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Monaghan AS, Hooyman A, Dibble LE, Mehta SH, Peterson DS. Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease. J Neurol Phys Ther 2024:01253086-990000000-00061. [PMID: 38489661 DOI: 10.1097/npt.0000000000000471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND AND PURPOSE Reactive balance training improves reactive postural control in people with Parkinson disease (PwPD). However, the extent to which reactive balance training generalizes to a novel, unpracticed reactive balance task is unknown. This study aimed to determine whether reactive training stepping through support surface translations can be generalized to an unpracticed, instrumented tether-release task. METHODS Twenty-five PwPD (70.52 years ± 7.15; Hoehn and Yahr range 1-3) completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Stepping was trained through a 2-week (6-session) intervention with repeated support surface translations. Performance on an untrained tether-release task (generalization task) was measured at 2 baseline assessments (B1 and B2, 2 weeks apart), immediately after the intervention (P1), and 2 months after training (P2). The tether-release task outcomes were the anterior-posterior margin of stability (MOS), step length, and step latency during backward and forward steps. RESULTS After support surface translation practice, tether-release stepping performance improved in MOS, step length, and step latency for both backward and forward steps compared to baseline (P < 0.05). Improvements in MOS and step length during backward and forward steps in the tether-release task, respectively, were related to stepping changes in the practiced task. However, the improvements in the generalization task were not retained for 2 months. DISCUSSION AND CONCLUSIONS These findings support short-term generalization from trained balance tasks to novel, untrained tasks. These findings contribute to our understanding of the effects and generalization of reactive step training in PwPD. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A465).
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Affiliation(s)
- Andrew S Monaghan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, Georgia (A.S.M.); School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona (A.H.); Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah (L.E.D.); Department of Neurology, Mayo Clinic, Scottsdale, Arizona (S.H.M.); College of Health Solutions, Arizona State University, Tempe, Arizona (D.S.P.); and Phoenix VA Health Care Center, Phoenix, Arizona (D.S.P.)
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Monaghan AS, Hooyman A, Dibble LE, Mehta SH, Peterson DS. Stability Changes in Fall-Prone Individuals With Parkinson Disease Following Reactive Step Training. J Neurol Phys Ther 2024; 48:46-53. [PMID: 37259190 DOI: 10.1097/npt.0000000000000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND PURPOSE Poor reactive steps may lead to falls in people with Parkinson disease (PwPD). However, whether reactive steps can be improved in PwPD at risk for falls or whether step training reduces falls remains unclear. This study aimed to determine whether 2 weeks of reactive step training result in (1) immediate and retained improvements in stepping and (2) fewer prospective falls in PwPD at fall risk. METHODS Twenty-five PwPD (70.52 years ± 7.15; Hoehn & Yahr range 1-3) at risk for falls completed a multiple baseline, open-label, uncontrolled pre-/postintervention study. Stepping performance was assessed at 2 baseline assessments (B1 and B2) followed by a 2-week, 6-session training protocol. Stepping was assessed immediately (P1) and 2 months after training (P2). Primary outcomes were anterior-posterior margin of stability (MOS), step length, and step latency during backward stepping. Fall frequency was measured for 2 months before and after training. RESULTS MOS during backward steps was significantly larger (better) after training ( P < 0.001, d = 0.83), and improvements were retained for 2 months ( P = 0.04, d = 0.66). Step length was not statistically significant different after training ( P = 0.13, d = 0.46) or at follow-up ( P = 0.08, d = 0.62), although effect sizes were medium and large, respectively. Step latency improved after initial exposure ( P = 0.01, d = 0.60) but not following training ( P = 0.43, d = 0.35). Twelve participants experienced fewer falls after training than before (10 = no change, 5 = increase; P = 0.12). Greater improvements in MOS were related to fewer falls ( P = 0.04). DISCUSSION AND CONCLUSIONS Two weeks of reactive step training resulted in immediate and retained improvements in some reactive stepping outcomes in PwPD at risk for falls and may reduce fall risk. Reactive step training may be a viable approach to reduce falls in PwPD.
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Affiliation(s)
- Andrew S Monaghan
- College of Health Solutions, Arizona State University, Phoenix (A.S.M., D.S.P.); School of Biological and Health Systems Engineering, Arizona State University, Tempe (A.H.); Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City (L.E.D.); Mayo Clinic, Scottsdale, Arizona (S.H.M.); and Phoenix VA Health Care Center, Phoenix, Arizona (D.S.P.)
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3
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Bhagwat AP, Deodhe NP. The Effect of Perturbation-Based Balance Training vs Step Training on Reaction Time in Older Persons: A Review. Cureus 2023; 15:e48104. [PMID: 38046742 PMCID: PMC10691396 DOI: 10.7759/cureus.48104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
As the global population ages, understanding the impact of aging on cognitive abilities becomes increasingly crucial. One such cognitive function that exhibits significant changes with advancing age is reaction time (RT). This article presents a comprehensive analysis of RT in older adults, examining its underlying mechanisms, age-related changes, and implications for cognitive functioning. Through a review of existing literature, this study explores various factors influencing RT in older individuals, including sensory, motor, and cognitive processes. It highlights how age-related changes in the central nervous system, such as declines in processing speed and neural efficiency, play a significant role in prolonging RTs. Additionally, the role of cumulative life experiences and environmental factors in shaping reaction time in older adults is discussed.
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Affiliation(s)
- Anushka P Bhagwat
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishigandha P Deodhe
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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De Maio M, Castellani L, Cugusi L, Cortis C, Fusco A. The Effect of a Combined Exercise Program on Postural Control and Fine Motor Skills in Parkinson's Disease: Study Design. Int J Environ Res Public Health 2022; 19:15216. [PMID: 36429935 PMCID: PMC9691118 DOI: 10.3390/ijerph192215216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
Parkinson's disease (PD) is a progressive and neurodegenerative disorder defined by physical symptoms such as hand disability and postural instability. To counteract the detrimental effects of PD, physical activity programs showed improvements in overall aspects of physical functioning. Therefore, this protocol will aim to evaluate the effect a of postural and fine motor skills training program in older adults with PD. PD individuals, with mild to moderate stage PD, aged between 65 to 80 years, will be voluntary selected from the Nursing Home Residences and Rehabilitation Centers. Subsequently, they will be randomly assigned to intervention group (PD) to receive a combined training program (postural control and fine motor skills exercises) or to the Control group (CON) to receive a stretching program. Before (PRE) and after (POST) a 12-week program both groups will perform wobble board (WB) and grooved pegboard (GPT) tests. Different performances between groups will be expected: (1) no significant differences between PD and CON group for WB and GPT test values before the beginning of the training intervention (PRE); (2) significantly better WB and GPT test values in PD subjects after the training intervention (POST) when compared to the base values (PRE); and (3) no significant differences in WB and GPT test values in CON subjects after the training intervention (POST) when compared to the base values (PRE). The findings of the present study protocol could be used for future studies investigating clinical populations, such as PD, and the effects of different rehabilitative interventions aiming to improve postural control and fine motor skills performances assessed by WB and GPT tests.
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Affiliation(s)
- Marianna De Maio
- Department of Human Sciences, Society and Health, University of Cassino and Lazio Meridionale, Viale dell’Università, 03043 Cassino, Italy
| | - Loriana Castellani
- Department of Human Sciences, Society and Health, University of Cassino and Lazio Meridionale, Viale dell’Università, 03043 Cassino, Italy
| | - Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/B, 07100 Sassari, Italy
| | - Cristina Cortis
- Department of Human Sciences, Society and Health, University of Cassino and Lazio Meridionale, Viale dell’Università, 03043 Cassino, Italy
| | - Andrea Fusco
- Department of Human Sciences, Society and Health, University of Cassino and Lazio Meridionale, Viale dell’Università, 03043 Cassino, Italy
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Amato A, Baldassano S, Vasto S, Schirò G, Davì C, Drid P, Dos Santos Mendes FA, Caldarella R, D’Amelio M, Proia P. Effects of a Resistance Training Protocol on Physical Performance, Body Composition, Bone Metabolism, and Systemic Homeostasis in Patients Diagnosed with Parkinson's Disease: A Pilot Study. Int J Environ Res Public Health 2022; 19:ijerph192013022. [PMID: 36293598 PMCID: PMC9602560 DOI: 10.3390/ijerph192013022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/08/2022] [Accepted: 10/09/2022] [Indexed: 05/14/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor impairments and it is correlated with loss of bone mineral density. This study aimed to analyze the effects of resistance training on bone metabolism, systemic homeostasis, body composition, and physical performance in people with PD. Thirteen subjects (age 64.83 ± 5.70) with PD diagnosis were recruited. Participants performed neuromuscular tests, body composition assessment, and blood sample analysis at baseline, and after an 11 weeks-training period. Each training session lasted 90 min, three times a week. The participants had significant improvements in the timed up and go (p < 0.01), sit to stand (p < 0.01), dominant peg-board (p < 0.05), dominant foot-reaction time (p < 0.01), and functional reach tests (p < 0.05). They showed better pressure foot distributions in the left forefoot (p < 0.05) and hindfoot (p < 0.05) and increased cervical right lateral bending angle (p < 0.05). The protocol affects bone metabolism markers osteocalcin (p < 0.05), calcium (p < 0.01), PTH (p < 0.01), the C-terminal telopeptide (CTX) (p < 0.01), and vitamin D (p < 0.05). Eleven weeks of resistance training improved manual dexterity, static and dynamic balance, reaction time, cervical ROM, and reduced bone loss in people with PD.
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Affiliation(s)
- Alessandra Amato
- Sport and Exercise Sciences Research Unit, Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, 90128 Palermo, Italy
| | - Sara Baldassano
- Department of Biological Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, 90128 Palermo, Italy
- Correspondence: (S.B.); (P.P.)
| | - Sonya Vasto
- Department of Biological Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, 90128 Palermo, Italy
| | - Giuseppe Schirò
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Chiara Davì
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | | | - Rosalia Caldarella
- Department of Laboratory Medicine, “P. Giaccone” University Hospital, 90127 Palermo, Italy
| | - Marco D’Amelio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Patrizia Proia
- Sport and Exercise Sciences Research Unit, Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, 90128 Palermo, Italy
- Correspondence: (S.B.); (P.P.)
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Gamborg M, Hvid LG, Dalgas U, Langeskov‐Christensen M. Parkinson's disease and intensive exercise therapy - An updated systematic review and meta-analysis. Acta Neurol Scand 2022; 145:504-528. [PMID: 34997759 DOI: 10.1111/ane.13579] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/08/2021] [Accepted: 12/21/2021] [Indexed: 01/01/2023]
Abstract
In 2015, Uhrbrand et al. published the first review on Parkinson´s disease (PD) and exercise entirely based on randomized controlled trials (RCT) applying strict exercise definitions. The present review aimed to update the PD literature by assessing the effects of different intensive exercise modalities: resistance training (RT), endurance training (ET), and other intensive exercise modalities (OITM). An updated systematic literature search identified 33 new RCTs. Qualitative and quantitative analyses were performed. A total of 18 RT, 14 ET, and 1 OITM studies were identified (adding to the 8 RT, 6 ET, and 4 OITM studies identified by Uhrbrand et al. in 2015). RT, ET, and OITM were feasible, safe, and did not worsen PD symptoms. Furthermore, RT, ET, and OITM may positively affect functional outcomes (e.g., balance) and depressive symptoms in PD but inconsistencies across these findings warrant cautious conclusions. Meta-analyses showed that RT had a positive impact on muscle strength (standardized mean difference (SMD) = 0.83 [95% CI;0.54, 1.12]), functional capacity (Timed Up and Go Test (TUG): SMD = -0.62 [-1.01, -0.24]), and quality of life (SMD = -0.41 [-0.72, -0.09]), while ET had a positive impact on cardiorespiratory fitness (SMD = 0.27 [0.07, 0.47]) and functional capacity (TUG: SMD = -0.21 [-0.46, 0.04], 6-Min Walk Test: SMD = 0.89 [0.17, 1.62]), and a potentially positive impact on "on-medication" UPDRS-III (SMD = -0.15 [-0.38, 0.09]) and "off-medication" UPDRS-III (SMD = -0.19 [-0.41, 0.04]). In conclusion, RT, ET, and OITM all represent safe, feasible, and beneficial adjunct rehabilitation strategies in PD, with particularly RT and ET showing solid effects.
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Affiliation(s)
- Mads Gamborg
- Exercise Biology Department of Public Health Aarhus University Aarhus Denmark
| | - Lars G. 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
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Coelho DB, de Oliveira CEN, Guimarães MVC, Ribeiro de Souza C, dos Santos ML, de Lima-Pardini AC. A systematic review on the effectiveness of perturbation-based balance training in postural control and gait in Parkinson’s disease. Physiotherapy 2022; 116:58-71. [DOI: 10.1016/j.physio.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 12/29/2021] [Accepted: 02/17/2022] [Indexed: 10/19/2022]
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8
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Osborne JA, Botkin R, Colon-Semenza C, DeAngelis TR, Gallardo OG, Kosakowski H, Martello J, Pradhan S, Rafferty M, Readinger JL, Whitt AL, Ellis TD. Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association. Phys Ther 2021; 102:6485202. [PMID: 34963139 PMCID: PMC9046970 DOI: 10.1093/ptj/pzab302] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
A clinical practice guideline on Parkinson disease was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists and a neurologist. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for management of Parkinson disease. The Spanish version of this clinical practice guideline is available as a supplement (Suppl. Appendix 1).
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Affiliation(s)
- Jacqueline A Osborne
- Brooks Rehabilitation Hospital, Brooks Institute of Higher Learning, Jacksonville, Florida, USA
| | - Rachel Botkin
- Botkin Rehab Services, Physical Therapy, Columbus, Ohio, USA
| | - Cristina Colon-Semenza
- Department of Kinesiology, Doctor of Physical Therapy Program, University of Connecticut, Storrs, Connecticut, USA
| | - Tamara R DeAngelis
- Boston University Sargent College of Health and Rehabilitation Services, Physical Therapy and Athletic Training, Boston, Massachusetts, USA
| | - Oscar G Gallardo
- Rancho Los Amigos National Rehabilitation Center, Physical Therapy, Downey, California, USA
| | - Heidi Kosakowski
- Address all correspondence to Dr Kosakowski care of the Department of Practice of the American Physical Therapy Association at:
| | | | - Sujata Pradhan
- University of Washington, Rehabilitation Medicine, Seattle, Washington, USA
| | - Miriam Rafferty
- Northwestern University, Center for Education in Health Sciences, Chicago, Illinois, USA
| | | | | | - Terry D Ellis
- Boston University Sargent College of Health and Rehabilitation Services, Physical Therapy and Athletic Training, Boston, Massachusetts, USA
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9
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Wang S, Varas-Diaz G, Bhatt T. Muscle synergy differences between voluntary and reactive backward stepping. Sci Rep 2021; 11:15462. [PMID: 34326376 DOI: 10.1038/s41598-021-94699-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/08/2021] [Indexed: 11/08/2022] Open
Abstract
Reactive stepping responses are essential to prevent falls after a loss of balance. It has previously been well described that both voluntary and reactive step training could improve the efficacy of reactive stepping in different populations. However, the effect of aging on neuromuscular control during voluntary and reactive stepping remains unclear. Electromyography (EMG) signals during both backward voluntary stepping in response to an auditory cue and backward reactive stepping elicited by a forward slip-like treadmill perturbation during stance were recorded in ten healthy young adults and ten healthy older adults. Using muscle synergy analysis, we extracted the muscle synergies for both voluntary and reactive stepping. Our results showed that fewer muscle synergies were used during reactive stepping than during voluntary stepping in both young and older adults. Minor differences in the synergy structure were observed for both voluntary and reactive stepping between age groups. Our results indicate that there is a low similarity of muscle synergies between voluntary stepping and reactive stepping and that aging had a limited effect on the structure of muscle synergies. This study enhances our understanding of the neuromuscular basis of both voluntary and reactive stepping as well as the potential effect of aging on neuromuscular control during balance tasks.
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Magdi A, Sayed Ahmed AM, Elsayed E, Ahmad R, Ramakrishnan S, Gabor MG. Effects of cueing techniques on gait, gait-related mobility, and functional activities in patients with Parkinson’s disease: a systematic review and meta-analysis. Physical Therapy Reviews 2021. [DOI: 10.1080/10833196.2021.1908728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Assmaa Magdi
- Physiotherapy Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
| | | | - Esraa Elsayed
- Physiotherapy Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
| | - Razan Ahmad
- Physiotherapy Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
| | | | - Marian Grace Gabor
- Physiotherapy Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
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Bacanoiu MV, Mititelu RR, Danoiu M, Olaru G, Buga AM. Functional Recovery in Parkinson's Disease: Current State and Future Perspective. J Clin Med 2020; 9:jcm9113413. [PMID: 33114424 PMCID: PMC7692963 DOI: 10.3390/jcm9113413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 12/05/2022] Open
Abstract
Parkinson’s disease (PD) is one of the most frequent neurodegenerative disorders, affecting not only the motor function but also limiting the autonomy of affected people. In the last decade, the physical exercises of different intensities carried out by kinetic therapeutic activities, by robotic technologies or with the participation of sensory cues, have become increasingly appreciated in the management of Parkinson’s disease impairments. The aim of this paper was to evaluate the impact of physical exercises with and without physical devices on the motor and cognitive variables of PD patients. In order to achieve our objectives, we performed a systematic review of available original articles based on the impact of kinetic therapeutic activity. Through the search strategy, we selected original papers that were laboriously processed using characteristics related to physical therapy, or the tools used in physiological and psychological rehabilitation strategies for PD patients. In this study, we presented the most current intervention techniques in the rehabilitation programs of patients with Parkinson’s disease, namely the use of assisted devices, virtual imagery or the performing of physical therapies that have the capacity to improve walking deficits, tremor and bradykinesia, to reduce freezing episodes of gait and postural instability, or to improve motor and cognitive functions.
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Affiliation(s)
- Manuela Violeta Bacanoiu
- Department of Physical Therapy and Sports Medicine, University of Craiova, 200207 Craiova, Romania; (M.D.); (G.O.)
- Department of Laboratory Medicine, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
- Correspondence: (M.V.B.); (A.M.B.); Tel.: +40-0351-443-500 (A.M.B.)
| | - Radu Razvan Mititelu
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; or
| | - Mircea Danoiu
- Department of Physical Therapy and Sports Medicine, University of Craiova, 200207 Craiova, Romania; (M.D.); (G.O.)
| | - Gabriela Olaru
- Department of Physical Therapy and Sports Medicine, University of Craiova, 200207 Craiova, Romania; (M.D.); (G.O.)
| | - Ana Maria Buga
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; or
- Correspondence: (M.V.B.); (A.M.B.); Tel.: +40-0351-443-500 (A.M.B.)
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Rahmati Z, Behzadipour S, Schouten AC, Taghizadeh G, Firoozbakhsh K. Postural control learning dynamics in Parkinson's disease: early improvement with plateau in stability, and continuous progression in flexibility and mobility. Biomed Eng Online 2020; 19:29. [PMID: 32393271 PMCID: PMC7216342 DOI: 10.1186/s12938-020-00776-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background Balance training improves postural control in Parkinson’s disease (PD). However, a systematic approach for the development of individualized, optimal training programs is still lacking, as the learning dynamics of the postural control in PD, over a training program, are poorly understood. Objectives We investigated the learning dynamics of the postural control in PD, during a balance-training program, in terms of the clinical, posturographic, and novel model-based measures. Methods Twenty patients with PD participated in a balance-training program, 3 days a week, for 6 weeks. Clinical tests assessed functional balance and mobility pre-training, mid-training, and post-training. Center-of-pressure (COP) was recorded at four time-points during the training (pre-, week 2, week 4, and post-training). COP was used to calculate the sway measures and to identify the parameters of a patient-specific postural control model, at each time-point. The posturographic and model-based measures constituted the two sets of stability- and flexibility-related measures. Results Mobility- and flexibility-related measures showed a continuous improvement during the balance-training program. In particular, mobility improved at mid-training and continued to improve to the end of the training, whereas flexibility-related measures reached significance only at the end. The progression in the balance- and stability-related measures was characterized by early improvements over the first 3 to 4 weeks of training, and reached a plateau for the rest of the training. Conclusions The progression in balance and postural stability is achieved earlier and susceptible to plateau out, while mobility and flexibility continue to improve during the balance training.
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Affiliation(s)
- Zahra Rahmati
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.,Djawad Movafaghian Research Center in Neurorehab Technologies, Sharif University of Technology, Tehran, Iran
| | - Saeed Behzadipour
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran. .,Djawad Movafaghian Research Center in Neurorehab Technologies, Sharif University of Technology, Tehran, Iran.
| | - Alfred C Schouten
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Amaral-Felipe KMD, Yamada PDA, Abreu DCCD, Freire Júnior RC, Stroppa-Marques AEZ, Faganello-Navega FR. Kinematic gait parameters for older adults with Parkinson's disease during street crossing simulation. Hum Mov Sci 2020; 70:102599. [PMID: 32217200 DOI: 10.1016/j.humov.2020.102599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/14/2020] [Accepted: 02/27/2020] [Indexed: 12/11/2022]
Abstract
Safe street crossing is important for older adults' social inclusion. We assessed gait kinematic adaptation under different simulated street crossing conditions in older adults with Parkinson's disease (PD) and made comparisons with older adults without PD to understand how PD interferes in outdoor task performance, helping in the development of strategies to reduce road traffic accident risk. In 20 older adults without PD (control group - CG) and 20 with PD (GPD), we assessed usual gait (C1), gait during street crossing simulation (C2), and gait during reduced-time street crossing simulation (C3). Velocity, step length, and step, swing, stance, and double support time were analyzed. Spatiotemporal differences in gait between groups and conditions were analyzed. The GPD walked 16% slower in C1 and 12% slower in C2 and C3 than the CG. GPD also took 11% shorter steps in C1 and 9.5% shorter steps in C2. The double support time was 8.5% greater in C1. In intragroup comparisons, there were significant differences in all gait conditions. The CG showed increased velocity (C2 15% > C1; C3 13% > C2; C3 26% > C1), step length (C2 8% > C1; C3 5% > C2; C3 13% > C1), and swing time (C2 2% > C1; C3 3.7% > C2; C3 6% > C1), and decreased step time (C2 7.5% < C1; C3 8% < C2; C3 15% < C1), stance time (C2 1.3% < C1; C3 2.5% < C2; C3 3.6% < C1), and double support time (C2 6.3% < C1; C3 10.5% < C2; C3 16% < C1). GPD showed increased velocity (C2 19% > C1; C3 13.5% > C2; C3 29.7% > C1), step length, (C2 6% > C1; C3 7% > C2; C3 16% > C1), and swing time (C2 3% > C1; C3 3% > C2; C3 5.5% > C1) and decreased step time (C2 10.3% < C1; C3 7.7% < C2; C3 17% < C1), stance time (C2 1.7% < C1; C3 1.7% < C2; C3 3.4% < C1), and double support time (C2 7% < C1; C3 9.5% < C2; C3 16% < C1). Kinematic changes observed in the intergroup comparison show that participants with PD had lower velocity in all conditions. However, per the intragroup results, both participants with and without PD managed to significantly modify gait variables to attempt to cross the street in the given time. It is necessary to assess whether this increases fall risk by exposing them to road traffic accidents.
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Affiliation(s)
- Késia Maísa do Amaral-Felipe
- Institute of Biosciences, São Paulo State University (UNESP), Avenida vinte e quatro A, 1515, CEP 13506-900 Rio Claro, São Paulo, Brazil; Faculty Anhanguera of Jundiaí, Rua do Retiro, 3000, CEP 13209-002 Jundiaí, São Paulo, Brazil.
| | - Patrícia de Aguiar Yamada
- Institute of Biosciences, São Paulo State University (UNESP), Avenida vinte e quatro A, 1515, CEP 13506-900 Rio Claro, São Paulo, Brazil; Faculty of Higher Education of Interior São Paulo (FAIP), Avenida Antonieta Altenfelder, 65, CEP 17512-130 Marília, São Paulo, Brazil
| | - Daniela Cristina Carvalho de Abreu
- Laboratory of Assessment and Rehabilitation of Equilibrium, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, CEP 14049-900 Ribeirão Preto, São Paulo, Brazil
| | - Renato Campos Freire Júnior
- Laboratory of Assessment and Rehabilitation of Equilibrium, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, CEP 14049-900 Ribeirão Preto, São Paulo, Brazil; Faculty of Physical Education and Physiotherapy, Federal University of Amazonas, Avenida General Rodrigo Octavio Jordão Ramos, 1200, CEP 69067-005 Manaus, Amazonas, Brazil
| | - Ana Elisa Zuliani Stroppa-Marques
- Department of Physical Therapy and Occupational Therapy, School of Philosophy and Science, São Paulo State University (UNESP), Avenida Hygino Muzzi FIlho, 737, CEP 17525-000 Marília, São Paulo, Brazil
| | - Flávia Roberta Faganello-Navega
- Institute of Biosciences, São Paulo State University (UNESP), Avenida vinte e quatro A, 1515, CEP 13506-900 Rio Claro, São Paulo, Brazil; Department of Physical Therapy and Occupational Therapy, School of Philosophy and Science, São Paulo State University (UNESP), Avenida Hygino Muzzi FIlho, 737, CEP 17525-000 Marília, São Paulo, Brazil
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Olson M, Lockhart TE, Lieberman A. Motor Learning Deficits in Parkinson's Disease (PD) and Their Effect on Training Response in Gait and Balance: A Narrative Review. Front Neurol 2019; 10:62. [PMID: 30792688 PMCID: PMC6374315 DOI: 10.3389/fneur.2019.00062] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/17/2019] [Indexed: 01/30/2023] Open
Abstract
Parkinson's disease (PD) is a neurological disorder traditionally associated with degeneration of the dopaminergic neurons within the substantia nigra, which results in bradykinesia, rigidity, tremor, and postural instability and gait disability (PIGD). The disorder has also been implicated in degradation of motor learning. While individuals with PD are able to learn, certain aspects of learning, especially automatic responses to feedback, are faulty, resulting in a reliance on feedforward systems of movement learning and control. Because of this, patients with PD may require more training to achieve and retain motor learning and may require additional sensory information or motor guidance in order to facilitate this learning. Furthermore, they may be unable to maintain these gains in environments and situations in which conscious effort is divided (such as dual-tasking). These shortcomings in motor learning could play a large part in degenerative gait and balance symptoms often seen in the disease, as patients are unable to adapt to gradual sensory and motor degradation. Research has shown that physical and exercise therapy can help patients with PD to adapt new feedforward strategies to partially counteract these symptoms. In particular, balance, treadmill, resistance, and repeated perturbation training therapies have been shown to improve motor patterns in PD. However, much research is still needed to determine which of these therapies best alleviates which symptoms of PIGD, the needed dose and intensity of these therapies, and long-term retention effects. The benefits of such technologies as augmented feedback, motorized perturbations, virtual reality, and weight-bearing assistance are also of interest. This narrative review will evaluate the effect of PD on motor learning and the effect of motor learning deficits on response to physical therapy and training programs, focusing specifically on features related to PIGD. Potential methods to strengthen therapeutic effects will be discussed.
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Affiliation(s)
- Markey Olson
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
- Muhammad Ali Movement Disorders Clinic, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Thurmon E. Lockhart
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Abraham Lieberman
- Muhammad Ali Movement Disorders Clinic, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
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Fox SH, Katzenschlager R, Lim SY, Barton B, de Bie RMA, Seppi K, Coelho M, Sampaio C. International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease. Mov Disord 2018; 33:1248-1266. [DOI: 10.1002/mds.27372] [Citation(s) in RCA: 406] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Susan H. Fox
- Edmund J. Safra Program, Movement Disorder Clinic; Toronto Western Hospital; Toronto Ontario Canada
- University of Toronto Department of Medicine; Toronto Ontario Canada
| | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders; Danube Hospital; Vienna Austria
| | - Shen-Yang Lim
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders; University of Malaya; Kuala Lumpur Malaysia
| | - Brandon Barton
- Rush University Medical Center; Chicago Illinois USA
- Jesse Brown VA Medical Center; Chicago Illinois USA
| | - Rob M. A. de Bie
- Department of Neurology, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Klaus Seppi
- Department of Neurology; Medical University Innsbruck; Innsbruck Austria
| | - Miguel Coelho
- Department of Neurology, Santa Maria Hospital, Instituto de Medicina Molecular; University of Lisbon; Lisbon Portugal
| | - Cristina Sampaio
- Cure Huntington's Disease Initiative (CHDI) Management/CHDI Foundation, Princeton, NJ; USA
- Instituto de Medicina Molecular; University of Lisbon; Lisbon Portugal
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Abstract
OBJECTIVE To characterize the stability limits and region in patients with unilateral vestibulopathy according to the side of the lesion and determine if that imposes any bias. To analyze if the stability limits and region depend on the functional deficit as evaluated in the sensory organization test. METHODS Forty patients with chronic dizziness and without any vertigo spell for least 6 months prior to testing. In all of them, a unilateral vestibulopathy was diagnosed clinically and at vestibular testing. A computerized dynamic posturography system was used to test for the ability of patients and controls to displace their center of pressure (COP) to the corresponding LOS. The area was calculated and compared to other data from vestibular tests. RESULTS The area of stability among patients shows a reduction to 35-62% of the expected total. That reduction was not found to be dependent on age. CONCLUSION There is a symmetric reduction in the limits of stability (LOS) in patients with unilateral vestibulopathy who suffer chronic instability. None of the areas measured were correlated with the composite score of the sensory organization test and, as such, must be considered as an adjunct measure to characterize the postural limitations in those patients.
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Affiliation(s)
- Rafael Alvarez-Otero
- Department of Otorhinolaryngology, Complejo Asistencial Universitario de Palencia, University of Valladolid, Valladolid, Spain
| | - Nicolas Perez-Fernandez
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, University Hospital and Medical School, University of Navarra, Navarra, Spain
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Abstract
The purpose of this study was to investigate the effectiveness of strength training, performed against a different resistance from body weight, in improving motor and nonmotor symptoms in patients with Parkinson’s disease (PD). The following electronic databases were searched: PubMed, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science. The review was conducted and reported in accordance with the PRISMA statement. Thirteen high-quality randomized controlled trials were included. Strength training performed against external resistance is well tolerated and appears to be a suitable physical activity to improve both physical parameters and quality of life parameters of PD subjects. However, although the study intervention included strength training, only a few selected studies assessed the improvement of muscle strength. Despite the encouraging results, it is difficult to establish a correlation between strength training and the improvements made. Our review highlights the lack of common intent in terms of study design and the presence of different primary and secondary outcomes. Accordingly, further studies are needed to support the beneficial effects of different types of strength training in PD subjects and to underline the superiority of strength training in PD patients with respect to other training.
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Affiliation(s)
- Ileana Ramazzina
- Department of Biomedical, Biotechnological and Translational Sciences
| | - Benedetta Bernazzoli
- Department of Clinical and Experimental Medicine, Graduate School of Rehabilitation and Physical Medicine, University of Parma, Parma, Italy
| | - Cosimo Costantino
- Department of Biomedical, Biotechnological and Translational Sciences
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Swank C, Shearin S, Cleveland S, Driver S. Auditing the Physical Activity and Parkinson Disease Literature Using the Behavioral Epidemiologic Framework. PM R 2016; 9:612-621. [PMID: 27777097 DOI: 10.1016/j.pmrj.2016.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/04/2016] [Accepted: 10/07/2016] [Indexed: 11/26/2022]
Abstract
Motor and nonmotor symptoms associated with Parkinson disease place individuals at greater risk of sedentary behaviors and comorbidities. Physical activity is one modifiable means of improving health and reducing the risk of morbidity. We applied a behavioral framework to classify existing research on physical activity and Parkinson disease to describe the current evolution and inform knowledge gaps in this area. Research placed in phase 1 establishes links between physical activity and health-related outcomes; phase 2 develops approaches to quantify physical activity behavior; phase 3 identifies factors associated with implementation of physical activity behaviors; phase 4 assesses the effectiveness of interventions to promote activity; and phase 5 disseminates evidence-based recommendations. Peer-reviewed literature was identified by searching PubMed, Google Scholar, and EBSCO-host. We initially identified 287 potential articles. After further review, we excluded 109 articles, leaving 178 included articles. Of these, 75.84% were categorized into phase 1 (n = 135), 10.11% in phase 2 (n = 18), 9.55% into phase 3 (n = 17), 3.37% into phase 4 (n = 6), and 1.12% into phase 5 (n = 2). By applying the behavioral framework to the physical activity literature for people with Parkinson disease, we suggest this area of research is nascent with more than 75% of the literature in phase 1. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Chad Swank
- School of Physical Therapy, Texas Woman's University, 5500 Southwestern Medical Ave, Dallas, TX 75235-7299(∗).
| | - Staci Shearin
- Department of Physical Therapy, University of Texas Southwestern School of Health Professions, Dallas, TX(†)
| | | | - Simon Driver
- Baylor Institute for Rehabilitation, Dallas, TX(§)
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19
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Abstract
BACKGROUND Physical activity (PA) is increasingly advocated as an adjunct intervention for individuals with Parkinson's disease (PD). However, the specific benefits of PA on the wide variety of impairments observed in patients with PD has yet to be clearly identified. OBJECTIVE Highlight health parameters that are most likely to improve as a result of PA interventions in patients with PD. METHODS We compiled results obtained from studies examining a PA intervention in patients with PD and who provided statistical analyses of their results. 868 outcome measures were extracted from 106 papers published from 1981 to 2015. The results were classified as having a statistically significant positive effect or no effect. Then, outcome measures were grouped into four main categories and further divided into sub-categories. RESULTS Our review shows that PA seems most effective in improving Physical capacities and Physical and cognitive functional capacities. On the other hand, PA seems less efficient at improving Clinical symptoms of PD and Psychosocial aspects of life, with only 50% or less of results reporting positive effects. The impact of PA on Cognitive functions and Depression also appears weaker, but few studies have examined these outcomes. DISCUSSION Our results indicate that PA interventions have a positive impact on physical capacities and functional capacities. However, the effect of PA on symptoms of the disease and psychosocial aspects of life are moderate and show more variability. This review also highlights the need for more research on the effects of PA on cognitive functions, depression as well as specific symptoms of PD.
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Affiliation(s)
- Martine Lauzé
- Département des sciences de l’activité physique, Université du Québec à Montréal, QC, Canada
- Centre de Recherche Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Jean-Francois Daneault
- Centre de Recherche Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Christian Duval
- Département des sciences de l’activité physique, Université du Québec à Montréal, QC, Canada
- Centre de Recherche Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
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20
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Lopes JBP, Lameira de Melo GE, Lazzari RD, Santos CA, Franco de Moura RC, Dumont AJL, Braun LAF, Duarte NAC, Pareira RB, Miziara IM, Oliveira CS. Measures used for the evaluation of balance in individuals with Parkinson's disease: a systematic review. J Phys Ther Sci 2016; 28:1936-42. [PMID: 27390451 PMCID: PMC4932092 DOI: 10.1589/jpts.28.1936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/15/2016] [Indexed: 01/29/2023] Open
Abstract
[Purpose] The present literature review was conducted on the use of different measures for the evaluation of balance in patients with Parkinson's disease. [Materials and Methods] The PubMed, Bireme, SciELO, Lilacs, and PEDro electronic databases were searched for relevant studies. [Results] The searches initially led to the retrieval of 3,623 articles, 540 of which were potentially eligible after limiting the search to clinical trials published in the last five years. A total of 264 duplicates were removed, and 276 articles were excluded based on their titles and abstracts. The full texts of 84 articles were analyzed, and only those with a PEDro score higher than four points (n=25) were included in the review. [Conclusion] Different methods, such as scales, tests, and equipment, are used for the evaluation of balance in patients with Parkinson's disease. More than one measure has been employed in most studies, and there is no consensus on a single precise measure for the evaluation of balance in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Rodolfo Borges Pareira
- School of Postural and Manual Therapy, Salgado Institute of
Integral Health, Paraná, Brazil
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21
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Abstract
BACKGROUND Gradual increases in mass such as during pregnancy are associated with changes in gait at natural velocities. The purpose of this study was to examine how added mass at natural and imposed slow walking velocities would affect gait parameters. METHODS Eighteen adult females walked at two velocities (natural and 25 % slower than their natural pace) under four mass conditions (initial harness only (1 kg), 4.535 kg added anteriorly, 9.07 kg added anteriorly, and final harness only (1 kg)). We collected gait kinematics (100 Hz) using a motion capture system. RESULTS Added anterior mass decreased cycle time and stride length. Stride width decreased once the mass was removed (p < .01). Added mass resulted in smaller peak hip extension angles (p < .01). The imposed slow walking velocity increased cycle time, double limb support time and decreased stride length, peak hip extension angles, and peak plantarflexion angles (p < .01). With added anterior mass and an imposed slow walking velocity, participants decreased cycle time when mass was added and increased cycle time once the mass was removed (p < .01). CONCLUSIONS Gait adaptations may be commensurate with the magnitude of additional mass when walking at imposed slow versus natural velocities. This study presents a method for understanding how increased mass and imposed speed might affect gait independent of other effects related to pregnancy. Examining how added body mass and speed influence gait is one step in better understanding how women adapt to walking under different conditions.
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Affiliation(s)
- Simone V Gill
- Department of Occupational Therapy, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA.
- Program in Rehabilitation Sciences (PhD), Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA.
- Department of Medicine, Boston University, 715 Albany Street, Boston, MA, 02218, USA.
| | - Maureen Ogamba
- Department of Physical Therapy and Athletic Training, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA
| | - Cara L Lewis
- Program in Rehabilitation Sciences (PhD), Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA
- Department of Medicine, Boston University, 715 Albany Street, Boston, MA, 02218, USA
- Department of Physical Therapy and Athletic Training, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA
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22
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Abstract
Background The effect of levodopa on postural motor learning in people with Parkinson's disease is poorly understood. In particular, it is unknown whether levodopa affects improvement in protective postural responses after external perturbations such as a slip or trip, a critical aspect of fall prevention. Objective Determine the effect of levodopa on postural motor learning in people with Parkinson's disease. Methods We assessed improvement in protective postural responses in people with Parkinson's disease over short-term (1 day) perturbation training on and off levodopa. We also assessed retention and generalization of improvement. Participants were 22 individuals with Parkinson's disease. The primary outcome was total center of mass (COM) displacement after perturbation. Secondary outcomes assessed first step performance and included margin of stability at first foot contact. Results People with Parkinson's disease improved COM displacement (P = .011) and margin of stability (P = .016) over training. Improvements in these outcomes were more pronounced after training while on levodopa than off levodopa. Levodopa State × Training interactions were not observed for other step performance variables (eg, step latency, length, total number of steps). Improvements were retained for 24 hours, and for margin of stability, retention was more pronounced while on levodopa than off (P = .018). Conclusions Individuals with Parkinson's disease are able to improve protective postural responses through short-term perturbation training, and improvements were more pronounced when on levodopa for some variables. Perturbation training may be more effective if completed while optimally medicated with levodopa.
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Affiliation(s)
- Daniel S Peterson
- Veterans Affairs Portland Health Care System (VAPORHCS), Portland, OR, USA Oregon Health and Science University, Portland, OR, USA University of Utah, Salt Lake City, UT, USA
| | - Fay B Horak
- Veterans Affairs Portland Health Care System (VAPORHCS), Portland, OR, USA Oregon Health and Science University, Portland, OR, USA
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Wong-yu IS, Mak MK. Task- and Context-Specific Balance Training Program Enhances Dynamic Balance and Functional Performance in Parkinsonian Nonfallers: A Randomized Controlled Trial With Six-Month Follow-Up. Arch Phys Med Rehabil 2015; 96:2103-11. [DOI: 10.1016/j.apmr.2015.08.409] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/03/2015] [Accepted: 08/04/2015] [Indexed: 11/20/2022]
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Šumec R, Filip P, Sheardová K, Bareš M. Psychological Benefits of Nonpharmacological Methods Aimed for Improving Balance in Parkinson's Disease: A Systematic Review. Behav Neurol 2015; 2015:620674. [PMID: 26236107 DOI: 10.1155/2015/620674] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/07/2015] [Accepted: 06/10/2015] [Indexed: 01/20/2023] Open
Abstract
Parkinson's disease (PD) is a serious condition with a major negative impact on patient's physical and mental health. Postural instability is one of the cardinal difficulties reported by patients to deal with. Neuroanatomical, animal, and clinical studies on nonparkinsonian and parkinsonian subjects suggest an important correlation between the presence of balance dysfunction and multiple mood disorders, such as anxiety, depression, and apathy. Considering that balance dysfunction is a very common symptom in PD, we can presume that by its management we could positively influence patient's state of mind too. This review is an analysis of nonpharmacological methods shown to be effective and successful for improving balance in patients suffering from PD. Strategies such as general exercise, robotic assisted training, Tai Chi, Qi Gong, Yoga, dance (such as tango or ballet), box, virtual reality-based, or neurofeedback-based techniques and so forth can significantly improve the stability in these patients. Beside this physical outcome, many methods have also shown effect on quality of life, depression level, enjoyment, and motivation to continue in practicing the method independently. The purpose of this review is to provide information about practical and creative methods designed to improve balance in PD and highlight their positive impact on patient's psychology.
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Uhrbrand A, Stenager E, Pedersen MS, Dalgas U. Parkinson's disease and intensive exercise therapy--a systematic review and meta-analysis of randomized controlled trials. J Neurol Sci 2015; 353:9-19. [PMID: 25936252 DOI: 10.1016/j.jns.2015.04.004] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/17/2015] [Accepted: 04/02/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate and compare the effect of 3 intensive exercise therapy modalities - Resistance Training (RT), Endurance Training (ET) and Other Intensive Training Modalities (OITM) - in Parkinson's Disease (PD). Design A systematic review and meta-analysis of randomized controlled trials. METHODS A systematic literature search was conducted (Embase, Pubmed, Cinahl, SPORTDiscus, Cochrane, PEDro), which identified 15 studies that were categorized as RT, ET or OITM. The different exercise modalities were reviewed and a meta-analysis evaluating the effect of RT on muscle strength was made. RESULTS In PD intensive exercise therapy (RT, ET and OITM) is feasible and safe. There is strong evidence that RT can improve muscle strength in PD, which is underlined by the meta-analysis (g'=0.54 [95%CI 0.22;0.86]). There is moderate evidence that ET can improve cardio-respiratory fitness in PD. RT, ET and OITM may have beneficial effects on balance, walking performance, Unified Parkinson's Disease Rating Scale-III (UPDRS-III) score and quality of life in PD, but findings are inconsistent. No studies find deterioration in any outcomes following exercise therapy. CONCLUSION RT, ET and OITM all represent feasible, safe and beneficial adjunct rehabilitation therapies in PD.
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Affiliation(s)
- Anders Uhrbrand
- Section of Sport Science, Dep. Public Health, Aarhus University, Denmark.
| | - Egon Stenager
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Neurology & MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Vejle), Sønderborg Hospital, Denmark
| | | | - Ulrik Dalgas
- Section of Sport Science, Dep. Public Health, Aarhus University, Denmark
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Moreno Catalá M, Woitalla D, Arampatzis A. Recovery performance and factors that classify young fallers and non-fallers in Parkinson's disease. Hum Mov Sci 2015; 41:136-46. [PMID: 25816793 DOI: 10.1016/j.humov.2015.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/22/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
Postural instability is a major problem for Parkinson's disease patients (PDs). Identifying the causes of postural instability at a young age would contribute to the development of adequate training interventions aiming to reduce falls. The purpose of this study was to investigate the effect of muscle strength and balance ability on dynamic stability control after simulated disturbances and to develop an applicable tool able to classify young PDs into fallers and non-fallers. Twenty-five young PDs (12 fallers, 13 non-fallers, 48±5 yrs.) and 14 healthy controls participated in the study. Dynamic stability was examined during simulated forward falls. Muscle strength was assessed by isometric maximal plantarflexion and knee extension contractions. Balance ability was evaluated by measuring the anterior and posterior limits of stability (LoS). The fallers showed lower recovery performance in forward falls and lower muscle strength compared to controls. Muscle strength and anterior LoS were significantly associated to stability performance. These two factors could correctly classify 90% of PD fallers, establishing an accurate assessment tool to predict the falling risk in young PDs. Furthermore, muscle strength partly explained recovery performance; therefore, we can argue that young PDs with an increased falling risk may benefit from leg-extensors strengthening and stability training.
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Affiliation(s)
- María Moreno Catalá
- Department of Training and Movement Sciences, Humboldt-University Berlin, Philippstr. 13, 10115 Berlin, Germany.
| | - Dirk Woitalla
- Department of Neurology, St. Joseph Hospital, Ruhr-University, Gudrunstr. 56, 44791 Bochum, Germany.
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-University Berlin, Philippstr. 13, 10115 Berlin, Germany.
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27
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Rocha PA, Porfírio GM, Ferraz HB, Trevisani VFM. Effects of external cues on gait parameters of Parkinson's disease patients: A systematic review. Clin Neurol Neurosurg 2014; 124:127-34. [PMID: 25043443 DOI: 10.1016/j.clineuro.2014.06.026] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 06/10/2014] [Accepted: 06/16/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Priscila A Rocha
- Universidade Federal de São Paulo/Escola Paulista de Medicina-UNIFESP/EPM, Urgency Medicine and Medicine based in Evidence, São Paulo, SP, Brazil.
| | - Gustavo M Porfírio
- Universidade Federal de São Paulo/Escola Paulista de Medicina-UNIFESP/EPM, Urgency Medicine and Medicine based in Evidence, São Paulo, SP, Brazil
| | - Henrique B Ferraz
- Universidade Federal de São Paulo/Escola Paulista de Medicina-UNIFESP/EPM, Neurology, São Paulo, SP, Brazil
| | - Virginia F M Trevisani
- Universidade Federal de São Paulo/Escola Paulista de Medicina-UNIFESP/EPM, Urgency Medicine and Medicine based in Evidence, São Paulo, SP, Brazil
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Bonnet CT, Delval A, Defebvre L. Interest of active posturography to detect age-related and early Parkinson's disease-related impairments in mediolateral postural control. J Neurophysiol 2014; 112:2638-46. [PMID: 25143549 DOI: 10.1152/jn.00412.2014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Patients with Parkinson's disease display impairments of postural control most particularly in active, challenging conditions. The objective of the present study was to analyze early signs of disease-related and also age-related impairments in mediolateral body extension and postural control. Fifty-five participants (18 Hoehn and Yahr stage 2 patients in the off-drug condition, 18 healthy elderly control subjects, and 19 young adults) were included in the study. The participants performed a quiet stance task and two active tasks that analyzed the performance in mediolateral body motion: a limit of stability and a rhythmic weight shift task. As expected, the patients displayed significantly lower and slower body displacement (head, neck, lower back, center of pressure) than elderly control subjects when performing the two body excursion tasks. However, the behavioral variability in both tasks was similar between the groups. Under these active conditions, the patients showed significantly lower contribution of the hip postural control mechanisms compared with the elderly control subjects. Overall, the patients seemed to lower their performance in order to prevent a mediolateral postural instability. However, these patients, at an early stage of their disease, were not unstable in quiet stance. Complementarily, elderly control subjects displayed slower body performance than young adults, which therefore showed an additional age-related impairment in mediolateral postural control. Overall, the study illustrated markers of age-related and Parkinson's disease impairments in mediolateral postural control that may constrain everyday activities in elderly adults and even more in patients with Parkinson's disease.
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Affiliation(s)
- Cédrick T Bonnet
- Laboratoire de Neurosciences Fonctionnelles et Pathologies, CNRS, Université Lille, Lille, France;
| | - Arnaud Delval
- EA 1046, Service de Neurophysiologie Clinique, Hôpital Salengro, CHRU, Lille, France; and
| | - Luc Defebvre
- EA 1046, Service de Neurophysiologie Clinique, Hôpital Salengro, CHRU, Lille, France; and Service de Neurologie et Pathologie du Mouvement, Hôpital Salengro, CHRU, Lille, France
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Abstract
Objective. To examine the effects of technology-assisted balance and gait training on reducing falls in patients with Parkinson’s disease (PD). Methods. Eligible subjects were randomly allocated to an experimental group given technology-assisted balance and gait training (BAL, n = 26) and an active control group undertaking strengthening exercises (CON, n = 25). The training in each group lasted for 3 months. The number of fallers and fall rate were used as primary outcomes, and single-leg-stance-time, latency of postural response to perturbation, self-selected gait velocity, and stride length as secondary outcomes. Fall incidence was recorded over 15 months after the baseline assessment (Pre). Other tests were performed at Pre, after 3-month intervention (Post3m), at 3 months (Post6m), and 12 months (Post15m) after treatment completion. Results. Forty-five subjects who completed the 3-month training were included in the data analysis. There were fewer fallers in the BAL than in the CON group at Post3m, Post6m, and Post15m ( P < .05). In addition, the BAL group had lower fall rate than the CON group at Post3m and Post6m (incidence rate ratio: 0.111-0.188, P < .05), and marginally so at Post15m (incidence rate ratio: 0.407, P = .057). Compared with the CON subjects, the BAL subjects demonstrated greater reduction in the postural response latency and increase in the stride length against baseline at each assessment interval ( P < .05), and marginally more increases of single-leg-stance-time at Post3m ( P = .064), Post6m ( P = .041) and Post15m ( P = .087). Conclusions. Our positive findings provide evidence for the clinical use of technology-assisted balance and gait training in reducing falls in people with PD.
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Affiliation(s)
- Xia Shen
- Hong Kong Polytechnic University, Hong Kong, China
- Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
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Shen X, Mak MKY. Balance and Gait Training With Augmented Feedback Improves Balance Confidence in People With Parkinson’s Disease. Neurorehabil Neural Repair 2014; 28:524-35. [PMID: 24407915 DOI: 10.1177/1545968313517752] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background. Fear of falling has been identified as an important and independent fall-risk predictor in patients with Parkinson’s disease (PD). However, there are inconsistent findings on the effects of balance and gait training on balance confidence. Objective. To explore whether balance and gait training with augmented feedback can enhance balance confidence in PD patients immediately after treatment and at 3- and 12-month follow-ups. Methods. A total of 51 PD patients were randomly assigned to a balance and gait training (BAL) group or to an active control (CON) group. The BAL group received balance and gait training with augmented feedback, whereas CON participants received lower-limb strength training for 12 weeks. Outcome measures included Activities-Specific Balance Confidence (ABC) Scale, limits-of-stability test, single-leg-stance test, and spatiotemporal gait characteristics. All tests were administered before intervention (Pre), immediately after training (Post), and at 3 months (Post3m) and 12 months (Post12m) after treatment completion. Results. The ABC score improved marginally at Post and significantly at Post3m and Post12m only in the BAL group ( P < .017). Both participant groups increased their end point excursion at Post, but only the BAL group maintained the improvement at Post3m. The BAL group maintained significantly longer time-to-loss-of-balance during the single-leg stance test than the CON group at Post3m and Post12m ( P < .05). For gait characteristics, both participant groups increased gait velocity, but only the BAL group increased stride length at Post, Post3m, and Post12m ( P < .017). Conclusions. Positive findings from this study provide evidence that BAL with augmented feedback could enhance balance confidence and balance and gait performance in patients with PD.
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Affiliation(s)
- Xia Shen
- Hong Kong Polytechnic University, Hong Kong, China
- Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
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