Psychological Benefits of Nonpharmacological Methods Aimed for Improving Balance in Parkinson's Disease: A Systematic Review

The therapeutic effects of yoga in people with Parkinson's disease: a mini-review

Parkinson's disease (PD) is one of the most common neurodegenerative diseases, second only to Alzheimer's disease. Drugs and deep brain stimulation (DBS) are the main treatments for PD. However, the long-term side effects of drugs and the risks of surgery cannot be ignored. It is therefore important to research safe and effective complementary and alternative therapies for PD. Yoga, an ancient mind-body exercise, has been widely used in health promotion. Although, yoga can address a range of health problems, little is known about its role in people with PD. This article reviews the evidence that yoga improves PD symptoms, including movement disorders, balance function and emotional disturbance. The authors analyze the role and shortcomings of the yoga intervention process, with the aim of providing a scientific basis for the application of yoga training to people with PD.

A wearable inertial system to evaluate Tai Chi training motor effects in patients with Parkinson's disease. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023;2023:1-4. [PMID: 38083600 DOI: 10.1109/embc40787.2023.10340906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Physical therapy is strongly recommended for patients with neurological disorders. Tai Chi-based treatments seem to improve physical functions like gait speed and balance. However, assessments after treatment rely on semi-quantitative clinical scales affected by subjectivity with controversial results. This study aims at investigating whether Tai Chi could be a valid alternative to traditional physiotherapy rehabilitation. We propose a wearable system composed of two inertial devices able to objectively measure the effect of the rehabilitation treatment on the range of movement of the trunk. Seventeen patients with Parkinson's Disease (PD) were recruited and assessed. They have been randomly divided into two groups: group 1 followed a Tai Chi-based treatment, while group 2 underwent a traditional physiotherapy rehabilitation. The two groups have been assessed before (t0) and after the treatment (t1). No statistical differences have been found in the relative range of motion between the upper and lower sensors between the two groups at the baseline. Both treatments resulted in a significant improvement in the trunk range of movement (on the right side). Notably, the improvement in the effect size of the treatment was greater in group 1 than in group 2. In fact, even if both the groups benefited from their treatment group 1 gained larger mobility of the trunk if compared to group 2. Interestingly, no differences have been accounted adopting the traditional UPDRS III for motor symptoms of PD, strengthening the idea that objective measurement coming from wearable biomedical sensors could detect information otherwise neglected by traditional clinical tools.Clinical Relevance- This study preliminary confirms that beneficial motor effects after a Tai Chi rehabilitation program are comparable and quite better than after traditional physiotherapy, promoting Tai Chi as a valid alternative treatment for PD patients.

Benefits of dance for Parkinson's: The music, the moves, and the company

Dance classes designed for people with Parkinson's are very popular and associated not only with increasing individuals' motor control abilities but also their mood; not least by providing a social network and the enjoyment of the music. However, quantitative evidence of the benefits is inconsistent and often lacks in power. For a better understanding of the contradictory findings between participants' felt experiences and existing quantitative findings in response to dance classes, we employed a mixed method approach that focussed on the effects of music. Participant experience of the dance class was explored by means of semi-structured interviews and gait changes were measured in a within-subjects design through the Timed Up and Go (TUG) test before and after class, with and without music. We chose the TUG test for its ecological validity, as it is a simple test that resembles movements done in class. We hypothesised that the music and the dance class would have a facilitating effect on the TUG performance. In line with existing research, we found that before class, the gait of 26 participants was significantly improved when accompanied by a soundtrack. However, after class, music did not have a significantly facilitating effect, yet gait without music significantly improved after class compared to before. We suggest that whilst the music acts as an external stimulator for movement before the dance class, after the dance class, participants have an internalised music or rhythm that supports their motor control. Thus, externally played music is of less relevance. The importance of music was further emphasised in the qualitative data alongside social themes. A better understanding of how music and dance affects Parkinson's symptoms and what aspects make individuals 'feel better' will help in the design of future interventions.

The Effects of a Dance and Music-Based Intervention on Parkinson's Patients' Well-Being: An Interview Study

Previous research has shown the positive effects of music and dance-based interventions on the physical and psychosocial symptoms of Parkinson’s disease (PD). The aims of this study were: (1) to investigate how PD patients subjectively perceive the emotional, cognitive, and social benefits of a music- and dance-based intervention; (2) to apply an innovative methodology for an interview analysis combining findings from a linguistic text with an analytic approach and conducted with the software LIWC and from the content analysis performed by human coders. Extensive, open-ended interviews were conducted with 13 patients with PD who had participated in a dance and music program. The interviews were analyzed using both human coders and the computer-based approach. The results show that emotional and social aspects are considered the most frequent perceived benefits of the dance program. The data confirm the positive impact of dance- and music-based programs on promoting participants’ emotional and social well-being. A combined approach to text analysis appears to be a promising way to achieve more in-depth insights into patients’ subjective perceptions.

Benefits of Tango Therapy in Alleviating the Motor and Non-Motor Symptoms of Parkinson’s Disease Patients—A Narrative Review

The present study examines the efficacy of tango therapy on motor and non-motor symptomatology in Parkinson’s disease, as detailed in articles published over the previous four decades (1980–2022). All data was collected using PubMed, Google Scholar, Web of Science, and Science Direct. The present descriptive study outlines the advantages of tango in the rehabilitation of Parkinson’s disease’s motor and non-motor symptoms. Numerous studies have been conducted to determine the usefulness of tango for people with PD. Information from various research is critical for determining if tango is a useful supplementary therapy for the variety of symptoms related to Parkinson’s disease. The purpose of this review was to describe the present state of research on this subject. Thus, the objective of this review is to promote awareness of tango therapy’s therapeutic benefits for Parkinson’s disease.

Effects of Health Qigong Exercise on Lower Limb Motor Function in Parkinson's Disease

Purpose

This study explored the effects of Health Qigong exercise on lower limb motor function in patients with Parkinson's disease (PD).

Patients and Methods

A total of 40 patients with PD were recruited and randomly allocated into the experimental group and the control group. The experimental group completed an intervention of Health Qigong exercise over 12 weeks, while the control group did not perform any regular physical activity. Data relating to gait, lower-limb joint range of motion, Timed Up and Go, as well as scores for motor function scale from the Unified Parkinson's Comprehensive Rating Scale III (UPCRS III) before and after the intervention were collected for Repeated Measure ANOVA.

Results

Compared to the control group, Health Qigong exercise improved the constant- and high-speed stride length and gait velocity of patients, but not constant- and high-speed stride frequency. Left and right hip flexion and extension range were improved as well as left and right knee flexion range. Finally, Timed Up and Go time became significantly slower and UPCRS III score significantly decreased.

Conclusion

Health Qigong exercise can improve walking ability and lower limb joint range of motion in patients with PD, lessen motor difficulties, and improve the quality of life. This non-pharmacological exercise intervention may be a useful adjustment treatment for PD.

The effect of Tai Chi on functional mobility, balance and falls in Parkinson's disease: A systematic review and meta-analysis of systematic reviews

BACKGROUND

The aim of the study was to evaluate the effect of Tai Chi on functional mobility, balance and falls in Parkinson's disease.

MATERIALS AND METHODS

A comprehensive literature search was conducted to identify the systematic reviews and meta-analyses up to the end of October 2021. 601 studies were identified, and 16 of them were included in our study.

RESULTS

According to our meta-analysis; there was a significant effect of Tai Chi on balance (SMD, -0.777 95% CI -0.921 to -0.633; p = 0.000), functional mobility (SMD, -0.719 95% CI -0.944 to -0.494; p = 0.000), and falls (SMD, -0.456 95% CI -0.668 to -0.245; p = 0.000) in PD.

CONCLUSION

Our systematic review and meta-analysis found significant effects of Tai Chi on functional mobility, balance and falls in patients with PD.

The impact of dance activities on the health of persons with Parkinson's disease in Sweden

Purpose: Parkinson’s disease (PD) is associated with motor and non-motor symptoms that negatively influence the person’s quality of life. To reduce illness and increase quality of life, alternative treatments of PD such as dance might be experienced as beneficial. The aim of this study was to explore experiences of how a dance program in Sweden influences perceived physical, social, and emotional wellbeing in persons with PD.

Method: A qualitative method with semi-structured interviews and content analysis was used, and 10 participants with variations in age, gender, and how long they had been diagnosed with the disease were interviewed.

Results: The results showed that dancing was experienced as improving health, which implied feeling both calmed and excited, getting better sleep, and being able to move with more focus and freedom. The dance program was experienced as a social context through the importance of community, feelings of togetherness, and being able to compare oneself with others. Experiences of self-support included experiencing increased self-esteem and joy, but also a sense of being confirmed and having structure, which gave meaning to everyday life.

Conclusions: To reduce illness and increase quality of life in persons with PD, it is important to investigate alternative treatment methods, and this study shows the importance of participating in a dance program in Sweden for the life situation and health of people with PD.

Systematic review and meta-analysis of randomised controlled trials on the effects of yoga in people with Parkinson's disease

PURPOSE

Yoga may be a beneficial treatment for people with Parkinson's disease (PD). However, no studies have critically reviewed and meta-analyzed the scientific evidence for yoga's benefits regarding motor and non-motor symptoms. The purpose of this study was to conduct a systematic review and meta-analysis on the effectiveness of yoga as a rehabilitation strategy for PD.

MATERIALS AND METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was performed using MEDLINE/PubMed, PEDro, SPORTDiscus, and Scopus. Studies addressing any concepts on the impact of yoga intervention on physical and psychological outcomes in people with PD were included.

RESULTS

Fourteen RCTs were selected, with heterogeneous protocols and outcomes measures. Yoga interventions were safe and well-accepted for patients with mild to moderate PD. The descriptive analysis indicated that its practice might provide both physical and psychological benefits. Preliminary evidence showed that yoga has comparable or superior efficacy to exercise. A subsequent meta-analysis on five RCTs detected that yoga was more effective than passive control in ameliorating motor symptoms.

CONCLUSIONS

Yoga appears to be a promising rehabilitative therapy for individuals with PD. Recommendations are proposed for future studies.IMPLICATIONS FOR REHABILITATIONYoga is a safe and feasible therapy for people with mild to moderate PD.Yoga practice positively impacts physical and mental health in this population.When compared to exercise, yoga showed to have similar or even greater effects.

Differences Between Exergaming Rehabilitation and Conventional Physiotherapy on Quality of Life in Parkinson's Disease: A Systematic Review and Meta-Analysis

Parkinson's disease (PD) is a neurodegenerative condition with both motor and non-motor symptoms affecting the quality of life (QoL) of older adults. Exergaming rehabilitation allows the interaction of the subject with digital games through the implementation of repetitive functional activities. Conventional physiotherapy uses patient-centered programs that include a variety of active exercises. The aim of this review was to look into the effectiveness of exergaming rehabilitation on the QoL of people with PD and compare it with conventional physiotherapy. Five electronic databases were searched for eligible studies until February 2021. For the statistical analysis, the mean, standard deviation, and 95% confidence interval were used to calculate effect sizes between groups. To determine heterogeneity, statistical index I ² was used. A total of 548 participants were included in 14 studies. Exergaming rehabilitation related with improved QoL (p = 0.687, 95% CI: -1.682 to -0.734), balance (p = 0.039, 95% CI: 0.364-13.689), (p = 0.018, 95% CI: 0.446-4.830), and gait (p = 0.005, 95% CI: 0.351-1.924). No significant difference was found between groups regarding the Unified Parkinson's Disease Rating Scale (p = 0.196, 95% CI: -5.970 to 1.225) and for the Timed Up and Go Test (p = 0.12, 95% CI: 0.446-4.830). Exergames as a rehabilitation method can be used to provide alternative interactive intervention with positive results for QoL in people with PD. Further investigation is needed to assess the effect on mental health in this population group.

A randomised controlled trial on effectiveness and feasibility of sport climbing in Parkinson's disease

Physical activity is of prime importance in non-pharmacological Parkinson’s disease (PD) treatment. The current study examines the effectiveness and feasibility of sport climbing in PD patients in a single-centre, randomised controlled, semi-blind trial. A total of 48 PD patients without experience in climbing (average age 64 ± 8 years, Hoehn & Yahr stage 2–3) were assigned either to participate in a 12-week sport climbing course (SC) or to attend an unsupervised physical training group (UT). The primary outcome was the improvement of symptoms on the Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale part III (MDS-UPDRS-III). Sport climbing was associated with a significant reduction of the MDS-UPDRS-III (−12.9 points; 95% CI −15.9 to −9.8), while no significant improvement was to be found in the UT (−3.0 points; 95% CI −6.0 to 0.1). Bradykinesia, rigidity and tremor subscales significantly improved in SC, but not in the unsupervised control group. In terms of feasibility, the study showed a 99% adherence of participants to climbing sessions and a drop-out rate of only 8%. No adverse events occurred. This trial provides class III evidence that sport climbing is highly effective and feasible in mildly to moderately affected PD patients.

Effects of Health Qigong Exercises on Physical Function on Patients with Parkinson's Disease

Purpose

To measure motor function improvements in patients with Parkinson's disease (PD) using Health Qigong exercises.

Patients and Methods

Fifty-two PD patients (Hoehn and Yahr stages I to IV) were randomly divided into experimental and control groups. Twenty-six PD patients in the experimental group were intervened with routine medicine and fitness Qigong exercise. The other 26 PD patients as the control group were treated only with regular medication. Twelve-week intervention had been conducted for the study, and participants completed the scheduled exercises 4 times per week for 60 minutes each time. Data which included the one-legged blind balance, physical coordination, and gait was collected before, during, and after the intervention. Comparisons were made between the experimental and control groups through the repeated measures analysis of variance.

Results

A total of 40 participants (77% response rate) completed the study. There was no significant difference in baseline data. After 12 weeks of Health Qigong therapy, the length of time the one-legged blind balance test had increased (P < 0.01), and the time it took to TUG test was reduced (P < 0.01). Joint range of motion and gait significantly improved. The control group's there were no significant differences in the above variables, except for joint range of motion, which decreased.

Conclusion

Health Qigong exercises can significantly improve physical functions in patients with PD, especially for the balance ability, gait, joint range of motion in patients with PD. It can reduce their activity risk factor and improve their quality of life.

Sociability-based fitness approach in Parkinson's disease: Comparison with conventional rehabilitation

BACKGROUND AND PURPOSE

The effect of a sociability-based fitness approach on parkinsonian disability in patients with Parkinson's disease (PD) was assessed.

METHODS

Eighty patients diagnosed with PD were randomly assigned to either the group-based rehabilitation (GBR) group (n = 40) or the individual-based rehabilitation (IBR) group (n = 40). The primary outcome was the difference between the two groups in the mean change from baseline to post-training in the total score on the Unified Parkinson's Disease Rating Scale (UPDRS). The secondary outcomes included the change in mental status and the difference in the mean change from baseline to month 3 and month 6 in the total score on the UPDRS.

RESULTS

The mean (±SD) UPDRS scores were 72.0 ± 21.0 in the GBR group and 72.1 ± 18.6 in the IBR group. The UPDRS scores from baseline to post-training were 22.8 ± 13.5 in the GBR group and 10.9 ± 8.8 in the IBR group (difference 11.8 points; 95% confidence interval [CI] 5.0-18.6; p = 0.001). The difference between the groups from baseline to month 3 (difference 10.06 points; 95% CI 3.3-16.8) and the difference between the groups from baseline to month 6 (difference 11.7 points; 95% CI 4.9-18.5) were also significant (p = 0.004 and p = 0.001, respectively). The scores of cognitive function and depression had not changed significantly.

CONCLUSIONS

Patients receiving GBR demonstrated significant improvements in parkinsonian symptoms, suggesting that the sociability-based fitness can be applied to clinical treatment by sustaining the motivation in PD.

How COVID-19 will boost remote exercise-based treatment in Parkinson's disease: a narrative review

The lack of physical exercise during the COVID-19 pandemic-related quarantine measures is challenging, especially for patients with Parkinson's disease (PD). Without regular exercise not only patients, but also nursing staff and physicians soon noticed a deterioration of motor and non-motor symptoms. Reduced functional mobility, increased falls, increased frailty, and decreased quality of life were identified as consequences of increased sedentary behavior. This work overviews the current literature on problems of supplying conventional physiotherapy and the potential of telerehabilitation, allied health services, and patient-initiated exercise for PD patients during the COVID-19 period. We discuss recent studies on approaches that can improve remote provision of exercise to patients, including telerehabilitation, motivational tools, apps, exergaming, and virtual reality (VR) exercise. Additionally, we provide a case report about a 69-year-old PD patient who took part in a 12-week guided climbing course for PD patients prior to the pandemic and found a solution to continue her climbing training independently with an outdoor rope ladder. This case can serve as a best practice example for non-instructed, creative, and patient-initiated exercise in the domestic environment in difficult times, as are the current. Overall, many recent studies on telemedicine, telerehabilitation, and patient-initiated exercises have been published, giving rise to optimism that facilitating remote exercise can help PD patients maintain physical mobility and emotional well-being, even in phases such as the COVID-19 pandemic. The pandemic itself may even boost the need to establish comprehensive and easy-to-do telerehabilitation programs.

Hatha yoga training improves standing balance but not gait in Parkinson's disease

Background and purpose

Complementary therapies, such as yoga, have been proposed to address gait and balance problems in Parkinson's disease (PD). However, the effects of yoga on gait and static balance have not been studied systematically in people with PD (PWP). Here we evaluated the effects of a 12-week long Hatha yoga intervention on biomechanical parameters of gait and posture in PWP.

Methods

We employed a pilot randomized controlled trial design with two groups of mild-to-moderate PWP (immediate treatment, waitlist control; N = 10 each; Mean Hoehn and Yahr score = 2 for each group). Baseline Unified Parkinson's Disease Rating Scale (UPDRS) motor scores, and gait and postural kinematics including postural sway path length, cadence, walking speed, and turning time were obtained. The immediate treatment group received a 60-min Hatha yoga training twice a week for 12 weeks, while the waitlisted control group received no training. After 12 weeks, gait and postural kinematics were assessed (post-test for treatment group and second-baseline for waitlist group). Then, the waitlist group received the same yoga training and was evaluated post-training.

Results

After Hatha yoga training, UPDRS motor scores improved with an 8-point mean decrease which is considered as a moderate clinically important change for mild-moderate PD. Sway path length during stance decreased significantly (mean reduction: -34.4%). No significant between-group differences or improvements in gait kinematics were observed.

Conclusion

This study showed that a 12-week Hatha yoga training can improve static balance in PWP. We found no evidence that it systematically improves gait performance in PWP.

Tai Chi versus routine exercise in patients with early- or mild-stage Parkinson's disease: a retrospective cohort analysis

Parkinson's disease cannot be cured but symptoms can be improved by making use of physical therapy. The objective of the study was to compare the effect of routine exercises and Tai Chi on physical and clinical performance in elderly people suffering from Parkinson's disease. Data from interviews, physical and clinical performance, and levodopa consumption of 500 patients with confirmed Parkinson's disease (severity level I to III) were collected and analyzed. Participants who received 80 min/day Tai Chi 3 times/week for 2 months were included in the Tai Chi (TC) group (n=250) and those who received 90 min/day routine exercise 3 times/week for 2 months were included in routine exercise (RE) group (n=250). Timed up-and-go, 50-foot speed walk, and functional reach were improved by Tai Chi and routine exercise (P<0.05 for all) but intensities of Tai Chi for improvement of such parameters was higher than routine exercise. Incidence of falls was decreased by both physical therapies (P<0.05 for all) but more for the TC group (P<0.0001, q=38.512). In the TC group, at the end of follow-up, 22 (9%) patients were successful in withdrawal of levodopa treatment. Also, the dose of levodopa was decreased in patients of the TC group who had to continue levodopa. Tai Chi had the potential to slow down the progression of symptoms of Parkinson's disease and delayed the introduction of levodopa (level of evidence: III).

Prevalence and Risk Factors of Depression and Anxiety in Essential Tremor Patients: A Cross-Sectional Study in Southwest China

Background: Essential tremor (ET) is one of the most common movement disorders, and it has been associated with anxiety and depression, but risk factors for these mental symptoms are unclear. This study aimed to evaluate the prevalence and potential risk factors of depression and anxiety in ET patients in China. Methods: This cross-sectional study involved 245 Han Chinese patients with ET. Depression was assessed using the Hamilton Depression Rating Scale-24 Items, and anxiety was assessed using the Hamilton Anxiety Rating Scale. Clinico-demographic characteristics were compared between patients with or without depression or anxiety. Results: We revealed that 63.3% of patients had at least mild anxiety and 54.3% had at least mild depression. Severity of anxiety or depression was correlated with lower Mini-Mental State Exam score (P = 0.028 and P = 0.002, respectively), higher self-report functional disability score (P = 0.027 and P = 0.003, respectively), as well as the presence of tremor in the neck (both P < 0.001), face (P = 0.025 and P < 0.001, respectively), or voice (both P < 0.001). Binary logistic regression identified female sex, presence with cranial tremor, and greater functional disability score as risk factors of anxiety; the last two factors were also the determinants of depression. Neither anxiety nor depression correlated with physician-assessed severity of arm or leg tremor. Conclusion: Chinese ET patients show high prevalence of depression and anxiety. ET patients should be screened for these mental symptoms, especially women and those with cranial tremor and self-reported functional disability.

Kinematic analysis of dance-based exergaming: effect of song pace on center of mass and joint mobility

[Purpose] To establish a quantitative kinematic assessment method for examining postural stability and physical mobility during dance-based exergaming. [Participants and Methods] Fifteen young adults participated in one session of dance-based exergaming assessment using segments from Kinect ‘Just Dance 3’ consisting of slow-, medium-, and fast-paced songs. A motion capture system was used to record full body kinematics, and a customized MATLAB code was used to compute the variables of interest, such as center of mass sway area, excursion, and peaks, as well as step count and joint excursions. [Results] Total center of mass sway area and excursion were significantly greater for slow-paced (total sway area=1,077.6 ± 209.9 cm²; total excursion=629.8 ± 380.5 cm) and fast-paced (total sway area=314.1 ± 133.6 cm²; total excursion=478.5 ± 149.0 cm) songs than for the medium-paced song (total sway area=212.9 ± 346.0 cm²; total excursion=311.2 ± 119.5 cm). Joint excursion was greater for the knee (ranging from: (slow to fast-paced songs: 55.5°–83.1°) and hip (slow to fast-paced: 40.6°–50.4°) than for the ankle (slow to fast-paced: 32.2°–46.7°) for all three dance paces. Additionally, step count was significantly, positively correlated with song pace (r=0.52). [Conclusion] The current study was able to quantify and provide normative values for postural control and joint mobility among healthy young adults during dance-based exergaming with 3 hip-hop songs of different paces from the Microsoft Kinect ‘Just Dance 3’. The results indicated that different paces (intensities) of dance songs corresponded to distinct movement kinematic trends, particularly with slow-paced song having the maximum center of mass excursion and lowest joint excursion, while fast-paced song exhibits the reverse, along with medium-paced song exhibiting the highest hip and ankle joint angle excursions, while the fast-paced song had increased knee joint angle excursions.

N-Acetyl Cysteine Is Associated With Dopaminergic Improvement in Parkinson's Disease

This study assessed the biological and clinical effects in patients with Parkinson's disease (PD) of N-acetyl-cysteine (NAC), the prodrug to l-cysteine, a precursor to the natural biological antioxidant glutathione. Forty-two patients with PD were randomized to either weekly intravenous infusions of NAC (50 mg/kg) plus oral doses (500 mg twice per day) for 3 months or standard of care only. Participants received prebrain and postbrain imaging with ioflupane (DaTscan) to measure dopamine transporter (DAT) binding. In the NAC group, significantly increased DAT binding was found in the caudate and putamen (mean increase from 3.4% to 8.3%) compared with controls (P < 0.05), along with significantly improved PD symptoms (P < 0.0001). The results suggest NAC may positively affect the dopaminergic system in patients with PD, with corresponding positive clinical effects. Larger scale studies are warranted.

Treatment of psychiatric disturbances in hypokinetic movement disorders

Introduction: We reviewed studies that assessed the treatment of psychiatric disturbances in Parkinson's disease and atypical parkinsonisms. Neuropsychiatric disturbances in these conditions are frequent and have a profound impact on quality of life of patients and of their caregivers. It is therefore important to be familiar with the appropriate pharmacological and non-pharmacological interventions for treating these disorders. Areas covered: The authors searched for papers in English in Pubmed using the following keywords: Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, Lewy body dementia, depression, apathy, anxiety, fatigue, sleep disorders, obsessive compulsive disorders, psychosis, hallucinations, delusions, impulse control disorders. Expert opinion: In Parkinson's disease, depression may benefit from the optimization of dopaminergic therapy, from the use of antidepressants acting on both the serotoninergic and noradrenergic pathways and from cognitive behavioral therapy. Psychosis in Parkinson's disease may improve with the use of clozapine; the serotonin inverse agonist pimavanserin has been shown to be effective. Treatment of impulse control disorders is primarily based on the removal of dopamine agonists. No controlled studies have investigated the treatment of neuropsychiatric disorders in multiple system atrophy, progressive supranuclear palsy or corticobasal degeneration. Acethylcholinesterase inhibitors may be used to treat hallucinations in Lewy body dementia.

Efficacy of yoga, tai chi and qi gong on the main symptoms of chronic obstructive pulmonary disease: A systematic review

INTRODUCTION

The aim of this systematic review was to summarize the effects of yoga, qi gong or tai chi in COPD patients.

METHODS

Studies evaluating effects of the selected complementary therapies on lung function, dyspnea, quality of life or functional exercise capacity in COPD patients were identified and reviewed from three databases.

RESULTS

Eighteen studies were included. Six studies evaluated the effects of yoga and the others focused on tai chi or qi gong separately or combined. The duration of the programs ranged from 6 weeks to 6 months and the frequency from 2 to 7 times a week. Each session reached 30 to 90 minutes. Benefits were observed on lung function and functional exercise capacity but benefit was clearly stated neither on quality of life nor on dyspnea.

CONCLUSION

This systematic review highlights the potential of these therapies as complementary therapeutic approach in COPD patients.

Effects of Tai Chi Exercise on Reducing Falls and Improving Balance Performance in Parkinson's Disease: A Meta-Analysis

Introduction

Parkinson's disease (PD) is a common neurodegenerative disorder that may increase the risk of falls, functional limitation, and balance deficits. Tai Chi was used as an option for improving balance in people with PD. The aim of this meta-analysis was to evaluate the effects of Tai Chi on falls, balance, and functional mobility in individuals with PD.

Method

The literature search was conducted in PubMed, the Cochrane Library, CINAHL, PEDro, Medline, Embase, sportDISCUS, Trip, and the National Digital Library of Theses and Dissertations in Taiwan. Randomized controlled trials (RCTs) analyzing the effects of Tai Chi, compared to no intervention or to other physical training, on falls, functional mobility, and balance in PD patients were selected. The outcome measurements included fall rates, Berg Balance Scale (BBS), Functional Reach (FR) test, and the Timed Up and Go (TUG) test. Two reviewers independently assessed the methodological quality and extracted data from the studies using the PEDro scale.

Results

Five RCTs that included a total of 355 PD patients were included in this review. The quality of evidence in these studies was rated as moderate to high. Compared to no intervention or other physical training, Tai Chi significantly decreased fall rates (odds ratio = 0.47, 95% confidence interval (CI) 0.30 to 0.74, and p=0.001) and significantly improved balance and functional mobility (BBS mean difference (MD) = 3.47, 95% CI 2.11 to 4.80, and p < 0.001; FR MD = 3.55 cm, 95% CI 1.88 to 5.23, and p < 0.001; TUG MD = −1.06 s, 95% CI −1.61 to −0.51, and p < 0.001) in people with PD.

Conclusion

This meta-analysis provides moderate- to high-quality evidence from five RCTs that Tai Chi could be a good physical training strategy for preventing falls and improving balance and functional mobility in people with PD.

Finding Parameters around the Abdomen for a Vibrotactile System: Healthy and Patients with Parkinson's Disease

Freezing of Gait (FOG) is one of the most disabling gait disorders in Parkinson's Disease (PD), for which the efficacy of the medication is reduced, highlighting the use of non-pharmacological solutions. In particular, patients present less difficulties in overcoming FOG when using feedback and especially with Biofeedback Systems. In this study it is intended to detect the frequency threshold and the minimum interval of perception of the vibrotactile feedback, through a proposed wearable system, a waistband. Experimental tests were carried out that considered a temporal, spatial and spatiotemporal context, for which 15 healthy and 15 PD patients participated. It was detected as threshold frequency 180 Hz and for minimum interval of vibration perception 250 ms. The identification of this threshold frequency and this interval will allow us to select the frequency and the minimum interval of vibration to be used in a Vibrotactile Biofeedback Device for patients with PD, in order to help them to overcome FOG.

Physical Activity, Fatigue, and Sleep in People with Parkinson's Disease: A Secondary per Protocol Analysis from an Intervention Trial

Symptoms of Parkinson's can result in low physical activity and poor sleep patterns which can have a detrimental effect on a person's quality of life. To date, studies looking into exercise interventions for people with Parkinson's (PwP) for symptom management are promising but inconclusive. The aim of this study is to estimate the effect of a clearly defined exercise prescription on general physical activity levels, fatigue, sleep, and quality of life in PwP. Method. PwP randomised into either an exercise group (29; 16 males, 13 females; mean age 67 years (7.12)) or a control handwriting group (36; 19 males; 17 females; mean age 67 years (5.88)) as part of a larger trial were included in this substudy if they had completed a 6-month weekly exercise programme (intervention group) and had complete objective physical activity data (intervention and control group). Sleep and fatigue were recorded from self-reported measures, and physical activity levels measured through the use of accelerometers worn 24 hours/day over a seven-day testing period at baseline and following the 24-week intervention. A Wilcoxon's test followed by a Mann-Whitney post hoc analysis was used, and effect sizes were calculated. Results. Participants showed a significant increase in time spent in sedentary and light activities during the overnight period postintervention in both exercise and handwriting groups (p < 0.05) with a moderate effect found for the change in sedentary and light activities in the overnight hours for both groups, over time (0.32 and 0.37-0.38, resp.). There was no impact on self-reported fatigue or sleep. Conclusion. The observed moderate effect on sedentary and light activities overnight could suggest an objective improvement in sleep patterns for individuals participating in both exercise and handwriting interventions. This supports the need for further studies to investigate the role of behavioural interventions for nonmotor symptoms.

"Dance Therapy" as a psychotherapeutic movement intervention in Parkinson's disease

BACKGROUND

Previous studies in Parkinson's Disease (PD) have described benefits of dance for motor and non-motor outcomes, yet few studies specifically look at Dance Therapy (DT) as a specific psychotherapeutic model for PD. DT is the psychotherapeutic use of movement to improve physical, emotional, cognitive, and social integration and wellbeing.

OBJECTIVE

1) Explore the safety and feasibility of a 10-week DT program for PD. 2) Collect pilot data on efficacy of DT.

DESIGN/METHODS

Prospective, randomized-controlled study in subjects with PD. 13 participants randomized 2:1 to DT (n = 9) or support group (n = 4). Assessments were completed 1-2 weeks prior to the first session and after the final session, and included attendance, Hoehn and Yahr Scale (H&Y), Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Montreal Cognitive Assessment, Timed Up and Go, Berg Balance Scale, Beck Depression Inventory, Fatigue Severity Scale, Visual Analog Fatigue Scale, Parkinson's Disease Questionnaire-39, and an exit satisfaction survey.

RESULTS

All participants completed the study. The control group was older and had a higher mean baseline MDS-UPDRS III score (27.56 dance vs. 40.75 control) and H&Y score (2.11 dance vs. 2.50 control). 7 of 9 in DT and all control subjects attended at least 70% of classes. All participants in DT enjoyed the classes and most felt they were beneficial. The greatest improvement in motor measures was in MDS-UPDRS III (-4.12 (dance) vs. -1.75 (control)). Non-motor outcomes were explored as well.

CONCLUSIONS

DT is introduced as an enjoyable mind-body intervention for PD. Further studies powered for efficacy and with groups matched for disease severity are warranted.

Exercise Therapy for a Patient With Parkinson Disease and Back Pain: A Case Report

Objective

The purpose of this report is to describe an exercise intervention for an elderly patient with Parkinson disease with a chief complaint of lower back pain.

Clinical Features

The patient was an 85-year-old man who had been diagnosed with Parkinson disease and kyphosis. Back pain was preventing him from carrying out activities of daily living. He was referred for physical therapy for treatment to reduce lower back pain and increase function. An initial examination consisted of testing flexibility and range of motion and administering a pain severity scale and a Lower Extremity Functional Index (LEFI); the patient's initial LEFI score was 14/80.

Intervention and Outcome

Clinical observation was made during each of the patient's physical therapy sessions. After 5 weeks, the patient's LEFI score improved to 30/80. The patient reported that he had no more reoccurring back pain, was able to move much easier, and was able walk more efficiently and with better posture.

Conclusion

The patient in this case responded positively to a 5-week course of physical therapy that included exercise therapy. His back pain diminished and his function increased after the course of care.

Karate and Dance Training to Improve Balance and Stabilize Mood in Patients with Parkinson's Disease: A Feasibility Study

The present pilot study investigated the effect of karate (according to the rules of the German Karate Federation) and dance training compared to an inactive control group in patients with Parkinson's disease (PD). 65 patients were recruited. At the end, 37 patients completed the post-test. From those 37 patients, 16 had chosen the karate training, 9 the dance training and 12 the waiting control group. Before and after the whole training phase cognitive performance, emotional well-being and balance were measured. The results showed that both, karate and dance training groups, improved balance. Furthermore, the mood dropped only in the waiting control group receiving no training at all, whereas it remained stable in patients who attended the karate and dance group. The training adherence was higher in the karate than the dance group indicating a high acceptability in PD patients for karate. In sum, karate can have the same positive effects as dance for PD patients. Further studies with larger samples and more rigorous methodologies are required to investigate the reported effects in more detail.

Effect of Voluntary Wheel Running on Striatal Dopamine Level and Neurocognitive Behaviors after Molar Loss in Rats

The aim of the present study is to evaluate the effect of voluntary wheel running on striatal dopamine level and behavior of cognition and emotion in molar loss rats. Twenty-four Sprague-Dawley rats were enrolled in this study and randomly divided into following 4 groups: control group (C group), molar loss group (ML group), 1-week physical exercise before molar loss group (1W-ML group), and 4-week physical exercise before molar loss group (4W-ML group). The rats both in 4W-ML and 1W-ML groups were placed in the voluntary running wheel in order to exercise for 4 weeks and 1 week, respectively. Then, the rats in 4W-ML, 1W-M, and ML groups received bilateral molar loss operation. After 10 days, striatal dopamine level was detected by in vivo microdialysis coupled with high-performance liquid chromatography (HPLC) and electrochemical detection. All the rats received behavior test after microdialysis detection. The behavior tests including passive avoidance test were used to assess cognition and elevated plus maze test for emotion. The results indicated that voluntary wheel running promoted striatal dopamine level in rats of molar loss. Behavioral data indicated that voluntary wheel running promoted cognition and emotion recovery after molar loss. Therefore, we concluded physical exercise significantly improved the neurocognitive behaviors and increased the striatal dopamine level after molar loss in rats.

Effects of neurofeedback on the short-term memory and continuous attention of patients with moderate traumatic brain injury: A preliminary randomized controlled clinical trial

PURPOSE

There are some studies which showed neurofeedback therapy (NFT) can be effective in clients with traumatic brain injury (TBI) history. However, randomized controlled clinical trials are still needed for evaluation of this treatment as a standard option. This preliminary study was aimed to evaluate the effect of NFT on continuous attention (CA) and short-term memory (STM) of clients with moderate TBI using a randomized controlled clinical trial (RCT).

METHODS

In this preliminary RCT, seventeen eligible patients with moderate TBI were randomly allocated in two intervention and control groups. All the patients were evaluated for CA and STM using the visual continuous attention test and Wechsler memory scale-4th edition (WMS-IV) test, respectively, both at the time of inclusion to the project and four weeks later. The intervention group participated in 20 sessions of NFT through the first four weeks. Conversely, the control group participated in the same NF sessions from the fifth week to eighth week of the project.

RESULTS

Eight subjects in the intervention group and five subjects in the control group completed the study. The mean and standard deviation of participants' age were (26.75 ± 15.16) years and (27.60 ± 8.17) years in experiment and control groups, respectively. All of the subjects were male. No significant improvement was observed in any variables of the visual continuous attention test and WMS-IV test between two groups (p ≥ 0.05).

CONCLUSION

Based on our literature review, it seems that our study is the only study performed on the effect of NFT on TBI patients with control group. NFT has no effect on CA and STM in patients with moderate TBI. More RCTs with large sample sizes, more sessions of treatment, longer time of follow-up and different protocols are recommended.

Bienfaits du tai-chi sur la santé

Objectif

Résumer les données probantes sur les bienfaits du tai-chi sur la santé.

Sources d’information

Une revue de la littérature sur les bienfaits du tai-chi sur 25 affections différentes, de même que sur la santé en général et sur la forme physique, a été effectuée afin d’actualiser une revue des revues systématiques effectuée en 2014. Les revues systématiques et les essais cliniques récents ont été évalués et organisés en 5 groupes : données excellentes, bonnes, acceptables ou préliminaires, étayant un bienfait ou n’étayant aucun bienfait direct.

Message principal

Au cours des 45 dernières années, plus de 500 essais et 120 revues systématiques ont été publiés sur les bienfaits du tai-chi sur la santé. Les revues systématiques sur le tai-chi pour différentes affections ont donné lieu à d’excellentes données étayant un bienfait pour la prévention des chutes, l’arthrose, la maladie de Parkinson, la réadaptation dans les cas de maladie pulmonaire obstructive chronique et l’amélioration de la capacité cognitive chez les personnes âgées. Il existe de bonnes données étayant un bienfait pour la dépression, la réadaptation cardiaque et après un AVC et la démence. Les données étayant un bienfait pour l’amélioration de la qualité de vie des patients atteints de cancer, de fibromyalgie, d’hypertension et d’ostéoporose sont acceptables. Les données actuelles étayent l’absence d’un bienfait direct pour le diabète, la polyarthrite rhumatoïde ou l’insuffisance cardiaque chronique. Les revues systématiques portant sur les bienfaits sur la santé en général et la forme physique font état d’excellentes données étayant un bienfait pour l’amélioration de l’équilibre et de la capacité aérobique chez les personnes en mauvaise forme physique. Les données étayant une plus grande force dans les membres inférieurs sont bonnes. Les données étayant une amélioration du bien-être et du sommeil sont acceptables. Aucune étude n’a révélé que le tai-chi aggravait une affection. Une récente revue systématique sur l’innocuité du tai-chi a révélé que les événements indésirables étaient habituellement mineurs et principalement de nature musculosquelettique; aucun événement indésirable grave lié au tai-chi n’a été rapporté.

Conclusion

Il existe d’abondantes données étayant les effets du tai-chi sur la santé et la forme physique. En s’appuyant sur ces données, les médecins peuvent maintenant faire des recommandations éclairées à leurs patients, en précisant que le tai-chi fait toujours l’objet de recherches. Aussi, toute affection clinique doit faire l’objet d’un suivi médical continu.

Health benefits of tai chi: What is the evidence?

OBJECTIVE

To summarize the evidence on the health benefits of tai chi.

SOURCES OF INFORMATION

A literature review was conducted on the benefits of tai chi for 25 specific conditions, as well as for general health and fitness, to update a 2014 review of systematic reviews. Systematic reviews and recent clinical trials were assessed and organized into 5 different groups: evidence of benefit as excellent, good, fair, or preliminary, or evidence of no direct benefit.

MAIN MESSAGE

During the past 45 years more than 500 trials and 120 systematic reviews have been published on the health benefits of tai chi. Systematic reviews of tai chi for specific conditions indicate excellent evidence of benefit for preventing falls, osteoarthritis, Parkinson disease, rehabilitation for chronic obstructive pulmonary disease, and improving cognitive capacity in older adults. There is good evidence of benefit for depression, cardiac and stroke rehabilitation, and dementia. There is fair evidence of benefit for improving quality of life for cancer patients, fibromyalgia, hypertension, and osteoporosis. Current evidence indicates no direct benefit for diabetes, rheumatoid arthritis, or chronic heart failure. Systematic reviews of general health and fitness benefits show excellent evidence of benefit for improving balance and aerobic capacity in those with poor fitness. There is good evidence for increased strength in the lower limbs. There is fair evidence for increased well-being and improved sleep. There were no studies that found tai chi worsened a condition. A recent systematic review on the safety of tai chi found adverse events were typically minor and primarily musculoskeletal; no intervention-related serious adverse events have been reported.

CONCLUSION

There is abundant evidence on the health and fitness effects of tai chi. Based on this, physicians can now offer evidence-based recommendations to their patients, noting that tai chi is still an area of active research, and patients should continue to receive medical follow-up for any clinical conditions.

The Embodied Self in Parkinson's Disease: Feasibility of a Single Tango Intervention for Assessing Changes in Psychological Health Outcomes and Aesthetic Experience

Background: Dance is an embodied activity with benefits for mobility, balance, and quality of life (QoL) of persons affected by Parkinson's Disease (PD). It is enjoyable and likely to support adherence to movement prescriptions. The objective of this study was to assess the feasibility of measuring changes in psychological outcomes, specifically well-being, body self-efficacy, outcome expectations, and experienced beauty after a single Argentine Tango intervention in a workshop format. To anchor experienced beauty in a theory, the article introduces a model of embodied aesthetics featuring active art-making as a central aspect of healing in arts-based interventions.

Methods: In a single-group pre–post design, we tested the feasibility of measuring psychological changes of 34 PD patients from Southern Germany after an introductory workshop in Argentine Tango. They participated in a 90 min Tango for PD intervention and completed the Heidelberg State Inventory (HSI-24; (Koch et al., 2007)), the Body Self-Efficacy Scale (BSE; (Fuchs and Koch, 2014)) with a sub-dimension on aesthetic experience, and the Credibility-Expectancy Questionnaire (CEQ; (Devilly and Borkovec, 2000)) before and after the intervention. A subgroup completed the therapeutic factors of arts therapies-scale, a new measure to elaborate on the aesthetic experience. We analyzed pre–post-differences with a t-test for paired samples.

Results and Discussion: The study supports the feasibility of measuring health-related psychological changes from a single Argentine Tango intervention for PD patients, as well as acceptance and appropriateness of the intervention for the patient group. After the tango intervention, well-being, body self-efficacy, and outcome expectancies increased. Participants also experienced an increase in beauty of their movements and other aesthetic aspects. We suspect that, in addition to the functional and psychological factors identified so far, the aesthetic experience in dance may be an important therapeutic factor mediating several outcomes of dance and other arts-based interventions. A controlled study for evidence-based testing of targeted variables can now follow to examine the new hypotheses.

N-Acetyl Cysteine May Support Dopamine Neurons in Parkinson's Disease: Preliminary Clinical and Cell Line Data

Backgound

The purpose of this study was to assess the biological and clinical effects of n-acetyl-cysteine (NAC) in Parkinson’s disease (PD).

Methods

The overarching goal of this pilot study was to generate additional data about potentially protective properties of NAC in PD, using an in vitro and in vivo approach. In preparation for the clinical study we performed a cell tissue culture study with human embryonic stem cell (hESC)-derived midbrain dopamine (mDA) neurons that were treated with rotenone as a model for PD. The primary outcome in the cell tissue cultures was the number of cells that survived the insult with the neurotoxin rotenone. In the clinical study, patients continued their standard of care and were randomized to receive either daily NAC or were a waitlist control. Patients were evaluated before and after 3 months of receiving the NAC with DaTscan to measure dopamine transporter (DAT) binding and the Unified Parkinson’s Disease Rating Scale (UPDRS) to measure clinical symptoms.

Results

The cell line study showed that NAC exposure resulted in significantly more mDA neurons surviving after exposure to rotenone compared to no NAC, consistent with the protective effects of NAC previously observed. The clinical study showed significantly increased DAT binding in the caudate and putamen (mean increase ranging from 4.4% to 7.8%; p<0.05 for all values) in the PD group treated with NAC, and no measurable changes in the control group. UPDRS scores were also significantly improved in the NAC group (mean improvement of 12.9%, p = 0.01).

Conclusions

The results of this preliminary study demonstrate for the first time a potential direct effect of NAC on the dopamine system in PD patients, and this observation may be associated with positive clinical effects. A large-scale clinical trial to test the therapeutic efficacy of NAC in this population and to better elucidate the mechanism of action is warranted.

Trial Registration

ClinicalTrials.gov NCT02445651

Exercise and Nutritional Benefits in PD: Rodent Models and Clinical Settings

Physical exercise offers a highly effective health-endowering activity as has been evidence using rodent models of Parkinson's disease (PD). It is a particularly useful intervention in individuals employed in sedentary occupations or afflicted by a neurodegenerative disorder, such as PD. The several links between exercise and quality-of-life, disorder progression and staging, risk factors and symptoms-biomarkers in PD all endower a promise for improved prognosis. Nutrition provides a strong determinant for disorder vulnerability and prognosis with fish oils and vegetables with a mediterranean diet offering both protection and resistance. Three factors determining the effects of exercise on disorder severity of patients may be presented: (i) Exercise effects upon motor impairment, gait, posture and balance, (ii) Exercise reduction of oxidative stress, stimulation of mitochondrial biogenesis and up-regulation of autophagy, and (iii) Exercise stimulation of dopamine (DA) neurochemistry and trophic factors. Running-wheel performance, as measured by distance run by individual mice from different treatment groups, was related to DA-integrity, indexed by striatal DA levels. Finally, both nutrition and exercise may facilitate positive epigenetic outcomes, such as lowering the dosage of L-Dopa required for a therapeutic effect.