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Tedeschi R. Automated mechanical peripheral stimulation for gait rehabilitation in Parkinson's disease: A comprehensive review. Clin Park Relat Disord 2023; 9:100219. [PMID: 37780489 PMCID: PMC10539662 DOI: 10.1016/j.prdoa.2023.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023] Open
Abstract
Background Automated Mechanical Peripheral Stimulation (AMPS) has emerged as a potential rehabilitative intervention for gait abnormalities in Parkinson's disease (PD). However, the long-term effects and combined therapy with physical exercise remain unclear. This review aimed to explore the effects of automated mechanical peripheral stimulation (AMPS) on gait and motor performance in individuals with Parkinson's disease (PD). Methods A research was conducted in relevant databases to identify studies investigating the effects of AMPS on gait and motor outcomes in PD patients. Inclusion criteria were set based on Population, Concept, and Context (PCC) criteria. Data extraction and analysis were performed to synthesize the findings. Results Ten studies met the inclusion criteria and were included in the review. The studies collectively demonstrated positive effects of AMPS on gait parameters, such as walking velocity, stride length, and walking stability. Some studies also reported improvements in functional performance and muscle activation during walking. Conclusions The findings suggest that AMPS holds promise as a potential intervention to improve gait and motor performance in individuals with PD. However, the evidence is limited, and further well-designed randomized controlled trials are needed to establish the long-term efficacy and optimal protocols for AMPS in PD rehabilitation.
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Affiliation(s)
- Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Brognara L, Mafla-España MA, Gil-Molina I, Castillo-Verdejo Y, Cauli O. The Effects of 3D Custom Foot Orthotics with Mechanical Plantar Stimulation in Older Individuals with Cognitive Impairment: A Pilot Study. Brain Sci 2022; 12:brainsci12121669. [PMID: 36552129 PMCID: PMC9775314 DOI: 10.3390/brainsci12121669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Recent scientific evidence supports the idea that foot plantar stimulation increases the functional connectivity of brain regions involved in visuo-spatial and sensory-motor integration. In this before−after, non-randomised intervention study we assessed the change in several gait and postural parameters using inertial sensor measurements after acute plantar stimulation using custom 3D-printed insoles. The pilot study was performed on 22 institutionalised, older individuals with a high comorbidity burden who either walked autonomously or with the help of a cane. The intensity of the effects in the first mechanical plantar stimulation session (at one week) strongly predicted a change in the 180° turn duration (p < 0.05) and the standard deviation of the step duration (p < 0.05) during the timed up-and-go test. Based on these effects, researchers also predicted decreases in some postural parameters such as the root mean square of displacement on the anterior−posterior axis (p < 0.01). Thus, these preliminary findings provide a strong rationale for performing controlled clinical trials with larger samples to investigate the efficacy and mechanisms of mechanical plantar stimulation in frail elderly individuals.
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Affiliation(s)
- Lorenzo Brognara
- Department of Biomedical and Neuromotor Science, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy
- Correspondence:
| | - Mayra Alejandra Mafla-España
- Frailty and Cognitive Impairment Organized Group, University of Valencia, 46010 Valencia, Spain
- Department of Nursing, University of Valencia, Jaume Roig s/n, 46010 Valencia, Spain
| | | | | | - Omar Cauli
- Frailty and Cognitive Impairment Organized Group, University of Valencia, 46010 Valencia, Spain
- Department of Nursing, University of Valencia, Jaume Roig s/n, 46010 Valencia, Spain
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Marques NR, Kuroda MH, Moreno VC, Zámuner AR, Barbieri FA. Effects of automatic mechanical peripheral stimulation on gait biomechanics in older adults with Parkinson's disease: a randomized crossover clinical trial. Aging Clin Exp Res 2022; 34:1323-1331. [PMID: 35386097 DOI: 10.1007/s40520-022-02075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Automated mechanical peripheral stimulation (AMPS) is a rehabilitation technique suggested to correct gait abnormalities on Parkinson's disease. Although previous studies have suggested increments in functional performance and gait speed after AMPS intervention, little is known about its effect on gait biomechanics. OBJECTIVE To analyze the effect of an AMPS session on functional performance and gait biomechanics in subjects with Parkinson's disease. METHODS Twenty-eight subjects aged 67±3 years old participated in this study. Kinematics and muscle activation were recorded during walking at a preferred gait speed before and after AMPS and sham interventions. Footswitches sensors were used to record the kinematic parameters. Electromyographic (EMG) signals of tibialis anterior (TA) and gastrocnemius lateralis (GL) were recorded. Timed up and go (TUG) test and Short Physical Performance Battery (SPPB) were performed to assess functional performance. RESULTS GL activation increased after AMPS intervention before and after heel strike (p = 0.04; p < 0.01) and before and after toe-off (p = 0.013; p = 0.038). Also, after AMPS intervention, TA activation increased after heel strike (p = 0.007); and after sham intervention, TA activation reduced before and after heel strike (p = 0.038; and p = 0.007) and before toe-off (p = 0.013). The time of TUG test was shorter after AMPS intervention (p = 0.015). CONCLUSION AMPS intervention changed the EMG activation of ankle muscles during walking and functional performance. However, AMPS intervention did not change gait kinematics.
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Affiliation(s)
- Nise Ribeiro Marques
- Center of Healthy Science, Universidade do Sagrado Coração, USC, Rua Irmã Arminda, 10-50, Bauru, SP, CEP: 17011-160, Brazil.
| | - Marina Hiromi Kuroda
- Center of Healthy Science, Universidade do Sagrado Coração, USC, Rua Irmã Arminda, 10-50, Bauru, SP, CEP: 17011-160, Brazil
- Department of Physical Education, São Paulo State University, UNESP, Bauru, Brazil
| | - Vinicius Christianini Moreno
- Center of Healthy Science, Universidade do Sagrado Coração, USC, Rua Irmã Arminda, 10-50, Bauru, SP, CEP: 17011-160, Brazil
- Department of Physical Education, São Paulo State University, UNESP, Bauru, Brazil
| | - Antonio Roberto Zámuner
- Laboratorio de Investigación Clínica en Kinesiología, Department of Kinesiology, Universidad Católica del Maule, UCM, Talca, Chile
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Fujikawa J, Morigaki R, Yamamoto N, Oda T, Nakanishi H, Izumi Y, Takagi Y. Therapeutic Devices for Motor Symptoms in Parkinson’s Disease: Current Progress and a Systematic Review of Recent Randomized Controlled Trials. Front Aging Neurosci 2022; 14:807909. [PMID: 35462692 PMCID: PMC9020378 DOI: 10.3389/fnagi.2022.807909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pharmacotherapy is the first-line treatment option for Parkinson’s disease, and levodopa is considered the most effective drug for managing motor symptoms. However, side effects such as motor fluctuation and dyskinesia have been associated with levodopa treatment. For these conditions, alternative therapies, including invasive and non-invasive medical devices, may be helpful. This review sheds light on current progress in the development of devices to alleviate motor symptoms in Parkinson’s disease. Methods We first conducted a narrative literature review to obtain an overview of current invasive and non-invasive medical devices and thereafter performed a systematic review of recent randomized controlled trials (RCTs) of these devices. Results Our review revealed different characteristics of each device and their effectiveness for motor symptoms. Although invasive medical devices are usually highly effective, surgical procedures can be burdensome for patients and have serious side effects. In contrast, non-pharmacological/non-surgical devices have fewer complications. RCTs of non-invasive devices, especially non-invasive brain stimulation and mechanical peripheral stimulation devices, have proven effectiveness on motor symptoms. Nearly no non-invasive devices have yet received Food and Drug Administration certification or a CE mark. Conclusion Invasive and non-invasive medical devices have unique characteristics, and several RCTs have been conducted for each device. Invasive devices are more effective, while non-invasive devices are less effective and have lower hurdles and risks. It is important to understand the characteristics of each device and capitalize on these.
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Affiliation(s)
- Joji Fujikawa
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Ryoma Morigaki
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- *Correspondence: Ryoma Morigaki,
| | - Nobuaki Yamamoto
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Teruo Oda
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Hiroshi Nakanishi
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yuishin Izumi
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yasushi Takagi
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
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Zelada-Astudillo N, Moreno VC, Herrera-Santelices A, Barbieri FA, Zamunér AR. Effect of the combination of automated peripheral mechanical stimulation and physical exercise on aerobic functional capacity and cardiac autonomic control in patients with Parkinson's disease: a randomized clinical trial protocol. Trials 2021; 22:250. [PMID: 33823928 PMCID: PMC8025383 DOI: 10.1186/s13063-021-05177-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Automated peripheral mechanical stimulation (AMPS) has been proposed as a new complementary therapy with potential for improving motor and cardiovascular abnormalities in Parkinson's disease (PD). However, AMPS long-term effects and its combination with physical exercise are unknown. Thus, this study aims to compare the effects of a program of 12 weeks of physical exercise with a 12-week intervention program combining physical exercise and AMPS on the aerobic capacity, cardiac autonomic control, and gait parameters in patients with PD. METHODS A randomized, controlled clinical trial will be conducted. Older volunteers with PD will be randomly assigned to one of the two groups studied: (1) exercise or (2) AMPS + exercise. Both groups will undergo an exercise program of 24 sessions, for 12 weeks, performed twice a week. Before exercise sessions, the group AMPS + exercise will receive a session of active AMPS, while the group exercise will receive an AMPS sham intervention. Shapiro-Wilk's and Levene's tests will be used to check for data normality and homogeneity, respectively. In case parametric assumptions are fulfilled, per-protocol and intention-to-treat analyses will be performed using a mixed model analysis of variance to check for group*time interaction. Significance level will be set at 5%. DISCUSSION Several non-pharmacological treatment modalities have been proposed for PD, focusing primarily on the reduction of motor and musculoskeletal disorders. Regular exercise and motor training have been shown to be effective in improving quality of life. However, treatment options in general remain limited given the high prevalence and adverse impact of these disorders. So, developing new strategies that can potentiate the improvement of motor disabilities and also improve non-motor symptoms in PD is relevant. It is expected that the participants from both groups will improve their quality of life, gait parameters, and their cardiac autonomic control, with greater improvements being observed in the group combining active AMPS and physical exercise. TRIAL REGISTRATION ClinicalTrials.gov NCT04251728 . Registered on February 05, 2020.
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Affiliation(s)
- Nicolle Zelada-Astudillo
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Talca, Chile
| | - Vinicius Christianini Moreno
- São Paulo State University (UNESP), Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Andrea Herrera-Santelices
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Talca, Chile
- Servicio de Medicina Física y Rehabilitación, Hospital San Juan de Dios, Curicó, Chile
| | - Fabio Augusto Barbieri
- São Paulo State University (UNESP), Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Antonio Roberto Zamunér
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Talca, Chile.
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Pagnussat AS, Salazar AP, Pinto C, Redivo Marchese R, Rieder CRM, Alves Filho JO, Franco AR, Kleiner AFR. Plantar stimulation alters brain connectivity in idiopathic Parkinson's disease. Acta Neurol Scand 2020; 142:229-238. [PMID: 32299120 DOI: 10.1111/ane.13253] [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: 01/26/2020] [Revised: 03/25/2020] [Accepted: 04/11/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Individuals with Parkinson's disease (PD) and freezing of gait (FOG) present peripheral and central sensitivity disturbances that impair motor performance. This study aimed to investigate long-term effects of plantar sensory stimulation on brain activity, brain connectivity, and gait velocity of individuals with PD and FOG. METHODS Twenty-five participants were enrolled in this clinical trial (NCT02594540). Plantar sensory stimulation was delivered using the Automated Mechanical Peripheral Stimulation therapy (AMPS). Volunteers were randomly assigned to real or placebo AMPS groups and received eight sessions of treatment. The primary outcome was brain activity (task-based fMRI-active ankle dorsi-plantar flexion). Secondary outcomes were brain connectivity (resting state-RS fMRI) and gait velocity. fMRI was investigated on the left, right, and mid-sensory motor regions, left and right basal ganglia. RESULTS No changes in brain activity were observed when task-based fMRI was analyzed. After real AMPS, RS functional connectivity between basal ganglia and sensory-related brain areas increased (insular and somatosensory cortices). Gait velocity also increased after real AMPS. A positive correlation was found between gait velocity and the increased connectivity between sensory, motor and supplementary motor cortices. CONCLUSION Plantar sensory stimulation through AMPS was not able to modify brain activity. AMPS increased the RS brain connectivity mainly in areas related to sensory processing and sensorimotor integration. Plantar stimulation could be a way to improve plantar sensitivity and consequently ameliorate gait performance. However, the mechanisms behind the way AMPS influences brain pathways are still not completely known.
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Affiliation(s)
- Aline Souza Pagnussat
- Graduate Program in Rehabilitation Sciences Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
- Movement Analysis and Rehabilitation Laboratory Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | - Ana Paula Salazar
- Graduate Program in Rehabilitation Sciences Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
- Movement Analysis and Rehabilitation Laboratory Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | - Camila Pinto
- Graduate Program in Rehabilitation Sciences Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
- Movement Analysis and Rehabilitation Laboratory Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | - Ritchele Redivo Marchese
- Graduate Program in Rehabilitation Sciences Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
- Movement Analysis and Rehabilitation Laboratory Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | - Carlos R. M. Rieder
- Graduate Program in Rehabilitation Sciences Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | | | - Alexandre R. Franco
- Center for Biomedical Imaging and Neuromodulation Nathan S. Kline Institute for Psychiatric Research Orangeburg NY USA
- Center for the Developing Brain Child Mind Institute New York NY USA
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Mechanical somatosensory stimulation decreases blood pressure in patients with Parkinson's disease. J Hypertens 2020; 37:1714-1721. [PMID: 31107357 DOI: 10.1097/hjh.0000000000002084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The current study aimed to assess the effects of five cycles of automated mechanical somatosensory stimulation (AMSS) of the fore-feet on blood pressure (BP) and cardiovascular autonomic control in Parkinson's Disease patients. METHODS Out of 23 patients, 16 underwent an AMSS session every 72 h, for a total of five sessions per patient. Electrocardiogram, noninvasive beat-to-beat blood pressure and respiratory activity were recorded for 20 min in supine position at baseline and after the AMSS sessions. Main outcomes were the changes in SBP and DBP, in the spectral indices of cardiac sympathetic (LFRRn.u.) and vagal (HFRR) modulatory activities, cardiac sympathovagal relationship (LF/HF), vascular sympathetic modulation (LFSAP) and arterial baroreflex sensitivity (sequence technique). Symbolic analysis of heart rate variability provided additional indices of cardiac sympathetic (0V%) and vagal (2UV%) modulation to the sinoatrial node. RESULTS After five AMSS trials a reduction in SBP (baseline: 131.2 ± 15.5 mmHg; post-AMSS: 122.4 ± 16.2 mmHg; P = 0.0004) and DBP (baseline: 73.2 ± 6.1 mmHg; post-AMSS: 68.9 ± 6.2 mmHg; P = 0.008) was observed. Post-AMSS, spectral and symbolic indices of cardiovascular sympathetic control decreased and arterial baroreflex sensitivity increased (baseline: 5.7 ± 1.3 ms/mmHg; post-AMSS: 11.27 ± 2.7 ms/mmHg). CONCLUSION AMSS sessions were effective in reducing BP, increasing baroreflex sensitivity and decreasing cardiovascular sympathetic modulation in Parkinson's disease patients. AMSS might be useful to control supine hypertension in Parkinson's disease.
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Brognara L, Cauli O. Mechanical Plantar Foot Stimulation in Parkinson's Disease: A Scoping Review. Diseases 2020; 8:diseases8020012. [PMID: 32397588 PMCID: PMC7349899 DOI: 10.3390/diseases8020012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Parkinson′s disease (PD) is the second most prevalent neurodegenerative disease in older individuals. Neurorehabilitation-based interventions such as those improving gait are crucial for a holistic approach and to limit falls. Several studies have recently shown that mechanical plantar foot stimulation is a beneficial intervention for improving gait impairment in PD patients. The objective of this scoping review is to evaluate the beneficial effects of this stimulation on gait parameters, and to analyse protocols of foot stimulation and other effects in non-motor symptoms. Relevant articles were searched in the Medline database using Pubmed and Scopus, using the primary search terms ‘foot stimulation’ OR ‘plantar stimulation’ AND ‘Parkinson’s disease*’. Several protocols have been used for mechanical plantar foot stimulation (ranging from medical devices to textured insoles). The gait parameters that have been shown to be improved are stride length and walking speed. The beneficial effects are achieved after both acute and repeated plantar foot stimulation. Beneficial effects are observed in other organs and systems, such as muscle activation, brain connectivity, cardiovascular control in the central nervous system, and the release of brain-derived neurotrophic factor and cortisol in blood added evidence about this intervention’s impact on brain function. Mechanical plantar foot stimulation is a safe and effective add-on treatment able for improving gait impairments in PD patients during the L-dopa off state. Randomized and controlled clinical trials to study its eventual potentiating effect with different pharmacotherapy regimens are warranted.
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Affiliation(s)
- Lorenzo Brognara
- Department of Biomedical and Neuromotor Science, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy;
| | - Omar Cauli
- Frailty and Cognitive Impairment Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Department of Nursing, University of Valencia, c/Jaume Roig s/n, 46010 Valencia, Spain
- Correspondence:
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Viseux FJ. The sensory role of the sole of the foot: Review and update on clinical perspectives. Neurophysiol Clin 2020; 50:55-68. [DOI: 10.1016/j.neucli.2019.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/24/2019] [Accepted: 12/24/2019] [Indexed: 12/26/2022] Open
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Brognara L, Navarro-Flores E, Iachemet L, Serra-Catalá N, Cauli O. Beneficial Effect of Foot Plantar Stimulation in Gait Parameters in Individuals with Parkinson's Disease. Brain Sci 2020; 10:E69. [PMID: 32012779 PMCID: PMC7071420 DOI: 10.3390/brainsci10020069] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 11/17/2022] Open
Abstract
New treatments based on peripheral stimulation of the sensory-motor system have shown to be promising in rehabilitation strategies for patients with neurological disorders, including Parkinson's disease (PD), especially in regards to reducing gait impairment, and hence, the incidence of falls. The aim of this study was to evaluate the change in several gait parameters measured by sensor inertial measurement in PD patients after acute plantar stimulation, under the distal phalanx of the big toe, and underneath the head of the first metatarsal joint of both feet, using a 3D printing insole. In order to assess whether the effects are selective for PD patients, we compared the effect of the treatment in a control group (age-matched) consisting of patients with other neurological disorders which also displayed gait and balance impairment, and a similar cognitive function, depressive symptoms, body mass index, and comorbidity burden observed in the PD group. Plantar foot stimulation in PD patients eliminated the significant (p < 0.05) alterations existing in stride asymmetry and in stride variability. When comparing the effects of post-plantar stimulation with the respective basal level, considered as 100% in both groups, we observed a significant (p = 0.019, Mann-Whitney test) increase in stride length compared to basal in the PD group and control group. No significant effects of foot plantar stimulation were observed in any of the gait parameters in the control group. Plantar foot stimulation has a positive effect on the step and stride length, and has a positive effect on walking stability, measured by the increase in stride length. No significant effect was observed on bradykinesia because it did not improve walking velocity. These findings indicate that foot plantar stimulation using a 3D printing insole seems to generate a more stable walking pattern in PD patients, with an interesting applicability, and a low-cost, for reducing gait impairment in PD patients.
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Affiliation(s)
- Lorenzo Brognara
- Department of Biomedical and Neuromotor Science, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy; (L.B.); (L.I.)
| | - Emmanuel Navarro-Flores
- Frailty and cognitive impairment organized group, University of Valencia, 46010 Valencia, Spain;
- Department of Nursing, University of Valencia, c/Jaume Roig s/n, 4610 Valencia, Spain
| | - Lorenzo Iachemet
- Department of Biomedical and Neuromotor Science, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy; (L.B.); (L.I.)
| | | | - Omar Cauli
- Frailty and cognitive impairment organized group, University of Valencia, 46010 Valencia, Spain;
- Department of Nursing, University of Valencia, c/Jaume Roig s/n, 4610 Valencia, Spain
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Masiero S, Maghini I, Mantovani ME, Bakdounes L, Koutsikos K, Del Felice A, Sale P. Is the aquatic thermal environment a suitable place for providing rehabilitative treatment for person with Parkinson's disease? A retrospective study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:13-18. [PMID: 30397861 DOI: 10.1007/s00484-018-1632-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 05/24/2023]
Abstract
Many authors showed that aquatic physiotherapy could improve quality of life and reduce postural instability and risk of falling in elderly subjects. The aim of this research was to explore if the thermal aquatic environment is a suitable place for rehabilitative training in person with Parkinson disease (PwP) with results comparable to the standard physiotherapy. A retrospective study was conducted on a database of 14 persons with Parkinson who were admitted to a thermal aquatic rehabilitation to undergo treatments made to improve gait and balance impairments. The rehabilitation training consisted of 45-min sessions conducted twice a week, on non-consecutive days, over 4 weeks of functional re-education and kinesitherapy in the thermal pool. Educational and prevention instructions were also given to the patients during each session. Additionally, nutrition (diet), health education, and cognitive behavioral advice were given to our patients by therapists. The clinical characteristics of the sample were age 66 ± 9, disease duration 7 ± 5, and Hoehn and Yahr 1.5 ± 0.5. The statistical analysis showed a statistically significant improvement for the UPDRS p = 0.0005, for The Berg Balance Scale p = 0.0078, for the PDQ8 p = 0.0039, Tinetti p = 0.0068, and for Mini BESTest p = 0.0002. Our data suggest that this intervention could become a useful strategy in the rehabilitation program of PwP. The simplicity of treatment and the lack of side effects endorse the use of thermal aquatic environment for the gait and balance recovery in PwP.
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Affiliation(s)
- Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Irene Maghini
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Maria Eleonora Mantovani
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Leila Bakdounes
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Kostas Koutsikos
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Alessandra Del Felice
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Patrizio Sale
- Rehabilitation Department, Sant'Isidoro Hospital, Federazione Europea Ricerca Biomedica (FERB) Onlus, Trescore Balneario, BG, Italy.
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Pagnussat AS, Kleiner AFR, Rieder CRM, Frantz A, Ehlers J, Pinto C, Dorneles G, Netto CA, Peres A, Galli M. Plantar stimulation in parkinsonians: From biomarkers to mobility - randomized-controlled trial. Restor Neurol Neurosci 2018. [PMID: 29526852 DOI: 10.3233/rnn-170744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The decrease of Brain-Derived Neurotrophic Factor (BDNF) serum levels has been related to the pathophysiology of several neurodegenerative diseases as well as to neural plasticity and rehabilitation. Automated Mechanical Peripheral Stimulation (AMPS) has been investigated as a complementary therapy for Parkinson Disease (PD). OBJECTIVES (1) to investigate the effects of AMPS on BDNF and Cortisol serum levels of subjects with PD; (2) to evidence the interplay between BDNF and Cortisol serum levels and the functional mobility improvement after AMPS treatment. METHODS Thirty-three subjects with PD were randomized into two groups: effective stimulation (AMPS, n = 16) or placebo stimulation (AMPS SHAM, n = 17). Fourteen healthy aged-matched subjects were included as a reference group. Each AMPS group received eight sessions of treatment using a commercial medical device (Gondola™). BDNF and Cortisol serum levels, spatiotemporal gait parameters and TUG test were assessed at baseline and after eight sessions of treatment. RESULTS After the treatment, AMPS group showed significantly higher levels of BDNF and lower levels of Cortisol compared to AMPS SHAM. AMPS group also showed a positive effect on gait pattern as a higher improvement on gait velocity, stride length, and TUG performance was shown. CONCLUSION Effective AMPS treatment increased BDNF and decreased Cortisol serum levels and produced improvements in functional mobility.
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Affiliation(s)
- Aline Souza Pagnussat
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Ana F R Kleiner
- Politecnico di Milano, Dipartimento di Elettronica, Informazione e Bioingegneria, Milan, Italy
| | - Carlos R M Rieder
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Anapaula Frantz
- Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Jaira Ehlers
- Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Camila Pinto
- Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Gilson Dorneles
- Cellular and Molecular Immunology Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Carlos Alexandre Netto
- Department of Biochemistry, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Alessandra Peres
- Cellular and Molecular Immunology Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Research Center, Methodist University Center IPA, Porto Alegre, Brazil
| | - Manuela Galli
- Politecnico di Milano, Dipartimento di Elettronica, Informazione e Bioingegneria, Milan, Italy.,"Gait Analysis Lab" IRCCS San Raffaele Pisana, Rome, Italy
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Kleiner AFR, Souza Pagnussat A, Pinto C, Redivo Marchese R, Salazar AP, Galli M. Automated Mechanical Peripheral Stimulation Effects on Gait Variability in Individuals With Parkinson Disease and Freezing of Gait: A Double-Blind, Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 99:2420-2429. [PMID: 29902470 DOI: 10.1016/j.apmr.2018.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To assess the effects of automated peripheral stimulation (AMPS) in reducing gait variability of subjects with Parkinson disease (PD) and freezing of gait (FOG) treated with AMPS and to explore the effects of this treatment on gait during a single task (walking) and a dual task (walking while attending the word-color Stroop test). DESIGN Interventional, double-blinded, placebo-controlled, randomized trial. SETTING Clinical rehabilitation. PARTICIPANTS Thirty subjects were randomized into 2 groups: AMPS (n=15) and AMPS sham (n=15). INTERVENTIONS Both groups received 2 treatment sessions a week for 4 consecutive weeks (totaling 8 treatment sessions). AMPS was applied by using a medical device (Gondola™) and consisted in mechanical pressure stimulations delivered by metallic actuators on 4 areas of the feet. Treatment parameters and device configuration were modified for AMPS sham group. MAIN OUTCOME MEASURES Gait analyses were measured at baseline and after the first, fourth, and eighth treatment sessions. RESULTS Interactions among groups and sessions were found for both conditions while off anti-Parkinsonian medications. AMPS decreased gait variability in subjects with PD and FOG for both single and dual task conditions. CONCLUSIONS AMPS is an effective add-on therapy for treating gait variability in patients with PD and FOG.
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Affiliation(s)
- Ana Francisca Rozin Kleiner
- Politecnico di Milano, Department of Electronics, Information, and Bioengineering, Milan, Italy; University Center of Anápolis, Uni Evangélica, Anápolis, Goiás, Brazil.
| | - Aline Souza Pagnussat
- Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Camila Pinto
- Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Ritchele Redivo Marchese
- Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Ana Paula Salazar
- Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Manuela Galli
- Politecnico di Milano, Department of Electronics, Information, and Bioengineering, Milan, Italy
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Automated Mechanical Peripheral Stimulation Improves Gait Parameters in Subjects With Parkinson Disease and Freezing of Gait. Am J Phys Med Rehabil 2018; 97:383-389. [DOI: 10.1097/phm.0000000000000890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Galli M, Vicidomini C, Rozin Kleiner AF, Vacca L, Cimolin V, Condoluci C, Stocchi F, De Pandis MF. Peripheral neurostimulation breaks the shuffling steps patterns in Parkinsonian gait: a double blind randomized longitudinal study with automated mechanical peripheral stimulation. Eur J Phys Rehabil Med 2018; 54:860-865. [PMID: 29457707 DOI: 10.23736/s1973-9087.18.05037-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The shuffling steps pattern is a typical feature of gait in patients affected by Parkinson's disease (PD), which progressively reduces their quality of life, being related to the risk of falls in this population. Recently, Automated Mechanical Peripheral Stimulation (AMPS) was presented as an integrative rehabilitative treatment based on peripheral stimulation able to improve the gait spatiotemporal parameters in PD patients. AIM The aim of this study was to evaluate the effects of AMPS on shuffling steps pattern by analyzing the kinematic and spatio-temporal gait parameters. DESIGN Double blind randomized longitudinal study. SETTING Outpatients. POPULATION PD patients. METHODS In this double blind randomized longitudinal study, 14 patients with PD were treated with effective-AMPS (AMPS group), while 14 PD patients were treated with placebo-AMPS (SHAM group); 32 healthy subjects were deemed the control group (CG). A dedicated medical device (Gondola™ Medical Technologies, Stabio, Switzerland) was used to deliver both stimulations. Each treatment session lasted about 15 minutes, including preparation (approx. 10 to 13 minutes) and stimulation (approx. 2 minutes). All PD patients were given six AMPS/SHAM treatments sessions, twice a week, delivered during the off-levodopa phase, having withdrawn from dopaminergic medication overnight. We evaluated spatio-temporal and kinematic variables of gait with quantitative 3D-gait analysis as follows: before and after the first intervention (acute phase), then after the sixth session (long term phase). RESULTS We detected differences in all gait variables immediately after the first session of AMPS treatment and again after the sixth stimulation session. CONCLUSIONS AMPS treatment changes the shuffling steps pattern that is typical of PD subjects, increasing the ROM of hip, knee and ankle joints during the gait cycle. CLINICAL REHABILITATION IMPACT This data presents further evidence that a rehabilitative approach based on the AMPS treatment can induce improvements in the gait pattern of patients affected by PD.
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Affiliation(s)
- Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy -
| | - Caterina Vicidomini
- Biostructure and Bioimaging Institute (IBB), National Research Council (CNR), Naples, Italy.,San Raffaele Cassino Hospital, Tosinvest Sanità, Cassino, Italy
| | - Ana F Rozin Kleiner
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Measuring quality of life in individuals with Parkinson's disease attending a self-help club: cross-sectional study in Hungary. Int J Rehabil Res 2017; 41:81-83. [PMID: 29176514 DOI: 10.1097/mrr.0000000000000266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The prevalence of Parkinson's disease (PD) increases with aging. The aim of our cross-sectional study was to measure the quality of life of PD patients attending a self-help 'PD club' and to evaluate the potential positive effect of club life on quality of life. Data collection was carried out using questionnaires (PDQ-39, Hungarian version). Altogether, 101 individuals with clinically diagnosed PD were included, and finally 98 persons' data were analyzed. Among the eight dimensions, the highest score was found in 'bodily discomfort' and the lowest in 'social support'. The overall tendency of the results was similar to another Hungarian study, but the scores in all dimensions were significantly lower in our participants. These positive results seem to correlate with attending the 'PD club', indicating the potential beneficial effect of patients' organizations on promoting mental health.
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Quattrocchi CC, de Pandis MF, Piervincenzi C, Galli M, Melgari JM, Salomone G, Sale P, Mallio CA, Carducci F, Stocchi F. Acute Modulation of Brain Connectivity in Parkinson Disease after Automatic Mechanical Peripheral Stimulation: A Pilot Study. PLoS One 2015; 10:e0137977. [PMID: 26469868 PMCID: PMC4607499 DOI: 10.1371/journal.pone.0137977] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/23/2015] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The present study shows the results of a double-blind sham-controlled pilot trial to test whether measurable stimulus-specific functional connectivity changes exist after Automatic Mechanical Peripheral Stimulation (AMPS) in patients with idiopathic Parkinson Disease. METHODS Eleven patients (6 women and 5 men) with idiopathic Parkinson Disease underwent brain fMRI immediately before and after sham or effective AMPS. Resting state Functional Connectivity (RSFC) was assessed using the seed-ROI based analysis. Seed ROIs were positioned on basal ganglia, on primary sensory-motor cortices, on the supplementary motor areas and on the cerebellum. Individual differences for pre- and post-effective AMPS and pre- and post-sham condition were obtained and first entered in respective one-sample t-test analyses, to evaluate the mean effect of condition. RESULTS Effective AMPS, but not sham stimulation, induced increase of RSFC of the sensory motor cortex, nucleus striatum and cerebellum. Secondly, individual differences for both conditions were entered into paired group t-test analysis to rule out sub-threshold effects of sham stimulation, which showed stronger connectivity of the striatum nucleus with the right lateral occipital cortex and the cuneal cortex (max Z score 3.12) and with the right anterior temporal lobe (max Z score 3.42) and of the cerebellum with the right lateral occipital cortex and the right cerebellar cortex (max Z score 3.79). CONCLUSIONS Our results suggest that effective AMPS acutely increases RSFC of brain regions involved in visuo-spatial and sensory-motor integration. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that automatic mechanical peripheral stimulation is effective in modulating brain functional connectivity of patients with Parkinson Disease at rest. TRIAL REGISTRATION Clinical Trials.gov NCT01815281.
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Affiliation(s)
| | | | - Claudia Piervincenzi
- Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy
- Institute for Advanced Biomedical Technologies, University G. D’Annunzio Chieti-Pescara, Chieti, Italy
| | - Manuela Galli
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Jean Marc Melgari
- Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Gaetano Salomone
- Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Patrizio Sale
- Department of Neurology, Institute for Research and Medical Care, IRCCS San Raffaele, Rome, Italy
| | | | - Filippo Carducci
- Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy
| | - Fabrizio Stocchi
- Department of Neurology, Institute for Research and Medical Care, IRCCS San Raffaele, Rome, Italy
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The Parkinsonian Gait Spatiotemporal Parameters Quantified by a Single Inertial Sensor before and after Automated Mechanical Peripheral Stimulation Treatment. PARKINSONS DISEASE 2015; 2015:390512. [PMID: 26495152 PMCID: PMC4606184 DOI: 10.1155/2015/390512] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/05/2015] [Accepted: 09/02/2015] [Indexed: 11/18/2022]
Abstract
This study aims to evaluate the change in gait spatiotemporal parameters in subjects with Parkinson's disease (PD) before and after Automated Mechanical Peripheral Stimulation (AMPS) treatment. Thirty-five subjects with PD and 35 healthy age-matched subjects took part in this study. A dedicated medical device (Gondola) was used to administer the AMPS. All patients with PD were treated in off levodopa phase and their gait performances were evaluated by an inertial measurement system before and after the intervention. The one-way ANOVA for repeated measures was performed to assess the differences between pre- and post-AMPS and the one-way ANOVA to assess the differences between PD patients and the control group. Spearman's correlations assessed the associations between patients with PD clinical status (H&Y) and the percentage of improvement of the gait variables after AMPS (α < 0.05 for all tests). The PD group had an improvement of 14.85% in the stride length; 14.77% in the gait velocity; and 29.91% in the gait propulsion. The correlation results showed that the higher the H&Y classification, the higher the stride length percentage of improvement. The treatment based on AMPS intervention seems to induce a better performance in the gait pattern of PD patients, mainly in intermediate and advanced stages of the condition.
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