Prática mental após fisioterapia mantém mobilidade funcional de pessoas com doença de Parkinson

Overview of Effects of Motor Learning Strategies in Neurologic and Geriatric Populations: A Systematic Mapping Review

Objective

To provide a broad overview of the current state of research regarding the effects of 7 commonly used motor learning strategies to improve functional tasks within older neurologic and geriatric populations.

Data Sources

PubMed, CINAHL, and Embase were searched.

Study Selection

A systematic mapping review of randomized controlled trials was conducted regarding the effectiveness of 7 motor learning strategies-errorless learning, analogy learning, observational learning, trial-and-error learning, dual-task learning, discovery learning, and movement imagery-within the geriatric and neurologic population.

Data Extraction

Two thousand and ninety-nine articles were identified. After screening, 87 articles were included for further analysis. Two reviewers extracted descriptive data regarding the population, type of motor learning strategy/intervention, frequency and total duration intervention, task trained, movement performance measures, assessment time points, and between-group effects of the included studies. The risk of bias 2 tool was used to assess bias; additionally, papers underwent screening for sample size justification.

Data Synthesis

Identified articles regarding the effects of the targeted motor learning strategies started around the year 2000 and mainly emerged in 2010. Eight populations were included, for example, Parkinson's and stroke. Included studies were not equally balanced: analogy learning (n=2), errorless learning and trial-and-error learning (n=5), mental practice (n=19), observational learning (n=11), discovery learning (n=0), and dual-tasking (n=50). Overall studies showed a moderate-to-high risk of bias. Four studies were deemed sufficiently reliable to interpret effects. Positive trends regarding the effects were observed for dual-tasking, observational learning, and movement imagery.

Conclusions

Findings show a skewed distribution of studies across motor learning interventions, especially toward dual-tasking. Methodological shortcomings make it difficult to draw firm conclusions regarding the effectiveness of motor learning strategies to improve functional studies. Future researchers are strongly advised to follow guidelines that aid in maintaining methodological quality. Moreover, alternative designs fitting the complex practice situation should be considered.

Exploring motor imagery as a therapeutic intervention for Parkinson's disease patients: a scoping review

Background

Motor imagery (MI) has emerged as a promising therapeutic approach for Parkinson's disease (PD). MI entails mentally rehearsing motor actions without executing them. This cognitive process has garnered attention due to its potential benefits in aiding motor function recovery in patients. The purpose of this review was to highlight the findings observed in motor symptoms, balance, gait, and quality of life.

Methods

A literature search was carried out in Medline, Embase, Cochrane, and Physiotherapy Evidence Database (PEDro), from the first publication to February 2024. Studies with at least one keyword to PD and MI in the title were included.

Results

The analysis included 53 studies out of the 262 identified. These comprised 12 randomized controlled trials (RCTs) with an average PEDro score of 6.6 out of 10, as well as 41 non-RCT studies. Notably, the majority of the RCTs focused on balance, gait, and lower limb exercises. The experimental group found an 85.2% improvement on the Timed Up and Go (TUG) with a cognitive task (p < 0.02), 5.8% improvement on the TUG (p < 0.05), and 5.1% improvement in walking speed (p < 0.05). Other variables did not show significant improvement. In descriptive and non-RCT studies, there were various tasks and outcomes for the lower and upper limbs. It has been demonstrated that there was no difference in execution time in MI between patients and healthy subjects (HS), whereas motor execution was slower in patients. Several tasks were analyzed for the upper limb, including thumb opposition, joystick movements, and writing tasks with variable results. RCTs were more focused on balance, lower limbs, and walking. There was no specific outcome regarding the upper limb or speech. Additionally, the heterogeneity of tasks and outcomes across studies is also a limitation.

Conclusion

Current research on walking disorders in PD shows promise, but further investigations are crucial, particularly with an emphasis on upper limb function and speech. Studies with larger sample sizes and more precise methodologies are needed to enhance our understanding of the potential benefits of MI within the framework of comprehensive PD rehabilitation.

Effectiveness of Motor Imagery in the Rehabilitation of People With Parkinson's Disease: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVE

With more research completed using Motor imagery (MI) in people with Parkinson's disease, this study gathered and synthesized evidence on the use of MI for Parkinson's disease in improving rehabilitation outcomes.

METHODS

Medical Literature Analysis and Retrieval System Online, Embase, Web of Science, The Cochrane Library, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from inception to May 2023. We included randomized controlled trials that examine the effects of MI on individuals with Parkinson's disease. Two reviewers selected articles and extracted study characteristics and results independently. The Physiotherapy Evidence Database scale was used to assess the methodological quality. Mean differences and 95% confidence intervals were calculated. Heterogeneity was assessed using the I2 statistic.

RESULTS

Thirteen articles with 12 studies were included, involving 320 individuals with Parkinson's disease, with moderate to high methodological quality (mean = 6.62/10). Compared with the control group, 3 articles reported significant greater improvements in cognitive function, 7 reported significant greater improvement in motor function, 1 article reported significant greater improvement in quality of life, and 1 reported significant greater confidence in daily task performance. No statistically significant effects were found in the meta-analyses. Conclusion. Results of individual articles were in favor of the MI intervention. No statistically significant results were found in the meta-analyses. This might be due to the small number of studies and the heterogeneity of interventions and outcome measures used. MI may be effective in improving some rehabilitation outcomes, but meta-analytic evidence is lacking. More research with larger sample size and less heterogeneous samples, interventions, and outcome measures, is warranted.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42021230556.

Avaliação do risco de quedas entre pessoas com doença de Parkinson

RESUMO Objetivo identificar os fatores associados ao risco de quedas entre as pessoas com doença de Parkinson cadastradas na Associação Parkinson Santa Catarina. Método estudo transversal exploratório descritivo e de abordagem quantitativa, realizado com 53 pessoas cadastradas na Associação Parkinson Santa Catarina, no município de Florianópolis, Brasil, no período de junho a setembro de 2019. Foram aplicados questionário sociodemográfico, Escala de Hoehn e Yahr, Mini Exame do Estado Mental e Teste de Rastreio do Risco de Queda no Idoso. Os dados foram tabulados e analisados por meio do Sistema online de Ensino-Aprendizagem de Estatística SEstatNet®. Resultados foram identificados fatores de risco, como sexo, aumento da idade, redução da força muscular, instabilidade postural e diminuição da velocidade da marcha. Em relação aos estágios da doença, foi constatado que em todos houve piora da velocidade da marcha e o medo de cair é constante, aumentando com o agravamento da doença e o tempo de diagnóstico. Conclusão e implicações para a prática ao aprofundar o estudo do tema, o enfermeiro consegue compreender os acometimentos motores que levam à fragilização e à queda em pessoas com doença de Parkinson, elaborando estratégias para preveni-las.

Efeito imediato da estimulação auditiva rítmica nos parâmetros espaços-temporais da marcha de idosos sedentários: um estudo piloto

Resumo Objetivos Avaliar o efeito imediato da estimulação auditiva rítmica (EAR) com música sobre os parâmetros espaços-temporais da marcha em idosos sedentários e analisar possíveis interações com os episódios de quedas. Métodos Estudo piloto de intervenção com idosos sedentários (n=15), idade ≥ 60 anos, ambos os sexos, independentes na marcha. Adicionalmente, os idosos foram divididos em dois grupos, caidores (n=5) e não caidores (n=10), baseado no histórico de quedas no último ano. A avaliação dos parâmetros espaços-temporais da marcha foi realizada através do teste de Caminhada de 10 metros executado em marcha livre (T0), repetido com suporte da EAR com música (T1) e executado em marcha livre novamente (T2). Para a análise dos dados, foram utilizados a ANOVA de medidas repetidas e a ANOVA (two-way) para comparação entre os grupos, com o post hoc de Tukey. O tamanho do efeito das intervenções também foi calculado. Resultados Houve redução significativa do tempo e do número de passos e um aumento da velocidade da marcha (p<0,0001; com efeito grande) entre os momentos T0-T1 e T0-T2. Ambos os grupos caidores e não caidores apresentaram redução significativa do tempo e do número de passos (p<0,0001) e aumento da velocidade (p<0,0001), mas apenas na variável cadência houve efeito do grupo e da interação tempo e grupo. Conclusão Verificou-se um efeito imediato positivo do uso da EAR nos parâmetros espaços-temporais da marcha de idosos sedentários com maior efeito na cadência de idosos não caidores.

Efeitos da prática mental associada à fisioterapia motora sobre a marcha e o risco de quedas na doença de Parkinson: estudo piloto

RESUMO O objetivo deste estudo piloto, realizado em um hospital universitário de referência em Pernambuco, foi avaliar os efeitos da prática mental associada à fisioterapia motora sobre a marcha e o risco de queda em pessoas com doença de Parkinson. A amostra da pesquisa foi composta por 18 sujeitos, de ambos os sexos, com doença de Parkinson idiopática, divididos em grupo experimental (8 indivíduos) e controle (10 indivíduos). Ambos os grupos realizaram 15 sessões de 40 minutos de fisioterapia motora, duas vezes por semana. No grupo de intervenção, a fisioterapia foi associada a prática mental (15 minutos). Em relação às variáveis de desfecho primário, o tempo de execução do timed up and go e do teste de caminhada de 10 metros reduziu, mas a diferença não foi significativa. Em relação à velocidade, cadência e escore do dynamic gait index, houve aumento após a intervenção no grupo experimental, com diferença significativa (p=0,02). O número de passos foi mantido em ambos os grupos. Os resultados sugerem que a prática mental associada à fisioterapia motora reduz o risco de quedas em comparação com a fisioterapia motora aplicada isoladamente.