score in the PD group. The trunk flexor pattern influenced GPS domains, mainly of the ankle and the knee. DISCUSSION AND CONCLUSIONS Flexed posture of the trunk in patients with PD seems to influence both ankle and knee movement patterns during the gait. The GPS analysis provided direct and simplified kinematic information for the PD group. These results may have implications for understanding the importance of considering the positioning of the trunk during gait.
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Affiliation(s)
- Tauana Callais Franco do Nascimento
- Graduate Program in Rehabilitation Sciences, University of Brasília, Federal District, Brasília 72220-275, DF, Brazil; (T.C.F.d.N.); (F.A.d.S.M.)
| | - Flavia Martins Gervásio
- Department of Physiotherapy and Physical Education, College of Sport, State University of Goiás, Goiânia 74075-110, GO, Brazil;
| | - Antonia Pignolo
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90129 Palermo, Italy;
| | - Guilherme Augusto Santos Bueno
- Graduate Program in Sciences and Health Technologies, University of Brasília, Federal District, Brasília 72220-275, DF, Brazil;
| | - Aline Araújo do Carmo
- Department of Physiotherapy, University of Brasília, Federal District, Brasília 72220-275, DF, Brazil;
| | - Darlan Martins Ribeiro
- Henrique Santillo State Center of Rehabilitation and Readaptation, Goiânia 74653-230, GO, Brazil;
| | - Marco D’Amelio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90129 Palermo, Italy;
| | - Felipe Augusto dos Santos Mendes
- Graduate Program in Rehabilitation Sciences, University of Brasília, Federal District, Brasília 72220-275, DF, Brazil; (T.C.F.d.N.); (F.A.d.S.M.)
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Effects of a posture shirt with back active correction keeper on static and dynamic balance in Parkinson's disease. J Bodyw Mov Ther 2021; 28:138-143. [PMID: 34776132 DOI: 10.1016/j.jbmt.2021.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 04/27/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with Parkinson's disease (PD) suffer from postural disorders. This study aims at investigating the short- and medium-term effects of a shirt with appropriate tie-rods that allows to correct the posture of the trunk. METHODS This is a longitudinal clinical study in which a pressure platform was used to assess the static and dynamic baropodometry and the static stabilometry of 20 patients with PD (70.95 ± 8.39 years old; 13 males, time from the onset of symptoms: 6.95 ± 4.04 years, Unified Parkinson's Disease Rating Scale score: UPDRS = 7.25 ± 6.26) without and with a shirt, specifically designed for improving posture, at baseline and after one month of wearing. RESULTS The results showed a significant improvement in symmetry of loads (p = 0.015) and an enlargement of the foot contact surface (p = 0.038). A significant correlation was found between the change in forefoot load and time spent daily in wearing the shirt (R = 0.575, p = 0.008), with an optimal value identified at 8 h per day. CONCLUSION The use of a postural shirt in patients with PD symmetrized the postural load and enlarged the foot contact surface improving their balance.
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Koyanagi Y, Fukushi I, Nakamura M, Suzuki K, Oda N, Aita T, Seki H. The effect of body weight-supported overground gait training for patients with Parkinson's disease: A retrospective case-control observational study. PLoS One 2021; 16:e0254415. [PMID: 34283843 PMCID: PMC8291710 DOI: 10.1371/journal.pone.0254415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 06/25/2021] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the effects of body weight-supported overground gait training (BWSOGT) on motor abilities, such as gait and balance, in patients with Parkinson’s disease (PD). Design Retrospective case-controlled observational study with a 4-week follow-up. Setting Inpatient rehabilitation. Participants We selected 37 of 68 patients with PD. Inclusion criteria were (1) Hoehn & Yahr stage II–IV, (2) no medication adjustment during the study period, (3) at least 1 week since last medication adjustment, and (4) ability to walk more than 10 meters on their own. Exclusion criteria were (1) cerebrovascular disease or other complications affecting movement, (2) difficulty in measurement, (3) early discharge, (4) medication change during the study, and (5) development of complications. Interventions Patients were divided into two groups. Patients in Group I underwent 20 minutes of BWSOGT with a mobile hoist in addition to the standard exercises; Group II performed 20 minutes of gait training in place of BWSOGT. In both groups, training was performed for a total of 15 times/4 weeks. Main outcome measure(s) Participants were evaluated using the Unified Parkinson’s Disease Rating Scale total, part II, and part III; 10-m walk test; velocity; stride length; 6-minute walk test; timed up and go test; Berg Balance Scale; and freezing of gait before and after the intervention. Results There were significant decreases in the Unified Parkinson’s Disease Rating Scale total, part II, and part III in both groups; however, 6-minute walk test, timed up and go test, and freezing of gait results only improved in Group I. Conclusions BWSOGT for patients with PD improves gait ability and dynamic balance more than standard gait training.
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Affiliation(s)
- Yasuki Koyanagi
- Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
- Department of Neurology and Rehabilitation, National Hospital Organization Iwaki Hospital, Iwaki, Japan
- * E-mail:
| | - Isato Fukushi
- Faculty of Health Sciences, Uekusa Gakuen University, Chiba, Japan
- Clinical Research Center, Murayama Medical Center, Musashimurayama, Japan
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kouji Suzuki
- Department of Neurology and Rehabilitation, National Hospital Organization Iwaki Hospital, Iwaki, Japan
| | - Nobuhito Oda
- Department of Neurology and Rehabilitation, National Hospital Organization Iwaki Hospital, Iwaki, Japan
| | - Takashi Aita
- Department of Neurology and Rehabilitation, National Hospital Organization Iwaki Hospital, Iwaki, Japan
| | - Hareaki Seki
- Department of Neurology and Rehabilitation, National Hospital Organization Iwaki Hospital, Iwaki, Japan
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Nascimento LR, do Carmo WA, de Oliveira GP, Arêas FZDS, Dias FMV. Transcranial direct current stimulation provides no clinically important benefits over walking training for improving walking in Parkinson's disease: a systematic review. J Physiother 2021; 67:190-196. [PMID: 34147400 DOI: 10.1016/j.jphys.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022] Open
Abstract
QUESTIONS Does walking training combined with transcranial direct current stimulation (tDCS) improve walking (ie, speed, cadence and step length) and reduce falls and freezing, compared with no/sham intervention, in people with Parkinson's disease? Is walking training combined with tDCS superior to walking training alone? Are any benefits carried over to social participation and/or maintained beyond the intervention period? DESIGN A systematic review with meta-analyses of randomised clinical trials. PARTICIPANTS Ambulatory adults with a clinical diagnosis of Parkinson's disease. INTERVENTION tDCS combined with walking training. OUTCOME MEASURES Primary outcomes were walking speed, cadence and step length. Secondary outcomes were number of falls, fear of falling, freezing of gait and social participation. RESULTS Five trials involving 117 participants were included. The mean PEDro score of the included trials was 8 out of 10. Participants undertook training for 30 to 60 minutes, two to three times per week, on average for 4 weeks. Moderate-quality evidence indicated that the addition of tDCS to walking training produced negligible additional benefit over the effect of walking training alone on walking speed (MD -0.01 m/s, 95% CI -0.05 to 0.04), step length (MD 1.2 cm, 95% CI -1.2 to 3.5) or cadence (MD -3 steps/minute, 95% CI -6 to 1). No evidence was identified with which to estimate the effect of the addition of tDCS to walking training on freezing of gait, falls and social participation. CONCLUSION The addition of tDCS to walking training provided no clinically important benefits on walking in ambulatory people with Parkinson's disease. REGISTRATION PROSPERO CRD42020162908.
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Affiliation(s)
- Lucas Rodrigues Nascimento
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil; NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Willian Assis do Carmo
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Gabriela Pinto de Oliveira
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Fernando Zanela da Silva Arêas
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil; Laboratory of Cognitive Sciences and Neuropsychopharmacology, Department of Physiological Sciences, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Fernanda Moura Vargas Dias
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil
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Treadmill versus overground gait training in patients with lower limb burn injury: A matched control study. Burns 2021; 48:51-58. [PMID: 34154896 DOI: 10.1016/j.burns.2021.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/27/2021] [Accepted: 04/18/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gait impairment is commonly seen in patients with a lower limb burn injury (LLBI). Therefore, the aim of this study was to investigate the effects of two different gait training modes on gait symmetry, functional mobility and kinesiophobia in patients with LLBI. METHODS This matched control study was conducted between January 2017 and August 2018. Patients with LLBI (n=28) were allocated to 2 different groups by matching according to burn localization, age, and gender. Group 1 (overground group: n=14) received overground gait training in addition to standard burn rehabilitation, and Group 2 (treadmill group: n=14) received treadmill gait training in addition to standard burn rehabilitation. The rehabilitation program and gait training were started when the patient was admitted to the hospital and ended on discharge. These physical therapy interventions were performed 5 days per week. The gait training intensity, including walking speed and duration, was determined according to patient tolerance. Gait parameters, functional mobility, kinesiophobia and pain values were evaluated with GAITRite, the timed up-and-go test (TUG), Tampa Kinesiophobia Scale and Visual Analogue Scale, respectively. These evaluations were made twice; on admission and immediately prior to discharge. Gait symmetry was calculated using the Symmetry Index. RESULTS The baseline characteristics of the groups and initial outcome values were similar. In the comparison of the differences between the overground and treadmill groups, the change in kinesiophobia and TUG values were significantly higher in the treadmill group (p=0.01, p=0.02, respectively). The intragroup comparisons showed significant differences in SI in respect of step length (p=0.004), swing (p=0.006), stance (p=0.008) and velocity (p=0.001), cadence (p=0.001), TUG (p=0.001), kinesiophobia (p=0.001) and pain (p=0.001) in the overground group. Statistically significant differences were determined in step length (p=0.01), swing (p=0.01), stance (p=0.02) and velocity (p=0.001), cadence (p=0.001), TUG (p=0.001), kinesiophobia (p=0.001) and pain (p=0.001) in the treadmill group, when pre and post-training values were compared. CONCLUSIONS The results of this study have shown that treadmill gait training was more effective in the improvement of functional mobility and reduction in kinesiophobia levels of patients with LLBI compared to overground gait training. Both overground and treadmill gait training also provide greater improvements in the velocity and cadence, and gait symmetry for step length, swing and stance in patients with LLBI. CLINICAL TRIAL REGISTRATION NUMBER NCT03217526.
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Naro A, Pignolo L, Sorbera C, Latella D, Billeri L, Manuli A, Portaro S, Bruschetta D, Calabrò RS. A Case-Controlled Pilot Study on Rhythmic Auditory Stimulation-Assisted Gait Training and Conventional Physiotherapy in Patients With Parkinson's Disease Submitted to Deep Brain Stimulation. Front Neurol 2020; 11:794. [PMID: 32849240 PMCID: PMC7417712 DOI: 10.3389/fneur.2020.00794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/25/2020] [Indexed: 01/13/2023] Open
Abstract
Deep brain stimulation (DBS) is indicated when motor disturbances in patients with idiopathic Parkinson's disease (PD) are refractory to current treatment options and significantly impair quality of life. However, post–DBS rehabilitation is essential, with particular regard to gait. Rhythmic auditory stimulation (RAS)-assisted treadmill gait rehabilitation within conventional physiotherapy program plays a major role in gait recovery. We explored the effects of a monthly RAS–assisted treadmill training within a conventional physiotherapy program on gait performance and gait-related EEG dynamics (while walking on the RAS–aided treadmill) in PD patients with (n = 10) and without DBS (n = 10). Patients with DBS achieved superior results than those without DBS concerning gait velocity, overall motor performance, and the timed velocity and self-confidence in balance, sit-to-stand (and vice versa) and walking, whereas both groups improved in dynamic and static balance, overall cognitive performance, and the fear of falling. The difference in motor outcomes between the two groups was paralleled by a stronger remodulation of gait cycle–related beta oscillations in patients with DBS as compared to those without DBS. Our work suggests that RAS-assisted gait training plus conventional physiotherapy is a useful strategy to improve gait performance in PD patients with and without DBS. Interestingly, patients with DBS may benefit more from this approach owing to a more focused and dynamic re–configuration of sensorimotor network beta oscillations related to gait secondary to the association between RAS-treadmill, conventional physiotherapy, and DBS. Actually, the coupling of these approaches may help restoring a residually altered beta–band response profile despite DBS intervention, thus better tailoring the gait rehabilitation of these PD patients.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy
| | - Loris Pignolo
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - Chiara Sorbera
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy
| | - Desiree Latella
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy
| | - Alfredo Manuli
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy
| | - Simona Portaro
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, Messina, Italy
| | - Daniele Bruschetta
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
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Morenilla L, Márquez G, Sánchez JA, Bello O, López-Alonso V, Fernández-Lago H, Fernández-Del-Olmo MÁ. Postural Stability and Cognitive Performance of Subjects With Parkinson's Disease During a Dual-Task in an Upright Stance. Front Psychol 2020; 11:1256. [PMID: 32903649 PMCID: PMC7438725 DOI: 10.3389/fpsyg.2020.01256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/14/2020] [Indexed: 11/16/2022] Open
Abstract
Background The reviewed studies on center of pressure (COP) displacement in Parkinson’s disease (PD) subjects show important methodological differences and contradictory results with regard to healthy subjects. The dual-task paradigm method has been used to examine cognitive prioritization strategies to control concurrent postural and cognitive tasks. The motor requirements, such as pronouncing words, involved in the cognitive tasks used in double-task conditions could be related to the heterogeneity of the results. Research Objective To compare postural sway and cognitive performance in subjects with PD and controls using a dual-task paradigm with a cognitive task free of motor demands. We tried to examine the prioritization strategy of PD patients regarding healthy adults to control for concurrent postural and cognitive tasks. Materials and Methods 25 subjects with PD and 20 healthy controls carried out a postural task under both single-task and dual-task conditions. The postural task was to stand as still as possible, with eyes first open and then closed. The dual-task condition added a concurrent cognitive task based on phoneme monitoring. COP displacement variables and cognitive performance were compared between the groups and within-subject factors were also examined. Results PD participants showed higher COP displacement results than the controls. All participants shortened the mean sway radius in dual-task conditions compared with single-task conditions; only healthy subjects presented less transversal COP sway in dual-task conditions than in single-task conditions. The cognitive performance of PD patients on a phoneme monitoring task worsened when they carried it out while maintaining balance in a standing position compared to sitting. The opposite effect occurred in control subjects. Conclusion This study confirms the negative influence of Parkinson’s disease on the control of standing stability, increasing the COP sway amplitude. The attentional demands of a postural task, such as standing balance, may be greater in PD patients than in healthy subjects. This would affect the performance of patients during dual-task conditions to be able to control a postural task while performing other cognitive tasks. In these conditions, cognitive performance would be negatively affected. These results suggest that subjects with PD, at least during initial disease stages, prioritize postural control over other concurrent tasks, as is also seen in healthy subjects.
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Affiliation(s)
- Luis Morenilla
- Department of Physical Education, Faculty of Sport Sciences and Physical Education, University of A Coruña, A Coruña, Spain
| | - Gonzalo Márquez
- Department of Physical Education, Faculty of Sport Sciences and Physical Education, University of A Coruña, A Coruña, Spain
| | - José Andrés Sánchez
- Department of Physical Education, Faculty of Sport Sciences and Physical Education, University of A Coruña, A Coruña, Spain
| | - Olalla Bello
- Department of Biomedical Sciences, Medicine and Physical Therapy, Faculty of Physical Therapy, University of A Coruña, A Coruña, Spain
| | - Virginia López-Alonso
- Department of Physical Education, Center of Higher Education Alberta Giménez, Palma, Spain
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Hirjaková Z, Bizovská L, Bzdúšková D, Hlavačka F, Janura M. Postural stability after treadmill and overground walking in young and elderly. Gait Posture 2020; 80:84-89. [PMID: 32497980 DOI: 10.1016/j.gaitpost.2020.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/07/2020] [Accepted: 05/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ageing commonly disrupts the balance control and compensatory postural responses that contribute to maintaining balance and preventing falls during perturbation of posture. Improvement of compensatory postural responses during walking is one of the main goals in fall prevention programs which often include treadmill walking training. However, during treadmill walking, there is a sensory (visualsomatosensory and vestibular-somatosensory) conflict that can evoke aftereffects of self-motion sensation and could alter postural stability after training. RESEARCH QUESTION The aim of this study was to compare the effect of overground and treadmill walking on postural stability in healthy young and elderly subjects. METHODS Postural responses of 31 Young and 19 healthy Elderly before and after overground and treadmill walking were assessed by a force platform in four stance conditions: firm and foam surface with eyes open and eyes closed. RESULTS In Elderly group, velocity parameters significantly increased after treadmill walking but not after overground walking. This increase was found particularly in the conditions with eyes open in both types of surfaces (firm, foam). The velocity parameters values (expect Vx) were significantly increased in Elderly compared to Young almost in all four conditions after treadmill and overground walking. SIGNIFICANCE Our study suggests that Elderly become more unstable after treadmill walking and have greater difficulties to adapt to new balance circumstances caused by sensory conflict associated with treadmill walking. It seems that during treadmill walking and subsequent stance, vision is the major factor contributing to posture stabilization. Thus, the suitability of treadmill walking as a part of training programs for elderly adults with higher fall risk should be seriously considered.
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Affiliation(s)
- Zuzana Hirjaková
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, třída Míru 117, 771 11 Olomouc, Czech Republic; Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Sienkiewiczova 1, 813 71, Bratislava, Slovak Republic
| | - Lucia Bizovská
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, třída Míru 117, 771 11 Olomouc, Czech Republic
| | - Diana Bzdúšková
- Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Sienkiewiczova 1, 813 71, Bratislava, Slovak Republic.
| | - František Hlavačka
- Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Sienkiewiczova 1, 813 71, Bratislava, Slovak Republic
| | - Miroslav Janura
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, třída Míru 117, 771 11 Olomouc, Czech Republic
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Trunk Exercises Improve Balance in Parkinson Disease: A Phase II Randomized Controlled Trial. J Neurol Phys Ther 2020; 43:96-105. [PMID: 30883497 DOI: 10.1097/npt.0000000000000258] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Trunk control is important for maintaining balance; hence, deficient trunk control may contribute to balance problems in people with Parkinson disease (PD). Unfortunately, this deficit is poorly managed with pharmacological therapies, emphasizing the need for alternative therapies for these patients. This randomized controlled trial sought to examine the effects of a 12-week trunk-specific exercise-based intervention on balance in people with PD. METHODS Twenty-four people with PD and with a history of falls completed assessments of motor symptom severity, balance confidence, mobility, quality of life, and quiet-standing balance. Participants were then randomized to receive either 12 weeks of exercise or education and reassessed after 12 and 24 weeks. RESULTS Linear mixed-models analyses showed no significant changes in clinical outcomes following the intervention. However, during quiet standing, sway area on a foam surface without vision was reduced for the exercise group at 12 (-6.9 ± 3.1 cm; 95% confidence interval [CI] = -13.1 to -0.7; P = 0.029; d = 0.66) and 24 weeks (-7.9 ± 3.1 cm; 95% CI = -14.1 to -1.7; P = 0.013; d = 0.76). Furthermore, the exercise group demonstrated reduced sway variability at 12 (-0.2 ± 0.1 cm; 95% CI = -0.4 to 0.0; P = 0.042; d = 0.62) and 24 weeks in the medial-lateral direction (-0.2 ± 0.1 cm; 95% CI = -0.4 to 0.0; P = 0.043; d = 0.62). No changes in quiet standing balance were recorded for the education group. DISCUSSION AND CONCLUSIONS The results of this study suggest that exercise-based interventions targeting trunk strength, endurance, and mobility may be effective for improving quiet-standing balance in people with PD. However, additional research is needed to determine whether these improvements are sufficient to reduce falls risk.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A254).
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Rutz DG, Benninger DH. Physical Therapy for Freezing of Gait and Gait Impairments in Parkinson Disease: A Systematic Review. PM R 2020; 12:1140-1156. [PMID: 31994842 DOI: 10.1002/pmrj.12337] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 01/20/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Freezing of gait (FOG) is a major cause of falls and disability in Parkinson disease (PD). As FOG only partially improves in response to dopaminergic medication, physical therapy is an important element of its management. OBJECTIVE To assess the evidence for the physical interventions for FOG and gait impairments and to establish recommendations for clinical practice. LITERATURE SURVEY This review follows the guidelines for systematic reviews: the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Systematic search in PubMed, Embase, Physiotherapy Evidence Databases, and CINAHL for randomized controlled trials of PT interventions for FOG in PD patients until April 2018. SYNTHESIS Twenty randomized controlled trials (RCTs) were reviewed. In 12 RCTs, PT for FOG was assessed, which was the primary outcome measure in nine of these RCTs. In eight RCTs, PT for gait impairment (not targeting specifically FOG) in PD was assessed. The following PT interventions reduce FOG with a good category A recommendation: cueing strategies (P < .05) (visual and auditory); treadmill walking (P < .05); aquatic obstacle training (P < .01); supervised slackline training (P < .05). These interventions can be combined and maintain their efficacy when being applied concurrently: though there is a lack of long-term follow-up studies. The following PT interventions show possible benefit and need further investigations: balance and coordination training; aquatic gait training; sensory (tactile) cues. The treadmill training and auditory and visual cues are effective also for other gait disturbances in PD and improve gait kinematics. CONCLUSIONS Visual and auditory cueing and the treadmill training are effective interventions for FOG and gait impairments in PD patients (evidence level A- according to the European Federation of Neurological Societies). Tactile cues and other specific therapies targeting FOG are probably effective but need further studies.
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Affiliation(s)
- Dionys G Rutz
- Physical Therapy Unit, Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - David H Benninger
- Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Aerobic Exercise and Healthy Nutrition as Neuroprotective Agents for Brain Health in Patients with Parkinson's Disease: A Critical Review of the Literature. Antioxidants (Basel) 2020; 9:antiox9050380. [PMID: 32380715 PMCID: PMC7278852 DOI: 10.3390/antiox9050380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/13/2022] Open
Abstract
Parkinson’s disease (PD) is characterized by motor and nonmotor features that have an influence on patients’ quality of life at different levels. To date, some evidences have arisen on the effectiveness of physical trainings and nutrients intake in ameliorating functional and cognitive outcomes in PD patients. Physical activity is effective in improving both motor and nonmotor features and recent epidemiological investigations have revealed the pivotal role that dietary patterns may play in reducing the risk of PD highlighting the pathogenesis of the neurodegeneration. Specifically, aerobic exercise shows beneficial effects in improving motor functions and executive control in PD patients, as well as proper nutrition may help in improving neuroprotective agents counteracting neurodegeneration and allows patients to better interact with the medication. Our narrative review critically focused on aerobic exercise and nutrition in PD in order to point out the best prescriptions for brain health of affected patients. Implications for a therapeutic plan and rehabilitation for these patients are also discussed.
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Treadmill walking alters stride time dynamics in Parkinson's disease. Gait Posture 2020; 77:195-200. [PMID: 32058283 DOI: 10.1016/j.gaitpost.2020.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/01/2020] [Accepted: 02/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Treadmill training may be used to improve gait rhythmicity in people with Parkinson's disease. Treadmills, however, alter dynamical stride time fluctuations in healthy adults in a manner that mimics pathologic states, indicating the stride-to-stride fluctuations that characterize healthy gait are constrained. It is unclear if treadmills similarly alter dynamic gait properties in Parkinson's disease. RESEARCH QUESTION Do stride time fractal dynamics in individuals with Parkinson's disease differ between treadmill and overground walking? METHODS Fifteen participants with Parkinson's disease and 15 healthy age-similar adults walked for 6 min in a conventional overground condition and on a treadmill while wearing inertial measurement units. Gait speed, stride times and stride time variability were measured. Fractal exponents (α) were computed with adaptive fractal analysis. Inferential statistics were analyzed with mixed model analyses of variance and post hoc simple effects tests. RESULTS Mean gait speeds decreased and stride times increased on the treadmill but did not differ between the Parkinson's and control groups. Stride time variability was greater in the Parkinson's than control group in both conditions. Most relevant to our research question, stride time fractal exponents were greater on the treadmill (mean α = .910) than overground (mean α = .797) in individuals with Parkinson's disease, but not in healthy controls. SIGNIFICANCE The fractal scaling exponent α emanating from stride time fluctuations during treadmill walking increased toward a 1/f signal of α = 1.0 that has been interpreted as an optimal structural variability for gait. The clinical implication is that treadmill training may promote more efficient walking dynamics in people with Parkinson's disease than conventional overground training.
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Corticomuscular control of walking in older people and people with Parkinson's disease. Sci Rep 2020; 10:2980. [PMID: 32076045 PMCID: PMC7031238 DOI: 10.1038/s41598-020-59810-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/30/2020] [Indexed: 12/29/2022] Open
Abstract
Changes in human gait resulting from ageing or neurodegenerative diseases are multifactorial. Here we assess the effects of age and Parkinson’s disease (PD) on corticospinal activity recorded during treadmill and overground walking. Electroencephalography (EEG) from 10 electrodes and electromyography (EMG) from bilateral tibialis anterior muscles were acquired from 22 healthy young, 24 healthy older and 20 adults with PD. Event-related power, corticomuscular coherence (CMC) and inter-trial coherence were assessed for EEG from bilateral sensorimotor cortices and EMG during the double-support phase of the gait cycle. CMC and EMG power at low beta frequencies (13–21 Hz) was significantly decreased in older and PD participants compared to young people, but there was no difference between older and PD groups. Older and PD participants spent shorter time in the swing phase than young individuals. These findings indicate age-related changes in the temporal coordination of gait. The decrease in low-beta CMC suggests reduced cortical input to spinal motor neurons in older people during the double-support phase. We also observed multiple changes in electrophysiological measures at low-gamma frequencies during treadmill compared to overground walking, indicating task-dependent differences in corticospinal locomotor control. These findings may be affected by artefacts and should be interpreted with caution.
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Palasz E, Niewiadomski W, Gasiorowska A, Wysocka A, Stepniewska A, Niewiadomska G. Exercise-Induced Neuroprotection and Recovery of Motor Function in Animal Models of Parkinson's Disease. Front Neurol 2019; 10:1143. [PMID: 31736859 PMCID: PMC6838750 DOI: 10.3389/fneur.2019.01143] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/11/2019] [Indexed: 12/19/2022] Open
Abstract
Parkinson's disease (PD) is manifested by progressive motor, autonomic, and cognitive disturbances. Dopamine (DA) synthesizing neurons in the substantia nigra (SN) degenerate, causing a decline in DA level in the striatum that leads to the characteristic movement disorders. A disease-modifying therapy to arrest PD progression remains unattainable with current pharmacotherapies, most of which cause severe side effects and lose their efficacy with time. For this reason, there is a need to seek new therapies supporting the pharmacological treatment of PD. Motor therapy is recommended for pharmacologically treated PD patients as it alleviates the symptoms. Molecular mechanisms behind the beneficial effects of motor therapy are unknown, nor is it known whether such therapy may be neuroprotective in PD patients. Due to obvious limitations, human studies are unlikely to answer these questions; therefore, the use of animal models of PD seems indispensable. Motor therapy in animal models of PD characterized by the loss of dopaminergic neurons has neuroprotective and neuroregenerative effects, and the completeness of neuronal protection may depend on (i) degree of neuronal loss, (ii) duration and intensity of exercise, and (iii) time elapsed between insult and commencing of training. As the physical activity is neuroprotective for dopaminergic neurons, the question arises what is the mechanism of this protective action. A current hypothesis assumes a central role of neurotrophic factors in the neuroprotection of dopaminergic neurons, even though it is still not clear whether increased DA level in the nigrostriatal axis results from neurogenesis of dopaminergic neurons in the SN, recovery of the phenotype of dopaminergic neurons, increased sprouting of the residual dopaminergic axons in the striatum, or generation of local striatal neurons from inhibitory interneurons. In the present review, we discuss studies describing the influence of physical exercise on the PD-like changes manifested in animal models of the disease and focus our interest on the current state of knowledge on the mechanism of neuroprotection induced by physical activity as a supportive therapy in PD.
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Affiliation(s)
- Ewelina Palasz
- Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Science, Warsaw, Poland
| | - Wiktor Niewiadomski
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Anna Gasiorowska
- Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Science, Warsaw, Poland.,Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Adrianna Wysocka
- Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Science, Warsaw, Poland
| | - Anna Stepniewska
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Grazyna Niewiadomska
- Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Science, Warsaw, Poland
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Layne CS, Young DR, Lee BC, Glaze DG, Schwabe A, Suter B. Kinematics associated with treadmill walking in Rett syndrome. Disabil Rehabil 2019; 43:1585-1593. [PMID: 31613656 DOI: 10.1080/09638288.2019.1674389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Individuals with Rett syndrome suffer from severely impaired cognitive and motor performance. Current movement-related therapeutic programs often include traditional physical therapy activities and assisted treadmill walking routines for those individuals who are ambulatory. However, there are no quantitative reports of kinematic gait parameters obtained during treadmill walking. The purpose of this research was to characterize the kinematic patterns of the lower limbs during treadmill walking as speed was slowly increased. METHODS Seventeen independently ambulatory females diagnosed with a methyl-CpG-binding protein 2 gene mutation walked on a motorized treadmill while joint kinematics were obtained by a camera-based motion capture system and analysis software. RESULTS Stride times progressively decreased as treadmill speeds increased. There were significant main effects of speed on sagittal knee and hip ranges of motion and hip velocity. There were large joint asymmetries and variance values relative to other ambulatory patient populations, although variance values decreased as walking speed increased. CONCLUSIONS The results indicate that individuals with Rett syndrome can adapt their kinematic gait patterns in response to increasing treadmill speed, but only within a narrow range of speeds. We suggest that treadmill training for ambulatory individuals with Rett syndrome may promote improved walking kinematics and possibly provide overall health benefits.Implications for rehabilitationWalking is an activity that can counter the negative impacts of the sedentary lifestyle of many individuals with disabilities, including those individuals with Rett syndrome.Documentation of the lower limb kinematic patterns displayed during walking by ambulatory females with Rett syndrome can be used by clinicians to evaluate their patients' gait performance in response to therapeutic and pharmacological interventions designed to promote walking.The ability to adapt to increases in treadmill speed suggests that a training program of treadmill walking may be effective in promoting improved gait performance in individuals with Rett syndrome.
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Affiliation(s)
- Charles S Layne
- Department of Health and Human Performance, University of Houston, Houston, TX, USA.,Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA.,Center for Neuro-Engineering and Cognitive Science, University of Houston, Houston, TX, USA
| | - David R Young
- Department of Health and Human Performance, University of Houston, Houston, TX, USA.,Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA
| | - Beom-Chan Lee
- Department of Health and Human Performance, University of Houston, Houston, TX, USA.,Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA
| | - Daniel G Glaze
- Blue Bird Circle Rett Center, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Aloysia Schwabe
- Blue Bird Circle Rett Center, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Bernhard Suter
- Blue Bird Circle Rett Center, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
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Rahmati Z, Schouten AC, Behzadipour S, Taghizadeh G, Firoozbakhsh K. Disentangling stability and flexibility degrees in Parkinson's disease using a computational postural control model. J Neuroeng Rehabil 2019; 16:104. [PMID: 31412926 PMCID: PMC6694532 DOI: 10.1186/s12984-019-0574-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/07/2019] [Indexed: 01/11/2023] Open
Abstract
Background Impaired postural control in Parkinson’s disease (PD) seriously compromises life quality. Although balance training improves mobility and postural stability, lack of quantitative studies on the neurophysiological mechanisms of balance training in PD impedes the development of patient-specific therapies. We evaluated the effects of a balance-training program using functional balance and mobility tests, posturography, and a postural control model. Methods Center-of-pressure (COP) data of 40 PD patients before and after a 12-session balance-training program, and 20 healthy control subjects were recorded in four conditions with two tasks on a rigid surface (R-tasks) and two on foam. A postural control model was fitted to describe the posturography data. The model comprises a neuromuscular controller, a time delay, and a gain scaling the internal disturbance torque. Results Patients’ axial rigidity before training resulted in slower COP velocity in R-tasks; which was reflected as lower internal torque gain. Furthermore, patients exhibited poor stability on foam, remarked by abnormal higher sway amplitude. Lower control parameters as well as higher time delay were responsible for patients’ abnormal high sway amplitude. Balance training improved all clinical scores on functional balance and mobility. Consistently, improved ‘flexibility’ appeared as enhanced sway velocity (increased internal torque gain). Balance training also helped patients to develop the ‘stability degree’ (increase control parameters), and to respond more quickly in unstable condition of stance on foam. Conclusions Projection of the common posturography measures on a postural control model provided a quantitative framework for unraveling the neurophysiological factors and different recovery mechanisms in impaired postural control in PD. Electronic supplementary material The online version of this article (10.1186/s12984-019-0574-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zahra Rahmati
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.,Djawad Movafaghian Research Center in Rehab Technologies, Sharif University of Technology, Tehran, Iran
| | - Alfred C Schouten
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Saeed Behzadipour
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran. .,Djawad Movafaghian Research Center in Rehab Technologies, Sharif University of Technology, Tehran, Iran.
| | - Ghorban Taghizadeh
- School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Abstract
Parkinson's disease is the second most common neurodegenerative disease with a prevalence rate of 1-2 per 1000 of the population worldwide. Pharmacological management is the mainstay of treatment. Despite optimal medication, motor impairment particularly balance and gait impairment persist leading to various degree of disability and reduced quality-of-life. The present review describes motor impairment including postural impairment, gait dysfunction, reduced muscle strength and aerobic capacity and falls. Physical therapy and complementary exercises have been proven to improve motor performance and functional mobility. Evidence on the efficacy of physical therapy and complementary exercises is presented in this review. These exercises include gait training with cues, gait training with treadmill, Nordic walking, brisk walking, balance training, virtual reality interventions, Tai Chi and dance. All these treatment interventions produce short-term beneficial effects and some interventions demonstrate long-term benefit. Gait training with treadmill enhance walking performance and the effects sustain for 3-6 months. Balance training improves balance, function and reduces fall rate, and these effects carry over to at least 12 months after training ended. Sustained Tai Chi for 6 months, dance therapy for 12 months, progressive resistive training for 24 months alleviates the PD motor symptoms, suggesting that they could slow down PD progression. Based on this evidence, individuals with PD are encouraged to sustain their training in order to improve/maintain their physical ability and to combat the progression of PD.
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Affiliation(s)
- Margaret K Y Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Irene S K Wong-Yu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Fernández-Lago H, Bello O, Salgado AV, Fernandez-del-Olmo M. Acute kinematic and neurophysiological effects of treadmill and overground walking in Parkinson’s disease. NeuroRehabilitation 2019; 44:433-443. [DOI: 10.3233/nre-182638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Helena Fernández-Lago
- Faculty of Nursing and Physical Therapy, University of Lleida, Lleida, Spain
- Research Group of Health Care (GRECS), IRBLleida, Spain
| | - Olalla Bello
- Department of Physical Therapy, Faculty of Physical Therapy, University of A Coruña, A Coruña, Spain
| | - Antía Vidal Salgado
- Department of Physical Education, Faculty of Sciences of Sport and Physical Education, University of A Coruña, A Coruña, Spain
| | - Miguel Fernandez-del-Olmo
- Department of Physical Education, Faculty of Sciences of Sport and Physical Education, University of A Coruña, A Coruña, Spain
- Physical Education and Sports Area, University of Rey Juan Carlos, Madrid, Spain
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Ambrus M, Sanchez JA, Sanchez Miguel JA, Del-Olmo F. Test-retest reliability of stride length-cadence gait relationship in Parkinson's disease. Gait Posture 2019; 71:177-180. [PMID: 31075660 DOI: 10.1016/j.gaitpost.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/09/2019] [Accepted: 05/02/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The gait pattern in Parkinson´s disease (PD) subjects is characterized by a specific deficit of the internal regulation of the stride length (SL), while the control of the cadence (Cad) remains intact. The purpose of the present study was to evaluate the reliability of the stride length-cadence relationship (SLCrel) in a group of PD subjects. METHODS Thirty five PD subjects performed two sessions, separated by a three month resting period. In each session Gait speed, SL and Cad were evaluated at five different self-selected speed conditions: preferred, slow, very slow, fast and very fast. Linear regression analysis was used to explore the SLCrel and to determine the slope, intercept and coefficient of determination (R2) for each participant. Test-retest reliability for the slope and intercept was calculated using intra-class correlation coefficient (ICC), 95% confidence interval (CI), and standard error of mean (SEM). RESULTS There were no significant differences in the slope and intercept between the two sessions. The overall speed was significantly faster in the second session compared with the first one (F = 4.60, p = 0.03). The SLCrel showed high reliability across the sessions (ICC = 0.89 and ICC = 0.91; 95% CI = 0.80-0.95 and 95% CI = 0.82-0.95; SEM = 0.002 and SEM = 0.073, for the slope and interception, respectively). CONCLUSIONS The SLCrel in Parkinsonian gait is a reproducible measure across a period of three months, and may be a useful tool to explore the specificity of gait rehabilitation interventions in PD subjects.
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Affiliation(s)
- Mira Ambrus
- King Juan Carlos University, Faculty of Sciences of Sport and Physical Education, Area of Sport Sciences, Avenida de Atenas s/n, Alcorcón, Madrid, 28992, Spain; University of A Coruña, Department of Sport Sciences, Av. Ernesto Che Guevara 112
| | - Jose A Sanchez
- King Juan Carlos University, Faculty of Sciences of Sport and Physical Education, Area of Sport Sciences, Avenida de Atenas s/n, Alcorcón, Madrid, 28992, Spain; University of A Coruña, Department of Sport Sciences, Av. Ernesto Che Guevara 112
| | - Jose A Sanchez Miguel
- King Juan Carlos University, Faculty of Sciences of Sport and Physical Education, Area of Sport Sciences, Avenida de Atenas s/n, Alcorcón, Madrid, 28992, Spain; University of A Coruña, Department of Sport Sciences, Av. Ernesto Che Guevara 112
| | - Fernandez Del-Olmo
- King Juan Carlos University, Faculty of Sciences of Sport and Physical Education, Area of Sport Sciences, Avenida de Atenas s/n, Alcorcón, Madrid, 28992, Spain; University of A Coruña, Department of Sport Sciences, Av. Ernesto Che Guevara 112.
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Treadmill exercise intervention improves gait and postural control in alpha-synuclein mouse models without inducing cerebral autophagy. Behav Brain Res 2019; 363:199-215. [DOI: 10.1016/j.bbr.2018.11.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 11/22/2018] [Accepted: 11/23/2018] [Indexed: 12/21/2022]
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Olson M, Lockhart TE, Lieberman A. Motor Learning Deficits in Parkinson's Disease (PD) and Their Effect on Training Response in Gait and Balance: A Narrative Review. Front Neurol 2019; 10:62. [PMID: 30792688 PMCID: PMC6374315 DOI: 10.3389/fneur.2019.00062] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/17/2019] [Indexed: 01/30/2023] Open
Abstract
Parkinson's disease (PD) is a neurological disorder traditionally associated with degeneration of the dopaminergic neurons within the substantia nigra, which results in bradykinesia, rigidity, tremor, and postural instability and gait disability (PIGD). The disorder has also been implicated in degradation of motor learning. While individuals with PD are able to learn, certain aspects of learning, especially automatic responses to feedback, are faulty, resulting in a reliance on feedforward systems of movement learning and control. Because of this, patients with PD may require more training to achieve and retain motor learning and may require additional sensory information or motor guidance in order to facilitate this learning. Furthermore, they may be unable to maintain these gains in environments and situations in which conscious effort is divided (such as dual-tasking). These shortcomings in motor learning could play a large part in degenerative gait and balance symptoms often seen in the disease, as patients are unable to adapt to gradual sensory and motor degradation. Research has shown that physical and exercise therapy can help patients with PD to adapt new feedforward strategies to partially counteract these symptoms. In particular, balance, treadmill, resistance, and repeated perturbation training therapies have been shown to improve motor patterns in PD. However, much research is still needed to determine which of these therapies best alleviates which symptoms of PIGD, the needed dose and intensity of these therapies, and long-term retention effects. The benefits of such technologies as augmented feedback, motorized perturbations, virtual reality, and weight-bearing assistance are also of interest. This narrative review will evaluate the effect of PD on motor learning and the effect of motor learning deficits on response to physical therapy and training programs, focusing specifically on features related to PIGD. Potential methods to strengthen therapeutic effects will be discussed.
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Affiliation(s)
- Markey Olson
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
- Muhammad Ali Movement Disorders Clinic, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Thurmon E. Lockhart
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Abraham Lieberman
- Muhammad Ali Movement Disorders Clinic, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
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Ambrus M, Sanchez JA, Fernandez-Del-Olmo M. Walking on a treadmill improves the stride length-cadence relationship in individuals with Parkinson's disease. Gait Posture 2019; 68:136-140. [PMID: 30476690 DOI: 10.1016/j.gaitpost.2018.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/03/2018] [Accepted: 11/17/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The gait pattern in Parkinson´s disease (PD) is characterized by a deficit in the internal regulation of stride length (SL), while the control of cadence (Cad) remains intact. The use of the treadmill as a gait rehabilitation tool has provided novel options for treatment of gait impairments in PD. However, it remains unclear whether walking on the treadmill changes the stride length-cadence relationship (SLCrel) in PD. The purpose of the present study was to analyze the SLCrel in PD subjects walking on a treadmill vs. overground, and to further compare the SLCrel to that of age-matched healthy subjects. METHODS Fifteen PD subjects and fifteen age-matched controls walked overground and on a treadmill at five different self-selected speeds. Gait speed, SL and Cad were recorded at each self-selected speed. A linear regression analysis was conducted to explore the SLCrel and to determine the slope and intercept for each participant. RESULTS PD subjects showed a lower intercept than control subjects when walking both overground and on a treadmill (F = 8.51, p = 0.007). In comparison with walking overground, walking on a treadmill resulted in a significant increase in the intercept in both PD and control groups (F = 12.17, p = 0.002). There were no significant differences in the slope of the SLCrel. CONCLUSION PD subjects are able to improve the internal regulation of SL when walking on a treadmill. Our results confirm the potential therapeutic effects of treadmill training for gait rehabilitation in PD and suggest that the mechanisms underlying the positive effects of treadmill training on PD subjects are sustained.
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Affiliation(s)
- M Ambrus
- Departamento de Educacion Fisica e Deportiva, Facultade de Ciencias do Deporte e a Educacion Fisica, Universidade da Coruna, Av. Ernesto Che Guevara 121, Pazos-Lians, 15179, Oleiros, A Coruna, Spain.
| | - J A Sanchez
- Departamento de Educacion Fisica e Deportiva, Facultade de Ciencias do Deporte e a Educacion Fisica, Universidade da Coruna, Av. Ernesto Che Guevara 121, Pazos-Lians, 15179, Oleiros, A Coruna, Spain.
| | - M Fernandez-Del-Olmo
- Departamento de Educacion Fisica e Deportiva, Facultade de Ciencias do Deporte e a Educacion Fisica, Universidade da Coruna, Av. Ernesto Che Guevara 121, Pazos-Lians, 15179, Oleiros, A Coruna, Spain.
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Ni M, Hazzard JB, Signorile JF, Luca C. Exercise Guidelines for Gait Function in Parkinson’s Disease: A Systematic Review and Meta-analysis. Neurorehabil Neural Repair 2018; 32:872-886. [DOI: 10.1177/1545968318801558] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This systematic review and meta-analysis is to provide comprehensive evidence-based exercise recommendations targeting walking function for adults with Parkinson’s disease. Methods. Fixed- or random-effect meta-analyses estimated standardized effect sizes (Hedge’s g), comparing treatment effects from exercise with nonexercise and another form of exercise (non-EXE control and EXE control). Cuing and exercise duration were used as moderators for subanalyses. Results. The 40 included randomized controlled trials comprised 1656 patients. The exercise group showed significantly superior performance in timed up-and-go ( g = −0.458; g = −0.390) compared with non-EXE control and EXE control; significantly greater improvement in comfortable walking speed ( g = 0.449), fast walking speed ( g = 0.430), and stride or step length ( g = 0.379) compared with non-EXE control; and significantly greater cadence ( g = 0.282) compared with EXE controls. No significant differences between intervention and control groups were observed for double-leg support time (DLST), dynamic gait index (DGI), 6-minute walk test, or freezing of gait questionnaire (FOG-Q). Notably, treatment effect from the exercise of interest compared with a standard exercise was greater than for nonexercise for cadence and FOG-Q. Moreover, EXE control was favored for DLST and DGI. Cuing had a significantly positive effect on stride length alone. Exercise duration significantly, but negatively, influenced the treatment effect on comfortable walking speed. Conclusion. Gait-specific training, rather than a general exercise program, should be emphasized if gait is the outcome of interest. Further investigation is needed on exercise dosage and its selective effect on more challenging walking tasks, endurance, and freezing of gait.
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Affiliation(s)
- Meng Ni
- Bloomsburg University of Pennsylvania, Bloomsburg, PA, USA
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Bello O, Marquez G, Fernandez-Del-Olmo M. Effect of Treadmill Walking on Leg Muscle Activation in Parkinson's Disease. Rejuvenation Res 2018; 22:71-78. [PMID: 29962320 DOI: 10.1089/rej.2018.2084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Treadmills are often used as rehabilitation devices to improve gait in Parkinson's disease (PD). Kinematic differences between treadmill and overground gait have been reported. However, electromyographic (EMG) patterns during treadmill and overground walking have not been systematically compared. The aim of this study was to assess the effects of treadmill gait on the magnitude of the EMG activity of the lower limb muscles in PD. We measured EMG activity of the tibialis anterior, gastrocnemius medialis, vastus lateralis, and biceps femoris of nine individuals with PD and nine healthy matched controls. Comparisons between walking overground with walking on a treadmill and with walking with a treadmill simulator were carried out. The treadmill simulator is a device that simulates treadmill conditions with the exception of the belt. Our results have shown that treadmill walking is associated with several EMG differences compared with overground walking. The key finding of the study is that coactivation of the thigh muscles was significantly decreased (37%; p = 0.008) in PD subjects when walking on the treadmill in comparison with overground walking. The changes observed in the coactivation level may be related to the belt movement, since no changes were reported during walking with the treadmill simulator. Understanding the differences between treadmill and overground gait as well as the mechanisms that result in improvement of gait disturbances may optimize rehabilitative protocols for patients with PD.
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Affiliation(s)
- Olalla Bello
- 1 Learning and Human Movement Control Group, INEF Galicia, University of A Coruña, A Coruña, Spain.,2 Department of Physical Therapy, Faculty of Physical Therapy, University of A Coruña, A Coruña, Spain
| | - Gonzalo Marquez
- 3 Neuroscience of Human Movement, Faculty of Sport, Catholic University of Murcia (UCAM), Murcia, Spain
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Fox SH, Katzenschlager R, Lim SY, Barton B, de Bie RMA, Seppi K, Coelho M, Sampaio C. International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease. Mov Disord 2018; 33:1248-1266. [DOI: 10.1002/mds.27372] [Citation(s) in RCA: 406] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Susan H. Fox
- Edmund J. Safra Program, Movement Disorder Clinic; Toronto Western Hospital; Toronto Ontario Canada
- University of Toronto Department of Medicine; Toronto Ontario Canada
| | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders; Danube Hospital; Vienna Austria
| | - Shen-Yang Lim
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders; University of Malaya; Kuala Lumpur Malaysia
| | - Brandon Barton
- Rush University Medical Center; Chicago Illinois USA
- Jesse Brown VA Medical Center; Chicago Illinois USA
| | - Rob M. A. de Bie
- Department of Neurology, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Klaus Seppi
- Department of Neurology; Medical University Innsbruck; Innsbruck Austria
| | - Miguel Coelho
- Department of Neurology, Santa Maria Hospital, Instituto de Medicina Molecular; University of Lisbon; Lisbon Portugal
| | - Cristina Sampaio
- Cure Huntington's Disease Initiative (CHDI) Management/CHDI Foundation, Princeton, NJ; USA
- Instituto de Medicina Molecular; University of Lisbon; Lisbon Portugal
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Chen YH, Kuo TT, Kao JH, Huang EYK, Hsieh TH, Chou YC, Hoffer BJ. Exercise Ameliorates Motor Deficits and Improves Dopaminergic Functions in the Rat Hemi-Parkinson's Model. Sci Rep 2018; 8:3973. [PMID: 29507426 PMCID: PMC5838260 DOI: 10.1038/s41598-018-22462-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/23/2018] [Indexed: 01/08/2023] Open
Abstract
To determine the influences of exercise on motor deficits and dopaminergic transmission in a hemiparkinson animal model, we measured the effects of exercise on the ambulatory system by estimating spatio-temporal parameters during walking, striatal dopamine (DA) release and reuptake and synaptic plasticity in the corticostriatal pathway after unilateral 6-OHDA lesions. 6-OHDA lesioned hemiparkinsonian rats were exercised on a fixed speed treadmill for 30 minutes per day. Controls received the same lesion but no exercise. Animals were subsequently analyzed for behavior including gait analysis, rotarod performance and apomorphine induced rotation. Subsequently, in vitro striatal dopamine release was analyzed by using FSCV and activity-dependent plasticity in the corticostriatal pathway was measured in each group. Our data indicated that exercise could improve motor walking speed and increase the apomorphine-induced rotation threshold. Exercise also ameliorated spatiotemporal impairments in gait in PD animals. Exercise increased the parameters of synaptic plasticity formation in the corticostriatal pathway of PD animals as well as the dynamics of dopamine transmission in PD animals. Fixed speed treadmill training 30 minutes per day could ameliorate spatial-temporal gait impairment, improve walking speed, dopamine transmission as well as corticostriatal synaptic plasticity in the unilateral 6-OHDA lesioned rat model.
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Affiliation(s)
- Yuan-Hao Chen
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C..
| | - Tung-Tai Kuo
- Graduate Institute of Computer and Communication Engineering, National Taipei University of Technology, Taipei, Taiwan, R.O.C
| | - Jen-Hsin Kao
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Eagle Yi-Kung Huang
- Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Tsung-Hsun Hsieh
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Barry J Hoffer
- Graduate Program on Neuroregeneration, Taipei Medical University, Taipei, Taiwan
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Duncan RP, Van Dillen LR, Garbutt JM, Earhart GM, Perlmutter JS. Physical therapy and deep brain stimulation in Parkinson's Disease: protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2018; 4:54. [PMID: 29484198 PMCID: PMC5822622 DOI: 10.1186/s40814-018-0243-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 02/02/2018] [Indexed: 01/28/2023] Open
Abstract
Background Subthalamic nucleus deep brain stimulation (STN-DBS) reduces tremor, muscle stiffness, and bradykinesia in people with Parkinson’s Disease (PD). Walking speed, known to be reduced in PD, typically improves after surgery; however, other important aspects of gait may not improve. Furthermore, balance may worsen and falls may increase after STN-DBS. Thus, interventions to improve balance and gait could reduce morbidity and improve quality of life following STN-DBS. Physical therapy (PT) effectively improves balance and gait in people with PD, but studies on the effects of PT have not been extended to those treated with STN-DBS. As such, the efficacy, safety, and feasibility of PT in this population remain to be determined. The purpose of this pilot study is to address these unmet needs. We hypothesize that PT designed to target balance and gait impairment will be effective, safe, and feasible in this population. Methods/design Participants with PD treated with STN-DBS will be randomly assigned to either a PT or control group. Participants assigned to PT will complete an 8-week, twice-weekly PT program consisting of exercises designed to improve balance and gait. Control group participants will receive the current standard of care following STN-DBS, which does not include prescription of PT. The primary aim is to assess preliminary efficacy of PT on balance (Balance Evaluation Systems Test). A secondary aim is to assess efficacy of PT on gait (GAITRite instrumented walkway). Participants will be assessed OFF medication/OFF stimulation and ON medication/ON stimulation at baseline and at 8 and 12 weeks after baseline. Adverse events will be measured over the duration of the study, and adherence to PT will be measured to determine feasibility. Discussion To our knowledge, this will be the first study to explore the preliminary efficacy, safety, and feasibility of PT for individuals with PD with STN-DBS. If the study suggests potential efficacy, then this would justify larger trials to test effectiveness and safety of PT for those with PD with STN-DBS. Trial registration NCT03181282 (clinicaltrials.gov). Registered on 7 June 2017. Electronic supplementary material The online version of this article (10.1186/s40814-018-0243-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ryan P Duncan
- 1Program in Physical Therapy, Washington University School of Medicine in Saint Louis, Campus Box 8502, 4444 Forest Park Blvd, St. Louis, MO 63108 USA.,2Department of Neurology, Washington University School of Medicine in Saint Louis, St. Louis, MO USA
| | - Linda R Van Dillen
- 1Program in Physical Therapy, Washington University School of Medicine in Saint Louis, Campus Box 8502, 4444 Forest Park Blvd, St. Louis, MO 63108 USA.,3Department of Orthopaedic Surgery, Washington University School of Medicine in Saint Louis, St. Louis, MO USA
| | - Jane M Garbutt
- 4Department of Medicine, Washington University School of Medicine in Saint Louis, St. Louis, MO USA.,5Department of Pediatrics, Washington University School of Medicine in Saint Louis, St. Louis, MO USA
| | - Gammon M Earhart
- 1Program in Physical Therapy, Washington University School of Medicine in Saint Louis, Campus Box 8502, 4444 Forest Park Blvd, St. Louis, MO 63108 USA.,2Department of Neurology, Washington University School of Medicine in Saint Louis, St. Louis, MO USA.,6Department of Neuroscience, Washington University School of Medicine in Saint Louis, St. Louis, MO USA
| | - Joel S Perlmutter
- 1Program in Physical Therapy, Washington University School of Medicine in Saint Louis, Campus Box 8502, 4444 Forest Park Blvd, St. Louis, MO 63108 USA.,2Department of Neurology, Washington University School of Medicine in Saint Louis, St. Louis, MO USA.,6Department of Neuroscience, Washington University School of Medicine in Saint Louis, St. Louis, MO USA.,7Department of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, MO USA.,8Program in Occupational Therapy, Washington University School of Medicine in Saint Louis, St. Louis, MO USA
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Ghai S, Ghai I, Schmitz G, Effenberg AO. Effect of rhythmic auditory cueing on parkinsonian gait: A systematic review and meta-analysis. Sci Rep 2018; 8:506. [PMID: 29323122 PMCID: PMC5764963 DOI: 10.1038/s41598-017-16232-5] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/06/2017] [Indexed: 01/11/2023] Open
Abstract
The use of rhythmic auditory cueing to enhance gait performance in parkinsonian patients' is an emerging area of interest. Different theories and underlying neurophysiological mechanisms have been suggested for ascertaining the enhancement in motor performance. However, a consensus as to its effects based on characteristics of effective stimuli, and training dosage is still not reached. A systematic review and meta-analysis was carried out to analyze the effects of different auditory feedbacks on gait and postural performance in patients affected by Parkinson's disease. Systematic identification of published literature was performed adhering to PRISMA guidelines, from inception until May 2017, on online databases; Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE and PROQUEST. Of 4204 records, 50 studies, involving 1892 participants met our inclusion criteria. The analysis revealed an overall positive effect on gait velocity, stride length, and a negative effect on cadence with application of auditory cueing. Neurophysiological mechanisms, training dosage, effects of higher information processing constraints, and use of cueing as an adjunct with medications are thoroughly discussed. This present review bridges the gaps in literature by suggesting application of rhythmic auditory cueing in conventional rehabilitation approaches to enhance motor performance and quality of life in the parkinsonian community.
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Affiliation(s)
- Shashank Ghai
- Institute of Sports Science, Leibniz University Hannover, Hannover, Germany.
| | - Ishan Ghai
- School of Life Sciences, Jacobs University Bremen, Bremen, Germany
| | - Gerd Schmitz
- Institute of Sports Science, Leibniz University Hannover, Hannover, Germany
| | - Alfred O Effenberg
- Institute of Sports Science, Leibniz University Hannover, Hannover, Germany
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Layne CS, Lee BC, Young DR, Glaze DG, Schwabe A, Suter B. Temporal Gait Measures Associated With Overground and Treadmill Walking in Rett Syndrome. J Child Neurol 2018; 33:883073818780471. [PMID: 29926771 DOI: 10.1177/0883073818780471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rett syndrome is a severe neurodevelopmental disorder leading to intellectual impairment and global developmental delays, including difficulty or inability to walk. Assessing differences in temporal parameters and associated variability between overground and treadmill walking is important if gait training is to be incorporated into intervention protocols. Fourteen female patients with Rett syndrome (mean age 10.4 years ± SD 5.1) were evaluated during overground and treadmill walking. Stride, stance, swing, and double support times, and the variance of these measures, were obtained. Wilcoxon signed-rank tests were used to assess for potential differences between overground and treadmill measures. Treadmill gait resulted in decreases in swing and double support times. When normalized to stride time, treadmill gait displayed an increase in stance time with decreases in swing and double support times. Excepting stance time, treadmill gait resulted in decreased variability, indicating a more regularized gait while walking on the treadmill. These results suggest that treadmill walking can be beneficial for ambulatory patients with Rett syndrome and could be incorporated into a therapeutic protocol designed to maintain the maximum degree of mobility and overall general health as part of a comprehensive health management approach.
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Affiliation(s)
- Charles Shannon Layne
- 1 Health and Human Performance, University of Houston, Houston, TX, USA
- 2 Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA
- 3 Center for Neuro-Engineering and Cognitive Science, University of Houston, Houston, TX, USA
| | - Beom-Chan Lee
- 1 Health and Human Performance, University of Houston, Houston, TX, USA
- 2 Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA
| | - David Ryan Young
- 1 Health and Human Performance, University of Houston, Houston, TX, USA
- 2 Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA
| | - Daniel Gordon Glaze
- 4 Blue Bird Circle Rett Center, Houston, TX, USA
- 5 Texas Children's Hospital, Houston, TX, USA
- 6 Baylor College of Medicine, Houston, TX, USA
| | - Aloysia Schwabe
- 5 Texas Children's Hospital, Houston, TX, USA
- 6 Baylor College of Medicine, Houston, TX, USA
| | - Bernhard Suter
- 4 Blue Bird Circle Rett Center, Houston, TX, USA
- 5 Texas Children's Hospital, Houston, TX, USA
- 6 Baylor College of Medicine, Houston, TX, USA
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40
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Mollaei N, Bicho E, Sousa N, Gago MF. Different protocols for analyzing behavior and adaptability in obstacle crossing in Parkinson's disease. Clin Interv Aging 2017; 12:1843-1857. [PMID: 29158667 PMCID: PMC5683812 DOI: 10.2147/cia.s147428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Imbalance and tripping over obstacles as a result of altered gait in older adults, especially in patients with Parkinson’s disease (PD), are one of the most common causes of falls. During obstacle crossing, patients with PD modify their behavior in order to decrease the mechanical demands and enhance dynamic stability. Various descriptions of dynamic traits of gait that have been collected over longer periods, probably better synthesize the underlying structure and pattern of fluctuations in gait and can be more sensitive markers of aging or early neurological dysfunction and increased risk of falls. This confirmation challenges the clinimetric of different protocols and paradigms used for gait analysis up till now, in particular when analyzing obstacle crossing. The authors here present a critical review of current knowledge concerning the interplay between the cognition and gait in aging and PD, emphasizing the differences in gait behavior and adaptability while walking over different and challenging obstacle paradigms, and the implications of obstacle negotiation as a predictor of falls. Some evidence concerning the effectiveness of future rehabilitation protocols on reviving obstacle crossing behavior by trial and error relearning, taking advantage of dual-task paradigms, physical exercise, and virtual reality have been put forward in this article.
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Affiliation(s)
- Nafiseh Mollaei
- Centro Algoritmi, Campus Azurem, University of Minho, Guimarães
| | - Estela Bicho
- Centro Algoritmi, Campus Azurem, University of Minho, Guimarães
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga.,ICVS-3B's-PT Government Associate Laboratory, Braga
| | - Miguel Fernandes Gago
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga.,ICVS-3B's-PT Government Associate Laboratory, Braga.,Neurology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
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41
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Treadmill Walking Combined With Anodal Transcranial Direct Current Stimulation in Parkinson Disease. Am J Phys Med Rehabil 2017; 96:801-808. [DOI: 10.1097/phm.0000000000000751] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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42
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Current Trends in Exercise Intervention Research, Technology, and Behavioral Change Strategies for People With Disabilities. Am J Phys Med Rehabil 2017; 96:748-761. [DOI: 10.1097/phm.0000000000000743] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Vallabhajosula S, McMillion AK, Freund JE. The effects of exergaming and treadmill training on gait, balance, and cognition in a person with Parkinson’s disease: A case study. Physiother Theory Pract 2017; 33:920-931. [DOI: 10.1080/09593985.2017.1359867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Srikant Vallabhajosula
- Department of Physical Therapy Education, School of Health Sciences, Elon University, Elon, NC, USA
| | - Amy K. McMillion
- Department of Physical Therapy Education, School of Health Sciences, Elon University, Elon, NC, USA
| | - Jane E. Freund
- Department of Physical Therapy Education, School of Health Sciences, Elon University, Elon, NC, USA
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44
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Khademi-Kalantari K, Rahimi F, Hosseini SM, Baghban AA, Jaberzadeh S. Lower limb muscular activity during walking at different speeds: Over-ground versus treadmill walking: A voluntary response evaluation. J Bodyw Mov Ther 2017; 21:605-611. [PMID: 28750972 DOI: 10.1016/j.jbmt.2016.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/15/2016] [Accepted: 09/05/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the overall lower limb muscular activity pattern during treadmill walking compared to over-ground walking. METHODOLOGY The study was conducted on 25 healthy young females. Surface electromyography was recorded from gastrocnemius, hamstrings, vasti and gluteus medius muscles during walking over-ground and treadmill at 3 different speeds (comfortable, slow and fast). The pattern of muscle activity was compared between two walking conditions at different speeds by the voluntary response index method. Voluntary response index is composed of two numeric values: magnitude which represents the strength of overall muscular activity, and similarity index which represents the resemblance of overall muscle activity. RESULTS The main effect of walking conditions and speed as well as their interaction effect (P < 0.001) on magnitude of muscle activity were significant but not for similarity index. CONCLUSIONS The pattern of muscular activity during walking on treadmill and over-ground was similar but walking on treadmill induced higher muscular activity in the lower limb musculature.
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Affiliation(s)
- Khosro Khademi-Kalantari
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Rahimi
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Majid Hosseini
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzade Baghban
- Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shapour Jaberzadeh
- School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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45
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Filippin N, da Costa PHL, Mattioli R. Treadmill training with additional body load: Effects on the gait of people with Parkinson's disease. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.6.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aim: The aim of this study was to assess the effects of treadmill walking training with additional body load on the gait of people with moderate Parkinson's disease. Methods: Nine people with Parkinson's disease (Hoehn and Yahr Scale 2–3) and gait disturbance participated in this study. This study was an A1–B–A2 single-case. Phases A1 and A2 included 6 weeks of gait training on a treadmill with a 10% increase of normal body mass. Phase B included 6 weeks of conventional physical therapy (control condition). Measurements included ground reaction forces, spatiotemporal and kinematic variables during walking on the ground at baseline and after each phase. Findings: A significant increase in propulsive forces, stride length, speed, and maximum hip extension during stance were observed after the training programme. No changes in joint range of motion of ankle, knee, and hip were observed. Conclusions: Treadmill training with additional body load was associated with an improvement in important variables for the maintenance of a functional gait, and it is a promising alternative to optimise the rehabilitation process together with conventional physical therapy. However, further studies are needed.
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Affiliation(s)
- Nadiesca Filippin
- Professor, Department of Physical Therapy, Franciscan University Center, Santa Maria, Rio Grande do Sul, Brazil
| | - Paula Hentschel Lobo da Costa
- Professor, Department of Physical Education, Movement Analysis Laboratory, Federal University of São Carlos, São Paulo, Brazil
| | - Rosana Mattioli
- Professor, Department of Physical Therapy, Laboratory of Neuroscience, Federal University of São Carlos, São Paulo, Brazil
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46
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Ahn S, Lee J, Chu SH, Sohn YH. Uncertainty and depression in people with Parkinson's disease: A cross-sectional study. Nurs Health Sci 2017; 19:220-227. [DOI: 10.1111/nhs.12332] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 11/28/2016] [Accepted: 12/14/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Sangwoo Ahn
- School of Nursing; University of Minnesota; Minneapolis Minnesota USA
| | - JuHee Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing; Yonsei University; Seoul South Korea
| | - Sang Hui Chu
- Mo-Im Kim Nursing Research Institute, College of Nursing; Yonsei University; Seoul South Korea
| | - Young H. Sohn
- College of Medicine; Yonsei University; Seoul South Korea
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Lander JJ, Moran MF. Does positive pressure body weight-support alter spatiotemporal gait parameters in healthy and parkinsonian individuals? NeuroRehabilitation 2017; 40:271-276. [DOI: 10.3233/nre-161412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Joshua J. Lander
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
- Lander Sport and Health Sciences, Westport, CT, USA
| | - Matthew F. Moran
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
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Ayan C, Varela S, Vila MH, Seijo-Martinez M, Cancela JM. Treadmill training combined with water and land-based exercise programs: Effects on Parkinson's disease patients. NeuroRehabilitation 2017; 39:295-9. [PMID: 27372364 DOI: 10.3233/nre-161360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a need for studies about the effects of treadmill training (TT) on Parkinson's disease (PD) patients when combined with other exercise training modalities. OBJECTIVE To identify the effects of a multicomponent rehabilitation program on the illness impact, quality of life and fitness level in Parkinson's disease. METHODS Participants were assigned to two exercise groups: water and land-based exercise (WL) or water and land-based exercise plus treadmill training (TWL). The water and land-based exercise group performed one water-based exercise and one land-based exercise session per week for 15 weeks. Participants in the water and land-based exercise plus treadmill training added two sessions of treadmill training to this schedule. The Senior Fitness Test (SFT) was used to assess the sample's fitness level. RESULTS Participants in the water and land-based exercise Group experienced significant benefits in the disease impact (UPDRS t = 3.083; p = 0.029) and quality of life (PDQ-39 t = 2.942; p = 0.036). The addition of treadmill training did not have any significant effect on these variables. Both programs showed similar effects on the fitness components evaluated. CONCLUSION Adding treadmill training to a combination of water and land-based exercise programs may have limited effects on quality of life and the impact on the disease.
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Affiliation(s)
- Carlos Ayan
- Faculty of Education and Sports Science, Healthy Fit Research Group, University of Vigo, Pontevedra, Spain
| | - Silvia Varela
- Faculty of Education and Sports Science, Healthy Fit Research Group, University of Vigo, Pontevedra, Spain
| | - M Helena Vila
- Faculty of Education and Sports Science, Healthy Fit Research Group, University of Vigo, Pontevedra, Spain
| | | | - José M Cancela
- Faculty of Education and Sports Science, Healthy Fit Research Group, University of Vigo, Pontevedra, Spain
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Belchior LD, Tomaz BS, Abdon APV, Frota NAF, Mont’Alverne DGB, Gaspar DM. Treadmill in Parkinson’s: influence on gait, balance, BDNF and Reduced Glutathione. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.s01.ao09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Parkinson’s disease (PD) is characterized by nigrostriatal degeneration, with dopaminergic depletion, and inflammatory and oxidative changes in the brain, leading to movement and coordination disorders. Recent studies have shown that treadmill training can be beneficial for these patients, but there is little evidence assessing the related blood parameters, such as oxidative stress and neurotrophin levels. Objective: Assess the influence of treadmill training for patients with Parkinson’s on gait, balance, Brain-Derived Neurotrophic Factor (BDNF) and reduced glutathione. Methods: Twenty-two patients with PD (Hoehn and Yahr II and III), older than 40 years, were randomly allocated to two groups: CG (n = 12) - drug treatment and IG (n = 10) - treadmill. Assessments related to functional capacity (quality of life, static and dynamic analysis of gait) and blood parameters such as GSH and BDNF were conducted before and after the eight-week intervention. Results: The demographic data of the groups were homogeneous in terms of age, sex, height, weight, time since disease onset, mini mental examination and the geriatric depression scale. Significant intergroup differences were found for the mental component summary, surface variation, latero-lateral oscillation, antero-posterior oscillation and mean velocity in the post-intervention period. The IG exhibited a strong association between BDNF and GSH, with statistically significant values. Conclusion: It was concluded that controlled treadmill walking improves static balance, quality of life and plasma BDNF and GSH levels in patients with PD.
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50
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Cole MH, Sweeney M, Conway ZJ, Blackmore T, Silburn PA. Imposed Faster and Slower Walking Speeds Influence Gait Stability Differently in Parkinson Fallers. Arch Phys Med Rehabil 2016; 98:639-648. [PMID: 27993586 DOI: 10.1016/j.apmr.2016.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/13/2016] [Accepted: 11/10/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the effect of imposed faster and slower walking speeds on postural stability in people with Parkinson disease (PD). DESIGN Cross-sectional cohort study. SETTING General community. PARTICIPANTS Patients with PD (n=84; 51 with a falls history; 33 without) and age-matched controls (n=82) were invited to participate via neurology clinics and preexisting databases. Of those contacted, 99 did not respond (PD=36; controls=63) and 27 were not interested (PD=18; controls=9). After screening, a further 10 patients were excluded; 5 had deep brain stimulation surgery and 5 could not accommodate to the treadmill. The remaining patients (N=30) completed all assessments and were subdivided into PD fallers (n=10), PD nonfallers (n=10), and age-matched controls (n=10) based on falls history. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Three-dimensional accelerometers assessed head and trunk accelerations and allowed calculation of harmonic ratios and root mean square (RMS) accelerations to assess segment control and movement amplitude. RESULTS Symptom severity, balance confidence, and medical history were established before participants walked on a treadmill at 70%, 100%, and 130% of their preferred speed. Head and trunk control was lower for PD fallers than PD nonfallers and older adults. Significant interactions indicated head and trunk control increased with speed for PD nonfallers and older adults, but did not improve at faster speeds for PD fallers. Vertical head and trunk accelerations increased with walking speed for PD nonfallers and older adults, while the PD fallers demonstrated greater anteroposterior RMS accelerations compared with both other groups. CONCLUSIONS The results suggest that improved gait dynamics do not necessarily represent improved walking stability, and this must be respected when rehabilitating gait in patients with PD.
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Affiliation(s)
- Michael H Cole
- Australian Catholic University, School of Exercise Science, Banyo, Queensland, Australia.
| | - Matthew Sweeney
- Australian Catholic University, School of Exercise Science, Banyo, Queensland, Australia
| | - Zachary J Conway
- Australian Catholic University, School of Exercise Science, Banyo, Queensland, Australia
| | - Tim Blackmore
- Australian Catholic University, School of Exercise Science, Banyo, Queensland, Australia; University of Portsmouth, Department of Sport and Exercise Science, Hampshire, United Kingdom
| | - Peter A Silburn
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
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