1
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Mustile M, Kourtis D, Ladouce S, Edwards MG, Volpe D, Pilleri M, Pelosin E, Donaldson DI, Ietswaart M. Investigating the Brain Mechanisms of Externally Cued Sit-to-Stand Movement in Parkinson's Disease. Mov Disord 2024. [PMID: 38984716 DOI: 10.1002/mds.29889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/01/2024] [Accepted: 05/28/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND One of the more challenging daily-life actions for Parkinson's disease patients is starting to stand from a sitting position. Parkinson's disease patients are known to have difficulty with self-initiated movements and benefit from external cues. However, the brain processes underlying external cueing as an aid remain unknown. The advent of mobile electroencephalography (EEG) now enables the investigation of these processes in dynamic sit-to-stand movements. OBJECTIVE To identify cortical correlates of the mechanisms underlying auditory cued sit-to-stand movement in Parkinson's disease. METHODS Twenty-two Parkinson's disease patients and 24 healthy age-matched participants performed self-initiated and externally cued sit-to-stand movements while cortical activity was recorded through 32-channel mobile EEG. RESULTS Overall impaired integration of sensory and motor information can be seen in the Parkinson's disease patients exhibiting less modulation in the θ band during movement compared to healthy age-matched controls. How Parkinson's disease patients use external cueing of sit-to-stand movements can be seen in larger high β power over sensorimotor brain areas compared to healthy controls, signaling sensory integration supporting the maintenance of motor output. This appears to require changes in cognitive processing to update the motor plan, reflected in frontal θ power increases in Parkinson's disease patients when cued. CONCLUSION These findings provide the first neural evidence for why and how cueing improves motor function in sit-to-stand movement in Parkinson's disease. The Parkinson's disease patients' neural correlates indicate that cueing induces greater activation of motor cortical areas supporting the maintenance of a more stable motor output, but involves the use of cognitive resources to update the motor plan. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Magda Mustile
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
- The Psychological Sciences Research Institute, University of Louvain, Louvain-la-Neuve, Belgium
| | - Dimitrios Kourtis
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Simon Ladouce
- Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Martin G Edwards
- The Psychological Sciences Research Institute, University of Louvain, Louvain-la-Neuve, Belgium
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
| | - Manuela Pilleri
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - David I Donaldson
- School of Psychology and Neuroscience, University of St Andrews, St. Andrews, United Kingdom
| | - Magdalena Ietswaart
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
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2
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Ernst M, Folkerts AK, Gollan R, Lieker E, Caro-Valenzuela J, Adams A, Cryns N, Monsef I, Dresen A, Roheger M, Eggers C, Skoetz N, Kalbe E. Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis. Cochrane Database Syst Rev 2024; 4:CD013856. [PMID: 38588457 PMCID: PMC11001292 DOI: 10.1002/14651858.cd013856.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Physical exercise is effective in managing Parkinson's disease (PD), but the relative benefit of different exercise types remains unclear. OBJECTIVES To compare the effects of different types of physical exercise in adults with PD on the severity of motor signs, quality of life (QoL), and the occurrence of adverse events, and to generate a clinically meaningful treatment ranking using network meta-analyses (NMAs). SEARCH METHODS An experienced information specialist performed a systematic search for relevant articles in CENTRAL, MEDLINE, Embase, and five other databases to 17 May 2021. We also searched trial registries, conference proceedings, and reference lists of identified studies up to this date. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing one type of physical exercise for adults with PD to another type of exercise, a control group, or both. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data. A third author was involved in case of disagreements. We categorized the interventions and analyzed their effects on the severity of motor signs, QoL, freezing of gait, and functional mobility and balance up to six weeks after the intervention using NMAs. Two review authors independently assessed the risk of bias using the risk of bias 2 (RoB 2) tool and rated the confidence in the evidence using the CINeMA approach for results on the severity of motor signs and QoL. We consulted a third review author to resolve any disagreements. Due to heterogeneous reporting of adverse events, we summarized safety data narratively and rated our confidence in the evidence using the GRADE approach. MAIN RESULTS We included 154 RCTs with a total of 7837 participants with mostly mild to moderate disease and no major cognitive impairment. The number of participants per study was small (mean 51, range from 10 to 474). The NMAs on the severity of motor signs and QoL included data from 60 (2721 participants), and 48 (3029 participants) trials, respectively. Eighty-five studies (5192 participants) provided safety data. Here, we present the main results. We observed evidence of beneficial effects for most types of physical exercise included in our review compared to a passive control group. The effects on the severity of motor signs and QoL are expressed as scores on the motor scale of the Unified Parkinson's Disease Rating Scale (UPDRS-M) and the Parkinson's Disease Questionnaire 39 (PDQ-39), respectively. For both scales, higher scores denote higher symptom burden. Therefore, negative estimates reflect improvement (minimum clinically important difference: -2.5 for UPDRS-M and -4.72 for PDQ-39). Severity of motor signs The evidence from the NMA (60 studies; 2721 participants) suggests that dance and gait/balance/functional training probably have a moderate beneficial effect on the severity of motor signs (dance: mean difference (MD) -10.18, 95% confidence interval (CI) -14.87 to -5.36; gait/balance/functional training: MD -7.50, 95% CI -11.39 to -3.48; moderate confidence), and multi-domain training probably has a small beneficial effect on the severity of motor signs (MD -5.90, 95% CI -9.11 to -2.68; moderate confidence). The evidence also suggests that endurance, aqua-based, strength/resistance, and mind-body training might have a small beneficial effect on the severity of motor signs (endurance training: MD -5.76, 95% CI -9.78 to -1.74; aqua-based training: MD -5.09, 95% CI -10.45 to 0.40; strength/resistance training: MD -4.96, 95% CI -9.51 to -0.40; mind-body training: MD -3.62, 95% CI -7.24 to 0.00; low confidence). The evidence is very uncertain about the effects of "Lee Silverman Voice training BIG" (LSVT BIG) and flexibility training on the severity of motor signs (LSVT BIG: MD -6.70, 95% CI -16.48 to 3.08; flexibility training: MD 4.20, 95% CI -1.61 to 9.92; very low confidence). Quality of life The evidence from the NMA (48 studies; 3029 participants) suggests that aqua-based training probably has a large beneficial effect on QoL (MD -15.15, 95% CI -23.43 to -6.87; moderate confidence). The evidence also suggests that mind-body, gait/balance/functional, and multi-domain training and dance might have a small beneficial effect on QoL (mind-body training: MD -7.22, 95% CI -13.57 to -0.70; gait/balance/functional training: MD -6.17, 95% CI -10.75 to -1.59; multi-domain training: MD -5.29, 95% CI -9.51 to -1.06; dance: MD -3.88, 95% CI -10.92 to 3.00; low confidence). The evidence is very uncertain about the effects of gaming, strength/resistance, endurance, and flexibility training on QoL (gaming: MD -8.99, 95% CI -23.43 to 5.46; strength/resistance training: MD -6.70, 95% CI -12.86 to -0.35; endurance training: MD -6.52, 95% CI -13.74 to 0.88; flexibility training: MD 1.94, 95% CI -10.40 to 14.27; very low confidence). Adverse events Only 85 studies (5192 participants) provided some kind of safety data, mostly only for the intervention groups. No adverse events (AEs) occurred in 40 studies and no serious AEs occurred in four studies. AEs occurred in 28 studies. The most frequently reported events were falls (18 studies) and pain (10 studies). The evidence is very uncertain about the effect of physical exercise on the risk of adverse events (very low confidence). Across outcomes, we observed little evidence of differences between exercise types. AUTHORS' CONCLUSIONS We found evidence of beneficial effects on the severity of motor signs and QoL for most types of physical exercise for people with PD included in this review, but little evidence of differences between these interventions. Thus, our review highlights the importance of physical exercise regarding our primary outcomes severity of motor signs and QoL, while the exact exercise type might be secondary. Notably, this conclusion is consistent with the possibility that specific motor symptoms may be treated most effectively by PD-specific programs. Although the evidence is very uncertain about the effect of exercise on the risk of adverse events, the interventions included in our review were described as relatively safe. Larger, well-conducted studies are needed to increase confidence in the evidence. Additional studies recruiting people with advanced disease severity and cognitive impairment might help extend the generalizability of our findings to a broader range of people with PD.
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Affiliation(s)
- Moritz Ernst
- Cochrane Haematology, Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ann-Kristin Folkerts
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Romina Gollan
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Emma Lieker
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Caro-Valenzuela
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nora Cryns
- Cochrane Haematology, Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Cochrane Haematology, Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Antje Dresen
- Institute of Medical Sociology, Health Services Resarch, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mandy Roheger
- Ambulatory Assessment in Psychology, Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, Marburg, Germany
- Department of Neurology, Knappschaftskrankenhaus Bottrop GmbH, Bottrop, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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3
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Martin RA, Fulk G, Dibble L, Boolani A, Vieira ER, Canbek J. Modeling Cues May Reduce Sway Following Sit-To-Stand Transfer for People with Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2023; 23:4701. [PMID: 37430617 DOI: 10.3390/s23104701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 07/12/2023]
Abstract
Cues are commonly used to overcome the effects of motor symptoms associated with Parkinson's disease. Little is known about the impact of cues on postural sway during transfers. The objective of this study was to identify if three different types of explicit cues provided during transfers of people with Parkinson's disease results in postural sway more similar to healthy controls. This crossover study had 13 subjects in both the Parkinson's and healthy control groups. All subjects completed three trials of uncued sit to stand transfers. The Parkinson's group additionally completed three trials of sit to stand transfers in three conditions: external attentional focus of reaching to targets, external attentional focus of concurrent modeling, and explicit cue for internal attentional focus. Body worn sensors collected sway data, which was compared between groups with Mann Whitney U tests and between conditions with Friedman's Tests. Sway normalized with modeling but was unchanged in the other conditions. Losses of balance presented with reaching towards targets and cueing for an internal attentional focus. Modeling during sit to stand of people with Parkinson's disease may safely reduce sway more than other common cues.
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Affiliation(s)
- Rebecca A Martin
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - George Fulk
- Department of Rehabilitation Science, Emory University, Atlanta, GA 30322, USA
| | - Lee Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84112, USA
| | - Ali Boolani
- Honors Program, Clarkson University, Potsdam, NY 13669, USA
| | - Edgar R Vieira
- Department of Physical Therapy, Florida International University, Miami, 33199 FL, USA
| | - Jennifer Canbek
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
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4
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Ernst M, Folkerts AK, Gollan R, Lieker E, Caro-Valenzuela J, Adams A, Cryns N, Monsef I, Dresen A, Roheger M, Eggers C, Skoetz N, Kalbe E. Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis. Cochrane Database Syst Rev 2023; 1:CD013856. [PMID: 36602886 PMCID: PMC9815433 DOI: 10.1002/14651858.cd013856.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Physical exercise is effective in managing Parkinson's disease (PD), but the relative benefit of different exercise types remains unclear. OBJECTIVES To compare the effects of different types of physical exercise in adults with PD on the severity of motor signs, quality of life (QoL), and the occurrence of adverse events, and to generate a clinically meaningful treatment ranking using network meta-analyses (NMAs). SEARCH METHODS An experienced information specialist performed a systematic search for relevant articles in CENTRAL, MEDLINE, Embase, and five other databases to 17 May 2021. We also searched trial registries, conference proceedings, and reference lists of identified studies up to this date. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing one type of physical exercise for adults with PD to another type of exercise, a control group, or both. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data. A third author was involved in case of disagreements. We categorized the interventions and analyzed their effects on the severity of motor signs, QoL, freezing of gait, and functional mobility and balance up to six weeks after the intervention using NMAs. Two review authors independently assessed the risk of bias using the risk of bias 2 (RoB 2) tool and rated the confidence in the evidence using the CINeMA approach for results on the severity of motor signs and QoL. We consulted a third review author to resolve any disagreements. Due to heterogeneous reporting of adverse events, we summarized safety data narratively and rated our confidence in the evidence using the GRADE approach. MAIN RESULTS We included 156 RCTs with a total of 7939 participants with mostly mild to moderate disease and no major cognitive impairment. The number of participants per study was small (mean 51, range from 10 to 474). The NMAs on the severity of motor signs and QoL included data from 71 (3196 participants), and 55 (3283 participants) trials, respectively. Eighty-five studies (5192 participants) provided safety data. Here, we present the main results. We observed evidence of beneficial effects for most types of physical exercise included in our review compared to a passive control group. The effects on the severity of motor signs and QoL are expressed as scores on the motor scale of the Unified Parkinson Disease Rating Scale (UPDRS-M) and the Parkinson's Disease Questionnaire 39 (PDQ-39), respectively. For both scales, higher scores denote higher symptom burden. Therefore, negative estimates reflect improvement (minimum clinically important difference: -2.5 for UPDRS-M and -4.72 for PDQ-39). Severity of motor signs The evidence from the NMA (71 studies; 3196 participants) suggests that dance has a moderate beneficial effect on the severity of motor signs (mean difference (MD) -10.32, 95% confidence interval (CI) -15.54 to -4.96; high confidence), and aqua-based, gait/balance/functional, and multi-domain training might have a moderate beneficial effect on the severity of motor signs (aqua-based: MD -7.77, 95% CI -13.27 to -2.28; gait/balance/functional: MD -7.37, 95% CI -11.39 to -3.35; multi-domain: MD -6.97, 95% CI -10.32 to -3.62; low confidence). The evidence also suggests that mind-body training and endurance training might have a small beneficial effect on the severity of motor signs (mind-body: MD -6.57, 95% CI -10.18 to -2.81; endurance: MD -6.43, 95% CI -10.72 to -2.28; low confidence). Flexibility training might have a trivial or no effect on the severity of motor signs (MD 2.01, 95% CI -4.82 to 8.98; low confidence). The evidence is very uncertain about the effects of strength/resistance training and "Lee Silverman Voice training BIG" (LSVT BIG) on the severity of motor signs (strength/resistance: MD -6.97, 95% CI -11.93 to -2.01; LSVT BIG: MD -5.49, 95% CI -14.74 to 3.62; very low confidence). Quality of life The evidence from the NMA (55 studies; 3283 participants) suggests that aqua-based training probably has a large beneficial effect on QoL (MD -14.98, 95% CI -23.26 to -6.52; moderate confidence). The evidence also suggests that endurance training might have a moderate beneficial effect, and that gait/balance/functional and multi-domain training might have a small beneficial effect on QoL (endurance: MD -9.16, 95% CI -15.68 to -2.82; gait/balance/functional: MD -5.64, 95% CI -10.04 to -1.23; multi-domain: MD -5.29, 95% CI -9.34 to -1.06; low confidence). The evidence is very uncertain about the effects of mind-body training, gaming, strength/resistance training, dance, LSVT BIG, and flexibility training on QoL (mind-body: MD -8.81, 95% CI -14.62 to -3.00; gaming: MD -7.05, 95% CI -18.50 to 4.41; strength/resistance: MD -6.34, 95% CI -12.33 to -0.35; dance: MD -4.05, 95% CI -11.28 to 3.00; LSVT BIG: MD 2.29, 95% CI -16.03 to 20.44; flexibility: MD 1.23, 95% CI -11.45 to 13.92; very low confidence). Adverse events Only 85 studies (5192 participants) provided some kind of safety data, mostly only for the intervention groups. No adverse events (AEs) occurred in 40 studies and no serious AEs occurred in four studies. AEs occurred in 28 studies. The most frequently reported events were falls (18 studies) and pain (10 studies). The evidence is very uncertain about the effect of physical exercise on the risk of adverse events (very low confidence). Across outcomes, we observed little evidence of differences between exercise types. AUTHORS' CONCLUSIONS We found evidence of beneficial effects on the severity of motor signs and QoL for most types of physical exercise for people with PD included in this review, but little evidence of differences between these interventions. Thus, our review highlights the importance of physical exercise regarding our primary outcomes severity of motor signs and QoL, while the exact exercise type might be secondary. Notably, this conclusion is consistent with the possibility that specific motor symptoms may be treated most effectively by PD-specific programs. Although the evidence is very uncertain about the effect of exercise on the risk of adverse events, the interventions included in our review were described as relatively safe. Larger, well-conducted studies are needed to increase confidence in the evidence. Additional studies recruiting people with advanced disease severity and cognitive impairment might help extend the generalizability of our findings to a broader range of people with PD.
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Affiliation(s)
- Moritz Ernst
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ann-Kristin Folkerts
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Romina Gollan
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Emma Lieker
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Caro-Valenzuela
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nora Cryns
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Antje Dresen
- Institute of Medical Sociology, Health Services Resarch, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mandy Roheger
- Ambulatory Assessment in Psychology, Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, Marburg, Germany
- Department of Neurology, Knappschaftskrankenhaus Bottrop GmbH, Bottrop, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Machado S, Teixeira D, Monteiro D, Imperatori C, Murillo-Rodriguez E, da Silva Rocha FP, Yamamoto T, Amatriain-Fernández S, Budde H, Carta MG, Caixeta L, de Sá Filho AS. Clinical applications of exercise in Parkinson's disease: what we need to know? Expert Rev Neurother 2022; 22:771-780. [PMID: 36168890 DOI: 10.1080/14737175.2022.2128768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Exploring the potential of exercise in the rehabilitation process of patients with Parkinson's (PD) may be an interesting treatment perspective. Exercise-induced responses derived from neurotrophic elements appear to ameliorate the decline in neurodegeneration. Despite this understanding, the literature needs to be updated. AREAS COVERED Our review focuses on: a) the key mechanisms of exercise on PD, highlighting mainly the responses related to neuroplasticity; b) the effects induced by different traditional types of exercise, also highlighting the effects of complementary therapies related to movement; c) the volume of exercise required to support efficient results are explored in the context of PD. Additionally, the proposition of new clinical application strategies in the context of PD will also be determined. EXPERT OPINION It is suggested that different intensities of aerobic exercise be explored for the treatment of PD. The results associated with high intensity seem promising for performance, physiological and clinical parameters, such as BDNF production and cognition. On the other hand, the diversification of tasks and repetition of motor gestures appear as consistent arguments to exercise prescription. Finally, for future investigations, the neuromodulation strategy in association with aerobic exercise appears as a potential inducer of benefits on gait and cognitive function.
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Affiliation(s)
- Sergio Machado
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil.,Physical Activity Neuroscience Laboratory (LABNAF), Neurodiversity Institute, Queimados-RJ, Brazil.,Intercontinental Neuroscience Research Group, Mérida, Mexico
| | - Diogo Teixeira
- Universidade Lusófona, Faculty of Physical Education and Sport, Lisbon, Portugal; Research Center in Sport, Physical Education, and Exercise and Health (CIDEFES), Lisbon, Portugal
| | - Diogo Monteiro
- ESECS, Polytechnic of Leiria, 2411-901 Leiria, Portugal; Research Center in Sport, Health and Human Development (CIDESD), 5000-558, Vila Real, Portugal.,Life Quality Research Centre (CIEQV), Leiria, Portugal
| | - Claudio Imperatori
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,Cognitive and Clinical Psychology Laboratory, Department of Human Sciences European University of Rome, Rome, Italy
| | - Eric Murillo-Rodriguez
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, División Ciencias de la Salud, Universidad Anáhuac Mayab, Mexico
| | | | - Tetsuya Yamamoto
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,Graduate School of Technology, Industrial and Social Sciences, Tokushima University, Tokushima, Japan
| | - Sandra Amatriain-Fernández
- Institute for Systems Medicine (ISM) at the Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
| | - Henning Budde
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,Institute for Systems Medicine (ISM) at the Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
| | - Mauro Giovanni Carta
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Leonardo Caixeta
- Neurology and Neuropsychiatry Department of Clinical Medicine, Federal University of Goiás, School of Medicine, Goiânia, Brazil
| | - Alberto Souza de Sá Filho
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, División Ciencias de la Salud, Universidad Anáhuac Mayab, Mexico.,Department of Physical Education, Paulista University, Goiânia, Brazil
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6
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Faltinsen E, Todorovac A, Staxen Bruun L, Hróbjartsson A, Gluud C, Kongerslev MT, Simonsen E, Storebø OJ. Control interventions in randomised trials among people with mental health disorders. Cochrane Database Syst Rev 2022; 4:MR000050. [PMID: 35377466 PMCID: PMC8979177 DOI: 10.1002/14651858.mr000050.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Control interventions in randomised trials provide a frame of reference for the experimental interventions and enable estimations of causality. In the case of randomised trials assessing patients with mental health disorders, many different control interventions are used, and the choice of control intervention may have considerable impact on the estimated effects of the treatments being evaluated. OBJECTIVES To assess the benefits and harms of typical control interventions in randomised trials with patients with mental health disorders. The difference in effects between control interventions translates directly to the impact a control group has on the estimated effect of an experimental intervention. We aimed primarily to assess the difference in effects between (i) wait-list versus no-treatment, (ii) usual care versus wait-list or no-treatment, and (iii) placebo interventions (all placebo interventions combined or psychological, pharmacological, and physical placebos individually) versus wait-list or no-treatment. Wait-list patients are offered the experimental intervention by the researchers after the trial has been finalised if it offers more benefits than harms, while no-treatment participants are not offered the experimental intervention by the researchers. SEARCH METHODS In March 2018, we searched MEDLINE, PsycInfo, Embase, CENTRAL, and seven other databases and six trials registers. SELECTION CRITERIA We included randomised trials assessing patients with a mental health disorder that compared wait-list, usual care, or placebo interventions with wait-list or no-treatment . DATA COLLECTION AND ANALYSIS Titles, abstracts, and full texts were reviewed for eligibility. Review authors independently extracted data and assessed risk of bias using Cochrane's risk of bias tool. GRADE was used to assess the quality of the evidence. We contacted researchers working in the field to ask for data from additional published and unpublished trials. A pre-planned decision hierarchy was used to select one benefit and one harm outcome from each trial. For the assessment of benefits, we summarised continuous data as standardised mean differences (SMDs) and dichotomous data as risk ratios (RRs). We used risk differences (RDs) for the assessment of adverse events. We used random-effects models for all statistical analyses. We used subgroup analysis to explore potential causes for heterogeneity (e.g. type of placebo) and sensitivity analyses to explore the robustness of the primary analyses (e.g. fixed-effect model). MAIN RESULTS We included 96 randomised trials (4200 participants), ranging from 8 to 393 participants in each trial. 83 trials (3614 participants) provided usable data. The trials included 15 different mental health disorders, the most common being anxiety (25 trials), depression (16 trials), and sleep-wake disorders (11 trials). All 96 trials were assessed as high risk of bias partly because of the inability to blind participants and personnel in trials with two control interventions. The quality of evidence was rated low to very low, mostly due to risk of bias, imprecision in estimates, and heterogeneity. Only one trial compared wait-list versus no-treatment directly but the authors were not able to provide us with any usable data on the comparison. Five trials compared usual care versus wait-list or no-treatment and found a SMD -0.33 (95% CI -0.83 to 0.16, I² = 86%, 523 participants) on benefits. The difference between all placebo interventions combined versus wait-list or no-treatment was SMD -0.37 (95% CI -0.49 to -0.25, I² = 41%, 65 trials, 2446 participants) on benefits. There was evidence of some asymmetry in the funnel plot (Egger's test P value of 0.087). Almost all the trials were small. Subgroup analysis found a moderate effect in favour of psychological placebos SMD -0.49 (95% CI -0.64 to -0.30; I² = 53%, 39 trials, 1656 participants). The effect of pharmacological placebos versus wait-list or no-treatment on benefits was SMD -0.14 (95% CI -0.39 to 0.11, 9 trials, 279 participants) and the effect of physical placebos was SMD -0.21 (95% CI -0.35 to -0.08, I² = 0%, 17 trials, 896 participants). We found large variations in effect sizes in the psychological and pharmacological placebo comparisons. For specific mental health disorders, we found significant differences in favour of all placebos for sleep-wake disorders, major depressive disorder, and anxiety disorders, but the analyses were imprecise due to sparse data. We found no significant differences in harms for any of the comparisons but the analyses suffered from sparse data. When using a fixed-effect model in a sensitivity analysis on the comparison for usual care versus wait-list and no-treatment, the results were significant with an SMD of -0.46 (95 % CI -0.64 to -0.28). We reported an alternative risk of bias model where we excluded the blinding domains seeing how issues with blinding may be seen as part of the review investigation itself. However, this did not markedly change the overall risk of bias profile as most of the trials still included one or more unclear bias domains. AUTHORS' CONCLUSIONS We found marked variations in effects between placebo versus no-treatment and wait-list and between subtypes of placebo with the same comparisons. Almost all the trials were small with considerable methodological and clinical variability in factors such as mental health population, contents of the included control interventions, and outcome domains. All trials were assessed as high risk of bias and the evidence quality was low to very low. When researchers decide to use placebos or usual care control interventions in trials with people with mental health disorders it will often lead to lower estimated effects of the experimental intervention than when using wait-list or no-treatment controls. The choice of a control intervention therefore has considerable impact on how effective a mental health treatment appears to be. Methodological guideline development is needed to reach a consensus on future standards for the design and reporting of control interventions in mental health intervention research.
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Affiliation(s)
- Erlend Faltinsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Adnan Todorovac
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | | | - Asbjørn Hróbjartsson
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mickey T Kongerslev
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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7
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Saba RA, Maia DP, Cardoso FEC, Borges V, F. Andrade LA, Ferraz HB, Barbosa ER, Rieder CRDM, da Silva DJ, Chien HF, Capato T, Rosso AL, Souza Lima CF, Bezerra JMF, Nicaretta D, Povoas Barsottini OG, Godeiro-Júnior C, Broseghini Barcelos L, Gisbert Cury R, Spitz M, Azevedo Silva SMC, Della Colletta MV. Guidelines for Parkinson’s disease treatment: consensus from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology - motor symptoms. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:316-329. [DOI: 10.1590/0004-282x-anp-2021-0219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/02/2021] [Indexed: 11/21/2022]
Abstract
ABSTRACT The treatment of Parkinson's disease (PD) is challenging, especially since it is considered highly individualized. The Brazilian Academy of Neurology has recognized the need to disseminate knowledge about the management of PD treatment, adapting the best evidence to the Brazilian reality. Thus, the main published treatment guidelines were reviewed based on the recommendations of group from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology.
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Affiliation(s)
- Roberta Arb Saba
- Universidade Federal de São Paulo, Brazil; Hospital do Servidor Público Estadual, Brazil
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8
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Osborne JA, Botkin R, Colon-Semenza C, DeAngelis TR, Gallardo OG, Kosakowski H, Martello J, Pradhan S, Rafferty M, Readinger JL, Whitt AL, Ellis TD. Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association. Phys Ther 2021; 102:6485202. [PMID: 34963139 PMCID: PMC9046970 DOI: 10.1093/ptj/pzab302] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
A clinical practice guideline on Parkinson disease was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists and a neurologist. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for management of Parkinson disease. The Spanish version of this clinical practice guideline is available as a supplement (Suppl. Appendix 1).
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Affiliation(s)
- Jacqueline A Osborne
- Brooks Rehabilitation Hospital, Brooks Institute of Higher Learning, Jacksonville, Florida, USA
| | - Rachel Botkin
- Botkin Rehab Services, Physical Therapy, Columbus, Ohio, USA
| | - Cristina Colon-Semenza
- Department of Kinesiology, Doctor of Physical Therapy Program, University of Connecticut, Storrs, Connecticut, USA
| | - Tamara R DeAngelis
- Boston University Sargent College of Health and Rehabilitation Services, Physical Therapy and Athletic Training, Boston, Massachusetts, USA
| | - Oscar G Gallardo
- Rancho Los Amigos National Rehabilitation Center, Physical Therapy, Downey, California, USA
| | - Heidi Kosakowski
- Address all correspondence to Dr Kosakowski care of the Department of Practice of the American Physical Therapy Association at:
| | | | - Sujata Pradhan
- University of Washington, Rehabilitation Medicine, Seattle, Washington, USA
| | - Miriam Rafferty
- Northwestern University, Center for Education in Health Sciences, Chicago, Illinois, USA
| | | | | | - Terry D Ellis
- Boston University Sargent College of Health and Rehabilitation Services, Physical Therapy and Athletic Training, Boston, Massachusetts, USA
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9
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Li J, Liu Z, Du Z, Zhu N, Qiu X, Xu X. Cortical Activation During Finger Tapping Task Performance in Parkinson's Disease Is Influenced by Priming Conditions: An ALE Meta-Analysis. Front Hum Neurosci 2021; 15:774656. [PMID: 34916919 PMCID: PMC8669914 DOI: 10.3389/fnhum.2021.774656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
The finger tapping task (FTT) is commonly used in the evaluation of dyskinesia among patients with Parkinson's disease (PD). Past research has indicated that cortical activation during FTT is different between self-priming and cue-priming conditions. To evaluate how priming conditions affect the distribution of brain activation and the reorganization of brain function, and to investigate the differences in brain activation areas during FTT between PD patients and healthy control (HC) participants, we conducted an activation likelihood estimation (ALE) meta-analysis on the existing literature. Analyses were based on data from 15 independent samples that included 181 participants with PD and 164 HC participants. We found that there was significantly more activation in the middle frontal gyrus, precentral gyrus, post-central gyrus, superior parietal lobe, inferior parietal lobule, cerebellum, and basal ganglia during FTT in PD patients than in HCs. In self-priming conditions, PD patients had less activation in the parietal lobe and insular cortex but more activation in the cerebellum than the HCs. In cue-priming conditions, the PD patients showed less activation in the cerebellum and frontal-parietal areas and more activation in the superior frontal gyrus and superior temporal gyrus than the HCs. Our study illustrates that cue-priming manipulations affect the distribution of activity in brain regions involved in motor control and motor performance in PD patients. In cue-priming conditions, brain activity in regions associated with perceptual processing and inhibitory control was enhanced, while sensory motor areas associated with attention and motor control were impaired.
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Affiliation(s)
- Jingjing Li
- Graduate School, Wuhan Sports University, Wuhan, China
| | - Zheng Liu
- ANU College of Health and Medicine, Australian National University, Canberra, ACT, Australia
- Sydney School of Education and Social Work, University of Sydney, Sydney, NSW, Australia
| | - Zhongquan Du
- Graduate School, Wuhan Sports University, Wuhan, China
| | - Ningning Zhu
- Graduate School, Wuhan Sports University, Wuhan, China
| | - Xueqing Qiu
- Graduate School, Wuhan Sports University, Wuhan, China
| | - Xia Xu
- College of Health Science, Wuhan Sports University, Wuhan, China
- Hubei Key Laboratory of Exercise Training and Monitoring, Wuhan Sports University, Wuhan, China
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10
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The Effect of Landmarks With Their Color on Learning Basketball Lay-Up in Beginners. JOURNAL OF MOTOR LEARNING AND DEVELOPMENT 2021. [DOI: 10.1123/jmld.2020-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to determine the effect of landmarks on learning basketball lay-up in beginners. Twenty-seven females (age = 20.30 ± 0.24 years, height = 164.37 ± 0.53 cm) participated in this study. They were assigned to three groups: no landmark group, colored landmark group, and black and white landmark group. All participants performed basketball lay-up for six sessions. The colored group and black and white group trained with the landmarks on the ground while the no landmark group trained without any landmarks based on a trainer instruction. Posttest was performed at the end of the last session of training and also in the retention test following 72 hr. All trials were assessed through 5-point Likert scales, ranging from 1 (very poor) to 5 (very good). The results showed that using landmarks significantly changed the lay-up pattern; however, these changes were not significant for color and lay-up shot accuracy.
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11
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Hirakawa Y, Takeda K, Koyama S, Naoi Y, Matsushita T, Nagai T, Motoya I, Sakurai H, Kanada Y, Kawamura N, Kawamura M, Tanabe S. Effect of Lee Silverman Voice Treatment (LSVT)® BIG on motor symptoms in a patient with severe Parkinson's disease: a case report. Physiother Theory Pract 2021; 38:3159-3168. [PMID: 34125001 DOI: 10.1080/09593985.2021.1938304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Lee Silverman Voice Treatment® BIG (LSVT® BIG) is widely used to improve motor symptoms in patients with mild-to-moderate Parkinson's disease (PD).Objective: To describe the effect of LSVT® BIG on the motor symptoms of a patient with severe PD.Case Description: A 77-year-old woman who was diagnosed with PD received a 4-week LSVT® BIG program under the supervision of certified LSVT® BIG physical therapists. Her disease severity was classified as Hoehn and Yahr stage 4. The unified Parkinson's disease rating scale (UPDRS) part 3, 10-m walk test (10MWT), timed up-and-go test (TUG), Berg balance scale (BBS), and 30-s chair stand test (30-s CST) were used for assessment before and after intervention.Outcomes: The UPDRS part 3, 10MWT, TUG, BBS, and 30-s CST improved after intervention (33 to 26, 0.51 to 0.69 m/s, 38.1 to 23.2 seconds, 11 to 34, and 3 to 9 times, respectively). All improvements exceeded the Minimal Clinically Important Difference or Minimal Detectable Change values (2.5, 0.16 m/s, 3.5 seconds, 5, and 3 times, respectively).Conclusions: These results indicated that LSVT® BIG appears to have improved motor symptoms in a patient with severe PD. Further studies, ideally randomized controlled trials, are needed to confirm these findings.
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Affiliation(s)
- Yuichi Hirakawa
- Department of Rehabilitation, Kawamura Hospital, Gifu, Japan.,Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Kazuya Takeda
- Department of Rehabilitation, Kawamura Hospital, Gifu, Japan
| | - Soichiro Koyama
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yuki Naoi
- Department of Rehabilitation, Kawamura Hospital, Gifu, Japan
| | | | - Tomoko Nagai
- Department of Rehabilitation, Kawamura Hospital, Gifu, Japan
| | - Ikuo Motoya
- Department of Rehabilitation, Kawamura Hospital, Gifu, Japan
| | - Hiroaki Sakurai
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yoshikiyo Kanada
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | | | - Mami Kawamura
- Department of Neurology, Kawamura Hospital, Gifu, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
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12
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Soke F, Kocer B, Fidan I, Keskinoglu P, Guclu-Gunduz A. Effects of task-oriented training combined with aerobic training on serum BDNF, GDNF, IGF-1, VEGF, TNF-α, and IL-1β levels in people with Parkinson's disease: A randomized controlled study. Exp Gerontol 2021; 150:111384. [PMID: 33965556 DOI: 10.1016/j.exger.2021.111384] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a chronic neurodegenerative disease characterized by the death of dopaminergic neurons in the substantia nigra pars compacta. Exercise training, which is incorporated both goal-based training such as task-oriented training (TOT) and aerobic training (AT), has been suggested to induce neuroprotection. However, molecular mechanisms which may underlie exercise-induced neuroprotection are still largely unknown. Thus, the aim of the present study was to investigate the effects of TOT combined with AT (TOT-AT) on serum brain-derived neurotrophic factor (BDNF), glial cell-derived growth factor (GDNF), insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF), tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β) levels in people with PD (PwPD). METHODS Forty PwPD were randomized into 8-week of either exercise group (n = 20) or control group (n = 20). The exercise group received TOT-AT while the control group received only AT. Serum BDNF, GDNF, IGF-1, VEGF, TNF-α, and IL-1β levels determined with ELISA were assessed at baseline and after training. RESULTS A total of 29 PwPD completed this study. Our results showed no significant change in the serum BDNF, GDNF, IGF-1, VEGF, TNF-α, and IL-1β levels in both groups. After the intervention period, no significant difference was observed between the groups regarding the serum BDNF, GDNF, IGF-1, VEGF, TNF-α, and IL-1β levels. CONCLUSION TOT-AT could not be an effective exercise method for changing serum concentrations of BDNF, GDNF, IGF-1, VEGF, TNF-α, and IL-1β in the rehabilitation of PD.
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Affiliation(s)
- Fatih Soke
- University of Health Sciences, Gulhane Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | - Bilge Kocer
- Diskapi Yildirim Beyazit Teaching and Research Hospital, Department of Neurology, Ankara, Turkey
| | - Isil Fidan
- Gazi University, Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey
| | - Pembe Keskinoglu
- Dokuz Eylul University, Department of Biostatistics, School of Medicine, Izmir, Turkey
| | - Arzu Guclu-Gunduz
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
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13
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Task-oriented circuit training combined with aerobic training improves motor performance and balance in people with Parkinson's Disease. Acta Neurol Belg 2021; 121:535-543. [PMID: 31741209 DOI: 10.1007/s13760-019-01247-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/12/2019] [Indexed: 12/19/2022]
Abstract
Goal-based training such as task practice combined with aerobic training (AT) has been suggested to improve motor performance and neuroplasticity for people with Parkinson's Disease (PwPD); however, its effect on clinical outcomes is unclear. Therefore, the main aim was to investigate the effects of task-oriented circuit training combined with AT (TOCT-AT) on balance and gait in PwPD. The secondary aim was to investigate the effects of TOCT-AT on functional mobility, balance confidence, disease severity, and quality of life. Twenty-six PwPD were randomly assigned to either to the experimental group (n = 14) or the control group (n = 12). The control group received AT, while the experimental group received TOCT-AT three times a week for 8 weeks. The main outcomes were the Berg Balance Scale (BBS), Postural Stability Test (PST), Limits of Stability Test (LOS), Pull Test (PT), Six Minute Walk Test (6MWT), Timed Up and Go Test (TUG), Activities-specific Balance Confidence Scale (ABC), Unified Parkinson's Disease Rating Scale (UPDRS), and eight-item Parkinson's Disease Questionnaire (PDQ-8) were secondary outcomes. After intervention, between-group comparisons showed that the experimental group significantly improved more than the control group in all outcomes (p < 0.05). Additionally, both groups significantly improved in BBS, 6MWT, TUG, ABC, UPDRS-II, UPDRS-III, UPDRS total, and PDQ-8 (p < 0.05), while only the experimental group significantly improved in PST, LOS, and PT (p < 0.001). This study suggest that TOCT-AT could improve balance and gait performance, which could also be positively translated into functional mobility, balance confidence, disease severity, and quality of life in PwPD.
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14
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Alatawi SF. A scoping review of the nature of physiotherapists' role to avoid fall in people with Parkinsonism. Neurol Sci 2021; 42:3733-3748. [PMID: 33443671 PMCID: PMC8413181 DOI: 10.1007/s10072-020-05015-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 12/18/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is considered a neurological disease with a high prevalence rate among population. One of its main problems is recurrent fall which has numerous contributing factors such as history of fall, fear of falling, gait deficits, impaired balance, poor functional mobility, and muscle weakness. OBJECTIVE To review and explore the focus/nature of interventions which target the role of physiotherapy preventing fall in patients with PD. METHOD A scoping review was led dependent on Arksey and O'Malley as discussed by Wood et al. (2002). This paper based on this structure to perceive intervention studies have been embraced in physiotherapy to prevent fall after Parkinson's disease. The search included various databases. The referencing arrangements of every pertinent paper were additionally filtered for more studies. FINDINGS A total of 173 articles were included, 39 of which met the eligibility criteria. Fifteen studies reported on the direct impact of physiotherapy on fall, while the rest examined the impacts of physiotherapy on factors that are associated with fall. Different outcomes, interventions types, and duration were used in these studies. Findings showed a favorable result of physiotherapy on fall and near fall incidence, balance, gait, functional mobility, muscle strength, and fear of falling. CONCLUSION Physiotherapy has the possibility to decrease fall incidence and fall risk in people with PD. However, the heterogeneity in the patients' selection, intervention studies, outcome measures chosen, time since the onset of disease, variation in intensity, and duration of treatment between included studies make the comparisons difficult. Consequently, more studies are needed on best intervention.
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Affiliation(s)
- Salem F. Alatawi
- grid.440760.10000 0004 0419 5685Associate professor of neurorehabilitation Department of Physical Therapy Faculty of Applied Medical Sciences, University of Tabuk, Tabuk City, Saudi Arabia
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15
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Cabrera-Martos I, Ortiz-Rubio A, Torres-Sánchez I, Rodríguez-Torres J, López-López L, Valenza MC. A randomized controlled study of whether setting specific goals improves the effectiveness of therapy in people with Parkinson's disease. Clin Rehabil 2018; 33:465-472. [PMID: 30501396 DOI: 10.1177/0269215518815217] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE: To evaluate the effects of an intervention based on a specific set of goals on goal attainment, manual dexterity, hand grip strength and finger prehension force compared to a standardized approach in patients with Parkinson's disease. DESIGN: Randomized controlled trial. SETTING: Home-based. PARTICIPANTS: Fifty patients with a clinical diagnosis of Parkinson's disease acknowledging impaired manual ability were randomized into two groups. INTERVENTIONS: Patients in the experimental group ( n = 25) were included in an intervention focused on task components that involved goals proposed by participants. Patients in the control group ( n = 25) received a standard intervention focused on impairments in range of motion, grasp and manipulation. Home condition and duration (four weeks, twice a week) were similar in both groups. MAIN OUTCOME MEASURES: The primary outcome measure was goal achievement assessed with the Goal Attainment Scaling. Secondary outcomes were manual dexterity evaluated with the Purdue Pegboard Test and hand grip strength and finger prehension force assessed using a dynamometer. RESULTS: After four weeks, significant between-group improvement in goal attainment was observed in the experimental group (change 17.36 ± 7.48 vs. 4.03 ± 6.43, P < 0.001). Compared to the control group, the experimental group also showed a significant improvement ( P < 0.05) in manual dexterity (postintervention values in the most affected arm 10.55 ± 1.95 vs. 7.33 ± 3.63 pins, P < 0.001) and finger prehension force (postintervention values in the most affected arm 8.03 ± 1.93 vs. 6.31 ± 1.85 kg, P = 0.010). CONCLUSIONS: Targeting therapy toward specific goals leads to greater changes in arm function than a standardized approach in people with Parkinson's disease.
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Affiliation(s)
- Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Torres-Sánchez
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Janet Rodríguez-Torres
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura López-López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Robinson AG, Dennett AM, Snowdon DA. Treadmill training may be an effective form of task-specific training for improving mobility in people with Parkinson's disease and multiple sclerosis: a systematic review and meta-analysis. Physiotherapy 2018; 105:174-186. [PMID: 30876717 DOI: 10.1016/j.physio.2018.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 11/04/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Task-specific training is an effective form of rehabilitation for improving mobility in neurological conditions. However, it remains unclear if task-specific training is effective in people with progressive disease. OBJECTIVE To establish the efficacy of task-specific training on the mobility of individuals with progressive neurological conditions. DATA SOURCES Electronic databases MEDLINE, EMBASE, CINAHL and Cochrane Database of Systematic Reviews. STUDY ELIGIBILITY CRITERIA Randomised controlled trials investigating the effect of task-specific training on mobility and falls rate in individuals with progressive neurological conditions. STUDY APPRAISAL/SYNTHESIS METHODS Risk of bias of individual studies was assessed using the Physiotherapy Evidence Database (PEDro) Scale. Mean differences (MD) and 95% confidence intervals were calculated and combined in meta-analysis. RESULTS Analysis of 16 trials found treadmill training improved comfortable walking velocity (m/second) in people with Parkinson's disease (MD 0.21m/second, 95%CI 0.15 to 0.27) and multiple sclerosis (MD 0.36m/second, 95%CI 0.20 to 0.52). Treadmill training improved stride length (m) (MD 0.12m, 95%CI 0.02 to 0.23) and step length (m) (MD 0.12m, 95%CI 0.01 to 0.23) in people with Parkinson's disease and walking endurance in people with multiple sclerosis (MD 26.53m, 95%CI 12.23 to 40.84). Treadmill training had no effect on cadence and did not improve walking endurance in Parkinson's disease. Over-ground walking did not improve mobility in Parkinson's disease or multiple sclerosis. LIMITATIONS Study sample sizes were small and findings must be interpreted with caution. CONCLUSION Treadmill training may be effective for improving mobility in people with Parkinson's disease and multiple sclerosis. The effectiveness of over-ground walking is uncertain. SYSTEMATIC REVIEW PROSPERO REGISTRATION NUMBER CRD42016047334.
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Affiliation(s)
- Alexandra G Robinson
- Department of Physiotherapy, Eastern Health, Peter James Centre, Cnr. Mahoneys Road & Burwood Highway, Burwood East VIC, 3151, Australia.
| | - Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, and School of Allied Health, La Trobe University, Victoria, Australia.
| | - David A Snowdon
- Allied Health Clinical Research Office, Eastern Health, and School of Allied Health, La Trobe University, Victoria, Australia.
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Cash MF, Ulanowski E, Danzl M. Development of a community-based golf and exercise program for people with Parkinson's disease. Complement Ther Clin Pract 2018; 33:149-155. [PMID: 30396614 DOI: 10.1016/j.ctcp.2018.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/26/2022]
Abstract
Individuals with Parkinson's disease (PD) typically display symptoms of rigidity, bradykinesia, and postural instability that can limit participation in recreational activities. The purpose of this clinical report is to describe the development, implementation, and outcomes of a novel and innovative community-based golf and exercise program for individuals with PD. In response to community interest, the program was developed through a unique partnership that blended the expertise of physical therapists and golf professionals. The 6-week program consisted of golf instruction and task-specific exercises. Improvements were noted in seven of eight participants for golf performance (driving distance and club head speed) and quality of life (PD Questionnaire-39) outcome measures. This report describes the design and implementation of a golf and exercise program for people with PD based on community need, evidence, and clinical expertise. Considerations and recommendations for future programs are discussed, such as program length, staffing, volunteers, funding, location, and resources.
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Affiliation(s)
- Megan F Cash
- 4960 Norton Healthcare Blvd. Rehabilitation Services, Norton Healthcare, Louisville, KY, 40241, USA; 2001 Newburg Road, Nolen C. Allen Hall, Physical Therapy Program, School of Movement and Rehabilitation Sciences, College of Health Professions, Bellarmine University, Louisville, KY, 40205, USA.
| | - Elizabeth Ulanowski
- 2001 Newburg Road, Nolen C. Allen Hall, Physical Therapy Program, School of Movement and Rehabilitation Sciences, College of Health Professions, Bellarmine University, Louisville, KY, 40205, USA.
| | - Megan Danzl
- 2001 Newburg Road, Nolen C. Allen Hall, Physical Therapy Program, School of Movement and Rehabilitation Sciences, College of Health Professions, Bellarmine University, Louisville, KY, 40205, USA.
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Park J, Cohen I. Effects of Exercise Interventions in Older Adults with Various Types of Dementia: Systematic Review. ACTIVITIES, ADAPTATION & AGING 2018. [DOI: 10.1080/01924788.2018.1493897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Juyoung Park
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, Florida, USA
| | - Iris Cohen
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, Florida, USA
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Conradsson D, Leavy B, Hagströmer M, Nilsson MH, Franzén E. Physiotherapy for Parkinson's Disease in Sweden: Provision, Expertise, and Multi-professional Collaborations. Mov Disord Clin Pract 2017; 4:843-851. [PMID: 30363397 DOI: 10.1002/mdc3.12525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/21/2017] [Accepted: 07/03/2017] [Indexed: 01/25/2023] Open
Abstract
Background Evidence for the positive effects of physiotherapy for persons with Parkinson's disease (PwPD) is rapidly increasing. However, little is known about the provision of physiotherapy for PwPD in everyday practice. The objective of this study was to gain insight into the nature of physiotherapeutic care for PwPD in hospitals, primary care units, and community services in Sweden. Methods A web-based survey was sent out to 2956 members of the Swedish Association of Physiotherapists, including questions about treatment, measurement tools, multi-professional collaborations, adherence to physiotherapy guidelines, professional expertise, and needs for gaining expertise regarding PwPD. Results Of the 1189 physiotherapists who completed the survey, 705 were treating 1 or more PwPD per month in hospitals (21%), in primary care units (37%), and in the community (42%). Physiotherapy frequently targeted a wide range of musculoskeletal and mobility impairments; however, freezing of gait and pain were less frequently treated. Measurement tools recommended for PwPD were infrequently used, and there was a preference for single-item questions/tools compared with multi-item instruments. Collaboration with other health care professionals for the rehabilitation of PwPD was rare and was more evident in hospitals than in primary care units and the community. Adherence to physiotherapy guidelines was poor, and most respondents reported that they treated too few PwPD to retain their expertise and they perceived a need to increase their knowledge and skills about physiotherapy for PwPD. Conclusion The current findings emphasize the need to strengthen expertise regarding the assessment and treatment of PwPD among physiotherapists in Sweden and to apply strategies endorsing multi-professional collaboration for PD rehabilitation.
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Affiliation(s)
- David Conradsson
- Division of Physiotherapy Departmlent of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden.,Function Area Occupational Therapy and Physiotherapy Department Allied Health Professionals Function Karolinska University Hospital Stockholm Sweden
| | - Breiffni Leavy
- Division of Physiotherapy Departmlent of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden.,Stockholms Sjukhem Foundation Stockholm Sweden
| | - Maria Hagströmer
- Division of Physiotherapy Departmlent of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden.,Function Area Occupational Therapy and Physiotherapy Department Allied Health Professionals Function Karolinska University Hospital Stockholm Sweden
| | - Maria H Nilsson
- Department of Health Sciences Faculty of Medicine Lund University Lund Sweden.,Memory Clinic Skåne University Hospital Malmö Sweden
| | - Erika Franzén
- Division of Physiotherapy Departmlent of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden.,Function Area Occupational Therapy and Physiotherapy Department Allied Health Professionals Function Karolinska University Hospital Stockholm Sweden.,Stockholms Sjukhem Foundation Stockholm Sweden
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Costa-Ribeiro A, Maux A, Bosford T, Aoki Y, Castro R, Baltar A, Shirahige L, Moura Filho A, Nitsche MA, Monte-Silva K. Transcranial direct current stimulation associated with gait training in Parkinson's disease: A pilot randomized clinical trial. Dev Neurorehabil 2017; 20:121-128. [PMID: 26864140 DOI: 10.3109/17518423.2015.1131755] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study is to investigate the effects of transcranial direct current stimulation (tDCS) combined with cueing gait training (CGT) on functional mobility in patients with Parkinson´s disease (PD). METHODS A pilot double-blind controlled, randomized clinical trial was conducted with 22 patients with PD assigned to the experimental (anodal tDCS plus CGT) and control group (sham tDCS plus CGT). The primary outcome (functional mobility) was assessed by 10-m walk test, cadence, stride length, and Timed Up and Go test. Motor impairment, bradykinesia, balance, and quality of life were analyzed as secondary outcomes. Minimal clinically important differences (MCIDs) were observed when assessing outcome data. RESULTS Both groups demonstrated similar gains in all outcome measures, except for the stride length. The number of participants who showed MCID was similar between groups. CONCLUSION The CGT provided many benefits to functional mobility, motor impairment, bradykinesia, balance, and quality of life. However, these effect magnitudes were not influenced by stimulation, but tDCS seems to prolong the effects of cueing therapy on functional mobility.
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Affiliation(s)
- Adriana Costa-Ribeiro
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Ariadne Maux
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Thamyris Bosford
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Yumi Aoki
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Rebeca Castro
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Adriana Baltar
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Lívia Shirahige
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Alberto Moura Filho
- b Department of Physical Therapy, Laboratory of Kinesiology and Functional Assessment , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Michael A Nitsche
- c Department of Clinical Neurophysiology , Georg August University , Goettingen , Germany.,d Leibniz Research Centre for Working Environment and Human Resources , Dortmund , Germany.,e Department of Neurology , University Medical Hospital Bergmannsheil , Bochum , Germany
| | - Kátia Monte-Silva
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
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Radder DL, Sturkenboom IH, van Nimwegen M, Keus SH, Bloem BR, de Vries NM. Physical therapy and occupational therapy in Parkinson's disease. Int J Neurosci 2017; 127:930-943. [DOI: 10.1080/00207454.2016.1275617] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Danique L.M. Radder
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ingrid H. Sturkenboom
- Department of Rehabilitation-Occupational Therapy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marlies van Nimwegen
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Samyra H. Keus
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nienke M. de Vries
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
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Sugiyama T, Liew SL. The Effects of Sensory Manipulations on Motor Behavior: From Basic Science to Clinical Rehabilitation. J Mot Behav 2016; 49:67-77. [PMID: 27935445 DOI: 10.1080/00222895.2016.1241740] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Modifying sensory aspects of the learning environment can influence motor behavior. Although the effects of sensory manipulations on motor behavior have been widely studied, there still remains a great deal of variability across the field in terms of how sensory information has been manipulated or applied. Here, the authors briefly review and integrate the literature from each sensory modality to gain a better understanding of how sensory manipulations can best be used to enhance motor behavior. Then, they discuss 2 emerging themes from this literature that are important for translating sensory manipulation research into effective interventions. Finally, the authors provide future research directions that may lead to enhanced efficacy of sensory manipulations for motor learning and rehabilitation.
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Affiliation(s)
- Taisei Sugiyama
- a Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy , University of Southern California , Los Angeles , California
| | - Sook-Lei Liew
- a Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy , University of Southern California , Los Angeles , California.,b Division of Biokinesiology and Physical Therapy , University of Southern California , Los Angeles , California.,c Department of Neurology , University of Southern California , Los Angeles , California
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23
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Shen X, Wong-Yu ISK, Mak MKY. Effects of Exercise on Falls, Balance, and Gait Ability in Parkinson's Disease: A Meta-analysis. Neurorehabil Neural Repair 2015; 30:512-27. [PMID: 26493731 DOI: 10.1177/1545968315613447] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Postural instability and falls are complex and disabling features of Parkinson's disease (PD) and respond poorly to anti-Parkinsonian medication. There is an imperative need to evaluate the effectiveness of exercise interventions in enhancing postural stability and decreasing falls in the PD population. The objectives of our study were to determine the effects of exercise training on the enhancement of balance and gait ability and reduction in falls for people with PD and to investigate potential factors contributing to the training effects on balance and gait ability of people with PD. We included 25 randomized control trials of a moderate methodological quality in our meta-analysis. The trials examined the effects of exercise training on balance and gait ability and falls against no intervention and placebo intervention. The results showed positive effects of exercise intervention on enhancing balance and gait performance (Hedges' g = 0.303 over the short-term in 24 studies and 0.419 over the long-term in 12 studies; P < .05) and reducing the fall rate (rate ratio = 0.485 over the short-term in 4 studies and 0.413 over the long-term in 5 studies; P < .05). The longest follow-up duration was 12 months. There was no evidence that training decreased the number of fallers over the short- or long-term (P > .05). The results of our metaregression and subgroup analysis showed that facility-based training produced greater training effects on improving PD participants' balance and gait ability (P < .05). The findings support the application of exercise training to improve balance and gait ability and prevent falls in people with PD.
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Affiliation(s)
- Xia Shen
- The Hong Kong Polytechnic University, Hong Kong Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
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A Kinect-Based System for Lower Limb Rehabilitation in Parkinson's Disease Patients: a Pilot Study. J Med Syst 2015; 39:103. [PMID: 26265237 DOI: 10.1007/s10916-015-0289-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
This work brings together the emerging virtual reality techniques and the natural user interfaces to offer new possibilities in the field of rehabilitation. We have designed a rehabilitation game based on a low cost device (Microsoft Kinect(TM)) connected to a personal computer. It provides patients having Parkinson's Disease (PD) with a motivating way to perform several motor rehabilitation exercises to improve their rehabilitation. The experiment was tested on seven Parkinson's Disease patients and results demonstrated significant improvements in completion time score and in the 10 Meters Walk Test score. Nevertheless, additional research is needed to determine if this type of training has a long-term impact. Both the device and protocol were well accepted by subjects, being safe and easy to use. We conclude that our work provides a simple and suitable tool resulting in a more enriching rehabilitation process where motivation is highly encouraged in PD patients. Feedback coming from participants corroborate the hypothesis that the system can be applied not only in clinical rehabilitation centers but at home.
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Foster ER, Bedekar M, Tickle-Degnen L. Systematic review of the effectiveness of occupational therapy-related interventions for people with Parkinson's disease. Am J Occup Ther 2014; 68:39-49. [PMID: 24367954 DOI: 10.5014/ajot.2014.008706] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We describe the results of a systematic review of the literature on occupational therapy-related interventions for people with Parkinson's disease (PD). Three broad categories of intervention emerged: (1) exercise or physical activity; (2) environmental cues, stimuli, and objects; and (3) self-management and cognitive-behavioral strategies. Moderate to strong evidence exists for task-specific benefits of targeted physical activity training on motor performance, postural stability, and balance. Low to moderate evidence indicates that more complex, multimodal activity training supports improvement in functional movement activities. The evidence is moderate that the use of external supports during functional mobility or other movement activities has positive effects on motor control. In addition, moderate evidence is available that individualized interventions focused on promoting participant wellness initiatives and personal control by means of cognitive-behavioral strategies can improve targeted areas of quality of life. The implications for practice, education, and research are discussed.
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Affiliation(s)
- Erin R Foster
- Erin R. Foster, OTD, MSCI, OTR/L, is Assistant Professor, Program in Occupational Therapy, Departments of Neurology and Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Mayuri Bedekar
- Mayuri Bedekar, MS, OTR/L, is Occupational Therapist, HCR ManorCare, Roselle, IL
| | - Linda Tickle-Degnen
- Linda Tickle-Degnen, PhD, OTR/L, FAOTA, is Professor and Chair, Department of Occupational Therapy, Tufts University, 26 Winthrop Street, Medford, MA 02155;
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Delval A, Moreau C, Bleuse S, Tard C, Ryckewaert G, Devos D, Defebvre L. Auditory cueing of gait initiation in Parkinson’s disease patients with freezing of gait. Clin Neurophysiol 2014; 125:1675-81. [DOI: 10.1016/j.clinph.2013.12.101] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/04/2013] [Accepted: 12/17/2013] [Indexed: 01/05/2023]
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Frazzitta G, Maestri R, Bertotti G, Riboldazzi G, Boveri N, Perini M, Uccellini D, Turla M, Comi C, Pezzoli G, Ghilardi MF. Intensive Rehabilitation Treatment in Early Parkinson’s Disease. Neurorehabil Neural Repair 2014; 29:123-31. [DOI: 10.1177/1545968314542981] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Although physical exercise improves motor aspects of Parkinson’s disease (PD), it is not clear whether it may also have a neuroprotective effect. Objective. In this 2-year follow-up study, we determined whether intensive exercise in the early stages of the disease slows down PD progression. Methods. Forty newly diagnosed patients with PD were treated with rasagiline and randomly assigned to 2 groups: MIRT Group (two 28-day multidisciplinary intensive rehabilitation treatments [MIRT], at 1-year interval) and Control Group (only drug). In both groups, Unified Parkinson’s Disease Rating Scale Section II (UPDRS II), UPDRS III, 6-minute walking test (6MWT), Timed Up-and-Go test (TUG); PD Disability Scale (PDDS), and l-dopa equivalents were assessed at baseline (T0), 6 months (T1), 1 year (T2), 18 months (T3), and 2 years (T4) later. Results. Over 2 years, UPDRS II, UPDRS III, TUG, and PDDS differentially progressed in the 2 groups: In the MIRT Group, all scores at T4 were better than at T0 (all Ps < .03). No changes were noted in the Control Group. l-dopa equivalent dosages increased significantly only in the Control Group ( P = .0015), with a decrease in the percentages of patients in monotherapy (T1 40%; T2, T3, and T4 20%). In the MIRT Group, the percentages of such patients remained higher (T1 and T2 100%; T3 89%; T4 75%). Conclusions. These results suggest that MIRT might slow down the progression of motor decay, it might delay the need for increasing drug treatment, and thus, it might have a neuroprotective effect.
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Affiliation(s)
- Giuseppe Frazzitta
- “Moriggia-Pelascini” Hospital, Gravedona ed Uniti, Italy
- Fondazione Europea Ricerca Biomedica FERB, “S. Isidoro” Hospital, Trescore Balneario, Italy
| | - Roberto Maestri
- Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy
| | - Gabriella Bertotti
- Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy
| | - Giulio Riboldazzi
- Macchi Foundation, Varese and Department of Rehabilitation, “Le Terrazze” Hospital, Cunardo, Italy
| | - Natalia Boveri
- Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy
| | | | | | | | | | - Gianni Pezzoli
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy
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Shu HF, Yang T, Yu SX, Huang HD, Jiang LL, Gu JW, Kuang YQ. Aerobic exercise for Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2014; 9:e100503. [PMID: 24983753 PMCID: PMC4077570 DOI: 10.1371/journal.pone.0100503] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/23/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although some trials assessed the effectiveness of aerobic exercise for Parkinson's disease (PD), the role of aerobic exercise in the management of PD remained controversial. OBJECTIVE The purpose of this systematic review is to evaluate the evidence about whether aerobic exercise is effective for PD. METHODS Seven electronic databases, up to December 2013, were searched to identify relevant studies. Two reviewers independently extracted data and assessed methodological quality based on PEDro scale. Standardised mean difference (SMD) and 95% confidence intervals (CI) of random-effects model were calculated. And heterogeneity was assessed based on the I2 statistic. RESULTS 18 randomized controlled trials (RCTs) with 901 patients were eligible. The aggregated results suggested that aerobic exercise should show superior effects in improving motor actions (SMD, -0.57; 95% CI -0.94 to -0.19; p = 0.003), balance (SMD, 2.02; 95% CI 0.45 to 3.59; p = 0.01), and gait (SMD, 0.33; 95% CI 0.17 to 0.49; p<0.0001) in patients with PD, but not in quality of life (SMD, 0.11; 95% CI -0.23 to 0.46; p = 0.52). And there was no valid evidence on follow-up effects of aerobic exercise for PD. CONCLUSION Aerobic exercise showed immediate beneficial effects in improving motor action, balance, and gait in patients with PD. However, given no evidence on follow-up effects, large-scale RCTs with long follow-up are warrant to confirm the current findings.
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Affiliation(s)
- Hai-Feng Shu
- Department of Neurosurgery, General Hospital of the People's Liberation Army Chengdu Military Region, Chengdu, Sichuan, China
| | - Tao Yang
- Department of Neurosurgery, General Hospital of the People's Liberation Army Chengdu Military Region, Chengdu, Sichuan, China
| | - Si-Xun Yu
- Department of Neurosurgery, General Hospital of the People's Liberation Army Chengdu Military Region, Chengdu, Sichuan, China
| | - Hai-Dong Huang
- Department of Neurosurgery, General Hospital of the People's Liberation Army Chengdu Military Region, Chengdu, Sichuan, China
| | - Ling-Li Jiang
- Department of Neurosurgery, General Hospital of the People's Liberation Army Chengdu Military Region, Chengdu, Sichuan, China
| | - Jian-Wen Gu
- Department of Neurosurgery, General Hospital of the People's Liberation Army Chengdu Military Region, Chengdu, Sichuan, China
| | - Yong-Qin Kuang
- Department of Neurosurgery, General Hospital of the People's Liberation Army Chengdu Military Region, Chengdu, Sichuan, China
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Tomlinson CL, Herd CP, Clarke CE, Meek C, Patel S, Stowe R, Deane KHO, Shah L, Sackley CM, Wheatley K, Ives N. Physiotherapy for Parkinson's disease: a comparison of techniques. Cochrane Database Syst Rev 2014; 2014:CD002815. [PMID: 24936965 PMCID: PMC7120367 DOI: 10.1002/14651858.cd002815.pub2] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite medical therapies and surgical interventions for Parkinson's disease (PD), patients develop progressive disability. The role of physiotherapy is to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person. The overall aim is to optimise independence, safety and wellbeing, thereby enhancing quality of life. Trials have shown that physiotherapy has short-term benefits in PD. However, which physiotherapy intervention is most effective remains unclear. OBJECTIVES To assess the effectiveness of one physiotherapy intervention compared with a second approach in patients with PD. SEARCH METHODS Relevant trials were identified by electronic searches of numerous literature databases (for example MEDLINE, EMBASE) and trial registers, plus handsearching of major journals, abstract books, conference proceedings and reference lists of retrieved publications. The literature search included trials published up to the end of January 2012. SELECTION CRITERIA Randomised controlled trials of one physiotherapy intervention versus another physiotherapy intervention in patients with PD. DATA COLLECTION AND ANALYSIS Data were abstracted independently from each paper by two authors. Trials were classified into the following intervention comparisons: general physiotherapy, exercise, treadmill training, cueing, dance and martial arts. MAIN RESULTS A total of 43 trials were identified with 1673 participants. All trials used small patient numbers (average trial size of 39 participants); the methods of randomisation and concealment of allocation were poor or not stated in most trials. Blinded assessors were used in just over half of the trials and only 10 stated that they used intention-to-treat analysis.A wide variety of validated and customised outcome measures were used to assess the effectiveness of physiotherapy interventions. The most frequently reported physiotherapy outcomes were gait speed and timed up and go, in 19 and 15 trials respectively. Only five of the 43 trials reported data on falls (12%). The motor subscales of the Unified Parkinson's Disease Rating Scale and Parkinson's Disease Questionnaire-39 were the most commonly reported clinician-rated disability and patient-rated quality of life outcome measures, used in 22 and 13 trials respectively. The content and delivery of the physiotherapy interventions varied widely in the trials included within this review, so no quantitative meta-analysis could be performed. AUTHORS' CONCLUSIONS Considering the small number of participants examined, the methodological flaws in many of the studies, the possibility of publication bias, and the variety of interventions, formal comparison of the different physiotherapy techniques could not be performed. There is insufficient evidence to support or refute the effectiveness of one physiotherapy intervention over another in PD.This review shows that a wide range of physiotherapy interventions to treat PD have been tested . There is a need for more specific trials with improved treatment strategies to underpin the most appropriate choice of physiotherapy intervention and the outcomes measured.
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Affiliation(s)
- Claire L Tomlinson
- University of BirminghamBirmingham Clinical Trials UnitRobert Aitken InstituteEdgbastonBirminghamUKB15 2TT
| | - Clare P Herd
- College of Medical and Dental SciencesSchool of Clinical and Experimental MedicineUniversity of BirminghamEdgbastonBirminghamUKB15 2TT
| | - Carl E Clarke
- College of Medical and Dental SciencesSchool of Clinical and Experimental MedicineUniversity of BirminghamEdgbastonBirminghamUKB15 2TT
| | - Charmaine Meek
- University of BirminghamPrimary Care Clinical SciencesPrimary Care Clinical Sciences BuildingEdgbastonBirminghamUKB15 2TT
| | - Smitaa Patel
- University of BirminghamBirmingham Clinical Trials UnitRobert Aitken InstituteEdgbastonBirminghamUKB15 2TT
| | - Rebecca Stowe
- University of BirminghamBirmingham Clinical Trials UnitRobert Aitken InstituteEdgbastonBirminghamUKB15 2TT
| | - Katherine HO Deane
- University of East AngliaEdith Cavell BuildingColney LaneNorwichUKNR4 7UL
| | - Laila Shah
- University of BirminghamBirmingham Clinical Trials UnitRobert Aitken InstituteEdgbastonBirminghamUKB15 2TT
| | | | - Keith Wheatley
- University of BirminghamCancer Research Clinical Trials Unit, School of Cancer SciencesEdgbastonBirminghamUKB15 2TT
| | - Natalie Ives
- University of BirminghamBirmingham Clinical Trials UnitRobert Aitken InstituteEdgbastonBirminghamUKB15 2TT
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Canning CG, Paul SS, Nieuwboer A. Prevention of falls in Parkinson's disease: a review of fall risk factors and the role of physical interventions. Neurodegener Dis Manag 2014; 4:203-21. [DOI: 10.2217/nmt.14.22] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
SUMMARY Falls in people with Parkinson's disease (PD) are frequent and recurrent events with devastating and widespread consequences. Despite this, understanding of the predictive and explanatory value of fall risk factors, as well as the development and testing of interventions aimed at reducing falls, are in their infancy. This review focuses on fall prediction and risk factors that are potentially remediable with physical interventions. We show that falls can be predicted with high accuracy using a simple three-step clinical tool. Evidence from recently published randomized controlled trials supports the implementation of balance-challenging exercises in reducing falls. Larger scale trials utilizing technologically advanced monitoring methods will further elucidate those interventions most likely to be cost effective according to individual risk factor profiles.
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Affiliation(s)
- Colleen G Canning
- Clinical & Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia
| | - Serene S Paul
- Clinical & Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia
- The George Institute for Global Health, PO Box M201, Missenden Rd, NSW 2050, Australia
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, University of Leuven, Tervuursevest 101, B-3001 Heverlee, Belgium
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Galna B, Jackson D, Schofield G, McNaney R, Webster M, Barry G, Mhiripiri D, Balaam M, Olivier P, Rochester L. Retraining function in people with Parkinson's disease using the Microsoft kinect: game design and pilot testing. J Neuroeng Rehabil 2014; 11:60. [PMID: 24731758 PMCID: PMC4022057 DOI: 10.1186/1743-0003-11-60] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 04/01/2014] [Indexed: 12/23/2022] Open
Abstract
Background Computer based gaming systems, such as the Microsoft Kinect (Kinect), can facilitate complex task practice, enhance sensory feedback and action observation in novel, relevant and motivating modes of exercise which can be difficult to achieve with standard physiotherapy for people with Parkinson’s disease (PD). However, there is a current need for safe, feasible and effective exercise games that are appropriate for PD rehabilitation. The aims of this study were to i) develop a computer game to rehabilitate dynamic postural control for people with PD using the Kinect; and ii) pilot test the game’s safety and feasibility in a group of people with PD. Methods A rehabilitation game aimed at training dynamic postural control was developed through an iterative process with input from a design workshop of people with PD. The game trains dynamic postural control through multi-directional reaching and stepping tasks, with increasing complexity across 12 levels of difficulty. Nine people with PD pilot tested the game for one session. Participant feedback to identify issues relating to safety and feasibility were collected using semi-structured interviews. Results Participants reported that they felt safe whilst playing the game. In addition, there were no adverse events whilst playing. In general, the participants stated that they enjoyed the game and seven of the nine participants said they could imagine themselves using the game at home, especially if they felt it would improve their balance. The Flow State Scale indicated participants were immersed in the gameplay and enjoyed the experience. However, some participants reported that they found it difficult to discriminate between different types and orientations of visual objects in the game and some also had difficulty with the stepping tasks, especially when performed at the same time as the reaching tasks. Conclusion Computer-based rehabilitation games using the Kinect are safe and feasible for people with PD although intervention trials are needed to test their safety, feasibility and efficacy in the home.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Lynn Rochester
- Clinical Ageing Research Unit, Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL, UK.
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van Wegen EEH, Hirsch MA, Huiskamp M, Kwakkel G. Harnessing Cueing Training for Neuroplasticity in Parkinson Disease. TOPICS IN GERIATRIC REHABILITATION 2014. [DOI: 10.1097/tgr.0000000000000005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE, Stowe R, Shah L, Sackley CM, Deane KHO, Wheatley K, Ives N. Physiotherapy versus placebo or no intervention in Parkinson's disease. Cochrane Database Syst Rev 2013; 2013:CD002817. [PMID: 24018704 PMCID: PMC7120224 DOI: 10.1002/14651858.cd002817.pub4] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite medical therapies and surgical interventions for Parkinson's disease (PD), patients develop progressive disability. Physiotherapy aims to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person. The overall aim is to optimise independence, safety, and well-being, thereby enhancing quality of life. OBJECTIVES To assess the effectiveness of physiotherapy intervention compared with no intervention in patients with PD. SEARCH METHODS We identified relevant trials by conducting electronic searches of numerous literature databases (e.g. MEDLINE, EMBASE) and trial registers, and by handsearching major journals, abstract books, conference proceedings, and reference lists of retrieved publications. The literature search included trials published up to the end of January 2012. SELECTION CRITERIA Randomised controlled trials of physiotherapy intervention versus no physiotherapy intervention in patients with PD. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from each article. We used standard meta-analysis methods to assess the effectiveness of physiotherapy intervention compared with no physiotherapy intervention. Trials were classified into the following intervention comparisons: general physiotherapy, exercise, treadmill training, cueing, dance, and martial arts. We used tests for heterogeneity to assess for differences in treatment effect across these different physiotherapy interventions. MAIN RESULTS We identified 39 trials with 1827 participants. We considered the trials to be at a mixed risk of bias as the result of unreported allocation concealment and probable detection bias. Compared with no intervention, physiotherapy significantly improved the gait outcomes of speed (mean difference 0.04 m/s, 95% confidence interval (CI) 0.02 to 0.06, P = 0.0002); two- or six-minute walk test (13.37 m, 95% CI 0.55 to 26.20, P = 0.04) and Freezing of Gait questionnaire (-1.41, 95% CI -2.63 to -0.19, P = 0.02); functional mobility and balance outcomes of Timed Up & Go test (-0.63 s, 95% CI -1.05 to -0.21, P = 0.003), Functional Reach Test (2.16 cm, 95% CI 0.89 to 3.43, P = 0.0008), and Berg Balance Scale (3.71 points, 95% CI 2.30 to 5.11, P < 0.00001); and clinician-rated disability using the Unified Parkinson's Disease Rating Scale (UPDRS) (total -6.15 points, 95% CI-8.57 to -3.73, P < 0.00001; activities of daily living: -1.36, 95% CI -2.41 to -0.30, P = 0.01; and motor: -5.01, 95% CI -6.30 to -3.72, P < 0.00001). No difference between arms was noted in falls (Falls Efficacy Scale: -1.91 points, 95% CI -4.76 to 0.94, P = 0.19) or patient-rated quality of life (PDQ-39 Summary Index: -0.38 points, 95% CI -2.58 to 1.81, P = 0.73). One study reported that adverse events were rare; no other studies reported data on this outcome. Indirect comparisons of the different physiotherapy interventions revealed no evidence that the treatment effect differed across physiotherapy interventions for any of the outcomes assessed. AUTHORS' CONCLUSIONS Benefit for physiotherapy was found in most outcomes over the short term (i.e. < 3 months) but was significant only for speed, two- or six-minute walk test, Freezing of Gait questionnaire, Timed Up & Go, Functional Reach Test, Berg Balance Scale, and clinician-rated UPDRS. Most of the observed differences between treatments were small. However, for some outcomes (e.g. speed, Berg Balance Scale, UPDRS), the differences observed were at, or approaching, what are considered minimal clinically important changes. These benefits should be interpreted with caution because the quality of most of the included trials was not high. Variation in measurements of outcome between studies meant that our analyses include a small proportion of the participants recruited.This review illustrates that a wide range of approaches are employed by physiotherapists to treat patients with PD. However, no evidence of differences in treatment effect was noted between the different types of physiotherapy interventions being used, although this was based on indirect comparisons. A consensus menu of 'best practice' physiotherapy is needed, as are large, well-designed randomised controlled trials undertaken to demonstrate the longer-term efficacy and cost-effectiveness of 'best practice' physiotherapy in PD.
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Affiliation(s)
- Claire L Tomlinson
- University of BirminghamBirmingham Clinical Trials UnitRobert Aitken InstituteEdgbastonBirminghamUKB15 2TT
| | - Smitaa Patel
- University of BirminghamBirmingham Clinical Trials UnitRobert Aitken InstituteEdgbastonBirminghamUKB15 2TT
| | - Charmaine Meek
- University of BirminghamPrimary Care Clinical SciencesPrimary Care Clinical Sciences BuildingEdgbastonBirminghamUKB15 2TT
| | - Clare P Herd
- College of Medical and Dental SciencesSchool of Clinical and Experimental MedicineUniversity of BirminghamEdgbastonBirminghamUKB15 2TT
| | - Carl E Clarke
- College of Medical and Dental SciencesSchool of Clinical and Experimental MedicineUniversity of BirminghamEdgbastonBirminghamUKB15 2TT
| | - Rebecca Stowe
- University of BirminghamBirmingham Clinical Trials UnitRobert Aitken InstituteEdgbastonBirminghamUKB15 2TT
| | - Laila Shah
- University of BirminghamBirmingham Clinical Trials UnitRobert Aitken InstituteEdgbastonBirminghamUKB15 2TT
| | | | - Katherine HO Deane
- University of East AngliaEdith Cavell BuildingColney LaneNorwichUKNR4 7TJ
| | - Keith Wheatley
- University of BirminghamCancer Research UK Clinical Trials Unit, School of Cancer SciencesEdgbastonBirminghamUKB15 2TT
| | - Natalie Ives
- University of BirminghamBirmingham Clinical Trials UnitRobert Aitken InstituteEdgbastonBirminghamUKB15 2TT
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Ferreira JJ, Katzenschlager R, Bloem BR, Bonuccelli U, Burn D, Deuschl G, Dietrichs E, Fabbrini G, Friedman A, Kanovsky P, Kostic V, Nieuwboer A, Odin P, Poewe W, Rascol O, Sampaio C, Schüpbach M, Tolosa E, Trenkwalder C, Schapira A, Berardelli A, Oertel WH. Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson's disease. Eur J Neurol 2013; 20:5-15. [PMID: 23279439 DOI: 10.1111/j.1468-1331.2012.03866.x] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 08/06/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To summarize the 2010 EFNS/MDS-ES evidence-based treatment recommendations for the management of Parkinson's disease (PD). This summary includes the treatment recommendations for early and late PD. METHODS For the 2010 publication, a literature search was undertaken for articles published up to September 2009. For this summary, an additional literature search was undertaken up to December 2010. Classification of scientific evidence and the rating of recommendations were made according to the EFNS guidance. In cases where there was insufficient scientific evidence, a consensus statement ('good practice point') is made. RESULTS AND CONCLUSIONS For each clinical indication, a list of therapeutic interventions is provided, including classification of evidence.
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Affiliation(s)
- J J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics and Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Effect of externally cued training on dynamic stability control during the sit-to-stand task in people with Parkinson disease. Phys Ther 2013; 93:492-503. [PMID: 23139427 PMCID: PMC3613339 DOI: 10.2522/ptj.20100423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies have shown that people with Parkinson disease (PD) have difficulty performing the sit-to-stand task because of mobility and stability-related impairments. Despite its importance, literature on the quantification of dynamic stability control in people with PD during this task is limited. OBJECTIVE The study objective was to examine differences in dynamic stability control between people with PD and people who were healthy and the extent to which externally cued training could improve such control during the sit-to-stand task in people with PD. DESIGN This was a quasi-experimental controlled trial. METHODS The performance of 21 people with PD was compared with that of 12 older adults who dwelled in the community. People with PD were randomly assigned to 2 groups: a group that did not receive training and a group that received audiovisually cued training (3 times per week for 4 weeks) for speeding up performance on the sit-to-stand task. Outcome measures recorded at baseline and after 4 weeks included center-of-mass position, center-of-mass velocity, and stability against either backward or forward balance loss (backward or forward stability) at seat-off and movement termination. RESULTS Compared with people who were healthy, people with PD had greater backward stability resulting from a more anterior center-of-mass position at seat-off. This feature, combined with decreased forward stability at movement termination, increased their risk of forward balance loss at movement termination. After training, people with PD achieved greater backward stability through increased forward center-of-mass velocity at seat-off and reduced the likelihood of forward balance loss at movement termination through a posterior shift in the center-of-mass position. LIMITATIONS The study applied stability limits derived from adults who were healthy to people with PD, and the suggested impact on the risk of balance loss and falling is based on these theoretical stability limits. CONCLUSIONS For people with PD, postural stability against backward balance loss at task initiation was increased at the expense of possible forward balance loss at task termination. Task-specific training with preparatory audiovisual cues resulted in improved overall dynamic stability against both forward and backward balance loss.
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Effect of cued training on motor evoked potential and cortical silent period in people with Parkinson’s disease. Clin Neurophysiol 2013; 124:545-50. [DOI: 10.1016/j.clinph.2012.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 08/23/2012] [Accepted: 08/24/2012] [Indexed: 11/18/2022]
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Archibald N, Miller N, Rochester L. Neurorehabilitation in Parkinson disease. HANDBOOK OF CLINICAL NEUROLOGY 2013; 110:435-42. [PMID: 23312662 DOI: 10.1016/b978-0-444-52901-5.00037-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Parkinson disease (PD) is the second commonest neurodegenerative disorder in the UK with an increasing prevalence in our aging population. The clinical features of PD are varied with a variety of "motor" and "nonmotor" symptoms and the condition is best thought of as a multisystem neurodegenerative disorder rather than as a "pure" movement disorder. Although the mainstay of treatment is pharmacological, nonpharmacological interventions are vital as part of a multidisciplinary approach to the disorder. Neurorehabilitative interventions have been used for some time in the treatment of PD but, until recently, there has been little evidence to support the clinical impression that physiotherapy, occupational therapy, and speech and language therapy have a positive impact on both motor and nonmotor symptoms. This chapter will review the current evidence base for neurorehabilitation in PD and discuss the challenges of service provision within healthcare systems.
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Affiliation(s)
- Neil Archibald
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, UK.
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Tomlinson CL, Patel S, Meek C, Clarke CE, Stowe R, Shah L, Sackley CM, Deane KHO, Herd CP, Wheatley K, Ives N. Physiotherapy versus placebo or no intervention in Parkinson's disease. Cochrane Database Syst Rev 2012:CD002817. [PMID: 22895932 DOI: 10.1002/14651858.cd002817.pub3] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite medical therapies and surgical interventions for Parkinson's disease (PD), patients develop progressive disability. The role of physiotherapy aims to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person. The overall aim is to optimise independence, safety and well-being, thereby enhancing quality of life. OBJECTIVES To assess the effectiveness of physiotherapy intervention compared with no intervention in patients with PD. SEARCH METHODS We identified relevant trials by electronic searches of numerous literature databases (e.g. MEDLINE, EMBASE) and trial registers, plus handsearching of major journals, abstract books, conference proceedings and reference lists of retrieved publications. The literature search included trials published up to end of December 2010. SELECTION CRITERIA Randomised controlled trials of physiotherapy intervention versus no physiotherapy intervention in patients with PD. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from each article. We used standard meta-analysis methods to assess the effectiveness of physiotherapy intervention compared with no physiotherapy intervention. Trials were classified into the following intervention comparisons: general physiotherapy, exercise, treadmill training, cueing, dance and martial arts. We used tests for heterogeneity to assess for differences in treatment effect across these different physiotherapy interventions. MAIN RESULTS We identified 33 trials with 1518 participants. Compared with no-intervention, physiotherapy significantly improved the gait outcomes of velocity (mean difference 0.05 m/s, 95% confidence interval (CI): 0.02 to 0.07, P = 0.0002), two- or six-minute walk test (16.40 m, CI: 1.90 to 30.90, P = 0.03) and step length (0.03 m, CI: 0 to 0.06, P = 0.04); functional mobility and balance outcomes of Timed Up & Go test (-0.61 s, CI: -1.06 to -0.17, P = 0.006), Functional Reach Test (2.16 cm, CI: 0.89 to 3.43, P = 0.0008) and Berg Balance Scale (3.36 points, CI: 1.91 to 4.81, P < 0.00001); and clinician-rated disability using the Unified Parkinson's Disease Rating Scale (UPDRS) (total: -4.46 points, CI -7.16 to -1.75, P = 0.001; activities of daily living: -1.36, CI -2.41 to -0.30, P = 0.01; and motor: -4.09, CI: -5.59 to -2.59, P < 0.00001). There was no difference between arms in falls or patient-rated quality of life. Indirect comparisons of the different physiotherapy interventions found no evidence that the treatment effect differed across the physiotherapy interventions for any of the outcomes assessed. AUTHORS' CONCLUSIONS Benefit for physiotherapy was found in most outcomes over the short-term (i.e. < three months), but was only significant for velocity, two- or six-minute walk test, step length, Timed Up & Go, Functional Reach Test, Berg Balance Scale and clinician-rated UPDRS. Most of the observed differences between the treatments were small. However, for some outcomes (e.g. velocity, Berg Balance Scale and UPDRS), the differences observed were at, or approaching, what are considered minimally clinical important changes.The review illustrates that a wide range of approaches are employed by physiotherapists to treat PD. However, there was no evidence of differences in treatment effect between the different types of physiotherapy interventions being used, though this was based on indirect comparisons. There is a need to develop a consensus menu of 'best-practice' physiotherapy, and to perform large well-designed randomised controlled trials to demonstrate the longer-term efficacy and cost-effectiveness of 'best practice' physiotherapy in PD.
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Affiliation(s)
- Claire L Tomlinson
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK.
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Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE, Stowe R, Shah L, Sackley C, Deane KHO, Wheatley K, Ives N. Physiotherapy intervention in Parkinson's disease: systematic review and meta-analysis. BMJ 2012; 345:e5004. [PMID: 22867913 PMCID: PMC3412755 DOI: 10.1136/bmj.e5004] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the effectiveness of physiotherapy compared with no intervention in patients with Parkinson's disease. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Literature databases, trial registries, journals, abstract books, and conference proceedings, and reference lists, searched up to the end of January 2012. REVIEW METHODS Randomised controlled trials comparing physiotherapy with no intervention in patients with Parkinson's disease were eligible. Two authors independently abstracted data from each trial. Standard meta-analysis methods were used to assess the effectiveness of physiotherapy compared with no intervention. Tests for heterogeneity were used to assess for differences in treatment effect across different physiotherapy interventions used. Outcome measures were gait, functional mobility and balance, falls, clinician rated impairment and disability measures, patient rated quality of life, adverse events, compliance, and economic analysis outcomes. RESULTS 39 trials of 1827 participants met the inclusion criteria, of which 29 trials provided data for the meta-analyses. Significant benefit from physiotherapy was reported for nine of 18 outcomes assessed. Outcomes which may be clinically significant were speed (0.04 m/s, 95% confidence interval 0.02 to 0.06, P<0.001), Berg balance scale (3.71 points, 2.30 to 5.11, P<0.001), and scores on the unified Parkinson's disease rating scale (total score -6.15 points, -8.57 to -3.73, P<0.001; activities of daily living subscore -1.36, -2.41 to -0.30, P=0.01; motor subscore -5.01, -6.30 to -3.72, P<0.001). Indirect comparisons of the different physiotherapy interventions found no evidence that the treatment effect differed across the interventions for any outcomes assessed, apart from motor subscores on the unified Parkinson's disease rating scale (in which one trial was found to be the cause of the heterogeneity). CONCLUSIONS Physiotherapy has short term benefits in Parkinson's disease. A wide range of physiotherapy techniques are currently used to treat Parkinson's disease, with little difference in treatment effects. Large, well designed, randomised controlled trials with improved methodology and reporting are needed to assess the efficacy and cost effectiveness of physiotherapy for treating Parkinson's disease in the longer term.
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Affiliation(s)
- Claire L Tomlinson
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK
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Tomlinson CL, Patel S, Meek C, Clarke CE, Stowe R, Shah L, Sackley CM, Deane KHO, Herd CP, Wheatley K, Ives N. Physiotherapy versus placebo or no intervention in Parkinson's disease. Cochrane Database Syst Rev 2012:CD002817. [PMID: 22786482 DOI: 10.1002/14651858.cd002817.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite medical therapies and surgical interventions for Parkinson's disease (PD), patients develop progressive disability. The role of physiotherapy aims to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person. The overall aim is to optimise independence, safety and well-being, thereby enhancing quality of life. OBJECTIVES To assess the effectiveness of physiotherapy intervention compared with no intervention in patients with PD. SEARCH METHODS We identified relevant trials by electronic searches of numerous literature databases (e.g. MEDLINE, EMBASE) and trial registers, plus handsearching of major journals, abstract books, conference proceedings and reference lists of retrieved publications. The literature search included trials published up to end of December 2010. SELECTION CRITERIA Randomised controlled trials of physiotherapy intervention versus no physiotherapy intervention in patients with PD. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from each article. We used standard meta-analysis methods to assess the effectiveness of physiotherapy intervention compared with no physiotherapy intervention. Trials were classified into the following intervention comparisons: general physiotherapy, exercise, treadmill training, cueing, dance and martial arts. We used tests for heterogeneity to assess for differences in treatment effect across these different physiotherapy interventions. MAIN RESULTS We identified 33 trials with 1518 participants. Compared with no-intervention, physiotherapy significantly improved the gait outcomes of velocity (mean difference 0.05 m/s, 95% confidence interval (CI): 0.02 to 0.07, P = 0.0002), two- or six-minute walk test (16.40 m, CI: 1.90 to 30.90, P = 0.03) and step length (0.03 m, CI: 0 to 0.06, P = 0.04); functional mobility and balance outcomes of Timed Up & Go test (-0.61 s, CI: -1.06 to -0.17, P = 0.006), Functional Reach Test (2.16 cm, CI: 0.89 to 3.43, P = 0.0008) and Berg Balance Scale (3.36 points, CI: 1.91 to 4.81, P < 0.00001); and clinician-rated disability using the Unified Parkinson's Disease Rating Scale (UPDRS) (total: -4.46 points, CI -7.16 to -1.75, P = 0.001; activities of daily living: -1.36, CI -2.41 to -0.30, P = 0.01; and motor: -4.09, CI: -5.59 to -2.59, P < 0.00001). There was no difference between arms in falls or patient-rated quality of life. Indirect comparisons of the different physiotherapy interventions found no evidence that the treatment effect differed across the physiotherapy interventions for any of the outcomes assessed. AUTHORS' CONCLUSIONS Benefit for physiotherapy was found in most outcomes over the short-term (i.e. < three months), but was only significant for velocity, two- or six-minute walk test, step length, Timed Up & Go, Functional Reach Test, Berg Balance Scale and clinician-rated UPDRS. Most of the observed differences between the treatments were small. However, for some outcomes (e.g. velocity, Berg Balance Scale and UPDRS), the differences observed were at, or approaching, what are considered minimally clinical important changes.The review illustrates that a wide range of approaches are employed by physiotherapists to treat PD. However, there was no evidence of differences in treatment effect between the different types of physiotherapy interventions being used, though this was based on indirect comparisons. There is a need to develop a consensus menu of 'best-practice' physiotherapy, and to perform large well-designed randomised controlled trials to demonstrate the longer-term efficacy and cost-effectiveness of 'best practice' physiotherapy in PD.
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Affiliation(s)
- Claire L Tomlinson
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK.
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Fox C, Ebersbach G, Ramig L, Sapir S. LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson Disease. PARKINSON'S DISEASE 2012; 2012:391946. [PMID: 22530161 PMCID: PMC3316992 DOI: 10.1155/2012/391946] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 11/02/2011] [Accepted: 11/06/2011] [Indexed: 11/27/2022]
Abstract
Recent advances in neuroscience have suggested that exercise-based behavioral treatments may improve function and possibly slow progression of motor symptoms in individuals with Parkinson disease (PD). The LSVT (Lee Silverman Voice Treatment) Programs for individuals with PD have been developed and researched over the past 20 years beginning with a focus on the speech motor system (LSVT LOUD) and more recently have been extended to address limb motor systems (LSVT BIG). The unique aspects of the LSVT Programs include the combination of (a) an exclusive target on increasing amplitude (loudness in the speech motor system; bigger movements in the limb motor system), (b) a focus on sensory recalibration to help patients recognize that movements with increased amplitude are within normal limits, even if they feel "too loud" or "too big," and (c) training self-cueing and attention to action to facilitate long-term maintenance of treatment outcomes. In addition, the intensive mode of delivery is consistent with principles that drive activity-dependent neuroplasticity and motor learning. The purpose of this paper is to provide an integrative discussion of the LSVT Programs including the rationale for their fundamentals, a summary of efficacy data, and a discussion of limitations and future directions for research.
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Affiliation(s)
- Cynthia Fox
- National Center for Voice and Speech, University of Colorado Boulder, Campus Box 409, Boulder, CO 80305, USA
| | - Georg Ebersbach
- Movement Disorders Clinic, Paracelsusring 6a, 14547 Beelitz-Heilstätten, Germany
| | - Lorraine Ramig
- National Center for Voice and Speech, University of Colorado Boulder, Campus Box 409, Boulder, CO 80305, USA
| | - Shimon Sapir
- Departments of Physiotherapy and Communication Sciences and Disorders, University of Haifa, Mount Carmel, Haifa 31905, Israel
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Allen NE, Sherrington C, Suriyarachchi GD, Paul SS, Song J, Canning CG. Exercise and motor training in people with Parkinson's disease: a systematic review of participant characteristics, intervention delivery, retention rates, adherence, and adverse events in clinical trials. PARKINSON'S DISEASE 2011; 2012:854328. [PMID: 22191077 PMCID: PMC3236465 DOI: 10.1155/2012/854328] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 08/18/2011] [Indexed: 01/29/2023]
Abstract
There is research evidence that exercise and motor training are beneficial for people with Parkinson's disease (PD), and clinicians seek to implement optimal programs. This paper summarizes important factors about the nature and reporting of randomized controlled trials of exercise and/or motor training for people with PD which are likely to influence the translation of research into clinical practice. Searches identified 53 relevant trials with 90 interventions conducted for an average duration of 8.3 (SD 4.2) weeks. Most interventions were fully supervised (74%) and conducted at a facility (79%). Retention rates were high with 69% of interventions retaining ≥85% of their participants; however adherence was infrequently reported, and 72% of trials did not report adverse events. Overall, the labor-intensive nature of most interventions tested in these trials and the sparse reporting of adherence and adverse events are likely to pose difficulties for therapists attempting to balance benefits and costs when selecting protocols that translate to sustainable clinical practice for people with PD.
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Affiliation(s)
- Natalie E. Allen
- Clinical and Rehabilitation Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW 1825, Australia
| | - Catherine Sherrington
- Musculoskeletal Division, The George Institute for Global Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Gayanthi D. Suriyarachchi
- Clinical and Rehabilitation Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW 1825, Australia
| | - Serene S. Paul
- Clinical and Rehabilitation Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW 1825, Australia
| | - Jooeun Song
- Clinical and Rehabilitation Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW 1825, Australia
| | - Colleen G. Canning
- Clinical and Rehabilitation Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW 1825, Australia
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Reliability in one-repetition maximum performance in people with Parkinson's disease. PARKINSONS DISEASE 2011; 2012:928736. [PMID: 22135765 PMCID: PMC3205703 DOI: 10.1155/2012/928736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 08/05/2011] [Accepted: 09/01/2011] [Indexed: 11/17/2022]
Abstract
Strength training is
an effective modality to improve muscular
strength and functional performance in people
with Parkinson's disease (PWP). One-repetition maximum (1-RM) is the gold standard
assessment of strength; however, PWP suffer from
day-to-day variations in symptom severity and
performance characteristics, potentially
adversely affecting the reliability of 1-RM
performance. Herein, we assessed the reliability
of 1-RM in PWP. Forty-six participants completed
two sessions of 1-RM testing of knee extension,
knee flexion, chest press, and biceps curl at
least 72 hours apart. Significantly differences
between testing sessions were identified for
knee extension (P < 0.001), knee flexion (P = 0.042), and biceps curl (P = 0.001); however, high reliability (ICC > 0.90)
was also identified between sessions. Interestingly, almost third of subjects failed to perform better on the second testing session. These findings suggest that 1-RM testing can be safely performed in PWP and that disease-related daily variability may influence 1-RM performance.
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The PIT: SToPP Trial-A Feasibility Randomised Controlled Trial of Home-Based Physiotherapy for People with Parkinson's Disease Using Video-Based Measures to Preserve Assessor Blinding. PARKINSONS DISEASE 2011; 2012:360231. [PMID: 22046578 PMCID: PMC3199203 DOI: 10.1155/2012/360231] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 08/22/2011] [Indexed: 11/25/2022]
Abstract
Purpose. To trial four-week's physiotherapy targeting chair transfers for people with Parkinson's disease (PwPD) and explore the feasibility of reliance on remote outcome measurement to preserve blinding. Scope. We recruited 47 PwPD and randomised 24 to a focused home physiotherapy programme (exercise, movement strategies, and cueing) and 23 to a control group. We evaluated transfers (plus mobility, balance, posture, and quality of life) before and after treatment and at followup (weeks 0, 4, 8, and 12) from video produced by, and questionnaires distributed by, treating physiotherapists. Participants fed back via end-of-study questionnaires. Thirty-five participants (74%) completed the trial. Excluding dropouts, 20% of questionnaire data and 9% of video data were missing or unusable; we had to evaluate balance in situ. We noted trends to improvement in transfers, mobility, and balance in the physiotherapy group not noted in the control group. Participant feedback was largely positive and assessor blinding was maintained in every case. Conclusions. Intense, focused physiotherapy at home appears acceptable and likely to bring positive change in those who can participate. Remote outcome measurement was successful; questionnaire followup and further training in video production would reduce missing data. We advocate a fully powered trial, designed to minimise dropouts and preserve assessor blinding, to evaluate this intervention.
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Allen NE, Sherrington C, Paul SS, Canning CG. Balance and falls in Parkinson's disease: a meta-analysis of the effect of exercise and motor training. Mov Disord 2011; 26:1605-15. [PMID: 21674624 DOI: 10.1002/mds.23790] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 03/23/2011] [Accepted: 04/17/2011] [Indexed: 11/11/2022] Open
Abstract
This systematic review with meta-analysis aimed to determine the effects of exercise and motor training on the performance of balance-related activities and falls in people with Parkinson's disease. Sixteen randomized and quasi-randomized controlled trials that assessed the efficacy of exercise and/or motor training against no intervention or placebo intervention were included. The primary outcome measures were balance-related activity performance (15 trials) and falls (2 trials). The pooled estimate of the effect of exercise and motor training indicated significantly improved balance-related activity performance (Hedges' g, 0.33; 95% confidence interval, 0.11-0.55; P=.003), but there was no evidence of an effect on the proportion of fallers (risk ratio, 1.02; 95% confidence interval, 0.66-1.58, P=.94). Balance-related activity performance improved to a greater extent in the trials of programs involving highly challenging balance training, but the difference in effect sizes was not statistically significant (P=.166). Exercise and motor training can improve the performance of balance-related activities in people with Parkinson's disease. However, further research is required to determine if falls can be prevented in this population.
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Affiliation(s)
- Natalie E Allen
- Neurological Rehabilitation Research Group, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
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Mak MKY, Yang F, Pai YC. Limb collapse, rather than instability, causes failure in sit-to-stand performance among patients with parkinson disease. Phys Ther 2011; 91:381-91. [PMID: 21273628 PMCID: PMC3048819 DOI: 10.2522/ptj.20100232] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 11/10/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies focused on describing successful sit-to-stand (STS) performance in patients with Parkinson disease (PD). Little is known about why these patients fail to perform this transfer activity. Objective This study aimed to determine the role of dynamic stability and limb support in governing successful STS performance in patients with PD and to determine the limits of recovery for discriminating between successful and failed STS trials. DESIGN This was a cross-sectional study. METHODS Twenty-eight patients with PD were instructed to perform the STS task. Kinematic data on 18 successful trials and 14 failed trials (when the patients fell backward) were collected with a motion analysis system. Dynamic stability was determined by the anteroposterior position of the body's center of mass (COM) relative to the base of support (BOS) and by the anteroposterior velocity of the COM relative to the BOS (Velocity(COM/BOS,AP)). Limb support was characterized by the hip height (Height(hip)). RESULTS /b> The findings revealed no between-group ("risers" versus "fallers") differences in dynamic stability. The fallers shifted their COM in a significantly more anterior position to compensate for their lower Velocity(COM/BOS,AP) at seat-off. It was in the vertical direction that the fallers had significantly reduced peak COM velocity (Velocity(COM,vertical)) and lower corresponding Height(hip) than the risers. Results of a stepwise regression model showed that Velocity(COM/BOS,AP) and Height(hip) at the instant of peak Velocity(COM,vertical) could best predict the STS outcome (success versus failure), with an overall prediction accuracy of 87.5%. The limit differentiating successful from failed STS trials was: Height(hip)=-0.814 Velocity(COM/BOS,AP) + 0.463. Limitations All of the patients were community dwelling and had a moderate level of disease severity. The results cannot be generalized to those who are institutionalized or with advanced PD. CONCLUSIONS Limb support and ill-timed peak forward COM velocity, rather than dynamic stability, play the dominant roles in determining successful STS performance in patients with PD.
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Affiliation(s)
- Margaret K Y Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
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Rochester L, Nieuwboer A, Lord S. Physiotherapy for Parkinson’s disease: defining evidence within a framework for intervention. Neurodegener Dis Manag 2011. [DOI: 10.2217/nmt.11.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Parkinson’s disease (PD) is a complex multisystem disorder presenting with motor and non-motor deficits in function. Current medical management addresses the symptoms of PD pharmacologically and surgically and targets mainly the dopaminergic system. Symptoms that are not responsive or become resistant to dopamine remain poorly controlled such as gait, postural instability and falls. Management of these problems often falls to the physiotherapist, raising questions as to the nature and evidence for practice. It is clear that evidence to support physiotherapy in the management of PD is accumulating exponentially. However, the heterogenous nature of interventions and trials creates difficulty when applying evidence in the clinical setting. We present a clinical framework to identify and review evidence for the key therapeutic approaches in PD, which we describe as exercise and movement strategy training. Evidence is restricted to that from randomized clinical trials. We argue that physiotherapy efficacy is well established, and the challenge now is to refine its application through the apposite use of selected exercise and movement strategies; consideration of dose intensity; subpopulation; concern for non-motor symptoms; and regard for the course of the disease. We highlight current developments in the evidence that emphasize the potential for motor learning and neuroplasticity. Finally, implications for clinical management, including tools to aid implementation of the evidence and advice for referral, are discussed and recommendations for future work made.
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Affiliation(s)
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium
| | - Susan Lord
- Institute for Ageing & Health, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
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Ebersbach G, Ebersbach A, Edler D, Kaufhold O, Kusch M, Kupsch A, Wissel J. Comparing exercise in Parkinson's disease-the Berlin BIG Study. Mov Disord 2010; 25:1902-8. [DOI: 10.1002/mds.23212] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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