Physiotherapy in Parkinson's Disease: A Meta-Analysis of Present Treatment Modalities

Physiotherapy and Exercise in Parkinson's Disease

Physiotherapy is an important treatment strategy in Parkinson's disease. Guidelines recommend early and regular physiotherapy referrals, which may improve a variety of symptoms, including falls. There are multiple types of physiotherapy with different goals and benefits. Exercise as well can improve symptoms and may alter disease trajectory. Studies are limited by heterogenous interventions and outcome measures, and further research is needed in generating high-quality research and expanding physical therapy access.

Effect of an adapted physical activity program in Parkinson's disease: A randomized controlled study (APA-Park)

CONTEXT

Previous studies assessing adapted physical activity (APA) in Parkinson's disease (PD) have been very heterogeneous regarding methodology and intervention, and have generally not addressed the question of combining various types of physical activity with a long-term evaluation.

OBJECTIVES

To evaluate the immediate and long-term effect of a 3-month APA program, combining endurance, resistance training and stretching on motor symptoms, body composition, cardiorespiratory function and metabolic profile in PD patients.

METHODS

In this controlled trial, we randomly assigned forty-four PD patients in a 1:1 ratio to receive a 3-month APA program (APA + group, n = 22), or freely practice physical activity (APA- group, n = 22). The patients were evaluated for parkinsonian symptoms (UPDRS-III), body composition, cardiorespiratory function and metabolic profile at baseline, immediately after the end of the program (M3) and six months later (M9).

RESULTS

Between baseline and M3, the mean UPDRS-III score decreased in PD patients from the APA + group whereas it increased in the APA- group (-1.2 ± 6.6 vs. +1.9 ± 8.9; p = 0.04), regardless of age, sex, disease duration, dopaminergic treatment, UPDRS-III and axial score at baseline, but these between group differences waned at M9. No between group difference was observed regarding the evolution of body composition, metabolic profile or cardiorespiratory function between baseline, M3 and M9.

CONCLUSION

A 3-month APA program combining endurance and resistance training plus stretching is more efficient for improving motor symptoms in PD compared to an unstructured engagement in non-specific physical activities. However, the benefits fade away six months after discontinuation of the program.

STATISTICAL ANALYSIS CONDUCTED BY

LAMBERT Céline, CHU Clermont-Ferrand, DRCI, Biostatistics Unit, Clermont-Ferrand, FRANCE.

REGISTRATION NUMBER

clinicaltrials.gov number NCT02816619.

Is physical therapy recommended for people with parkinson's disease treated with subthalamic deep brain stimulation? a delphi consensus study

BACKGROUND

Although deep brain stimulation of the subthalamic nucleus (STN-DBS) induces motor benefits in people with Parkinson's disease (PwPD), its effect on motor axial symptoms (e.g., postural instability, trunk posture alterations) and gait impairments (e.g., freezing of gait) is still ambiguous. Physical therapy (PT) effectively complements pharmacological treatment to improve postural stability, gait performance, and other dopamine-resistant symptoms (e.g. freezing of gait) in the general population with PD. Despite the positive potential of combined PT and STN-DBS surgery, scientific results are still lacking. We therefore involved worldwide leading experts on DBS and motor rehabilitation in PwPD in a consensus Delphi panel to define the current level of PT recommendation following STN-DBS surgery.

METHODS

After summarizing the few available findings through a systematic scoping review, we identified clinically and academically experienced DBS clinicians (n = 21) to discuss the challenges related to PT following STN-DBS. A 5-point Likert scale questionnaire was used and based on the results of the systematic review, thirty-nine questions were designed and submitted to the panel-half related to general considerations on PT following STN-DBS, and half related to PT treatments.

RESULTS

Despite the low-to-moderate quality of data, the few available rehabilitation studies suggested that PT could improve dynamic and static balance, gait performance and posture in the population with PD receiving STN-DBS. Similarly, the panellists strongly agreed that PT might help improve motor symptoms and quality of life, and it may be prescribed to maximize the effects of stimulation. The experts agreed that physical therapists could be part of the multidisciplinary team taking care of the patients. Also, they agreed that conventional PT, but not massage or manual therapy, should be prescribed because of the specificity of STN-DBS implantation.

CONCLUSIONS

Although RCT evidence is lacking, upon Delphi panel, PT for PwPD receiving STN-DBS can be potentially useful to maximize clinical improvement. However, more research is needed, with RCTs and well-designed studies. The rehabilitation and DBS community should expand this area of research to create guidelines for PT following STN-DBS.

Balance exercise interventions in Parkinson's disease: A systematic mapping review of components, progression, and intensity

BACKGROUND

Rehabilitation in individuals with Parkinson's disease (PD) often includes balance training, but knowledge about optimal training content remains limited.

OBJECTIVES

To describe the design, content, delivery, and reporting of balance training for individuals with PD, and furthermore, to map the systematic use and reporting of methods monitoring intensity in balance training interventions for individuals with PD.

METHODS

Six databases were searched. Interventions with at least 50 % of exercises challenging balance control were included. Balance training types (exergaming, multi-modal, sensory-motor integrated, and task-oriented) were categorized based on specific balance exercise components: motor (limits of stability, anticipatory motor strategies, reactive motor strategies, and control of dynamics), sensory (vestibular, visual, and somatosensory systems), and cognitive (dual-tasking in motor or cognitive activities). Training Frequency, Intensity, Time, Type, Volume, and Progression (FITT-VP principles) were extracted.

RESULTS

In total, 114 studies (interventions n = 126) with 5335 participants (mean age: 67.5 years; mean PD duration: 6.8 years) were included. The highest mean number of balance components was found in the multi-modal (5.8), followed by sensory-motor (5.6), task-oriented (4.2), and exergaming (4.0). Intensity strategies were reported in 93 % of the exergaming interventions, which was superior to the other training types (multi-modal (18 %), sensory-motor (17 %), and task-oriented (6 %)).

CONCLUSIONS

Multi-modal and sensory-motor interventions had a greater focus on challenging balance components compared to other types of training, while exergaming interventions demonstrated superior reporting of intensity strategies. Future research is encouraged to prioritize implementing intensity strategies and aim to incorporate a broader range of balance components within balance training exercises.

Mapping the challenges and facilitators faced by orthotists, physiotherapists and prosthetists to integrating non-3D gait evaluation into routine practice: A scoping review of key concepts and knowledge gaps

OBJECTIVE

To systematically map the existing literature on the challenges and facilitators associated with integrating non-3D gait evaluation into routine clinical practice by orthotists, physiotherapists and prosthetists across diverse settings and contexts, while identifying gaps in the evidence base related to these challenges and facilitators.

DATA SOURCES

Following PRISMA-ScR guidelines, we searched databases from 1980 to December 2024 (CINAHL, OVID [including APA PSYCH], PEDRO and WEB OF SCIENCE - ALL DATABASES [including MEDLINE]). We also carried out secondary searching through reference lists and Google Scholar.

STUDY SELECTION

Two authors separately screened 100 sources for calibration. One author screened the remaining sources and referred ambiguous sources to two others. Included sources studied challenges and facilitators to non-3D gait evaluation.

DATA EXTRACTION

Two authors developed and piloted an ExcelTM data extraction form using 20 sources. Thereafter, one author extracted data, spot-checked by a second author.

DATA SYNTHESIS

We screened 11,641 sources, selecting 11 for inclusion. Ten focused solely on physiotherapy, one examined physiotherapy and prosthetics, none addressed orthotics.

CONCLUSIONS

This scoping review examines challenges and facilitators to the adoption of non-3D gait evaluation methods in orthotics, physiotherapy and prosthetics. Despite benefits, these methods are underused due to clinician awareness, confidence, experience, motivation, environmental constraints, resource limitations (e.g., cost) and time pressures. Gait evaluation methods may also be difficult to use, unrealistic, or lack meaningful data. Clearer guidelines, targeted education and healthcare provider support are essential. Improving the usability of gait evaluation methods and their integration into clinical practice is critical. Research gaps in prosthetics, orthotics and specific gait evaluation methods highlight the need for further investigation to enhance training and inform policy adjustments, improving patient outcomes. Future research should investigate clinician perspectives on specific gait evaluation methods, such as video vector and standardised observational gait assessments, across specialties and their different specialisms.

Physiotherapists use dance in their clinical practice in creative and diverse ways

PURPOSE

To investigate how physiotherapists use dance in clinical practice.

METHODS

This was a cross-sectional study of Canadian physiotherapists with a web-based questionnaire distributed via social media and professional and healthcare organizations. Responses were analyzed with descriptive statistics and descriptive content analysis.

RESULTS

Of the 81 respondents included in the analysis, 36 (44%) had used dance in practice, while 45 (56%) had not. Respondents were more likely to have used dance in practice if they had formal dance experience (X2 (1, n = 81) = 3.73, p = .044). The rationale for implementing dance included improving physical, psychosocial, and cognitive outcomes. Common barriers were clinician inexperience and insufficient resources, while a common concern about using dance was that they may not be taken seriously.

CONCLUSION

Canadian physiotherapists used dance clinically in more diverse ways than reported in the scientific literature. Future work should evaluate these specific dance interventions and inform the development of clinical practice guidelines.

Integrating virtual reality into multidisciplinary care for Parkinson's disease: A narrative review

Parkinson's disease (PD) is a neurodegenerative disorder characterized by both motor and non-motor symptoms, significantly impacting patients' functionality and quality of life. Clinical exercise, as part of a multidisciplinary approach, is gaining a crucial role in PD management. Goal-based exercises, combining physical activity with cognitive tasks, external feedback and cues, motor sequencing strategies and dual-tasking may enhance motor learning processes and guide physiotherapy programs.Virtual reality (VR) and exergaming have also emerged as promising tools in PD rehabilitation, offering challenging activities in multisensory environments. They provide intensive and repetitive training, augmented feedback, and tailored exercises in highly interactive and enriched environments. Clinical studies have presented promising results in people with PD, supported by neuroimaging studies showing distinct brain activation patterns post-VR training. However, heterogeneity in study design and lack of standardized characterization of VR systems hinder further application in PD rehabilitation.In this review, we appraise the distinguishing features between different VR systems, highlight VR-related motor and cognitive training in PD and explore how VR interventions are aligned with principles of neuroplasticity and motor learning in PD.

Motor Learning-based Clinical Pilates Training for the Parkinson's Disease Rehabilitation @Parkinsonpilates: A Parallel Group, Randomised Controlled Trial with 3-Month Follow-up

OBJECTIVES

To examine the effect of integrated motor learning clinical pilates protocol we developed for patients with Parkinson's Disease (pwPD) on providing enduring motor skills in walking, balance, reaction time, cadence, and functional mobility at 3-months follow-up.

DESIGN

A parallel-group, randomized controlled trial (RCT).

SETTING

XXX Medical Center, XXX, and XXX Physiotherapy and Rehabilitation Center, Nicosia.

PARTICIPANTS

32 pwPD with Hoehn&Yahr stages 2-3 were randomly assigned to the Parkinsonpilates Group (PP) and the Conventional Physiotherapy (CP) Group.

INTERVENTIONS

Both groups received 60minutes of training, twice a week, and a home physiotherapy program 4 times a week, for 12 weeks. The intervention group received PP, while the CP group received general physiotherapy training for PD.

MAIN OUTCOME MEASURES

The primary outcomes were untimed Gait and Balance Scale, Cadence, and Nelson Foot Reaction Test scores. The secondary outcomes were The Unified Parkinson's Disease Rating Scale-III subscales, Timed Up and Go Test, Functional Reach Test, and Berg Balance Scale. Outcomes were convened 4 times: pre-test, 6. weeks, post-treatment, and after 3-month follow-up.

RESULTS

At post-test, gait and balance, reaction time, functional mobility, static and dynamic balance showed a significant improvement in PP compared to CP, and the motor examination was similar(p>.05). In addition to these results at follow-up, functional mobility was similar(p>.05) and cadence(p<.05) showed a significant improvement in PP. In addition, according to pairwise comparisons, the PP showed a significant improvement in cadence and reaction time in all 4 measures compared to CP.

CONCLUSIONS

More studies are needed to clarify the effects of the program we developed for PD. It should not be ignored that our protocol can be improved again according to the suggestions of future studies.

The glamor of and insights regarding hydrotherapy, from simple immersion to advanced computer-assisted exercises: A narrative review

Water-based therapy has been gaining attention in recent years and is being widely used in clinical settings. Hydrotherapy is the most important area of water-based therapy, and it has distinct advantages and characteristics compared to conventional land-based exercises. Several new techniques and pieces of equipment are currently emerging with advances in computer technologies. However, comprehensive reviews of hydrotherapy are insufficient. Hence, this study reviewed the status quo, mechanisms, adverse events and contraindications, and future prospects of the use of hydrotherapy. This study aims to comprehensively review the latest information regarding the application of hydrotherapy to musculoskeletal diseases, neurological diseases, and COVID-19. We have attempted to provide a "take-home message" regarding the clinical applications and mechanisms of hydrotherapy based on the latest evidence available.

Use of Transcranial Magnetic Stimulation to Probe Neuroplasticity and Predict Gait Performance After Treadmill Training in Parkinson's Disease

BACKGROUND

Reduced step length is a hallmark of gait disturbance in people with Parkinson's disease (PD). Although treadmill training is effective for improving step length, the associated neural mechanisms have not been fully investigated. Moreover, exploring the baseline neurophysiological predictors for step length improvement after training could facilitate personalized gait rehabilitation for PD.

OBJECTIVE

The aim of this study was to investigate the neuroplastic changes in corticomotor excitability after treadmill training and to explore whether baseline neurophysiological measures could predict step length improvement in PD.

METHODS

Data from 61 participants with idiopathic PD who completed 12 treadmill training sessions were included. Gait performances and corticomotor excitability measured by transcranial magnetic stimulation (TMS) were obtained at baseline, postintervention, and 1-month follow-up. TMS outcomes included motor-evoked potentials, cortical silent period (CSP), intracortical facilitation (ICF), and short-interval intracortical inhibition (SICI). General estimating equation analysis and principal-component analyses were used to determine the neuroplastic changes induced by training, and multiple linear regression analysis was performed to explore the baseline TMS predictors for step length improvement at 1-month follow-up.

RESULTS

After treadmill training, SICI and CSP significantly increased and shared an emerging relationship. Regression analysis showed that female sex and greater baseline ICF and SICI were significant predictors of step length improvement at the follow-up.

CONCLUSIONS

This study advanced the understanding of neuroplastic changes induced by treadmill training in PD and showed that preserved SICI and ICF were predictors for lasting step length improvement after training. Future studies could investigate other influential factors for treadmill training in PD. © 2024 International Parkinson and Movement Disorder Society.

Favorable effect of Karate Kata on self-esteem, anxiety and fatigue in people living with HIV

In the general population, and among people living with human immunodeficiency virus (PLHIV), sport activity is associated with better health, physically and psychologically. HIV is associated with low self-esteem. We hypothesized that Karate Kata practice could improve self-esteem in PLHIV. We conducted an interventional study with PLHIV in long-term care in our hospital. The main objective was to assess the effect of Karate Kata practice on self-esteem. The secondary objectives were to assess the effect of karate Kata on mood states, sleep, pain, balance and cognitive functions. The program consisted in group lessons of Karate Kata, 75 minutes, once a week, for 20 weeks. We compared the following points after versus before the Karate Kata program: self-esteem (Rosenberg scale), mood states (Profile of Mood States scale including anxiety, anger, confusion-perplexity, depression-discouragement, fatigue, vigor-activity and interpersonal relations), sleep (Pittsburg scale), pain (visual analog pain scale), balance (unipedal stance test) and cognitive functions (Dubois test). The 17 participants were 8 men and 9 women. The mean age was 53 years old. The self-esteem test (Rosenberg scale) was significantly improved after versus before Karate lessons: 31.9 versus 29.1 (p = 0.012). Likewise, anxiety, anger, fatigue and confusion-perplexity were lower after versus before Karate Kata lessons (respectively 8.1 versus 13.2, p = 0.024; 9.4 versus 15.8, p = 0.011; 6 versus 8.8, p = 0.035; 5.6 versus 8.3, p = 0.005). THUS, our study found that, for PLHIV, Karate Kata lessons had favorable effects on self-esteem, anxiety, anger, fatigue and confusion-perplexity. To conclude, as with physical activity in general, Karate Kata should be encouraged for PLHIV.ClinicalTrials.gov identifier (NCT number): NCT04560153.

A Usability Pilot Study of a Sensor-Guided Interactive System for Dexterity Training in Parkinson's Disease

This pilot study aimed to evaluate the usability of a new, feedback-based dexterity training system in people with Parkinson's disease (PwPD) and healthy adults. Seven PwPD and seven healthy adults participated in the study. The System Usability Scale (SUS) and the Post-Study System Usability Questionnaire Version 3 (PSSUQ) were used to assess usability. Additionally, the feedback shown as a counter, detected through newly developed algorithms, was evaluated by comparing the device-detected repetitions during six exercises to those counted by a supervisor. High median SUS scores of 92.5 were obtained in both PwPD (IQR = 81.25-98.75) and healthy adults (IQR = 87.5-93.75, maximum score 100, minimum score 0). Similarly, high PSSUQ median scores were achieved after the session (1.14, IQR = 1.00-1.33, PD; 1.08, IQR = 1.00-1.58, healthy adults, maximum score 1, minimum score 7). PwPD completed 648 repetitions, with 551 (85%) correctly recognized by the system. For healthy adults, 883 out of 913 (97%) repetitions were classified as right. The present study showed high usability and high perceived user satisfaction for the new training system in all study participants. The system effectively detects exercise repetition rates but requires further refinement to enhance accuracy for specific pinch grip exercises.

Effect of group exercise on quality of life for Parkinson disease: systematic review and meta-analysis

PURPOSE

Motor and non-motor symptoms can negatively affect quality of life (QoL) for people with Parkinson Disease (PD). Our purpose was to investigate the effects of group exercise (GE) compared to individual exercise (IE) and usual care (UC) on QoL for people with PD. A systematic review and meta-analysis were performed with randomized controlled trials that studied the effects of GE compared to IE and UC on QoL for people with PD.

MATERIALS AND METHODS

The systematic search was performed in EBSCO, PubMed, and Science Direct databases. Quality of methodology was assessed using the Cochrane GRADE approach. Thirteen studies met all inclusion criteria and were included in the analysis.

RESULTS

No significant difference was found on QoL between GE and IE; however, QoL was significantly improved with GE compared to UC. Results were based on low to moderate quality of evidence.

CONCLUSIONS

Based on low to moderate quality of evidence, GE has a similar effect on QoL when compared to IE and has a small and statistically significant effect when compared to UC, regardless of the patient reported outcome measure used or the total volume of exercise prescribed. GE may be an appropriate option for people with PD to improve their QoL.

Gait physiotherapy with motor imagery in people with Parkinson's disease: a protocol for randomized control GAITimagery trial

Introduction

According to people with Parkinson's disease (PD), gait impairments are the most disabling motor symptoms of PD. Recently, motor imagery (MI) has gained notoriety as a gait training technique due to the flexibility of its use, however, it has not been demonstrated that causes a superior effect when included in physiotherapy. This study aims to determine if gait training combined with MI has a greater effect on the gait of people with PD than just gait training.

Methods

The GAITimagery is designed as a double-blind, randomized control trial, including a convenience sample in 2 parallel groups (1:1) with two interventions of 2 sessions per week during 6-week and 8-week follow-up. The initial recruitment will be 88 participants with idiopathic PD and unimpaired cognition state, who will be randomly divided into two groups: GAITimagery (GiG) or the active control Gait group (GaG). Both will perform the same gait exercises but only GiG will include MI training. Gait speed is the primary outcome, while Maximum gait speed (m/s) and Gait speed variability are the secondary results. The tertiary outcomes are related to Quality of life, Daily life activities, Freezing of gait, Balance, Mobility, and Gait performance measures to psychometrics and biomechanics instruments. All results will be measured at baseline (t0), post-training (t1), and follow-up assessment (t2) 8 weeks after finished physiotherapy programs.

Discussion

The GAITimagery program standardizes the application of MI exercises related to the improvement of parkinsonian gait at the same time that monitoring the vividness referred by the participants session by session. The effectiveness of this MI-exclusive program includes subjective and objective measurement tools to detect minimal changes after training. This still-to-be-finish study will support the therapeutic decisions on whether or not to allocate session time to imagery exercises depending on the effect size achieved and the comparison with a control gait training.

Exploring Context Allows Us to Better Understand Physical Activity in People with and Without Parkinson's Who Have Fallen: A Mixed Methods Study

Background: Falls are a frequent and serious problem for older adults, especially for those living with Parkinson's. The relationship between falls and physical activity is complex, and people often restrict activity following a fall. Exercise is an important aspect of reducing further risk of a fall and a key component of the management of Parkinson's. The aim of this study was to understand the types of activity they are engaged in, the environments in which they take place, and the experience of people with and without Parkinson's who have fallen. Method: Seventeen people with Parkinson's and thirteen older adults who had experienced at least one fall in the previous year were recruited to this mixed methods study. Activity levels were captured over one week using accelerometers and body-worn cameras, allowing the type and location of activity to be recorded and analysed. This information informed an interview. Results: Findings showed that although both groups often achieved up to 10,000 steps per day, this was in very short bouts of activity. Sedentary activity, such as watching television, dominated the findings. Participants were aware of the benefits of being active but described many barriers to achieving the level of activity they would like to.

Exploring access to community neurorehabilitation for people with progressive neurological conditions: a qualitative study

PURPOSE

Community neurorehabilitation enables people with progressive neurological conditions (PNCs) to manage their symptoms to live an active, fulfilling life; however, it is not accessible to all. This study explored the factors influencing access to community neurorehabilitation in Northern Ireland from the perspective of people with PNCs and their carers.

METHODS

Eleven people living with a PNC and three carers took part in virtual focus groups. Data was thematically analysed using the framework method.

RESULTS

Access to neurorehabilitation was described as a staged journey, driven by people with PNCs, and impacted by interactions with others. Four themes were identified: the person in the driving seat, describing the value of person-centred care and the need for proactivity; the traffic lights, depicting the role and influence of health care professionals (HCPs); the need for direction; and roadworks and roadblocks, identifying additional barriers to access. In addition, six fundamentals of good access were identified.

CONCLUSIONS

This study adds depth to our understanding of the complexity, and the roles and needs of people with PNCs and HCPs, in accessing community neurorehabilitation. Further research is needed to determine how best to empower people to access rehabilitation.

Quality assessment and umbrella review of systematic reviews about dance for people with Parkinson's disease

OBJECTIVE(S)

To determine (1) the quality of systematic reviews about dance-based intervention in individuals with Parkinson's disease (PD) and (2) standard evidence for dance-based intervention efficacy based on the categories of The International Classification of Functioning, Disability, and Health (ICF) from the World Health Organization's (WHO).

METHODS

The data source included MEDLINE, PUBMED, Embase, Scopus, CENTRAL (Cochrane Library), CINAHL, PEDro, SPORTDiscus, APA PsycNet (APA PsycINFO), LILACS, SciELO, and AMED. Pairs of independent reviewers screened titles, abstracts, and full texts of eligible studies by using the software Covidence. Criteria included: systematic review designs; individuals with PD; dance-based interventions aimed to change critical PD symptoms matched to IFC domains (body functions, activities, and participation). Independent reviewers extracted information regarding the characteristics of all systematic reviews included and appraised quality using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2). Randomized controlled trials and their risk of bias were identified within each review and were used to perform an updated pairwise meta-analysis.

RESULTS

Of the 571 manuscripts screened, 55 reviews met the inclusion criteria. The overall confidence in the results of 38 reviews (69%) was rated as 'critically low,' nine (9%) as 'low,' one (2%) as 'moderate,' while seven of 55 reviews (13%) were rated as 'high'. Dance associated with pharmacological usual care is better than pharmacological usual care alone for essential components of ICF, such as motor symptoms severity (body function), depressive symptoms (body function), balance (body function and activity), and functional mobility (activity), but not for gait distance (activity) and quality of life (participation). Dance is also superior to multimodal exercise to improve balance.

CONCLUSIONS

Clinicians and people with PD can refer to this paper for a summary of high-quality reviews and the overall evidence supporting dance as an adjunct rehabilitation. This umbrella review not only underscores the therapeutic potential of dance but also reinforces the use of arts-based approaches into healthcare practices for people with neurological conditions.

Balance and gait disorders in de novo Parkinson's disease: support for early rehabilitation

BACKGROUND

Postural instability is considered a late complication of Parkinson's disease (PD). However, growing evidence shows that balance and gait problems may occur early in the disease.

OBJECTIVE

To describe balance, gait, and falls/near falls in persons with newly diagnosed, untreated PD ("de novo"), and to compare this with persons with mild-moderate PD (Later PD). In addition, we evaluated differences relative to PD subtypes in de novo PD.

METHODS

De novo (n = 54) and Later (n = 58) PD were assessed regarding motor symptoms, balance, gait, and falls/near falls.

RESULTS

At least 25% of de novo PD had impaired reactive balance and/or comfortable gait speed ≤ 1.0 m/s. At least 50% had abnormal dynamic balance. A third reported balance problems during dual-tasking. Five persons (9%) reported falls/near falls. The median (q1-q3) motor symptom score was 21 (14-28) in de novo PD and 13.5 (9-20) in Later PD (p < 0.001). Later PD performed worse on more balance-demanding tests and a higher percentage of individuals reported falls/near falls (p ≤ 0.048). De novo PIGD PD (n = 10) exhibited worse motor symptoms, reactive and dynamic balance, gait speed, mobility, and freezing of gait as compared to the non-PIGD de novo PD (n = 37) (p ≤ 0.049).

CONCLUSION

Balance and gait were impaired in de novo PD and most pronounced in PIGD subtype. In addition, balance difficulties during dual-tasking and falls/near falls were evident during this early stage. The lower scores of motor symptoms in Later PD did not result in better mobility, balance, or less falls/near falls indicating that medications have less effect on these symptoms.

Psychiatric Disorders and Cognitive Fluctuations in Parkinson's Disease: Changing Approaches in the First Decades of the 21st Century

Parkinson's Disease (PD) is a multifaceted neurodegenerative disorder characterized, in addition to the well-recognized motor disturbances, by a complex interplay between cognitive and psychiatric manifestations. We dissect the complex landscape of PD-related psychiatric symptoms, taking into account the impact of functional neurological disorders, somatic delusions, impulse control disorders, and conditions within the bipolar spectrum. The newer entities of somatoform and functional neurological disorders, as well as preexisting bipolar spectrum disorders, are analyzed in detail. Moreover, we emphasize the need for a holistic understanding of PD, wherein the cognitive and psychiatric dimensions are valued alongside motor symptoms. Such an approach aims to facilitate early detection and personalized interventions, and enhance the overall quality of life for individuals suffering from this neurodegenerative disorder.

Effects of transcranial direct current stimulation (tDCS) associated with balance training in individuals with Parkinson's: Study protocol for a randomized clinical trial

The present study aimed to investigate the effects of balance training associated with cerebellar tDCS on postural control in individuals with PD. This is a randomized clinical trial in which individuals were allocated to an experimental group (EG) or placebo group (PG), in which a conventional protocol of 10 Physiotherapy sessions for locomotor training and postural control was applied. In the EG, tDCS was applied, with a current setting of 1.5 mA for 20 min simultaneously with postural control training. In the PG, tDCS was applied in sham mode, with the same electrode positioning and the same number of sessions as the EG. The sample compared 34 individuals with PD (EG: 17; PG: 17).Cerebellar tDCS associated with balance training may help improve postural control and balance in walkers with Parkinson's Disease. The hypothesis is, if walking improve, the benefits may be accompanied by better balance and reduced fear of falling, and individuals may experience greater free-living physical activity at home and in the community.

Evaluating the reliability and validity of the Icelandic translation of the Mini-BESTest in rehabilitation patients: an international implication for balance assessment

BACKGROUND

The Mini-BESTest (Balance Evaluation Systems Test) is a standardized balance evaluation tool. The psychometric properties of the Mini-BESTest are being established around the world.

PURPOSE

This study aimed to evaluate the reliability and validity of the Icelandic translation of the Mini-BESTest.

METHODS

Thirty rehabilitation inpatients (16/14 women/men), with mixed diagnoses and a range of self-assessed balance, were assessed with the: Mini-BESTest on two occasions; Activities-specific Balance Confidence Scale; Berg Balance Scale; Timed Up and Go test; and 10 Meter Walk Test. Statistical analyses included the Intraclass Correlation Coefficient (ICC), standard error of measurement (SEM), Cronbach's alpha (α), Pearson's r, and the independent t-test.

RESULTS

Relative reliability demonstrated good test-retest (ICC3.1 = 0.84), intra-rater reliability (ICC3.1 = 0.86), and excellent inter-rater reliability (ICC2.1 = 0.96). Absolute reliability (SEM) was 1.607, and internal consistency (α) was 0.80. Construct validity was supported by a high correlation between the Mini-BESTest and other standardized measures (r =  ±0.6-0.73). The Mini-BESTest discriminated between patients with poor versus good self-rated balance (p ˂ 0.001), with no floor or ceiling effects.

CONCLUSION

The psychometric properties of the Icelandic translation of the Mini-BESTest are comparable with the original version and other translations. These results for this mixed patient group should be relevant to clinicians and researchers internationally.

System-level barriers account for non-compliance to physiotherapy among persons with Parkinson's disease at the Korle Bu Teaching Hospital, Ghana: an explanatory mixed-method study

Background

Despite the increasing importance of physiotherapy and robust evidence, there is still limited studies assessing compliance rates and barriers to physiotherapy appointments for Persons with Parkinson disease (PwPD) especially in low-resource settings such as Ghana.

Objective

To assess compliance rates and identify barriers to adhering to physiotherapy appointments among PwPD receiving physiotherapy management at a tertiary hospital in Ghana.

Methods

A sequential explanatory mixed method design was used. The quantitative part involved a retrospective survey of health records of PwPD who reported at the Korle-Bu teaching hospital physiotherapy PD-clinic from 2013-2021. The qualitative part involved semi-structured telephone interviews among defaulters from the year with highest clinic attendance. Quantitative data was descriptively analyzed. For the qualitative data, a deductive qualitative content analysis of the transcribed audiotaped interviews was conducted.

Results

Eighty-six PD records (56 males) were included. Overall mean (SD) age was 67(±11) and ranged from 38-90 years. The year 2014 recorded the highest number of attendees (n=20/86; 23%). Overall, 88% of the participants had stopped physiotherapy. Six PwPD participated in the interviews. System-level barriers were mainly recorded as the reasons for patients defaulting physiotherapy.

Conclusion

The majority of PwPD had stopped physiotherapy and system-level barriers were the key reasons.

Utilization of Neurology and Allied Health Services by People With Parkinson's Disease in Israel: A Retrospective Observational Study

BACKGROUND

Sustainable utilization of neurology and allied health professions' services is pivotal for effective management of Parkinson disease (PD) and is correlated with positive health-related outcomes.

OBJECTIVES

(1) To describe the utilization of neurology and allied health services by people with PD (PwP); (2) to explore the associations between demographic and structural variables and utilization; and (3) to test associations between utilization and unplanned hospitalizations.

METHODS

A retrospective observational cohort study of 1761 PwP in the years 2014-2019 was conducted. Utilization of neurology and allied health services was mapped. Regression models were examined to test associations between demographic and structural variables, utilization of neurology and physical therapy (PT), and unplanned hospitalizations.

RESULTS

Approximately 50% of the study population utilized neurology services. Utilization rate of allied health services ranged between 0% and 19%. The likelihood of utilizing neurology services increased for people with extended health insurance and people with more years since diagnosis and decreased for women and for people living at a great distance from a neurology service. The likelihood of utilizing PT increased for Jews and people with extended health insurance and decreased for people with more years since diagnosis and for people living at a great distance from a PT service. Among patients with fewer years since diagnosis (<5 years), those who utilized PT had a higher likelihood of unplanned hospitalization.

CONCLUSIONS

Neurology and allied health services are underutilized by PwP, particularly by minorities and women. Policymakers should take proactive steps to increase utilization.

VIDEO ABSTRACT AVAILABLE

for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A496 ).

Online training program maintains motor functions and quality of life in patients with Parkinson's disease

Objective

Several systematic reviews have shown that physical exercise positively affects motor function (MF) and quality of life (QoL) in patients with Parkinson's disease (PD). After the coronavirus disease (COVID-19) pandemic, numerous studies were conducted to reveal the effects of telerehabilitation for patients with PD. However, only a few empirical results of online programs for PD patients have been reported. Therefore, this study aimed to determine the effects of an online physical and cognitive training program on MF and QoL in patients with PD.

Methods

We evaluated the impact of our online program on the QoL and MF of patients with PD by comparing data at baseline and after six months of intervention. For the QoL assessment, we used the Schwab and England Activities of Daily Living scale and Parkinson's Disease Questionnaire (PDQ-39), whereas, for MF, we measured movement status using the modified 20-m walk test and timed up-and-go (TUG) test.

Results

We enrolled 20 patients for QoL and 19 for MF in this study. For PDQ-39, social support (p = 0.046, δ = 0.320) and cognitions (p = 0.028, δ = 0.268) significantly improved. Additionally, cadence (p = 0.032, g = -0.377) in the modified 20-m walk and exam duration (p = 0.003, δ = 0.296) and forward gait (p = 0.003, δ = 0.341) in the TUG test showed significant differences before and after the intervention.

Conclusion

Our results suggest that online physical and cognitive training programs positively affect MF and QoL in individuals with PD.

Exploring Responsiveness to Highly Challenging Balance and Gait Training in Parkinson's Disease

BACKGROUND

Exercise potentially improves gait, balance, and habitual physical activity in Parkinson's disease (PD). However, given the heterogeneous nature of the disease, it is likely that people respond differently to exercise interventions. Factors determining responsiveness to exercise interventions remain unclear.

OBJECTIVES

To address this uncertainty, we explored the responsiveness to our highly challenging balance and gait intervention (HiBalance) in people with PD.

METHODS

Thirty-nine participants with mild-moderate PD who underwent the HiBalance intervention from our randomized controlled trial were included. We defined response in three domains: (1) balance based on Mini-BESTest, (2) gait based on gait velocity, and (3) physical activity based on accelerometry-derived steps per day. In each domain, we explored three responsiveness levels: high, low, or non-responders according to the change from pre- to post-intervention. Separate Random Forests for each responder domain classified these responsiveness levels and identified variable importance.

RESULTS

Only the Random Forest for the balance domain classified all responsiveness levels above the chance level indicated by a Cohen's kappa of "slight" agreement. Variable importance differed among the responsiveness levels. Slow gait velocity indicated high responders in the balance domain but showed low probabilities for low and non-responders. For low and non-responders, fall history or no falls, respectively, were more important.

CONCLUSIONS

Among three responder domains and responsiveness levels, we could moderately classify responders in the balance domain, but not for the gait or physical activity domain. This can guide inclusion criteria for balance-targeted, personalized intervention studies in people with PD.

Breaking barriers in Parkinson's care: the multidisciplinary team approach

Parkinson's disease is a complex neurodegenerative disorder presenting a range of motor and non-motor symptoms that greatly impact both patients and caregivers. The diverse needs arising from these symptoms make a multidisciplinary team (MDT) approach crucial for effective management. This article explores the role and benefits of MDTs in Parkinson's care, highlighting how collaborative models improve clinical outcomes and quality of life. MDTs integrate neurologists, nurse specialists, therapists, and other professionals to deliver comprehensive, patient-centered care. The inclusion of patients and caregivers fosters shared decision-making, enhancing health outcomes. However, challenges like limited controlled trials, lack of comprehensive guidelines, and under-referral remain. Innovative models, such as telehealth and community-based care, offer promising solutions, especially in underserved regions. The article advocates for further research and standardized guidelines to optimize the MDT approach for Parkinson's disease.

Perceptions of individuals with Parkinson's disease about a telerehabilitation protocol performed during the COVID-19 pandemic: a qualitative study

PURPOSE

To understand the perceptions and meaning of the experience of individuals with Parkinson's disease (PD) when participating in a telerehabilitation protocol during COVID-19 pandemic.

METHODS

This is a qualitative descriptive analytical study with a phenomenological basis, regarding the individuals' perceptions of telerehabilitation. The interviews were conducted by a semi-structured interview guide and carried out via recorded phone calls, which were later transcribed, categorized, and analyzed based on the principles of phenomenology according to the propositions of Martins and Bicudo.

RESULTS

From the qualitative analysis, four themes that configure the structure of the phenomenon emerged: 1) Expectations regarding physical therapy through telerehabilitation during the pandemic; 2) Experiences of the new routine; 3) Perceptions about oneself in the light of the proposed telerehabilitation program; 4) A view of the protocol.

CONCLUSION

Apprehension and fear were present during the implementation of the protocol, however, previous experience with face-to-face physical therapy and the team allowed feelings of happiness, contentment, welcomeness, and satisfaction with the possibility of resuming the activities. The individuals actively participated in the program with commitment and co-responsibility, but the lack of physical contact, limited equipment, and constant concern for the safety and individuality of the participants must be emphasized.

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

Background

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

Methods

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

Results

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

Conclusion

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

Combining Transcranial Direct Current Stimulation with Exercise to Improve Mobility, Stability, and Tremor Management in 25 Individuals with Parkinson's Disease

BACKGROUND/OBJECTIVES

Parkinson's disease (PD) is a neurodegenerative disorder characterized by tremors, balance impairments, and mobility limitations. Innovative approaches like combining transcranial direct current stimulation (tDCS) with exercise show promise in addressing these symptoms. This study investigates the effects of exercise combined with tDCS on mobility and tremor management in PD patients.

METHODS

Twenty-five individuals aged 60-75 (66.6 ± 7.33), diagnosed with PD (Hoehn and Yahr stage 2-3), were assigned to three groups in a randomized controlled design: exercise with active tDCS (n = 8), exercise with sham tDCS (n = 8), and a control group (n = 9). Dual-task training sessions focusing on walking speed, balance, and force control were conducted over ten sessions.

RESULTS

No significant differences were detected across the groups for grip strength or force control measures (p > 0.05). Significant improvements were observed in the intervention group: the Timed Up and Go (TUG) test showed a significant reduction in time (mean difference = 2.498 s, p < 0.001, ηp2 = 0.331); anterior-posterior displacement significantly increased (mean difference = 21.375 mm, p = 0.0269, ηp2 = 0.303); and force-tremor decoupling improved, with coherence in the 1-4 Hz band significantly decreasing (p = 0.0067). Finally, changes in TUG from post- to pre-treatment values were significantly positively correlated with the changes in coherence (R = 0.468, p = 0.018).

CONCLUSIONS

Combining tDCS with exercise enhances mobility and tremor management in PD patients. These findings support the potential for such interventions to improve functional outcomes and quality of life for individuals with PD.

Exercise as medicine in Parkinson's disease

Parkinson's disease (PD) is an incurable and progressive neurological disorder leading to deleterious motor and non-motor consequences. Presently, no pharmacological agents can prevent PD evolution or progression, while pharmacological symptomatic treatments have limited effects in certain domains and cause side effects. Identification of interventions that prevent, slow, halt or mitigate the disease is therefore pivotal. Exercise is safe and represents a cornerstone in PD rehabilitation, but exercise may have even more fundamental benefits that could change clinical practice. In PD, the existing knowledge base supports exercise as (1) a protective lifestyle factor preventing the disease (ie, primary prevention), (2) a potential disease-modifying therapy (ie, secondary prevention) and (3) an effective symptomatic treatment (ie, tertiary prevention). Based on current evidence, a paradigm shift is proposed, stating that exercise should be individually prescribed as medicine to persons with PD at an early disease stage, alongside conventional medical treatment.

The effects of Baduanjin on fine motor skills in mild and moderate Parkinson's disease: A randomized controlled trial

Background

Fine motor impairment is common in Parkinson's disease (PD), which reduces patients' quality of life. There are few suitable targeted treatments. We conducted a clinical trial to determine whether Baduanjin Qigong exercise would increase fine motor skills in PD patients.

Methods

Sixty PD patients (Hoehn-Yahr stage 1-4) with hand fine motor impairment were randomly assigned to the Baduanjin group and the physical activity group. Baduanjin group practiced Baduanjin exercise five times weekly for 40 min (warm-up 5 min, Baduanjin 30 min, cool-down 5 min). The usual physical activity groups maintained their habit of usual physical activities. The participants underwent assessments in the "ON" medication state at baseline and 4-week follow-up time points. The Purdue Pegboard Test (PPT) was used as the primary outcome to assess manual dexterity. The secondary outcomes included the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, part III (MDS-UPDRS III), and the Parkinson's disease questionnaire (PDQ-39).

Results

The results of PPT revealed the Baduanjin group showed statistically significant improvement in the "non-dominant hand" and "assembly" scores compared to the usual physical activity group (P < 0.05), but with no significant difference in "dominant hand" and "both hands" (P > 0.05). Additionally, the Baduanjin group showed better performance in the PDQ-39 (P < 0.05).

Conclusion

Our study concludes that a 4-week Baduanjin exercise is effective in improving fine motor function and quality of life in patients with mild and moderate PD. The results suggest a promising intervention to be implemented in community or home settings for managing fine motor impairment in PD.

Complexities and challenges of translating intervention success to real world gait in people with Parkinson's disease

Background

Unstable gait leading to falls negatively impacts the quality of life in many people with Parkinson's disease (PD). Systematic review evidence provides moderate to strong evidence of efficacy for a wide range of physiotherapy-based interventions to reduce gait impairment. However, outcomes have often focused on gait assessments conducted in controlled laboratory or clinical environments.

Objective

This perspective investigates the complexities and challenges of conducting real-world gait assessments in people with PD and the factors that may influence the translation from improved lab-assessed gait to improved real-world gait.

Methods

Through a thorough review of current literature, we present an in-depth analysis of current methodological approaches to real-world gait assessments and the challenges that may influence the translation of an intervention's success from lab-based outcomes to improved walking during daily life.

Results

We identified six key factors that may influence the translation of intervention success into real-world environments at different stages of the process. These factors comprise the gait intervention, parameters analyzed, sensor setup, assessment protocols, characteristics of walking bouts, and medication status. We provide recommendations for each factor based on our synthesis of current literature.

Conclusion

This perspective emphasizes the importance of measuring intervention success outside of the laboratory environment using real-world gait assessments. Our findings support the need for future studies to bridge the gap between proven efficacy for gait as assessed in controlled laboratory environments and real-world impact for people with PD.

Effectiveness of physiotherapy rehabilitation approaches for Parkinson's disease: A Durrës case study

BACKGROUND AND PURPOSE

The article's significance lies in the substantial rise in the risk of developing Parkinson's disease (PD), necessitating the exploration of various approaches to rehabilitation and medical treatment. The purpose of the article is to detect the direct effect of physiotherapy for patients with PD and to identify how it helps in slowing down cardio-pulmonary failure, improving the posture, balance, bradykinesia and tremor.

METHODS

The research utilised clinical data from 407 PD patients aged 30-100 years at the Central Polyclinic of Durrës, spanning 2011-2022, and included a systematic literature review and statistical analysis comparing physiotherapy outcomes with European Union standards.

RESULTS

The research demonstrates the efficiency of physiotherapy in the short and long term in the treatment of PD for patients and medical personnel. All information can be used to increase the functional abilities of patients and minimise complications after physiotherapy and to estimate the effectiveness of different exercises in delaying PD. Older adults, particularly those aged 71-80, are most affected by PD, with males more likely to be diagnosed. Physiotherapy rehabilitation improves motor symptoms, posture, and balance in 30-80-year-olds, but its effectiveness declines with age. Advanced rehabilitation methods in Italy lead to better outcomes, suggesting the potential for improvement in Durres disease.

CONCLUSIONS

The study emphasises the need for improved rehabilitation strategies for older patients by recommending tailored programs, advanced methods, standardisation, training, and long-term monitoring. Further research should concentrate on the long-term sustainability of physiotherapy benefits, the development of targeted interventions for older patients, and the integration of innovative therapeutic approaches.

Benefits of Rhythmic Auditory Stimulation and Lee Silverman Voice Treatment in a Parkinson's Disease Patient With Meningoencephalitis: A Case Report

Parkinson's disease (PD) is a neurological disorder characterized by motor and non-motor symptoms that significantly impact patients' quality of life. Meningoencephalitis, an inflammation of the brain and its surrounding membranes, exacerbates the neurological features of PD, leading to considerable disability. This case report describes a 73-year-old female with a five-year history of PD who presented with meningoencephalitis. She exhibited pyrexia, dyspnea, and neurological symptoms consistent with meningeal irritation. Diagnostic investigations indicated viral meningoencephalitis. Following medical management, the patient completed a four-week physical therapy program, including Lee Silverman voice treatment, rhythmic auditory stimulation, and proprioceptive neuromuscular facilitation exercises. These physiotherapy interventions focused on mobilization to improve range of motion, muscle strength, neuromuscular coordination, and functional ability. Quantitative outcome measures - such as the Unified Parkinson's Disease Rating Scale, Modified Hoehn and Yahr stage, and Parkinson's Disease Questionnaire-39 - showed positive changes following the intervention. The outcomes highlight the benefits of a multifaceted rehabilitation approach for patients with PD and concurrent meningoencephalitis. This case underscores the importance of initiating physiotherapy early to enhance motor outcomes and quality of life in patients with complex neurological conditions.

A Review of Recent Advances in Cognitive-Motor Dual-Tasking for Parkinson's Disease Rehabilitation

BACKGROUND

Parkinson's disease is primarily characterized by the degeneration of motor neurons, leading to significant impairments in movement. Initially, physical therapy was predominantly employed to address these motor issues through targeted rehabilitation exercises. However, recent research has indicated that cognitive training can enhance the quality of life for patients with Parkinson's. Consequently, some researchers have posited that the simultaneous engagement in computer-assisted motor and cognitive dual-task (CADT) may yield superior therapeutic outcomes.

METHODS

A comprehensive literature search was performed across various databases, and studies were selected following PRISMA guidelines, focusing on CADT rehabilitation interventions.

RESULTS

Dual-task training enhances Parkinson's disease (PD) rehabilitation by automating movements and minimizing secondary task interference. The inclusion of a sensor system provides real-time feedback to help patients make immediate adjustments during training. Furthermore, CADT promotes more vigorous participation and commitment to training exercises, especially those that are repetitive and can lead to patient boredom and demotivation. Virtual reality-tailored tasks, closely mirroring everyday challenges, facilitate more efficient patient adaptation post-rehabilitation.

CONCLUSIONS

Although the current studies are limited by small sample sizes and low levels, CADT rehabilitation presents as a significant, effective, and potential strategy for PD.

Physical therapy in patients with Parkinson's disease treated with Deep Brain Stimulation: a Delphi panel study

Although deep brain stimulation of the subthalamic nucleus (STN-DBS) induces motor benefits in people with Parkinson's disease (PwPD), the size and duration of the effects of STN-DBS on motor axial (e.g., postural instability, trunk posture alterations) and gait impairments (e.g., freezing of gait - FOG) are still ambiguous. Physical therapy (PT) effectively complements pharmacological treatment to improve postural stability, gait performance, and other dopamine-resistant symptoms (e.g. festination, hesitation, axial motor dysfunctions, and FOG) in PwPD who are non-surgically treated. Despite the potential for positive adjuvant effects of PT following STN-DBS surgery, there is a paucity of science available on the topic. In such a scenario, gathering the opinion and expertise of leading investigators worldwide was pursued to study motor rehabilitation in PwPD following STN-DBS. After summarizing the few available findings through a systematic review, we identified clinical and academically experienced DBS clinicians (n=21) to discuss the challenges related to PT following STN-DBS. A 5-point Likert scale questionnaire was used and based on the results of the systematic review along with a Delphi method. Thirty-nine questions were submitted to the panel - half related to general considerations on PT following STN-DBS, half related to PT treatments. Despite the low-to-moderate quality, the few available rehabilitative studies suggested that PT could improve dynamic and static balance, gait performance and posture. Similarly, panellists strongly agreed that PT might help in improving motor symptoms and quality of life, and it may be possibly prescribed to maximize the effects of the stimulation. The experts agreed that physical therapists could be part of the multidisciplinary team taking care of the patients. Also, they agreed on prescribing of conventional PT, but not massage or manual therapy. Our results will inform the rehabilitation and the DBS community to engage, publish and deepen this area of research. Such efforts may spark guidelines for PT following STN-DBS.

Current interventional model for movement in Parkinson's disease: network meta-analysis based on the improvement of motor ability

Aim

To identify optimally therapeutic exercise interventions for improving motor ability among patients with Parkinson's disease (PD), we conducted a network meta-analysis (NMA) of randomized controlled trials comparing different exercise regimens.

Methods

Relevant RCTs were retrieved by searching PubMed, Embase, Cochrane, Web of Science, CINAHL, CBM, China National Knowledge Infrastructure (CNKI), Wan fang, VIP, and other databases from inception to July 9, 2023 is available in English as the primary language. Exercise outcomes as measured by Movement Disorder Society- Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III) score change were evaluated and ranked using STATA software version 18.0. All included studies were assessed for methodological quality using the Cochrane Risk of Bias tool.

Results

The final NMA included 71 studies involving 3,732 participants, 87 intervention experiments, and 27distinct interventions. Although most exercise interventions showed some efficacy (reducing MDS-UPDRS-III score), cumulative ranking probability surface (SUCRA) values indicated that the best exercise interventions for motor function improvement were archery (95.6%), riding a bicycle (80.9%), and binary rhythm dance (80.8%).

Conclusion

An exercise intervention comprising archery, cycling, and(or) binary rhythm dance may yield superior improvements in motor function among patients with Parkinson's disease.

Parkinson's disease motor intervention patterns: a network meta-analysis based on patient motor function

Background

Parkinson's disease is characterized by symptoms such as bradykinesia and rigidity, which worsen as the disease progresses, significantly impacting patients' independence and quality of life. This study utilizes a network meta-analysis approach to quantify information gathered from randomized controlled trials (RCTs) regarding motor interventions that effectively improve the motor function of Parkinson's disease patients, aiming to provide evidence for selecting appropriate exercise intervention strategies for patients.

Methods

A systematic search strategy for randomized controlled trials (RCTs) restricted to English was constructed based on multiple biomedical databases. Databases searched included PubMed, Embase, Cochrane, Web of Science, CINAHL, CBM, China National Knowledge Infrastructure (CNKI), Wan fang, VIP, etc., with searches conducted from inception to July 9, 2023. Two authors screened all studies, extracted data, and used frequency domain analysis methods. Network meta-analysis was performed using STATA software version 18.0 to compare and rank exercises that could effectively improve the motor function of Parkinson's disease patients (measured by indicators such as MDS-UPDRS-III, TUG, BBS, Mini-BES Test, 6MWT scores). Additionally, a series of analyses and evaluations were conducted, such as assessing the methodological quality of included studies using the Cochrane risk of bias tool.

Results

The network meta-analysis included a total of 111 studies involving 5,358 participants, 133 intervention experiments, and 31 intervention measures. Although most exercise interventions showed effectiveness, cumulative ranking curves under the surface (SUCRA) values showed that archery exercise significantly improved patients' MDS-UPDRS-III scores (SUCRA = 95.6%), significantly superior to routine care [standardized mean difference (SMD = 16.92, 95%CI = -28.97, -4.87)]. High-intensity and agility exercise (High strength and agility) referred to as high-intensity exercise or agility training or a combination of both, collectively termed as high-intensity agility training, significantly improved patients' completion time for the time-up-and-go test (SUCRA = 99.7%), (SMD = -7.88, 95%CI = -9.47, -6.28). Dance and Tai Chi exercises significantly improved patients' balance abilities: Mini-Balance Evaluation Systems Test (SUCRA = 77.9%), (SMD = 5.25, 95%CI = -0.42, 10.92) for dance intervention and Berg Balance Scale (SUCRA = 94.7%), (SMD = 11.22, 95%CI = 3.26, 19.18) for Tai Chi intervention. Dance also significantly improved patients' walking ability in the 6-min walk test (SUCRA = 80.5%), (SMD = 71.31, 95%CI = 13.77, 128.84).

Conclusion

Compared to other exercises, archery, dance, Tai Chi, and high-intensity agility exercises demonstrate superior efficacy in improving the motor function of Parkinson's disease patients.

Assessing the factors that influence the utilization and delivery of rehabilitation services among persons with Parkinson's disease: A scoping review

RATIONALE

Rehabilitation has the potential to significantly improve the lives of people and, most importantly, for persons with Parkinson's disease (PD). Although numerous studies have reported the benefits of rehabilitation for persons with PD (PwPD), these services are still limited and underutilized even when patients exhibit problems that require rehabilitation.

AIMS AND OBJECTIVES

This review aims to describe the (a) indication for referral for rehabilitation services, (b) patterns of referral for rehabilitation and (c) factors that facilitate or hinder the utilization and delivery of rehabilitation services among PwPD.

METHODS

A comprehensive literature search was conducted across selected databases, African Journals Online, EBSCOhost (CINAHL, Africa-wide), PubMed, SCOPUS and Web of Science. Studies published in English from January 2002 until December 2022 were applied as limiters. Reference and grey data sources tracking were also conducted. Two reviewers conducted the study selection, screening of titles, abstracts and full text and data charting. A descriptive analysis was performed. Findings were narratively presented and illustrated with tables, diagrams and descriptive formats as appropriate.

RESULTS

Twelve studies were included in the review; however, none were from Africa. Impairments and activity limitations were the key functioning problems indicated for rehabilitation. Age, gender, income, race, disease stage, specific functioning problems, quality of life and care by a neurologist were the main predictors for referral to rehabilitation. Physiotherapy, occupational therapy and speech and language therapy were the most utilized rehabilitation services and were sometimes utilized together. The rate of rehabilitation service utilization among PwPD ranged from 0.9% to 62.5%. Lack of referrals and limited rehabilitation units/professionals were the common barriers to rehabilitation service utilization.

CONCLUSION

Per the studies reviewed, utilization of rehabilitation services is generally low among PwPD. Lack of referral and nonavailability of professionals are cited as barriers to access. Adequate measures are needed to improve rehabilitation services for all PwPD.

Sensorimotor functioning changes in response to global exercise versus handwriting upper limb exercise training in Parkinson's disease, results from a phase II randomised controlled trial

INTRODUCTION

People with Parkinson's disease (PwPD) present motor alterations which can impact daily life tasks that require speed and/or accuracy of movement.

OBJECTIVE

A sub analysis of NCT01439022, aiming to estimate the extent to which two different exercise training protocols (global and handwriting upper limb exercise training) impact reaction time, travel speed, and accuracy in PwPD.

METHODS

Seventy PwPD, right-side dominant were randomised 1:1 into two six-month training protocol groups; 35 PwPD performed global exercise training and 35 performed specific training (handwriting upper limb exercise movements). Assessments of speed-accuracy and trade-off were carried out at baseline, after 3 and 6 months of training, and at a 12-month follow-up. The current study used data from a previous publication of a randomised controlled trial that included a 6-month self-managed community exercise programme for PwPD. For the present study we included only the participants who completed the Fitts' task during the baseline assessment.

RESULTS

In the upper limb assessments, no main effects were found for the number of touches, but the exercise group showed a marginal increase over time on the left side. Error averages on the left side decreased significantly for the exercise group from baseline to 6 and 12 months. The exercise group also presented a lower Error CoV and the Reaction Time CoV increased on the right side. Significant findings for Fitts r on the left side indicated lower values for the exercise group, with improvements continuing at 12 months.

CONCLUSION

We report the potential of global exercise interventions to facilitate improvements in reaction time and travel speed, as well as other motor control metrics, with lasting effects at 12 months, particularly on the non-dominant side.

MoveONParkinson: developing a personalized motivational solution for Parkinson's disease management

Introduction

Despite the effectiveness of exercise-based interventions on symptom management and disease progression, many people with Parkinson's Disease (PwPD) do not exercise regularly. In line with the ubiquitous use of digital health technology, the MoveONParkinson digital solution was developed, comprising a Web Platform and a Mobile App with a Conversational Agent (CA). The interface features were designed based on the principles of Social Cognitive Theory with the goal of fostering behavior change in PwPD for sustained exercise participation and improved disease management.

Methods

Using a mixed methods approach, this study aimed to collect feedback, assess the acceptability of the Mobile App and the Web Platform, and evaluate the usability of the latter. Quantitative data, which included questionnaire responses and the System Usability Scale (SUS) scores, were analyzed using descriptive statistics, heatmaps, and correlation matrices. Qualitative data, comprising semi-structured and thinking-aloud interview transcripts, were subjected to an inductive thematic analysis. A total of 28 participants were involved in the study, comprising 20 physiotherapists (average age: 34.50 ± 10.4), and eight PwPD (average age: 65.75 ± 8.63; mean Hoehn & Yahr: 2.0 (± 0.76)).

Results

Three main themes emerged from the thematic analysis of the interviews, namely: Self-management (Theme 1), User Engagement (Theme 2), and Recommendations (Theme 3). The assessment of the Mobile App and the CA (mean score: 4.42/5.0 ± 0.79) suggests that PwPD were able to navigate this interface without notable difficulties. The mean SUS score of 79.50 (± 12.40%) with a 95% confidence interval ranging from 73.70 to 85.30, reveal good usability.

Discussion

These findings indicate a high level of acceptability of the MoveONParkinson digital solution, serving as a foundation for assessing its impact on exercise engagement and, subsequently, its influence on symptom management and quality of life of PwPD.

Brain modulation after exergaming training in advanced forms of Parkinson's disease: a randomized controlled study

BACKGROUND

Physical activity combined with virtual reality and exergaming has emerged as a new technique to improve engagement and provide clinical benefit for gait and balance disorders in people with Parkinson's disease (PD).

OBJECTIVE

To investigate the effects of a training protocol using a home-based exergaming system on brain volume and resting-state functional connectivity (rs-FC) in persons with PD.

METHODS

A single blind randomized controlled trial was conducted in people with PD with gait and/or balance disorders. The experimental (active) group performed 18 training sessions at home by playing a custom-designed exergame with full body movements, standing in front of a RGB-D Kinect® motion sensor, while the control group played using the computer keyboard. Both groups received the same training program. Clinical scales, gait recordings, and brain MRI were performed before and after training. We assessed the effects of both training on both the grey matter volumes (GVM) and rs-FC, within and between groups.

RESULTS

Twenty-three patients were enrolled and randomly assigned to either the active (n = 11) or control (n = 12) training groups. Comparing pre- to post-training, the active group showed significant improvements in gait and balance disorders, with decreased rs-FC between the sensorimotor, attentional and basal ganglia networks, but with an increase between the cerebellar and basal ganglia networks. In contrast, the control group showed no significant changes, and rs-FC significantly decreased in the mesolimbic and visuospatial cerebellar and basal ganglia networks. Post-training, the rs-FC was greater in the active relative to the control group between the basal ganglia, motor cortical and cerebellar areas, and bilaterally between the insula and the inferior temporal lobe. Conversely, rs FC was lower in the active relative to the control group between the pedunculopontine nucleus and cerebellar areas, between the temporal inferior lobes and the right thalamus, between the left putamen and dorsolateral prefrontal cortex, and within the default mode network.

CONCLUSIONS

Full-body movement training using a customized exergame induced brain rs-FC changes within the sensorimotor, attentional and cerebellar networks in people with PD. Further research is needed to comprehensively understand the neurophysiological effects of such training approaches. Trial registration ClinicalTrials.gov NCT03560089.

[Multidisciplinary Complex Treatment of Parkinson's disease : Cornerstone of an individualized treatment]

BACKGROUND

The inpatient Parkinson's disease multimodal complex treatment (PD-MCT) was applied more than 15,000 times in 2022, in Germany. This number is increasing as is Parkinson's disease (PD), which affects more than 400,000 people in Germany and leads to 100,000 disability-adjusted life years. In recent years, several observational studies have been conducted on the effectiveness of this kind of multidisciplinary care.

OBJECTIVE

To summarize and discuss the evidence on the nature, benefits and potential of PD-MCT.

METHODS

A narrative review of selected empirical findings was carried out.

RESULTS

The PD-MCT frequently lasts for 2-3 weeks and aims to maintain the quality of life of people with PD. Disease symptoms and activities of daily living are jointly improved by pharmacological strategies and activating therapies (physiotherapy, occupational therapy, speech and language therapy, physical training, art therapy). The PD-MCT is a useful measure to avoid or mitigate crisis situations in the course of the disease. A total of eight observational studies (n = 1246) have shown good effectiveness with a total mean improvement of the International Parkinson and Movement Disorder Society unified Parkinson's disease rating scale III (MDS-UPDRS III) by 7.8 points. The transfer of effects into everyday life through intensive and specialized community-based care must be ensured in order to achieve sustained effects on the quality of life. Ideally, this transfer can be supported by integrated PD networks and digital technologies in the future.

CONCLUSION

There is potential for development in the standardization, patient selection and quality assurance of PD-MCT as well as in the embedding in care structures such as PD networks. Open research questions include a precise definition of the target group and higher quality evidence of short-term and long-term effectiveness.

Walking training with auditory cueing improves walking speed more than walking training alone in ambulatory people with Parkinson's disease: a systematic review

QUESTIONS

In people with Parkinson's disease, what is the effect of adding external cueing (ie, visual, auditory or somatosensorial cueing) to walking training compared with walking training alone in terms of walking, mobility, balance, fear of falling and freezing? Are any benefits carried over to participation or maintained beyond the intervention period?

DESIGN

Systematic review of randomised trials with meta-analysis.

PARTICIPANTS

Ambulatory adults with Parkinson's disease.

INTERVENTION

Walking training with external cueing compared with walking training without external cueing.

OUTCOME MEASURES

Walking (ie, speed, stride length and cadence), mobility, balance, fear of falling, freezing and participation.

RESULTS

Ten trials involving a total of 309 participants were included. The mean PEDro score of the included trials was 5 (range 4 to 8). Walking training with auditory cueing improved walking speed by 0.09 m/s (95% CI 0.02 to 0.15) more than walking training alone. Although the best estimate was that auditory cueing may also improve stride length by 5 cm, this estimate was imprecise (95% CI -2 to 11). The addition of visual cueing to walking training did not improve walking speed or stride length. Results regarding cadence, mobility, balance, fear of falling, and freezing and maintenance of benefits beyond the intervention period remain uncertain.

CONCLUSION

This systematic review provided low-quality evidence that walking training with auditory cueing is more effective than walking training alone for improving walking speed in Parkinson's disease. Cueing is an inexpensive and easy to implement intervention, so the mean estimate might be considered clinically worthwhile, although the confidence interval spans clinically trivial and worthwhile effects.

REGISTRATION

PROSPERO CRD42021255065.

Effects of Upper Limb Exercise or Training on Hand Dexterity and Function in People With Parkinson Disease: A Systematic Review and Meta-analysis

OBJECTIVE

This systematic review investigated the effects of exercise and training on hand dexterity and function outcomes in people with Parkinson disease (PD).

DATA SOURCES

We searched 5 databases (MEDLINE Ovid, CINAHL, PEDro, PubMed, Cochrane Database) from inception to October 2022.

STUDY SELECTION

Included studies were randomized controlled trials delivering upper limb exercise or training interventions to people with PD and evaluating 1 or more upper limb activity outcomes. Two independent reviewers screened 668 articles for inclusion.

DATA EXTRACTION

Two reviewers independently extracted data relating to study participants, intervention characteristics, and key outcomes. Cochrane Risk of Bias and GRADE tools assessed methodological quality of included studies, and strength of evidence for 3 outcomes: hand dexterity, self-reported hand function, and handwriting performance. Meta-analyses synthesized results for within-hand dexterity and self-reported function.

RESULTS

Eighteen randomized controlled trials (n=704) with low to unclear risk of bias were identified. Experimental interventions varied considerably in their approach and treatment dose, and 3 studies focused on training handwriting. Meta-analysis showed moderate quality evidence of a small positive effect on within-hand dexterity (SMD=0.26; 95% CI 0.07, 0.44). Very low-quality evidence pointed toward a nonsignificant effect on self-reported hand function (SMD=0.67; 95% CI -0.40, 1.75). A narrative review of handwriting interventions showed low quality evidence for improved performance after training.

CONCLUSIONS

There is moderate certainty of evidence supporting the use of exercise and training to address dexterity problems, but evidence remains unclear for self-reported hand function and handwriting. Our findings suggest that training could employ task-related approaches. Future research should interrogate aspects of clinical practice such as optimal dose and key ingredients for effective interventions.

The effect of home-based exercise on motor and non-motor symptoms with Parkinson's disease patients: A systematic review and network meta-analysis

OBJECTIVE

To evaluate the effects of home-based exercise in Parkinson's disease (PD) patients.

DESIGN

A network meta-analysis of randomized controlled trials.

METHODS

This study systematically searched PubMed, MEDLINE, Embase, Cochrane library and Web of Science. The quality of the literature was assessed using the Cochrane Risk of Bias 2.0 criteria. The data were pooled using R software. Results are presented as pooled standardized mean difference (SMD) with 95% confidence interval (CI).

RESULTS

Thirty studies involving 2264 PD patients were included. Meta-analysis results showed that home-based exercise had a small effect in relieving overall motor symptoms in PD patients (SMD: -.28, 95% Crl [-.43; -.14]), improving quality of life (SMD = .15 [.03, .26]), walking speed (SMD = .30 [.04, .56]), balance ability (SMD = .18 [.04, .33]; p < .0001) and finger dexterity (SMD = .28 [.10, .46]). Mixed exercise (Mix) had better effects on improving motor symptoms and quality of life. In addition, the results of dose analysis showed that only mixed exercise exceeding 850 METs-min per week and more than 18 weeks can significantly alleviate the overall motor symptoms of PD patients.

CONCLUSION

Home-based exercise was an effective form of therapy for alleviating motor symptoms. In addition, Mix appeared to be more suitable for PD patients engaging in home-based exercise. Existing evidence suggested that significant therapeutic effects were achieved with a Mix, with a weekly exercise volume exceeding 850 METs and a duration of more than 18 weeks.

RELEVANCE TO CLINICAL PRACTICE

Home-based exercise had a small effect in relieving overall motor symptoms in PD patients, improving quality of life, walking speed, balance ability and finger dexterity. In terms of exercise dosage, we recommend the exercise period is no less than 18 weeks and the dose per is no less than 850 METs-min. No Patient or Public Contribution.

Trends in Physiotherapy Interventions and Medical Costs for Parkinson's Disease in South Korea, 2011-2020

OBJECTIVE

Physiotherapy (PT), which is an effective strategy for managing Parkinson's disease (PD), can influence health care utilization. We analyzed trends in health care utilization, PT interventions, and medical costs among patients with PD.

METHODS

Using data from the Korean National Health Insurance Service from 2011 to 2020, we analyzed the number of patients with PD and their health care utilization and assessed the odds ratio (OR) for receiving regular PTs.

RESULTS

Over 10 years, 169,613 patients with PD were included in the analysis. The number of patients with PD increased annually from 49,417 in 2011 to 91,841 in 2020. The number of patients with PD receiving PT increased from 4,847 (9.81%) in 2011 to 13,163 (14.33%) in 2020, and the number of PT prescriptions increased from 81,220 in 2011 to 377,651 in 2019. Medical costs per patient with PD increased from 1,686 United States dollars (USD) in 2011 to 3,202 USD in 2020. The medical expenses for each patient with PD receiving PT increased from 6,582 USD in 2011 to 13,475 USD in 2020. Moreover, regular PTs were administered to 31,782 patients (18.74%) and were administered only through hospitalization. Those patients in their 50s with disabilities demonstrated a high OR for regular PTs, whereas those aged 80 years or older and residing outside of Seoul had a low OR.

CONCLUSION

The PD burden increased in South Korea between 2011 and 2020, as did health care utilization and medical costs. A significant increase in medical expenses can be associated with increased PD incidence and PT interventions. Regular PT applications remain restricted and have barriers to access.

Validity and reliability of the Italian version of the short Parkinson's evaluation scale (SPES/SCOPA)

Background

In the medical and rehabilitative field, it is essential to employ tools such as evaluation scales and performance tests to assess the impact of Parkinson's disease on QoL of affected individuals. The Short Parkinson's Evaluation Scale (SPES) is a reliable and valid tool, applicable both in research and clinical practices, useful in assessing motor damage, activities of daily living, and motor complications in patients with Parkinson's disease. The aim of the study is to investigate validity and reliability of the Italian version of the SPES-SCOPA scale.

Methods

Translation and cultural adaptation were performed. Included patients had diagnosis of Parkinson's disease, no concurrent pathologies, MiniMental test score above 2 and signed informed consent; they were recruited at the Department of Human Neurosciences in Sapienza University of Rome, from February 2023 to November 2023. Test-retest reliability was evaluated through Intraclass Correlation Coefficient (ICC), internal consistency was assessed using Cronbach's Alpha and construct validity using Pearson's correlation between SPES-SCOPA and the gold standard PDQ-39.

Results

101 patients were recruited. Inter-rater evaluation was conducted on 62 patients, while 39 underwent an intra-rater assessment. The analysis showed statistically significant data with a Cronbach's Alpha value of 0.89 for the entire scale; test-retest reliability results are statistically significant for all subscales. Correlation between PDQ-39 domains and SPES/SCOPA subscales were statistically significant for most measurements.

Conclusion

This research shows that the Italian version of SPES-SCOPA scale has excellent psychometric properties.

Wearable biofeedback device to assess gait features and improve gait pattern in people with parkinson's disease: a case series

INTRODUCTION

People with Parkinson's Disease (PD) show abnormal gait patterns compromising their independence and quality of life. Among all gait alterations due to PD, reduced step length, increased cadence, and decreased ground-reaction force during the loading response and push-off phases are the most common. Wearable biofeedback technologies offer the possibility to provide correlated single or multi-modal stimuli associated with specific gait events or gait performance, hence promoting subjects' awareness of their gait disturbances. Moreover, the portability and applicability in clinical and home settings for gait rehabilitation increase the efficiency in the management of PD. The Wearable Vibrotactile Bidirectional Interface (BI) is a biofeedback device designed to extract gait features in real-time and deliver a customized vibrotactile stimulus at the waist of PD subjects synchronously with specific gait phases. The aims of this study were to measure the effect of the BI on gait parameters usually compromised by the typical bradykinetic gait and to assess its usability and safety in clinical practice.

METHODS

In this case series, seven subjects (age: 70.4 ± 8.1 years; H&Y: 2.7 ± 0.3) used the BI and performed a test on a 10-meter walkway (10mWT) and a two-minute walk test (2MWT) as pre-training (Pre-trn) and post-training (Post-trn) assessments. Gait tests were executed in random order with (Bf) and without (No-Bf) the activation of the biofeedback stimulus. All subjects performed three training sessions of 40 min to familiarize themselves with the BI during walking activities. A descriptive analysis of gait parameters (i.e., gait speed, step length, cadence, walking distance, double-support phase) was carried out. The 2-sided Wilcoxon sign-test was used to assess differences between Bf and No-Bf assessments (p < 0.05).

RESULTS

After training subjects improved gait speed (Pre-trn_No-Bf: 0.72(0.59,0.72) m/sec; Post-trn_Bf: 0.95(0.69,0.98) m/sec; p = 0.043) and step length (Pre-trn_No-Bf: 0.87(0.81,0.96) meters; Post-trn_Bf: 1.05(0.96,1.14) meters; p = 0.023) using the biofeedback during the 10mWT. Similarly, subjects' walking distance improved (Pre-trn_No-Bf: 97.5 (80.3,110.8) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.028) and the duration of the double-support phase decreased (Pre-trn_No-Bf: 29.7(26.8,31.7) %; Post-trn_Bf: 27.2(24.6,28.7) %; p = 0.018) during the 2MWT. An immediate effect of the BI was detected in cadence (Pre-trn_No-Bf: 108(103.8,116.7) step/min; Pre-trn_Bf: 101.4(96.3,111.4) step/min; p = 0.028) at Pre-trn, and in walking distance at Post-trn (Post-trn_No-Bf: 112.5(97.5,124.5) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.043). SUS scores were 77.5 in five subjects and 80.3 in two subjects. In terms of safety, all subjects completed the protocol without any adverse events.

CONCLUSION

The BI seems to be usable and safe for PD users. Temporal gait parameters have been measured during clinical walking tests providing detailed outcomes. A short period of training with the BI suggests improvements in the gait patterns of people with PD. This research serves as preliminary support for future integration of the BI as an instrument for clinical assessment and rehabilitation in people with PD, both in hospital and remote environments.

TRIAL REGISTRATION

The study protocol was registered (DGDMF.VI/P/I.5.i.m.2/2019/1297) and approved by the General Directorate of Medical Devices and Pharmaceutical Service of the Italian Ministry of Health and by the ethics committee of the Lombardy region (Milan, Italy).

Trans-Spinal Theta Burst Magnetic Stimulation in Parkinson's Disease and Gait Disorders

BACKGROUND

Gait disorders in patients with Parkinson's disease (PD) can become disabling with disease progression without effective treatment.

OBJECTIVES

To investigate the efficacy of intermittent θ burst trans-spinal magnetic stimulation (TsMS) in PD patients with gait and balance disorders.

METHODS

This was a randomized, parallel, double-blind, controlled trial. Active or sham TsMS was applied at third thoracic vertebra with 100% of the trans-spinal motor threshold, during 5 consecutive days. Participants were evaluated at baseline, immediately after last session, 1 and 4 weeks after last session. Primary outcome was Total Timed Up and Go (TUG) values comparing active versus sham phases 1 week after intervention. The secondary outcome measurements consisted of motor, gait and balance scales, and questionnaires for quality of life and cognition.

RESULTS

Thirty-three patients were included, average age 68.5 (6.4) years in active group and 70.3 (6.3) years in sham group. In active group, Total TUG mean baseline was 107.18 (95% CI, 52.1-116.1), and 1 week after stimulation was 93.0 (95% CI, 50.7-135.3); sham group, Total TUG mean baseline was 101.2 (95% CI, 47.1-155.3) and 1 week after stimulation 75.2 (95% CI 34.0-116.4), P = 0.54. Similarly, intervention had no significant effects on secondary outcome measurements. During stimulation period, five patients presented with mild side effects (three in active group and two in sham group).

DISCUSSION

TsMS did not significantly improve gait or balance analysis in patients with PD and gait disorders. The protocol was safe and well tolerated. © 2024 International Parkinson and Movement Disorder Society.