1
|
Handlery R, Handlery K, Kahl D, Koon L, Cabe SL, Regan EW. High Intensity Functional Training for People with Parkinson's & Their Care Partners: A Feasibility Study. Am J Health Promot 2024; 38:648-660. [PMID: 38311368 DOI: 10.1177/08901171241231085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
PURPOSE Various forms of exercise have proven health benefits for people with Parkinson's (pwPD) yet high intensity functional training (HIFT) has yet to be studied. The purpose of this study was to examine the feasibility, physical and psychosocial impacts of a HIFT program for pwPD and their care partners (CPs). DESIGN A single group, pre-post design with assessments before, in the middle (13 weeks), and after the 25-week intervention. SETTING Community fitness facility. PARTICIPANTS Fourteen pwPD (10 at Hoehn Yahr Stage ≤2, 4 females) and 10 CPs (5 females) were included (mean age = 71.5 (6.1)). INTERVENTION A 25-week HIFT program (≤49 exercise sessions, ≤75 min long). MEASURES Recruitment, retention, attendance, safety and exercise intensity (measured via session-Rating of Perceived Exertion (RPE)) was assessed in addition to cardiovascular endurance, lower extremity strength, walking speed, balance, exercise self-efficacy, balance confidence, social support for exercise and health-related quality of life. ANALYSIS Descriptive data was used to describe feasibility measures. Wilcoxon signed-rank test was used to compare pre- and post-program data. Effect size, r, was calculated. RESULTS Recruitment rates were ≥40% for pwPD and CPs and retention rates were 80% for pwPD and 62.5% for CPs. Average session attendance was 71.2% with 15 adverse events reported, including 7 non-injurious falls. Median session-RPE was 5 (IQR = 1) out of 10. PwPD demonstrated significant improvements in cardiovascular endurance, self-selected and fast walking speeds, balance and social support for exercise. CPs demonstrated significant improvements in cardiovascular endurance and lower extremity strength. Exercise self-efficacy, balance confidence and health-related quality of life did not significantly change for pwPD or CPs. CONCLUSION High intensity functional training appears feasible for pwPD and their CPs and may lead to health benefits. Healthcare providers should consider HIFT as another option to engage pwPD in community-based exercise.
Collapse
Affiliation(s)
- Reed Handlery
- School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, AR, USA
| | - Kaci Handlery
- School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, AR, USA
| | - Dana Kahl
- School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, AR, USA
| | - Lyndsie Koon
- Research and Training Center on Independent Living, University of Kansas, Lawrence, KS, USA
| | - Samuell Leyton Cabe
- School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, AR, USA
| | - Elizabeth Wherley Regan
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
2
|
Capato TTC, Chen J, Miranda JDA, Chien HF. Assisted technology in Parkinson's disease gait: what's up? ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-10. [PMID: 38395424 PMCID: PMC10890908 DOI: 10.1055/s-0043-1777782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/21/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Gait disturbances are prevalent and debilitating symptoms, diminishing mobility and quality of life for Parkinson's disease (PD) individuals. While traditional treatments offer partial relief, there is a growing interest in alternative interventions to address this challenge. Recently, a remarkable surge in assisted technology (AT) development was witnessed to aid individuals with PD. OBJECTIVE To explore the burgeoning landscape of AT interventions tailored to alleviate PD-related gait impairments and describe current research related to such aim. METHODS In this review, we searched on PubMed for papers published in English (2018-2023). Additionally, the abstract of each study was read to ensure inclusion. Four researchers searched independently, including studies according to our inclusion and exclusion criteria. RESULTS We included studies that met all inclusion criteria. We identified key trends in assistive technology of gait parameters analysis in PD. These encompass wearable sensors, gait analysis, real-time feedback and cueing techniques, virtual reality, and robotics. CONCLUSION This review provides a resource for guiding future research, informing clinical decisions, and fostering collaboration among researchers, clinicians, and policymakers. By delineating this rapidly evolving field's contours, it aims to inspire further innovation, ultimately improving the lives of PD patients through more effective and personalized interventions.
Collapse
Affiliation(s)
- Tamine T. C. Capato
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands.
| | - Janini Chen
- Universidade de São Paulo, Faculdade de Medicina FMUSP, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil.
| | - Johnny de Araújo Miranda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
| | - Hsin Fen Chien
- Universidade de São Paulo, Faculdade de Medicina FMUSP, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil.
| |
Collapse
|
3
|
Irons JY, Williams A, Holland J, Jones J. An Exploration of People Living with Parkinson's Experience of Cardio-Drumming; Parkinson's Beats: A Qualitative Phenomenological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:514. [PMID: 38673425 PMCID: PMC11050379 DOI: 10.3390/ijerph21040514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/13/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
Research has shown that physical activity has a range of benefits for people living with Parkinson's (PLwP), improving muscle strength, balance, flexibility, and walking, as well as non-motor symptoms such as mood. Parkinson's Beats is a form of cardio-drumming, specifically adapted for PLwP, and requires no previous experience nor skills. Nineteen PLwP (aged between 55 and 80) took part in the regular Parkinson's Beats sessions in-person or online. Focus group discussions took place after twelve weeks to understand the impacts of Parkinson's Beats. Through the framework analysis, six themes and fifteen subthemes were generated. Participants reported a range of benefits of cardio-drumming, including improved fitness and movement, positive mood, the flow experience, and enhanced social wellbeing. A few barriers to participation were also reported. Future research is justified, and best practice guidelines are needed to inform healthcare professionals, PLwP and their care givers.
Collapse
Affiliation(s)
- J. Yoon Irons
- School of Psychology, College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK
| | - Alison Williams
- Parkinson’s Scotland Office, 1/14 King James VI Business Centre, Friarton Road, Perth PH2 8DY, UK; (A.W.); (J.H.)
| | - Jo Holland
- Parkinson’s Scotland Office, 1/14 King James VI Business Centre, Friarton Road, Perth PH2 8DY, UK; (A.W.); (J.H.)
| | - Julie Jones
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen AB10 7QG, UK;
| |
Collapse
|
4
|
Palm D, Swarowsky A, Gullickson M, Shilling H, Wolden M. Effects of Group Exercise on Motor Function and Mobility for Parkinson Disease: A Systematic Review and Meta-Analysis. Phys Ther 2024; 104:pzae014. [PMID: 38335243 DOI: 10.1093/ptj/pzae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/22/2023] [Accepted: 11/30/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Parkinson disease (PD) is associated with a predictable decline in motor function and mobility that is commonly managed with exercise. There is a limited understanding of the effects of group exercise compared to individual exercise (IE) and usual care (UC) on motor function and mobility. Our purpose was to investigate the effects of group exercise compared to IE and UC on motor function and mobility for people with PD. METHODS A systematic review and meta-analysis was performed with randomized control trials that investigated the effects of group compared with IE and UC on motor function and mobility for people with PD. A systematic search was performed in PubMed, EBSCO, and Science Direct databases. Methodological quality was assessed using the Cochrane Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS Twenty-three studies assessed at least 1 mobility-related outcome measure, met our inclusion criteria, and were included in quantitative analysis. There was no significant difference on motor function and mobility between group exercise and IE for all standardized outcome assessment meta-analyses. Motor function and mobility were significantly improved with group exercise compared to UC in 9 of 11 standardized outcome assessment meta-analyses. Results were based upon low to moderate quality of evidence. CONCLUSION Based upon low to moderate quality of evidence, group exercise has a similar to larger effect as IE and UC on improving motor function and mobility for people with PD. When used in combination with skilled physical therapy, group exercise may be an appropriate adjunct to individualized physical therapy to maximize mobility and function. IMPACT Long-term adherence to exercise is essential to maintain mobility and motor function for people with PD. Our study suggests group exercise is as effective as IE and may be an appropriate option to encourage long-term adherence related to increased access, socialization, and accountability.
Collapse
Affiliation(s)
- Diana Palm
- Physical Therapy Program, University of Jamestown, Fargo, North Dakota, USA
| | | | | | - Holly Shilling
- Physical Therapy Program, University of Jamestown, Fargo, North Dakota, USA
| | - Mitch Wolden
- Physical Therapy Program, University of Jamestown, Fargo, North Dakota, USA
| |
Collapse
|
5
|
Baudendistel ST, Franz JR, Schmitt AC, Wade FE, Pappas MC, Au KLK, Hass CJ. Visual feedback improves propulsive force generation during treadmill walking in people with Parkinson disease. J Biomech 2024; 167:112073. [PMID: 38599018 PMCID: PMC11046741 DOI: 10.1016/j.jbiomech.2024.112073] [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: 08/29/2023] [Revised: 01/29/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
Persons with Parkinson's disease experience gait alterations, such as reduced step length. Gait dysfunction is a significant research priority as the current treatments targeting gait impairment are limited. This study aimed to investigate the effects of visual biofeedback on propulsive force during treadmill walking in persons with Parkinson's. Sixteen ambulatory persons with Parkinson's participated in the study. They received real-time biofeedback of anterior ground reaction force during treadmill walking at a constant speed. Peak propulsive force values were measured and normalized to body weight. Spatiotemporal parameters were also assessed, including stride length and double support percent. Persons with Parkinson's significantly increased peak propulsive force during biofeedback compared to baseline (p <.0001, Cohen's dz = 1.69). Variability in peak anterior ground reaction force decreased across repeated trials (p <.0001, dz = 1.51). While spatiotemporal parameters did not show significant changes individually, stride length and double support percent improved marginally during biofeedback trials. Persons with Parkinson's can increase propulsive force with visual biofeedback, suggesting the presence of a propulsive reserve. Though stride length did not significantly change, clinically meaningful improvements were observed. Targeting push-off force through visual biofeedback may offer a potential rehabilitation technique to enhance gait performance in Persons with Parkinson's. Future studies could explore the long-term efficacy of this intervention and investigate additional strategies to improve gait in Parkinson's disease.
Collapse
Affiliation(s)
- Sidney T Baudendistel
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA; Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA.
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Abigail C Schmitt
- Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Francesca E Wade
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Marc C Pappas
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA
| | | | - Chris J Hass
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA; Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| |
Collapse
|
6
|
Kegelmeyer DA, Minarsch R, Kostyk SK, Kline D, Smith R, Kloos AD. Use of a Robotic Walking Device for Home and Community Mobility in Parkinson Disease: A Randomized Controlled Trial. J Neurol Phys Ther 2024; 48:102-111. [PMID: 38441461 DOI: 10.1097/npt.0000000000000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
BACKGROUND/PURPOSE Gait impairments in Parkinson disease (PD) contribute to decreased quality of life. This randomized controlled trial examined immediate- and longer-term effects of a single joint robotic exoskeleton device (EXOD), the Honda Walking Assist device, on gait. METHODS Participants (n = 45) with PD (Hoehn and Yahr stages 1-3) were randomized to a robotic-assisted gait training (RAGT) group (n = 23) or control (CON) group (n = 22). The RAGT group was tested with and without the EXOD at baseline and then received supervised in-home and community training with the EXOD twice weekly for 8 weeks. The CON group received no interventions. Outcome measures included gait speed (primary), gait endurance (6-minute walk test), perceived ease of walking, and questionnaires and logs assessing performance of daily activities, freezing of gait, and daily activity levels. RESULTS Forty participants completed the study. No significant immediate impact of EXOD usage on participants' gait measures was found. Differences in gait speed and secondary outcome measures postintervention were not significantly different between the RAGT and CON groups. Participants with greater disease severity (worse baseline motor scores) had greater improvements in stride length during unassisted walking after the intervention than those with lower severity (mean difference: 3.22, 95% confidence interval: 0.05-6.40; P = 0.04). DISCUSSION AND CONCLUSIONS All RAGT participants could use the EXOD safely. The RAGT treatment used in this mostly low impairment population of people with PD may be ineffective and/or was insufficiently dosed to see a positive treatment effect. Our findings suggest that RAGT interventions in PD may be more effective in individuals with greater motor impairments.
Collapse
Affiliation(s)
- Deb A Kegelmeyer
- Division of Physical Therapy (D.A.K., R.M., R.S., A.D.K.) and Departments of Neurology and Neurosciences (S.K.K.), College of Medicine, The Ohio State University, Columbus; Center for Biostatistics (D.K.), The Ohio State University, Columbus; and Department of Biostatistics and Data Science (D.K.), Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | | | | | | | | |
Collapse
|
7
|
Khan A, Ezeugwa J, Ezeugwu VE. A systematic review of the associations between sedentary behavior, physical inactivity, and non-motor symptoms of Parkinson's disease. PLoS One 2024; 19:e0293382. [PMID: 38551932 PMCID: PMC10980241 DOI: 10.1371/journal.pone.0293382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/19/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD), known for motor symptoms, often presents early non-motor issues that significantly affect patients' quality of life. While effective treatments are limited, physical activity and exercise offer potential benefits. However, an overlooked aspect of the movement intensity continuum is prolonged sitting or sedentary behavior, and physical inactivity. Thus, this study aimed to conduct a systematic review investigating the associations between sedentary behavior, physical inactivity, and non-motor symptoms, specifically cognitive impairment, depression, and poor sleep in PD. METHODS Conforming to PRISMA guidelines, a systematic search of the literature was conducted via electronic databases including MEDLINE, CINAHL, Scopus, PubMed and PsycINFO up to February 28, 2023. Studies were included if they investigated associations between sedentary behavior or physical inactivity and at least one non-motor symptom such as depression, poor sleep, and/or cognitive impairment, in adults aged 18 years or older with PD. Quality assessment of the studies was performed using the Newcastle-Ottawa scale for cross-sectional and cohort studies. RESULTS Of the 463 publications found, 7 studies met the inclusion criteria (n = 980 unique participants). Sample sizes ranged from 17 to 487 participants, and all studies were observational, conducted in home or community settings. Collectively, these studies show that higher amounts of both objectively-measured and self-reported sedentary time are associated with worse scores on standardized measures of cognition and the Parkinson's Disease Questionnaire (PDQ) summary index and its subscales, such as cognition (memory and concentration). Additionally, longitudinal cohort studies suggest that physical inactivity and higher sedentary behavior are associated with depression and cognitive impairment in PD. Less sleep was associated with higher sedentary behavior. CONCLUSION Associations observed between physical inactivity, sedentary behavior, and non-motor symptoms in PD underscore the need to address these factors for enhanced well-being. Further well-designed studies are essential to assess the impact of reducing sedentary behavior and physical inactivity on non-motor symptoms in PD. Prospero registration number: PROSPERO (ID: CRD42023405422) on April 11, 2023.
Collapse
Affiliation(s)
- Aiza Khan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Joy Ezeugwa
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Victor E. Ezeugwu
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
8
|
Allen NE, Romaliiska O, Naisby J. Pain and the Non-Pharmacological Management of Pain in People with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024:JPD230227. [PMID: 38457146 DOI: 10.3233/jpd-230227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Pain is a distressing and universal experience, yet everyone's pain experience is influenced by a complex array of biological, psychological, and social factors. For people with Parkinson's disease (PwP), these biopsychosocial factors include neurodegeneration and the psychological and social factors that accompany living with a chronic, neurodegenerative condition in addition to the factors experienced by those in the general population (e.g., living with co-morbidities such as osteoarthritis). The way these factors influence each individual is likely to determine which pain management strategies are optimal for them. This review first describes pain and the biopsychosocial model of pain. It explores how pain is classified in Parkinson's disease (PD) and describes the three main types of pain: nociceptive, neuropathic, and nociplastic pain. This background provides context for a discussion of non-pharmacological pain management strategies that may aid in the management of pain in PwP; exercise, psychological strategies, acupuncture and massage. While there is little PD-specific research to inform the non-pharmacological management of pain, findings from current PD research are combined with that from chronic pain research to present recommendations for clinical practice. Recommendations include assessment that incorporates potential biopsychosocial contributors to pain that will then guide a holistic, multi-modal approach to management. As exercise provides overall benefits for PwP, those with chronic pain should be carefully monitored with exercise prescribed and adjusted accordingly. Research is needed to develop and evaluate multi-modal approaches to pain management that are delivered in a biopsychosocial framework.
Collapse
Affiliation(s)
- Natalie Elizabeth Allen
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Oksana Romaliiska
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jenni Naisby
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, United Kingdom
| |
Collapse
|
9
|
Langeskov-Christensen M, Franzén E, Grøndahl Hvid L, Dalgas U. Exercise as medicine in Parkinson's disease. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-332974. [PMID: 38418216 DOI: 10.1136/jnnp-2023-332974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
Parkinson's disease (PD) is an incurable and progressive neurological disorder leading to deleterious motor and non-motor consequences. Presently, no pharmacological agents can prevent PD evolution or progression, while pharmacological symptomatic treatments have limited effects in certain domains and cause side effects. Identification of interventions that prevent, slow, halt or mitigate the disease is therefore pivotal. Exercise is safe and represents a cornerstone in PD rehabilitation, but exercise may have even more fundamental benefits that could change clinical practice. In PD, the existing knowledge base supports exercise as (1) a protective lifestyle factor preventing the disease (ie, primary prevention), (2) a potential disease-modifying therapy (ie, secondary prevention) and (3) an effective symptomatic treatment (ie, tertiary prevention). Based on current evidence, a paradigm shift is proposed, stating that exercise should be individually prescribed as medicine to persons with PD at an early disease stage, alongside conventional medical treatment.
Collapse
Affiliation(s)
- Martin Langeskov-Christensen
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Neurology, Viborg Regional Hospital, Viborg, Denmark
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Grøndahl Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
- The Danish MS Hospitals, Ry and Haslev, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
10
|
Weston AR, Antonellis P, Fino PC, Hoppes CW, Lester ME, Weightman MM, Dibble LE, King LA. Quantifying Turning Tasks With Wearable Sensors: A Reliability Assessment. Phys Ther 2024; 104:pzad134. [PMID: 37802908 DOI: 10.1093/ptj/pzad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/05/2023] [Accepted: 10/02/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE The aim of this study was to establish the test-retest reliability of metrics obtained from wearable inertial sensors that reflect turning performance during tasks designed to imitate various turns in daily activity. METHODS Seventy-one adults who were healthy completed 3 turning tasks: a 1-minute walk along a 6-m walkway, a modified Illinois Agility Test (mIAT), and a complex turning course (CTC). Peak axial turning and rotational velocity (yaw angular velocity) were extracted from wearable inertial sensors on the head, trunk, and lumbar spine. Intraclass correlation coefficients (ICCs) were established to assess the test-retest reliability of average peak turning speed for each task. Lap time was collected for reliability analysis as well. RESULTS Turning speed across all tasks demonstrated good to excellent reliability, with the highest reliability noted for the CTC (45-degree turns: ICC = 0.73-0.81; 90-degree turns: ICC = 0.71-0.83; and 135-degree turns: ICC = 0.72-0.80). The reliability of turning speed during 180-degree turns from the 1-minute walk was consistent across all body segments (ICC = 0.74-0.76). mIAT reliability ranged from fair to excellent (end turns: ICC = 0.52-0.72; mid turns: ICC = 0.50-0.56; and slalom turns: ICC = 0.66-0.84). The CTC average lap time demonstrated good test-retest reliability (ICC = 0.69), and the mIAT average lap time test-retest reliability was excellent (ICC = 0.91). CONCLUSION Turning speed measured by inertial sensors is a reliable outcome across a variety of ecologically valid turning tasks that can be easily tested in a clinical environment. IMPACT Turning performance is a reliable and important measure that should be included in clinical assessments and clinical trials.
Collapse
Affiliation(s)
- Angela R Weston
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah, USA
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, San Antonio, Texas, USA
| | - Prokopios Antonellis
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, San Antonio, Texas, USA
| | - Mark E Lester
- Department of Physical Therapy, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | | | - Leland E Dibble
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
11
|
Rosenfeldt AB, Lopez-Lennon C, Suttman E, Jansen AE, Owen K, Dibble LE, Alberts JL. Use of a Home-Based, Commercial Exercise Platform to Remotely Monitor Aerobic Exercise Adherence and Intensity in People With Parkinson Disease. Phys Ther 2024; 104:pzad174. [PMID: 38206881 PMCID: PMC10851856 DOI: 10.1093/ptj/pzad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 09/29/2023] [Accepted: 11/15/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Physical therapists are well-positioned to prescribe exercise outside of a clinical setting to promote positive health behaviors in people with Parkinson disease (PD). Traditionally, a barrier to precise exercise prescription has been reliance on participant self-reported exercise adherence and intensity. Home-based, commercially available exercise platforms offer an opportunity to remotely monitor exercise behavior and facilitate adherence based on objective performance metrics. The primary aim of this project was to characterize the feasibility and processes of remote aerobic exercise data monitoring from a home-based, commercially available platform in individuals participating in the 12-month Cyclical Lower Extremity Exercise for PD II (CYCLE-II) randomized clinical trial. Secondary aims focused on using exercise behavior to classify the cohort into exercise archetypes and describing a shared decision-making process to facilitate exercise adherence. METHODS Data from each exercise session were extracted, visualized, and filtered to ensure ride integrity. Weekly exercise frequency was used to determine exercise archetypes: Adherent (2-4 exercise sessions per week), Over-adherent (>4 exercise sessions per week), and Under-adherent (<2 exercise sessions per week). RESULTS A total of 123 people with PD completed 22,000+ exercise sessions. Analysis of exercise frequency indicated that 79% of participants were adherent; 8% were over-adherent; and 13% were under-adherent. Three case reports illustrate how shared decision-making with the use of exercise performance data points guided exercise prescription. CONCLUSIONS The number of exercise sessions and completeness of the data indicate that people with PD were able to utilize a commercial, home-based exercise platform to successfully engage in long-term aerobic exercise. Physical therapists can use objective data as a part of a shared decision-making process to facilitate exercise adherence. IMPACT Commercially available exercise platforms offer a unique approach for physical therapists to monitor exercise behavior outside of a clinical setting. The methods used in this project can serve as a roadmap to utilizing data from consumer-based platforms.
Collapse
Affiliation(s)
- Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Cielita Lopez-Lennon
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Erin Suttman
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - A Elizabeth Jansen
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kelsey Owen
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
12
|
Lorenzo-García P, Cavero-Redondo I, Núñez de Arenas-Arroyo S, Guzmán-Pavón MJ, Priego-Jiménez S, Álvarez-Bueno C. Effects of physical exercise interventions on balance, postural stability and general mobility in Parkinson's disease: a network meta-analysis. J Rehabil Med 2024; 56:jrm10329. [PMID: 38298133 PMCID: PMC10847976 DOI: 10.2340/jrm.v56.10329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/30/2023] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE To assess which type of physical exercise intervention has the most beneficial effects on balance, postural stability and general mobility in patients with Parkinson's disease. These parameters were assessed using the Activities-specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (MiniBESTest) and Timed Up and Go Test (TUG). DESIGN Network meta-analysis. METHODS The PubMed, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched up to August 2022 to identify randomized controlled trials on the effects of physical exercise interventions on balance, postural stability, and general mobility. The network meta-analysis included pairwise and indirect comparisons of results on the ABC scale, BBS, MiniBESTest, and TUG across 8 categories of physical exercise. RESULTS Eighty-six studies with a total of 4,693 patients were included. For the ABC scale, the indirect comparison showed that the highest effect size was observed for balance vs sensorimotor training without including endurance interventions (0.62; 95% confidence interval (95% CI) 0.06, 1.17). The highest effect sizes for BBS were observed for alternative exercises (1.21; 95% CI 0.62, 1.81), body-weight supported (BWS) interventions (1.31; 95% CI 0.57, 2.05), dance (1.18; 95% CI 0.33, 2.03) and sensorimotor training, including endurance interventions (1.10; 95% CI 0.46, 1.75) vs control groups. Indirect comparisons showed that the highest effect size for the MiniBESTest were observed for balance (0.75; 95% CI 0.46, 1.04) and resistance (0.58; 95% CI 0.10, 1.07) vs control groups. For the TUG, comparisons showed a significant effect size for alternative exercises (-0.54; 95% CI -0.82, -0.26), balance (-0.42; 95% CI -0.75, -0.08), resistance (-0.60; 95% CI -0.89, -0.31), and sensorimotor training including endurance interventions (-0.61; 95% CI -0.95, -0.27) vs control comparisons. CONCLUSION Balance interventions improve balance, postural stability, and general mobility in people with Parkinson's disease. Moreover, alternative exercises, dance, BWS interventions, resistance, and sensorimotor training, including and not including endurance interventions, are also effective.
Collapse
Affiliation(s)
| | - Iván Cavero-Redondo
- Universidad de Castilla La Mancha, Health and Social Research Center, Cuenca, Spain; Facultad de Ciencias de La Salud, Universidad Autónoma de Chile, Talca, Chile
| | | | | | | | - Celia Álvarez-Bueno
- Universidad de Castilla La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| |
Collapse
|
13
|
Barboza NM, Laskovski L, Volpe RP, Silva TCOD, Pereira LA, Silva PGBD, Smaili SM. Perceptions of individuals with Parkinson's disease about a telerehabilitation protocol performed during the COVID-19 pandemic: a qualitative study. Disabil Rehabil 2024:1-10. [PMID: 38264886 DOI: 10.1080/09638288.2024.2305687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE To understand the perceptions and meaning of the experience of individuals with Parkinson's disease (PD) when participating in a telerehabilitation protocol during COVID-19 pandemic. METHODS This is a qualitative descriptive analytical study with a phenomenological basis, regarding the individuals' perceptions of telerehabilitation. The interviews were conducted by a semi-structured interview guide and carried out via recorded phone calls, which were later transcribed, categorized, and analyzed based on the principles of phenomenology according to the propositions of Martins and Bicudo. RESULTS From the qualitative analysis, four themes that configure the structure of the phenomenon emerged: 1) Expectations regarding physical therapy through telerehabilitation during the pandemic; 2) Experiences of the new routine; 3) Perceptions about oneself in the light of the proposed telerehabilitation program; 4) A view of the protocol. CONCLUSION Apprehension and fear were present during the implementation of the protocol, however, previous experience with face-to-face physical therapy and the team allowed feelings of happiness, contentment, welcomeness, and satisfaction with the possibility of resuming the activities. The individuals actively participated in the program with commitment and co-responsibility, but the lack of physical contact, limited equipment, and constant concern for the safety and individuality of the participants must be emphasized.
Collapse
Affiliation(s)
- Natália Mariano Barboza
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
| | - Larissa Laskovski
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
| | - Renata Pasquarelli Volpe
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
| | - Taís Caroline Oliveira da Silva
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
| | - Larissa Alessandra Pereira
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
| | - Patrícia Gonçalves Broto da Silva
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
| | - Suhaila Mahmoud Smaili
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
| |
Collapse
|
14
|
Clarkin CM, Ward-Ritacco CL, Mahler L. Exercise-Induced Functional Changes in People with Parkinson's Disease following External Cueing and Task-Based Intervention. Rehabil Res Pract 2024; 2024:6188546. [PMID: 38283384 PMCID: PMC10817815 DOI: 10.1155/2024/6188546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 08/09/2023] [Accepted: 12/23/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction The purpose of this study was to evaluate change in motor function, gait speed, dynamic balance, balance confidence, and quality of life (QoL) in nine participants with Parkinson's disease (PwPD) completing Lee Silverman Voice Treatment BIG (LSVT-BIG), an external cueing and task-based intervention. Although supported as an efficacious treatment in PwPD, there is limited research examining clinically meaningful change in outcome measures related to external cueing and task-based interventions. Materials and Methods This was a case series of nine PwPD (age range 64-76 years, 55% male) who completed the LSVT-BIG protocol. Disease duration ranged from 1 to 17 years and was classified as moderate in all participants (Hoehn and Yahr = 2 or 3). Outcome measures included motor function (MDS-UPDRS Part III Motor), gait speed, dynamic balance (MiniBEST), Activities-specific Balance Confidence (ABC), and Summary Index for PD Quality of Life 39 (PDQ-SI). Assessments were completed at baseline (BASE), end of treatment (EOT), and 4 weeks after EOT (EOT+4). Results Minimal detectable change (MDC) or minimal clinical important difference (MCID) was observed in one or more outcome measures in 8 of 9 participants at EOT and EOT+4 across domains of motor function (67%, 78%), gait speed (78%, 67%), balance confidence (44%, 33%), quality of life (44%, 78%), and dynamic balance (22%, 22%). Discussion. In this case series, 8 of 9 participants showed MDC or MCID changes across multiple functional domains. Improvements were observed immediately post (EOT) and 4-week post-treatment (EOT+4) suggesting a temporal component of the LSVT-BIG impact on functional change. Future research should include clinical trials to examine additional external cueing and task-based intervention efficacy with consideration of intensity, frequency, and mode of delivery across disease severity.
Collapse
Affiliation(s)
- Christine M. Clarkin
- Physical Therapy Department, University of Rhode Island, Kingston, Rhode Island, USA
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA
| | - Christie L. Ward-Ritacco
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Kinesiology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Leslie Mahler
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Communicative Disorders, University of Rhode Island, Kingston, Rhode Island, USA
| |
Collapse
|
15
|
Goldman JG, Volpe D, Ellis TD, Hirsch MA, Johnson J, Wood J, Aragon A, Biundo R, Di Rocco A, Kasman GS, Iansek R, Miyasaki J, McConvey VM, Munneke M, Pinto S, St Clair KA, Toledo S, York MK, Todaro R, Yarab N, Wallock K. Delivering Multidisciplinary Rehabilitation Care in Parkinson's Disease: An International Consensus Statement. JOURNAL OF PARKINSON'S DISEASE 2024; 14:135-166. [PMID: 38277303 PMCID: PMC10836578 DOI: 10.3233/jpd-230117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Parkinson's disease (PD) is a complex neurodegenerative disorder impacting everyday function and quality of life. Rehabilitation plays a crucial role in improving symptoms, function, and quality of life and reducing disability, particularly given the lack of disease-modifying agents and limitations of medications and surgical therapies. However, rehabilitative care is under-recognized and under-utilized in PD and often only utilized in later disease stages, despite research and guidelines demonstrating its positive effects. Currently, there is a lack of consensus regarding fundamental topics related to rehabilitative services in PD. OBJECTIVE The goal of the international Parkinson's Foundation Rehabilitation Medicine Task Force was to develop a consensus statement regarding the incorporation of rehabilitation in PD care. METHODS The Task Force, comprised of international multidisciplinary experts in PD and rehabilitation and people directly affected by PD, met virtually to discuss topics such as rehabilitative services, existing therapy guidelines and rehabilitation literature in PD, and gaps and needs. A systematic, interactive, and iterative process was used to develop consensus-based statements on core components of PD rehabilitation and discipline-specific interventions. RESULTS The expert-based consensus statement outlines key tenets of rehabilitative care including its multidisciplinary approach and discipline-specific guidance for occupational therapy, physical therapy, speech language pathology/therapy, and psychology/neuropsychology across all PD stages. CONCLUSIONS Rehabilitative interventions should be an essential component in the comprehensive treatment of PD, from diagnosis to advanced disease. Greater education and awareness of the benefits of rehabilitative services for people with PD and their care partners, and further evidence-based and scientific study are encouraged.
Collapse
Affiliation(s)
- Jennifer G Goldman
- JPG Enterprises LLC, Medical Division, Chicago, IL, USA
- ^Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniele Volpe
- Fresco Parkinson Institute, Fiesole, Italy
- Fresco Parkinson Center Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
- NYU Grossman School of Medicine, New York, NY, USA
| | - Terry D Ellis
- Boston University Sargent College of Health and Rehabilitation Sciences, Boston, MA, USA
| | - Mark A Hirsch
- Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, NC, USA
| | - Julia Johnson
- Kings College Hospital NHS Foundation Trust, London, UK
| | - Julia Wood
- Lewy Body Dementia Association, Lilburn, GA, USA
| | - Ana Aragon
- Independent Consultant Occupational Therapist, Bath, UK
| | | | | | | | | | | | | | - Marten Munneke
- Radboudumc Center of Expertise for Movement Disorders, Nijmegen, Netherlands
| | - Serge Pinto
- The French National Centre for Scientific Research, Aix-Marseille University, Aix-en-Provence, France
| | | | - Santiago Toledo
- ^Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Ronnie Todaro
- Voz Advisors, New York, NY, USA
- ^Parkinson's Foundation, New York, NY, USA
| | | | | |
Collapse
|
16
|
Corcos DM, Lamotte G, Luthra NS, McKee KE. Advice to People with Parkinson's in My Clinic: Exercise. JOURNAL OF PARKINSON'S DISEASE 2024; 14:609-617. [PMID: 38189710 PMCID: PMC11091645 DOI: 10.3233/jpd-230277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 01/09/2024]
Abstract
There is compelling evidence that exercise must be part of main line therapy for people with Parkinson's disease. In this viewpoint, we outline the four key components of exercise: aerobic exercise, resistance exercise, flexibility exercise, and neuromotor exercises (posture, gait, balance, and agility) that can improve both motor and non-motor symptoms of the disease and, in the case of aerobic exercise, may delay the disease. We outline guidelines on how to change and optimize the exercise prescription at different stages of the disease.
Collapse
Affiliation(s)
- Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Guillaume Lamotte
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Nijee S. Luthra
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Kathleen E. McKee
- Neurosciences Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA
| |
Collapse
|
17
|
Macpherson CE, Fineman J, Chandrana A, Quinn L. Development of a Physical Therapy Telehealth Examination Battery for People with Parkinson Disease. Int J Telerehabil 2023; 15:e6592. [PMID: 38162943 PMCID: PMC10754248 DOI: 10.5195/ijt.2023.6592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Scope The rapid transition to telehealth following the COVID-19 pandemic raised challenges for remote delivery of physical therapy. One challenge was identifying outcome measures for people with Parkinson Disease (PwP) that could safely be conducted via telehealth. This paper evaluates the feasibility of a telehealth physical therapy examination battery for PwP in early to middle stage of disease progression. Methodology We reviewed recommended outcome measures from the American Physical Therapy Association's Academy of Neurologic Physical Therapy (ANPT) Parkinson Evidence Database to Guide Effectiveness (EDGE) document and evaluated their appropriateness for remote administration. A clinical decision tree was created to streamline the examination process, incorporating elements of the ANPT movement analysis of tasks as a movement screen. The examination battery was then conducted on three PwP and evaluated for safety and feasibility. Conclusion This physical therapy telehealth examination battery provides physical therapists with a method to conduct safe and efficient remote assessments for PwP.
Collapse
Affiliation(s)
- Chelsea E. Macpherson
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Julie Fineman
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
- Doctor of Physical Therapy Program, Marist College, Poughkeepsie, NY, USA
| | - Anuja Chandrana
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
- Department of Rehabilitation and Regenerative Medicine (Physical Therapy), Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
18
|
Kim R, Lee TL, Lee H, Ko DK, Lee JH, Shin H, Lim D, Jun JS, Byun K, Park K, Jeon B, Kang N. Effects of physical exercise interventions on cognitive function in Parkinson's disease: An updated systematic review and meta-analysis of randomized controlled trials. Parkinsonism Relat Disord 2023; 117:105908. [PMID: 37922635 DOI: 10.1016/j.parkreldis.2023.105908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To determine whether physical exercise interventions can improve cognitive function, including overall performance and specific domains, in patients with Parkinson's disease (PD) and to provide potential evidence on how cognitive benefits can be optimized by exercise prescriptions. METHODS Using PubMed, Web of Science, and Cochrane Library (from inception to August 2022), four independent reviewers screened the search results and extracted data from randomized controlled trials of physical exercise interventions in patients with PD with an outcome measure of cognitive function. Random-effects meta-analysis models were used to report standardized mean differences (SMDs) with 95 % confidence intervals (CIs). RESULTS Twenty-one randomized controlled trials including 761 patients with PD were eligible for inclusion. Physical exercise interventions led to significant improvements in global cognitive function (SMD = 0.69; 95 % CI = 0.31 to 1.06; P < 0.001). With respect to cognitive domains, the significant effect of exercise was found on executive function (SMD = 0.94; 95 % CI = 0.05 to 1.83; P = 0.039), but not on attention/working memory, language, memory, and visuospatial function. In moderator variable analyses, the effect on global cognition was observed in combined exercise programs (SMD = 0.79; 95 % CI = 0.46 to 1.12; P < 0.001), whereas there were no significant positive effects in aerobic exercise programs, strength exercise programs, and flexibility exercise programs. In addition, exercise interventions of light-to-moderate intensity with at least 60 min in duration, and of any frequency or period, were beneficial to the global cognitive function. CONCLUSION This updated systematic review and meta-analysis suggests that physical exercise interventions are effective in improving global cognitive function and, to a lesser extent, executive function in patients with PD. At least 60 min a day of combined exercise programs on as many days of the week as feasible may be recommended as the non-pharmacological therapeutic option to improve cognitive function.
Collapse
Affiliation(s)
- Ryul Kim
- Department of Neurology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea.
| | - Tae Lee Lee
- Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea
| | - Hanall Lee
- Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea
| | - Do-Kyung Ko
- Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea
| | - Joon Ho Lee
- Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea
| | - Heehyun Shin
- Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea
| | - Dabin Lim
- Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Kyeongho Byun
- Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea
| | - Kiwon Park
- Department of Mechatronics Engineering, Incheon National University, Incheon, South Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Nyeonju Kang
- Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea.
| |
Collapse
|
19
|
Proud EL, Miller KJ, Morris ME, McGinley JL, Blennerhassett JM. Effects of Upper Limb Exercise or Training on Hand Dexterity and Function in People With Parkinson Disease: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2023:S0003-9993(23)00663-9. [PMID: 38042246 DOI: 10.1016/j.apmr.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/19/2023] [Accepted: 11/12/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE This systematic review investigated the effects of exercise and training on hand dexterity and function outcomes in people with Parkinson disease (PD). DATA SOURCES We searched 5 databases (MEDLINE Ovid, CINAHL, PEDro, PubMed, Cochrane Database) from inception to October 2022. STUDY SELECTION Included studies were randomized controlled trials delivering upper limb exercise or training interventions to people with PD and evaluating 1 or more upper limb activity outcomes. Two independent reviewers screened 668 articles for inclusion. DATA EXTRACTION Two reviewers independently extracted data relating to study participants, intervention characteristics, and key outcomes. Cochrane Risk of Bias and GRADE tools assessed methodological quality of included studies, and strength of evidence for 3 outcomes: hand dexterity, self-reported hand function, and handwriting performance. Meta-analyses synthesized results for within-hand dexterity and self-reported function. RESULTS Eighteen randomized controlled trials (n=704) with low to unclear risk of bias were identified. Experimental interventions varied considerably in their approach and treatment dose, and 3 studies focused on training handwriting. Meta-analysis showed moderate quality evidence of a small positive effect on within-hand dexterity (SMD=0.26; 95% CI 0.07, 0.44). Very low-quality evidence pointed toward a nonsignificant effect on self-reported hand function (SMD=0.67; 95% CI -0.40, 1.75). A narrative review of handwriting interventions showed low quality evidence for improved performance after training. CONCLUSIONS There is moderate certainty of evidence supporting the use of exercise and training to address dexterity problems, but evidence remains unclear for self-reported hand function and handwriting. Our findings suggest that training could employ task-related approaches. Future research should interrogate aspects of clinical practice such as optimal dose and key ingredients for effective interventions.
Collapse
Affiliation(s)
- Elizabeth L Proud
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia.
| | - Kimberly J Miller
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia; BC Children's Hospital Research Institute, Vancouver, Canada
| | - Meg E Morris
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Australia; Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Australia
| | - Jennifer L McGinley
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia
| | | |
Collapse
|
20
|
Kool N, Kool J, Bachmann S. Duration of rehabilitation therapy to achieve a minimal clinically important difference in mobility, walking endurance and patient-reported physical health: an observational study. J Rehabil Med 2023; 55:jrm12322. [PMID: 37987632 PMCID: PMC10680980 DOI: 10.2340/jrm.v55.12322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/07/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE To compare the duration of exercise therapy needed to achieve a minimal clinically important difference in mobility, walking endurance and patient-reported global physical health in patients referred for inpatient rehabilitation after knee surgery, hip surgery, or with multiple sclerosis or Parkinson's disease. DESIGN Retrospective pre-post intervention observational cohort study. SUBJECTS A total of 388 patients (57% women, mean age 65.6 years (standard deviation 9.5)) with a minimum length of stay 10 days were included between 1 January 2020 and 30 April 2021. METHODS Outcomes were assessed at the start of, and discharge from, rehabilitation, using the following measures: mobility (Timed Up and Go test), walking endurance (6-minute walk test), patient-reported global physical health (Global Physical Health subscale of the 10-item Patient-Reported Outcomes Measurement Information System). The duration of exercise therapy needed to achieve a minimal clinically important difference was determined using anchor-based and distribution-based methods. RESULTS The duration of therapy needed to achieve a minimal clinically important difference was longer in patients with multiple sclerosis or Parkinson's disease (18-88 h) than in patients after knee or hip surgery (8-25 h). In all patient groups, the duration of exercise therapy needed, determined using the distribution-based method, was shortest for patient-reported global physical health (knee surgery 9.6 h, hip surgery 6.8 h, multiple sclerosis 38.7 h, Parkinson's disease 18.4 h). CONCLUSION The duration of active therapies required to achieve a minimal clinically important difference in physical outcomes varies widely (range 8-88 h) among different patient groups and outcomes.
Collapse
Affiliation(s)
- Nicoline Kool
- Department of Rehabilitation Medicine, Kliniken Valens, Valens, Switzerland.
| | - Jan Kool
- Department of Rehabilitation Medicine, Kliniken Valens, Valens, Switzerland
| | - Stefan Bachmann
- Department of Rehabilitation Medicine, Kliniken Valens, Valens, Switzerland
| |
Collapse
|
21
|
Otlet V, Vandamme C, Warlop T, Crevecoeur F, Ronsse R. Effects of overground gait training assisted by a wearable exoskeleton in patients with Parkinson's disease. J Neuroeng Rehabil 2023; 20:156. [PMID: 37974229 PMCID: PMC10655429 DOI: 10.1186/s12984-023-01280-y] [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: 06/28/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND In the recent past, wearable devices have been used for gait rehabilitation in patients with Parkinson's disease. The objective of this paper is to analyze the outcome of a wearable hip orthosis whose assistance adapts in real time to the patient's gait kinematics via adaptive oscillators. In particular, this study focuses on a metric characterizing natural gait variability, i.e., the level of long-range autocorrelations (LRA) in series of stride durations. METHODS Eight patients with Parkinson's disease (Hoehn and Yahr stages 1[Formula: see text]2.5) performed overground gait training three times per week for four consecutive weeks, assisted by a wearable hip orthosis. Gait was assessed based on performance metrics such as the hip range of motion, speed, stride length and duration, and the level of LRA in inter-stride time series assessed using the Adaptive Fractal Analysis. These metrics were measured before, directly after, and 1 month after training. RESULTS After training, patients increased their hip range of motion, their gait speed and stride length, and decreased their stride duration. These improvements were maintained 1 month after training. Regarding long-range autocorrelations, the population's behavior was standardized towards a metric closer to the one of healthy individuals after training, but with no retention after 1 month. CONCLUSION This study showed that an overground gait training with adaptive robotic assistance has the potential to improve key gait metrics that are typically affected by Parkinson's disease and that lead to higher prevalence of fall. TRIAL REGISTRATION ClinicalTrials.gov Identifer NCT04314973. Registered on 11 April 2020.
Collapse
Affiliation(s)
- Virginie Otlet
- Institute of Mechanics, Materials, and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium.
- Institute of Neuroscience, UCLouvain, Brussels, Belgium.
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.
| | - Clémence Vandamme
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, UCLouvain, Louvain-la-Neuve, Belgium
| | - Thibault Warlop
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Service de Neurologie, Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
- Service de Neurologie (Pathologie du Mouvement), Centre Hospitalier Universitaire de Lille, Lille, France
| | - Frédéric Crevecoeur
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, UCLouvain, Louvain-la-Neuve, Belgium
| | - Renaud Ronsse
- Institute of Mechanics, Materials, and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
| |
Collapse
|
22
|
Capato TTC, Rodrigues R, Cury RG, Teixeira MJ, Barbosa ER. Clinical assessment of upper limb impairments and functional capacity in Parkinson's disease: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:1008-1015. [PMID: 37899049 PMCID: PMC10689111 DOI: 10.1055/s-0043-1772769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/19/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Parkinson's disease (PD) may progressively reduce the upper limb's functionality. Currently, there is no standardized upper limb functional capacity assessment in PD in the rehabilitation field. OBJECTIVE To identify specific outcome measurements to assess upper limbs in PD and access functional capacity. METHODS We systematically reviewed and analyzed the literature in English published from August/2012 to August/2022 according to PRISMA. The following keywords were used in our search: "upper limbs" OR "upper extremity" and "Parkinson's disease." Two researchers searched independently, including studies accordingly to our inclusion and exclusion criteria. Registered at PROSPERO CRD42021254486. RESULTS We found 797 studies, and 50 were included in this review (n = 2.239 participants in H&Y stage 1-4). The most common upper limbs outcome measures found in the studies were: (i) UPDRS-III and MDS-UPDRS to assess the severity and progression of PD motor symptoms (tremor, bradykinesia, and rigidity) (ii) Nine Hole Peg Test and Purdue Pegboard Test to assess manual dexterity; (iii) Spiral test and Funnel test to provoke and assess freezing of upper limbs; (iv) Technology assessment such as wearables sensors, apps, and other device were also found. CONCLUSION We found evidence to support upper limb impairments assessments in PD. However, there is still a large shortage of specific tests to assess the functional capacity of the upper limbs. The upper limbs' functional capacity is insufficiently investigated during the clinical and rehabilitation examination due to a lack of specific outcome measures to assess functionality.
Collapse
Affiliation(s)
- Tamine T. C. Capato
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands.
| | - Rúbia Rodrigues
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
| | - Rubens G. Cury
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
| | | | - Egberto R. Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
| |
Collapse
|
23
|
LaMarca A, Tse I, Keysor J. Rehabilitation Technologies for Chronic Conditions: Will We Sink or Swim? Healthcare (Basel) 2023; 11:2751. [PMID: 37893825 PMCID: PMC10606667 DOI: 10.3390/healthcare11202751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Chronic conditions such as stroke, Parkinson's disease, spinal cord injury, multiple sclerosis, vestibular disorders, chronic pain, arthritis, diabetes, chronic obstructive pulmonary disease (COPD), and heart disease are leading causes of disability among middle-aged and older adults. While evidence-based treatment can optimize clinical outcomes, few people with chronic conditions engage in the recommended levels of exercise for clinical improvement and successful management of their condition. Rehabilitation technologies that can augment therapeutic care-i.e., exoskeletons, virtual/augmented reality, and remote monitoring-offer the opportunity to bring evidence-based rehabilitation into homes. Successful integration of rehabilitation techniques at home could help recovery and access and foster long term self-management. However, widespread uptake of technology in rehabilitation is still limited, leaving many technologies developed but not adopted. METHODS In this narrative review, clinical need, efficacy, and obstacles and suggestions for implementation are discussed. The use of three technologies is reviewed in the management of the most prevalent chronic diseases that utilize rehabilitation services, including common neurological, musculoskeletal, metabolic, pulmonary, and cardiac conditions. The technologies are (i) exoskeletons, (ii) virtual and augmented reality, and (iii) remote monitoring. RESULTS Effectiveness evidence backing the use of technology in rehabilitation is growing but remains limited by high heterogeneity, lack of long-term outcomes, and lack of adoption outcomes. CONCLUSION While rehabilitation technologies bring opportunities to bridge the gap between clinics and homes, there are many challenges with adoption. Hybrid effectiveness and implementation trials are a possible path to successful technology development and adoption.
Collapse
Affiliation(s)
- Amber LaMarca
- Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA 02129, USA;
| | - Ivy Tse
- Doctor of Physical Therapy Program, MGH Institute of Health Professions, Boston, MA 02129, USA
| | - Julie Keysor
- School of Health Care Leadership, MGH Institute of Health Professions, Boston, MA 02129, USA
| |
Collapse
|
24
|
Cai L, Tang S, Liu Y, Zhang Y, Yang Q. The application of weighted gene co-expression network analysis and support vector machine learning in the screening of Parkinson's disease biomarkers and construction of diagnostic models. Front Mol Neurosci 2023; 16:1274268. [PMID: 37908486 PMCID: PMC10614158 DOI: 10.3389/fnmol.2023.1274268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Background This study aims to utilize Weighted Gene Co-expression Network Analysis (WGCNA) and Support Vector Machine (SVM) algorithm for screening biomarkers and constructing a diagnostic model for Parkinson's disease. Methods Firstly, we conducted WGCNA analysis on gene expression data from Parkinson's disease patients and control group using three GEO datasets (GSE8397, GSE20163, and GSE20164) to identify gene modules associated with Parkinson's disease. Then, key genes with significantly differential expression from these gene modules were selected as candidate biomarkers and validated using the GSE7621 dataset. Further functional analysis revealed the important roles of these genes in processes such as immune regulation, inflammatory response, and cell apoptosis. Based on these findings, we constructed a diagnostic model by using the expression data of FLT1, ATP6V0E1, ATP6V0E2, and H2BC12 as inputs and training and validating the model using SVM algorithm. Results The prediction model demonstrated an AUC greater than 0.8 in the training, test, and validation sets, thereby validating its performance through SMOTE analysis. These findings provide strong support for early diagnosis of Parkinson's disease and offer new opportunities for personalized treatment and disease management. Conclusion In conclusion, the combination of WGCNA and SVM holds potential in biomarker screening and diagnostic model construction for Parkinson's disease.
Collapse
Affiliation(s)
- Lijun Cai
- Department of Pathophysiology, College of Basic Medical Sciences, Guizhou Medical University, Guiyang, Guizhou, China
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Shuang Tang
- Department of Pathophysiology, College of Basic Medical Sciences, Guizhou Medical University, Guiyang, Guizhou, China
| | - Yin Liu
- Department of Pathophysiology, College of Basic Medical Sciences, Guizhou Medical University, Guiyang, Guizhou, China
| | - Yingwan Zhang
- Department of Pathophysiology, College of Basic Medical Sciences, Guizhou Medical University, Guiyang, Guizhou, China
| | - Qin Yang
- Department of Pathophysiology, College of Basic Medical Sciences, Guizhou Medical University, Guiyang, Guizhou, China
| |
Collapse
|
25
|
Silva-Batista C, Wilhelm JL, Scanlan KT, Stojak M, Carlson-Kuhta P, Chen S, Liu W, de la Huerta TNG, Horak FB, Mancini M, King LA. Balance telerehabilitation and wearable technology for people with Parkinson's disease (TelePD trial). BMC Neurol 2023; 23:368. [PMID: 37833645 PMCID: PMC10571293 DOI: 10.1186/s12883-023-03403-3] [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: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Balance impairments, that lead to falls, are one of the main symptoms of Parkinson's disease (PD). Telerehabilitation is becoming more common for people with PD; however, balance is particularly challenging to assess and treat virtually. The feasibility and efficacy of virtual assessment and virtual treatment of balance in people with PD are unknown. The present study protocol has three aims: I) to determine if a virtual balance and gait assessment (instrumented L-shape mobility test) with wearable sensors can predict a gold-standard, in-person clinical assessment of balance, the Mini Balance Evaluation Systems Test (Mini-BESTest); II) to explore the effects of 12 sessions of balance telerehabilitation and unsupervised home exercises on balance, gait, executive function, and clinical scales; and III) to explore if improvements after balance telerehabilitation transfer to daily-life mobility, as measured by instrumented socks with inertial sensors worn for 7 days. METHODS The TelePD Trial is a prospective, single-center, parallel-group, single-blind, pilot, randomized, controlled trial. This trial will enroll 80 eligible people with PD. Participants will be randomized at a 1:1 ratio into receiving home-based balance exercises in either: 1) balance telerehabilitation (experimental group, n = 40) or 2) unsupervised exercises (control group, n = 40). Both groups will perform 12 sessions of exercise at home that are 60 min long. The primary outcome will be Mini-BESTest. The secondary outcomes will be upper and lower body gait metrics from a prescribed task (instrumented L-shape mobility test); daily-life mobility measures over 7 days with wearable sensors in socks, instrumented executive function tests, and clinical scales. Baseline testing and 7 days of daily-life mobility measurement will occur before and after the intervention period. CONCLUSION The TelePD Trial will be the first to explore the usefulness of using wearable sensor-based measures of balance and gait remotely to assess balance, the feasibility and efficacy of balance telerehabilitation in people with PD, and the translation of balance improvements after telerehabilitation to daily-life mobility. These results will help to develop a more effective home-based balance telerehabilitation and virtual assessment that can be used remotely in people with balance impairments. TRIAL REGISTRATION This trial was prospectively registered on ClinicalTrials.gov (NCT05680597).
Collapse
Affiliation(s)
- Carla Silva-Batista
- Balance Disorders Laboratory, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, OP-3297239, USA
| | - Jennifer L Wilhelm
- Balance Disorders Laboratory, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, OP-3297239, USA
| | - Kathleen T Scanlan
- Balance Disorders Laboratory, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, OP-3297239, USA
| | - Margaret Stojak
- Balance Disorders Laboratory, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, OP-3297239, USA
| | - Patricia Carlson-Kuhta
- Balance Disorders Laboratory, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, OP-3297239, USA
| | - Siting Chen
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - William Liu
- Balance Disorders Laboratory, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, OP-3297239, USA
| | - Tomas Nicolás García de la Huerta
- Balance Disorders Laboratory, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, OP-3297239, USA
| | - Fay B Horak
- Balance Disorders Laboratory, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, OP-3297239, USA
- APDM Precision Motion of Clario, Portland, OR, USA
| | - Martina Mancini
- Balance Disorders Laboratory, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, OP-3297239, USA
| | - Laurie A King
- Balance Disorders Laboratory, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, OP-3297239, USA.
| |
Collapse
|
26
|
Costa V, Suassuna ADOB, Brito TSS, da Rocha TF, Gianlorenco AC. Physical exercise for treating non-motor symptoms assessed by general Parkinson's disease scales: systematic review and meta-analysis of clinical trials. BMJ Neurol Open 2023; 5:e000469. [PMID: 37808516 PMCID: PMC10551973 DOI: 10.1136/bmjno-2023-000469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/31/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Parkinson's disease is a movement disorder that also manifests non-motor symptoms (NMS). Physical exercise is a prominent strategy that can have an impact on NMS; however, the evidence is limited. Our aim was to verify the effects of exercise on NMS, as assessed using general NMS scales. Methods This study is a systematic review and meta-analysis. Two searches were conducted on the PubMed, Cochrane Library, Scopus, Web of Science, Embase, Science Direct and PEDro databases from September to December 2022. The PEDro scale was used to assess the methodological quality of the studies. Results Twenty-three studies were included. The interventions were classified as multimodal, aerobic, resistance, dance, conventional physical therapy and other types. Five studies had high risk of bias. Eight studies were included in the meta-analyses. According to the criteria, four studies compared exercise with non-exercise (n=159), two compared multimodal exercise with cognitive/leisure approaches (n=128), and two compared aerobic with conventional exercise (n=40). No statistical differences were observed between exercise and non-exercise (-0.26 (-0.58 to 0.05)) and between multimodal and cognitive approaches (0.21 (-0.14 to 0.55)). However, trends were observed in the direction of exercise and cognitive approaches. A significant difference was observed favouring aerobic over conventional exercise (-0.72 (-1.36 to -0.08)). Conclusions Our findings suggest that exercise may have an effect on general NMS compared with non-exercise, although only a trend was observed. It was also observed for cognitive approaches over multimodal exercises. Aerobic exercise showed near-large effects compared with conventional exercise.
Collapse
Affiliation(s)
- Valton Costa
- Neurosciences Laboratory, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Alice de Oliveira Barreto Suassuna
- Department of Electrical Engineering, Centre for Innovation and Technology Assessment in Health, Federal University of Uberlandia, Uberlandia, Brazil
| | - Thanielle Souza Silva Brito
- Neurosciences Laboratory, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Thalita Frigo da Rocha
- Neurosciences Laboratory, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Anna Carolyna Gianlorenco
- Neurosciences Laboratory, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| |
Collapse
|
27
|
He S, Fang W, Wu J, Lv H, Zhang J, Wang T, Huang Y, Li G, Li M. Whether mindfulness-guided therapy can be a new direction for the rehabilitation of patients with Parkinson's disease: a network meta-analysis of non-pharmacological alternative motor-/sensory-based interventions. Front Psychol 2023; 14:1162574. [PMID: 37780170 PMCID: PMC10540073 DOI: 10.3389/fpsyg.2023.1162574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/20/2023] [Indexed: 10/03/2023] Open
Abstract
Background The treatment for Parkinson's disease (PD) consumes a lot of manpower and financial resources. Non-pharmacological alternative motor-/sensory-based interventions are optimized for the rehabilitation of PD patients. Mindfulness-based therapy shows ideal efficacy, but the diversity of the therapy brings difficulties to the selection of clinicians and patients. Methods Network meta-analysis in the Bayesian framework was used to evaluate the efficacy of non-pharmacological alternative motor-/sensory-based interventions in improving motor and non-motor symptoms in PD patients. Results A total of 58 studies (2,227 patients) were included. Compared with the non-intervention group, qigong was associated with improved outcomes in the Timed Up and Go (TUG) test (mean difference (MD) -5.54, 95% confidence interval (CI) -8.28 to -2.77), and UPDRS-I (MD -15.50, 95% CI -19.93 to -7.63). Differences between non-pharmacological alternative motor-/sensory-based interventions were not significant for PDQ-39, UPDRS-I, or UPDRS-II; however, qigong was superior to dance (MD -3.91, 95% CI -6.90 to -0.95), Tai Chi (MD -3.54, 95% CI -6.53 to -0.69), acupuncture (MD -6.75, 95% CI -10.86 to -2.70), music (MD -3.91, 95% CI -7.49 to -0.48), and exercise (MD -3.91, 95% CI -6.49 to -1.33) in the TUG test. Conclusion This network meta-analysis supports mindfulness-based therapy (e.g., qigong, yoga, and Tai Chi) as a preferred non-pharmacological alternative motor-/sensory-based intervention for PD rehabilitation. Systematic review registration https://inplasy.com/inplasy-2022-10-0109/, INPLASY2022100109.
Collapse
Affiliation(s)
- Shenglan He
- Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wanyi Fang
- Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiaoyang Wu
- Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hang Lv
- The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jueyu Zhang
- Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital (Fifth Clinical Medical College of Guangzhou University of Chinese Medicine), Guangzhou, China
| | - Tunyi Wang
- Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yingjie Huang
- Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guangyao Li
- Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Min Li
- Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
28
|
Aquino C, Luo L, Agarwal P, Garg K, Rosenow JM, Corcos DM, Miocinovic S, Jimenez-Shahed J. Deep Brain Stimulation as an Exclusion Criterion in Parkinson's Disease Studies: Time to Rethink? Mov Disord 2023; 38:1602-1605. [PMID: 37533294 DOI: 10.1002/mds.29554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Affiliation(s)
- Camila Aquino
- Department of Clinical Neurosciences and Department of Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lan Luo
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Pinky Agarwal
- Department of Medicine, Booth Gardner Parkinson's Care Center, Kirkland, Washington, USA
| | - Khushi Garg
- Thomas Jefferson High School for Science and Technology, Alexandria, Virginia, USA
| | - Joshua M Rosenow
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Joohi Jimenez-Shahed
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| |
Collapse
|
29
|
Evancho A, Tyler WJ, McGregor K. A review of combined neuromodulation and physical therapy interventions for enhanced neurorehabilitation. Front Hum Neurosci 2023; 17:1151218. [PMID: 37545593 PMCID: PMC10400781 DOI: 10.3389/fnhum.2023.1151218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Rehabilitation approaches for individuals with neurologic conditions have increasingly shifted toward promoting neuroplasticity for enhanced recovery and restoration of function. This review focuses on exercise strategies and non-invasive neuromodulation techniques that target neuroplasticity, including transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and peripheral nerve stimulation (PNS). We have chosen to focus on non-invasive neuromodulation techniques due to their greater potential for integration into routine clinical practice. We explore and discuss the application of these interventional strategies in four neurological conditions that are frequently encountered in rehabilitation settings: Parkinson's Disease (PD), Traumatic Brain Injury (TBI), stroke, and Spinal Cord Injury (SCI). Additionally, we discuss the potential benefits of combining non-invasive neuromodulation with rehabilitation, which has shown promise in accelerating recovery. Our review identifies studies that demonstrate enhanced recovery through combined exercise and non-invasive neuromodulation in the selected patient populations. We primarily focus on the motor aspects of rehabilitation, but also briefly address non-motor impacts of these conditions. Additionally, we identify the gaps in current literature and barriers to implementation of combined approaches into clinical practice. We highlight areas needing further research and suggest avenues for future investigation, aiming to enhance the personalization of the unique neuroplastic responses associated with each condition. This review serves as a resource for rehabilitation professionals and researchers seeking a comprehensive understanding of neuroplastic exercise interventions and non-invasive neuromodulation techniques tailored for specific diseases and diagnoses.
Collapse
Affiliation(s)
- Alexandra Evancho
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William J. Tyler
- Department of Biomedical Engineering, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Physical Medicine and Rehabilitation, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Keith McGregor
- Department of Clinical and Diagnostic Studies, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| |
Collapse
|
30
|
Dornas FM, Bispo FMM, Viana YG, Vasconcelos JM, de Carvalho Lana R, Polese JC. Predictors of balance in individuals with Parkinson's disease: A cross-sectional study. J Bodyw Mov Ther 2023; 35:64-68. [PMID: 37330804 DOI: 10.1016/j.jbmt.2023.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/09/2023] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Some previous studies investigated predictors of balance in individuals with Parkinson's Disease (PD). However, outcomes commonly evaluated in the rehabilitation of individuals with PD that could predict balance deficits have not yet been investigated. OBJECTIVE To determine whether the variables muscle strength, physical activity and depression are predictors of balance in individuals with PD. MATERIAL AND METHODS This is a cross-sectional study in which the investigated variables included: trunk and knee extensors' muscle strength (modified sphygmomanometer test - MST), physical activity level (Adjusted Human Activity Profile score) and depression (Patient Health Questionnaire-9 - PHQ-9). The outcome variable was balance, as assessed by the Mini-BESTest. Multiple regression analysis was used to determine which predictor variables explain the outcome variable. RESULTS A total of 50 individuals with PD, mean age 67 ± 8.8 years, 68% male, 40% HY 2.5 were included. The mean value of the dominant limb extensor muscle strength was 139 ± 45 mmHg, and the mean trunk extensor muscle strength value was 81.9 ± 19 mmHg. More than half of the sample (52%, n = 26) was classified as moderately active. Most of the sample (78%) had mild depression. The average Mini-BESTest score was 21 ± 5.4. The physical activity level explained 29% of the balance variance. When depression was included in the model, the explained variance increased to 35%. The other independent variables were not included in the model. CONCLUSION The findings of the present study showed that the physical activity level and depression were able to explain 35% of the balance variation.
Collapse
Affiliation(s)
- Fernanda Maciel Dornas
- Post Graduate Program of Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Flavia Meire Marques Bispo
- Post Graduate Program of Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Yasmine Guimarães Viana
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Julia Mafra Vasconcelos
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Raquel de Carvalho Lana
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Janaine Cunha Polese
- Post Graduate Program of Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil; Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.
| |
Collapse
|
31
|
Meulenberg CJW, Rehfeld K, Jovanović S, Marusic U. Unleashing the potential of dance: a neuroplasticity-based approach bridging from older adults to Parkinson's disease patients. Front Aging Neurosci 2023; 15:1188855. [PMID: 37434737 PMCID: PMC10331838 DOI: 10.3389/fnagi.2023.1188855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder that affects >1% of individuals worldwide and is manifested by motor symptoms such as tremor, rigidity, and bradykinesia, as well as non-motor symptoms such as cognitive impairment and depression. Non-pharmacological interventions such as dance therapy are becoming increasingly popular as complementary therapies for PD, in addition to pharmacological treatments that are currently widely available. Dance as a sensorimotor activity stimulates multiple layers of the neural system, including those involved in motor planning and execution, sensory integration, and cognitive processing. Dance interventions in healthy older people have been associated with increased activation of the prefrontal cortex, as well as enhanced functional connectivity between the basal ganglia, cerebellum, and prefrontal cortex. Overall, the evidence suggests that dance interventions can induce neuroplastic changes in healthy older participants, leading to improvements in both motor and cognitive functions. Dance interventions involving patients with PD show better quality of life and improved mobility, whereas the literature on dance-induced neuroplasticity in PD is sparse. Nevertheless, this review argues that similar neuroplastic mechanisms may be at work in patients with PD, provides insight into the potential mechanisms underlying dance efficacy, and highlights the potential of dance therapy as a non-pharmacological intervention in PD. Further research is warranted to determine the optimal dance style, intensity, and duration for maximum therapeutic benefit and to determine the long-term effects of dance intervention on PD progression.
Collapse
Affiliation(s)
| | - Kathrin Rehfeld
- Institute for Sport Science, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Saša Jovanović
- Faculty of Physical Education and Sport, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Uros Marusic
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Department of Health Sciences, Alma Mater Europaea–ECM, Maribor, Slovenia
| |
Collapse
|
32
|
Ginis P, Goris M, De Groef A, Blondeel A, Gilat M, Demeyer H, Troosters T, Nieuwboer A. Validation of Commercial Activity Trackers in Everyday Life of People with Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2023; 23:4156. [PMID: 37112496 PMCID: PMC10144957 DOI: 10.3390/s23084156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 06/19/2023]
Abstract
Maintaining physical activity is an important clinical goal for people with Parkinson's disease (PwPD). We investigated the validity of two commercial activity trackers (ATs) to measure daily step counts. We compared a wrist- and a hip-worn commercial AT against the research-grade Dynaport Movemonitor (DAM) during 14 days of daily use. Criterion validity was assessed in 28 PwPD and 30 healthy controls (HCs) by a 2 × 3 ANOVA and intraclass correlation coefficients (ICC2,1). The ability to measure daily step fluctuations compared to the DAM was studied by a 2 × 3 ANOVA and Kendall correlations. We also explored compliance and user-friendliness. Both the ATs and the DAM measured significantly fewer steps/day in PwPD compared to HCs (p < 0.01). Step counts derived from the ATs showed good to excellent agreement with the DAM in both groups (ICC2,1 > 0.83). Daily fluctuations were detected adequately by the ATs, showing moderate associations with DAM-rankings. While compliance was high overall, 22% of PwPD were disinclined to use the ATs after the study. Overall, we conclude that the ATs had sufficient agreement with the DAM for the purpose of promoting physical activity in mildly affected PwPD. However, further validation is needed before clinical use can be widely recommended.
Collapse
Affiliation(s)
- Pieter Ginis
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), 3000 Leuven, Belgium
| | - Maaike Goris
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), 3000 Leuven, Belgium
| | - An De Groef
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders (GRID), 3000 Leuven, Belgium
- MOVANT Research Group, Department of Rehabilitation Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Astrid Blondeel
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders (GRID), 3000 Leuven, Belgium
- Pulmonary Rehabilitation, Respiratory Department, University Hospitals Gasthuisberg, 3000 Leuven, Belgium
| | - Moran Gilat
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), 3000 Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders (GRID), 3000 Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders (GRID), 3000 Leuven, Belgium
- Pulmonary Rehabilitation, Respiratory Department, University Hospitals Gasthuisberg, 3000 Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), 3000 Leuven, Belgium
| |
Collapse
|
33
|
Lorenzo-García P, Núñez de Arenas-Arroyo S, Cavero-Redondo I, Guzmán-Pavón MJ, Priego-Jiménez S, Álvarez-Bueno C. Physical Exercise Interventions on Quality of Life in Parkinson Disease: A Network Meta-analysis. J Neurol Phys Ther 2023; 47:64-74. [PMID: 36730998 DOI: 10.1097/npt.0000000000000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Physical exercise is considered an effective intervention for maintaining or improving quality of life (QoL) in patients with Parkinson disease (PD), but there is no evidence showing which type of physical exercise intervention has more positive effects. This systematic review and meta-analysis aimed to synthesize the evidence regarding the effectiveness of exercise interventions on improving QoL in patients with PD, comparing different types of exercise interventions. METHODS A literature search was conducted through January 2022. The methodological quality of the trials was assessed using the Cochrane risk of bias tool RoB2. For the meta-analysis, physical exercise interventions were classified into 5 training categories: resistance, endurance, alternative exercises, dance, and sensorimotor interventions. A standard meta-analysis and network meta-analysis were carried out to evaluate the efficacy of the different types of physical exercise interventions. RESULTS The search retrieved 2451 studies, 48 of which were included in this network meta-analysis with a total of 2977 patients with PD. The indirect effects of the network meta-analysis showed positive results for alternative exercises (-0.46; 95% confidence interval [CI]: -0.76, -0.16), dance (-0.63; 95% CI: -1.08, -0.17), and sensorimotor interventions (-0.23; 95% CI: -0.40, -0.07) versus control comparisons. DISCUSSION AND CONCLUSIONS More research is needed to determine the types of physical exercise interventions that are most beneficial and for which conditions of the disease they have the most positive effects.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A398 ).
Collapse
Affiliation(s)
- Patricia Lorenzo-García
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain (P.L.-G., S.N.d.A.-A., C.Á.-B.); Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile (I.C.-R.) Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay (C.Á.-B.); Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain (M.J.G.-P.); and Hospital Virgen de la Luz, Hermandad de Donantes de Sangre, Cuenca, Spain (S.P.-J.)
| | | | | | | | | | | |
Collapse
|
34
|
Gauthier LV, Rider JV, Donkers S. Applying Behavior Change Techniques to Support Client Outcomes in Outpatient Neurorehabilitation: A Clinician Guide. Arch Phys Med Rehabil 2023; 104:711-715. [PMID: 36502892 DOI: 10.1016/j.apmr.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022]
|
35
|
Heyn PC, Wong DC, Hirsch MA, van Wegen EEH, Hein A, Sood P. Falls Prevention, Home Safety, and Rehabilitation Services for People With Parkinson Disease: A Client and Caregiver Guide. Arch Phys Med Rehabil 2023:S0003-9993(23)00089-8. [PMID: 36758716 DOI: 10.1016/j.apmr.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 02/10/2023]
Affiliation(s)
- Patricia C Heyn
- Center for Optimal Aging, Professor of Physical Therapy, School of Health Sciences, Marymount University, 4040 Fairfax Drive, Unit 211, Arlington VA 22203, USA.
| | - Diana Chen Wong
- Clinical Adjunct Faculty, New York University, Steinhardt School of Culture, Education, and Human Development, Department of Occupational Therapy, 82 Washington Square East, 6th Floor, New York, NY 10003
| | - Mark A Hirsch
- Dept of Physical Medicine and Rehabilitation, Carolinas Rehabilitation; Adjunct Professor, Department of Orthopedic Surgery and Rehabilitation, Wake Forest School of Medicine; Director, Department of PM&R Residency Research Education Program, Carolinas Rehabilitation; Director, Parkinson and Movement Disorders Lab, Carolinas Rehabilitation, Office: 704-355-7673, Fax: 704-355-0709. https://twitter.com/MarkAHirsch
| | - E E H van Wegen
- Department of Rehabilitation Medicine, Amsterdam UMC location VUmc, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Art Hein
- Clinical Specialist-Parkinson's Disease, Certified Myofascial Trigger Point Therapist Carolinas Rehabilitation-Indian Trail, 6048 West Hwy 74, Indian Trail, North Carolina 28079, 980-993-5540 OFFICE, 980-993-5542 FAX; Atrium Health, Carolinas HealthCare System is Atrium Health
| | - Pallavi Sood
- Center for Optimal Aging, Marymount University, Arlington, VA, 22203 USA
| |
Collapse
|
36
|
Improvement of Balance, Motor Aspects, and Activities of Daily Living in Parkinson's Disease after a Sequential Multimodal Aquatic- and Land-Based Intervention Program. Rehabil Res Pract 2023; 2023:2762863. [PMID: 36654865 PMCID: PMC9842425 DOI: 10.1155/2023/2762863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/29/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative, with heterogeneous clinical conditions and motor changes that reduce functioning. Postural instability is one of the motor aspects of disease progression, with a potential increase in the risk of falls, consequently affecting the activities of daily living (ADL). The objective of this study was to verify the influence of a multimodal intervention program (MIP) sequentially applied in aquatic- (AEs) and land-based environments (LEs) on balance, postural control, motor activities, and ADL in people with PD. It is an interventional clinical study with patients in stages 1 to 4 in the Hoehn and Yahr scale, assessed with Berg Balance Scale (BBS), Mini-Balance Evaluation System Test (Mini-BESTest), Unified Parkinson's Disease Rating Scale (UPDRS) II and III, Dynamic Gait Index (DGI), and quiet stance (QS) analysis in a force platform. The MIP was conducted sequentially with aquatic- (AIs) and land-based interventions (LIs) for 12 weeks each, twice a week, each session lasting 1 hour, and a 12-week interval between interventions. The comparison analysis was made with Friedman ANOVA, and the multiple comparisons with Wilcoxon signed-rank, Bonferroni correction, and effect size (r). The sample comprised 18 people with PD (66.83 ± 11.74 years). The AI and the full intervention (FI) had a large effect according to BBS. With Mini-BESTest, the LI and FI had a large effect. According to UPDRS II, the MIP improved ADL after LI, with a medium effect, and the motor aspects of UPDRS III improved after LI and FI, with a large effect. DGI was not sensitive in the analyses, with a ceiling effect after FI. No differences were identified in QS analyses. This research identified improved balance, ADL, and motor aspects in people with PD after sequential MIP in AI and LI, indicating that land-based and aquatic interventions are complementary and advantageous to people with PD.
Collapse
|
37
|
Le Sant G, Lecharte T, Goreau V, Nordez A, Gross R, Cattagni T. Motor performance, motor impairments, and quality of life after eccentric resistance training in neurological populations: A systematic review and meta-analyses. NeuroRehabilitation 2023; 53:33-50. [PMID: 37424484 DOI: 10.3233/nre-230035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND Many overlapping factors impair motor performance and quality of life in neurological patients. Eccentric resistance training (ET) has potential benefits for improving motor performance and treating motor impairments better than some traditional rehabilitation approaches. OBJECTIVE To estimate the effect of ET in neurological settings. METHODS Seven databases were reviewed up to May 2022 according to PRSIMA guidelines to find randomized clinical trials involving adults with a neurological condition, who underwent ET as set by the American College of Sports Medicine. Motor performance (main outcome) was assessed as strength, power and capacities during activity. Secondary outcomes (impairments) were muscle structure, flexibility, muscle activity, tone, tremor, balance and fatigue. Tertiary outcomes were risk of fall, and self-reports of quality of life. RESULTS Ten trials were included, assessed using Risk of Bias 2.0 tool, and used to compute meta-analyses. Effective effects in favour of ET were found for strength and power, but not for capacities during activity. Mixed results were found for secondary and tertiary outcomes. CONCLUSION ET may be a promising intervention to better improve strength/power in neurological patients. More studies are needed to improve the quality of evidence underlying changes responsible for these results.
Collapse
Affiliation(s)
- Guillaume Le Sant
- Movement - Interactions - Performance (MIP), CHU Nantes, University of Nantes, Nantes, France
- School of Physiotherapy, IFM3, R, Saint-Sébastien-sur-Loire, France
| | - Thomas Lecharte
- Movement - Interactions - Performance (MIP), CHU Nantes, University of Nantes, Nantes, France
| | - Valentin Goreau
- Movement - Interactions - Performance (MIP), CHU Nantes, University of Nantes, Nantes, France
- School of Physiotherapy, IFM3, R, Saint-Sébastien-sur-Loire, France
| | - Antoine Nordez
- Movement - Interactions - Performance (MIP), CHU Nantes, University of Nantes, Nantes, France
- Institut Universitaire de France (IUF), Paris, France
| | - Raphaël Gross
- Movement - Interactions - Performance (MIP), CHU Nantes, University of Nantes, Nantes, France
| | - Thomas Cattagni
- Movement - Interactions - Performance (MIP), CHU Nantes, University of Nantes, Nantes, France
| |
Collapse
|
38
|
Zajac JA, Porciuncula F, Cavanaugh JT, McGregor C, Harris BA, Smayda KE, Awad LN, Pantelyat A, Ellis TD. Feasibility and Proof-of-Concept of Delivering an Autonomous Music-Based Digital Walking Intervention to Persons with Parkinson's Disease in a Naturalistic Setting. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1253-1265. [PMID: 37840504 PMCID: PMC10657706 DOI: 10.3233/jpd-230169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Reduced motor automaticity in Parkinson's disease (PD) negatively impacts the quality, intensity, and amount of daily walking. Rhythmic auditory stimulation (RAS), a clinical intervention shown to improve walking outcomes, has been limited by barriers associated with the need for ongoing clinician input. OBJECTIVE To assess the feasibility, proof-of-concept, and preliminary clinical outcomes associated with delivering an autonomous music-based digital walking intervention based on RAS principles to persons with PD in a naturalistic setting. METHODS Twenty-three persons with PD used the digital intervention independently for four weeks to complete five weekly 30-minute sessions of unsupervised, overground walking with music-based cues. The intervention progressed autonomously according to real-time gait sensing. Feasibility of independent use was assessed by examining participant adherence, safety, and experience. Intervention proof-of-concept was assessed by examining spatiotemporal metrics of gait quality, daily minutes of moderate intensity walking, and daily steps. Preliminary clinical outcomes were assessed following intervention completion. RESULTS Participants completed 86.4% of sessions and 131.1% of the prescribed session duration. No adverse events were reported. Gait speed, stride length, and cadence increased within sessions, and gait variability decreased (p < 0.05). Compared to baseline, increased daily moderate intensity walking (mean Δ= +21.44 minutes) and steps (mean Δ= +3,484 steps) occurred on designated intervention days (p < 0.05). Quality of life, disease severity, walking endurance, and functional mobility were improved after four weeks (p < 0.05). CONCLUSIONS Study findings supported the feasibility and potential clinical utility of delivering an autonomous digital walking intervention to persons with PD in a naturalistic setting.
Collapse
Affiliation(s)
- Jenna A. Zajac
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Franchino Porciuncula
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - James T. Cavanaugh
- Department of Physical Therapy, University of New England, Portland, ME, USA
| | - Colin McGregor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Louis N. Awad
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Alexander Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Terry D. Ellis
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| |
Collapse
|
39
|
Guseva OV, Zhukova NG. [Rehabilitation's possibility of the patients with severe Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:56-60. [PMID: 36946398 DOI: 10.17116/jnevro202312303156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE The application of the individual rehabilitating approach by hypokinesia and lack of physical activity in severe Parkinson's disease patient. MATERIAL AND METHODS In the study were 43 patients with Parkinson's disease (17 men and 26 women; at the age 68.39±7.18 years) with 3-4 stage Hoehn and Yahr included. The physical state was previously defined. 10 individual complex lessons with the power exercises, the transfer training with external cueing, flexibility, balance-therapy, preparation of somatoreception to walking and the walking were in patient's stage with walking speed evaluation after the therapy conducted. RESULTS Before the treatment 25 (58%) persons could not the test «6 minutes walking» perform, the time of the test «Up and Go» was lengthened and the grip strength was decreased, moreover in women the grip strength was less critical level. After the treatment the all patients participated in the test «6 minutes walking». Walking distance increased by 32.17 meter; p<0.01. THE CONCLUSION The individual complex rehabilitation in patient stage's approach in severe Parkinson's disease patient let improve the walking.
Collapse
Affiliation(s)
- O V Guseva
- Siberian State Medical University, Tomsk, Russia
| | - N G Zhukova
- Siberian State Medical University, Tomsk, Russia
| |
Collapse
|
40
|
Lang CE, Holleran CL, Strube MJ, Ellis TD, Newman CA, Fahey M, DeAngelis TR, Nordahl TJ, Reisman DS, Earhart GM, Lohse KR, Bland MD. Improvement in the Capacity for Activity Versus Improvement in Performance of Activity in Daily Life During Outpatient Rehabilitation. J Neurol Phys Ther 2023; 47:16-25. [PMID: 35930404 PMCID: PMC9750113 DOI: 10.1097/npt.0000000000000413] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We addressed questions about the potential discrepancy between improvements in activity capacity and improvements in activity performance in daily life. We asked whether this discrepancy is: Common in routine, outpatient care, or an artifact of intervention studies? Unique to upper limb (UL) rehabilitation, or is it seen in walking rehabilitation too? Only seen in persons with stroke, or a broader neurorehabilitation problem?
Collapse
Affiliation(s)
- Catherine E. Lang
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Carey L. Holleran
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Michael J Strube
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Terry D. Ellis
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Caitlin A. Newman
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Meghan Fahey
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Tamara R. DeAngelis
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Timothy J. Nordahl
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Darcy S. Reisman
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Gammon M. Earhart
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Keith R. Lohse
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Marghuretta D. Bland
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| |
Collapse
|
41
|
King LA, Carlson-Kuhta P, Wilhelm JL, Lapidus JA, Dale ML, Talman LS, Barlow N, Mancini M, Horak FB. TURN-IT: a novel turning intervention program to improve quality of turning in daily life in people with Parkinson's disease. BMC Neurol 2022; 22:442. [PMID: 36443737 PMCID: PMC9703770 DOI: 10.1186/s12883-022-02934-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND People with Parkinson's disease (PD) have a high fall rate and many falls are associated with turns. Despite this, there is minimal research on effects of rehabilitation on the quality of turns. Further, quantifying turns in the home may have broader implications since rehabilitation of turns would ideally improve turning in real world mobility. METHODS Sixty people with PD and a history of falls will be randomized to receive either a novel TURNing InTervention (TURN-IT) or no intervention (control group). The TURN-IT group will be seen for 6 weeks (18 visits) for an individualized, progressive program that is based on the specific constraints of turning in PD. Wearable sensors will be used to measure 7 days of mobility, including turns, before and after intervention or control period. In addition, blinded assessments of gait, mobility and turns will occur before and after intervention for both groups and falls will be monitored for twelve months post intervention with bimonthly email questionnaires. DISCUSSION This study has the potential to change how we rehabilitate and assess turning in people with PD and falls. There are several novel aspects to our study including a comprehensive turning-focused intervention that is tailored to the underlying constraints that impair turning in people with PD. Further, our outcome measure of turning quality during 7 days of daily life is novel and has implications for determining real-life changes after rehabilitation. The ultimate goal of this rehabilitation intervention is to improve how patients turn in daily life and to reduce falls. TRIALS REGISTRATION This protocol is registered at clinicaltrials.gov; #NCT04897256; https://clinicaltrials.gov/ct2/show/NCT04897256?term=Horak&cond=Parkinson+Disease&draw=2&rank=4 .
Collapse
Affiliation(s)
- L A King
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
| | - P Carlson-Kuhta
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - J L Wilhelm
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - J A Lapidus
- School of Public Health, Oregon Health & Science University, Portland State University, Portland, OR, USA
| | - M L Dale
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - L S Talman
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - N Barlow
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - M Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - F B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA.,APDM Wearable Technologies, a Clario Company, Portland, OR, USA
| |
Collapse
|
42
|
Roberts M. Invited Clinical Commentary On: Wellness Aging Model Related to Inactivity, Illness, and Injury (WAMI-3): A Tool to Encourage Prevention in Practice. J Geriatr Phys Ther 2022; 45:178-179. [PMID: 36256918 DOI: 10.1519/jpt.0000000000000367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Mary Roberts
- Canton Therapies-Canton Health Center, University of Michigan Medical Group, Canton
| |
Collapse
|
43
|
Torriani-Pasin C, Domingues VL, de Freitas TB, Silva TAD, Caldeira MF, Júnior RPA, Lara ARF, Antonio BDA, Palma GCDS, Makhoul MP, Mochizuki L. Adherence rate, barriers to attend, safety and overall experience of a physical exercise program via telemonitoring during COVID-19 pandemic for individuals with Parkinson's disease: A feasibility study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1959. [PMID: 35633094 PMCID: PMC9348085 DOI: 10.1002/pri.1959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/30/2022] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
Background Telemonitoring can maintain daily exercise routine during the COVID‐19 pandemic of individuals with Parkinson's disease (PD). However, there are barriers to adherence and attendance with remote physical rehabilitation. The main objective of this study was to evaluate adherence rate, barriers to attendance, and safety of a telemonitoring program for individuals with PD; and secondarily to evaluate the individual and their family members perceived overall experience when performing the telemonitoring physical exercise program. Methods This was a phase 1 of a clinical trial, engaging 19 individuals with idiopathic PD of an in‐person community rehabilitation program. For 24 weeks an asynchronous telemonitoring physical exercise program delivered two sessions per week by video including warm‐up, balance, aerobic and resistance exercises, and cool‐down. During the remote program were verified: adherence rate at entrance, attendance rate, barriers to attend, safety, and overall experience of the program. Results and conclusion Only one participant did not perform any session and 18 participants completed between 2 and 34 sessions. Participants with a caregiver showed higher attendance rates. The most frequently cited barriers to attend the program were: pain; lack of motor skills; and reduced physical fitness. In relation to safety of the program, the most frequently reported was fear of falling. Although participants reported the telemonitoring program induced health benefits and they had positive experiences for themselves and for their families, most of participants prefer an in‐person program. In this sense, the asynchronous telemonitoring physical exercise program was safe, showed moderate adherence, with attendance rate depending on the presence of a companion.
Collapse
Affiliation(s)
- Camila Torriani-Pasin
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Vitoria Leite Domingues
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Tatiana Beline de Freitas
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | - Marina Portugal Makhoul
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Luis Mochizuki
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
44
|
Barbosa ER, Limongi JCP, Chien HF, Barbosa PM, Torres MRC. How I treat Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:94-104. [PMID: 35976316 PMCID: PMC9491431 DOI: 10.1590/0004-282x-anp-2022-s126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a complex neurodegenerative condition. Treatment strategies through all stages of disease progression could affect quality of life and influence the development of future complications, making it crucial for the clinician to be on top of the literature. OBJECTIVE This paper reviews the current treatment of PD, from early to advanced stages. METHODS A literature review was conducted focusing on the treatment of PD, in the different stages of progression. RESULTS Every individual with a new diagnosis of PD should be encouraged to start exercising regularly. In the early stage, treatment should focus on using the lowest dose of levodopa or combination therapy that provides maximum functional capacity, and does not increase the risk of complications, such as peak dose dyskinesias and impulse control disorders. At the moderate and advanced stages, motor fluctuations and complications of treatment dominate the picture, making quality of life one important issue. Rehabilitation programs can improve motor symptoms and should be offered to all patients at any stage of disease progression. CONCLUSION Many factors need to be considered when deciding on the best treatment strategy for PD, such as disease progression, presence of risk factors for motor and behavioral complications, potential side effects from dopaminergic therapy and phenotypical variabilities. Treatment should focus on functional capacity and quality of life throughout the whole disease course.
Collapse
Affiliation(s)
- Egberto Reis Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Grupo de Distúrbios do Movimento, São Paulo, SP, Brazil
| | - João Carlos Papaterra Limongi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Grupo de Distúrbios do Movimento, São Paulo, SP, Brazil
| | - Hsin Fen Chien
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Grupo de Distúrbios do Movimento, São Paulo, SP, Brazil
| | - Pedro Melo Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Grupo de Distúrbios do Movimento, São Paulo, SP, Brazil
| | - Marcela Reuter Carréra Torres
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Grupo de Distúrbios do Movimento, São Paulo, SP, Brazil
| |
Collapse
|
45
|
The Category of Conventional Physiotherapy: The Case of Parkinson’s Disease Guidelines. J Pers Med 2022; 12:jpm12050730. [PMID: 35629152 PMCID: PMC9143172 DOI: 10.3390/jpm12050730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/10/2022] Open
Abstract
This opinion paper reviews the use of the category of “conventional physiotherapy” (CPT) in Parkinson’s disease (PD)-relevant reviews and meta-analyses and points out serious inconsistencies within and among them. These are first discussed in general, leading to the conclusion that, in most cases, the category of CPT encompasses a range of incompatible interventions. This undermines previous conclusions about their superiority or inferiority relative to various other treatment modalities. Next, the update to the European Physiotherapy Guidelines is discussed in detail, since it treats CPT as a global and time-independent category per se, ascribing effects in various domains to it. This introduces several important biases into the findings presented in this publication. These are subsequently discussed, and it is concluded that the categorisation of various physiotherapy techniques under the umbrella term of CPT is empty, or even dangerous, and should be abandoned. Other categories are suggested as a replacement, including “Other Physiotherapy Techniques” and “Multimodal Training”.
Collapse
|