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Legutke BR, Gobbi LTB, Orcioli-Silva D, Santos PCRD, Moraca GAG, Vitório R, Beretta VS. Transcranial direct current stimulation suggests not improving postural control during adapted tandem position in people with Parkinson's disease: A pilot study. Behav Brain Res 2023; 452:114581. [PMID: 37453515 DOI: 10.1016/j.bbr.2023.114581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Balance impairments in people with Parkinson's disease (PD) demonstrated mainly in challenging postural tasks, such as increased body oscillation may be attributed to the deficits in the brain structures functionality involved in postural control (e.g., motor cortex, midbrain, and brainstem). Although promising results, the effect of transcranial direct current stimulation (tDCS) on postural control in people with PD is unclear, especially in objective measures such as the center of pressure (CoP) parameters. Thus, we analyzed the effects of a single session of tDCS on the CoP parameters during the adapted tandem position in people with PD. METHODS Nineteen people with PD participated in this crossover, randomized, and double-blind study. Anodal tDCS was applied over the primary motor cortex in two conditions of stimulation (2 mA/active and sham) on two different days for 20 min immediately before the postural control evaluation. Participants remained standing in an adapted tandem position for the postural control assessment for 30 s (three trials). CoP parameters were acquired by a force plate. RESULTS No significant differences were demonstrated between stimulation conditions (p-value range = 0.15-0.89). CONCLUSIONS Our results suggested that a single session of tDCS with 2 mA does not improve the postural control of people with PD during adapted tandem.
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Affiliation(s)
- Beatriz Regina Legutke
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Israel; The Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Gabriel Antonio Gazziero Moraca
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Rodrigo Vitório
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil; São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, São Paulo, Brazil.
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Cristini J, Parwanta Z, De las Heras B, Medina-Rincon A, Paquette C, Doyon J, Dagher A, Steib S, Roig M. Motor Memory Consolidation Deficits in Parkinson's Disease: A Systematic Review with Meta-Analysis. JOURNAL OF PARKINSON'S DISEASE 2023; 13:865-892. [PMID: 37458048 PMCID: PMC10578244 DOI: 10.3233/jpd-230038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The ability to encode and consolidate motor memories is essential for persons with Parkinson's disease (PD), who usually experience a progressive loss of motor function. Deficits in memory encoding, usually expressed as poorer rates of skill improvement during motor practice, have been reported in these patients. Whether motor memory consolidation (i.e., motor skill retention) is also impaired is unknown. OBJECTIVE To determine whether motor memory consolidation is impaired in PD compared to neurologically intact individuals. METHODS We conducted a pre-registered systematic review (PROSPERO: CRD42020222433) following PRISMA guidelines that included 46 studies. RESULTS Meta-analyses revealed that persons with PD have deficits in retaining motor skills (SMD = -0.17; 95% CI = -0.32, -0.02; p = 0.0225). However, these deficits are task-specific, affecting sensory motor (SMD = -0.31; 95% CI -0.47, -0.15; p = 0.0002) and visuomotor adaptation (SMD = -1.55; 95% CI = -2.32, -0.79; p = 0.0001) tasks, but not sequential fine motor (SMD = 0.17; 95% CI = -0.05, 0.39; p = 0.1292) and gross motor tasks (SMD = 0.04; 95% CI = -0.25, 0.33; p = 0.7771). Importantly, deficits became non-significant when augmented feedback during practice was provided, and additional motor practice sessions reduced deficits in sensory motor tasks. Meta-regression analyses confirmed that deficits were independent of performance during encoding, as well as disease duration and severity. CONCLUSION Our results align with the neurodegenerative models of PD progression and motor learning frameworks and emphasize the importance of developing targeted interventions to enhance motor memory consolidation in PD.
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Affiliation(s)
- Jacopo Cristini
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Zohra Parwanta
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Bernat De las Heras
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Almudena Medina-Rincon
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
- Grupo de investigación iPhysio, San Jorge University, Zaragoza, Aragón, Spain
- Department of Physiotherapy, San Jorge University, Zaragoza, Aragón, Spain
| | - Caroline Paquette
- Department of Kinesiology & Physical Education, McGill University, Montreal, QC,Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
| | - Julien Doyon
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Alain Dagher
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Simon Steib
- Department of Human Movement, Training and Active Aging, Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Marc Roig
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
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[New approaches in exercise therapy for Parkinson's disease]. Z Gerontol Geriatr 2022; 55:644-649. [PMID: 36367560 DOI: 10.1007/s00391-022-02123-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exercise therapy is an important component in the treatment of motor symptoms in people with Parkinson's disease (PD). In this context, goal-based task-specific training has shown to be particularly effective compared to nonspecific approaches. OBJECTIVE In this article two novel exercise interventions for targeted improvement of motor function in PD are presented: 1) task-specific training with perturbations and 2) combined task-specific and cardiovascular training. MATERIAL AND METHODS Summary and discussion of the current evidence for both therapeutic approaches. RESULTS First randomized controlled trials show that perturbation training is an effective task-specific training to improve gait and balance function and potentially reduce falls. Experimental findings on combined cardiovascular exercise and task-specific training suggest that processes of neuroplasticity are enhanced, thereby improving therapy outcomes. However, the quality of evidence for both therapeutic approaches is currently low. CONCLUSION The presented exercise approaches show promising results in first randomized controlled studies and have the potential to improve treatment outcomes in PD. Further high-quality clinical studies are needed to ensure an effective transfer into practice.
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Readinger J, Eastlack M, Von Nieda K, Kantak S, Sawyer K. Feasibility and longitudinal effects of repeated participation in an annual, brief and intense exercise program in individuals with Parkinson's disease: A case report. Physiother Theory Pract 2021; 38:3194-3205. [PMID: 34313192 DOI: 10.1080/09593985.2021.1952667] [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: 10/20/2022]
Abstract
BACKGROUND Functional decline is expected over time in persons with Parkinson's disease (PD). Intense exercise (RPE ≥ 5-7/10), incorporating motor learning principles, may be beneficial. Purpose:The purpose of this case report is to describe the feasibility and longitudinal effects after individuals with PD participated in multiple, 3.5-day, intensive exercise programs called Movement Camp (Camp). METHODS Developed based on the principles of skill, capacity, and motivation, the Camp was offered four times (spring 2014-spring 2017) over the course of three years. Camp consisted of 3.5 days, with approximately 5.5 hours of exercise per day. The four participants on whom we are reporting were selected because they participated in three or more Camps, thus providing longitudinal data. Participants rotated through high-intensity, one-hour exercise stations targeting balance, endurance, gait, upper extremity function and three 30-minute group training sessions. Balance (Mini-BESTest), endurance (six-minute walk test), gait speed, and function (five times sit-to-stand) were examined. RESULTS Testing was completed prior to, post, and six weeks post intervention. Over three years, participants maintained or improved performance on most measures. CONCLUSION The outcomes of this case report suggest that brief, intensive exercise based on motor learning principles is feasible and may maintain or improve function in persons with PD over three years.
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Affiliation(s)
- Janet Readinger
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Marty Eastlack
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Kristin Von Nieda
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Shailesh Kantak
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Karen Sawyer
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
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de Carvalho KS, Coelho DB, de Souza CR, Silva-Batista C, Shida TKF, Teixeira LA, de Lima-Pardini AC. Preserved flexibility of dynamic postural control in individuals with Parkinson's disease. Gait Posture 2021; 86:240-244. [PMID: 33774585 DOI: 10.1016/j.gaitpost.2021.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Continuous oscillation of the support base requires anticipatory and reactive postural adjustments to maintain a stable balance. In this context, postural control flexibility or the ability to adjust balance mechanisms following the requirements of the environment is needed to counterbalance the predictable, continuous perturbation of body balance. Considering the inflexibility of postural responses in individuals with Parkinson's disease (PD), maintaining stability in the support base's continuous oscillations may be challenging. Varying the frequency of platform oscillation is an exciting approach to assess the interactions between reactive and anticipatory adjustments. RESEARCH QUESTION This study aimed to analyze postural responses of individuals with PD on an oscillatory support base across different frequencies. METHODS Thirty participants with moderate PD diagnosis (M = 64.47 years, SD = 8.59; Hoehn and Yahr scale 3) and fifteen healthy age-matched controls (M = 65.8 years, SD = 4.2) were tested. Subjects maintained a dynamic balance on a platform oscillating in sinusoidal translations. Four oscillation frequencies were evaluated in different trials that ranged from 0.2 to 0.8 Hz in steps of 0.2 Hz. RESULTS Analysis showed similar performance between PD and healthy participants, with modulation of amplitudes of head displacement, center of pressure, center of mass and feet-head coordination to platform oscillation frequency. DISCUSSION Our findings suggest a preserved ability of individuals with PD to dynamically control body balance on a support base with predictable oscillatory translations.
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Affiliation(s)
- Kárin Santana de Carvalho
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Daniel Boari Coelho
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil; Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, São Paulo, Brazil.
| | - Caroline Ribeiro de Souza
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Carla Silva-Batista
- Exercise Neuroscience Research Group, School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo, Brazil
| | | | - Luis Augusto Teixeira
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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Beretta VS, Carpenter MG, Barbieri FA, Santos PCR, Orcioli-Silva D, Pereira MP, Gobbi LTB. Does the impaired postural control in Parkinson's disease affect the habituation to non-sequential external perturbation trials? Clin Biomech (Bristol, Avon) 2021; 85:105363. [PMID: 33932865 DOI: 10.1016/j.clinbiomech.2021.105363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND How people with Parkinson's disease habituate their postural response to unpredictable translation perturbation is not totally understood. We compared the capacity to change the postural responses after unexpected external perturbation and investigated the habituation plateaus of postural responses to non-sequential perturbation trials in people with Parkinson's disease and healthy older adults. METHODS In people with Parkinson's disease (n = 37) and older adults (n = 20), sudden posterior support-surface translational were applied in 7 out of 17 randomized trials to ensure perturbation unpredictability. Electromyography and center of pressure parameters of postural response were analyzed by ANOVAs (Group vs. Trials). Two simple planned contrasts were performed to determine at which trial the responses first significantly habituate, and by which trials the habituation plateaus. FINDINGS Older adults demonstrated a first response change in trial 5 and habituation plateaus after trial 4, while for people with Parkinson's disease, the first change occurred in trial 2 and habituation plateau after trial 5 observed by center of pressure range. People with Parkinson's disease demonstrated a greater center of pressure range in trial 1 compared to older adults. Independent of trial, people with Parkinson's disease vs. older adults demonstrated a greater ankle muscle co-activation and recovery time. INTERPRETATION Despite the greater center of pressure range in the first trial, people with Parkinson's disease can habituate to unpredictable perturbations. This is reflected by little, to no difference in the time-course of adaptation for all but 2 parameters that showed only marginal differences between people with Parkinson's disease and older adults.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Mark Gregory Carpenter
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabio Augusto Barbieri
- São Paulo State University (Unesp), School of Sciences, Graduate Program in Movement Sciences, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Paulo Cezar Rocha Santos
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Marcelo Pinto Pereira
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
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Dynamic posturography and posturographic training for Parkinson's disease in a routine clinical setting. Gait Posture 2020; 82:281-286. [PMID: 33002838 DOI: 10.1016/j.gaitpost.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/28/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postural instability in Parkinson's disease (PD) often is ill-responsive to drugs and DBS. Physiotherapy is recommended but practicability and cost effectiveness are debatable. RESEARCH QUESTION Can a simple 'plug and play' posturography system produce clinically meaningful measures and elicit postural motor learning in PD patients? METHODS 40 moderately affected PD patients in a general neurology outpatient clinic who complained of postural instability were included to practice shifts and stabilization of the center of pressure (COP) in a low intensity (once weekly 20-25 minutes over 6 weeks) dynamic posturographic training using the Biodex balance systemTM. Average deviations from mean COP position and from the center of the base of support (BOS) with different degrees of visual feedback in static and dynamic posturographic tasks other than the training tasks, the Berg-Balance-Scale (BBS) and patient self-ratings (FES-I, ABC scale) were assessed before and after training. RESULTS Posturographic performance was significantly better with eyes open than closed and more so with explicit visual feedback of COP position (p < 0.005). Only with this latter type of feedback and only the deviation form the BOS in dynamic and static posturography was significantly correlated with BBS and UPDRS III (p < 0.001). The deviation from the BOS under explicit visual feedback significantly improved after training (p < 0.005) whereas BBS, FES-I and ABC-scale did not. SIGNIFICANCE Our posturography procedures were well applicable as a routine clinical tool. They yielded clinically valid measures when COP position was visible and directional shifts from the BOS centre were quantified. Our training was effective for this posturographic measure only. Its significance as a predictor for clinical efficacy of higher intensity and longer term training schedules is hypothesized and warrants further studies.
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Sozzi S, Nardone A, Schieppati M. Adaptation of balancing behaviour during continuous perturbations of stance. Supra-postural visual tasks and platform translation frequency modulate adaptation rate. PLoS One 2020; 15:e0236702. [PMID: 32735602 PMCID: PMC7394407 DOI: 10.1371/journal.pone.0236702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 07/13/2020] [Indexed: 01/01/2023] Open
Abstract
When humans are administered continuous and predictable perturbations of stance, an adaptation period precedes the steady state of balancing behaviour. Little information is available on the modulation of adaptation by vision and perturbation frequency. Moreover, performance of supra-postural tasks may modulate adaptation in as yet unidentified ways. Our purpose was to identify differences in adaptation associated to distinct visual tasks and perturbation frequencies. Twenty non-disabled adult volunteers stood on a platform translating 10 cm in antero-posterior (AP) direction at low (LF, 0.18 Hz) and high frequency (HF, 0.56 Hz) with eyes open (EO) and closed (EC). Additional conditions were reading a text fixed to platform (EO-TP) and reading a text stationary on ground (EO-TG). Peak-to-peak (PP) displacement amplitude and AP position of head and pelvis markers were computed for each of 27 continuous perturbation cycles. The time constant and extent of head and pelvis adaptation and the cross-correlation coefficients between head and pelvis were compared across visual conditions and frequencies. Head and pelvis mean positions in space varied little across conditions and perturbation cycles but the mean head PP displacements changed over time. On average, at LF, the PP displacement of the head and pelvis increased progressively. Adaptation was rapid or ineffective with EO, but slower with EO-TG, EO-TP, EC. At HF, the head PP displacement amplitude decreased progressively with fast adaptation rates, while the pelvis adaptation was not apparent. The results show that visual tasks can modulate the adaptation rate, highlight the effect of the perturbation frequency on adaptation and provide evidence of priority assigned to pelvis stabilization over visual tasks at HF. The effects of perturbation frequency and optic flow and their interaction with other sensory inputs and cognitive tasks on the adaptation strategies should be investigated in impaired individuals and considered in the design of rehabilitation protocols.
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Affiliation(s)
- Stefania Sozzi
- Centro Studi Attività Motorie, ICS Maugeri SPA SB, IRCCS, Institute of Pavia, Pavia, Italy
| | - Antonio Nardone
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- Neurorehabilitation and Spinal Units, ICS Maugeri SPA SB, IRCCS Institute of Pavia, Pavia, Italy
- * E-mail:
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Interindividual Balance Adaptations in Response to Perturbation Treadmill Training in Persons With Parkinson Disease. J Neurol Phys Ther 2020; 43:224-232. [PMID: 31517749 DOI: 10.1097/npt.0000000000000291] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Perturbation training is a promising approach to reduce fall incidence in persons with Parkinson disease (PwPD). This study aimed to evaluate interindividual differences in balance adaptations in response to perturbation treadmill training (PTT) and identify potential outcome predictors. METHODS PwPD (n = 43, Hoehn & Yahr stage 1-3.5) were randomly assigned to either 8 weeks of PTT or conventional treadmill training (CTT) without perturbations. At baseline and following intervention, data from 4 domains of balance function (reactive, anticipatory, dynamic postural control, and quiet stance) were collected. Using responder analysis we investigated interindividual differences (responder rates and magnitude of change) and potential predictive factors. RESULTS PTT showed a significantly higher responder rate in the Mini Balance Evaluation Systems Test (Mini-BESTest) subscore reactive postural control, compared with CTT (PTT = 44%; CTT = 10%; risk ratio = 4.22, confidence interval = 1.03-17.28). Additionally, while between-groups differences were not significant, the proportion of responders in the measures of dynamic postural control was higher for PTT compared with CTT (PTT: 22%-39%; CTT: 5%-10%). The magnitude of change in responders and nonresponders was similar in both groups. PTT responders showed significantly lower initial balance performance (4/8 measures) and cognitive function (3/8 measures), and were older and at a more advanced disease stage, based on descriptive evaluation. DISCUSSION AND CONCLUSIONS Our findings suggest that PTT is beneficial to improve reactive balance in PwPD. Further, PTT appeared to be effective only for a part of PwPD, especially for those with lower balance and cognitive function, which needs further attention.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A1).
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Morris ME, Dreher T. Gait and Posture Virtual Special Issue "Gait Complexity in Parkinson's Disease". Gait Posture 2020; 78:89-90. [PMID: 30639119 DOI: 10.1016/j.gaitpost.2018.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
| | - Thomas Dreher
- Pediatric Orthopaedics and Traumatology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
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Karthivashan G, Ganesan P, Park SY, Lee HW, Choi DK. Lipid-based nanodelivery approaches for dopamine-replacement therapies in Parkinson's disease: From preclinical to translational studies. Biomaterials 2019; 232:119704. [PMID: 31901690 DOI: 10.1016/j.biomaterials.2019.119704] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 12/09/2019] [Accepted: 12/18/2019] [Indexed: 12/26/2022]
Abstract
The incidence of Parkinson's disease (PD), the second most common neurodegenerative disorder, has increased exponentially as the global population continues to age. Although the etiological factors contributing to PD remain uncertain, its average incidence rate is reported to be 1% of the global population older than 60 years. PD is primarily characterized by the progressive loss of dopaminergic (DAergic) neurons and/or associated neuronal networks and the subsequent depletion of dopamine (DA) levels in the brain. Thus, DA or levodopa (l-dopa), a precursor of DA, represent cardinal targets for both idiopathic and symptomatic PD therapeutics. While several therapeutic strategies have been investigated over the past decade for their abilities to curb the progression of PD, an effective cure for PD is currently unavailable. Even DA replacement therapy, an effective PD therapeutic strategy that provides an exogenous supply of DA or l-dopa, has been hindered by severe challenges, such as a poor capacity to bypass the blood-brain barrier and inadequate bioavailability. Nevertheless, with recent advances in nanotechnology, several drug delivery systems have been developed to bypass the barriers associated with central nervous system therapeutics. In here, we sought to describe the adapted lipid-based nanodrug delivery systems used in the field of PD therapeutics and their recent advances, with a particular focus placed on DA replacement therapies. This work initially explores the background of PD; offers descriptions of the most recent molecular targets; currently available clinical medications/limitations; an overview of several lipid-based PD nanotherapeutics, functionalized nanoparticles, and technical aspects in brain delivery; and, finally, presents future perspectives to enhance the use of nanotherapeutics in PD treatment.
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Affiliation(s)
- Govindarajan Karthivashan
- Department of Biotechnology, College of Biomedical and Health Science, Konkuk University, Chungju, 27478, Republic of Korea; Research Institute of Inflammatory Diseases (RID), College of Biomedical and Health Science and BK21plus Glocal Education Program of Nutraceuticals Development, Konkuk University, Chungju, 27478, Republic of Korea
| | - Palanivel Ganesan
- Department of Biotechnology, College of Biomedical and Health Science, Konkuk University, Chungju, 27478, Republic of Korea; Department of Biomedical Chemistry, Nanotechnology Research Center, Department of Applied Life Science, College of Biomedical and Health Science, Konkuk University, Chungju, 27478, Republic of Korea
| | - Shin-Young Park
- Department of Biotechnology, College of Biomedical and Health Science, Konkuk University, Chungju, 27478, Republic of Korea
| | - Ho-Won Lee
- Department of Neurology, Kyungpook National University School of Medicine and Brain Science & Engineering Institute, Kyungpook National University, Daegu, 41404, Republic of Korea
| | - Dong-Kug Choi
- Department of Biotechnology, College of Biomedical and Health Science, Konkuk University, Chungju, 27478, Republic of Korea; Research Institute of Inflammatory Diseases (RID), College of Biomedical and Health Science and BK21plus Glocal Education Program of Nutraceuticals Development, Konkuk University, Chungju, 27478, Republic of Korea.
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Human Balance in Response to Continuous, Predictable Translations of the Support Base: Integration of Sensory Information, Adaptation to Perturbations, and the Effect of Age, Neuropathy and Parkinson’s Disease. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9245310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This short narrative review article moves from early papers that described the behaviour of healthy subjects balancing on a motorized platform continuously translating in the antero-posterior direction. Research from the laboratories of two of the authors and related investigations on dynamic balancing behaviour are briefly summarized. More recent findings challenging time-honoured views are considered, such as the statement that vision plays a head-in-space stabilizing role. The time interval to integrate vision or its withdrawal in the balancing pattern is mentioned as well. Similarities and differences between ageing subjects and patients with peripheral or central disorders are concisely reported. The muscle activities recorded during the translation cycles suggest that vision and amplitude changes of the anticipatory postural activities play a predominant role in controlling dynamic balance during prolonged administration of the predictable perturbation. The potential of this paradigm for rehabilitation of balance problems is discussed.
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Slade SC, Finkelstein DI, McGinley JL, Morris ME. Exercise and physical activity for people with Progressive Supranuclear Palsy: a systematic review. Clin Rehabil 2019; 34:23-33. [PMID: 31559853 PMCID: PMC6943961 DOI: 10.1177/0269215519877235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: To conduct a systematic review to evaluate exercise and structured physical activity for people living with Progressive Supranuclear Palsy. Data sources: AMED, CINAHL, Cochrane, EMBASE, Informit, MEDLINE, PEDro, PsycINFO, PubMed and SportDiscus were searched until 18 August 2019. Reference lists of included studies were hand-searched. Methods: Cochrane guidelines informed review methods. English language peer-reviewed studies of any design, in any setting, were included. Method quality was appraised with the Physiotherapy Evidence Database scale and Joanna Briggs Institute instruments. Data were extracted for study design, sample characteristics and therapy content. Effectiveness was calculated where possible. Results: Eleven studies were included. Method appraisal showed moderate to high risk of bias. Research designs included three randomized controlled trials, two quasi-experimental studies, one cohort study, four case studies and one case series. Sample sizes ranged from 1 to 24. Exercise interventions included supported and robot-assisted gait training, gaze training, balance re-education and auditory-cued motor training. Dosage ranged from two to five sessions per week over four to eight weeks. End-of-intervention effect sizes were small (6-minute walk test: –0.07; 95% confidence interval (CI): –0.87, 0.73) to moderate (balance: –0.61; 95% CI: –1.40, 0.23; Timed Up and Go: 0.42; 95% CI: –0.49, 1.33) and statistically non-significant. Function, quality of life and adverse events were inconsistently reported. Conclusions: For people with Progressive Supranuclear Palsy, robust evidence was not found for therapeutic exercises. Reported improvements in walking were derived from two clinical trials. The effects of structured physical activity for people with advanced Progressive Supranuclear Palsy are not known.
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Affiliation(s)
- Susan C Slade
- La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services and Sport, SHE College, La Trobe University, Melbourne, VIC, Australia
| | - David I Finkelstein
- Parkinson's Disease Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jennifer L McGinley
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC, Australia
| | - Meg E Morris
- La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services and Sport, SHE College, La Trobe University, Melbourne, VIC, Australia.,Healthscope, North Eastern Rehabilitation Centre, Ivanhoe, VIC, Australia
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Olson M, Lockhart TE, Lieberman A. Motor Learning Deficits in Parkinson's Disease (PD) and Their Effect on Training Response in Gait and Balance: A Narrative Review. Front Neurol 2019; 10:62. [PMID: 30792688 PMCID: PMC6374315 DOI: 10.3389/fneur.2019.00062] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/17/2019] [Indexed: 01/30/2023] Open
Abstract
Parkinson's disease (PD) is a neurological disorder traditionally associated with degeneration of the dopaminergic neurons within the substantia nigra, which results in bradykinesia, rigidity, tremor, and postural instability and gait disability (PIGD). The disorder has also been implicated in degradation of motor learning. While individuals with PD are able to learn, certain aspects of learning, especially automatic responses to feedback, are faulty, resulting in a reliance on feedforward systems of movement learning and control. Because of this, patients with PD may require more training to achieve and retain motor learning and may require additional sensory information or motor guidance in order to facilitate this learning. Furthermore, they may be unable to maintain these gains in environments and situations in which conscious effort is divided (such as dual-tasking). These shortcomings in motor learning could play a large part in degenerative gait and balance symptoms often seen in the disease, as patients are unable to adapt to gradual sensory and motor degradation. Research has shown that physical and exercise therapy can help patients with PD to adapt new feedforward strategies to partially counteract these symptoms. In particular, balance, treadmill, resistance, and repeated perturbation training therapies have been shown to improve motor patterns in PD. However, much research is still needed to determine which of these therapies best alleviates which symptoms of PIGD, the needed dose and intensity of these therapies, and long-term retention effects. The benefits of such technologies as augmented feedback, motorized perturbations, virtual reality, and weight-bearing assistance are also of interest. This narrative review will evaluate the effect of PD on motor learning and the effect of motor learning deficits on response to physical therapy and training programs, focusing specifically on features related to PIGD. Potential methods to strengthen therapeutic effects will be discussed.
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Affiliation(s)
- Markey Olson
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
- Muhammad Ali Movement Disorders Clinic, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Thurmon E. Lockhart
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Abraham Lieberman
- Muhammad Ali Movement Disorders Clinic, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
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15
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Motor learning in people with Parkinson's disease: Implications for fall prevention across the disease spectrum. Gait Posture 2018; 61:311-319. [PMID: 29413803 DOI: 10.1016/j.gaitpost.2018.01.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/21/2018] [Accepted: 01/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls are a significant burden for people with Parkinson's disease (PD), however, individuals across the spectrum of disease severity respond differently to fall prevention interventions. Despite the multifactorial causes of falls in people with PD, recent work has provided insight into interventions that hold promise for fall prevention. Further, studies have begun to identify patient characteristics that may predict responsiveness to such interventions. RESEARCH QUESTION We discuss (i) the postural motor learning abilities of people with mild versus severe PD that could affect their ability to benefit from fall prevention interventions, (ii) how people with different severity of PD respond to such interventions, and (iii) the practical considerations of providing effective fall prevention interventions for people with PD across the spectrum of disease severity. METHODS This narrative review consolidates recent work on postural motor learning and fall prevention rehabilitation involving exercise in people with PD. RESULTS People with PD are able to improve postural motor control through practice, enabling them to benefit from exercise which challenges their gait and balance to reduce falling. Worsening of axial and cognitive symptoms may result in diminished learning, and those with more severe PD may require fully supervised, high intensity programs to reduce falls. SIGNIFICANCE Understanding how people with PD across the spectrum of disease severity differ in their postural motor learning ability and response to different fall prevention interventions will enable researchers and clinicians to refine such interventions and their delivery to minimize falls and their negative sequelae in people with PD.
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