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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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2
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Goh L, Canning CG, Song J, Clemson L, Allen NE. The effect of rehabilitation interventions on freezing of gait in people with Parkinson's disease is unclear: a systematic review and meta-analyses. Disabil Rehabil 2023; 45:3199-3218. [PMID: 36106644 DOI: 10.1080/09638288.2022.2120099] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 08/21/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To summarize the effects of rehabilitation interventions to reduce freezing of gait (FOG) in people with Parkinson's disease. METHODS A systematic review with meta-analyses of randomized trials of rehabilitation interventions that reported a FOG outcome was conducted. Quality of included studies and certainty of FOG outcome were assessed using the PEDro scale and GRADE framework. RESULTS Sixty-five studies were eligible, with 62 trialing physical therapy/exercise, and five trialing cognitive and/or behavioral therapies. All meta-analyses produced very low-certainty evidence. Physical therapy/exercise had a small effect on reducing FOG post-intervention compared to control (Hedges' g= -0.26, 95% CI= -0.38 to -0.14, 95% prediction interval (PI)= -0.38 to -0.14). We are uncertain of the effects on FOG post-intervention when comparing: exercise with cueing to without cueing (Hedges' g= -0.58, 95% CI= -0.86 to -0.29, 95% PI= -1.23 to 0.08); action observation training plus movement strategy practice to practice alone (Hedges' g= -0.56, 95% CI= -1.16 to 0.05); and dance to multimodal exercises (Hedges' g= -0.64, 95% CI= -1.53 to 0.25). CONCLUSIONS We are uncertain if physical therapy/exercise, cognitive or behavioral therapies, are effective at reducing FOG.Implications for rehabilitationFOG leads to impaired mobility and falls, but the effect of rehabilitation interventions (including physical therapy/exercise and cognitive/behavioral therapies) on FOG is small and uncertain.Until more robust evidence is generated, clinicians should assess FOG using both self-report and physical measures, as well as other related impairments such as cognition, anxiety, and fear of falling.Interventions for FOG should be personalized based on the individual's triggers and form part of a broader exercise program addressing gait, balance, and falls prevention.Interventions should continue over the long term and be closely monitored and adjusted as individual circumstances change.
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Affiliation(s)
- Lina Goh
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jooeun Song
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lindy Clemson
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Natalie E Allen
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Jin Y, Lee Y, Park S, Lee S, Lim C. Effects of Curved-Path Gait Training on Gait Ability in Middle-Aged Patients with Stroke: Protocol for a Randomized Controlled Trial. Healthcare (Basel) 2023; 11:1777. [PMID: 37372895 DOI: 10.3390/healthcare11121777] [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: 04/12/2023] [Revised: 05/22/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Introduction: This study aimed to investigate the effects of curved-path stride gait training on the gait ability of patients with stroke. (2) Materials and Methods: Thirty patients with stroke were randomly assigned to curved-path stride gait training (n = 15) and general gait training groups (n = 15). Both groups underwent training for 30 min five times a week for 8 weeks. The gait ability of each was assessed using the Dynamic Gait Index (DGI), Timed-Up-and-Go (TUG) test, 10-meter walk test, and Figure-of-8 walk test (F8WT). (3) Results: The curved-path gait training group showed significant differences in the DGI, TUG test, 10-m walk test, and F8WT pre- versus post- intervention (p < 0.05). The general gait training group showed no significant difference in F8WT pre- versus post-intervention (p > 0.05). Additionally, there was a statistically significant intergroup difference in gait ability (p < 0.05). (4) Conclusions: Curved-path gait training resulted in greater improvement in gait ability than general gait training. Therefore, curved-path gait training can be a meaningful intervention for improving the gait ability of patients with stroke.
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Affiliation(s)
- Youngmi Jin
- Department of Special Education of Graduate School, Dankook University, Yongin 16890, Republic of Korea
| | - Yubin Lee
- Department of Health Science, Gachon University Graduate School, Incheon 21936, Republic of Korea
| | - Seiyoun Park
- Department of Physical Therapy, Wonkwang Health Science University, Iksan 54538, Republic of Korea
| | - Sangbin Lee
- Department of Physical Therapy, Namseoul University, Cheonan 31020, Republic of Korea
| | - Chaegil Lim
- Department of Physical Therapy, Gachon University, Incheon 21936, Republic of Korea
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Chen CY, Wang WN, Lu MK, Yang YW, Yu T, Wu TN, Tsai CH. The Rehabilitative Effect of Archery Exercise Intervention in Patients with Parkinson's Disease. PARKINSON'S DISEASE 2023; 2023:9175129. [PMID: 37333719 PMCID: PMC10270763 DOI: 10.1155/2023/9175129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023]
Abstract
Background Archery exercise exerts a rehabilitative effect on patients with paraplegia and might potentially serve as complementary physiotherapy for patients with Parkinson's disease. Objective This study aimed to examine the rehabilitative effects of an archery intervention. Methods A randomized controlled trial of a 12-week intervention was performed in patients with idiopathic Parkinson's disease. Thirty-one of the 39 eligible patients recruited from a medical center in Taiwan participated in the trial, of whom 16 were in the experimental group practicing archery exercises and 15 were in the control group at the beginning; twenty-nine completed the whole process. The Purdue pegboard test (PPT), the Unified Parkinson's Disease Rating Scale I to III (UPDRS I to III), physical fitness test, and timed up and go test (TUG) were used to assess the intervention effects of archery exercise. Results Compared to the control group, the outcome differences between the posthoc and baseline tests in PPT, UPDRS I to III, lower extremity muscular strength, and TUG in the experimental group (between-group difference in difference's mean: 2.07, 1.59, 1.36, -2.25, -3.81, -9.10, 3.57, and -1.51, respectively) did show positive changes and their effect sizes examined from Mann-Whitney U tests (η: 0.631, 0.544, 0.555, 0.372, 0.411, 0.470, 0.601, and 0.381, respectively; Ps < 0.05) were medium to large, indicating that the archery intervention exerted promising effects on improving hand flexibility and finger dexterity, activity functions in motor movement, lower extremity muscular strength, and gait and balance ability. Conclusions Traditional archery exercise was suggested to have a rehabilitative effect for mild to moderate Parkinson's disease and could be a form of physiotherapy. Nevertheless, studies with larger sample sizes and extended intervention periods are needed to ascertain the long-term effects of archery exercise.
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Affiliation(s)
- Chiu-Ying Chen
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Nursing and Graduate Institute of Nursing, Asia University, Taichung, Taiwan
| | - Wei-Ning Wang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Ming-Kuei Lu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- Ph.D. Program for Translational Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan
| | - Yu-Wan Yang
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Tsung Yu
- Department of Public Health, National Cheng Kung University, Tainan, Taiwan
| | - Trong-Neng Wu
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Chon-Haw Tsai
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Lorenzo-García P, Núñez de Arenas-Arroyo S, Cavero-Redondo I, Guzmán-Pavón MJ, Priego-Jiménez S, Álvarez-Bueno C. Physical Exercise Interventions on Quality of Life in Parkinson Disease: A Network Meta-analysis. J Neurol Phys Ther 2023; 47:64-74. [PMID: 36730998 DOI: 10.1097/npt.0000000000000414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Physical exercise is considered an effective intervention for maintaining or improving quality of life (QoL) in patients with Parkinson disease (PD), but there is no evidence showing which type of physical exercise intervention has more positive effects. This systematic review and meta-analysis aimed to synthesize the evidence regarding the effectiveness of exercise interventions on improving QoL in patients with PD, comparing different types of exercise interventions. METHODS A literature search was conducted through January 2022. The methodological quality of the trials was assessed using the Cochrane risk of bias tool RoB2. For the meta-analysis, physical exercise interventions were classified into 5 training categories: resistance, endurance, alternative exercises, dance, and sensorimotor interventions. A standard meta-analysis and network meta-analysis were carried out to evaluate the efficacy of the different types of physical exercise interventions. RESULTS The search retrieved 2451 studies, 48 of which were included in this network meta-analysis with a total of 2977 patients with PD. The indirect effects of the network meta-analysis showed positive results for alternative exercises (-0.46; 95% confidence interval [CI]: -0.76, -0.16), dance (-0.63; 95% CI: -1.08, -0.17), and sensorimotor interventions (-0.23; 95% CI: -0.40, -0.07) versus control comparisons. DISCUSSION AND CONCLUSIONS More research is needed to determine the types of physical exercise interventions that are most beneficial and for which conditions of the disease they have the most positive effects.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A398 ).
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Affiliation(s)
- Patricia Lorenzo-García
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain (P.L.-G., S.N.d.A.-A., C.Á.-B.); Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile (I.C.-R.) Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay (C.Á.-B.); Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain (M.J.G.-P.); and Hospital Virgen de la Luz, Hermandad de Donantes de Sangre, Cuenca, Spain (S.P.-J.)
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Álvarez-Bueno C, Deeks JJ, Cavero-Redondo I, Jolly K, Torres-Costoso AI, Price M, Fernandez-Rodriguez R, Martínez-Vizcaíno V. Effect of Exercise on Motor Symptoms in Patients With Parkinson's Disease: A Network Meta-analysis. J Geriatr Phys Ther 2023; 46:E87-E105. [PMID: 34392264 DOI: 10.1519/jpt.0000000000000322] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although the pharmacological approach may help with motor symptoms in Parkinson's disease (PD), they are clearly not the complete solution. Thus, for the treatment of PD motor symptoms, physical activity has been proposed as an effective intervention. METHODS A systematic search in MEDLINE, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials databases was conducted to identify randomized controlled trials testing the effectiveness of exercise interventions on motor symptoms of PD. Physical exercise interventions were divided into 9 categories: endurance, resistance, combined, balance, dance, alternative exercises, body weight supported, sensorimotor interventions including endurance exercise, and sensorimotor interventions not including endurance exercise. A pairwise meta-analysis for direct and indirect comparisons between intervention and control/nonintervention groups was carried out. RESULTS Fifty-six studies met the inclusion criteria, including 2740 participants, aged between 57.6 and 77.7 years. Results showed that sensorimotor training including endurance (effect size [ES]-1.09; 95% confidence interval [CI], -1.68 to -0.50), resistance (ES-0.82; 95% CI, -1.23 to -0.41), and dance (ES-0.64; 95% CI, -1.24 to -0.05) were the most effective physical activity interventions for mitigating PD motor symptoms. CONCLUSION Physical activity interventions are an effective strategy for the management of motor symptoms in patients with PD. Among the different exercise intervention programs, those including more complex and demanding activities (sensorimotor training including endurance, resistance, and dance) seem to be the most effective physical activity interventions.
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Affiliation(s)
- Celia Álvarez-Bueno
- Social and Health Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Iván Cavero-Redondo
- Social and Health Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
- Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Santiago, Chile
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Ana I Torres-Costoso
- Social and Health Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Malcolm Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | | | - Vicente Martínez-Vizcaíno
- Social and Health Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
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7
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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: 22] [Impact Index Per Article: 22.0] [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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8
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Kwok JYY, Smith R, Chan LML, Lam LCC, Fong DYT, Choi EPH, Lok KYW, Lee JJ, Auyeung M, Bloem BR. Managing freezing of gait in Parkinson's disease: a systematic review and network meta-analysis. J Neurol 2022; 269:3310-3324. [PMID: 35244766 DOI: 10.1007/s00415-022-11031-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Freezing of gait (FOG) is one of the most disabling gait disorders affecting 80% of patients with Parkinson's disease (PD). Clinical guidelines recommend a behavioral approach for gait rehabilitation, but there is a wide diversity of behavioral modalities. OBJECTIVE The objective of this network meta-analysis was to compare the effectiveness of different behavioral interventions for FOG management in PD patients. METHODS Six databases were searched for randomized controlled trials of behavioral interventions for FOG management among PD patients from 1990 to December 2021. Bayesian network meta-analysis was used to combine both direct and indirect trial evidence on treatment effectiveness, while the surface under the cumulative ranking (SUCRA) score was used to estimate the ranked probability of intervention effectiveness. RESULTS Forty-six studies were included in the qualitative synthesis. Among, 36 studies (1454 patients) of 72 interventions or control conditions (12 classes) were included in the network meta-analysis, with a mean intervention period of 10.3 weeks. After adjusting for the moderating effect of baseline FOG severity, obstacle training [SMD -2.1; 95% credible interval (Crl): -3.3, -0.86], gait training with treadmill (SMD -1.2; 95% Crl: -2.0, -0.34), action observation training (SMD -1.0; 95% Crl: -1.9, -0.14), conventional physiotherapy (SMD -0.70; 95% Crl: -1.3, -0.12) and general exercise (SMD -0.64; 95% Crl: -1.2, -0.11) demonstrated significant improvement on immediate FOG severity compared to usual care. The SUCRA rankings suggest that obstacle training, gait training on treadmill and general exercises are most likely to reduce FOG severity. CONCLUSION Obstacle training, gait training on treadmill, general exercises, action observation training and conventional physiotherapy demonstrated immediate real-life benefits on FOG symptoms among patients with mild-moderate PD. With the promising findings, the sustained effects of high complexity motor training combined with attentional/cognitive strategy should be further explored. Future trials with rigorous research designs using both subjective and objective outcome measures, long-term follow-up and cost-effective analysis are warranted to establish effective behavioral strategies for FOG management.
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Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China.
| | - Robert Smith
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Lily Man Lee Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Leo Chun Chung Lam
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Jung Jae Lee
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Man Auyeung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, People's Republic of China
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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9
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Bishnoi A, Lee R, Hu Y, Mahoney JR, Hernandez ME. Effect of Treadmill Training Interventions on Spatiotemporal Gait Parameters in Older Adults with Neurological Disorders: Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052824. [PMID: 35270516 PMCID: PMC8909968 DOI: 10.3390/ijerph19052824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 12/07/2022]
Abstract
Objective: Treadmill interventions have been shown to promote ‘normal’ walking patterns, as they facilitate the proper movement and timing of the lower limbs. However, prior reviews have not examined which intervention provides the most effective treatment of specific gait impairments in neurological populations. The objective of this systematic review was to review and quantify the changes in gait after treadmill interventions in adults with neurological disorders. Data Sources: A keyword search was performed in four databases: PubMed, CINAHL, Scopus, and Web of Science (January 2000−December 2021). We performed the search algorithm including all possible combinations of keywords. Full-text articles were examined further using forward/backward search methods. Study Selection: Studies were thoroughly screened using the following inclusion criteria: study design: Randomized Controlled Trial (RCT); adults ≥55 years old with a neurological disorder; treadmill intervention; spatiotemporal gait characteristics; and language: English. Data Extraction: A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, and spatiotemporal gait parameters including stride length, stride time, step length, step width, step time, stance time, swing time, single support time, double support time, or cadence. Data Synthesis: We found a total of 32 studies to be included in our systematic review through keyword search, out of which 19 studies included adults with stroke and 13 studies included adults with PD. We included 22 out of 32 studies in our meta-analysis that examined gait in adults with neurological disorders, which only yielded studies including Parkinson’s disease (PD) and stroke patients. A meta-analysis was performed among trials presenting with similar characteristics, including study population and outcome measure. If heterogeneity was >50% (denoted by I2), random plot analysis was used, otherwise, a fixed plot analysis was performed. All analyses used effect sizes and standard errors and a p < 0.05 threshold was considered statistically significant (denoted by *). Overall, the effect of treadmill intervention on cadence (z = 6.24 *, I2 = 11.5%) and step length (z = 2.25 *, I2 = 74.3%) in adults with stroke was significant. We also found a significant effect of treadmill intervention on paretic step length (z = 2.34 *, I2 = 0%) and stride length (z = 6.09 *, I2 = 45.5%). For the active control group, including adults with PD, we found that overground physical therapy training had the largest effect on step width (z = −3.75 *, I2 = 0%). Additionally, for PD adults in treadmill intervention studies, we found the largest significant effect was on step length (z = 2.73 *, I2 = 74.2%) and stride length (z = −2.54 *, I2 = 96.8%). Conclusion: Treadmill intervention with sensory stimulation and body weight support treadmill training were shown to have the largest effect on step length in adults with PD and stroke.
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Affiliation(s)
- Alka Bishnoi
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
| | - Rachel Lee
- Department of Solid Organ Transplant, University of Chicago Medical Center, Chicago, IL 60637, USA;
| | - Yang Hu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
| | - Jeannette R. Mahoney
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Manuel E. Hernandez
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (A.B.); (Y.H.)
- Correspondence:
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10
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de Almeida FO, Santana V, Corcos DM, Ugrinowitsch C, Silva-Batista C. Effects of Endurance Training on Motor Signs of Parkinson's Disease: A Systematic Review and Meta-Analysis. Sports Med 2022; 52:1789-1815. [PMID: 35113386 DOI: 10.1007/s40279-022-01650-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Evidence has demonstrated that endurance training (ET) reduces the motor signs of Parkinson's disease (PD). However, there has not been a comprehensive meta-analysis of studies to date. OBJECTIVE The aim of this study was to compare the effect of ET versus nonactive and active control conditions on motor signs as assessed by either the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) or Movement Disorder Society-UPDRS-III (MDS-UPDRS-III). METHODS A random-effect meta-analysis model using standardized mean differences (Hedges' g) determined treatment effects. Moderators (e.g., combined endurance and physical therapy training [CEPTT]) and meta-regressors (e.g., number of sessions) were used for sub-analyses. Methodological quality was assessed by the Physiotherapy Evidence Database. RESULTS Twenty-seven randomized controlled trials (RCTs) met inclusion criteria (1152 participants). ET is effective in decreasing UPDRS-III scores when compared with nonactive and active control conditions (g = - 0.68 and g = - 0.33, respectively). This decrease was greater (within- and between-groups average of - 8.0 and - 6.8 point reduction on UPDRS-III scores, respectively) than the moderate range of clinically important changes to UPDRS-III scores (- 4.5 to - 6.7 points) suggested for PD. Although considerable heterogeneity was observed between RCTs (I2 = 74%), some moderators that increased the effect of ET on motor signs decreased the heterogeneity of the analyses, such as CEPTT (I2 = 21%), intensity based on treadmill speed (I2 = 0%), self-perceived exertion rate (I2 = 33%), and studies composed of individuals with PD and freezing of gait (I2 = 0%). Meta-regression did not produce significant relationships between ET dosage and UPDRS-III scores. CONCLUSIONS ET is effective in decreasing UPDRS-III scores. Questions remain about the dose-response relationship between ET and reduction in motor signs.
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Affiliation(s)
| | - Vagner Santana
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo, Brazil
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Carlos Ugrinowitsch
- Laboratory of Adaptations To Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Carla Silva-Batista
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo, Brazil. .,School of Arts, Sciences and Humanities of University of São Paulo, St. Arlindo Béttio, 1000, 03828-000, Vila Guaraciaba, São Paulo, Brazil. .,Laboratory of Adaptations To Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
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11
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Dong S, Wang Y, Wei H, Du S, Li X, Zhu J, Wang Y, Cai Z. Effects of Baduanjin Exercise on Rehabilitation of Patients With Mild to Moderate Parkinson’s Disease. Front Neurosci 2022; 15:827180. [PMID: 35126049 PMCID: PMC8811304 DOI: 10.3389/fnins.2021.827180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives Rehabilitation, aerobic exercise, and many traditional Chinese exercises are known to significantly improve balance in patients with Parkinson’s disease. Baduanjin, a traditional physical and mental exercise, has long been practiced for health care as it regulates organs, the nervous and motor systems. Methods We recruited 31 eligible participants. Patients underwent a 3-week Baduanjin program, including 35-min exercise daily. Scores on the Modified Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Non-motor Symptoms Scale (NMSS), and gait and balance tests were compared before and after the Baduanjin program. Results MDS-UPDRS-total (t = 4.669, P ≤ 0.001), MDS-UPDRS part-I (t = 5.805, P ≤ 0.001), MDS-UPDRS part-II (t = 5.234, P ≤ 0.001), MDS-UPDRS part-III (t = 3.274, P = 0.003), and NMSS (t = 4.815, P ≤ 0.001) scores significantly decreased after the 3-week intervention. Gait parameters like step (t = 2.289, P = 0.030) and cycle (t = 2.181, P = 0.038) durations also significantly improved, while Balance-check® indicators, including the total score (t = −2.147, P = 0.041) and grade (t = 3.432, P = 0.002) significantly differed before and after exercise. Conclusion Baduanjin exercise shows beneficial effects for non-motor symptoms, balance, gait, and daily activities in patients with Parkinson’s disease. Baduanjin can be included in the patients’ family exercise, which is conducive to their rehabilitation, as well as for obtaining important social and economic benefits. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [ChiCTR-IPR-17011875].
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Affiliation(s)
- Shuangshuang Dong
- Department of Neurology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
- Department of Neurology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
| | - Yiqing Wang
- Department of Neurology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Hongyu Wei
- Department of Neurology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Shouyun Du
- Department of Neurology, Guanyun People’s Hospital, Lianyungang, China
| | - Xiaojing Li
- Department of Neurology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Jianbing Zhu
- Department of Radiology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Yi Wang
- Department of Radiology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Zenglin Cai
- Department of Neurology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
- Department of Neurology, Gusu University of Nanjing Medical University, Suzhou, China
- Department of Neurology, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
- *Correspondence: Zenglin Cai,
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12
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Lee HS, Shim SR, Kim JH, Ko M. Effects of curved path walking compared to straight path walking in older adults with cognitive deficits: A systematic review and network meta-analysis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1935. [PMID: 35037347 DOI: 10.1002/pri.1935] [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: 09/16/2021] [Revised: 12/03/2021] [Accepted: 12/30/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether the existing literature provides evidence that curved path walking time can be a reliable marker of cognitive impairment among older adults using a network meta-analysis (NMA). DATA SOURCES PubMed, Web of Science, ScienceDirect, Scopus, and Korean Studies Information Service System (KSISS) electronic databases were searched in December 2019. STUDY SELECTION Studies that included the following variables were selected: (P): patients with cognitive impairment, (I): straight path versus curved path walking, (C): control group without cognitive impairment, (O): walking time, and (S): cross-sectional or longitudinal study design. In total, 21 studies were selected for the NMA, which was performed to compare the standardized mean difference (SMD) of walking time on curved and straight paths. RESULTS Older adults with dementia had significantly longer walking times than older adults with mild cognitive impairment (MCI) for both straight path walking and curved path walking. The SMD of straight path walking time was 0.59 (95% credible interval [CrI]: 0.39, 0.81) for older adults with MCI and 0.90 (95% CrI: 0.65, 1.16) for older adults with dementia. The SMD of walking time on a curved path was 0.52 (95% CrI: -0.22, 1.26) for older adults with MCI and 1.98 (95% CrI: 1.20, 2.92) for those with dementia. In older adults with dementia, the correlation coefficient of the Fisher's z value was higher for curved path walking than for straight path walking. CONCLUSION The way people with dementia walk exhibits signs of cognitive impairments. NMA confirmed that older adults with dementia requires significantly longer time to walk the same distance than healthy controls or older adults with MCI for both curved and straight path walking.
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Affiliation(s)
- Han Suk Lee
- Department of Physical Therapy, University of Eulji, Seongnam-si, Korea
| | - Sung Ryul Shim
- Department of Preventive Medicine, Korea University College of Medicine and School of Medicine, Seoul, Korea
| | - Jun Ho Kim
- Department of Physical Therapy, University of Eulji, Seongnam-si, Korea
| | - Mansoo Ko
- Department of Physical Therapy, University of Texas Medical Branch, Galveston, Texas, USA
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13
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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: 48] [Impact Index Per Article: 16.0] [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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14
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D'Cruz N, Seuthe J, De Somer C, Hulzinga F, Ginis P, Schlenstedt C, Nieuwboer A. Dual Task Turning in Place: A Reliable, Valid, and Responsive Outcome Measure of Freezing of Gait. Mov Disord 2021; 37:269-278. [PMID: 34939224 DOI: 10.1002/mds.28887] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/31/2021] [Accepted: 11/24/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Freezing of gait (FOG) is a complex symptom in Parkinson's disease (PD) that is both elusive to elicit and varied in its presentation. These complexities present a challenge to measuring FOG in a sensitive and reliable way, precluding therapeutic advancement. OBJECTIVE We investigated the reliability, validity, and responsiveness of manual video annotations of the turning-in-place task and compared it to the sensor-based FOG ratio. METHODS Forty-five optimally medicated people with PD and FOG performed rapid alternating 360° turns without and with an auditory stroop dual task, thrice over two consecutive days. The tasks were video recorded, and inertial sensors were placed on the lower back and shins. Interrater reliability between three raters, criterion validity with self-reported FOG, and responsiveness to single-session split-belt treadmill (SBT) training were investigated and contrasted with the sensor-based FOG ratio. RESULTS Visual ratings showed excellent agreement between raters for the percentage time frozen (%TF) (ICC [intra-class correlation coefficient] = 0.99), the median duration of a FOG episode (ICC = 0.90), and the number of FOG episodes (ICC = 0.86). Dual tasking improved the sensitivity and validity of visual FOG ratings resulting in increased FOG detection, criterion validity with self-reported FOG ratings, and responsiveness to a short SBT intervention. The sensor-based FOG ratio, on the contrary, showed complex FOG presentation-contingent relationships with visual and self-reported FOG ratings and limited responsiveness to SBT training. CONCLUSIONS Manual video annotations of FOG during dual task turning in place generate reliable, valid, and sensitive outcomes for investigating therapeutic effects on FOG. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Jana Seuthe
- Department of Neurology, Christian-Albrechts-University (CAU) Kiel, University Hospital Schleswig-Holstein, Kiel, Germany.,Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Clara De Somer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Femke Hulzinga
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Pieter Ginis
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Christian Schlenstedt
- Department of Neurology, Christian-Albrechts-University (CAU) Kiel, University Hospital Schleswig-Holstein, Kiel, Germany.,Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
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15
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Cui CK, Lewis SJG. Future Therapeutic Strategies for Freezing of Gait in Parkinson's Disease. Front Hum Neurosci 2021; 15:741918. [PMID: 34795568 PMCID: PMC8592896 DOI: 10.3389/fnhum.2021.741918] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/05/2021] [Indexed: 12/28/2022] Open
Abstract
Freezing of gait (FOG) is a common and challenging clinical symptom in Parkinson’s disease. In this review, we summarise the recent insights into freezing of gait and highlight the strategies that should be considered to improve future treatment. There is a need to develop individualised and on-demand therapies, through improved detection and wearable technologies. Whilst there already exist a number of pharmacological (e.g., dopaminergic and beyond dopamine), non-pharmacological (physiotherapy and cueing, cognitive training, and non-invasive brain stimulation) and surgical approaches to freezing (i.e., dual-site deep brain stimulation, closed-loop programming), an integrated collaborative approach to future research in this complex area will be necessary to systematically investigate new therapeutic avenues. A review of the literature suggests standardising how gait freezing is measured, enriching patient cohorts for preventative studies, and harnessing the power of existing data, could help lead to more effective treatments for freezing of gait and offer relief to many patients.
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Affiliation(s)
- Cathy K Cui
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia
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Polhemus A, Delgado-Ortiz L, Brittain G, Chynkiamis N, Salis F, Gaßner H, Gross M, Kirk C, Rossanigo R, Taraldsen K, Balta D, Breuls S, Buttery S, Cardenas G, Endress C, Gugenhan J, Keogh A, Kluge F, Koch S, Micó-Amigo ME, Nerz C, Sieber C, Williams P, Bergquist R, Bosch de Basea M, Buckley E, Hansen C, Mikolaizak AS, Schwickert L, Scott K, Stallforth S, van Uem J, Vereijken B, Cereatti A, Demeyer H, Hopkinson N, Maetzler W, Troosters T, Vogiatzis I, Yarnall A, Becker C, Garcia-Aymerich J, Leocani L, Mazzà C, Rochester L, Sharrack B, Frei A, Puhan M. Walking on common ground: a cross-disciplinary scoping review on the clinical utility of digital mobility outcomes. NPJ Digit Med 2021; 4:149. [PMID: 34650191 PMCID: PMC8516969 DOI: 10.1038/s41746-021-00513-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/09/2021] [Indexed: 02/08/2023] Open
Abstract
Physical mobility is essential to health, and patients often rate it as a high-priority clinical outcome. Digital mobility outcomes (DMOs), such as real-world gait speed or step count, show promise as clinical measures in many medical conditions. However, current research is nascent and fragmented by discipline. This scoping review maps existing evidence on the clinical utility of DMOs, identifying commonalities across traditional disciplinary divides. In November 2019, 11 databases were searched for records investigating the validity and responsiveness of 34 DMOs in four diverse medical conditions (Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, hip fracture). Searches yielded 19,672 unique records. After screening, 855 records representing 775 studies were included and charted in systematic maps. Studies frequently investigated gait speed (70.4% of studies), step length (30.7%), cadence (21.4%), and daily step count (20.7%). They studied differences between healthy and pathological gait (36.4%), associations between DMOs and clinical measures (48.8%) or outcomes (4.3%), and responsiveness to interventions (26.8%). Gait speed, step length, cadence, step time and step count exhibited consistent evidence of validity and responsiveness in multiple conditions, although the evidence was inconsistent or lacking for other DMOs. If DMOs are to be adopted as mainstream tools, further work is needed to establish their predictive validity, responsiveness, and ecological validity. Cross-disciplinary efforts to align methodology and validate DMOs may facilitate their adoption into clinical practice.
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Affiliation(s)
- Ashley Polhemus
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Laura Delgado-Ortiz
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Gavin Brittain
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, England
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle, UK
| | - Francesca Salis
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Heiko Gaßner
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Michaela Gross
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Cameron Kirk
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rachele Rossanigo
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Diletta Balta
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University hospitals Leuven, Leuven, Belgium
| | - Sara Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Gabriela Cardenas
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Christoph Endress
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Julia Gugenhan
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Alison Keogh
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Felix Kluge
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sarah Koch
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - M Encarna Micó-Amigo
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Corinna Nerz
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Chloé Sieber
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Parris Williams
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ronny Bergquist
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Magda Bosch de Basea
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Ellen Buckley
- Insigneo Institute, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Clint Hansen
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Lars Schwickert
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Kirsty Scott
- Insigneo Institute, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Sabine Stallforth
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Janet van Uem
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andrea Cereatti
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University hospitals Leuven, Leuven, Belgium
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle, UK
| | - Alison Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Letizia Leocani
- Department of Neurology, San Raffaele University, Milan, Italy
| | - Claudia Mazzà
- Insigneo Institute, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Basil Sharrack
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, England
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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17
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Gilat M, Ginis P, Zoetewei D, De Vleeschhauwer J, Hulzinga F, D'Cruz N, Nieuwboer A. A systematic review on exercise and training-based interventions for freezing of gait in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:81. [PMID: 34508083 PMCID: PMC8433229 DOI: 10.1038/s41531-021-00224-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/12/2021] [Indexed: 12/16/2022] Open
Abstract
Freezing of gait (FOG) in Parkinson's disease (PD) causes severe patient burden despite pharmacological management. Exercise and training are therefore advocated as important adjunct therapies. In this meta-analysis, we assess the existing evidence for such interventions to reduce FOG, and further examine which type of training helps the restoration of gait function in particular. The primary meta-analysis across 41 studies and 1838 patients revealed a favorable moderate effect size (ES = -0.37) of various training modalities for reducing subjective FOG-severity (p < 0.00001), though several interventions were not directly aimed at FOG and some included non-freezers. However, exercise and training also proved beneficial in a secondary analysis on freezers only (ES = -0.32, p = 0.007). We further revealed that dedicated training aimed at reducing FOG episodes (ES = -0.24) or ameliorating the underlying correlates of FOG (ES = -0.40) was moderately effective (p < 0.01), while generic exercises were not (ES = -0.14, p = 0.12). Relevantly, no retention effects were seen after cessation of training (ES = -0.08, p = 0.36). This review thereby supports the implementation of targeted training as a treatment for FOG with the need for long-term engagement.
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Affiliation(s)
- Moran Gilat
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium.
| | - Pieter Ginis
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Demi Zoetewei
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Joni De Vleeschhauwer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Femke Hulzinga
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
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18
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Hirono T, Ikezoe T, Yamagata M, Kato T, Umehara J, Yanase K, Nakao S, Tsuboyama T, Tabara Y, Matsuda F, Ichihashi N. Age-related changes in gait speeds and asymmetry during circular gait and straight-line gait in older individuals aged 60-79 years. Geriatr Gerontol Int 2021; 21:404-410. [PMID: 33780140 DOI: 10.1111/ggi.14150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/16/2021] [Accepted: 03/05/2021] [Indexed: 01/28/2023]
Abstract
AIM The present study aimed to investigate the age-related changes in gait speeds and asymmetry during circular and straight-line gaits among older adults aged 60-79 years. METHODS The study included 391 community-dwelling older adults aged >60 years, who participated in the Nagahama cohort study. They were assigned to four age groups: 60-64 years (early 60s), 65-69 years (late 60s), 70-74 years (early 70s) and 75-79 years (late 70s). For the circular gait test, the time required to walk twice around a 1-m diameter circle for right and left rotations were measured. The average time of the two trials was measured as the circular gait time, and the side-to-side difference in the circular gait times was calculated as an asymmetry index. Walking speed, asymmetry of step length, and asymmetry of stance duration time during straight-line gait at comfortable and maximal walking pace were measured. RESULTS Circular gait time in older women in the late 70s group was significantly slower than that in other age groups; however, no age-related change was observed in older men. Maximal gait speeds in the early and late 70s groups were significantly slower than those in the early 60s group. CONCLUSIONS Age-related decline in circular gait speed was observed in older women aged ≥75 years, but not in older men. Maximal straight-line gait speed decreased significantly in both genders after the age of 70 years. Geriatr Gerontol Int 2021; 21: 404-410.
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Affiliation(s)
- Tetsuya Hirono
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Tome Ikezoe
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Momoko Yamagata
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.,Department of Human Development, Graduate School of Human Development and Environment, Kobe University, Kobe, Japan
| | - Takehiro Kato
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.,Center for Information and Neural Networks, National Institute of Information and Communications Technology, Osaka, Japan
| | - Ko Yanase
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sayaka Nakao
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tadao Tsuboyama
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,School of Health Sciences, Bukkyo University, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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19
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Arêas FZDS, Nakamura-Palacios EM, Boening A, Arêas GPT, Nascimento LR. Does neuromodulation transcranial direct current stimulation (tDCS) associated with peripheral stimulation through exercise to walk have an impact on falls in people with Parkinson's disease? Med Hypotheses 2020; 144:109916. [PMID: 32526508 DOI: 10.1016/j.mehy.2020.109916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/14/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
Parkinson's disease (PD) is one of the most prevalent neurodegenerative diseases in the world, with a high degree of disability. Among the various therapeutic possibilities, brain stimulation appears in a promising approach, with deep brain stimulation (DBS) being the best described and successful, yet it has the limitation of being invasive. In this context we present transcranial direct current stimulation (tDCS), a non-invasive treatment that brings a new perspective when thinking about treatment of neurological diseases. It is easy to handle, low cost, few side effects and good adherence to patients. TDCS presents good evidence for clinical practice, but when it comes to PD the results obtained are inconclusive and some protocols have not yet been tested. In this hypothesis we propose that the use of tDCS applied in the supplemental motor areas, together with a gait training, can facilitate the motor learning and modulate the neurons for better potentiation of the exercises together with patients with walking difficulties due to PD.
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Affiliation(s)
- Fernando Zanela da Silva Arêas
- Center of Health Sciences, Discipline of Physical Therapy, Federal University of Espírito Santo (UFES), Vitória, ES, Brazil; Laboratory of Cognitive Sciences and Neuropsychopharmacology, Departament of Physiological Sciences, Federal University of Espírito Santo , Vitória, ES, Brazil
| | - Ester Miyuki Nakamura-Palacios
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Departament of Physiological Sciences, Federal University of Espírito Santo , Vitória, ES, Brazil
| | - Augusto Boening
- Center of Health Sciences, Discipline of Physical Therapy, Federal University of Espírito Santo (UFES), Vitória, ES, Brazil
| | | | - Lucas Rodrigues Nascimento
- Center of Health Sciences, Discipline of Physical Therapy, Federal University of Espírito Santo (UFES), Vitória, ES, Brazil; NeuroGroup, Department of Physical Therapy, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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20
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Kim DY, Oh HM, Bok SK, Chang WH, Choi Y, Chun MH, Han SJ, Han TR, Jee S, Jung SH, Jung HY, Jung TD, Kim MW, Kim EJ, Kim HS, Kim YH, Kim Y, Kim DY, Kim DY, Kim DK, Ko SH, Ko MH, Lee JK, Lee J, Lee SJ, Lee SG, Lim SH, Oh BM, Paik NJ, Park KD, Park SW, Park GY, Park JH, Park YG, Pyun SB, Ryu B, Seo HG, Shin YI, Sohn MK, Yang SN, Don Yoo S, Yoo WK. KSNR Clinical Consensus Statements: Rehabilitation of Patients with Parkinson's Disease. BRAIN & NEUROREHABILITATION 2020; 13:e17. [PMID: 36744191 PMCID: PMC9879460 DOI: 10.12786/bn.2020.13.e17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/09/2020] [Accepted: 05/18/2020] [Indexed: 11/08/2022] Open
Abstract
Clinical consensus statements (CCSs) aim to improve care for patients with Parkinson's disease (PD) and reduce the variability of rehabilitation methods in clinical practice. A literature search was conducted to find available evidence on the rehabilitation of patients with PD and to determine the scope of CCSs. The selection of PD rehabilitation domains and key questions was done using the modified Delphi method in 43 expert panels. These panels achieved a consensus on 11 key questions regarding rehabilitation assessment and goal setting, gait and balance, activities of daily living, and swallowing and communication disorders. After the completion of an agreement procedure, 11 key consensus statements were developed by the consensus panel. These statements addressed the needs of rehabilitation as a continuum in patients with PD. They included the appropriate rehabilitation initiation time, assessment items, rehabilitation contents, and complication management. This agreement can be used by physiatrists, rehabilitation therapists, and other practitioners who take care of patients with PD. The consensus panel also highlighted areas where a consensus could not be reached. The development of more focused CCS or clinical practice guidelines that target specific rehabilitation approaches is considered the next needed step.
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Affiliation(s)
| | - Doo Young Kim
- Department of Rehabilitation Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Hyun Mi Oh
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Soo-Kyung Bok
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yongmin Choi
- Department of Rehabilitation Medicine, School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo Jeong Han
- Department of Rehabilitation, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Tai-Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Han Young Jung
- Department of Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Min Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Eun Joo Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Hyoung Seop Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yongwook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine & Rehabilitation, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan, Korea
| | - Sam-Gyu Lee
- Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byungju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University, College of Medicine, Seoul, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine & Rehabilitation, Hallym University College of Medicine, Chuncheon, Korea
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21
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Rutz DG, Benninger DH. Physical Therapy for Freezing of Gait and Gait Impairments in Parkinson Disease: A Systematic Review. PM R 2020; 12:1140-1156. [PMID: 31994842 DOI: 10.1002/pmrj.12337] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 01/20/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Freezing of gait (FOG) is a major cause of falls and disability in Parkinson disease (PD). As FOG only partially improves in response to dopaminergic medication, physical therapy is an important element of its management. OBJECTIVE To assess the evidence for the physical interventions for FOG and gait impairments and to establish recommendations for clinical practice. LITERATURE SURVEY This review follows the guidelines for systematic reviews: the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Systematic search in PubMed, Embase, Physiotherapy Evidence Databases, and CINAHL for randomized controlled trials of PT interventions for FOG in PD patients until April 2018. SYNTHESIS Twenty randomized controlled trials (RCTs) were reviewed. In 12 RCTs, PT for FOG was assessed, which was the primary outcome measure in nine of these RCTs. In eight RCTs, PT for gait impairment (not targeting specifically FOG) in PD was assessed. The following PT interventions reduce FOG with a good category A recommendation: cueing strategies (P < .05) (visual and auditory); treadmill walking (P < .05); aquatic obstacle training (P < .01); supervised slackline training (P < .05). These interventions can be combined and maintain their efficacy when being applied concurrently: though there is a lack of long-term follow-up studies. The following PT interventions show possible benefit and need further investigations: balance and coordination training; aquatic gait training; sensory (tactile) cues. The treadmill training and auditory and visual cues are effective also for other gait disturbances in PD and improve gait kinematics. CONCLUSIONS Visual and auditory cueing and the treadmill training are effective interventions for FOG and gait impairments in PD patients (evidence level A- according to the European Federation of Neurological Societies). Tactile cues and other specific therapies targeting FOG are probably effective but need further studies.
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Affiliation(s)
- Dionys G Rutz
- Physical Therapy Unit, Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - David H Benninger
- Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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22
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Gao C, Liu J, Tan Y, Chen S. Freezing of gait in Parkinson's disease: pathophysiology, risk factors and treatments. Transl Neurodegener 2020; 9:12. [PMID: 32322387 PMCID: PMC7161193 DOI: 10.1186/s40035-020-00191-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background Freezing of gait (FOG) is a common, disabling symptom of Parkinson's disease (PD), but the mechanisms and treatments of FOG remain great challenges for clinicians and researchers. The main focus of this review is to summarize the possible mechanisms underlying FOG, the risk factors for screening and predicting the onset of FOG, and the clinical trials involving various therapeutic strategies. In addition, the limitations and recommendations for future research design are also discussed. Main body In the mechanism section, we briefly introduced the physiological process of gait control and hypotheses about the mechanism of FOG. In the risk factor section, gait disorders, PIGD phenotype, lower striatal DAT uptake were found to be independent risk factors of FOG with consistent evidence. In the treatment section, we summarized the clinical trials of pharmacological and non-pharmacological treatments. Despite the limited effectiveness of current medications for FOG, especially levodopa resistant FOG, there were some drugs that showed promise such as istradefylline and rasagiline. Non-pharmacological treatments encompass invasive brain and spinal cord stimulation, noninvasive repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) and vagus nerve stimulation (VNS), and physiotherapeutic approaches including cues and other training strategies. Several novel therapeutic strategies seem to be effective, such as rTMS over supplementary motor area (SMA), dual-site DBS, spinal cord stimulation (SCS) and VNS. Of physiotherapy, wearable cueing devices seem to be generally effective and promising. Conclusion FOG model hypotheses are helpful for better understanding and characterizing FOG and they provide clues for further research exploration. Several risk factors of FOG have been identified, but need combinatorial optimization for predicting FOG more precisely. Although firm conclusions cannot be drawn on therapeutic efficacy, the literature suggested that some therapeutic strategies showed promise.
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Affiliation(s)
- Chao Gao
- 1Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- 1Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyan Tan
- 1Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengdi Chen
- 1Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,2Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province China
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23
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Bekkers EMJ, Mirelman A, Alcock L, Rochester L, Nieuwhof F, Bloem BR, Pelosin E, Avanzino L, Cereatti A, Della Croce U, Hausdorff JM, Nieuwboer A. Do Patients With Parkinson's Disease With Freezing of Gait Respond Differently Than Those Without to Treadmill Training Augmented by Virtual Reality? Neurorehabil Neural Repair 2020; 34:440-449. [PMID: 32202203 DOI: 10.1177/1545968320912756] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background. People with Parkinson's disease and freezing of gait (FOG+) have more falls, postural instability and cognitive impairment compared with FOG-. Objective. To conduct a secondary analysis of the V-TIME study, a randomized, controlled investigation showing a greater reduction of falls after virtual reality treadmill training (TT + VR) compared with usual treadmill walking (TT) in a mixed population of fallers. We addressed whether these treadmill interventions led to similar gains in FOG+ as in FOG-. Methods. A total of 77 FOG+ and 44 FOG- were assigned randomly to TT + VR or TT. Participants were assessed pre- and posttraining and at 6 months' follow-up. Main outcome was postural stability assessed by the Mini Balance Evaluation System Test (Mini-BEST) test. Falls were documented using diaries. Other outcomes included the New Freezing of Gait Questionnaire (NFOG-Q) and the Trail Making Test (TMT-B). Results. Mini-BEST scores and the TMT-B improved in both groups after training (P = .001), irrespective of study arm and FOG subgroup. However, gains were not retained at 6 months. Both FOG+ and FOG- had a greater reduction of falls after TT + VR compared with TT (P = .008). NFOG-Q scores did not change after both training modes in the FOG+ group. Conclusions. Treadmill walking (with or without VR) improved postural instability in both FOG+ and FOG-, while controlling for disease severity differences. As found previously, TT + VR reduced falls more than TT alone, even among those with FOG. Interestingly, FOG itself was not helped by training, suggesting that although postural instability, falls and FOG are related, they may be controlled by different mechanisms.
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Affiliation(s)
| | - Anat Mirelman
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lisa Alcock
- Newcastle University, Newcastle upon Tyne, UK
| | | | - Freek Nieuwhof
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Elisa Pelosin
- University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Avanzino
- University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Cereatti
- University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Ugo Della Croce
- University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Jeffrey M Hausdorff
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rush University Medical Center, Chicago, IL, USA
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24
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D'Cruz N, Vervoort G, Fieuws S, Moreau C, Vandenberghe W, Nieuwboer A. Repetitive Motor Control Deficits Most Consistent Predictors of Conversion to Freezing of Gait in Parkinson's Disease: A Prospective Cohort Study. JOURNAL OF PARKINSONS DISEASE 2020; 10:559-571. [PMID: 32039860 DOI: 10.3233/jpd-191759] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The onset of freezing of gait (FOG) represents a turning point in the lives of patients with Parkinson's disease (PD). FOG increases fall risk and is associated with worse physical and mental health related quality of life, thus increasing disease burden. Moreover, therapeutic studies aiming to ameliorate freezing have had limited success. In a step towards pre-emptive therapy to delay or prevent the onset of FOG, this prospective cohort study set out to uncover clinical markers of conversion to FOG. OBJECTIVE Investigate clinical markers of conversion to FOG. METHODS Sixty PD patients without FOG were followed up for two years and underwent extensive clinical testing each year. FOG classification was made with the New Freezing of Gait Questionnaire. Clinical predictors of conversion to FOG were investigated using univariate analysis and through building a multivariable model using all measured components. RESULTS Twelve patients developed FOG during the study (Incidence: 11.5% per year). Due to the large number of predictors, univariate analyses did not survive multiple comparison correction, precluding strong inference on any one predictor. Overall, the effect sizes suggested that motor deficits including difficulties with repetitive movement scaling (AUC: 0.71), coordination (AUC: 0.73) and consistency (AUC: 0.76) as well as gait asymmetry (AUC: 0.79) and variability (AUC: 0.71) were most predictive of conversion. Further, converters reported more subjective cognitive difficulty (AUC: 0.74), although their measured performance was similar to non-converters. Multivariable analyses further showed that the two components most consistently selected in the predictive model were: 1) an MDS-UPDRS component with worse axial motor, hand use and non-motor symptoms; and 2) finger tapping abnormalities. CONCLUSION Conversion to FOG was predicted mainly by objective and clinical measures of motor dyscontrol, as non-motor disturbances were surfacing. Although based on a small cohort with limited converters, this novel finding informs future studies aimed at FOG prevention.
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Affiliation(s)
- Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Griet Vervoort
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Steffen Fieuws
- KU Leuven, Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Caroline Moreau
- University of Lille, Expert Center for Parkinson Disease, CHU Lille, Inserm UMR, France
| | - Wim Vandenberghe
- KU Leuven, Department of Neurosciences, Laboratory for Parkinson Research, Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
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25
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Cosentino C, Baccini M, Putzolu M, Ristori D, Avanzino L, Pelosin E. Effectiveness of Physiotherapy on Freezing of Gait in Parkinson's Disease: A Systematic Review and Meta‐Analyses. Mov Disord 2019; 35:523-536. [DOI: 10.1002/mds.27936] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/31/2019] [Accepted: 11/12/2019] [Indexed: 01/02/2023] Open
Affiliation(s)
- Carola Cosentino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health University of Genova Genova Italy
| | - Marco Baccini
- Motion Analysis Laboratory, Unit of Functional Rehabilitation Azienda Sanitaria di Firenze Florence Italy
| | - Martina Putzolu
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health University of Genova Genova Italy
| | - Diego Ristori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health University of Genova Genova Italy
| | - Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology University of Genoa Genoa Italy
- Ospedale Policlinico San Martino‐IRCCS Genoa Italy
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health University of Genova Genova Italy
- Ospedale Policlinico San Martino‐IRCCS Genoa Italy
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26
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Delgado-Alvarado M, Marano M, Santurtún A, Urtiaga-Gallano A, Tordesillas-Gutierrez D, Infante J. Nonpharmacological, nonsurgical treatments for freezing of gait in Parkinson's disease: A systematic review. Mov Disord 2019; 35:204-214. [PMID: 31769904 DOI: 10.1002/mds.27913] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/20/2019] [Accepted: 09/27/2019] [Indexed: 01/12/2023] Open
Abstract
Freezing of gait is a disabling phenomenon that appears in a substantial number of Parkinson's disease (PD) patients as the disease evolves. It is considered to be one of the most relevant contributing factors to worsening of quality of life. Current pharmacological or surgical treatment options have limited efficacy. Thus, alternative nonpharmacological/nonsurgical approaches have emerged in recent years in an attempt to improve quality of life in PD. This systematic review summarizes studies of such therapies over the past 5 years. Thirty-five studies were evaluated by use of a qualitative evaluation, while the methodological quality was assessed using validated tools. According to our results, there appear to be two broad categories of nonpharmacological therapies: those that seek a long-lasting benefit and those that aim to achieve a transient effect to overcome the freezing of gait episode. Among the former, it is possible to differentiate between "passive" therapies, which include transcranial magnetic stimulation or transcranial direct current stimulation, and "active" therapies, which are based on different cognitive or physical training programs. Finally, "transient effect" therapies use different types of cues, such as visual, auditory, or proprioceptive stimuli, to attempt to shift the patient's habitual motor control to a goal-directed one. In conclusion, a broad spectrum of nonpharmacological/nonsurgical approaches for freezing of gait has emerged in recent years with promising results. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Manuel Delgado-Alvarado
- Neurology Department, Sierrallana Hospital, Torrelavega, Spain.,Psychiatry Research Area, IDIVAL, University Hospital Marqués de Valdecilla, Santander, Spain.,Biomedical Research Networking Center for Mental Health (CIBERSAM), Madrid, Spain
| | - Massimo Marano
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Ana Santurtún
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain
| | | | - Diana Tordesillas-Gutierrez
- Biomedical Research Networking Center for Mental Health (CIBERSAM), Madrid, Spain.,Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL, Santander, Spain
| | - Jon Infante
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain.,Centro de investigación en red de enfermedades neurodegenerativas (CIBERNED), Madrid, Spain
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27
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Abstract
Parkinson's disease (PD) is one of the most common neurodegenerative diseases in the world. Unfortunately, most of the currently used clinical therapies against PD are symptomatic and there is still no remedy can stop disease progression. Collective evidence shows that various kinds of exercise may reduce the risk of PD and do have positive impacts on both motor and nonmotor symptoms of PD. Additionally, exercise can also ameliorate the side effects such as wearing-off and dyskinesia induced by anti-PD therapeutics. In parallel with its benefits in ameliorating clinical symptoms, exercise modulates a range of supporting systems for brain maintenance and plasticity including neurogenesis, synaptogenesis, enhanced metabolism and angiogenesis. Exercise provides all these broad benefits on PD through inhibiting oxidative stress, repairing mitochondrial damage, and promoting the production of growth factors. Moreover, exercise reduces risk of other geriatric diseases such as diabetes, hypertension and cardiovascular disease, which may also contribute to PD pathogenesis. In summary, exercise is increasingly considered to be a complementary strategy to PD medications. In this chapter, we summarize the recent research progress on the beneficial effects of exercise on PD, discuss the underlying mechanisms, and highlight the promising prospects of exercise for antiparkinsonian therapy.
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Affiliation(s)
- Xiaojiao Xu
- Center for Clinical Research on Neurological Diseases, The First Affiliated Hospital, Dalian Medical University, Dalian, China; Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Zhenfa Fu
- Center for Clinical Research on Neurological Diseases, The First Affiliated Hospital, Dalian Medical University, Dalian, China; Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Weidong Le
- Center for Clinical Research on Neurological Diseases, The First Affiliated Hospital, Dalian Medical University, Dalian, China; Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital, Dalian Medical University, Dalian, China.
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28
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Yang YR, Cheng SJ, Lee YJ, Liu YC, Wang RY. Cognitive and motor dual task gait training exerted specific training effects on dual task gait performance in individuals with Parkinson's disease: A randomized controlled pilot study. PLoS One 2019; 14:e0218180. [PMID: 31220121 PMCID: PMC6586283 DOI: 10.1371/journal.pone.0218180] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/28/2019] [Indexed: 11/25/2022] Open
Abstract
Gait impairments in Parkinson’s disease (PD) are aggravated under dual task conditions. Providing effective training to enhance different dual task gait performance is important for PD rehabilitation. This pilot study aimed to investigate the effects of cognitive and motor dual task gait training on dual task gait performance in PD. Eighteen PD participants (n = 6 per training group) were assigned to cognitive dual task gait training (CDTT), motor dual task gait training (MDTT), or general gait training (control) group randomly. The training was 30 min each session, 3 sessions per week for 4 weeks. Primary outcomes including gait performance during cognitive dual task, motor dual task, and single walking were assessed at pre- and post-training. The results showed decreased double support time during cognitive dual task walking after CDTT (-17.1±10.3%) was significantly more than MDTT (6.3±25.6%, p = .006) and control training (-5.6±7.8%, p = .041). Stride time variability during motor dual task walking decreased more after MDTT (-16.3±32.3%) than CDTT (38.6±24.0%, p = .015) and control training (36.8±36.4%, p = .041). CDTT also improved motor dual task walking performance especially on gait speed (13.8±10.71%, p = .046) stride length (10.5±6.6%, p = .046), and double support time (-8.0±2.0%, p = .028). CDTT improved single walking performance as well on gait speed (11.4±5.5%, p = .046), stride length (9.2±4.6%, p = .028), and double support time (-8.1±3.0%, p = .028). In summary, our preliminary data showed 12-session of CDTT decreased double support time during cognitive dual task walking, and MDTT reduced gait variability during motor dual task walking. Different training strategy can be adopted for possibly different training effects in people with PD.
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Affiliation(s)
- Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jung Cheng
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yu-Ju Lee
- Department of Rehabilitation Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Yan-Ci Liu
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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29
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Godi M, Giardini M, Schieppati M. Walking Along Curved Trajectories. Changes With Age and Parkinson's Disease. Hints to Rehabilitation. Front Neurol 2019; 10:532. [PMID: 31178816 PMCID: PMC6543918 DOI: 10.3389/fneur.2019.00532] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/03/2019] [Indexed: 01/11/2023] Open
Abstract
In this review, we briefly recall the fundamental processes allowing us to change locomotion trajectory and keep walking along a curved path and provide a review of contemporary literature on turning in older adults and people with Parkinson's Disease (PD). The first part briefly summarizes the way the body exploits the physical laws to produce a curved walking trajectory. Then, the changes in muscle and brain activation underpinning this task, and the promoting role of proprioception, are briefly considered. Another section is devoted to the gait changes occurring in curved walking and steering with aging. Further, freezing during turning and rehabilitation of curved walking in patients with PD is mentioned in the last part. Obviously, as the research on body steering while walking or turning has boomed in the last 10 years, the relevant critical issues have been tackled and ways to improve this locomotor task proposed. Rationale and evidences for successful training procedures are available, to potentially reduce the risk of falling in both older adults and patients with PD. A better understanding of the pathophysiology of steering, of the subtle but vital interaction between posture, balance, and progression along non-linear trajectories, and of the residual motor learning capacities in these cohorts may provide solid bases for new rehabilitative approaches.
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Affiliation(s)
- Marco Godi
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Pavia, Italy
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Pavia, Italy
| | - Marco Schieppati
- Department of Exercise and Sport Science, International University of Health, Exercise and Sports, LUNEX University, Differdange, Luxembourg
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30
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Lee HS, Ko M, Park SW, Braden H. Concurrent validity of the Groningen Meander Walking and Timed Up and Go tests in older adults with dementia. Physiother Theory Pract 2019; 36:1432-1437. [PMID: 30739570 DOI: 10.1080/09593985.2019.1579285] [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] [Indexed: 10/27/2022]
Abstract
Background and Purpose: The Groningen Meander Walking time (GMW-sec) test has not been clinically validated as a feasible assessment to test functional mobility skills. The purpose of this study was to determine the concurrent validity of the GMW-sec test with the Timed Up and Go (TUG) test in older adults with dementia. Methods: This study included a cross-sectional and between subjects design with one factor, which had three different levels of group. Consecutive sampling was used to recruit 145 elderly participants in dementia and senior care facilities. Participants were divided into three groups based on the result of a Mini-Mental Status Exam for Dementia Screening: 57 older adults with dementia, 25 older adults with mild cognitive impairment, and 63 healthy older adults. Results: Spearman rank order correlation showed that the TUG test had moderate association with the GMW-sec test not only in older adults with dementia (r = 0.69; p < 0.01), but also for the mild cognitive group (r = 0.63; p = 0.01) and healthy group (r = 0.47; p < 0.01). Older adults with dementia had a significant functional reduction for both GMW-sec and TUG tests compared to other two groups (p < 0.01). Discussion and Conclusion: Turning motions with the TUG test may cause similar challenges that relate to a curved walking path for the GMW-sec test in older adults with dementia. Both the TUG and GMW-sec tests could be effective approaches for screening the severity of cognitive impairment on functional mobility in people with dementia.
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Affiliation(s)
- Han-Suk Lee
- Department of Physical Therapy, Eulji University , Seongnam-si, Gyeonggi-do, South Korea
| | - Mansoo Ko
- Department of Physical Therapy, University of Texas Medical Branch , Galveston, Texas, USA
| | - Sun-Wook Park
- Department of Physical Therapy, Samsung Medical Center , Gangnam-gu, Seoul, South Korea
| | - Heather Braden
- Department of Physical Therapy, Angelo State University , San Angelo, Texas, USA
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31
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Spildooren J, Vinken C, Van Baekel L, Nieuwboer A. Turning problems and freezing of gait in Parkinson’s disease: a systematic review and meta-analysis. Disabil Rehabil 2018; 41:2994-3004. [DOI: 10.1080/09638288.2018.1483429] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Joke Spildooren
- REVAL – Rehabilitation Research Center, BIOMED – Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Cathérine Vinken
- REVAL – Rehabilitation Research Center, BIOMED – Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Laura Van Baekel
- REVAL – Rehabilitation Research Center, BIOMED – Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation, KU Leuven, Leuven, Belgium
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32
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Freezing of gait: Promising avenues for future treatment. Parkinsonism Relat Disord 2018; 52:7-16. [PMID: 29550375 DOI: 10.1016/j.parkreldis.2018.03.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/19/2018] [Accepted: 03/10/2018] [Indexed: 01/17/2023]
Abstract
Freezing of gait is a devastating symptom of Parkinson's disease and other forms of parkinsonism. It poses a major burden on both patients and their families, as freezing often leads to falls, fall-related injuries and a loss of independence. Treating freezing of gait is difficult for a variety of reasons: it has a paroxysmal and unpredictable nature; a multifaceted pathophysiology, with an interplay between motor elements (disturbed stepping mechanisms) and non-motor elements (cognitive decline, anxiety); and a complex (and likely heterogeneous) underlying neural substrate, involving multiple failing neural networks. In recent years, advances in translational neuroscience have offered new insights into the pathophysiology underlying freezing. Furthermore, the mechanisms behind the effectiveness of available treatments (or lack thereof) are better understood. Driven by these concepts, researchers and clinicians have begun to improve currently available treatment options, and develop new and better treatment methods. Here, we evaluate the range of pharmacological (i.e. closed-looped approaches), surgical (i.e. multi-target and adaptive deep brain and spinal cord stimulation) and behavioural (i.e. biofeedback and cueing on demand) treatment options that are under development, and propose novel avenues that are likely to play a crucial role in the clinical management of freezing of gait in the near future. The outcomes of this review suggest that the successful future management of freezing of gait will require individualized treatments that can be implemented in an on-demand manner in response to imminent freezing. With this review we hope to guide much-needed advances in treating this devastating symptom of Parkinson's disease.
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