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Singer T, Fahey P, Liu KPY. Effectiveness of Motor Imagery in the Rehabilitation of People With Parkinson's Disease: A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2024; 38:460-475. [PMID: 38686907 DOI: 10.1177/15459683241246493] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
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.
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Affiliation(s)
- Tabitha Singer
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
- Brain Injury Rehabilitation Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia
| | - Paul Fahey
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Karen P Y Liu
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
- South Western Sydney Local Health District, NSW, Australia
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Handlery R, Handlery K, Kahl D, Koon L, Cabe SL, Regan EW. High Intensity Functional Training for People with Parkinson's & Their Care Partners: A Feasibility Study. Am J Health Promot 2024; 38:648-660. [PMID: 38311368 DOI: 10.1177/08901171241231085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
PURPOSE Various forms of exercise have proven health benefits for people with Parkinson's (pwPD) yet high intensity functional training (HIFT) has yet to be studied. The purpose of this study was to examine the feasibility, physical and psychosocial impacts of a HIFT program for pwPD and their care partners (CPs). DESIGN A single group, pre-post design with assessments before, in the middle (13 weeks), and after the 25-week intervention. SETTING Community fitness facility. PARTICIPANTS Fourteen pwPD (10 at Hoehn Yahr Stage ≤2, 4 females) and 10 CPs (5 females) were included (mean age = 71.5 (6.1)). INTERVENTION A 25-week HIFT program (≤49 exercise sessions, ≤75 min long). MEASURES Recruitment, retention, attendance, safety and exercise intensity (measured via session-Rating of Perceived Exertion (RPE)) was assessed in addition to cardiovascular endurance, lower extremity strength, walking speed, balance, exercise self-efficacy, balance confidence, social support for exercise and health-related quality of life. ANALYSIS Descriptive data was used to describe feasibility measures. Wilcoxon signed-rank test was used to compare pre- and post-program data. Effect size, r, was calculated. RESULTS Recruitment rates were ≥40% for pwPD and CPs and retention rates were 80% for pwPD and 62.5% for CPs. Average session attendance was 71.2% with 15 adverse events reported, including 7 non-injurious falls. Median session-RPE was 5 (IQR = 1) out of 10. PwPD demonstrated significant improvements in cardiovascular endurance, self-selected and fast walking speeds, balance and social support for exercise. CPs demonstrated significant improvements in cardiovascular endurance and lower extremity strength. Exercise self-efficacy, balance confidence and health-related quality of life did not significantly change for pwPD or CPs. CONCLUSION High intensity functional training appears feasible for pwPD and their CPs and may lead to health benefits. Healthcare providers should consider HIFT as another option to engage pwPD in community-based exercise.
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Affiliation(s)
- Reed Handlery
- School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, AR, USA
| | - Kaci Handlery
- School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, AR, USA
| | - Dana Kahl
- School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, AR, USA
| | - Lyndsie Koon
- Research and Training Center on Independent Living, University of Kansas, Lawrence, KS, USA
| | - Samuell Leyton Cabe
- School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, AR, USA
| | - Elizabeth Wherley Regan
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, SC, USA
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do Amaral CMS, de Almeida SB, de Almeida RP, do Nascimento SL, Ribeiro RM, Braga-Neto P. Effectiveness of vestibular rehabilitation on postural balance in Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials. BMC Neurol 2024; 24:161. [PMID: 38745275 PMCID: PMC11092171 DOI: 10.1186/s12883-024-03649-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Postural balance impairment can affect the quality of life of patients with Parkinson's disease. Previous studies have described connections of the vestibular system with postural functions, suggesting a potential participation of the basal ganglia in receiving vestibular stimuli. This systematic review aims to summarize the evidence on the effectiveness of vestibular rehabilitation on postural balance in patients with Parkinson's disease. METHODS A systematic review was conducted using the electronic databases: PubMed, Embase, Scopus and PEDro. The study selection was independently conducted by two reviewers, and disagreements were evaluated by a third reviewer. The included studies had no restrictions on publication dates or languages and the last update occurred in July 2023. RESULTS From the 485 studies found in the searches, only 3 studies were deemed eligible for the systematic review involving a total of 130 participants. The Berg Balance Scale was described as the tool for evaluation of postural balance in all studies. The meta-analysis showed statistically significant results in favor of vestibular rehabilitation (MD = 5.35; 95% CI = 2.39, 8.31; P < 0.001), regardless of the stage of Parkinson's disease. Although the effect size was suggested as a useful functional gain, the analysis was done with caution, as it only included 3 randomized controlled trials. The risk of bias using the RoB-2 was considered as being of "some concern" in all studies. Furthermore, the quality of the evidence based on the Grading of Recommendations Assessment Development and Evaluation system, produced by pooling the included studies was considered very low. CONCLUSION Compared to other interventions, vestibular rehabilitation has potential to assist the postural balance of patients with Parkinson's disease. However, the very low quality of the evidence demonstrates uncertainty about the impact of this clinical practice. More robust studies are needed to confirm the benefits of this therapy in patients with Parkinson's disease. This study was prospectively registered in PROSPERO: CRD42020210185.
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Affiliation(s)
- Carla Marineli Saraiva do Amaral
- Division of Neurology, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Rodolfo Teófilo - Fortaleza - Ceará, R.Prof. Costa Mendes Street - 4th floor, Fortaleza, 1608, Brazil
| | - Samuel Brito de Almeida
- Division of Neurology, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Rodolfo Teófilo - Fortaleza - Ceará, R.Prof. Costa Mendes Street - 4th floor, Fortaleza, 1608, Brazil
| | - Renata Parente de Almeida
- Department of Health Sciences, Faculty of Phonoaudiology, University of Fortaleza, Fortaleza, Brazil
| | | | - Rodrigo Mariano Ribeiro
- Division of Neurology, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Rodolfo Teófilo - Fortaleza - Ceará, R.Prof. Costa Mendes Street - 4th floor, Fortaleza, 1608, Brazil
| | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Rodolfo Teófilo - Fortaleza - Ceará, R.Prof. Costa Mendes Street - 4th floor, Fortaleza, 1608, Brazil.
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Jia Q, Jing L, Zhu Y, Han M, Jiao P, Wang Y, Xu Z, Duan Y, Wang M, Cai X. Real-Time Precise Targeting of the Subthalamic Nucleus via Transfer Learning in a Rat Model of Parkinson's Disease Based on Microelectrode Arrays. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1787-1795. [PMID: 38656860 DOI: 10.1109/tnsre.2024.3393116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
In neurodegenerative disorders, neuronal firing patterns and oscillatory activity are remarkably altered in specific brain regions, which can serve as valuable biomarkers for the identification of deep brain regions. The subthalamic nucleus (STN) has been the primary target for DBS in patients with Parkinson's disease (PD). In this study, changes in the spike firing patterns and spectral power of local field potentials (LFPs) in the pre-STN (zona incerta, ZI) and post-STN (cerebral peduncle, cp) regions were investigated in PD rats, providing crucial evidence for the functional localization of the STN. Sixteen-channel microelectrode arrays (MEAs) with sites distributed at different depths and widths were utilized to record neuronal activities. The spikes in the STN exhibited higher firing rates than those in the ZI and cp. Furthermore, the LFP power in the delta band in the STN was the greatest, followed by that in the ZI, and was greater than that in the cp. Additionally, increased LFP power was observed in the beta bands in the STN. To identify the best performing classification model, we applied various convolutional neural networks (CNNs) based on transfer learning to analyze the recorded raw data, which were processed using the Gram matrix of the spikes and the fast Fourier transform of the LFPs. The best transfer learning model achieved an accuracy of 95.16%. After fusing the spike and LFP classification results, the time precision for processing the raw data reached 500 ms. The pretrained model, utilizing raw data, demonstrated the feasibility of employing transfer learning for training models on neural activity. This approach highlights the potential for functional localization within deep brain regions.
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Borders JC, Lowell ER, Huber JE, Quinn L, Michelle S Troche. A Preliminary Study of Voluntary Cough Motor Performance and Learning With Skill Training and Biofeedback. J Speech Lang Hear Res 2024; 67:1299-1323. [PMID: 38557139 DOI: 10.1044/2024_jslhr-23-00516] [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] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE Sensorimotor cough skill training (CST) has been shown to improve cough strength, as well as facilitate changes during training (i.e., motor performance) and generalization to untrained tasks (i.e., motor learning). However, there is a gap in our understanding of the effects of voluntary CST (without sensory stimuli) on motor performance and learning. Furthermore, the contribution of physiologic factors, such as lung volume, a driver of cough strength in healthy adults, and treatment-specific factors, such as biofeedback, remains unexamined. METHOD Twenty individuals with Parkinson's disease (PD) completed pre- and post-CST single voluntary, sequential voluntary, and reflex cough testing. Participants were randomized to biofeedback or no biofeedback groups. They completed one CST session involving 25 trials of voluntary coughs, with the treatment target set 25% above baseline peak flow. Participants were instructed to "cough hard" to exceed the target. In the biofeedback group, participants received direct visualization of the target line in real time. RESULTS Cough peak flow showed positive improvements in motor performance (β = .02; 95% credible interval [CI]: 0.01, 0.03) and learning (β = .26; 95% CI: 0.03, 0.47). Changes in lung volume from pre- to post-CST did not predict treatment response. No differences in treatment response were detected between the biofeedback groups. CONCLUSIONS A single session of voluntary CST improved voluntary cough motor performance and learning. Although lung volume increased during CST, changes to lung volume did not predict treatment response. These findings demonstrate the potential of voluntary CST to improve motor performance and motor learning among individuals with PD and cough dysfunction. SUPPLEMENTAL MATERIAL AND OPEN SCIENCE FORM https://doi.org/10.23641/asha.25447444.
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Emilie R Lowell
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Jessica E Huber
- Motor Speech Laboratory, Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Lori Quinn
- Neurorehabilitation Research Laboratory, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Raccagni C, Sidoroff V, Paraschiv-Ionescu A, Roth N, Schönherr G, Eskofier B, Gassner H, Kluge F, Teatini F, Seppi K, Goebel G, Benninger DH, Aminian K, Klucken J, Wenning G. Effects of physiotherapy and home-based training in parkinsonian syndromes: protocol for a randomised controlled trial (MobilityAPP). BMJ Open 2024; 14:e081317. [PMID: 38692728 PMCID: PMC11086482 DOI: 10.1136/bmjopen-2023-081317] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/14/2023] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Gait and mobility impairment are pivotal signs of parkinsonism, and they are particularly severe in atypical parkinsonian disorders including multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). A pilot study demonstrated a significant improvement of gait in patients with MSA of parkinsonian type (MSA-P) after physiotherapy and matching home-based exercise, as reflected by sensor-based gait parameters. In this study, we aim to investigate whether a gait-focused physiotherapy (GPT) and matching home-based exercise lead to a greater improvement of gait performance compared with a standard physiotherapy/home-based exercise programme (standard physiotherapy, SPT). METHODS AND ANALYSIS This protocol was deployed to evaluate the effects of a GPT versus an active control undergoing SPT and matching home-based exercise with regard to laboratory gait parameters, physical activity measures and clinical scales in patients with Parkinson's disease (PD), MSA-P and PSP. The primary outcomes of the trial are sensor-based laboratory gait parameters, while the secondary outcome measures comprise real-world derived parameters, clinical rating scales and patient questionnaires. We aim to enrol 48 patients per disease group into this double-blind, randomised-controlled trial. The study starts with a 1 week wearable sensor-based monitoring of physical activity. After randomisation, patients undergo a 2 week daily inpatient physiotherapy, followed by 5 week matching unsupervised home-based training. A 1 week physical activity monitoring is repeated during the last week of intervention. ETHICS AND DISSEMINATION This study, registered as 'Mobility in Atypical Parkinsonism: a Trial of Physiotherapy (Mobility_APP)' at clinicaltrials.gov (NCT04608604), received ethics approval by local committees of the involved centres. The patient's recruitment takes place at the Movement Disorders Units of Innsbruck (Austria), Erlangen (Germany), Lausanne (Switzerland), Luxembourg (Luxembourg) and Bolzano (Italy). The data resulting from this project will be submitted to peer-reviewed journals, presented at international congresses and made publicly available at the end of the trial. TRIAL REGISTRATION NUMBER NCT04608604.
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Affiliation(s)
- Cecilia Raccagni
- Department of Neurology, Provincial Hospital of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano, Italy
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Victoria Sidoroff
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Nils Roth
- Artificial Intelligence in Biomedical Engineering, FAU, Erlangen, Germany
| | - Gudrun Schönherr
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Björn Eskofier
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Heiko Gassner
- Department of Molecular Neurology, Erlangen University Hospital, Erlangen, Germany
| | - Felix Kluge
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Francesco Teatini
- Department of Neurology, Provincial Hospital of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano, Italy
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - David H Benninger
- Service de Neurologie, Départment des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Kamiar Aminian
- Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Jochen Klucken
- Department of Molecular Neurology, Friedrich-Alexander University Erlangen, Nürnberg, Germany
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Digital Medicine - Dep. of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
- Digital Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Gregor Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Tucak C, Chih H, Mastaglia F, Rodrigues J. The 'PD Warrior' exercise programme improves motor outcomes and quality of life in patients with early Parkinson disease: results of a pilot study. Intern Med J 2024; 54:823-832. [PMID: 38100122 DOI: 10.1111/imj.16301] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/19/2023] [Indexed: 05/18/2024]
Abstract
BACKGROUND 'PD Warrior' (PDW) is a popular exercise programme for Parkinson disease; however, there are no published studies on the outcomes of the programme. AIMS To investigate short-term functional and quality of life (QoL) outcomes after the PDW 10-week programme in a pilot study of individuals with early Parkinson Disease (PD). METHODS Twenty individuals with PD (Hoehn & Yahr 1-3) attending a hospital outpatient clinic were recruited into the PDW 10-week programme, comprising a weekly 1-h supervised class complemented by an individualised daily home exercise programme. Participants had the following assessments at baseline and after completion of the programme: Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) Part III, timed up-and-go (TUG), 10-m walk test (10mWT), 6-min walking test (6MWT), balance tests, fine motor skills, 7-day Parkinson KinetiGraph (PKG) and PDQ-39 QoL scale. RESULTS Seventeen individuals completed the programme. Significant improvements were observed in MDS-UPDRS motor score (P = 0.019, d = 0.68, MCID 7); 6MWT distance (P < 0.001, d = 1.16); walking time during motor or cognitive dual tasking (P = 0.006, d = 0.77; P = 0.005, d = 0.79, respectively); and the PDQ-39 emotional well-being subdomain (P = 0.009; MCID 4.2); as well as improvements trending to significance in bradykinesia (P = 0.025, d = 0.73), 10mWT walking time (P = 0.023, d = 0.61) and borderline improvement in balance (P = 0.056, d = 0.50). CONCLUSIONS The outcomes of this study support the efficacy of the PDW programme in individuals with early PD and provide justification for future trials and investigation of its effects.
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Affiliation(s)
- Claire Tucak
- Physiotherapy Department, Hollywood Private Hospital, Nedlands, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - HuiJun Chih
- Curtin School of Population Health, Clinical Trials Enabling Platform, Curtin University, Perth, Western Australia, Australia
| | - Frank Mastaglia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
- Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Julian Rodrigues
- Perth Neurology Clinic, Hollywood Private Hospital, Nedlands, Western Australia, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Neurosciences Queensland, Spring Hill, Queensland, Australia
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Langer A, Hansen C, Roth D, Santer A, Flotz A, Gruber J, Wizany L, Hasenauer S, Pokan R, Dabnichki P, Treven M, Zimmel S, Schmoeger M, Willinger U, Gassner L, Brücke C, Maetzler W, Zach H. Vertical locomotion improves horizontal locomotion: effects of climbing on gait and other mobility aspects in Parkinson's disease. A secondary analysis from a randomized controlled trial. J Neuroeng Rehabil 2024; 21:63. [PMID: 38678241 PMCID: PMC11055236 DOI: 10.1186/s12984-024-01363-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND In the Climb Up! Head Up! trial, we showed that sport climbing reduces bradykinesia, tremor, and rigidity in mildly to moderately affected participants with Parkinson's disease. This secondary analysis aimed to evaluate the effects of sport climbing on gait and functional mobility in this cohort. METHODS Climb Up! Head Up! was a 1:1 randomized controlled trial. Forty-eight PD participants (Hoehn and Yahr stage 2-3) either participated in a 12-week, 90-min-per-week sport climbing course (intervention group) or were engaged in regular unsupervised physical activity (control group). Relevant outcome measures for this analysis were extracted from six inertial measurement units placed on the extremities, chest, and lower back, that were worn during supervised gait and functional mobility assessments before and after the intervention. Assessments included normal and fast walking, dual-tasking walking, Timed Up and Go test, Instrumented Stand and Walk test, and Five Times Sit to Stand test. RESULTS Compared to baseline, climbing improved gait speed during normal walking by 0.09 m/s (p = 0.005) and during fast walking by 0.1 m/s. Climbing also reduced the time spent in the stance phase during fast walking by 0.03 s. Climbing improved the walking speed in the 7-m- Timed Up and Go test by 0.1 m/s (p < 0.001) and the turning speed by 0.39 s (p = 0.052), the speed in the Instrumented Stand and Walk test by 0.1 m/s (p < 0.001), and the speed in the Five Times Sit to Stand test by 2.5 s (p = 0.014). There was no effect of sport climbing on gait speed or gait variables during dual-task walking. CONCLUSIONS Sport climbing improves gait speed during normal and fast walking, as well as functional mobility in people with Parkinson's disease. Trial registration This study was registered within the U.S. National Library of Medicine (No: NCT04569981, date of registration September 30th, 2020).
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Affiliation(s)
- Agnes Langer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, 24105, Kiel, Germany
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, 1090, Vienna, Austria
| | - Agnes Santer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Anna Flotz
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Jakob Gruber
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Laurenz Wizany
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Sebastian Hasenauer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Rochus Pokan
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, 1090, Vienna, Austria
| | - Peter Dabnichki
- School of Engineering, RMIT University, 3000, Melbourne, VIC, Australia
| | - Marco Treven
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Sarah Zimmel
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Michaela Schmoeger
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Ulrike Willinger
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Lucia Gassner
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, 1090, Vienna, Austria
- School of Engineering, RMIT University, 3000, Melbourne, VIC, Australia
| | - Christof Brücke
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, 24105, Kiel, Germany
| | - Heidemarie Zach
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria.
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Palm D, Swarowsky A, Gullickson M, Shilling H, Wolden M. Effects of Group Exercise on Motor Function and Mobility for Parkinson Disease: A Systematic Review and Meta-Analysis. Phys Ther 2024; 104:pzae014. [PMID: 38335243 DOI: 10.1093/ptj/pzae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/22/2023] [Accepted: 11/30/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Parkinson disease (PD) is associated with a predictable decline in motor function and mobility that is commonly managed with exercise. There is a limited understanding of the effects of group exercise compared to individual exercise (IE) and usual care (UC) on motor function and mobility. Our purpose was to investigate the effects of group exercise compared to IE and UC on motor function and mobility for people with PD. METHODS A systematic review and meta-analysis was performed with randomized control trials that investigated the effects of group compared with IE and UC on motor function and mobility for people with PD. A systematic search was performed in PubMed, EBSCO, and Science Direct databases. Methodological quality was assessed using the Cochrane Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS Twenty-three studies assessed at least 1 mobility-related outcome measure, met our inclusion criteria, and were included in quantitative analysis. There was no significant difference on motor function and mobility between group exercise and IE for all standardized outcome assessment meta-analyses. Motor function and mobility were significantly improved with group exercise compared to UC in 9 of 11 standardized outcome assessment meta-analyses. Results were based upon low to moderate quality of evidence. CONCLUSION Based upon low to moderate quality of evidence, group exercise has a similar to larger effect as IE and UC on improving motor function and mobility for people with PD. When used in combination with skilled physical therapy, group exercise may be an appropriate adjunct to individualized physical therapy to maximize mobility and function. IMPACT Long-term adherence to exercise is essential to maintain mobility and motor function for people with PD. Our study suggests group exercise is as effective as IE and may be an appropriate option to encourage long-term adherence related to increased access, socialization, and accountability.
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Affiliation(s)
- Diana Palm
- Physical Therapy Program, University of Jamestown, Fargo, North Dakota, USA
| | | | | | - Holly Shilling
- Physical Therapy Program, University of Jamestown, Fargo, North Dakota, USA
| | - Mitch Wolden
- Physical Therapy Program, University of Jamestown, Fargo, North Dakota, USA
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Bartolo M, Castelli A, Calabrese M, Buttacchio G, Zucchella C, Tamburin S, Fontana A, Copetti M, Fasano A, Intiso D. A wearable system for visual cueing gait rehabilitation in Parkinson's disease: a randomized non-inferiority trial. Eur J Phys Rehabil Med 2024; 60:245-256. [PMID: 38483335 DOI: 10.23736/s1973-9087.24.08381-3] [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: 04/13/2024]
Abstract
BACKGROUND Gait disturbances represent one of the most disabling features of Parkinson's disease (PD). AIM The aim of this study was to evaluate the non-inferiority of a new wearable visual cueing system (Q-Walk) for gait rehabilitation in PD subjects, compared to traditional visual cues (stripes on the floor). DESIGN Open-label, monocentric, randomized controlled non-inferiority trial. SETTING Outpatients. POPULATION Patients affected by idiopathic PD without cognitive impairment, Hoehn and Yahr stage II-IV, Unified Parkinson's Disease Rating Scale motor section III ≥2, stable drug usage since at least 3 weeks. METHODS At the enrollment (T0), all subjects underwent a clinical/functional evaluation and the instrumental gait and postural analysis; then they were randomly assigned to the Study Group (SG) or Control Group (CG). Rehabilitation program consisted in 10 consecutive individual sessions (5 sessions/week for 2 consecutive weeks). Each session included 60 minutes of conventional physiotherapy plus 30 minutes of gait training by Q-Walk (SG) or by traditional visual cues (CG). Follow-up visits were scheduled at the end of the treatment (T1) and after 3 months (T2). RESULTS Fifty-two subjects were enrolled in the study, 26 in each group. The within-groups analysis showed a significant improvement in clinical scales and instrumental data at T1 and at T2, compared to baseline, in both groups. According to the between-group analysis, Q-Walk cueing system was not-inferior to the traditional cues for gait rehabilitation. The satisfaction questionnaire revealed that most subjects described the Q-Walk cueing system as simple, motivating and easily usable, possibly suitable for home use. CONCLUSIONS Data showed that motor rehabilitation of PD subjects performed by means of the new wearable Q-Walk cueing system was feasible and as effective as traditional cues in improving gait parameters and balance. CLINICAL REHABILITATION IMPACT Wearable devices can act as an additional rehabilitation strategy for long-term and continuous care, allowing patients to train intensively and extensively in household settings, favoring a tailor-made and personalized approach as well as remote monitoring.
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Affiliation(s)
- Michelangelo Bartolo
- Neurorehabilitation Unit, Rehabilitation Department, HABILITA Zingonia, Zingonia, Bergamo, Italy -
| | - Alberto Castelli
- Neurorehabilitation Unit, Rehabilitation Department, HABILITA Zingonia, Zingonia, Bergamo, Italy
| | - Marzia Calabrese
- Neurorehabilitation Unit, Rehabilitation Department, HABILITA Zingonia, Zingonia, Bergamo, Italy
| | - Giampiero Buttacchio
- Neurorehabilitation Unit, Rehabilitation Department, HABILITA Zingonia, Zingonia, Bergamo, Italy
| | | | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Department of Parkinson's Disease and Movement Disorders Rehabilitation, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Como, Italy
| | - Domenico Intiso
- Unit of Neurorehabilitation and Rehabilitation Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
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Bissolotti L, Artiles-Sánchez J, Alonso-Pérez JL, Fernández-Carnero J, Abuín-Porras V, Sinatti P, Villafañe JH. Virtual Reality-Based Assessment for Rehabilitation of the Upper Limb in Patients with Parkinson's Disease: A Pilot Cross-Sectional Study. Medicina (Kaunas) 2024; 60:555. [PMID: 38674201 PMCID: PMC11051709 DOI: 10.3390/medicina60040555] [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] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/20/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: This study aimed to examine the responsiveness and concurrent validity of a serious game and its correlation between the use of serious games and upper limbs (UL) performance in Parkinson's Disease (PD) patients. Materials and Methods: Twenty-four consecutive upper limbs (14 males, 8 females, age: 55-83 years) of PD patients were assessed. The clinical assessment included: the Box and Block test (BBT), Nine-Hole Peg test (9HPT), and sub-scores of the Unified Parkinson's Disease Rating-Scale Motor section (UPDRS-M) to assess UL disability. Performance scores obtained in two different tests (Ex. A and Ex. B, respectively, the Trolley test and Mushrooms test) based on leap motion (LM) sensors were used to study the correlations with clinical scores. Results: The subjective fatigue experienced during LM tests was measured by the Borg Rating of Perceived Exertion (RPE, 0-10); the BBT and 9HPT showed the highest correlation coefficients with UPDRS-M scores (ICCs: -0.652 and 0.712, p < 0.05). Exercise A (Trolley test) correlated with UPDRS-M (ICC: 0.31, p < 0.05), but not with the 9HPT and BBT tests (ICCs: -0.447 and 0.390, p < 0.05), while Exercise B (Mushroom test) correlated with UPDRS-M (ICC: -0.40, p < 0.05), as did these last two tests (ICCs: -0.225 and 0.272, p < 0.05). The mean RPE during LM tests was 3.4 ± 3.2. The evaluation of upper limb performance is feasible and does not induce relevant fatigue. Conclusions: The analysis of the ICC supports the use of Test B to evaluate UL disability and performance in PD patients, while Test A is mostly correlated with disability. Specifically designed serious games on LM can serve as a method of impairment in the PD population.
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Affiliation(s)
- Luciano Bissolotti
- Fondazione Teresa Camplani Casa di Cura Domus Salutis, 25123 Brescia, Italy;
| | - Justo Artiles-Sánchez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, C/Inocencio García 1, 38300 Santa Cruz de Tenerife, Spain;
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
| | - José Luís Alonso-Pérez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, C/Inocencio García 1, 38300 Santa Cruz de Tenerife, Spain;
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (V.A.-P.); (P.S.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Onelife Center, Multidisciplinary Pain Treatment Center, 28925 Alcorcón, Spain
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28032 Madrid, Spain;
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora URJC-Banco de Santander, 28922 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonoma de Madrid, 28049 Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, 28029 Madrid, Spain
| | - Vanesa Abuín-Porras
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (V.A.-P.); (P.S.)
| | - Pierluigi Sinatti
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (V.A.-P.); (P.S.)
| | - Jorge Hugo Villafañe
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (V.A.-P.); (P.S.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
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LeLaurin JH, Salloum RG, Okun MS. Current practices of burst vs. spaced physical therapy applied to Parkinson's disease. Parkinsonism Relat Disord 2024; 120:106022. [PMID: 38325254 DOI: 10.1016/j.parkreldis.2024.106022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Jennifer H LeLaurin
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Ramzi G Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA; Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
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Huang X, Dong K, Gan C, Xu Z, Lei D, Dong X, Liu H, Chen X. Effect of Rhythmically Cued Exercise Interventions on Functions in Patients With Parkinson Disease: A Meta-Analysis. Phys Ther 2024; 104:pzad158. [PMID: 37962936 DOI: 10.1093/ptj/pzad158] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/06/2023] [Accepted: 10/06/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE The purpose of this review was to investigate the efficacy of rhythmically cued exercise interventions on motor function, cognition, and mental state in patients with Parkinson disease. METHODS PubMed, Cochrane Database, Web of Science, Embase, and CINAHL were searched June 15, 2023. Original studies investigating the efficacy of rhythmically cued exercise interventions on the functions of patients with Parkinson disease were included. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. The protocol was registered in PROSPERO (CRD42022371203). RESULTS A total of 38 original studies involving 1486 participants were included. Rhythmically cued exercise interventions demonstrated superior effects on motor function compared to exercise therapy without rhythm (standardized mean difference [SMD] = -0.31). However, no significant improvements were observed in cognition and mental state. Overall, significant improvements were observed in motor examination (SMD = -0.61), Timed "Up & Go" Test (mean difference [MD] = -0.91), activities of daily living (SMD = -0.49), balance (SMD = 0.59), walking velocity (MD = 0.06), step length (MD = 2.65), and stride length (MD = 0.04) following rhythmically cued exercise interventions. No significant improvements were observed in freezing of gait and cadence. Assessment of publication bias showed no significant evidence of publication bias. Meta-regression analyses revealed a significant association between treatment duration and improvement in motor function. Furthermore, adverse events and dropout rates did not significantly differ between the 2 groups. CONCLUSION Rhythmically cued exercise interventions are effective in improving motor function in the early to middle stages of Parkinson disease. More than 10 weeks of intervention yielded better results. However, these interventions do not have a significant impact on cognition and mental states. Importantly, rhythmically cued exercise interventions are safe and well tolerated. Large-scale trials are needed for further confirmation. IMPACT This study contributes to the development of safe and reliable home rehabilitation programs, aiming to enhance the quality of life for patients with Parkinson disease.
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Affiliation(s)
- Xin Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ke Dong
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chu Gan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhiqin Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Di Lei
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xinghua Dong
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hanjun Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xi Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Noé T. [The adapted physical activity teacher, a professional helping people to live better with Parkinson's disease]. Soins 2024; 69:29-32. [PMID: 38453396 DOI: 10.1016/j.soin.2023.12.022] [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] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Recognized by numerous scientific studies as an effective non-drug therapy for the treatment of most chronic illnesses, physical activity is booming. Many players are currently sharing the market. Among these professionals is the adapted physical activity teacher. They have a university degree in adapted physical activity and health. They propose motorized teaching situations using adapted physical activities, whether sporting or artistic, under technical, material, regulatory and motivational conditions that are appropriate to the situation and to the safety of the participant. The aim is rehabilitation, education, prevention and/or social integration.
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Affiliation(s)
- Tim Noé
- Groupement hospitalier Eaubonne-Montmorency, Hôpital Simone-Veil, 14 rue de Saint-Prix, 95600 Eaubonne, France.
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15
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Braz de Oliveira MP, Rigo Lima C, da Silva SLA, Firmino Vaz Figueira EC, David Truax B, Smaili SM. Effect of aquatic exercise programs according to the International Classification of Functionality, Disability and Health domains in individuals with Parkinson's disease: a systematic review and meta-analysis with GRADE quality assessment. Disabil Rehabil 2024; 46:429-442. [PMID: 36644928 DOI: 10.1080/09638288.2022.2164800] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate the effects of aquatic exercise programs (AEP) in body structure and function, activity, and participation outcomes in individuals with Parkinson's disease (PD) with mild to moderate disability levels. METHODS Six databases were searched from inception until November 2022. Randomized clinical trials that used AEP alone, AEP combined and/or compared two types of AEP were included. The quality of evidence was assessed by the GRADE approach and the standardized mean differences (SMD) were calculated the meta-analysis. RESULTS Twelve studies (n = 380) were included. AEP alone was superior to active control in improving body structure and function outcome: postural balance (low evidence, SMD = 0.47, p = 0.02). No statistically significant differences were found for the other body structure and function outcomes: lower limb muscle strength (p = 0.14) and depressive symptoms (p = 0.79), activity outcomes: mobility (p = 0.32) and participation outcomes: quality of life (p = 0.05). AEP combined showed no statistically significant difference for the outcomes of body structure and function: postural balance (p = 0.11) and activity: mobility (p = 0.21) when compared to active control. CONCLUSION AEP showed positive effects on body structure and function outcome (postural balance) in individuals with PD with mild to moderate disability levels while, no significant improvements were noticed for activity and participation outcomes.IMPLICATIONS FOR REHABILITATIONOur findings indicate that aquatic exercise programs (AEP) lead to significant improvements on body structure and function (i.e., postural balance) in individuals with Parkinson's disease (PD).The AEP evaluated in this study implemented postural balance, gait, single and double training, as well as aerobic exercises, trunk mobility exercises, and Ai Chi.The average duration, frequency, and total time implemented were 50 minutes, three times a week, for seven weeks, respectively.Considering the potential benefits identified in this study, AEP can be recommended as an adjunct treatment strategy for individuals with PD.Additionally, the use of the International Classification of Functionality, Disability and Health on the development of rehabilitation treatment plans is advised.
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Affiliation(s)
- Marcos Paulo Braz de Oliveira
- Department of Physical Therapy, Healthy Aging Research Laboratory, Federal University of São Carlos, São Paulo, Brazil
| | - Carla Rigo Lima
- Department of Physical Therapy, Mechanisms of Spinal Manual Therapy Laboratory, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Brendon David Truax
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suhaila Mahmoud Smaili
- Department of Physical Therapy, Neurofunctional Physical Therapy Research Group, State University of Londrina, Londrina, Brazil
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Maggio MG, Cezar RP, Milardi D, Borzelli D, DE Marchis C, D'Avella A, Quartarone A, Calabrò RS. Do patients with neurological disorders benefit from immersive virtual reality? A scoping review on the emerging use of the computer-assisted rehabilitation environment. Eur J Phys Rehabil Med 2024; 60:37-43. [PMID: 37971719 PMCID: PMC10939039 DOI: 10.23736/s1973-9087.23.08025-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/06/2023] [Revised: 09/11/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Virtual reality (VR) is an advanced technology that creates simulated environments and conditions. By offering the possibility of combining motor, cognitive, and well-being in conjunction with the potential to manipulate multi-sensorial features in a safe environment, VR has emerged as a promising powerful rehabilitation tool. Among advanced VR systems, various authors have highlighted promising effects in the rehabilitation of the computer-assisted rehabilitation environment (CAREN - Motekforce Link; Amsterdam, The Netherlands). In our scoping review, we aimed to map the existing evidence on the use of CAREN in the rehabilitation of neurological patients. EVIDENCE ACQUISITION This scoping review was conducted following the PRISMA guidelines. A search was carried out for all peer-reviewed articles published until June 30, 2023, using the following databases: PubMed, Embase, Cochrane Database, PeDro and Web of Science. The following terms have been used: ("Cognitive Rehabilitation" OR "Motor Rehabilitation" OR "CAREN" or "Computer-Assisted Rehabilitation Environment") AND ("Virtual Reality" OR "Rehab"). EVIDENCE SYNTHESIS From the assessed studies, only seven met the inclusion criteria: 1) one study concerned cognitive rehabilitation in patients suffering from Parkinson's Disease (PD); 2) one was on the usability of CAREN in PD patients; 3) two studies related to the influence of emotional components to CAREN rehabilitation; 4) three studies were related to motor rehabilitation using CAREN, and involved individuals with PD, Multiple Sclerosis, TBI, respectively. Generally, the few assessed studies demonstrate that CAREN is a safe and potentially effective tool to treat different symptoms (including gait and vestibular disturbances, executive function, depressive mood, and anxiety) in patients with different neurological disorders. CONCLUSIONS The reviewed literature indicated the potential use of CAREN in improving motor and cognitive skills with conflicting results on emotional aspects. However, since the data comes from few and small sample size studies, further research is needed to confirm the effectiveness of the tool in neurorehabilitation.
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Affiliation(s)
| | - Rocha P Cezar
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- The Center of Advanced Technology in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Demetrio Milardi
- Department of Biomedical Sciences, Dentistry, and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Daniele Borzelli
- Department of Biomedical Sciences, Dentistry, and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | | | - Andrea D'Avella
- Department of Biomedical Sciences, Dentistry, and Morpho-Functional Imaging, University of Messina, Messina, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
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Parry R, Buttelli O, Sellam N, Riff J, Vidailhet M, Welter ML, Lalo E. 'Le regard des autres': the experience of walking in social environments as a person with Parkinson's disease. Psychol Health 2024; 39:171-194. [PMID: 35255746 DOI: 10.1080/08870446.2022.2047187] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine the experience of people with Parkinson's disease when walking in different social situations, and improve understanding of how this affects participation in meaningful activity. METHODS A convenience sample of fourteen people with Parkinson's disease and a history of gait dysfunction was recruited. In-depth interviews and direct observations were conducted in the participants' home environments. Specific examples from community mobility were reviewed using first person interviewing techniques with the support of video footage. Interview transcripts were analyzed using an interpretive phenomenological approach to derive key themes. RESULTS The feeling of 'being looked at' (le regard des autres) was the central theme in participant discourse. This sentiment was inextricably linked to the given norms of the social setting, and the relationships between participants and others within that environment. Participants sought to manage how they were perceived by others through modification of posture/gait patterns; disclosure of their neurological disease; and avoidance/withdrawal from social situations. CONCLUSION Further to the functional aspects of mobility, gait is important for maintaining self-image in people with Parkinson's disease. Affective gaze interactions have significant consequences upon participation restriction. These findings underscore the interest of activities which strengthen self-image and validate movement diversity in PD rehabilitation.
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Affiliation(s)
- Ross Parry
- LINP2 - Laboratoire Interdisciplinaire en Neurosciences, Physiologie et Psychologie: Activité Physique, Santé et Apprentissages, UPL, Université Paris Nanterre, Nanterre, France
| | - Olivier Buttelli
- Sciences et Techniques des Activités Physiques et Sportive, Université d'Orléans, Orléans, France
| | - Narjis Sellam
- Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Jacques Riff
- Sciences et Techniques des Activités Physiques et Sportive, Université d'Orléans, Orléans, France
| | - Marie Vidailhet
- Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- Department of Neurology, AP-HP, Salpêtrière Hospital, Paris, France
| | - Marie-Laure Welter
- Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- Department of Neurophysiology, Rouen University Hospital and University of Rouen, Rouen, France
| | - Elodie Lalo
- Sciences et Techniques des Activités Physiques et Sportive, Université d'Orléans, Orléans, France
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Corcos DM, Lamotte G, Luthra NS, McKee KE. Advice to People with Parkinson's in My Clinic: Exercise. J Parkinsons Dis 2024; 14:609-617. [PMID: 38189710 PMCID: PMC11091645 DOI: 10.3233/jpd-230277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 01/09/2024]
Abstract
There is compelling evidence that exercise must be part of main line therapy for people with Parkinson's disease. In this viewpoint, we outline the four key components of exercise: aerobic exercise, resistance exercise, flexibility exercise, and neuromotor exercises (posture, gait, balance, and agility) that can improve both motor and non-motor symptoms of the disease and, in the case of aerobic exercise, may delay the disease. We outline guidelines on how to change and optimize the exercise prescription at different stages of the disease.
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Affiliation(s)
- Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Guillaume Lamotte
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Nijee S. Luthra
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Kathleen E. McKee
- Neurosciences Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA
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Savoie FA, Benoit S, Riesco E, Tanguay A. Long-term impact of a community-based adapted boxing program on physical functioning and quality of life of individuals with Parkinson's disease. NeuroRehabilitation 2024; 54:473-484. [PMID: 38640181 DOI: 10.3233/nre-230382] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
BACKGROUND Adapted boxing can help improve the physical functioning and health-related quality of life (HRQoL) of individuals with Parkinson's disease (PD). Whether these benefits persist longitudinally is unclear. OBJECTIVE The purpose of this retrospective study was to evaluate the impact of a community-based adapted boxing program on the physical functioning and HRQoL of individuals with PD over 1-1.5 years. METHODS Twenty-six individuals with PD agreed to share their results on tests administered upon enrollment in the program (PRE) and ∼431 days later (POST). The tests included the Fullerton Advanced Balance scale, (FAB), the Timed Up-and-Go test (TUG), the 30-second Sit-to-Stand test (30-STS), and the PD questionnaire-39 (PDQ-39). RESULTS From PRE to POST, performance significantly improved on the TUG and 30-STS tests (both p < 0.001), but not on the FAB (p = 0.79). Over the same period, PDQ-39 scores significantly increased (p = 0.05). No PRE to POST changes surpassed the minimal detectable change threshold. CONCLUSION The results of this study suggest that adapted boxing is at worst non-detrimental and at best potentially beneficial for muscle strength, endurance, and functional mobility in individuals with PD. However, adapted boxing probably cannot fully counteract the HRQoL decrements that accompany PD progression.
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Affiliation(s)
- Félix-Antoine Savoie
- Departement des Sciences de la Santé, Université du Québec à Rimouski, Rimouski, QC, Canada
- Centre de Recherche sur le Vieillissement, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Simon Benoit
- Faculté des Sciences de l'Activité Physique, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Eléonor Riesco
- Centre de Recherche sur le Vieillissement, Université de Sherbrooke, Sherbrooke, QC, Canada
- Faculté des Sciences de l'Activité Physique, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Andréanne Tanguay
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
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Goffredo M, Baglio F, DE Icco R, Proietti S, Maggioni G, Turolla A, Pournajaf S, Jonsdottir J, Zeni F, Federico S, Cacciante L, Cioeta M, Tassorelli C, Franceschini M, Calabrò RS. Efficacy of non-immersive virtual reality-based telerehabilitation on postural stability in Parkinson's disease: a multicenter randomized controlled trial. Eur J Phys Rehabil Med 2023; 59:689-696. [PMID: 37847247 PMCID: PMC10795069 DOI: 10.23736/s1973-9087.23.07954-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/02/2023] [Revised: 05/19/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND The implementation of regular prolonged, and effective rehabilitation in people with Parkinson's disease is essential for ensuring a good quality of life. However, the continuity of rehabilitation care may find barriers related to economic, geographic, and social issues. In these scenarios, telerehabilitation could be a possible solution to guarantee the continuity of care. AIM To investigate the efficacy of non-immersive virtual reality-based telerehabilitation on postural stability in people with Parkinson's disease, compared to at-home self-administered structured conventional motor activities. DESIGN Multicenter randomized controlled trial. SETTING Five rehabilitation hospitals of the Italian Neuroscience and Rehabilitation Network. POPULATION Individuals diagnosed with Parkinson's disease. METHODS Ninety-seven participants were randomized into two groups: 49 in the telerehabilitation group (non-immersive virtual reality-based telerehabilitation) and 48 in the control group (at-home self-administered structured conventional motor activities). Both treatments lasted 30 sessions (3-5 days/week for, 6-10 weeks). Static and dynamic balance, gait, and functional motor outcomes were registered before and after the treatments. RESULTS All participants improved the outcomes at the end of the treatments. The primary outcome (mini-Balance Evaluation Systems Test) registered a greater significant improvement in the telerehabilitation group than in the control group. The gait and endurance significantly improved in the telerehabilitation group only, with significant within-group and between-group differences. CONCLUSIONS Our results showed that non-immersive virtual reality-based telerehabilitation is feasible, improves static and dynamic balance, and is a reasonably valuable alternative for reducing postural instability in people with Parkinson's disease. CLINICAL REHABILITATION IMPACT Non-immersive virtual reality-based telerehabilitation is an effective and well-tolerated modality of rehabilitation which may help to improve access and scale up rehabilitation services as suggested by the World Health Organization's Rehabilitation 2030 agenda.
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Affiliation(s)
- Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | | | - Roberto DE Icco
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefania Proietti
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy
| | - Giorgio Maggioni
- Unità di Neuroriabilitazione, ICS Maugeri SB IRCCS Veruno, Veruno, Novara, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sanaz Pournajaf
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | | | - Federica Zeni
- Unità di Neuroriabilitazione, ICS Maugeri SB IRCCS Veruno, Veruno, Novara, Italy
| | - Sara Federico
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, Venice, Italy
| | - Luisa Cacciante
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, Venice, Italy
| | - Matteo Cioeta
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Marco Franceschini
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy
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Emmery L, Hackney ME, Kesar T, McKay JL, Rosenberg MC. An integrated review of music cognition and rhythmic stimuli in sensorimotor neurocognition and neurorehabilitation. Ann N Y Acad Sci 2023; 1530:74-86. [PMID: 37917153 PMCID: PMC10841443 DOI: 10.1111/nyas.15079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
This work reviews the growing body of interdisciplinary research on music cognition, using biomechanical, kinesiological, clinical, psychosocial, and sociological methods. The review primarily examines the relationship between temporal elements in music and motor responses under varying contexts, with considerable relevance for clinical rehabilitation. After providing an overview of the terminology and approaches pertinent to theories of rhythm and meter from the musical-theoretical and cognitive fields, this review focuses on studies on the effects of rhythmic sensory stimulation on gait, rhythmic cues' effect on the motor system, reactions to rhythmic stimuli attempting to synchronize mobility (i.e., musical embodiment), and the application of rhythm for motor rehabilitation for individuals with Parkinson's disease, stroke, mild cognitive impairment, Alzheimer's disease, and other neurodegenerative or neurotraumatic diseases. This work ultimately bridges the gap between the musical-theoretical and cognitive science fields to facilitate innovative research in which each discipline informs the other.
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Affiliation(s)
- Laura Emmery
- Department of Music, Emory College of Arts and Sciences, Emory University, Atlanta, Georgia, USA
| | - Madeleine E. Hackney
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA HealthCare System, Decatur, Georgia, USA
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Veterans Affairs Birmingham/Atlanta Geriatric Research Education and Clinical Center
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University School of Nursing, Atlanta, Georgia, USA
| | - Trisha Kesar
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J. Lucas McKay
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Michael C. Rosenberg
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
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Otlet V, Vandamme C, Warlop T, Crevecoeur F, Ronsse R. Effects of overground gait training assisted by a wearable exoskeleton in patients with Parkinson's disease. J Neuroeng Rehabil 2023; 20:156. [PMID: 37974229 PMCID: PMC10655429 DOI: 10.1186/s12984-023-01280-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND In the recent past, wearable devices have been used for gait rehabilitation in patients with Parkinson's disease. The objective of this paper is to analyze the outcome of a wearable hip orthosis whose assistance adapts in real time to the patient's gait kinematics via adaptive oscillators. In particular, this study focuses on a metric characterizing natural gait variability, i.e., the level of long-range autocorrelations (LRA) in series of stride durations. METHODS Eight patients with Parkinson's disease (Hoehn and Yahr stages 1[Formula: see text]2.5) performed overground gait training three times per week for four consecutive weeks, assisted by a wearable hip orthosis. Gait was assessed based on performance metrics such as the hip range of motion, speed, stride length and duration, and the level of LRA in inter-stride time series assessed using the Adaptive Fractal Analysis. These metrics were measured before, directly after, and 1 month after training. RESULTS After training, patients increased their hip range of motion, their gait speed and stride length, and decreased their stride duration. These improvements were maintained 1 month after training. Regarding long-range autocorrelations, the population's behavior was standardized towards a metric closer to the one of healthy individuals after training, but with no retention after 1 month. CONCLUSION This study showed that an overground gait training with adaptive robotic assistance has the potential to improve key gait metrics that are typically affected by Parkinson's disease and that lead to higher prevalence of fall. TRIAL REGISTRATION ClinicalTrials.gov Identifer NCT04314973. Registered on 11 April 2020.
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Affiliation(s)
- Virginie Otlet
- Institute of Mechanics, Materials, and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium.
- Institute of Neuroscience, UCLouvain, Brussels, Belgium.
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.
| | - Clémence Vandamme
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, UCLouvain, Louvain-la-Neuve, Belgium
| | - Thibault Warlop
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Service de Neurologie, Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
- Service de Neurologie (Pathologie du Mouvement), Centre Hospitalier Universitaire de Lille, Lille, France
| | - Frédéric Crevecoeur
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, UCLouvain, Louvain-la-Neuve, Belgium
| | - Renaud Ronsse
- Institute of Mechanics, Materials, and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
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23
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Bianchini E, Galli S, Alborghetti M, De Carolis L, Zampogna A, Hansen C, Vuillerme N, Suppa A, Pontieri FE. Four Days Are Enough to Provide a Reliable Daily Step Count in Mild to Moderate Parkinson's Disease through a Commercial Smartwatch. Sensors (Basel) 2023; 23:8971. [PMID: 37960670 PMCID: PMC10649244 DOI: 10.3390/s23218971] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023]
Abstract
Daily steps could be a valuable indicator of real-world ambulation in Parkinson's disease (PD). Nonetheless, no study to date has investigated the minimum number of days required to reliably estimate the average daily steps through commercial smartwatches in people with PD. Fifty-six patients were monitored through a commercial smartwatch for 5 consecutive days. The total daily steps for each day was recorded and the average daily steps was calculated as well as the working and weekend days average steps. The intraclass correlation coefficient (ICC) (3,k), standard error of measurement (SEM), Bland-Altman statistics, and minimum detectable change (MDC) were used to evaluate the reliability of the step count for every combination of 2-5 days. The threshold for acceptability was set at an ICC ≥ 0.8 with a lower bound of CI 95% ≥ 0.75 and a SAM < 10%. ANOVA and Mann-Whitney tests were used to compare steps across the days and between the working and weekend days, respectively. Four days were needed to achieve an acceptable reliability (ICC range: 0.84-0.90; SAM range: 7.8-9.4%). In addition, daily steps did not significantly differ across the days and between the working and weekend days. These findings could support the use of step count as a walking activity index and could be relevant to developing monitoring, preventive, and rehabilitation strategies for people with PD.
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Affiliation(s)
- Edoardo Bianchini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France;
| | - Silvia Galli
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
| | - Marika Alborghetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
| | - Lanfranco De Carolis
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
| | - Alessandro Zampogna
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.Z.); (A.S.)
| | - Clint Hansen
- Department of Neurology, Kiel University, 24105 Kiel, Germany;
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France;
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Institut Universitaire de France, 75005 Paris, France
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.Z.); (A.S.)
- IRCCS Neuromed Institute, 86077 Pozzilli, Italy
| | - Francesco E. Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
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Tonnesen M, Nielsen CV. Navigating (un)certainty in 'downhill' trajectories: An ethnographic study about rehabilitees' and professionals' experiences of goal-setting in Parkinson's disease rehabilitation. Clin Rehabil 2023; 37:1420-1434. [PMID: 37093740 DOI: 10.1177/02692155231170690] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
OBJECTIVE To explore rehabilitees' and professionals' experiences of goal-setting in a context of (un)certainty with a progressive neurodegenerative disease and how they navigate this (un)certainty in Parkinson's disease rehabilitation. DESIGN A long-term multi-sited ethnographic fieldwork (2019-2020) following 20 rehabilitees and their goals over time and settings. Observation at 30 goal-setting meetings. PARTICIPANTS Rehabilitees and professionals in Danish Parkinson's disease rehabilitation. Two randomly chosen groups of rehabilitees attending a Parkinson's disease course at a rehabilitation centre participated. METHODS Semi-structured interviews and participant observation. RESULTS Living with Parkinson's disease holds a certainty that the condition will progress yet an uncertainty regarding the pace and severity, as indicated by the notion (un)certainty. The (un)certainty challenges goal-setting. Reflecting on goal-setting, rehabilitees brought forth existential, economical, and societal considerations. Some expressed an ambivalent view, questioning the value of goal-setting with a progressive condition, yet finding own rehabilitation goals relevant. Others expressed a pragmatic view, attuning goals to fit the situation. Professionals found that the visible and invisible symptoms and the uncertain pace of Parkinson's made goal-setting challenging. They had to strike a balance between mentioning symptoms to come, yet not rendering the future too bleak. CONCLUSIONS Rehabilitees and professionals found that setting goals in a condition that progresses is no easy task. They made use of strategies such as observation, repetition, future-proofing strategies, and attuning goals to navigate the (un)certainty. In goal-setting, to maintain functioning with progressive Parkinson's disease was a viable goal. Participants found they just do the best they can to navigate (un)certainty.
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Affiliation(s)
- Merete Tonnesen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Defactum, Central Denmark Region, Aarhus, Denmark
| | - Claus V Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Defactum, Central Denmark Region, Aarhus, Denmark
- Region Hospital Gødstrup, Herning, Denmark
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25
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Lahude AB, Souza Corrêa P, P Cabeleira ME, Cechetti F. The impact of virtual reality on manual dexterity of Parkinson's disease subjects: a systematic review. Disabil Rehabil Assist Technol 2023; 18:1237-1244. [PMID: 35077662 DOI: 10.1080/17483107.2021.2001060] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To present the latest available evidence on the effects of a VR-based therapy on the manual dexterity of PD subjects. MATERIALS AND METHODS The search was conducted in PubMed, EMBASE, and PEDro databases. Were included in the systematic review Randomized Clinical Trials, Pilot and Feasibility studies published up to December 2020. The studies should include at least one of the following assessments: Box and Blocks Test, 9-Hole Peg Test; Purdue Pegboard Test. PEDro Scale was used to assess the methodological quality of the included studies. RESULTS Eight studies were included in the review. Most studies have shown an improvement in outcomes for manual dexterity, but most of them presented a high risk of bias with low methodological quality. A high heterogeneity was observed in the protocols used for each study. CONCLUSION The results suggest that VR-based therapy has great potential and feasibility to be used as a manual dexterity rehabilitation protocol in PD subjects. However, these results must be interpreted carefully and studies with greater methodological rigor must be conducted.Implications For RehabilitationRehabilitation programs using virtual reality seem to have greater adherence to the user.Immersive virtual reality systems seem to do better in manual dexterity than non-immersive systems.It is plausible to use virtual reality systems in telerehabilitation for manual dexterity training in subjects with Parkinson's' Disease.The use of Virtual Reality by the therapist in a rehabilitation program allows him to modulate the exercises, enabling a wide variety of therapeutic options.
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Affiliation(s)
- Arthur Both Lahude
- Post-Graduation Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Philipe Souza Corrêa
- Post-Graduation Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Maria Eduarda P Cabeleira
- Post-Graduation Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Fernanda Cechetti
- Post-Graduation Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Rong P, Benson J. Intergenerational choral singing to improve communication outcomes in Parkinson's disease: Development of a theoretical framework and an integrated measurement tool. Int J Speech Lang Pathol 2023; 25:722-745. [PMID: 36106430 DOI: 10.1080/17549507.2022.2110281] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: This study presented an initial step towards developing the evidence base for intergenerational choral singing as a communication-focussed rehabilitative approach for Parkinson's disease (PD).Method: A theoretical framework was established to conceptualise the rehabilitative effect of intergenerational choral singing on four domains of communication impairments - motor drive, timing mechanism, sensorimotor integration, higher-level cognitive and affective functions - as well as activity/participation, and quality of life. A computer-assisted multidimensional acoustic analysis was developed to objectively assess the targeted domains of communication impairments. Voice Handicap Index and the World Health Organization's Quality of Life assessment-abbreviated version were used to obtain patient-reported outcomes at the activity/participation and quality of life levels. As a proof of concept, a single subject with PD was recruited to participate in 9 weekly 1-h intergenerational choir rehearsals. The subject was assessed before, 1 week post, and 8 weeks post-choir.Result: Notable trends of improvement were observed in multiple domains of communication impairments at 1 week post-choir. Some improvements were maintained at 8 weeks post-choir. Patient-reported outcomes exhibited limited pre-post changes.Conclusion: This study provided the theoretical groundwork and an empirical measurement tool for future validation of intergenerational choral singing as a novel rehabilitation for PD.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence, KS, USA and
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27
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de Faria J, Sousa LR, Dorásio ACP, Pereira MP, Moraes R, Crozara LF, Hallal CZ. Multicomponent and mat Pilates training increased gait speed in individuals with Parkinson's disease when walking and carrying a load: A single-blinded randomized controlled trial. Physiother Res Int 2023; 28:e2031. [PMID: 37395268 DOI: 10.1002/pri.2031] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/30/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND AND PURPOSE Gait disorders in individuals with Parkinson's disease (IwPD) are among the most disabling symptoms. Physical exercise has been proposed for the treatment of IwPD because it shows positive effects on gait variables. Given the importance of physical activity in the rehabilitation process of IwPD, the assessment of interventions to identify those most promising for improving or maintaining gait performance is of great relevance. Therefore, this study evaluated the effects of Mat Pilates Training (MPT) and Multicomponent Training (MCT) on the spatiotemporal variables of gait in situations of daily dual-task performance in IwPD. Gait analysis in a daily dual-task context allows the simulation of real-life conditions where individuals have a higher risk of falling than in single-task walking. METHODS We conducted a single-blinded randomized controlled trial with 34 mild-to-moderate IwPD (Hoehn-Yahr stage 1-2). They were randomized to one of two interventions: MPT or MCT. All participants performed the training for 60 min, three times per week, for 20 weeks. Spatiotemporal gait variables were evaluated in a daily life situation to increase the ecological validity of the measurements, which included gait speed, stride time, double support time, swing time, and cadence. The individuals walked on a platform holding two bags with a load corresponding to 10% of their body mass. RESULTS After the intervention, there was a significant improvement in gait speed in both groups: MPT (p = 0.047) and MCT (p = 0.015). The MPT group reduced the cadence (p = 0.005) and the MCT group increased the stride length (p = 0.026) after the intervention. DISCUSSION Both groups had positive effects on gait speed with load transport resulting from the two proposed interventions. However, the MPT group showed a spatiotemporal adjustment of speed and cadence that can increase gait stability, which was not found in the MCT group.
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Affiliation(s)
- Júlia de Faria
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Lucas Resende Sousa
- Faculty of Medicine (FAMED), Federal University of Uberlândia, Uberlândia, Brazil
| | - Ana Cláudia Pamplona Dorásio
- Department of Physiotherapy - Faculty of Physical Education (FAEFI), Federal University of Uberlândia, Uberlândia, Brazil
| | - Miriam Pimenta Pereira
- Department of Physiotherapy - Faculty of Physical Education (FAEFI), Federal University of Uberlândia, Uberlândia, Brazil
| | - Renato Moraes
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Luciano Fernandes Crozara
- Department of Physical Education - Faculty of Physical Education (FAEFI), Federal University of Uberlândia, Uberlândia, Brazil
| | - Camilla Zamfolini Hallal
- Department of Physiotherapy - Faculty of Physical Education (FAEFI), Federal University of Uberlândia, Uberlândia, Brazil
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Masaki M, Takeuchi M, Kasahara M, Minakawa K, Inagaki Y, Ogawa Y, Sato Y, Yokota M, Maruyama S, Obinata S. Association of activities of daily living, mobility and balance ability, and symptoms of Parkinson's disease with the masses and amounts of intramuscular non-contractile tissue of the trunk and lower extremity muscles in patients with Parkinson's disease. J Med Ultrason (2001) 2023; 50:551-560. [PMID: 37646863 DOI: 10.1007/s10396-023-01356-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/16/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE We examined the association of activities of daily living (ADL), mobility and balance ability, and symptoms of Parkinson's disease (PD) with the masses and amounts of intramuscular non-contractile tissue of the trunk and lower extremity muscles in patients with PD. METHODS The subjects were 11 community-dwelling patients with PD. ADL were assessed using the Functional Independence Measure. Mobility capacity was assessed based on measurement of maximal walking speed and timed up-and-go time, while balance ability was evaluated based on measurement of one-legged stance time. The symptoms of PD were assessed based on measurement of the Hoehn and Yahr stage and Unified Parkinson's Disease Rating Scale. Muscle thickness (MT) and echo intensity (EI) of the trunk and lower extremity muscles were also measured using an ultrasound imaging device. RESULTS Partial correlation analysis revealed an association between reduced ADL and increased EI of the lumbar erector spinae muscle; reduced mobility capacity and increased EI of the rectus abdominis and gluteus minimus muscles; and reduced balance ability and decreased MT of the lumbar erector spinae muscle and increased EI of the lumbar erector spinae, semitendinosus, and tibialis posterior muscles. Partial correlation analysis also showed an association between symptoms of severe PD and decreased MT of the tibialis anterior muscles and increased EI of the lumbar erector spinae, gluteus minimus, and tibialis posterior muscles. CONCLUSION The properties of the trunk and lower extremity muscles may be critical for ADL, mobility and balance ability, and symptoms of PD in patients with PD.
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Affiliation(s)
- Mitsuhiro Masaki
- Department of Physical Therapy, Takasaki University of Health and Welfare, 501 Nakaorui-machi, Takasaki, Gunma, 370-0033, Japan.
| | - Moeka Takeuchi
- Department of Rehabilitation, Iwamuro Rehabilitation Hospital, 772-1 Iwamuronsen, Nishikan-ku, Niigata, Niigata, 953-0104, Japan
| | - Maki Kasahara
- Department of Rehabilitation, Tsunoda Hospital, 675-4 Kamishinden, Tamamura-machi, Sawagun, Gunma, 370-1133, Japan
| | - Kota Minakawa
- Tsutsumi Orthopaedic Clinic, 3-8-24 Terauchidonosawa, Akita, Akita, 011-0901, Japan
| | - Yukika Inagaki
- Department of Rehabilitation, Sawarabi Medical Welfare Center, 168-1 Oyagi-machi, Takasaki, Gunma, 370-0072, Japan
| | - Yukine Ogawa
- Department of Rehabilitation, Sannocho Hospital, 5-2-30 Hon-cho, Sanjo, Niigata, 955-0071, Japan
| | - Yoshino Sato
- Suzuki Otolaryngology Clinic, 6-5-37 Meike, Chuo-ku, Niigata, Niigata, 950-0941, Japan
| | - Minori Yokota
- Department of Rehabilitation, Takeda General Hospital, 3-27 Yamaga-machi, Aizuwakamatsu, Fukushima, 965-8585, Japan
| | - Seina Maruyama
- Piapupu Sports, 2-11-18 Dekijima, Chuo-ku, Niigata, Niigata, 950-0962, Japan
| | - Shunsuke Obinata
- Department of Rehabilitation, National Hospital Organization Nishiniigata Chuo Hospital, 1-14-1 Masago, Nishi-ku, Niigata, Niigata, 950-2085, Japan
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Carroll SJ, Dale MJ, Bail K. "Out and proud…. in all your shaking glory" the wellbeing impact of a dance program with public dance performance for people with Parkinson's disease: a qualitative study. Disabil Rehabil 2023; 45:3272-3283. [PMID: 36111837 DOI: 10.1080/09638288.2022.2122598] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/26/2022] [Accepted: 09/04/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To explore if and how Parkinson's disease dance class participation and public performance contributes to perceptions of wellbeing. MATERIALS AND METHODS A qualitative design using audio-recorded one-on-one semi-structured interviews with five class participants and three teachers/volunteers from two metropolitan Dance for Wellbeing class locations. Data were inductively thematically analysed by three researchers. RESULTS Five themes illustrated the experience of dance class and performance for people with Parkinson's Disease: 1) 'the enabling learning environment'; 2) 'physical benefits from class participation; 3) 'mental/psychological benefits from class participation'; 4) 'social benefits from class participation; 5) 'sense of self and life engagement from class participation'. Themes 4 and 5 in particular were considered to be 'magnified by public performance', providing an opportunity for solidarity within the group and a supportive avenue for "coming out" and living publicly with the PD diagnosis. CONCLUSION Dance performance magnifies health and wellbeing experiences of people with Parkinson's disease when part of an enabling, inclusive and emotionally and physically safe learning dance class environment. Elements of holistic benefits, as well as the fun and playful nature of the experience may be important elements to consider for motivation, recruitment and retention in this population.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals should consider the use of dance class as an art-based activity that has a holistic therapeutic benefit.Flexible and fun environments are constructive for dancers to sustain attendance and interest.Rehabilitation professionals can be cognisant of the impact of public dance performance as 'coming out' with Parkinson's Disease.
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Affiliation(s)
| | - Michael J Dale
- Health Research Institute, University of Canberra, Bruce, Australia
| | - Kasia Bail
- School of Nursing, Midwifery and Public Health, and Ageing Research Group, University of Canberra, Bruce, Australia
- Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra Hospital, Canberra, Australia
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Goh L, Canning CG, Song J, Clemson L, Allen NE. The effect of rehabilitation interventions on freezing of gait in people with Parkinson's disease is unclear: a systematic review and meta-analyses. Disabil Rehabil 2023; 45:3199-3218. [PMID: 36106644 DOI: 10.1080/09638288.2022.2120099] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/19/2021] [Revised: 08/21/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To summarize the effects of rehabilitation interventions to reduce freezing of gait (FOG) in people with Parkinson's disease. METHODS A systematic review with meta-analyses of randomized trials of rehabilitation interventions that reported a FOG outcome was conducted. Quality of included studies and certainty of FOG outcome were assessed using the PEDro scale and GRADE framework. RESULTS Sixty-five studies were eligible, with 62 trialing physical therapy/exercise, and five trialing cognitive and/or behavioral therapies. All meta-analyses produced very low-certainty evidence. Physical therapy/exercise had a small effect on reducing FOG post-intervention compared to control (Hedges' g= -0.26, 95% CI= -0.38 to -0.14, 95% prediction interval (PI)= -0.38 to -0.14). We are uncertain of the effects on FOG post-intervention when comparing: exercise with cueing to without cueing (Hedges' g= -0.58, 95% CI= -0.86 to -0.29, 95% PI= -1.23 to 0.08); action observation training plus movement strategy practice to practice alone (Hedges' g= -0.56, 95% CI= -1.16 to 0.05); and dance to multimodal exercises (Hedges' g= -0.64, 95% CI= -1.53 to 0.25). CONCLUSIONS We are uncertain if physical therapy/exercise, cognitive or behavioral therapies, are effective at reducing FOG.Implications for rehabilitationFOG leads to impaired mobility and falls, but the effect of rehabilitation interventions (including physical therapy/exercise and cognitive/behavioral therapies) on FOG is small and uncertain.Until more robust evidence is generated, clinicians should assess FOG using both self-report and physical measures, as well as other related impairments such as cognition, anxiety, and fear of falling.Interventions for FOG should be personalized based on the individual's triggers and form part of a broader exercise program addressing gait, balance, and falls prevention.Interventions should continue over the long term and be closely monitored and adjusted as individual circumstances change.
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Affiliation(s)
- Lina Goh
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jooeun Song
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lindy Clemson
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Natalie E Allen
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Kwon SH, Park JK, Koh YH. A systematic review and meta-analysis on the effect of virtual reality-based rehabilitation for people with Parkinson's disease. J Neuroeng Rehabil 2023; 20:94. [PMID: 37475014 PMCID: PMC10360300 DOI: 10.1186/s12984-023-01219-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Virtual reality (VR) is a promising solution for individuals with Parkinson's disease (PD) who experience symptoms that affect their daily activities and independence. Through VR-based rehabilitation, patients can improve their motor skills in a safe and stress-free environment, making it an attractive alternative to traditional in-person rehabilitation during the COVID-19 pandemic. This study aimed to provide the most recent and convincing evidence on the rehabilitative effects of VR technology compared with conventional treatments. METHODS Two investigators systematically searched Embase, MEDLINE, CINAHL, PEDro, and the Cochrane Library from their inception until May 31, 2022, to identify randomized controlled trials (RCTs) comparing the effectiveness of VR training with that of conventional treatment for patients with PD. Studies were selected based on the patient, intervention, comparator, and outcome criteria and assessed for the risk of bias using the Cochrane tool. Meta-analysis was conducted by pooling mean differences with 95% confidence intervals. RESULTS A total of 14 RCTs, involving 524 participants, were included in the meta-analysis. The results indicated that VR-based rehabilitation significantly improved balance function, as measured using the Berg balance scale (BBS) and activities-specific balance confidence. However, no statistically significant differences in gait ability, activities of daily living, motor function, and quality of life were observed between the experimental and control groups. Subgroup analysis revealed that combination therapy affected heterogeneity in the BBS analysis. Meta-regression analysis demonstrated a significant positive relationship, indicating that more recent studies have shown greater improvements in balance function. CONCLUSION This study's findings suggest that VR-based rehabilitation is a promising intervention for improving balance function in patients for PD compared with conventional treatment, and recent research supports its efficacy. However, future research should focus on conducting long-term follow-up studies and developing standardized protocols to comprehensively establish this intervention's potential benefits.
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Affiliation(s)
- Sun-Ho Kwon
- Division of Brain Disease Research, Department for Chronic Disease Convergence Research, Korea National Institute of Health, 187 Osongsaengmyeong2‑ro, Osong‑eup, Cheongju‑si, Chungcheongbuk‑do 28159 Republic of Korea
| | - Jae Kyung Park
- Division of Brain Disease Research, Department for Chronic Disease Convergence Research, Korea National Institute of Health, 187 Osongsaengmyeong2‑ro, Osong‑eup, Cheongju‑si, Chungcheongbuk‑do 28159 Republic of Korea
| | - Young Ho Koh
- Division of Brain Disease Research, Department for Chronic Disease Convergence Research, Korea National Institute of Health, 187 Osongsaengmyeong2‑ro, Osong‑eup, Cheongju‑si, Chungcheongbuk‑do 28159 Republic of Korea
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Brodie MA, Pelicioni PH, Okubo Y, Chan DY, Carroll V, Toson B, Vigano D, Macagno M, Sternberg S, Schreier G, Lovell NH. Immediate Effects of Lower Limb Sensory Simulation Using Smart Socks to Stabilize Gait in People with Parkinson's Disease. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083091 DOI: 10.1109/embc40787.2023.10340604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
People with Parkinson's disease (PD) experience gait impairment that can lead to falls and poor quality of life. Here we investigate the feasibility of using smart socks to stimulate the lower limbs of people with PD to reduce excessive step time variability during walking. We hypothesised that rythmic excitation of lower limb afferents, matched to a participant's comfortable pace, would entrain deficient neuro-muscular signals resulting in improved gait. Five people with mild to moderate PD symptoms (70 ± 9 years) were tested on medication before and after a 30-minute familierization session. Paired t-tests and Cohen's d were used to assess gait changes and report effect sizes. Participant experiences were recorded through structured interviews. Lower limb stimulation resulted in an acute 15% increase in gait speed (p=0.006, d=0.62), an 11% increase in step length (p=0.04, d=0.35), a 44% reduction in step time variability (p=0.03, d=0.91), a 22% increase in perceived gait quality (p=0.04, d=1.17), a 24% reduction in mental effort to walk (p=0.02, d=0.79) and no statistical difference for cadence (p=0.16). Participants commented positively on the benefit of stimulation during training but found that stimulation could be distracting when not walking and the socks hard to put on. While the large effects for step time variability and percieved gait quality (Cohen's d > 0.8) are promising, limitations regarding sample size, potential placebo effects and translation to the home environment should be addressed by future studies.Clinical Relevance- This study demonstrates the feasibility of using smart stimulating socks to reduce excessive step time variability in people with PD. As step time variability is a risk factor for falls, the use of smart textiles to augment future rehabilitation programs warrants further investigation.
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Petrovski D, Tirosh O, McCarthy C, Kameneva T. Video See-Through Pipelines for Virtual Reality Headsets and their Impact on Gait. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38082690 DOI: 10.1109/embc40787.2023.10340876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
This study investigated the impact of different video see-through pipelines in virtual reality on gait. A mobility task was conducted with healthy participants to evaluate the gait adaptions using different video see-through pipelines. The gait parameters observed for this study were stride length, maximum toe clearance and walking speed. The results showed an impact on gait where the gait parameters were reduced when participants used a high latency and restricted field of view pipeline. However, when participants used a pipeline with low latency and a field of view closer to normal vision, less impact on gait was achieved. As virtual reality poses a promising future for gait rehabilitation in patients with Parkinson's disease, this result highlights the need to carefully consider the video see-through pipeline and display characteristics when considering its use for gait rehabilitation or mobility studies in general.Clinical relevance- This study demonstrates the impact of virtual reality systems on gait using different video see- through pipelines during a mobility task. This may be useful for clinicians who use virtual reality in gait rehabilitation and aid them in choosing the most suitable virtual reality system for therapy.
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Chan HL, Chang YJ, Chen RS, Kuo CC, Chen YT, Liaw JW, Liao GS, Lin WT. Laser-light Visual Cueing Shoes with Foot Pressures and Inertial Sensing for Individuals with Parkinson's Disease . Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38082776 DOI: 10.1109/embc40787.2023.10340072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Gait disorder is a core problem in individuals with Parkinson's disease (PD), including bradykinesia, shuffling steps, festinating gait, and freeze of gait (FOG). Laser-light visual cueing has been demonstrated to be efficient in the mediation of gaits and the reduction in number of FOG episodes. However, previous approaches commonly adopted independent controls of visual cueing on left and right sides which was prone to produce two cues while individual was not in normal walking. In this study, we developed laser-light visual shoes which produced interlaced visual cues for left and right feet in a manner of one-side cueing at a time, solving the aforementioned problem. With parallel measurement of foot inertial data and foot pressures in each shoe, our results showed that the proposed visual cueing made PD individuals in the on-medication condition walk with a longer stance and swing times, that is, they walked more carefully and stable. The proposed approach can also be used to study kinematic and kinetic characteristics of gaits in the off-medication condition to clarify the mediation of visual cueing on motor control of PD individuals.Clinical Relevance- This demonstrates the effect of laser-light visual cueing on gaits in individuals with Parkinson's disease.
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Wu TL, Murphy A, Chen C, Kulic D. Auditory cueing strategy for stride length and cadence modification: a feasibility study with healthy adults. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-6. [PMID: 38082659 DOI: 10.1109/embc40787.2023.10340001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
People with Parkinson's Disease experience gait impairments that significantly impact their quality of life. Visual, auditory, and tactile cues can alleviate gait impairments, but they can become less effective due to the progressive nature of the disease and changes in people's motor capability. In this study, we develop a human-in-the-loop (HIL) framework that monitors two key gait parameters, stride length and cadence, and continuously learns a person-specific model of how the parameters change in response to the feedback. The model is then used in an optimization algorithm to improve the gait parameters. This feasibility study examines whether auditory cues can be used to influence stride length in people without gait impairments. The results demonstrate the benefits of the HIL framework in maintaining people's stride length in the presence of a secondary task.Clinical relevance- This paper proposes a gait rehabilitation framework that provides a personalized cueing strategy based on the person's real-time response to cues. The proposed approach has potential application to people with Parkinson's Disease.
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Han T, Liu Q, Hu Y, Wang Y, Xue K. Effect of Pro-kin visual feedback balance training on balance function of individuals with early Parkinson's disease: a randomized controlled pilot trial. Afr Health Sci 2023; 23:582-588. [PMID: 38223579 PMCID: PMC10782303 DOI: 10.4314/ahs.v23i2.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 01/16/2024] Open
Abstract
Background Parkinson's disease (PD) is the second most common neurodegenerative disease. Patients often present with balance dysfunction. Several studies have applied visual feedback training to stroke patients and demonstrated significant improvement. However, the application of visual feedback balance training in PD patients has not been reported. Objective To observe the effects of visual feedback balance training combined with conventional rehabilitation training on the balance function of patients with early PD. Methods Fifty patients with early PD were randomly divided into control group and observation group. The control group received conventional rehabilitation training, including body position transfer, weight shifting, movement in all directions and gait training. The observation group were added with visual feedback balance training on the basis of the training above. All patients were trained 5 times per week for 4 weeks. Berg Balance Scale (BBS), Time Up-and-Go test (TUG) and Pro-Kin balance training instrument were used to evaluate the balance function of patients before and after treatment, and the balance function were compared between the two groups. Results The BBS and TUG scores of the observation group and the control group were improved significantly (P<0.01), and the BBS and TUG scores of the observation group were improved more obviously than control group (P<0.01). The length and area of eye open and closed condition in the observation group and the control group were significantly reduced compared with those before training (P<0.01), and the degree of reduction in the observation group was more obvious (P<0.01). The length and area of the observation group and the control group before and after training when eye open were smaller than those when eye closed (P<0.01). Conclusion The conventional rehabilitation therapy can improve the balance function of PD patients, but the combination of visual feedback balance training and conventional rehabilitation therapy can improve the balance function more significantly.
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Affiliation(s)
- Tingting Han
- Sino-French Department of Neurological Rehabilitation, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Qian Liu
- Cerebrovascular Disease Center, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yaguang Hu
- Department of Pharmacy, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Yuxia Wang
- Department of Respiratory Medicine, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Kangying Xue
- Vaccination Hub, Monash Health, Melbourne, Victoria, Australia
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Fernández-González D, Rodriguez-Costa I, Sanz-Esteban I, Estrada-Barranco C. Therapeutic intervention with virtual reality in patients with Parkinson's disease for upper limb motor training: A systematic review. Rehabilitacion (Madr) 2023; 57:100751. [PMID: 36344299 DOI: 10.1016/j.rh.2022.06.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022]
Abstract
To analyze the scientific evidence regarding changes in upper extremities in patients with Parkinson's disease who use virtual reality as part of their neurological rehabilitation treatment. The search was carried out in the following databases: MEDLINE, Cochrane Library, PEDROs and SCOPUS. The following inclusion criteria were applied to a total of 106 articles: Randomized clinical trials with an age of 5 years, the sample had to be of patients with PD (regardless of their state of involvement) and who had performed RV in the treatment of limbs superiors. A total of n=7 articles were used, in which the variables corresponding to upper limb motor control were measured, such as: fine motor dexterity, gross motor dexterity, strength, tremor, functionality and speed. Virtual Reality as tool in neurorehabilitation in patients with Parkinson's disease shows positive effects in all measurements related to upper limb motor control.
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Affiliation(s)
| | - I Rodriguez-Costa
- Humanization in the Intervention of Physiotherapy for the Integral Attention to the People (HIPATIA) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - I Sanz-Esteban
- Universidad Europea de Madrid, Faculty of Sport Sciences, Department of Physiotherapy, Villaviciosa de Odón, Madrid, Spain
| | - C Estrada-Barranco
- Universidad Europea de Madrid, Faculty of Sport Sciences, Department of Physiotherapy, Villaviciosa de Odón, Madrid, Spain.
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Lena F, Modugno N, Greco G, Torre M, Cesarano S, Santilli M, Abdullahi A, Giovannico G, Etoom M. Rehabilitation Interventions for Improving Balance in Parkinson's Disease: A Narrative Review. Am J Phys Med Rehabil 2023; 102:270-274. [PMID: 35880770 DOI: 10.1097/phm.0000000000002077] [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: 11/25/2022]
Abstract
INTRODUCTION Postural instability is one of the latest clinical manifestations of Parkinson disease. Because of the limited therapeutic effect of pharmacological therapies, a favorable consideration has now become toward rehabilitation interventions. Thus, this study aimed to synthesize literature evidence to summarize the effects of rehabilitation interventions for improving balance in Parkinson disease. MATERIALS AND METHODS We conducted a narrative review of randomized-controlled clinical trials comparing the effects of interventions, control interventions, and no interventions on balance-related outcomes. A comprehensive search using the MEDLINE database was conducted from January 2000 to September 2021. This review included the following causes of balance-related impairments: inability to control body weight in the base of support, impaired attention and focus on balance, postural deformities, proprioceptive deficiency, sensory-motor integration, and coordination disorders, including visual and auditory-motor coordination. RESULTS Twenty randomized-controlled clinical trials were included in the review. Various balance-related outcomes were included. The included studies focused on the effectiveness of different rehabilitation interventions, including physical therapy, virtual reality and telerehabilitation, treadmill training, hydrotherapy, action observation training, balance and cues training interventions, and cognitive rehabilitation. CONCLUSIONS The results suggest that most of the included rehabilitation interventions have promising therapeutic effects in improving balance in Parkinson disease.
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Affiliation(s)
- Francesco Lena
- From the Department of Neurology, IRCCS INM Neuromed, Pozzilli, Italy (FL, NM, MS); Consorzio San Stef. Ar. Abruzzo, Pescara, Italy (G. Greco, MT, SC); Department of Physiotherapy, Bayero University, Kano, Nigeria (AA); Dipartimento di Medicina e Scienze del Benessere, Università degli Studi del Molise, Campobasso, Italy (G. Giovannico); and Physical Therapy Division-Allied Medical Sciences Department, Aqaba University of Technology, Aqaba, Jordan (ME)
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Cohen M, Herman T, Ganz N, Badichi I, Gurevich T, Hausdorff JM. Multidisciplinary Intensive Rehabilitation Program for People with Parkinson's Disease: Gaps between the Clinic and Real-World Mobility. Int J Environ Res Public Health 2023; 20:3806. [PMID: 36900826 PMCID: PMC10001519 DOI: 10.3390/ijerph20053806] [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: 12/05/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Intensive rehabilitation programs improve motor and non-motor symptoms in people with Parkinson's disease (PD), however, it is not known whether transfer to daily-living walking occurs. The effects of multidisciplinary-intensive-outpatient rehabilitation (MIOR) on gait and balance in the clinic and on everyday walking were examined. Forty-six (46) people with PD were evaluated before and after the intensive program. A 3D accelerometer placed on the lower back measured daily-living walking during the week before and after the intervention. Participants were also stratified into "responders" and "non-responders" based on daily-living-step-counts. After the intervention, gait and balance significantly improved, e.g., MiniBest scores (p < 0.001), dual-task gait speed increased (p = 0.016) and 6-minute walk distance increased (p < 0.001). Many improvements persisted after 3 months. In contrast, daily-living number of steps and gait quality features did not change in response to the intervention (p > 0.1). Only among the "responders", a significant increase in daily-living number of steps was found (p < 0.001). These findings demonstrate that in people with PD improvements in the clinic do not necessarily carry over to daily-living walking. In a select group of people with PD, it is possible to ameliorate daily-living walking quality, potentially also reducing fall risk. Nevertheless, we speculate that self-management in people with PD is relatively poor; therefore, to maintain health and everyday walking abilities, actions such as long-term engaging in physical activity and preserving mobility may be needed.
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Affiliation(s)
- Moriya Cohen
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6492416, Israel
- Ezra Lemarpeh Center, Bnei Brak 5111501, Israel
| | - Talia Herman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6492416, Israel
| | - Natalie Ganz
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6492416, Israel
| | | | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6492416, Israel
- Sagol School of Neuroscience, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6492416, Israel
- Sagol School of Neuroscience, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Rush Alzheimer’s Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
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Kang E, Jethani P, Foster ER. Person-centered goal setting is feasible in people with Parkinson's disease who have subjective cognitive decline: a mixed methods study. Disabil Rehabil 2023; 45:90-97. [PMID: 35023794 PMCID: PMC9719695 DOI: 10.1080/09638288.2022.2025930] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Evaluate the feasibility of person-centered goal setting in people with Parkinson's disease (PD) who have subjective cognitive decline and explore characteristics of the formulated goals. MATERIALS AND METHODS Participants completed person-centered goal setting as a part of two cognitive intervention studies. Participants were guided to develop at least three goals and rate the importance of each goal using a 10-point scale (1: not at all important - 10: extremely important). To evaluate the feasibility of person-centered goal setting, we calculated the mean number of formulated goals per person and the importance level of all goals. To explore goal characteristics, two independent authors coded all goals and synthesized them using deductive content analysis in consultation with the senior author. RESULTS Thirty participants formulated a total of 166 goals. The mean number of formulated goals per participant was 5.53 (SD = 2.22, range = 3 - 10). The mean importance level of all formulated goals was 8.3 (SD = 1.49, range = 4 - 10). Formulated goals ranged across diverse domains and categories. CONCLUSIONS Person-centered goal setting is feasible to guide people with PD to formulate personally meaningful goals. Findings highlight the diverse cognitive rehabilitation needs of people with PD, potential cognitive rehabilitation priorities, and future goal setting research directions.Implications for rehabilitationRehabilitation clinicians and researchers should not assume that people with PD who have subjective cognitive decline are not capable of engaging in their goal setting.Rehabilitation clinicians and researchers should acknowledge and act on our responsibility to enable people with PD who have subjective cognitive decline to engage in goal setting.Rehabilitation clinicians and researchers are encouraged to explore diverse goal domains to optimize goal setting and rehabilitation care among people with PD who have subjective cognitive decline.
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Affiliation(s)
- Eunyoung Kang
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Pooja Jethani
- Program in Occupational Therapy, Louisiana State University of Health Sciences, Shreveport, LA, USA
| | - Erin R. Foster
- Program in Occupational Therapy, Department of Neurology, & Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Maccarone MC, Masiero S. Can spa rehabilitative interventions play a role for patients suffering from neurodegenerative disorders at the early stages? A scoping review. Int J Biometeorol 2022; 66:2369-2377. [PMID: 36129582 PMCID: PMC9684286 DOI: 10.1007/s00484-022-02369-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 05/10/2023]
Abstract
The global burden of neurodegenerative disorders is significantly increasing as life expectancy rises but currently there is no cure for these conditions. An extensive search on MEDLINE (PubMed) and PEDro databases was conducted selecting clinical trials, Randomized Controlled Trials, and longitudinal studies published in the last 20 years in order to highlight what evidence there is for a role of spa rehabilitative interventions for patients with neurodegenerative diseases, in terms of motor function, symptoms, and quality of life (QoL) improvement and cost-effectiveness. A total of 225 publications were analyzed. Only three manuscripts were selected for review because they matched the inclusion criteria. These studies demonstrated statistically significant differences in the outcomes evaluated among patients affected by Parkinson's disease after thermal rehabilitative treatments: motor function, balance, QoL, and psychological well-being statistically improved. In addition, rehabilitation in the spa setting seemed to be cost-effective for these patients. However, further studies are needed to define the role of spa rehabilitative interventions for these patients as the literature is still limited.
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Affiliation(s)
| | - Stefano Masiero
- Physical Medicine and Rehabilitation School, University of Padova, Padua, Italy
- Rehabilitation Unit, Department of Neuroscience, University of Padova, Padua, Italy
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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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Maranesi E, Casoni E, Baldoni R, Barboni I, Rinaldi N, Tramontana B, Amabili G, Benadduci M, Barbarossa F, Luzi R, Di Donna V, Scendoni P, Pelliccioni G, Lattanzio F, Riccardi GR, Bevilacqua R. The Effect of Non-Immersive Virtual Reality Exergames versus Traditional Physiotherapy in Parkinson's Disease Older Patients: Preliminary Results from a Randomized-Controlled Trial. Int J Environ Res Public Health 2022; 19:ijerph192214818. [PMID: 36429537 PMCID: PMC9690935 DOI: 10.3390/ijerph192214818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/19/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 05/28/2023]
Abstract
(1) Background: Parkinson's disease (PD) is one of the most frequent causes of disability among older people. Recently, virtual reality and exergaming have been emerged as promising tools for gait and balance rehabilitation in PD patients. Our purpose is to evaluate an innovative treatment for older patients with PD, based on non-immersive virtual reality exergames, improving gait and balance and reducing falling risk. (2) Methods: Thirty PD patients were recruited and randomly divided into two groups, to receive a traditional rehabilitation (CG) or a technological rehabilitation (TG). (3) Results: A statistical improvement of balance at the end of treatments was observed in both groups (CG: 12.4 ± 0.7 vs. 13.5 ± 0.8, p = 0.017; TG: 13.8 ± 0.5 vs. 14.7 ± 0.4, p = 0.004), while the overall risk of falling was significantly reduced only in the TG (POMA Total: 24.6 ± 0.9 vs. 25.9 ± 0.7, p = 0.010). The results between groups shows that all POMA scores differ in a statistically significant manner in the TG, emphasizing improvement not only in balance but also in gait characteristics (9.7 ± 0.8 vs. 11.4 ± 0.2, p = 0.003). Moreover, TG also improves the psychological sphere, measured thorough MSC-(17.1 ± 0.4 vs. 16.5 ± 0.4, p = 0.034). Although an improvement in FES-I and Gait Speed can be observed, this increase does not turn out to be significant. (4) Conclusions: Results suggest how non-immersive virtual reality exergaming technology offers the opportunity to effectively train cognitive and physical domains at the same time.
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Affiliation(s)
| | - Elisa Casoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 60127 Ancona, Italy
| | - Renato Baldoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 60127 Ancona, Italy
| | - Ilaria Barboni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 60127 Ancona, Italy
| | - Nadia Rinaldi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy
| | - Barbara Tramontana
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy
| | | | | | | | | | - Valentina Di Donna
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy
| | - Pietro Scendoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy
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Meigal AY, Gerasimova-Meigal LI, Reginya SA, Soloviev AV, Moschevikin AP. Gait Characteristics Analyzed with Smartphone IMU Sensors in Subjects with Parkinsonism under the Conditions of "Dry" Immersion. Sensors (Basel) 2022; 22:7915. [PMID: 36298272 PMCID: PMC9611186 DOI: 10.3390/s22207915] [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: 08/19/2022] [Revised: 09/23/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Parkinson's disease (PD) is increasingly being studied using science-intensive methods due to economic, medical, rehabilitation and social reasons. Wearable sensors and Internet of Things-enabled technologies look promising for monitoring motor activity and gait in PD patients. In this study, we sought to evaluate gait characteristics by analyzing the accelerometer signal received from a smartphone attached to the head during an extended TUG test, before and after single and repeated sessions of terrestrial microgravity modeled with the condition of "dry" immersion (DI) in five subjects with PD. The accelerometer signal from IMU during walking phases of the TUG test allowed for the recognition and characterization of up to 35 steps. In some patients with PD, unusually long steps have been identified, which could potentially have diagnostic value. It was found that after one DI session, stepping did not change, though in one subject it significantly improved (cadence, heel strike and step length). After a course of DI sessions, some characteristics of the TUG test improved significantly. In conclusion, the use of accelerometer signals received from a smartphone IMU looks promising for the creation of an IoT-enabled system to monitor gait in subjects with PD.
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Affiliation(s)
- Alexander Y. Meigal
- Medical Institute, Petrozavodsk State University, 33, Lenina pr., 185910 Petrozavodsk, Russia
| | | | - Sergey A. Reginya
- Physical-Technical Institute, Petrozavodsk State University, 33, Lenina pr., 185910 Petrozavodsk, Russia
| | - Alexey V. Soloviev
- Physical-Technical Institute, Petrozavodsk State University, 33, Lenina pr., 185910 Petrozavodsk, Russia
| | - Alex P. Moschevikin
- Physical-Technical Institute, Petrozavodsk State University, 33, Lenina pr., 185910 Petrozavodsk, Russia
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Hashemi Y, Taghizadeh G, Azad A, Behzadipour S. The effects of supervised and non-supervised upper limb virtual reality exercises on upper limb sensory-motor functions in patients with idiopathic Parkinson's disease. Hum Mov Sci 2022; 85:102977. [PMID: 35932518 DOI: 10.1016/j.humov.2022.102977] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/01/2021] [Revised: 07/09/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Impairments of upper limb (UL) sensory-motor functions are common in Parkinson's disease (PD). Virtual reality exercises may improve sensory-motor functions in a safe environment and can be used in tele-rehabilitation. This study aimed to investigate the effects of supervised and non-supervised UL virtual reality exercises (ULVRE) on UL sensory-motor functions in patients with idiopathic PD. METHODS In this clinical trial study, 45 patients with idiopathic PD (29 male) by mean ± SD age of 58.64 ± 8.69 years were randomly allocated to either the control group (conventional rehabilitation exercises), supervised ULVRE or non-supervised ULVRE. Interventions were 24 sessions, 3 sessions/week. Before/after of interventions and follow-up period all assessment was done. Hand Active Sensation Test and Wrist Position Sense Test were used for assessing UL sensory function. Gross and fine manual dexterity were assessed by Box-Block Test and Nine-Hole Peg Test, respectively. Grip and pinch strength were evaluated by a dynamometer and pinch gauge, respectively. RESULTS The results showed significant improvement in discriminative sensory function (HAST-weight and HAST-total), wrist proprioception, gross manual dexterity and grip strength of both less and more affected hands as well as fine manual dexterity of the more affected hand in the three groups in patients with idiopathic PD (P < 0.05). CONCLUSION The results of this study indicated that both supervised and non-supervised ULVRE using the Kinect device might potentially improve some aspects of UL sensory-motor functions in patients with PD. Therefore, ULVRE using the Kinect device can be used in tele-rehabilitation, especially in the current limitations induced by the COVID-19 pandemic, for improving UL functions in patients with PD.
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Affiliation(s)
- Yazdan Hashemi
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Akram Azad
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Saeed Behzadipour
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran; Djavad Mowafaghian Research Center for Intelligent Neuro-rehabilitation Technologies, Tehran, Iran.
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Avenali M, Vaghi G, De Icco R, Grillo V, Susca C, Giudice C, Putortì A, Barnabei R, Allena M, Tassorelli C. Pearls & Oy-sters: Marionette Walk in Parkinson Disease: A Rare Dyskinetic-Dystonic Gait Pattern Complication Improved by Visual Cueing. Neurology 2022; 99:77-81. [PMID: 35584921 PMCID: PMC9280995 DOI: 10.1212/wnl.0000000000200714] [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] [Received: 11/05/2021] [Accepted: 03/25/2022] [Indexed: 11/15/2022] Open
Abstract
We report a case of a 60-year-old patient with a 10-year history of Parkinson disease who developed a dyskinetic-dystonic gait pattern highly affecting his personal and social life. After multiple unsuccessful attempts to improve the clinical condition by adapting the pharmacologic treatment, the patient underwent gait rehabilitation based on the use of visual cueing. This approach induced a relevant improvement in the dyskinetic-dystonic gait. Our case contributes to the phenotypic description of motor fluctuations in advanced Parkinson disease and suggests an additional therapeutic option to mitigate their impact on motor performances.
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Affiliation(s)
- Micol Avenali
- From the Department of Brain and Behavioral Sciences (M. Avenali, G.V., R.D.I., A.P., R.B., C.T.), University of Pavia; and Neurorehabilitation Unit (M. Avenali, G.V., R.D.I., V.G., C.S., C.G., A.P., R.B., M. Allena, C.T.), IRCCS Mondino Foundation, Pavia, Italy.
| | - Gloria Vaghi
- From the Department of Brain and Behavioral Sciences (M. Avenali, G.V., R.D.I., A.P., R.B., C.T.), University of Pavia; and Neurorehabilitation Unit (M. Avenali, G.V., R.D.I., V.G., C.S., C.G., A.P., R.B., M. Allena, C.T.), IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto De Icco
- From the Department of Brain and Behavioral Sciences (M. Avenali, G.V., R.D.I., A.P., R.B., C.T.), University of Pavia; and Neurorehabilitation Unit (M. Avenali, G.V., R.D.I., V.G., C.S., C.G., A.P., R.B., M. Allena, C.T.), IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina Grillo
- From the Department of Brain and Behavioral Sciences (M. Avenali, G.V., R.D.I., A.P., R.B., C.T.), University of Pavia; and Neurorehabilitation Unit (M. Avenali, G.V., R.D.I., V.G., C.S., C.G., A.P., R.B., M. Allena, C.T.), IRCCS Mondino Foundation, Pavia, Italy
| | - Cristopher Susca
- From the Department of Brain and Behavioral Sciences (M. Avenali, G.V., R.D.I., A.P., R.B., C.T.), University of Pavia; and Neurorehabilitation Unit (M. Avenali, G.V., R.D.I., V.G., C.S., C.G., A.P., R.B., M. Allena, C.T.), IRCCS Mondino Foundation, Pavia, Italy
| | - Carla Giudice
- From the Department of Brain and Behavioral Sciences (M. Avenali, G.V., R.D.I., A.P., R.B., C.T.), University of Pavia; and Neurorehabilitation Unit (M. Avenali, G.V., R.D.I., V.G., C.S., C.G., A.P., R.B., M. Allena, C.T.), IRCCS Mondino Foundation, Pavia, Italy
| | - Alessia Putortì
- From the Department of Brain and Behavioral Sciences (M. Avenali, G.V., R.D.I., A.P., R.B., C.T.), University of Pavia; and Neurorehabilitation Unit (M. Avenali, G.V., R.D.I., V.G., C.S., C.G., A.P., R.B., M. Allena, C.T.), IRCCS Mondino Foundation, Pavia, Italy
| | - Ruggero Barnabei
- From the Department of Brain and Behavioral Sciences (M. Avenali, G.V., R.D.I., A.P., R.B., C.T.), University of Pavia; and Neurorehabilitation Unit (M. Avenali, G.V., R.D.I., V.G., C.S., C.G., A.P., R.B., M. Allena, C.T.), IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- From the Department of Brain and Behavioral Sciences (M. Avenali, G.V., R.D.I., A.P., R.B., C.T.), University of Pavia; and Neurorehabilitation Unit (M. Avenali, G.V., R.D.I., V.G., C.S., C.G., A.P., R.B., M. Allena, C.T.), IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- From the Department of Brain and Behavioral Sciences (M. Avenali, G.V., R.D.I., A.P., R.B., C.T.), University of Pavia; and Neurorehabilitation Unit (M. Avenali, G.V., R.D.I., V.G., C.S., C.G., A.P., R.B., M. Allena, C.T.), IRCCS Mondino Foundation, Pavia, Italy
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Kwok JYY, Smith R, Chan LML, Lam LCC, Fong DYT, Choi EPH, Lok KYW, Lee JJ, Auyeung M, Bloem BR. Managing freezing of gait in Parkinson's disease: a systematic review and network meta-analysis. J Neurol 2022; 269:3310-3324. [PMID: 35244766 DOI: 10.1007/s00415-022-11031-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Freezing of gait (FOG) is one of the most disabling gait disorders affecting 80% of patients with Parkinson's disease (PD). Clinical guidelines recommend a behavioral approach for gait rehabilitation, but there is a wide diversity of behavioral modalities. OBJECTIVE The objective of this network meta-analysis was to compare the effectiveness of different behavioral interventions for FOG management in PD patients. METHODS Six databases were searched for randomized controlled trials of behavioral interventions for FOG management among PD patients from 1990 to December 2021. Bayesian network meta-analysis was used to combine both direct and indirect trial evidence on treatment effectiveness, while the surface under the cumulative ranking (SUCRA) score was used to estimate the ranked probability of intervention effectiveness. RESULTS Forty-six studies were included in the qualitative synthesis. Among, 36 studies (1454 patients) of 72 interventions or control conditions (12 classes) were included in the network meta-analysis, with a mean intervention period of 10.3 weeks. After adjusting for the moderating effect of baseline FOG severity, obstacle training [SMD -2.1; 95% credible interval (Crl): -3.3, -0.86], gait training with treadmill (SMD -1.2; 95% Crl: -2.0, -0.34), action observation training (SMD -1.0; 95% Crl: -1.9, -0.14), conventional physiotherapy (SMD -0.70; 95% Crl: -1.3, -0.12) and general exercise (SMD -0.64; 95% Crl: -1.2, -0.11) demonstrated significant improvement on immediate FOG severity compared to usual care. The SUCRA rankings suggest that obstacle training, gait training on treadmill and general exercises are most likely to reduce FOG severity. CONCLUSION Obstacle training, gait training on treadmill, general exercises, action observation training and conventional physiotherapy demonstrated immediate real-life benefits on FOG symptoms among patients with mild-moderate PD. With the promising findings, the sustained effects of high complexity motor training combined with attentional/cognitive strategy should be further explored. Future trials with rigorous research designs using both subjective and objective outcome measures, long-term follow-up and cost-effective analysis are warranted to establish effective behavioral strategies for FOG management.
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Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China.
| | - Robert Smith
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Lily Man Lee Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Leo Chun Chung Lam
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Jung Jae Lee
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Man Auyeung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, People's Republic of China
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Ossmy O, Mansano L, Frenkel-Toledo S, Kagan E, Koren S, Gilron R, Reznik D, Soroker N, Mukamel R. Motor learning in hemi-Parkinson using VR-manipulated sensory feedback. Disabil Rehabil Assist Technol 2022; 17:349-361. [PMID: 32657187 DOI: 10.1080/17483107.2020.1785561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/17/2020] [Revised: 05/07/2020] [Accepted: 06/17/2020] [Indexed: 01/10/2023]
Abstract
AIMS Modalities for rehabilitation of the neurologically affected upper-limb (UL) are generally of limited benefit. The majority of patients seriously affected by UL paresis remain with severe motor disability, despite all rehabilitation efforts. Consequently, extensive clinical research is dedicated to develop novel strategies aimed to improve the functional outcome of the affected UL. We have developed a novel virtual-reality training tool that exploits the voluntary control of one hand and provides real-time movement-based manipulated sensory feedback as if the other hand is the one that moves. The aim of this study was to expand our previous results, obtained in healthy subjects, to examine the utility of this training setup in the context of neuro-rehabilitation. METHODS We tested the training setup in patient LA, a young man with significant unilateral UL dysfunction stemming from hemi-parkinsonism. LA underwent daily intervention in which he intensively trained the non-affected upper limb, while receiving online sensory feedback that created an illusory perception of control over the affected limb. Neural changes were assessed using functional magnetic resonance imaging (fMRI) scans before and after training. RESULTS Training-induced behavioral gains were accompanied by enhanced activation in the pre-frontal cortex and a widespread increase in resting-state functional connectivity. DISCUSSION Our combination of cutting edge technologies, insights gained from basic motor neuroscience in healthy subjects and well-known clinical treatments, hold promise for the pursuit of finding novel and more efficient rehabilitation schemes for patients suffering from hemiplegia.Implications for rehabilitationAssistive devices used in hospitals to support patients with hemiparesis require expensive equipment and trained personnel - constraining the amount of training that a given patient can receive. The setup we describe is simple and can be easily used at home with the assistance of an untrained caregiver/family member. Once installed at the patient's home, the setup is lightweight, mobile, and can be used with minimal maintenance . Building on advances in machine learning, our software can be adapted to personal use at homes. Our findings can be translated into practice with relatively few adjustments, and our experimental design may be used as an important adjuvant to standard clinical care for upper limb hemiparesis.
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Affiliation(s)
- Ori Ossmy
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Lihi Mansano
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel
| | - Silvi Frenkel-Toledo
- Department of Physiotherapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Evgeny Kagan
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Shiri Koren
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Roee Gilron
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Reznik
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roy Mukamel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
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Capodaglio EM, Cavalagli A, Panigazzi M. Exergame for the functional rehabilitation of adults over 55 with neurological diseases. G Ital Med Lav Ergon 2022; 44:59-76. [PMID: 36346300] [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] [Subscribe] [Scholar Register] [Accepted: 01/01/2022] [Indexed: 05/18/2023]
Abstract
SUMMARY Rehabilitation based on Exergame is showing a rapid evolution, with interesting applications for the recovery of mobility, balance, postural control, coordination and fine motor skills, and including home-based training. At present, there are no precise indications for Exergamebased rehabilitation of people over 55 affected by stroke, Parkinson's disease, or multiple sclerosis. This review examines the proposed modalities and the effectiveness of Exergame-based rehabilitation interventions for adults over 55 with stroke, Parkinson's disease or multiple sclerosis, highlighting the limitations, advantages, controversies and impact of this approach. We examined randomized controlled trials published between 2016-2020, with search in the databases of PubMed, Scopus, Cochrane Library, RehabData, selecting 24 studies. The study of patients with chronic or subacute stroke in outpatient treatment, and with small sample sizes, prevails. Wide variability characterizes the rehabilitation methods, the technological platforms used, the type and dose of exercise administered, the outcome measures. The adequacy and efficacy of Exergames remains uncertain in the neurological elderly, and the functional improvement in the neurological adult patient is not yet attested using this type of approach.
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Affiliation(s)
- Edda Maria Capodaglio
- Istituti Clinici Scientifici Maugeri IRCCS, Occupational therapy and ergonomics unit of Pavia Institute, Italy
| | - Angela Cavalagli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Monica Panigazzi
- Istituti Clinici Scientifici Maugeri IRCCS, Occupational therapy and ergonomics unit of Pavia and Montescano Institutes, Italy
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Bishnoi A, Lee R, Hu Y, Mahoney JR, Hernandez ME. Effect of Treadmill Training Interventions on Spatiotemporal Gait Parameters in Older Adults with Neurological Disorders: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Environ Res Public Health 2022; 19:ijerph19052824. [PMID: 35270516 PMCID: PMC8909968 DOI: 10.3390/ijerph19052824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 12/07/2022]
Abstract
Objective: Treadmill interventions have been shown to promote ‘normal’ walking patterns, as they facilitate the proper movement and timing of the lower limbs. However, prior reviews have not examined which intervention provides the most effective treatment of specific gait impairments in neurological populations. The objective of this systematic review was to review and quantify the changes in gait after treadmill interventions in adults with neurological disorders. Data Sources: A keyword search was performed in four databases: PubMed, CINAHL, Scopus, and Web of Science (January 2000−December 2021). We performed the search algorithm including all possible combinations of keywords. Full-text articles were examined further using forward/backward search methods. Study Selection: Studies were thoroughly screened using the following inclusion criteria: study design: Randomized Controlled Trial (RCT); adults ≥55 years old with a neurological disorder; treadmill intervention; spatiotemporal gait characteristics; and language: English. Data Extraction: A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, and spatiotemporal gait parameters including stride length, stride time, step length, step width, step time, stance time, swing time, single support time, double support time, or cadence. Data Synthesis: We found a total of 32 studies to be included in our systematic review through keyword search, out of which 19 studies included adults with stroke and 13 studies included adults with PD. We included 22 out of 32 studies in our meta-analysis that examined gait in adults with neurological disorders, which only yielded studies including Parkinson’s disease (PD) and stroke patients. A meta-analysis was performed among trials presenting with similar characteristics, including study population and outcome measure. If heterogeneity was >50% (denoted by I2), random plot analysis was used, otherwise, a fixed plot analysis was performed. All analyses used effect sizes and standard errors and a p < 0.05 threshold was considered statistically significant (denoted by *). Overall, the effect of treadmill intervention on cadence (z = 6.24 *, I2 = 11.5%) and step length (z = 2.25 *, I2 = 74.3%) in adults with stroke was significant. We also found a significant effect of treadmill intervention on paretic step length (z = 2.34 *, I2 = 0%) and stride length (z = 6.09 *, I2 = 45.5%). For the active control group, including adults with PD, we found that overground physical therapy training had the largest effect on step width (z = −3.75 *, I2 = 0%). Additionally, for PD adults in treadmill intervention studies, we found the largest significant effect was on step length (z = 2.73 *, I2 = 74.2%) and stride length (z = −2.54 *, I2 = 96.8%). Conclusion: Treadmill intervention with sensory stimulation and body weight support treadmill training were shown to have the largest effect on step length in adults with PD and stroke.
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Affiliation(s)
- Alka Bishnoi
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
| | - Rachel Lee
- Department of Solid Organ Transplant, University of Chicago Medical Center, Chicago, IL 60637, USA;
| | - Yang Hu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
| | - Jeannette R. Mahoney
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Manuel E. Hernandez
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
- Correspondence:
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