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Bissolotti L, Rota M, Calza S, Romero-Morales C, Alonso-Pérez JL, López-Bueno R, Villafañe JH. Gender-Specific Differences in Spinal Alignment and Muscle Power in Patients with Parkinson's Disease. Diagnostics (Basel) 2024; 14:1143. [PMID: 38893669 PMCID: PMC11171582 DOI: 10.3390/diagnostics14111143] [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: 05/08/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is an advancing neurodegenerative disorder characterized by spinal anomalies and muscular weakness, which may restrict daily functional capacities. A gender-focused examination of these effects could provide valuable insights into customized rehabilitation strategies for both sexes. PURPOSE This study investigates the influence of spinal alignment on lower-limb function during the sit-to-stand (STS) movement in patients with Parkinson's disease compared to healthy individuals. METHODS A cross-sectional study was conducted with 43 consecutive patients with PD (25 males and 18 females; average age 73.7 ± 7.1 years) and 42 healthy controls (22 males and 20 females; average age 69.8 ± 6.0 years). Assessments included the International Physical Activity Questionnaire (IPAQ), Hoehn and Yahr staging, and measurements of vertical deviations from several spinal landmarks. Lower-limb muscle power during the STS task was evaluated using the Muscle Quality Index (MQI). RESULTS Both absolute (Watts) and relative (Watts/Kg) muscle power in the lower limbs were notably decreased in the PD group compared to the control group. Within the PD cohort, muscle power showed a negative relationship with age and a positive association with the degree of lumbar lordosis (PL-L3). Importantly, gender-specific analysis revealed that male patients with PD had significantly higher lower-limb muscle power compared to female patients with PD, highlighting the need for gender-tailored therapeutic approaches. CONCLUSIONS The findings suggest that preserving lumbar lordosis is crucial for maintaining effective lower-limb muscle biomechanics in individuals with Parkinson's disease.
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Affiliation(s)
- Luciano Bissolotti
- Fondazione Teresa Camplani Casa di Cura Domus Salutis, 25123 Brescia, Italy;
| | - Matteo Rota
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (M.R.); (S.C.)
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (M.R.); (S.C.)
| | - Carlos Romero-Morales
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
| | - José Luís Alonso-Pérez
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, C/Inocencio García 1, 38300 La Orotava, Canary Islands, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Onelife Center, Multidisciplinary Pain Treatment Center, 28925 Alcorcón, Spain
| | - Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, 50009 Zaragoza, Spain;
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46100 Valencia, Spain
| | - Jorge Hugo Villafañe
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
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Sattin D, Parma C, Lunetta C, Zulueta A, Lanzone J, Giani L, Vassallo M, Picozzi M, Parati EA. An Overview of the Body Schema and Body Image: Theoretical Models, Methodological Settings and Pitfalls for Rehabilitation of Persons with Neurological Disorders. Brain Sci 2023; 13:1410. [PMID: 37891779 PMCID: PMC10605253 DOI: 10.3390/brainsci13101410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Given the widespread debate on the definition of the terms "Body Schema" and "Body Image", this article presents a broad overview of the studies that have investigated the nature of these types of body representations, especially focusing on the innovative information about these two representations that could be useful for the rehabilitation of patients with different neurological disorders with motor deficits (especially those affecting the upper limbs). In particular, we analyzed (i) the different definitions and explicative models proposed, (ii) the empirical settings used to test them and (iii) the clinical and rehabilitative implications derived from the application of interventions on specific case reports. The growing number of neurological diseases with motor impairment in the general population has required the development of new rehabilitation techniques and a new phenomenological paradigm placing body schema as fundamental and intrinsic parts for action in space. In this narrative review, the focus was placed on evidence from the application of innovative rehabilitation techniques and case reports involving the upper limbs, as body parts particularly involved in finalistic voluntary actions in everyday life, discussing body representations and their functional role.
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Affiliation(s)
- Davide Sattin
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
| | - Chiara Parma
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
| | - Christian Lunetta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department-ALS Unit, Via Camaldoli 64, 20138 Milan, Italy;
| | - Aida Zulueta
- Istituti Clinici Scientifici Maugeri IRCCS, Labion, Via Camaldoli 64, 20138 Milan, Italy;
| | - Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
| | - Luca Giani
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
| | - Marta Vassallo
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Mario Picozzi
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Eugenio Agostino Parati
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
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Cao S, Cui Y, Jin J, Li F, Liu X, Feng T. Prevalence of axial postural abnormalities and their subtypes in Parkinson's disease: a systematic review and meta-analysis. J Neurol 2023; 270:139-151. [PMID: 36098837 DOI: 10.1007/s00415-022-11354-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Axial postural abnormalities, mainly involving the spinal deformities, are disabling symptoms of Parkinson's disease (PD). However, the prevalence of axial postural abnormalities in PD and their clinical correlates remain unclear. The present study aimed to conduct a systematic review and meta-analysis of the prevalence of overall and subtypes of axial postural abnormalities in PD. METHODS PubMed, Embase, Web of Science and Cochrane databases were searched up to 31st March, 2022. We identified studies that reported the prevalence of axial postural abnormalities in PD. The pooled estimate of prevalence was calculated using a random effect model. Subgroup analysis and meta-regression were performed. RESULTS There were 19 studies met the inclusion criteria. The overall prevalence of axial postural abnormalities in PD was 22.1% (95% CI 19.7-24.5%). The prevalence of each subtype of axial postural abnormalities was 19.6% for scoliosis (95% CI 10.6-28.7%), 10.2% for camptocormia (95% CI 7.7-12.7%), 8% for Pisa syndrome (95% CI 4.7-11.4%), and 7.9% for antecollis (95% CI 3.9-11.9%). Subgroup analysis showed that the measuring method of axial postural abnormalities exerted significant effects on prevalence estimates. Axial postural abnormalities in PD were associated with older age, longer disease duration, higher H-Y stage, greater levodopa equivalent daily dose, more severe motor symptoms, motor fluctuations, and akinetic-rigid subtype. CONCLUSIONS Axial postural abnormalities, which include scoliosis, camptocormia, Pisa syndrome, and antecollis, are not uncommon in patients with PD. Future research on axial postural abnormalities should be based on uniform diagnostic criteria and measuring methods.
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Affiliation(s)
- Shuangshuang Cao
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurology, Yidu Central Hospital of Weifang, Shandong, China
| | - Yusha Cui
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianing Jin
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Fangfei Li
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xin Liu
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Tao Feng
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Bissolotti L, Rota M, Calza S, Sanchez Romero EA, Battaglino A, Villafañe JH. Relationship between Lower Limbs Performance and Spinal Alignment in Parkinson’s Disease Patients: An Observational Study with Cross Sectional Design. J Clin Med 2022; 11:jcm11133775. [PMID: 35807060 PMCID: PMC9267576 DOI: 10.3390/jcm11133775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
Parkinson’s disease (PD) is a progressive neurodegenerative disease determining spinal deformities and muscle rigidity, weakness and dystonia that can be related to a change in muscular output during sit-to-stand tasks (STS). Purpose: The aim of this study was to determine the impacts of spinal alignment on lower limbs performance during STS tasks in Parkinson’s disease (PD) patients and healthy controls. Methods: In total, 43 consecutive PD patients (“PD” Group, 25 males and 18 females; age 73.7 ± 7.1) and 42 people not affected by any type of neurological disease (“CON” Group, 22 males, 20 females; age 69.8 ± 6.0) participated in the observational study. The clinical assessment included: IPAQ (International Physical Activity Questionnaire), Hoehn Yahr score, plumb-line distance from the spinous process of C7, kyphosis apex and the spinous process of L3 and S1. We used the Muscle Quality Index test (MQI) to assess muscle power output during STS in both groups. Results: The MQI test measurements of absolute and relative lower limb power was significantly lower in the PD group, in addition to a negative correlation with age and a positive correlation with PL-L3 in that group of patients. Conclusions: A final consideration regarding our results leads to the possibility that the preservation of lumbar lordosis may be one of the factors for maintaining efficient biomechanics of the lower limb muscles, with the preservation of the physiological contractile characteristics of these muscles being the objective for a multidisciplinary rehabilitation based on postural exercises of the spine and a program of training exercises for the lower limb muscles.
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Affiliation(s)
- Luciano Bissolotti
- Rehabilitation Service, Fondazione Teresa Camplani Casa di Cura Domus Salutis, 25123 Brescia, Italy;
- LARIN: Neuromuscular and Adapted Physical Activity Laboratory, 25123 Brescia, Italy
| | - Matteo Rota
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (M.R.); (S.C.)
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (M.R.); (S.C.)
| | - Eleuterio A. Sanchez Romero
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Correspondence: (E.A.S.R.); (J.H.V.); Tel.: +39-393-9064-922 (E.A.S.R.); Fax: +34-633-115-328 (E.A.S.R.)
| | | | - Jorge H. Villafañe
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy;
- Correspondence: (E.A.S.R.); (J.H.V.); Tel.: +39-393-9064-922 (E.A.S.R.); Fax: +34-633-115-328 (E.A.S.R.)
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Degradation of Polysorbate 20 by Sialate O-Acetylesterase in Monoclonal Antibody Formulations. J Pharm Sci 2021; 110:3866-3873. [PMID: 34487744 DOI: 10.1016/j.xphs.2021.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/22/2022]
Abstract
Polysorbates (PS) are surfactants commonly added in biologics formulations that can protect proteins from denaturation and aggregation. However, decreases in polysorbate 20 (PS20) content have been observed in some monoclonal antibody formulations, causing the formation of visible and/or subvisible particles that ultimately compromise the quality and stability of the therapeutic protein products. It was determined that the particles are mainly composed of free fatty acid, suggesting enzymatic hydrolysis of PS is responsible for the degradation of PS. Enrichment of host cell proteins (HCPs) by immunoprecipitation followed by shotgun proteomics have been utilized to identify the HCPs that can hydrolyze PS20. One HCP, sialate O-acetylesterase (SIAE), demonstrated strong enzymatic activity for PS20 degradation even at low concentration (<5 ppm level). Incubation of recombinant SIAE with PS20 resulted in a unique degradation pattern where the hydrolysis of monoester with short fatty acid chain (C12, C14) was observed but not the monoester with long fatty acid chain (C16, C18) or higher-order esters. SIAE was detected and quantitated in several formulated mAbs, and the amount of SIAE was positively correlated to PS20 degradation in these mAbs during incubation. Additional experiments also showed that when SIAE was depleted, PS20 degradation was diminished, suggesting a causality between SIAE and PS20 degradation. The lipase activity of SIAE is specific to PS20, but not to PS 80 (PS80), which contains monoesters with long chain fatty acid (C18) and higher-order esters. The specific esterase activity of SIAE on PS20 suggests a possible solution of using PS80 over PS20 to eliminate surfactant degradation in mAb products.
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Abraham A, Duncan RP, Earhart GM. The Role of Mental Imagery in Parkinson's Disease Rehabilitation. Brain Sci 2021; 11:brainsci11020185. [PMID: 33540883 PMCID: PMC7913152 DOI: 10.3390/brainsci11020185] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Parkinson’s disease (PD) is a disabling neurodegenerative disease whose manifestations span motor, sensorimotor, and sensory domains. While current therapies for PD include pharmacological, invasive, and physical interventions, there is a constant need for developing additional approaches for optimizing rehabilitation gains. Mental imagery is an emerging field in neurorehabilitation and has the potential to serve as an adjunct therapy to enhance patient function. Yet, the literature on this topic is sparse. The current paper reviews the motor, sensorimotor, and sensory domains impacted by PD using gait, balance, and pain as examples, respectively. Then, mental imagery and its potential for PD motor and non-motor rehabilitation is discussed, with an emphasis on its suitability for addressing gait, balance, and pain deficits in people with PD. Lastly, future research directions are suggested.
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Affiliation(s)
- Amit Abraham
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel 4077625, Israel
- Navigation and Accessibility Research Center of Ariel University (NARCA), Ariel University, Ariel 4077625, Israel
- Correspondence:
| | - Ryan P. Duncan
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO 63108, USA; (R.P.D.); (G.M.E.)
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Gammon M. Earhart
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO 63108, USA; (R.P.D.); (G.M.E.)
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
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Abraham A, Wright GN, Morrison MW, Hart A, Dickstein R, Hackney ME. 'Draw your pelvis' test for assessing pelvic schema in people with Parkinson's disease: a validity and reliability study. Somatosens Mot Res 2019; 36:156-161. [PMID: 31248306 DOI: 10.1080/08990220.2019.1632183] [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: 10/26/2022]
Abstract
Aim: Body schema (i.e., the mental representation of the body and its parts) is important for cognitive and motor functions, with the pelvis constituting a core element in such schema. Although people with Parkinson's disease exhibit misperceptions and deficits in body schema, there are currently no published tools available for assessing pelvic schema in this population. This study aimed to develop and establish feasibility, reliability, and validity of a novel drawing test - 'Draw Your Pelvis' - for assessing pelvic schema in people with Parkinson's disease. Materials and methods: Twenty people with idiopathic Parkinson's disease (Hoehn &Yahr stages I-III; M age: 65.75 ± 10.13) volunteered and were asked to manually draw a picture of their pelvis. Drawings were assessed and scored by 13 blinded raters over two sessions. Intra- and inter-rater reliability and content and criterion validity were investigated. Results: The 'Draw Your Pelvis' test is shown to be feasible and quick to administer, with excellent inter-rater reliability for consistency (0.954-0.968) and absolute agreement (0.946-0.961). It also demonstrates good-excellent (0.614-0.950) intra-rater reliability, and is content valid. Conclusions: The 'Draw Your Pelvis' test holds potential for clinicians and researchers in assessing pelvic schema and its deficits in people with Parkinson's disease. In addition, this test could be used for investigating the effect of therapeutic interventions on body schema in this population. Future studies should explore this test in additional populations.
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Affiliation(s)
- Amit Abraham
- a Division of General Medicine and Geriatrics, Department of Medicine , Emory University School of Medicine , Atlanta , GA , USA.,b Department of Kinesiology , University of Georgia , Athens , GA , USA
| | - Gene N Wright
- c Science Illustration Program, Lamar Dodd School of Art , University of Georgia , Athens , GA , USA
| | - Margaret W Morrison
- d Drawing and Painting Program, Lamar Dodd School of Art , University of Georgia , Athens , GA , USA
| | - Ariel Hart
- a Division of General Medicine and Geriatrics, Department of Medicine , Emory University School of Medicine , Atlanta , GA , USA
| | - Ruth Dickstein
- e Department of Physical Therapy, Faculty of Social Welfare and Health Sciences , University of Haifa , Haifa , Israel
| | - Madeleine E Hackney
- a Division of General Medicine and Geriatrics, Department of Medicine , Emory University School of Medicine , Atlanta , GA , USA.,f Department of Veterans Affairs Center for Visual and Neurocognitive Rehabilitation , Atlanta , GA , USA
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Abraham A, Wright GN, Morrison MW, Hart A, Dickstein R, Hackney ME. Psychometric properties of clock and pelvic drawings in Parkinson's disease: A validity and cross-sectional study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1781. [PMID: 31090203 DOI: 10.1002/pri.1781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) is characterized by visuospatial and body schema deficits. People with PD often exhibit hypometric movements and graphic hypometria (i.e., small drawing dimensions). The goal of the current study was to explore graphic-metric representation in people with PD by assessing pelvic and clock drawing dimensions (i.e., height and width) and by investigating associations between pelvic drawing dimensions and participant characteristics. METHODS Twenty people (16 males, 4 females; M age: 65.75 ± 10.13 years) with idiopathic PD (Hoehn &Yahr Stages I-III) volunteered to participate in this study. Draw Your Pelvis and Clock Drawing tests were used for assessing drawing dimensions, which were then correlated with PD severity, stage and duration, cognitive level, side of symptoms onset, and pelvic schema score. Bivariate and multiple linear regression analyses were also used. RESULTS Excellent (.844-.999) interrater reliability was shown for measuring pelvic and clock drawing dimensions. Pelvic drawing dimensions did not significantly (P > .05) differ in magnitude, whereas clock drawing height was significantly (p < .01) greater than width, both suggesting graphic dysmetria (i.e., distorted graphic dimensions). Pelvic drawing width was negatively associated with PD severity and stage, was positively associated with pelvic schema score, and predicted all three parameters. CONCLUSION Measuring pelvic drawing dimensions, and specifically pelvic drawing width, holds potential as an adjunct diagnostic measure in PD assessments and for detecting pelvic schema deficits or misperceptions. This test can be used by physical therapists in the clinic for assessing disease severity, stage, and pelvic schema in people with PD. The knowledge gained from this study contributes to a greater understanding of graphic-metric representation and associated deficits in people with PD. Future studies should explore the relationship between pelvic drawing dimensions and pelvic mentally imaged estimates, and their role in motor planning, control, and execution in people with PD.
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Affiliation(s)
- Amit Abraham
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Gene N Wright
- Science Illustration Program, Lamar Dodd School of Art, University of Georgia, Athens, GA, USA
| | - Margaret W Morrison
- Drawing and Painting Program, Lamar Dodd School of Art, University of Georgia, Athens, GA, USA
| | - Ariel Hart
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Ruth Dickstein
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Madeleine E Hackney
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA.,Center for Visual and Neurocognitive Rehabilitation, Atlanta Department of Veterans Affairs, Atlanta, GA, USA
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Abraham A, Hart A, Dickstein R, Hackney ME. "Will you draw me a pelvis?ˮ Dynamic neuro-cognitive imagery improves pelvic schema and graphic-metric representation in people with Parkinson's Disease: A randomized controlled trial. Complement Ther Med 2019; 43:28-35. [PMID: 30935544 DOI: 10.1016/j.ctim.2018.11.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/29/2018] [Accepted: 11/21/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Body schema (i.e., the mental representations of the body), vital for motor and cognitive functions, is often distorted in people with Parkinson's disease (PD). Deficits in body, and especially pelvic, schema can further exacerbate motor and cognitive deficits associated with PD. Such deficits, including those in graphic and metric misjudgments, can manifest in drawing tasks. Mental imagery is a recommended approach for PD rehabilitation with potential for ameliorating body schema. OBJECTIVE To investigate the effect of a two-week dynamic neuro-cognitive imagery (DNI) training versus in-home learning and exercise control (learning/exercise) on pelvic schema and graphic representation (i.e., drawing height and width). DESIGN Twenty participants with idiopathic PD (Hoehn&Yahr I-III; M age: 65.75 ± 10.13) were randomly allocated into either a DNI or a learning/exercise group. Participants were asked to complete the "Draw Your Pelvisˮ test in which they drew their pelvis at pre- and post-intervention. Drawings were assessed for pelvic schema score and drawing dimensions (i.e., height and weight). INTERVENTION DNI anatomical and metaphorical imagery focusing on pelvic anatomy and biomechanics. RESULTS No difference (p > .05) was detected at baseline between drawn pelvis height and width. Following intervention, improvements were greater in the DNI group for pelvic schema (p < .01), drawn pelvic width (p < .05) and width-height difference (p < .05). CONCLUSIONS This study suggests that DNI could serve as a rehabilitation path for improving body schema in people with PD. Future studies should explore DNI mechanisms of effect and the effect of enhanced pelvic schema on motor and non-motor deficits in this population.
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Affiliation(s)
- Amit Abraham
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Kinesiology, University of Georgia, Athens, Georgia, USA.
| | - Ariel Hart
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ruth Dickstein
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Madeleine E Hackney
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA; Atlanta Department of Veterans Affairs Center for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia, USA
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Dynamic Neuro-Cognitive Imagery Improves Mental Imagery Ability, Disease Severity, and Motor and Cognitive Functions in People with Parkinson's Disease. Neural Plast 2018; 2018:6168507. [PMID: 29725348 PMCID: PMC5872663 DOI: 10.1155/2018/6168507] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/03/2018] [Accepted: 01/09/2018] [Indexed: 11/17/2022] Open
Abstract
People with Parkinson's disease (PD) experience kinesthetic deficits, which affect motor and nonmotor functions, including mental imagery. Imagery training is a recommended, yet underresearched, approach in PD rehabilitation. Dynamic Neuro-Cognitive Imagery (DNI™) is a codified method for imagery training. Twenty subjects with idiopathic PD (Hoehn and Yahr stages I–III) were randomly allocated into DNI training (experimental; n = 10) or in-home learning and exercise program (control; n = 10). Both groups completed at least 16 hours of training within two weeks. DNI training focused on anatomical embodiment and kinesthetic awareness. Imagery abilities, disease severity, and motor and nonmotor functions were assessed pre- and postintervention. The DNI participants improved (p < .05) in mental imagery abilities, disease severity, and motor and spatial cognitive functions. Participants also reported improvements in balance, walking, mood, and coordination, and they were more physically active. Both groups strongly agreed they enjoyed their program and were more mentally active. DNI training is a promising rehabilitation method for improving imagery ability, disease severity, and motor and nonmotor functions in people with PD. This training might serve as a complementary PD therapeutic approach. Future studies should explore the effect of DNI on motor learning and control strategies.
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Villafañe JH, Bissolotti L, Zaina F, Arienti C, Donzelli S, Negrini S. Thoracic hyperkyphosis non invasively measured by general practitioners is associated with chronic low back pain: A cross-sectional study of 1364 subjects. J Bodyw Mov Ther 2017; 22:752-756. [PMID: 30100308 DOI: 10.1016/j.jbmt.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/31/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between trunk sagittal posture and nonspecific chronic low back pain (CLBP) by evaluating plumb-line distances in subjects recruited in an everyday clinical setting. METHODS Of the 1364 subjects recruited, 63.1% were female (mean age ± SD: 56.2 ± 16.8 years). Subjects were categorized into CLBP and control groups and were prospectively assessed over a 3-month period. They provided information about their daily activities and their history of CLBP. Prognostic factors were analysed using univariate and multivariate logistic regression analyses. A physical examination was performed to record demographic (i.e. age, height and weight) and pain characteristics, and the intensity of pain was assessed using a numerical visual analogue scale. Disability was assessed using the Roland-Morris Disability Questionnaire (RMDQ). A simple measure generally used for sagittal plane screening purposes during growth was also utilized. RESULTS Multivariate logistic regression analysis revealed that gender (OR = 1.70), RMDQ score (OR = 0.51) and thoracic hyperkyphosis (C7 + L3 at the plumb-line distance) (OR = 1.57) were associated with CLBP. The final regression model explained 85.6% (R2 = 0.56; P < 0.001) of the variability. CONCLUSIONS General practitioners can clinically and easily assess trunk posture in subjects with low back pain to identify subjects at higher risk of CLBP.
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Affiliation(s)
| | - Luciano Bissolotti
- Casa di Cura Domus Salutis, Brescia, Italy; LARIN: Neuromuscular and Adapted Physical Activity Laboratory, Brescia, Italy.
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy.
| | | | | | - Stefano Negrini
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy.
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Abstract
UNLABELLED MINI: Surgical planning in sagittal imbalance is recognized as a key step of treatment to ensure good clinical results. Surgimap is a reliable tool to predict satisfactory postoperative sagittal alignment. Setting by default pelvic tilt to 20° improves predictive value during surgical planning. STUDY DESIGN A cohort study. OBJECTIVE To evaluate the predictive value of surgical planning using Surgimap regarding postoperative sagittal alignment. SUMMARY OF BACKGROUND DATA Surgical planning in sagittal imbalance is recognized as a key step of treatment to ensure results. METHODS The study involved 40 nonconsecutive patients who underwent surgery for sagittal misalignment. Postoperative alignment measured by sagittal vertical axis (SVA) and pelvic tilt was considered the gold standard. Surgimap prediction of final alignment was considered the test. Planning and postoperative films were classified as properly and improperly aligned. Sensitivity, specificity, and positive and negative predictive values of Surgimap planning [using two different methods: direct simulation (method A) and simulation after correction of pelvic tilt to 20° (method B)] to detect postoperative improper alignment were calculated. RESULTS Seventeen (42.5%) of 40 patients had proper postoperative alignment. According to method A, a proper alignment was achieved in 13 patients [S = 76.5%, Sp = 73.9%, RR = 2.93 (95% confidence interval, CI 1.40; 6.12), P < 0.001]; According to method B, a proper alignment was achieved in 15 patients [S = 88.2%, Sp = 60.9%, RR = 2.25 (95% CI 1.32; 23.86), P < 0.001]. Kappa statistics indicate moderate agreement between actual postoperative alignment and computer prediction. CONCLUSION The ability of Surgimap to predict proper postoperative sagittal alignment was excellent in this cohort. Its ability to predict proper alignment was improved by correction of pelvic tilt to 20° during planning. LEVEL OF EVIDENCE 2.
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Abstract
Parkinson disease (PD) is increasingly prevalent in the aging population. Spine disorders in patients with PD may be degenerative in nature or may arise secondary to motor effects related to the parkinsonian disease process. Physicians providing care for patients with PD and spine pathologies must be aware of several factors that affect treatment, including the patterns of spinal deformity, complex drug interactions, and PD-associated osteoporosis. Following spine surgery, complication rates are higher in patients with PD than in those without the disease. Literature on spine surgery in this patient population is limited by small cohort size, the heterogeneous patient population, and variable treatment protocols. However, most studies emphasize the need for preoperative optimization of motor control with appropriate medications and deep brain stimulation, as well as consultation with a movement disorder specialist. Future studies must control for confounding variables, such as the type of surgery and PD severity, to improve understanding of spinal pathology and treatment options in this patient population.
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Bissolotti L, Berjano P, Zuccher P, Zenorini A, Buraschi R, Villafañe JH, Negrini S. Sagittal balance is correlated with Parkinson's Disease clinical parameters: an overview of spinopelvic alignment on 175 consecutive cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:471-478. [PMID: 28365858 DOI: 10.1007/s00586-017-5052-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to describe the disease-related sagittal balance changes in relation to the sacro-pelvic morphology of Parkinson's Disease patients with different duration of disease. METHODS One hundred and seventy-five consecutive Parkinson's Disease (PD) patients (102 males, 73 females; age: 55-83 years) participated in the cross-sectional study. The clinical assessment included: Hoehn Yahr (H&Y) score; Tinetti score; plumb line (PL) distance from the spinous process of C7, L3 and S1 and kyphosis apex. Lumbar lordosis (LL), thoracic kyphosis (TK), spinosacral (SSA) and spinopelvic (SPA) angles, spinal tilt, pelvic incidence (PI), sacral slope (SS) and pelvic tilt (PT) were radiographically assessed. RESULTS Spinosacral and spinopelvic were correlated with the duration of disease and Tinetti score, but not with age. We found a positive correlation between LL and both SSA and SPA. TK was significantly correlated with LL but not with pelvic parameters, while PI with SS and LL. CONCLUSIONS Female gender, high PI and high LL together with a low PL-C7 distance can be considered as protective factors for spinal imbalance and fall risk; negative factors are represented by male gender, longer disease duration, higher H&Y Class, and low PL-L3 distance. Looking at the pelvis is revealing new important insights in spinal disease management, both surgical and rehabilitative.
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Affiliation(s)
- Luciano Bissolotti
- Rehabilitation Service, Fondazione Teresa Camplani Casa di Cura Domus Salutis, Brescia, Italy.,LARIN: Neuromuscular and Adapted Physical Activity Laboratory, Brescia, Italy
| | | | - Paola Zuccher
- Rehabilitation Service, Fondazione Teresa Camplani Casa di Cura Domus Salutis, Brescia, Italy.,LARIN: Neuromuscular and Adapted Physical Activity Laboratory, Brescia, Italy
| | - Andrea Zenorini
- Rehabilitation Service, Fondazione Teresa Camplani Casa di Cura Domus Salutis, Brescia, Italy.,LARIN: Neuromuscular and Adapted Physical Activity Laboratory, Brescia, Italy
| | | | | | - Stefano Negrini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,IRCCS Don Gnocchi Foundation, Milan, Italy
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Negrini S, Bissolotti L, Ferraris A, Noro F, Bishop MD, Villafañe JH. Nintendo Wii Fit for balance rehabilitation in patients with Parkinson's disease: A comparative study. J Bodyw Mov Ther 2016; 21:117-123. [PMID: 28167167 DOI: 10.1016/j.jbmt.2016.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/20/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Impaired postural stability places individuals with Parkinson's disease (PD) at an increased risk for falls. OBJECTIVE We evaluated the effectiveness of 10 vs. 15 sessions of Nintendo Wii Fit for balance recovery for outpatients PD. METHODS Twenty-seven patients, 48.1% female (66 ± 8 years), with PD. Patients with PD were consecutively assigned to one of two groups receiving either 10 or 15 sessions (low dose or high dose group, respectively) with Nintendo Wii Fit in recovering balancing ability. All outcome measures were collected at baseline, immediately following the intervention period, and 1-month following the end of the intervention. MAIN OUTCOME MEASURE Falls risk test (FRT), Stability index (PST), Berg balance scale (BBS) and Tinetti scale. RESULTS The patients undergoing the 10 sessions demonstrated significantly improvement on the balance performances (Tinetti balance and gait scales, BBS and BSF) (all, P < 0.05) as those undergoing 15 treatment with Nintendo Wii Fit, but no significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way. CONCLUSIONS The results suggest that functional improvement can be made in fewer visits during outpatient rehabilitation sessions with Nintendo Wii Fit improving the efficiency of intervention.
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Affiliation(s)
- Stefano Negrini
- Department of Clinical and Experimental Sciences, University of Brescia, Italy; IRCCS Don Gnocchi Foundation, Milan, Italy.
| | | | | | | | - Mark D Bishop
- Department of Physical Therapy, University of Florida, USA.
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