Parkinson's disease: an investigation of exercise capacity, respiratory function, and gait

Evaluation of a finite state machine algorithm to measure stepping with ankle accelerometry: Performance across a range of gait speeds, tasks, and individual walking ability

Wearable sensors, including accelerometers, are a widely accepted tool to assess gait in clinical and free-living environments. Methods to identify phases and subphases of the gait cycle are necessary for comprehensive assessment of pathological gait. The current study evaluated the accuracy of a finite state machine (FSM) algorithm to detect strides by identifying gait cycle subphases from ankle-worn accelerometry. Algorithm performance was challenged across a range of speeds (0.4-2.6 m/s), task conditions (e.g., single- and dual-task walking), and individual characteristics. Specifically, the study included a range of treadmill speeds in young adults and overground walking conditions in older adults with neurological disease. Manually counted and algorithm-derived stride detection from acceleration data were evaluated using error analysis and Bland-Altman plots for visualization. Overall, the algorithm successfully detected strides (>96 % accuracy) across gait speed ranges and tasks, for young and older adults. The accuracy of an FSM algorithm combined with ankle-worn accelerometers, provides an analytical approach with affordable and portable tools that permits comprehensive assessment of gait unbounded by setting and proves to perform well in in walking tasks characterized by variable walking. These algorithm capabilities and advancements are critical for identifying phase dependent gait impairments in clinical and free-living assessment.

Dyspnea in Parkinson's disease

BACKGROUND

Dyspnea is an important non-motor symptom in Parkinson's disease (PD) that impacts quality of life. The mechanisms underlying dyspnea have been difficult to determine due to challenges separating central respiratory control abnormalities from peripheral respiratory muscle dysfunction and chest wall rigidity.

METHODS

A comprehensive literature review was conducted, searching the PubMed database for observational studies on respiratory dysfunction and dyspnea in PD. Inclusion criteria were studies with PD patients without other neurological disorders. Case studies were excluded. Data on study size, disease duration, control groups, and respiratory defects were extracted.

RESULTS

The search yielded 23 unique publications on pulmonary function in PD. Key findings were: 1) restrictive defects are common, with prevalence up to 85 % in some studies; 2) effects of levodopa on pulmonary function are variable across studies; 3) there is limited research on the role of central respiratory centers in dyspnea pathophysiology in PD. Proposed mechanisms include direct involvement of brainstem respiratory structures, loss of dopamine input to these regions, and astrocyte dysfunction affecting respiratory rhythm generation.

CONCLUSION

This review outlines potential mechanisms underlying dyspnea in PD, including central respiratory dysfunction, peripheral muscle/chest wall abnormalities, impaired respiratory sensation, and medication effects. More research is needed investigating specific brainstem regions involved, chemoreceptor pathology, correlations between respiratory load and perceived dyspnea, and medication effects on pulmonary function.

Rehabilitation in movement disorders: From basic mechanisms to clinical strategies

Movement disorders encompass a variety of conditions affecting the nervous system at multiple levels. The pathologic processes underlying movement disorders alter the normal neural functions and could lead to aberrant neuroplastic changes and to clinical phenomenology that is not expressed only through mere motor symptoms. Given this complexity, the responsiveness to pharmacologic and surgical therapies is often disappointing. Growing evidence supports the efficacy of neurorehabilitation for the treatment of movement disorders. Specific form of training involving both goal-based practice and aerobic training could drive and modulate neuroplasticity in order to restore the circuitries dysfunctions and to achieve behavioral gains. This chapter provides an overview of the alterations expressed in some movement disorders in terms of clinical signs and symptoms and plasticity, and suggests which ones and why tailored rehabilitation strategies should be adopted for the management of the different movement disorders.

Walking training augments the effects of expiratory muscle training in Parkinson's disease

OBJECTIVES

To investigate the effects of walking training combined with respiratory muscle training (RMT) on pulmonary function, respiratory muscle strength, and functional exercise capacity in patients with Parkinson's disease.

MATERIALS & METHODS

Thirty patients with Parkinson's disease were included in the study. Patients were randomly divided into two groups: the walking and RMT group (W + RMT, n = 15) and the RMT (n = 15) group. Spirometry, respiratory muscle strength, and a 6-min walking test were measured before and after the eighth week of the study. RMT was performed using inspiratory and expiratory threshold loading methods. Walking training intensity was adjusted according to the 6-min walking test. Patients performed 15 min of inspiratory muscle training and 15 min of expiratory muscle training in both groups, and 15 min of walking training in the W + RMT group in addition to RMT, twice per day, 5 days/week, for a total of 8 weeks at home. Training intensity was adjusted once per week for the groups at the hospital.

RESULTS

Respiratory muscle strength and 6-min walking distance were significantly increased (p = .001), and UPDRS-III scores were significantly improved (W + RMT: p = .008 and RMT: p = .01) in the two groups. The increase in maximal expiratory pressure was significantly higher in the W + RMT group than in the RMT group (p = .007).

CONCLUSION

Walking training increases the effect of expiratory muscle training in patients with Parkinson's disease.

Exercise Intolerance and Oxygen Desaturation in Patients with Parkinson's Disease: Triggers for Respiratory Rehabilitation?

The role that oxygen desaturation plays in exercise tolerance and its rehabilitative implications in patients with Parkinson's disease (PD) are unclear. We aimed to test exercise tolerance and oxygen saturation levels both during exercise and at night in PD patients to better define their rehabilitative needs. In clinically stable PD patients, undergoing inpatient rehabilitation, and in "ON" phase, we prospectively assessed clinical data, sleepiness, comorbidities, PD severity (Hoehn&Yahr, HY), motor function (ADLs, UPDRSII and UPDRSIII, Barthel Index, Functional Independence Measure), balance, spirometry, respiratory muscles (MIP/MEP), peak cough expiratory flow (PCEF), continuous night oxygen monitoring, and meters at 6MWT. Of 55 patients analyzed (28 with moderate-severe PD, HY ≥ 2.5), 37% and 23% showed moderate-severe impairment on UPDRSII and UPDRSIII, respectively; 96% had reduced exercise tolerance and severe respiratory muscles impairment (MIP/MEP < 45% pred.); 21.8% showed desaturations during exercise; and 12.7% showed nocturnal desaturations. At multiple regression, low exercise tolerance and low mean nocturnal and exercise-induced saturation correlated with several respiratory and motor function and disability indices (all p < 0.03). Exercise tolerance, exercise-induced desaturations, and nocturnal desaturations were extremely frequent in PD patients and were worse in more severe PD patients. This suggests considering a combined role for motor and respiratory rehabilitation in these patients.

Respiratory Disorders in Parkinson's Disease

BACKGROUND

Parkinson's disease (PD) non motor symptoms may present early in the disease course and worsen with advancing disease. Respiratory changes can affect individuals to remain physically active, contributing to a reduction of functionality and quality of life.

OBJECTIVE

The aim of this systematic review is to synthesize evidence of respiratory disorders in patients with PD.

METHODS

An electronic search was performed up to November 2020 on PubMed-MEDLINE, Embase, Web of Science, Lilacs, Cinahl, and Cochrane using the following keyword combination: [("Parkinson disease") AND ("respiratory function tests" OR "evaluation") AND ("respiratory system" OR "respiration disorders" OR "respiratory muscles")].

RESULTS

The electronic search resulted in 601 references in English or Portuguese. The selection process and data extraction were made by two independent reviewers. We selected 19 studies including cross-sectional studies that investigated the respiratory disorders in patients with PD through pulmonary function, respiratory muscle strength, or physical capacity evaluation. We excluded studies that considered patients with other diseases. Eighteen studies evaluated the pulmonary function in patients with PD, eleven studies verified the influence of PD on respiratory muscle strength, and three studies assessed the physical capacity through functional tests.

CONCLUSION

The evidence showed that PD patients have higher chances to present a pulmonary dysfunction, either obstructive or restrictive, when compared to healthy subjects. In addition, these patients present lower respiratory muscle strength and a consequent decrease in physical capacity in endurance exercises. The respiratory impairment in PD seems to be directly related to the progression of the disease.

The orphan nuclear receptor Nurr1 agonist amodiaquine mediates neuroprotective effects in 6-OHDA Parkinson's disease animal model by enhancing the phosphorylation of P38 mitogen-activated kinase but not PI3K/AKT signaling pathway

Recent studies implicate the defects or altered expression of the orphan nuclear receptor Nurr1 gene in the substantia nigra in Parkinson's disease pathogenesis. In an attempt to corroborate the treatment-modifying disease that would replicate the effect of Nurr1, it has been found that amodiaquine and Nurr1 had the same chemical scaffolding, indicating a crucial structure-activity relationship. Interestingly, amodiaquine stimulate the transcriptional function of Nurr1 by physical interaction with its ligand-binding domain (LBD). However, the signaling route by which Nurr1 is activated by amodiaquine to cause the protective effect remains to be elucidated. We first demonstrated that amodiaquine treatment ameliorated behavioural deficits in 6-OHDA Parkinson's disease mouse model, and it promoted dopaminergic neurons protection signified by Tyrosine hydroxylase (TH) and dopamine transporter (DAT) mRNA; Tyrosine hydroxylase (TH) protein expression level and the immunoreactivity in the substantia nigra compacta. Subsequently, we used inhibitors to ascertain the effect of amodiaquine on Akt and P38 Mapk as crucial signaling pathways for neuroprotection. Wortmannin (Akt Inhibitor) induced a significant reduction of Akt mRNA; however, there was no statistical difference between the amodiaquine-treated group and the control group suggesting that amodiaquine may not be the active stimulant of Akt. Western blot analysis confirmed that the phosphorylated Akt decreased significantly in the amodiaquine group compared to the control group. In the same vein, we found that amodiaquine substantially increased the level of phosphorylated P38 Mapk. When P38 Mapk inhibited by SB203580 (P38-Mapk Inhibitor), the total P38 Mapk but not the phosphorylated P38 Mapk decreased significantly, while tyrosine hydroxylase significantly increased. These results collectively suggest that amodiaquine can augment tyrosine hydroxylase expression via phosphorylated P38 Mapk while negatively regulating the phosphorylated Akt in protein expression.

Nonpharmacological interventions for respiratory health in Parkinson's disease: A systematic review and meta-analysis

BACKGROUND AND PURPOSE

Respiratory dysfunction in Parkinson's disease (PD) is often an underdiagnosed and untreated impairment associated with the disease. Clinically, a reactive approach to respiratory morbidity is taken, rather than preventative approaches that address underlying impairment/s. This systematic review identifies the current evidence to support nonpharmacological interventions to improve respiratory impairments in individuals with PD.

METHODS

The relevant literature was searched using a customised and systematic strategy. Randomised and nonrandomised control trials of nonpharmacological interventions targeting respiratory outcome measures in PD were included. Outcomes of interest were respiratory morbidity and mortality, respiratory muscle strength, spirometry measures, lung volumes, peak cough flow, and perception of dyspnoea.

RESULTS

Nonpharmacological interventions included: functional training, generalised strength training, respiratory muscle strength training, aerobic exercise, qigong, yoga, breath stacking, incentive spirometry and singing. Methodological quality of included studies varied. Meta-analyses of nonpharmacological interventions demonstrated significant effects for inspiratory muscle strength (mean difference [MD] 19.68; confidence interval [CI] 8.49, 30.87; z = 3.45; p = 0.0006; I2  = 2%), expiratory muscle strength (MD 18.97; CI 7.79, 30.14; z = 3.33; p = 0.0009; I2  = 23%) and peak expiratory flow (MD 72.21; CI 31.19, 113.24; z = 3.45; p = 0.0006; I2  = 0%). Best-evidence synthesis identified level 1 evidence supporting nonpharmacological interventions for improving peak cough flow and perceived dyspnoea. No studies were identified reporting outcomes of respiratory rate, inspiration:expiration ratio or respiratory morbidity or mortality in PD.

CONCLUSIONS

Nonpharmacological interventions improved respiratory muscle strength and peak expiratory flow in PD. Additional trials targeting respiratory dysfunction and longitudinal studies examining the relationship between respiratory dysfunction and morbidity and mortality rates in PD are required.

The Proprioceptive Neuromuscular Facilitation Concept in Parkinson Disease: A Systematic Review and Meta-Analysis

Objective

The aim of this review was to evaluate the effects of proprioceptive neuromuscular facilitation (PNF) in individuals with Parkinson disease.

Methods

This was a systematic review. We searched for articles with the keywords "Proprioceptive neuromuscular facilitation" and "Parkinson's disease." The databases searched were Scopus, ScienceDirect, Springer, Web of Science, LILACS (Latin American and Caribbean Health Sciences Literature), CINAHL (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Library, PEDro (Physiotherapy Evidence Database), SciELO (Scientific Electronic Library Online), Ovid, and PubMed, in addition to reference lists of relevant articles. All scientific articles published before November 2019 that addressed rehabilitative outcomes of PNF for individuals with Parkinson disease were considered. Two investigators independently screened studies according to the eligibility criteria.

Results

Of the 674 articles found, 6 were selected. The PEDro scores of 2 articles were 3 points, and the others scored 7, 8, and 9 points. The meta-analysis investigated 3 articles with the same outcomes: walking speed, stride length, and cadence. We found a statistical difference between PNF and other therapies for gait speed (M = 0.28, 95% confidence interval = 0.21-0.34, P < .001).

Conclusion

Based on the meta-analysis, we found that PNF is similar or superior to other therapies as relates to gait speed. The efficacy of PNF for indications of Parkinson disease, however, requires further investigation, as a sufficient number of qualified, well-designed, randomized controlled studies is lacking.

Oxygen cost of over-ground walking in persons with mild-to-moderate Parkinson's disease

BACKGROUND

Oxygen (O₂) cost of walking is a physiological marker of walking dysfunction and reflects the amount of O₂ consumed per kilogram of body weight per unit distance walked. The onset of walking dysfunction (i.e., reduced walking speed and shorter stride length) is commonly observed in Parkinson's disease (PD), even in the early stages of the disease. However, the O₂ cost of walking has not been assessed in persons with PD.

RESEARCH QUESTION

Does O₂ cost of walking differ between persons with PD and controls matched by age and sex?

METHODS

The sample included 31 persons with mild-to-moderate PD (Hoehn and Yahr stages 2-3) and 31 age- and sex-matched controls in this cross-sectional study. O₂ consumption (VO₂) was measured using a portable indirect calorimetry system during a 6-min period of over-ground walking at a normal comfortable speed, and the O₂ cost of walking was calculated based on the ratio of net relative VO₂ (ml kg^-1 min^-1) and speed (m min^-1).

RESULTS

There were no differences in resting VO₂, steady-state VO₂, and over-ground walking speed between persons with PD and controls (p > 0.05). There was a significant difference in the O₂ cost of walking between persons with PD and healthy controls (p < 0.01) such that persons with PD had a higher O₂ cost of walking. The mean(SD) O₂ cost of walking for persons with PD was 0.179 (0.038) ml kg^-1 m^-1, and the O₂ cost of walking for healthy controls was 0.153 (0.024) ml kg^-1 m^-1.

SIGNIFICANCE

Persons with PD demonstrated a higher O₂ cost of walking compared with controls, and this may reflect worse walking economy in PD. The possibility of worse walking economy under free-living conditions may result in reduced community ambulation and participation.

Dyspnea in Parkinson's disease: an approach to diagnosis and management

INTRODUCTION

Dyspnea is a complex and debilitating non-motor symptom experienced by a significant proportion of PD patients which results in limitations to physical ability and a reduction in quality of life.

AREAS COVERED

The authors highlight the underlying pathophysiological mechanisms that can contribute to dyspnea in PD patients, and provide the clinician with a practical working algorithm for the management of such patients. The authors further highlight important clinical red flags that should be heeded in dyspneic PD patients and discuss therapeutic strategies for managing dyspnea.

EXPERT OPINION

Although awareness of dyspnea in PD is increasing, further studies of its prevalence and natural history at different stages of the disease are needed. In particular, it is important to determine whether dyspnea could be an early or prodromal disease manifestation. Although peripheral mechanisms are likely to play a major role in the pathophysiology of dyspnea, the possibility that central changes in brainstem ventilatory control may also play a part warrants further investigation.

Combining a Cognitive Concurrent Task with a Motor or Motor-Cognitive Task: Which Is Better to Differentiate Levels of Affectation in Parkinson’s Disease?

Introduction

Cognitive decline usually coexists with motor impairment in PD. Multitask settings provide appropriate measures to evaluate the complex interaction between motor and cognitive impairments. The main objective was to analyze which concurrent task, i. e., motor or hybrid motor-cognitive, in combination with a cognitive task better differentiates between PD patients with mild and moderate levels of disease.

Methods

Thirty-seven individuals (19 male and 18 female) with idiopathic PD performed dual and triple tasks combining a cognitive task (phonemic fluency) with motor (pedaling) and/or cognitive-motor hybrid (tracking) tasks. Mild and moderate disability PD groups were specified considering the Hoehn and Yahr scale. Mixed ANOVA analyses for each of the concurrent task were carried out to test differences between the single and dual or triple condition performances comparing the low and high PD disability groups. Supplementary mixed ANCOVA analysis was performed considering the cognitive status as the covariate.

Results

The only significant differences between disability PD groups were found for performances in the cognitive-motor hybrid (tracking) task, both in dual and triple conditions. Our results showed a better performance for the mild rather than for the moderate disability group in the single condition task and a significant decline of the mild disability group in the dual and triple condition when compared to the levels of those shown by the moderate disability group. The group-condition interaction remained significant when the cognitive status was statistically controlled.

Conclusion

The hybrid of motor-cognitive task combining with a cognitive task (i. e., fluency) successfully differentiated between mild and moderate PD patients in the context of dual and triple multitask sets even when the cognitive status was statistically controlled. Our results highlight the importance of jointly measuring the complex interplay between motor and cognitive skills in PD.

Motor-cognitive approach and aerobic training: a synergism for rehabilitative intervention in Parkinson's disease

Parkinson's disease (PD) results in a complex deterioration of motor behavior. Effective pharmacological or surgical treatments addressing the whole spectrum of both motor and cognitive symptoms are lacking. The cumulative functional impairment may have devastating socio-economic consequences on both patients and caregivers. Comprehensive models of care based on multidisciplinary approaches may succeed in better addressing the overall complexity of PD. Neurorehabilitation is a highly promising non-pharmacological intervention for managing PD. The scientific rationale beyond rehabilitation and its practical applicability remain to be established. In the present perspective, we aim to discuss the current evidence supporting integrated motor-cognitive and aerobic rehabilitation approaches for patients with PD while suggesting a practical framework to optimize this intervention in the next future.

Respiratory repercussions of neurological diseases and how best to manage them

Introduction: The high incidence of respiratory impairments in patients with neurological diseases is recognized, but the design, dosage, and effectiveness of interventions to manage them are seen as an ongoing challenge.Areas covered: This article summarizes the evidence regarding the respiratory impairments in major neurological diseases, and how to best manage them.Expert opinion: On the balance of available evidence, respiratory impairments are part of the clinical profile of neurological diseases including Multiple Sclerosis, Stroke, and Parkinson's Disease, acquiring more importance as the pathologies progress. It is recognized that knowledge gaps remain in some areas of relevance related to respiratory function and further research is required. When considering the therapeutic options, the respiratory training emerges as the approach with most evidence. However, important questions remain unsolved: what kind, how much, and how to best include respiratory interventions is uncertain. At present, respiratory programs also fail to include clinically relevant factors such as ambulation and trunk stability.

Strength training improves the respiratory muscle strength and quality of life of elderly with Parkinson disease

BACKGROUND

The progression of Parkinson disease can lead to respiratory muscle weakness, reduced peak expiratory flow and quality of life (QoL). The aim was to evaluate the effects of strength training on levels of respiratory muscle strength, peak expiratory flow and QoL of elderly with Parkinson disease.

METHODS

A total of 28 patients were randomized into one of two groups: the control group (CG) comprised 16 participants, and the strength training group (STG) comprised 12 participants. All subjects maintained the standard pharmacological treatment for Parkinson disease, and the intervention group participated in a 16-week strength training program. The primary outcome was the measurement of respiratory muscle strength.

RESULTS

The STG showed improved values of maximum inspiratory pressures (36.11±11.82 to 52.94±24.17; P=0.01), maximum expiratory pressures (56.67±22.08 to 71.04±33.71; P=0.03) and QoL (41.75±20.33 to 34±20.92; P=0.0054); there was no significant difference in the peak expiratory flow (336.11±198.04 to 380±229.57; P=0.09). The CG showed significantly decreased values of peak expiratory flow (336.88±183.40 to 279.37±125.12, P=0.02) and non-significant changes in the other variables.

CONCLUSIONS

Sixteen weeks of strength training improves the inspiratory and expiratory muscle strength and QoL of elderly with Parkinson disease. These findings suggest that strength training could be considered an adjunct therapeutic intervention for elderly with Parkinson disease.

Effects of inspiratory muscle training on respiratory muscle strength, lung function, functional capacity and cardiac autonomic function in Parkinson's disease: Randomized controlled clinical trial protocol

BACKGROUND

Individuals with Parkinson's disease (PD), in addition to motor impairment, may evolve with respiratory and autonomic nervous system disorders. Currently, there are few studies with emphasis on muscle and pulmonary dysfunction and that verify the benefits of inspiratory muscle training (IMT) in this population.

AIM

The aim of this study was to evaluate whether IMT is effective for the improvement of respiratory muscle strength, lung function, thoracic mobility, functional capacity and cardiac autonomic function in PD.

METHODS

A randomized and controlled trial will be conducted with 26 participants with idiopathic PD, with aged between 50 and 65 years, in the Stages I to III by the Modified Hoehn and Yahr Scale. Respiratory muscle strength will be performed by manovacuometry and lung function by spirometry. Functional capacity will be evaluated by the 6-min walk test and autonomic cardiac function by heart rate variability. In addition, thoracic mobility measurement will also be performed. After the evaluations, these participants will be randomly assigned to two groups: the IMT group with Powerbreathe^® , which will perform the eight series of 2 min each, with 1 min of rest between them, totaling 30 min, at 60% of the maximum inspiratory pressure and the control group, who will perform the same training protocol but with the load maintained at 9 cmH₂ O. All participants will be submitted to the same motor training protocol.

CONCLUSION

It is expected that IMT increases the inspiratory muscle strength, contributing to the improved expiratory muscle strength, lung function, thoracic mobility, functional capacity and cardiac autonomic function in individuals with mild to moderate PD.

Association of Strength and Physical Functions in People with Parkinson's Disease

Background

Parkinson's disease is responsible for decrease of activities of daily living and mobility limitations. Association of strength with physical capacities and disease time can improve training methodologies and predict changes in physical fitness for this population, since the control center of movements and strength is the same.

Objective

Therefore, the aim of this study is to analyze if there are correlation between strength with functional tests (the sit-to-stand, the six-minute walk, and the timed-up-go) and disease time in people with Parkinson's disease.

Results

All functional tests correlations are significant, p < 0.05. The strength is positively correlated with the sit-to-stand and the six-minute walk. The strength is negatively correlated with the timed-up-go.

Conclusion

There are a correlation between strength with functional tests in people with PD, and changes in strength assessment can be used as predictor to changes in aerobic capacity.

High-intensity interval training in people with Parkinson's disease: a randomized, controlled feasibility trial

OBJECTIVES:

To investigate whether people with Parkinson's disease can exercise at a high-intensity across a 12-week intervention and to assess the impact of the intervention on cardiorespiratory fitness.

DESIGN:

This is a randomized, controlled, feasibility study with waiting list control. Assessors were blinded to group allocation.

SETTING:

The intervention took place at an exercise centre and assessments at a district general hospital.

SUBJECTS:

This study included 20 people with idiopathic Parkinson's disease.

INTERVENTION:

A total of 36 exercise sessions over 12 weeks, with each session lasting ~45 minutes, were conducted.

MAIN MEASURES:

The main measures were maximal heart rates achieved during exercise, recruitment rate, attendance, drop-out, change in peak oxygen consumption, cardiac output, cognitive function and quality of life. The study was considered technically feasible if participants achieved ⩾85% of maximal heart rate during exercise.

RESULTS:

There were 12 male and 8 female participants; they had a mean age of 68.5 years (standard deviation 6.825). Two participants were of Hoehn and Yahr stage I, 11 stage II and 7 stage III. In all, 17 participants completed the intervention. The median (interquartile range) proportion of repetitions delivered across the intervention which met our high-intensity criterion was 80% (67% to 84%). Mean peak heart rate was 88.8% of maximal. Peak oxygen consumption increased by 2.8 mL kg^-1 min^-1 in the intervention group and 1.5 mL kg^-1 min^-1 in the control group after 12 weeks of exercise. We estimate that a fully powered randomized controlled trial would require 30 participants per group.

CONCLUSION:

High-intensity interval exercise is feasible in people with Parkinson's disease. Improvements in cardiorespiratory function are promising.

Basal ganglia and beyond: The interplay between motor and cognitive aspects in Parkinson's disease rehabilitation

Parkinson's disease (PD) is characterized by motor and cognitive dysfunctions, affecting the motor behaviour. We summarize evidence that the interplay between motor and cognitive approaches is crucial in PD rehabilitation. Rehabilitation is complementary to pharmacological therapy and effective in reducing the PD disturbances, probably acting by inducing neuroplastic effects. The motor behaviour results from a complex integration between cortical and subcortical areas, underlying the motor, cognitive and motivational aspects of movement. The close interplay amongst these areas makes possible to learn, control and express habitual-automatic actions, which are dysfunctional in PD. The physiopathology of PD could be considered the base for the development of effective rehabilitation treatments. As the volitional action control is spared in early-medium stages of disease, rehabilitative approaches engaging cognition permit to achieve motor benefits and appear to be the most effective for PD. We will point out data supporting the relevance of targeting both motor and cognitive aspects in PD rehabilitation. Finally, we will discuss the role of cognitive engagement in motor rehabilitation for PD.

Turo (Qi Dance) Program for Parkinson's Disease Patients: Randomized, Assessor Blind, Waiting-List Control, Partial Crossover Study

CONTEXT

Qigong, Tai-chi and dancing have all been proven effective for Parkinson's disease (PD); however, no study has yet assessed the efficacy of Turo, a hybrid qigong dancing program developed to relieve symptoms in PD patients.

OBJECTIVE

To determine whether Turo may provide benefit in addressing the symptoms of PD patients.

DESIGN

Randomized, assessor blind, waiting-list control, partial crossover study.

SETTING

Kyung Hee University Korean Medicine Hospital, Seoul, Republic of Korea.

PARTICIPANTS

A total of 32 PD patients (mean age 65.7 ± 6.8).

INTERVENTION

Participants were assigned to the Turo group or the waiting-list control group. The Turo group participated in an 8-week Turo training program (60-minute sessions twice a week). The waiting-list control group received no additional treatment during the same period; then underwent the same 8-week Turo training.

OUTCOME MEASURES

The primary outcome was a score on the Unified Parkinson's Disease Rating Scale (UPDRS), and the secondary outcomes included the perceived health status assessed using the Parkinson's disease Quality of Life questionnaire (PDQL), balance function as assessed by the Berg Balance Scale (BBS) and the results of the Beck Depression Inventory (BDI).

RESULTS

The Turo group showed statistically significant improvements in the UPDRS (P < 0.01) and PDQL (P < 0.05) as compared to the control group. The changes in BBS scores displayed a tendency toward improvement, but was not statistically significant (P = 0.051).

CONCLUSION

These findings suggest that Turo PD training might improve the symptoms of PD patients.

Analysis of respiratory movements in a mouse model of late Parkinson's disease submitted to stress

Parkinson's disease (PD) is known to cause tremor and rigidity, but other symptoms such as respiratory and autonomic dysfunctions are a major cause of disability and mortality in patients. In this study, we examined respiratory movements by using cineradiography on a murine model of late/advanced PD. Under surgical anesthesia, C57BL/6J mice received an injection of either 6-OHDA or vehicle solution to the right striatum. Two weeks after surgery, the animals had their respiratory movements recorded by video X-ray without any restraint. During recordings the animals were submitted to a mild acute-stress challenge. Behavioral tests were performed to assess the severity of the 6-OHDA lesion. As a result, behavioral tests confirmed severe motor impairments in 6-OHDA mice as compared to controls. 6-OHDA mice showed a predominantly thoracic respiratory pattern with reduced diaphragmatic excursion, and reduced respiratory frequency after stress. These results suggest that advanced nigrostrial degeneration may cause respiratory alterations with the features of obstructive-type respiratory disorders.

Effects of therapeutic Tai chi on functional fitness and activities of daily living in patients with Parkinson disease

The purpose of the study is to investigate the effects of therapeutic Tai chi (TTC) on the functional fitness status and activities of daily living (ADL) of patients with Parkinson disease (PD). The participants were clinically stable PDs in Hoehn and Yahr stage 1–2. These patients were randomly assigned to either the TTC group (n=11) or the control (CON) group (n=9). The TTC exercised at the clinic 2 times a week and performed home-based activity 1 time per week for 12 weeks. All the PDs were evaluated for functional fitness test and ADL screen before and after the 12-week trial. There was a significant Time × group interaction effect on the arm curl (P<0.01), functional reach (P<0.05), and stand on foot with eyes opened (P<0.05) of the functional fitness as compared to the CON. The results of the functional reach test in the CON worsened significantly during the 12-week intervention in comparison with those of the TTC (P<0.01). Also ADL showed significant changed in TCC (P<0.05). Tai chi training showed good effects on the functional fitness in PDs. This study suggests that further research into the based such as Tai chi intervention must be developed PD’s quality of life in the future.

Cardiovascular dysfunction in untreated Parkinson's disease: A multi-modality assessment

BACKGROUND

The clinical presentation of Parkinson's disease (PD) includes a wide spectrum of non-motor features, including cardiovascular autonomic failure.

OBJECTIVE

To evaluate cardiovascular autonomic status and cardiac functional capacity in drug-naïve PD patients.

METHODS

18 newly-diagnosed PD patients underwent laboratory cardiovascular autonomic function tests using power spectral analysis of the R-R interval, blood pressure (BP) short-term variability and non-invasive baroreflex sensitivity (BRS). A two-dimensional (2D) transthoracic echocardiogram, spirometry and cardiopulmonary exercise test (CPET) were also performed. Thirteen patients underwent myocardial scintigraphy with [¹²³I] metaiodobenzylguanidine (MIBG).

RESULTS

At rest, total power spectral analysis of heart rate variability was lower in PD patients than in controls. BRS decreased during sympathetic activation in both patients and controls. While echocardiography and spirometry were normal, a mild degree of exercise intolerance was observed at the CPET in PD patients (mean V'O_2max: 83% of predicted; mean W_max: 80% of predicted). The heart-to-mediastinum (H/M) ratio of MIBG uptake was pathologically impaired in 9 patients, one of whom displayed a definite cardiovascular dysautonomic pattern.

CONCLUSIONS

Our results confirm that subclinical to overt cardiovascular autonomic failure may occur from the early stages of PD. The less efficient adaptive response to physical stimuli during the CPET and postural changes observed in untreated PD patients possibly reflect cardiac sympathetic denervation, although the involvement of PD-related motor impairment in physical deconditioning cannot be excluded.

Main determinants of physical activity levels in individuals with Parkinson’s disease

ABSTRACT This study analyzed the relationship between patient characteristics, factors associated with Parkinson’s disease (PD), and physical activity level of individuals affected by the disease. Forty-six volunteers with mild-to-moderate idiopathic PD were assessed using sections II/III of the Unified Parkinson’s Disease Rating Scale and their motor functions were classified according to the modified Hoehn and Yahr (HY) scale. Data such as age, disease duration, the Human Activity Profile (HAP), the Fatigue Severity Scale were collected. Lower limb bradykinesia and clinical subtypes of PD were defined. Two models that explained 76% of the variance of the HAP were used. The first comprised age, ability to perform activities of daily living (ADL), and the HY scale; the second comprised age, ability to perform ADL, and lower limb bradykinesia. Possible modifiable factors such as the ability to perform ADL and lower limb bradykinesia were identified as predictors of physical activity level of individuals with PD.

Lung Function Testing On and Off Dopaminergic Medication in Parkinson's Disease Patients With and Without Dysphagia

Background

Swallowing function in individuals with Parkinson's disease (PD) can be negatively affected by dopaminergic medication with associated inhibition of brainstem reflexes. Three different "swallowing-safety" profiles of PD patients were previously observed, classified according to swallowing safety on and off levodopa.

Methods

Here, we investigated the effects of l-dopa on pulmonary function tests (PFTs) on 26 individuals with PD from the three different swallowing-safety profiles. PFTs results were compared to predicted values and direct comparisons between the groups with or without dysphagia were performed with nonparametric statistical tests (i.e., Kruskal-Wallis).

Results

A short (12-hour) withdrawal from l-dopa did not result in any significant changes in PFTs, and no differences on PFTs results were observed between the different dysphagic groups the on and off l-dopa state. No correlation was observed between the PFTs results with swallowing safety profiles of PD patients.

Conclusions

Although deglutition seems to be at least partially affected by dopaminergic repletion, dopaminergic mechanisms do not seem to be responsible for PD patients' performance in PFTs.

Adaptive training with full-body movements to reduce bradykinesia in persons with Parkinson's disease: a pilot study

Background

Bradykinesia (slow movements) is a common symptom of Parkinson’s disease (PD) and results in reduced mobility and postural instability. The objective of this study is to develop and demonstrate a technology-assisted exercise protocol that is specifically aimed at reducing bradykinesia.

Methods

Seven persons with PD participated in this study. They were required to perform whole body reaching movements toward targets placed in different directions and at different elevations. Movements were recorded by a Microsoft Kinect movement sensor and used to control a human-like avatar, which was continuously displayed on a screen placed in front of the subjects. After completion of each movement, subjects received a 0-100 score that was inversely proportional to movement time. Target distance in the next movements was automatically adjusted in order to keep the score around a pre-specified target value. In this way, subjects always exercised with the largest movement amplitude they could sustain. The training protocol was organised into blocks of 45 movements toward targets placed in three different directions and at three different elevations (a total of nine targets). Each training session included a finite number of blocks, fitted within a fixed 40 minutes duration. The whole protocol included a total of 10 sessions (approximately two sessions/week).

As primary outcome measure we took the absolute average acceleration. Various aspects of movement performance were taken as secondary outcome measures, namely accuracy (undershoot error), path curvature, movement time, and average speed.

Results

Throughout sessions, we observed an increase of the absolute average acceleration and speed and decreased undershoot error and movement time. Exercise also significantly affected the relationship between target elevation and both speed and acceleration - the improvement was greater at higher elevations.

Conclusions

The device and the protocol were well accepted by subjects and appeared safe and easy to use. Our preliminary results point at a training-induced reduction of bradykinesia.

Asymmetrical pedaling patterns in Parkinson's disease patients

BACKGROUND

Approximately 1.5 million Americans are affected by Parkinson's disease (Deponti et al., 2013) which includes the symptoms of postural instability and gait dysfunction. Currently, clinical evaluations of postural instability and gait dysfunction consist of a subjective rater assessment of gait patterns using items from the Unified Parkinson's Disease Rating Scale, and assessments can be insensitive to the effectiveness of medical interventions. Current research suggests the importance of cycling for Parkinson's disease patients, and while Parkinson's gait has been evaluated in previous studies, little is known about lower extremity control during cycling. The purpose of this study is to examine the lower extremity coordination patterns of Parkinson's patients during cycling.

METHODS

Twenty five participants, ages 44-72, with a clinical diagnosis of idiopathic Parkinson's disease participated in an exercise test on a cycle ergometer that was equipped with pedal force measurements. Crank torque, crank angle and power produced by right and left leg were measured throughout the test to calculate Symmetry Index at three stages of exercise (20 W, 60 W, maximum performance).

FINDINGS

Decreases in Symmetry Index were observed for average power output in Parkinson's patients as workload increased. Maximum power Symmetry Index showed a significant difference in symmetry between performance at both the 20 W and 60 W stage and the maximal resistance stage. Minimum power Symmetry Index did not show significant differences across the stages of the test. While lower extremity asymmetries were present in Parkinson's patients during pedaling, these asymmetries did not correlate to postural instability and gait dysfunction Unified Parkinson's Disease Rating Scale scores.

INTERPRETATION

This pedaling analysis allows for a more sensitive measure of lower extremity function than the Unified Parkinson's Disease Rating Scale and may help to provide unique insight into current and future lower extremity function.

The Unified Parkinson's Disease Rating Scale as a predictor of peak aerobic capacity and ambulatory function

The Unified Parkinson's Disease Rating Scale (UPDRS) is a widely applied index of disease severity. Our objective was to assess the utility of UPDRS for predicting peak aerobic capacity (VO2 peak) and ambulatory function. Participants (n = 70) underwent evaluation for UPDRS (Total and Motor ratings), VO2 peak, 6-minute walk distance (6MW), and 30-foot self-selected walking speed (SSWS). Using regression, we determined the extent to which the Total and Motor UPDRS scores predicted each functional capacity measure after adjusting for age and sex. We also tested whether adding the Hoehn and Yahr scale (H-Y) to the model changed predictive power of the UPDRS. Adjusted for age and sex, both the Total UPDRS and Motor UPDRS subscale failed to predict VO2 peak. The Total UPDRS did weakly predict 6MW and SSWS (both p < 0.05), but the Motor UPDRS subscale did not predict these ambulatory function tests. After adding H-Y to the model, Total UPDRS was no longer an independent predictor of 6MW but remained a predictor of SSWS. We conclude that Total and Motor UPDRS rating scales do not predict VO2 peak, but that a weak relationship exists between Total UPDRS and measures of ambulatory function.

Influência da doença de Parkinson em capacidade física, função pulmonar e índice de massa magra corporal

INTRODUÇÃO: Pacientes com Doença de Parkinson (DP) apresentam obstrução grave das vias aéreas, fadiga e incoordenação dos músculos respiratórios, redução de massa muscular e fraqueza e fadiga musculares, levando a intolerância ao exercício e piora da qualidade de vida. OBJETIVOS: Avaliar e comparar o índice de massa magra corporal (IMMC), variáveis espirométricas, força muscular respiratória e capacidade física, em pacientes com DP e idosos saudáveis. Além disso, verificar quais dessas variáveis influenciam a capacidade física de pacientes com DP. MATERIAIS E MÉTODOS: Foram avaliados 25 indivíduos, de ambos os sexos, sendo dez pacientes com DP (Grupo DP [GDP]: 72,7 ± 10,0 anos) e 15 idosos saudáveis (Grupo saudável [GS]: 64,8 ± 6,7 anos), pela espirometria, pressões inspiratória (PImáx) e expiratória máximas (PEmáx), composição corporal e do teste de caminhada de seis minutos (TC6). RESULTADOS: O GDP apresentou valores significativamente menores de relação volume expiratório forçado no primeiro segundo/capacidade vital forçada, ventilação voluntária máxima (VVM), massa muscular, PImáx, PEmáx, e distância percorrida no TC6 comparado ao GS. No GDP, observaram-se correlações positivas moderadas significativas da PEmáx e VVM com a distância percorrida no TC6 (r = 0,84; r = 0,67, respectivamente), entre o IMMC com VVM (r = 0,69). CONCLUSÃO: O GDP apresentaram redução da massa muscular, da endurance e forças musculares respiratórias, e da capacidade física, se comparados aos idosos saudáveis. Além disso, a PEmáx e a VVM influenciam a capacidade física medida pelo TC6, assim como a massa muscular influencia a endurance da musculatura respiratória nos pacientes com DP. Assim, devemos tornar o TC6 um método padrão de avaliação na prática clínica.

Respiratory changes in Parkinson's disease may be unrelated to dopaminergic dysfunction

OBJECTIVE: To investigate the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in patients with Parkinson's disease (PD) during the on and off periods of levodopa and to compare with healthy controls. METHODS: Twenty-six patients were analyzed with Hoehn and Yahr scores (2-3) and 26 age and gender matched-controls. Statistical analysis was performed with Student's t-test for paired and independent samples. RESULTS: MIP and MEP values in patients were significantly lower than the values obtained in controls both for off and on stages -excepted for MIP in women (p=0.28). For patients with PD, the studied parameters did not differ between stages on and off, with the exception of MEP in women (p=0.00). CONCLUSIONS: Patients with PD have respiratory pressure lower than controls, even in early stages of the disease, and dopamine replacement has little impact over these respiratory pressures. These findings suggest that respiratory changes in PD may be unrelated to dopaminergic dysfunction.

A controlled clinical trial investigating the effects of cycle ergometry training on exercise tolerance, balance and quality of life in patients with Parkinson's disease

PURPOSE

To establish the effect of a 6-week programme of cycle ergometry training on exercise tolerance, balance, activities of daily living (ADL) and quality of life in individuals with Parkinson's disease (PD).

METHOD

Twenty-three subjects were recruited from the Parkinson's database of the neurology service in a large urban teaching hospital. Quasi-experimental study of interrupted time-series design was conducted with subjects acting as their own control. Assessments were carried out at baseline, week 7 following the control phase, and week 14 following the intervention phase. Intervention consisted of 30-min cycle ergometry training once weekly. Outcome measures included Six Minute Walk Test, Physiological Cost Index, Berg Balance Scale, Timed Up and Go Test (TUAG), ADL and mobility sections of the Unified Parkinson's disease Rating Scale (UPDRS) and the Parkinson's disease questionnaire (PDQ).

RESULTS

Statistically significant improvements were noted for the Berg Balance Scale (p = 0.003), TUAG (p = 0.019) and ADL (p = 0.006) and mobility (p = 0.021) sections of the UPDRS. A trend towards improvement was found for exercise tolerance. No significant effect on quality of life was found.

CONCLUSION

A 6-week programme of cycle ergometry training did not significantly influence exercise tolerance in this sample, but improved balance, functional abililty and PD-related disability were noted.

Repeatability of aerobic capacity measurements in Parkinson disease

PURPOSE

Maximal or peak aerobic capacity (VO(2peak)) during a maximal-effort graded exercise test is considered by many to be the "gold standard" outcome for assessing the effect of exercise training on cardiorespiratory fitness. The reliability of this measure in Parkinson disease (PD) has not been established, where the degree of motor impairment can vary greatly and is influenced by medications. This study examined the reliability of VO(2peak) during a maximal-effort graded exercise test in subjects with PD.

METHODS

Seventy healthy middle-aged and older subjects with PD Hoehn and Yahr stage 1.5-3 underwent a screening/acclimatization maximal-effort treadmill test followed by two additional maximal-effort treadmill tests with repeated measurements of VO(2peak). A third VO(2peak) test was performed in a subset of 21 subjects.

RESULTS

The mean VO(2peak) measurement was 2.4% higher in the second test compared with the first test (21.42 ± 4.3 vs 21.93 ± 4.50 mL·kg(-1)·min(-1), mean ± SD, P = 0.03). The intraclass correlation coefficients (ICC) for VO(2peak) expressed either as milliliters per kilogram per minute or as liters per minute were highly reliable, with ICC of 0.90 and 0.94, respectively. The maximum HR (ICC of 0.91) and final speed achieved during the tests (ICC of 0.94) were also highly reliable, with the respiratory quotient being the least reliable of the parameters measured (ICC of 0.65).

CONCLUSIONS

Our results demonstrate that measurement of VO(2peak) is reliable and repeatable in subjects with mild to moderate PD, thereby validating use of this parameter for assessing the effects of exercise interventions on cardiorespiratory fitness.

Energy cost of spontaneous walking in Parkinson's disease patients

In healthy subjects, comfortable walking minimizes the energy cost (E (c)) of locomotion. In Parkinson's disease (PD) patients walking is slower than in healthy subjects: this may increase E (c). Our aims were to analyze gait and E (c) in PD patients during walking, particularly at self-selected speed, and the possible pathological, mechanical, and cardiorespiratory limitations. Fourteen mild-to-moderate PD and 14 control subjects were enrolled. Subjects underwent 5-min walking tests at two speeds: self-selected and as-fast-as-possible speeds. Cardiopulmonary and gait parameters (heart rate, ventilation, gas exchanges, step count) were recorded. Velocity was reduced in PD compared to control subjects at both speeds (P < 0.05), and PD patients had shorter strides (P < 0.05) at both speeds and reduced cadence (P = 0.01) at fastest speed. No significant difference was found in E (c) at self-selected (0.12 ± 0.04 versus 0.11 ± 0.02 mLO(2) kg(-1) m(-1) in PD and control subjects, respectively) and maximal (0.14 ± 0.03 versus 0.15 ± 0.02 mLO(2) kg(-1) m(-1) in PD and control subjects, respectively) speed. However, the E (c) increment from self-selected to fastest velocity was significantly lower (P = 0.02) in PD patients. PD patients failed to walk at a self-selected speed, which minimizes the E (c). This could be mainly due to the inability to develop a wider stride. Cardiorespiratory adaptation was not affected, except for the possible reduced cardiac adaptation observed in some (28%) cases. Presumably, rehabilitation procedures that improve flexibility and step length may help maintain walking ability.

Exercício aeróbio e fortalecimento muscular melhoram o desempenho funcional na doença de Parkinson

INTRODUÇÃO: Indivíduos com doença de Parkinson (DP) apresentam déficits motores na marcha, postura e equilíbrio e tendem a apresentar redução mais acentuada do nível de atividade física do que indivíduos assintomáticos da mesma idade. O declínio físico pode estar associado à perda de força muscular, da capacidade física e piora do desempenho funcional na DP. OBJETIVO: Avaliar os efeitos de um programa de fortalecimento e condicionamento aeróbio no desempenho funcional e na capacidade física de indivíduos com DP. MATERIAIS E MÉTODOS: Dezessete indivíduos, com média de idade de 60,35 ± 9,94 anos e estágios I a III da Hoehn e Yahr, participaram de um programa de exercícios três vezes por semana durante 12 semanas. Avaliou-se a força muscular por meio do dinamômetro manual, o desempenho funcional por meio da Unified Parkinson Disease Rating Scale (UPDRS), avaliou-se também a velocidade da marcha e habilidade em usar escadas e a capacidade física por meio do perfil de atividade humana (PAH). Utilizou-se a estatística descritiva, testes t e ANOVA para medidas repetidas para a análise. RESULTADOS E DISCUSSÃO: Os dorsoflexores bilaterais foram o único grupo muscular a apresentar maior torque após a intervenção (F = 7,93; p = 0,008). Houve ganho nas medidas de desempenho funcional: velocidade da marcha (p = 0,028), velocidade para subir (p = 0,001) e descer (p = 0,002) escadas, no escore total da UPDRS (p = 0,007) e do PAH (p < 0,0001). CONSIDERAÇÕES FINAIS: O uso combinado de condicionamento aeróbio e fortalecimento muscular resultou em melhoras no desempenho funcional e na capacidade física de indivíduos com DP leve a moderada.

Exercise alleviates Parkinsonism: clinical and laboratory evidence

The present review examines the putative benefits for individuals afflicted with Parkinsonism, whether in the clinical setting or in the animal laboratory, accruing from different exercise regimes. The tendency for patients with Parkinson's disease (PD) to express either normal or reduced exercise capacity appears regulated by factors such as fatigue, quality-of-life and disorder severity. The associations between physical exercise and risk for PD, the effects of exercise on idiopathic Parkinsonism and quality-of-life, the effects of exercise on animal laboratory models of Parkinsonism and dopamine (DA) loss following neurotoxic insults, and the effects of exercise on the DA precursor, L-Dopa, efficacy are examined. It would appear to be case that in view of the particular responsiveness of the dopaminergic neurons to exercise, the principle of 'use it or lose' may be of special applicability among PD patients.

No increased risk of obstructive sleep apnea in Parkinson's disease

Pulmonary function abnormalities in Parkinson's disease (PD) might predispose patients to obstructive sleep apnea (OSA) and daytime sleepiness. Fifty-five idiopathic PD patients (mean age = 63.9) underwent three consecutive nights of in-laboratory polysomnography on their usual dopaminergic medications. Sleep apnea severity was compared to published, normative, population-based data from the Sleep Heart Health Study. Demographic and clinical data were compared in patients with and without OSA. The apnea-hyponea index (AHI) was stable across nights in PD patients, and was not different between PD patients and normative controls. Epworth Sleepiness Scale scores, Body Mass Index, and snoring did not correlate with AHI. Severity of OSA is stable across multiple nights in PD patients. Rates of OSA in PD are similar to those seen in the general population. Daytime sleepiness, snoring, and obesity may not be helpful in identifying OSA in PD.

Correlação das escalas de avaliação utilizadas na doença de Parkinson com aplicabilidade na fisioterapia

INTRODUÇÃO: A doença de Parkinson (DP) é uma patologia neurológica crônica e degenerativa do sistema nervoso central que acomete os gânglios da base, cujas características principais são tremor, rigidez e bradicinesia. Com o progresso terapêutico, desenvolveram-se várias escalas visando monitorar a evolução da doença e a eficácia de tratamentos. O objetivo deste estudo de revisão bibliográfica é caracterizar as principais escalas usadas para a avaliação da DP, discutindo sua aplicabilidade à prática fisioterapêutica. MATERIAIS E MÉTODO: Levantamento bibliográfico a partir de bases de dados como Scielo, Medline, Lilacs, PubMed, entre 1990 a 2005. RESULTADOS: Seis escalas são abordadas: Escala dos Estágios de Incapacidade de Hoehn e Yahr; Escala Unificada de Avaliação da DP (UPDRS); Escala de Sydney; Questionário da DP (PDQ-39); Qualidade de vida (PSN); Escala de atividade de Parkinson (PAS). Destacando-se a PDQ-39 pela percepção do paciente sobre sua qualidade de vida. A PAS é a que melhor atende aos objetivos específicos da fisioterapia, pois avalia os principais problemas de mobilidade funcional. Além das escalas de Hoehn e Yahr e a UPDRS, por sua confiabilidade, pois podem ser usadas por fisioterapeutas para melhor avaliação do estado clínico-funcional do paciente. CONCLUSÃO: A necessidade de monitorar a evolução dos pacientes e os resultados de intervenção fisioterapêutica exige do fisioterapeuta o conhecimento para utilizar medidas sistematizadas e de fácil aplicabilidade para avaliar pacientes com DP. Cabe a esse profissional optar pela que permita uma tomada de decisão clínica compatível com seu local de trabalho, com as necessidades do paciente e com o meio em que ele vive.

Multidimensional exercise for people with Parkinson's disease: A case report

The primary impairments associated with Parkinson's disease occur in combination with the secondary, preventable effects of immobility. A community-based fitness program may help increase activity and maintain function in people in the early or middle stages of the disease. This article describes a unique program designed to reduce fall risk and promote independent exercise for people with Parkinson's disease. Two 66-year-old males, both community ambulators and in early or middle stages of Parkinson's disease, participated in 3 months of various physical activities. Group balance classes were held twice weekly during the first month, participants joined a fitness center and self-directed their exercise program during the second month, and group Tai Chi classes were held twice weekly during the third month. At conclusion of the program, participants were given suggestions for continued physical fitness activities. After the 3-month program, improvements were noted for both individuals in functional reach, Timed Up and Go, and Berg Balance scores. Both participants continued to exercise regularly for at least 8 months following the program. Two individuals with Parkinson's disease demonstrated improvement in their balance test performance over a 3-month period. Perhaps most importantly, these participants independently continued exercising after completing this program.