1
|
Khobkhun F, Srivanitchapoom P, Thanakamchokchai J, Richards J. The effect of a home-based exercise program on gait characteristics in an individual with Parkinson's disease over a one-year period: A case study. J Bodyw Mov Ther 2024; 39:512-517. [PMID: 38876677 DOI: 10.1016/j.jbmt.2024.03.039] [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: 05/05/2023] [Revised: 02/29/2024] [Accepted: 03/13/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND The COVID-19 pandemic has placed a restriction on physiotherapy clinical visits for supervised exercise. It is important that individuals with Parkinson's Disease (PD) continue an exercise regime at home during the pandemic and also in normal situations. OBJECTIVE The purpose of this study was to explore the case history of an individual with PD who used a developed home-based exercise programme for one year during the COVID-19 pandemic. METHODS A 67 year-old married woman was diagnosed with PD stage 2.5 on the modified Hoehn and Yahr (HY) scale. Gait characteristics and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor scores were assessed at baseline, 10 weeks, and 12 months. The home-based exercise program included breathing exercises, posture correction, stretching exercises, rotation of the axial segments, balance training, and task-specific gait training. RESULTS After 12 months, her MDS-UPDRS motor scores decreased when compared to baseline and 10 weeks, and gait characteristics at 12 months showed an increase in the degree of foot rotation, step length, cadence, and gait speed when compared to baseline and 10 weeks. CONCLUSION This case study showed that improvements in MDS-UPDRS and gait characteristics can continue over a 12 month period as a result of a home-based exercise programme. Therefore, home-based exercise programs should be encouraged with weekly monitoring, especially in individuals with gait disorders which show deterioration.
Collapse
Affiliation(s)
- Fuengfa Khobkhun
- Parkinson Movement and Research Collaboration Laboratory, Faculty of Physical Therapy, Mahidol University, Salaya, Nakorn Pathom, Thailand.
| | - Prachaya Srivanitchapoom
- Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jenjira Thanakamchokchai
- Parkinson Movement and Research Collaboration Laboratory, Faculty of Physical Therapy, Mahidol University, Salaya, Nakorn Pathom, Thailand
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
McMahon L, McGrath D, Blake C, Lennon O. Responsiveness of respiratory function in Parkinson's Disease to an integrative exercise programme: A prospective cohort study. PLoS One 2024; 19:e0301433. [PMID: 38551984 PMCID: PMC10980210 DOI: 10.1371/journal.pone.0301433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/15/2024] [Indexed: 04/01/2024] Open
Abstract
INTRODUCTION Respiratory disorders are the most common cause of death in Parkinson's Disease (PD). Conflicting data exist on the aetiology of respiratory dysfunction in PD and few studies examine the effects of exercise-based interventions on respiratory measures. This study was conducted to better understand respiratory dysfunction in PD and to identify measures of dysfunction responsive to an integrative exercise programme. OBJECTIVES The objectives were to compare baseline respiratory measures with matched, published population norms and to examine immediate and longer-term effects of a 12-week integrated exercise programme on these measures. DESIGN Twenty-three people with mild PD (median Hoehn & Yahr = 2) self-selected to participate in this exploratory prospective cohort study. Evaluation of participants occurred at three time points: at baseline; following the 12-week exercise programme and at 4-month follow-up. OUTCOME MEASURES Outcome measures included: Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), FEV1/FVC ratio, Peak Expiratory Flow (PEF), Inspiratory Muscle Strength (MIP), Expiratory Muscle Strength (MEP), Peak Cough Flow (PCF), and Cardiovascular Fitness measures of estimated VO2 max and 6-Minute Walk Test (6MWT). RESULTS Compared to published norms, participants had impaired cough, reduced respiratory muscle strength, FEV, FVC, PEF and cardiovascular fitness. Post exercise intervention, statistically significant improvements were noted in MEP, cardiovascular fitness, and PEF. However only gains in PEF were maintained at 4-month follow-up. CONCLUSIONS Significant respiratory dysfunction exists, even in the early stages of PD. Metrics of respiratory muscle strength, peak expiratory flow and cardiovascular fitness appear responsive to an integrative exercise programme.
Collapse
Affiliation(s)
- Laura McMahon
- Health Sciences Centre, UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Denise McGrath
- Health Sciences Centre, UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Catherine Blake
- Health Sciences Centre, UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Olive Lennon
- Health Sciences Centre, UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| |
Collapse
|
4
|
Hodgson P, Jordan A, Sinani C, Charura D, Orange ST. The relationship between physical function and psychological symptoms in Parkinson's disease: A systematic review and meta-regression analysis. CNS Neurosci Ther 2024; 30:e14562. [PMID: 38334239 PMCID: PMC10853949 DOI: 10.1111/cns.14562] [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: 04/20/2023] [Revised: 08/21/2023] [Accepted: 12/01/2023] [Indexed: 02/10/2024] Open
Abstract
AIMS This systematic review and meta-regression aimed to examine available literature reporting measures of physical function, anxiety, and/or depression and whether any relationships exist between these measures in individuals with Parkinson's disease. METHODS MEDLINE, CINAHL, AMED, and APA PsychInfo databases were systematically searched. Screening, quality assessment, and data extraction were completed alongside meta-regression analysis. RESULTS Of 1175 studies retrieved, 40 were selected for analysis with only one study assessing the relationship between physical and psychological outcomes within their cohort. A total of 27 studies were also eligible for meta-regression analysis-a total sample of 1211 participants. Meta-regressions of five combinations of paired physical and psychological outcomes showed a significant moderating effect of symptoms of depression (Beck Depression Inventory) on mobility (Timed-Up-and-Go test; coefficient = 0.37, 95% CI 0.09 to 0.65, p = 0.012) and balance (Berg Balance Score) scores (coefficient = -1.25, 95% CI -1.77 to -0.73, p < 0.001). CONCLUSION Although physical and psychological outcomes of interest were used in all included studies, only one examined their relationship. Our analysis suggests that symptoms of depression may influence measures of mobility and balance. Specifically, as the severity of symptoms of depression increases, performance on measures of mobility and balance worsens.
Collapse
Affiliation(s)
- Philip Hodgson
- Tees, Esk and Wear Valleys NHS Foundation TrustYork St John UniversityYorkUK
- York St John UniversityYorkUK
| | | | | | | | | |
Collapse
|
5
|
Netukova S, Horakova L, Szabo Z, Krupicka R. Beyond timing and step counting in 360° turning-in-place assessment: a scoping review. Biomed Eng Online 2024; 23:13. [PMID: 38297359 PMCID: PMC10832107 DOI: 10.1186/s12938-024-01208-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Turning in place is a challenging motor task and is used as a brief assessment test of lower limb function and dynamic balance. This review aims to examine how research of instrumented analysis of turning in place is implemented. In addition to reporting the studied population, we covered acquisition systems, turn detection methods, quantitative parameters, and how these parameters are computed. METHODS Following the development of a rigorous search strategy, the Web of Science and Scopus were systematically searched for studies involving the use of turning-in-place. From the selected articles, the study population, types of instruments used, turn detection method, and how the turning-in-place characteristics were calculated. RESULTS Twenty-one papers met the inclusion criteria. The subject groups involved in the reviewed studies included young, middle-aged, and older adults, stroke, multiple sclerosis and Parkinson's disease patients. Inertial measurement units (16 studies) and motion camera systems (5 studies) were employed for gathering measurement data, force platforms were rarely used (2 studies). Two studies used commercial software for turn detection, six studies referenced previously published algorithms, two studies developed a custom detector, and eight studies did not provide any details about the turn detection method. The most frequently used parameters were mean angular velocity (14 cases, 7 studies), turn duration (13 cases, 13 studies), peak angular velocity (8 cases, 8 studies), jerkiness (6 cases, 5 studies) and freezing-of-gait ratios (5 cases, 5 studies). Angular velocities were derived from sensors placed on the lower back (7 cases, 4 studies), trunk (4 cases, 2 studies), and shank (2 cases, 1 study). The rest (9 cases, 8 studies) did not report sensor placement. Calculation of the freezing-of-gait ratio was based on the acceleration of the lower limbs in all cases. Jerkiness computation employed acceleration in the medio-lateral (4 cases) and antero-posterior (1 case) direction. One study did not reported any details about jerkiness computation. CONCLUSION This review identified the capabilities of turning-in-place assessment in identifying movement differences between the various subject groups. The results, based on data acquired by inertial measurement units across studies, are comparable. A more in-depth analysis of tests developed for gait, which has been adopted in turning-in-place, is needed to examine their validity and accuracy.
Collapse
Affiliation(s)
- Slavka Netukova
- Faculty of Biomedical Engineering, Department of Biomedical Informatics, Czech Technical University, Nam Sitna 3105, Prague, Czech Republic.
| | - Lucie Horakova
- Faculty of Biomedical Engineering, Department of Biomedical Informatics, Czech Technical University, Nam Sitna 3105, Prague, Czech Republic
| | - Zoltan Szabo
- Faculty of Biomedical Engineering, Department of Biomedical Informatics, Czech Technical University, Nam Sitna 3105, Prague, Czech Republic
| | - Radim Krupicka
- Faculty of Biomedical Engineering, Department of Biomedical Informatics, Czech Technical University, Nam Sitna 3105, Prague, Czech Republic
| |
Collapse
|
6
|
Deepa S, Kumaresan A, Suganthirabab P, Srinivasan V, Vishnuram S, Alagesan J, Krishnan Vasanthi R. Improving work life balance among female educationists during the COVID-19 lockdown. Work 2023:WOR220063. [PMID: 36872818 DOI: 10.3233/wor-220063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND The entire education industry switched from offline to online modes as a result of the coronavirus outbreak. Numerous teachers who were diagnosed with musculoskeletal, psychological, and other neurodegenerative diseases have reported increased exhaustion, lack of sleep, a decline in quality of life (QoL), a decrease in physical activity, and excessive stress from online classes during the COVID-19 lockdown, especially women. OBJECTIVE The aim of this study is to evaluate the effectiveness of three-modal exercise on fatigue, sleep, QoL as well as to determine the relationship between age, disease severity, disease stage and working years with women diagnosed with Parkinson's disease (PD). METHODS In this randomized controlled trial, 44 female educators in stages I-II with PD who were between the ages of 40 and 60 volunteered. For a total of 36 sessions over the course of six weeks, Group A received a three-modal fitness program through online video sessions, whereas Group B received Nordic walking. The outcome measures included the Fatigue Severity Scale, Parkinson's Disease Sleep Scale, and Parkinson's Disease Quality of Life Questionnaire-39. RESULTS Age, Hoehn and Yahr scale, working years, and PD in years did not correlate with each other (p > 0.50). The three-modal exercise experimental Group A showed statistically significant improvement in QoL (p 0.001), sleep (p 0.001), and fatigue (p 0.001). CONCLUSION Women in the field of education who participated in a three-modal exercise programme for PD reported a significant improvement in their level of exhaustion, sleep patterns, and quality of life.
Collapse
Affiliation(s)
- S Deepa
- Saveetha College of Physiotherapy, SIMATS, Chennai, India
| | - A Kumaresan
- Saveetha College of Physiotherapy, SIMATS, Chennai, India
| | | | | | | | | | | |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Klima DW, DiBartolo MC, Stewart J, Freijomil F, Oliver M, McAllister S. Rising From the Floor in Persons With Parkinson's Disease. J Gerontol Nurs 2023; 49:50-54. [PMID: 36594918 DOI: 10.3928/00989134-20221206-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although considerable research has targeted fall prevention among older adults with Parkinson's disease (PD), less is known about their ability to rise from the floor. The aim of the current exploratory study was to examine the relationship between floor rise and physical performance tests. A cross-sectional design was used. Twenty community-dwelling older adults with PD (mean age = 74.8 years, SD = 9.5 years) performed a standardized floor rise test and physical performance assessments in a structured task circuit. Mean time to rise from the floor was 14.9 seconds (SD = 7.6 seconds). Fourteen (70%) participants used a quadruped strategy to rise to stand. Supine-to-stand performance time was significantly correlated with all physical performance measures. Findings serve as a catalyst for nursing and rehabilitation professionals to examine floor rise ability, prevent adverse effects of a critical fall, and instruct fall recovery techniques in clinical settings. [Journal of Gerontological Nursing, 49(1), 50-54.].
Collapse
|
9
|
Telerehabilitation during social distancing for people with Parkinson's disease: a retrospective study. Acta Neurol Belg 2022:10.1007/s13760-022-02160-3. [PMID: 36527572 PMCID: PMC9759049 DOI: 10.1007/s13760-022-02160-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION/AIM Clinical worsening has been common in people with Parkinson's disease (PD) during the social distancing due to pandemic. It is unclear if telerehabilitation applied during social distancing preserves clinical aspects of people with PD who are frequent exercisers before the pandemic. Thus, we compared the effects of 10 months of supervised, home-based, real-time videoconferencing telerehabilitation (SRTT) and nonexercising control on clinical aspects in people with PD who are frequent exercisers before the pandemic. METHODS Fifty-seven (SRTT group) and 29 (nonexercising control group) people with PD were retrospectively assessed (Clinical Trials Registry: RBR-54sttfk). Only the SRTT group performed a 60-min online training sessions, 2-3 days per week, for 10 months (April 2020 to January 2021) during social distancing. Quality of life (PD Questionnaire [PDQ-39]), walking (item 28 from the Unified Parkinson's Disease Rating Scale part III [UPDRS-III]), posture (item 29 from the UPDRS-III), and freezing of gait (New-FOG questionnaire [NFOGQ]) were retrospectively assessed before (February-March 2020) and during social distancing (February-March 2021). The assessments were performed in-person and remotely before and during social distancing, respectively. RESULTS There were no between-group differences at baseline (p > 0.05). SRTT preserves PDQ-39 and walking scores but not posture and NFOGQ scores, while nonexercising control worsens scores in all variables. In addition, SRTT is more effective than nonexercising control in preserving PDQ-39 and walking scores. CONCLUSION During social distancing, long-term SRTT preserves the subjective quality of life and walking, but not subjective posture and FOG in people with PD who are frequent exercisers before the pandemic.
Collapse
|
10
|
Magaña JC, Deus CM, Giné-Garriga M, Montané J, Pereira SP. Exercise-Boosted Mitochondrial Remodeling in Parkinson's Disease. Biomedicines 2022; 10:biomedicines10123228. [PMID: 36551984 PMCID: PMC9775656 DOI: 10.3390/biomedicines10123228] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
Parkinson's disease (PD) is a movement disorder characterized by the progressive degeneration of dopaminergic neurons resulting in dopamine deficiency in the striatum. Given the estimated escalation in the number of people with PD in the coming decades, interventions aimed at minimizing morbidity and improving quality of life are crucial. Mitochondrial dysfunction and oxidative stress are intrinsic factors related to PD pathogenesis. Accumulating evidence suggests that patients with PD might benefit from various forms of exercise in diverse ways, from general health improvements to disease-specific effects and, potentially, disease-modifying effects. However, the signaling and mechanism connecting skeletal muscle-increased activity and brain remodeling are poorly elucidated. In this review, we describe skeletal muscle-brain crosstalk in PD, with a special focus on mitochondrial effects, proposing mitochondrial dysfunction as a linker in the muscle-brain axis in this neurodegenerative disease and as a promising therapeutic target. Moreover, we outline how exercise secretome can improve mitochondrial health and impact the nervous system to slow down PD progression. Understanding the regulation of the mitochondrial function by exercise in PD may be beneficial in defining interventions to delay the onset of this neurodegenerative disease.
Collapse
Affiliation(s)
- Juan Carlos Magaña
- Blanquerna Faculty of Psychology, Education and Sport Sciences, Ramon Llull University, 08022 Barcelona, Spain
| | - Cláudia M. Deus
- CNC—Center for Neuroscience and Cell Biology, CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal
- Correspondence: (C.M.D.); (J.M.)
| | - Maria Giné-Garriga
- Blanquerna Faculty of Psychology, Education and Sport Sciences, Ramon Llull University, 08022 Barcelona, Spain
- Blanquerna Faculty of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain
| | - Joel Montané
- Blanquerna Faculty of Psychology, Education and Sport Sciences, Ramon Llull University, 08022 Barcelona, Spain
- Blanquerna Faculty of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain
- Correspondence: (C.M.D.); (J.M.)
| | - Susana P. Pereira
- CNC—Center for Neuroscience and Cell Biology, CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, 4150-564 Porto, Portugal
| |
Collapse
|
11
|
Khobkhun F, Hollands M, Tretriluxana J, Srivanitchapoom P, Richards J, Ajjimaporn A. Benefits of task-specific movement program on en bloc turning in Parkinson's disease: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1963. [PMID: 35717662 DOI: 10.1002/pri.1963] [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: 08/22/2021] [Revised: 12/15/2021] [Accepted: 06/05/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION En bloc turning highlights a lack of rotational intersegmental coordination, which commonly impacts turning ability in people with Parkinson's disease (PD). Whilst this turning deficit responds fairly well to medical treatment, it may be further mitigated by performing specific exercise training. Thus, the present study aimed to examine the effects of a 4-week exercise program, which focused on task-specific movements (TSM program) on turning ability and clinical outcomes in people with PD. METHODS Twenty-two adults (67 ± 6 years) with early-to-mid-stage idiopathic PD were randomly assigned to an experimental group (EG; n = 11) or a control group (CG; n = 11). The exercise group (EG) group received a 60-min per session TSM program for 4 weeks (a total of 15 sessions), while the CG group performed their routine rehabilitation program (a total of 12 sessions). Inertial measurement units were used to measure turning kinematics including; onset latency of body segments and stepping characteristics. Clinical outcomes included the Unified Parkinson's Disease Rating Scale (UPDRS), functional reach test (FRT), and fall efficacy scale international (FES-I). Assessments were conducted at baseline and after 4 weeks. RESULTS In the EG, turning kinematics, UPDRS scores, FRT, and FES-I scale, were improved at the end of the 4-week program compared with the CG (all p < 0.05). IMPACT STATEMENT A 4-week TSM program could be a promising alternative rehabilitation program for improving "en bloc" turns and clinical outcomes in PD patients.
Collapse
Affiliation(s)
- Fuengfa Khobkhun
- College of Sports Science and Technology, Mahidol University, Nakhon Pathom, Thailand.,Brain and Behaviour Lab, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.,Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Mark Hollands
- Brain and Behaviour Lab, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Jarugool Tretriluxana
- Motor Control and Neural Plasticity Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Prachaya Srivanitchapoom
- Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jim Richards
- Allied Health Research Unit, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Amornpan Ajjimaporn
- College of Sports Science and Technology, Mahidol University, Nakhon Pathom, Thailand
| |
Collapse
|
12
|
Ferrazzoli D, Ortelli P, Iansek R, Volpe D. Rehabilitation in movement disorders: From basic mechanisms to clinical strategies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:341-355. [PMID: 35034747 DOI: 10.1016/b978-0-12-819410-2.00019-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Movement disorders encompass a variety of conditions affecting the nervous system at multiple levels. The pathologic processes underlying movement disorders alter the normal neural functions and could lead to aberrant neuroplastic changes and to clinical phenomenology that is not expressed only through mere motor symptoms. Given this complexity, the responsiveness to pharmacologic and surgical therapies is often disappointing. Growing evidence supports the efficacy of neurorehabilitation for the treatment of movement disorders. Specific form of training involving both goal-based practice and aerobic training could drive and modulate neuroplasticity in order to restore the circuitries dysfunctions and to achieve behavioral gains. This chapter provides an overview of the alterations expressed in some movement disorders in terms of clinical signs and symptoms and plasticity, and suggests which ones and why tailored rehabilitation strategies should be adopted for the management of the different movement disorders.
Collapse
Affiliation(s)
- Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy
| | - Paola Ortelli
- Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy; Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, National Parkinson Foundation Center of Excellence, Monash Health, Cheltenham, VIC, Australia; School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Daniele Volpe
- Department of Rehabilitation, Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
| |
Collapse
|
13
|
Lockwich J, Schwartzkopf-Phifer K, Skubik-Peplaski C, Andreatta RD, Kitzman P. Perceived exercise habits of individuals with Parkinson’s disease living in the community. Clin Park Relat Disord 2022; 6:100127. [PMID: 35005604 PMCID: PMC8719012 DOI: 10.1016/j.prdoa.2021.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022] Open
Abstract
Context Exercise has been shown to improve gait in individuals with Parkinson’s disease (PD). Stepping practice at higher intensity levels has been suggested as a beneficial treatment option to improve gait in the neurological population. Unfortunately, this mode is poorly understood and underutilized within the PD population. Information on what individuals with PD are doing for exercise would be beneficial to help tailor exercise programs to improve gait and provide exercise options in the community for intensity-based exercise. Objective To investigate the current exercise habits of individuals living with PD in the community aimed at improving walking and to understand the impact of perceived intensity on daily exercise practices. Design, setting, participants One hundred thirty-eight individuals with PD living in the community were surveyed online regarding their current exercise habits. Main outcome measure A total of 22 questions aimed to understand exercise selection, focus, and perceived intensity. Questions asked basic demographic, symptom presentation and management of disease related symptoms that were present while living with PD. Exercise questions focused understanding participants current function level, practice exercise habits and perceived levels of exercise intensity during daily routines. Results Of the 138 individuals surveyed for this preliminary study, eighty-seven percent of individuals with PD participated in exercise with seventy-five percent choosing walking as a mode for exercise. Sixty-five percent of the respondents noted that despite exercise, their walking speed and endurance has worsened since diagnosis. Eighty-one percent perceived exercising at moderate intensity levels, however little provocation of intensity symptoms was noted. Conclusion Our preliminary study survey results suggest that individuals with PD are exercising but not at high enough intensity levels to promote improvements in gait performance. Individuals with PD may need to be pushed at higher intensity levels, beyond their voluntary limits, to induce gait performance changes. These findings can provide a foundation for future fitness interventions within this population to target improving gait.
Collapse
Affiliation(s)
- Jordana Lockwich
- University of Evansville, Evansville IN 47722, USA
- Corresponding author at: Stone Family Center of Health Sciences, 515 Walnut Street, Evansville, IN 47708, USA.
| | | | | | | | | |
Collapse
|
14
|
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).
Collapse
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
| |
Collapse
|
15
|
Can a targeted home-based exercise programme improve turning characteristics in individuals with Parkinson's disease? Clin Biomech (Bristol, Avon) 2021; 89:105469. [PMID: 34474314 DOI: 10.1016/j.clinbiomech.2021.105469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/22/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Turns are often cited as a difficult task for individuals with Parkinson's disease and often lead to falls, however targeted exercise interventions may help to reduce this problem. This study examined the effects of a 10-week home-based exercise program focusing on turns which may be an exercise approach for improving mobility and reducing falls in individuals with Parkinson's disease. METHODS Turning and stepping characteristics were recorded using Inertial Measurement Units while participants performed a 180° standing turn. Eye movements were measured using a BlueGain electrooculography system. Clinical outcomes were assessed using the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Functional axial rotation-physical score and the Falls Efficacy Scale International. FINDINGS Twenty individuals with Parkinson's disease were matched by severity using the Modified Hoehn and Yahr scale and were randomly allocated to an exercise (n = 10) or control group (n = 10). Significant improvements were seen after 10 weeks in the exercise group only for; onset latency of body segments, step size, number of fast phase eye movements, the Movement Disorders Society-Unified Parkinson's Disease Rating Scale in motor and rigidity scores, Functional axial rotation-physical score and the Falls Efficacy Scale International. INTERPRETATION These results indicate that the home-based exercise programme targeting turning characteristics had positive effects on turning performance and clinical outcomes associated with falls in individuals with Parkinson's disease. These preliminary results support the notion that targeted home-based exercises may provide an effective intervention in this population.
Collapse
|
16
|
The Effects of a 10-Week Home-Based Exercise Programme in Individuals with Parkinson’s Disease during the COVID-19 Pandemic: A Pilot Study. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11104518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Current restrictions on clinical visits as a consequence of the COVID-19 pandemic has increased the need for home-based exercise regimes to facilitate useful, long term patterns of behaviour in individuals with Parkinson’s disease (PD). This study aimed to evaluate the effectiveness of a 10-week home-based exercise program designed to target improvements in axial rigidity and gait. The Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), motor scale and rigidity items, Functional axial rotation–physical (FAR-p), functional reach test (FRT), and time up and go (TUG) test were recorded. In addition, the 10-metre walk test, the fall efficacy scale international (FES-I) and the global rating of change score (GROC) were also recorded. Eighteen individuals were divided randomly into two groups: a home-based exercise group (n = 10) and a traditional physiotherapy control group (n = 8). Participants in the 10-week home-based exercise group showed significant improvements (p < 0.05) in the MDS-UPDRS rigidity item, FAR-p, step length, gait velocity, FRT and FES-I when compared with the control group. This study supports the use of home-based exercises in individuals with PD. These preliminary results also support the hypothesis that targeting axial deficits may be an effective approach for improving gait and reducing falls.
Collapse
|
17
|
Lim GRS, Ng CH, Kwan YH, Fong W. Prevalence and risk factors for falls in patients with spondyloarthritis: A systematic review. Int J Rheum Dis 2021; 24:623-632. [PMID: 33704897 DOI: 10.1111/1756-185x.14092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Patients with spondyloarthritis (SpA) may have a greater risk of falling due to poor postural balance and decreased mobility. To our best knowledge, there are no published reviews that study falls in patients with SpA. Therefore, we aim to systematically review the literature and identify the prevalence and risk factors of falls in patients with SpA. METHODS We conducted a systematic review using 5 electronic databases: PubMed, EMBASE, Scopus, Web of Science and Google Scholar using controlled vocabulary terms (eg MeSH terms) in the search strategy for the concepts: falls, fall risk, SpA and its subtypes. RESULTS We identified 7279 articles, of which 3 studies with a total of 441 patients were included. Prevalence of falls ranged from 13% to 25%. We identified 16 main factors across 5 categories. Under socio-demographic factors, functional limitation, decreased quality of life, advanced age and job loss were associated with an increased risk of falls. Poor balance and mobility and fear of falling were associated with increased risk of falls. Active disease and symptoms of SpA were medical factors that were associated with increased risk of falls. Medication factors including polypharmacy, myorelaxants and antidepressants were not associated with increased fall risk. CONCLUSION We identified potentially modifiable risk factors associated with increased risk of falls in patients with SpA, including functional limitation, poor balance and mobility, fear of falling and active disease. Clinicians should recognize these factors and address them in the holistic management of patients with SpA, thereby reducing falls and their complications.
Collapse
Affiliation(s)
- Grace Rui Si Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Caitlin Hsuen Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Yu Heng Kwan
- Program in Health Sciences and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Pharmacy, Faculty of Science, National University of School, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
18
|
McMahon L, Blake C, Lennon O. Nonpharmacological interventions for respiratory health in Parkinson's disease: A systematic review and meta-analysis. Eur J Neurol 2020; 28:1022-1040. [PMID: 33098349 DOI: 10.1111/ene.14605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/15/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Respiratory dysfunction in Parkinson's disease (PD) is often an underdiagnosed and untreated impairment associated with the disease. Clinically, a reactive approach to respiratory morbidity is taken, rather than preventative approaches that address underlying impairment/s. This systematic review identifies the current evidence to support nonpharmacological interventions to improve respiratory impairments in individuals with PD. METHODS The relevant literature was searched using a customised and systematic strategy. Randomised and nonrandomised control trials of nonpharmacological interventions targeting respiratory outcome measures in PD were included. Outcomes of interest were respiratory morbidity and mortality, respiratory muscle strength, spirometry measures, lung volumes, peak cough flow, and perception of dyspnoea. RESULTS Nonpharmacological interventions included: functional training, generalised strength training, respiratory muscle strength training, aerobic exercise, qigong, yoga, breath stacking, incentive spirometry and singing. Methodological quality of included studies varied. Meta-analyses of nonpharmacological interventions demonstrated significant effects for inspiratory muscle strength (mean difference [MD] 19.68; confidence interval [CI] 8.49, 30.87; z = 3.45; p = 0.0006; I2 = 2%), expiratory muscle strength (MD 18.97; CI 7.79, 30.14; z = 3.33; p = 0.0009; I2 = 23%) and peak expiratory flow (MD 72.21; CI 31.19, 113.24; z = 3.45; p = 0.0006; I2 = 0%). Best-evidence synthesis identified level 1 evidence supporting nonpharmacological interventions for improving peak cough flow and perceived dyspnoea. No studies were identified reporting outcomes of respiratory rate, inspiration:expiration ratio or respiratory morbidity or mortality in PD. CONCLUSIONS Nonpharmacological interventions improved respiratory muscle strength and peak expiratory flow in PD. Additional trials targeting respiratory dysfunction and longitudinal studies examining the relationship between respiratory dysfunction and morbidity and mortality rates in PD are required.
Collapse
Affiliation(s)
- L McMahon
- UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - C Blake
- UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - O Lennon
- UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
| |
Collapse
|
19
|
Khobkhun F, Hollands K, Hollands M, Ajjimaporn A. Effectiveness of exercise-based rehabilitation for the treatment of axial rigidity in people with Parkinson’s disease: A Scoping Review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1816127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Fuengfa Khobkhun
- Brain and Behaviour Lab, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- College of Sports Science and Technology, Mahidol University, Nakhon Pathom, Thailand
- Department of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Kristen Hollands
- Centre for Health Sciences Research Allerton Building, University of Salford, Salford, UK
| | - Mark Hollands
- Brain and Behaviour Lab, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Amornpan Ajjimaporn
- College of Sports Science and Technology, Mahidol University, Nakhon Pathom, Thailand
| |
Collapse
|
20
|
Behrman A, Cody J, Elandary S, Flom P, Chitnis S. The Effect of SPEAK OUT! and The LOUD Crowd on Dysarthria Due to Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1448-1465. [PMID: 32421347 PMCID: PMC7893519 DOI: 10.1044/2020_ajslp-19-00024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/09/2019] [Accepted: 02/12/2020] [Indexed: 05/31/2023]
Abstract
Purpose SPEAK OUT! and The LOUD Crowd is a standardized speech therapy program of 12 individual treatments combined with ongoing weekly group sessions for individuals with dysarthria due to Parkinson's disease (PD). The premise of this program is that individuals with PD must rely on goal-directed basal ganglia-cortical circuits to compensate for deficits in habitual, automatic control. The purpose of this study was to assess the outcome of this therapy program. Method Forty individuals with idiopathic PD received SPEAK OUT! in 12 individual 40-min sessions 3 times per week for 4 consecutive weeks and also participated in The LOUD Crowd. Assessments were conducted 3 times at baseline and then within 1 and 6 weeks after completion of the individual SPEAK OUT! sessions. Twenty-five adults without communication disorders were assessed on the same schedule. Acoustic outcome measures were mean intensity from reading and monologue, the prosody measures of standard deviation of intensity and frequency from reading and monologue, and the voice quality measure of cepstral peak prominence from reading. Patient perception of voice was also assessed with the Voice-Related Quality of Life. Results Posttherapy, mean intensity was greater and variation of frequency was larger in reading and monologue, while variation in intensity was larger in monologue but unchanged in reading. Cepstral peak prominence and Voice-Related Quality of Life scores were significantly higher (improved) after therapy. Conclusion These data contribute to evidence of the effectiveness of this program for hypokinetic dysarthria secondary to idiopathic PD and thus inform clinical practice in the selection among treatment options.
Collapse
Affiliation(s)
| | | | | | - Peter Flom
- Research Foundation, City University of New York, NY
- Peter Flom Consulting, New York, NY
| | | |
Collapse
|
21
|
|
22
|
Rahmati Z, Behzadipour S, Schouten AC, Taghizadeh G, Firoozbakhsh K. Postural control learning dynamics in Parkinson's disease: early improvement with plateau in stability, and continuous progression in flexibility and mobility. Biomed Eng Online 2020; 19:29. [PMID: 32393271 PMCID: PMC7216342 DOI: 10.1186/s12938-020-00776-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background Balance training improves postural control in Parkinson’s disease (PD). However, a systematic approach for the development of individualized, optimal training programs is still lacking, as the learning dynamics of the postural control in PD, over a training program, are poorly understood. Objectives We investigated the learning dynamics of the postural control in PD, during a balance-training program, in terms of the clinical, posturographic, and novel model-based measures. Methods Twenty patients with PD participated in a balance-training program, 3 days a week, for 6 weeks. Clinical tests assessed functional balance and mobility pre-training, mid-training, and post-training. Center-of-pressure (COP) was recorded at four time-points during the training (pre-, week 2, week 4, and post-training). COP was used to calculate the sway measures and to identify the parameters of a patient-specific postural control model, at each time-point. The posturographic and model-based measures constituted the two sets of stability- and flexibility-related measures. Results Mobility- and flexibility-related measures showed a continuous improvement during the balance-training program. In particular, mobility improved at mid-training and continued to improve to the end of the training, whereas flexibility-related measures reached significance only at the end. The progression in the balance- and stability-related measures was characterized by early improvements over the first 3 to 4 weeks of training, and reached a plateau for the rest of the training. Conclusions The progression in balance and postural stability is achieved earlier and susceptible to plateau out, while mobility and flexibility continue to improve during the balance training.
Collapse
Affiliation(s)
- Zahra Rahmati
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.,Djawad Movafaghian Research Center in Neurorehab Technologies, Sharif University of Technology, Tehran, Iran
| | - Saeed Behzadipour
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran. .,Djawad Movafaghian Research Center in Neurorehab Technologies, Sharif University of Technology, Tehran, Iran.
| | - Alfred C Schouten
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
23
|
Abstract
BACKGROUND AND PURPOSE Impaired gait, balance, and motor function are common in Parkinson disease (PD) and may lead to falls and injuries. Different forms of exercise improve motor function in persons with PD, but determining which form of exercise is most effective requires a direct comparison of various approaches. In this prospective, controlled trial, we evaluated the impact of tango, treadmill walking, and stretching on gait, balance, motor function, and quality of life. We hypothesized tango and treadmill would improve forward walking and motor symptom severity, and tango would also improve backward walking, balance, and quality of life. METHODS Ninety-six participants (age: 67.2 ± 8.9 years, 42% female) with mild to moderate idiopathic PD were serially assigned to tango, treadmill walking, or stretching (active control group) and attended 1-hour classes twice weekly for 12 weeks. Assessments occurred OFF anti-PD medication before and after the intervention and at follow-up 12 weeks after the intervention. RESULTS Forward velocity and backward velocity improved for the treadmill group from baseline to posttest and improvements persisted at follow-up. Backward velocity and motor functioning improved for the stretching group from baseline to posttest, but results did not persist at follow-up. There were no significant changes in the tango group across time points. DISCUSSION AND CONCLUSIONS Contrary to our hypotheses, only treadmill improved forward walking, while backward walking improved with treadmill and stretching. Future research should examine combinations of exercises with a focus on optimizing dosing and examining whether specific characteristics of people with PD correlate with different types of exercise.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A237).
Collapse
|
24
|
Ferrazzoli D, Ortelli P, Cucca A, Bakdounes L, Canesi M, Volpe D. Motor-cognitive approach and aerobic training: a synergism for rehabilitative intervention in Parkinson's disease. Neurodegener Dis Manag 2020; 10:41-55. [PMID: 32039653 DOI: 10.2217/nmt-2019-0025] [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: 12/13/2022] Open
Abstract
Parkinson's disease (PD) results in a complex deterioration of motor behavior. Effective pharmacological or surgical treatments addressing the whole spectrum of both motor and cognitive symptoms are lacking. The cumulative functional impairment may have devastating socio-economic consequences on both patients and caregivers. Comprehensive models of care based on multidisciplinary approaches may succeed in better addressing the overall complexity of PD. Neurorehabilitation is a highly promising non-pharmacological intervention for managing PD. The scientific rationale beyond rehabilitation and its practical applicability remain to be established. In the present perspective, we aim to discuss the current evidence supporting integrated motor-cognitive and aerobic rehabilitation approaches for patients with PD while suggesting a practical framework to optimize this intervention in the next future.
Collapse
Affiliation(s)
- Davide Ferrazzoli
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Paola Ortelli
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Alberto Cucca
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy.,The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, Department of Neurology, NYU School of Medicine, New York, NY 10017, USA
| | - Leila Bakdounes
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy
| | - Margherita Canesi
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy
| |
Collapse
|
25
|
Morris ME, Ellis TD, Jazayeri D, Heng H, Thomson A, Balasundaram AP, Slade SC. Boxing for Parkinson's Disease: Has Implementation Accelerated Beyond Current Evidence? Front Neurol 2019; 10:1222. [PMID: 31866923 PMCID: PMC6904341 DOI: 10.3389/fneur.2019.01222] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/04/2019] [Indexed: 01/23/2023] Open
Abstract
Background: Exercise and physical activity are argued to promote neural plasticity in Parkinson's disease (PD), with potential to slow disease progression. Boxing for PD is rapidly growing in popularity. Objectives: (i) To evaluate evidence on benefits and risks of boxing exercises for people living with PD and (ii) to appraise websites for evidence of global implementation of this intervention. Data Sources: We searched AMED, CINAHL, Cochrane, EMBASE, EMCARE, Health and Medical Collection via ProQuest, MEDLINE, and PEDro electronic databases for the research literature. Websites were also searched for evidence of successful implementation of boxing for PD. Study Selection: Published research and websites were considered if they reported data on adults with PD and boxing as an intervention. Data Extraction: For the literature review, two reviewers independently extracted data on study characteristics and intervention content. Risk of bias was assessed with the PEDro scale and Joanna Briggs Checklist. We conducted a quality appraisal of websites using the QUality Evaluation Scoring Tool (QUEST). Data Synthesis: Two studies, with a total of 37 participants, met the review eligibility criteria for the literature review. Risk of bias was low in these trials. Balance confidence, mobility, and quality of life were reported to improve with community-based boxing training programs delivered in 24–36 sessions over 12 weeks. PD medications were not always documented and some elements of the boxing interventions were incompletely reported against the CERT (Consensus on Exercise Reporting Template). Nine websites advocating boxing programs for PD were also evaluated. The QUEST analysis showed low-level quality, and little scientific evidence verifying findings, despite positive reports. Limitations: In the published literature, findings were limited due to the small number of included studies and participants. Websites were numerous yet often lacked verifiable data. Conclusions: Despite the recent growth in the popularity of boxing for PD and some positive findings, there is limited evidence of efficacy. Risks and disease-specific modifications have not been reported. Safety guidelines and health professional training are key considerations for implementation.
Collapse
Affiliation(s)
- Meg E Morris
- La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia.,Healthscope North Eastern Centre, Ivanhoe, VIC, Australia
| | - Terry D Ellis
- Center for Neurorehabilitation, Boston University College of Health and Rehabilitation Sciences, Sargent College, Boston, MA, United States
| | - Dana Jazayeri
- La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia.,Healthscope North Eastern Centre, Ivanhoe, VIC, Australia
| | - Hazel Heng
- La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Andrea Thomson
- La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Arun Prasad Balasundaram
- La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Susan C Slade
- La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia.,Healthscope North Eastern Centre, Ivanhoe, VIC, Australia
| |
Collapse
|
26
|
Kim J, Shin JH, Ryu JK, Jung JH, Kim CH, Lee HB, Kim DH, Lee SK, Roh D. Physical performance is more strongly associated with cognition in schizophrenia than psychiatric symptoms. Eur Psychiatry 2019; 61:72-78. [PMID: 31349152 DOI: 10.1016/j.eurpsy.2019.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Although neurocognitive dysfunction and physical performance are known to be impaired in patients with schizophrenia, evidence regarding the relationship between these two domains remains insufficient. Thus, we aimed to investigate the relationship between various physical performance domains and cognitive domains in individuals with schizophrenia, while considering other disorder-related clinical symptoms. METHODS Sixty patients with schizophrenia participated in the study. Cardiorespiratory fitness and functional mobility were evaluated using the step test and supine-to-standing (STS) test, respectively. Executive function and working memory were assessed using the Stroop task and Sternberg working memory (SWM) task, respectively. Clinical symptoms were evaluated using the Brief Psychiatric Rating Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory. Multivariate analyses were performed to adjust for relevant covariates and identify predictive factors associated with neurocognition. RESULTS Multiple regression analysis revealed that the step test index was most strongly associated with reaction time in the Stroop task (β = 0.434, p = 0.001) and SWM task (β = 0.331, p = 0.026), while STS test time was most strongly associated with accuracy on the Stoop task (β=-0.418, p = 0.001) and SWM task (β=-0.383, p = 0.007). Total cholesterol levels were positively associated with Stroop task accuracy (β=-0.307, p = 0.018) after controlling for other clinical correlates. However, clinical symptoms were not associated with any variables in Stroop or SWM task. CONCLUSIONS The present findings demonstrate the relationship between physical performance and neurocognition in patients with schizophrenia. Considering that these factors are modifiable, exercise intervention may help to improve cognitive symptoms in patients with schizophrenia, thereby leading to improvements in function and prognosis.
Collapse
Affiliation(s)
- Jiheon Kim
- Mind-neuromodulation Laboratory and Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, Gangwon-Do, 24253, Republic of Korea
| | - Ji-Hyeon Shin
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu, Gyungki-Do, 11765, Republic of Korea
| | - Jeh-Kwang Ryu
- Institute for Cognitive Science, College of Humanities, Seoul National University, 1 Gwanak-ro, Gwanak-Gu, Seoul, 08826, Republic of Korea
| | - Jae Hoon Jung
- Mind-neuromodulation Laboratory and Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, Gangwon-Do, 24253, Republic of Korea
| | - Chan-Hyung Kim
- Department of Psychiatry, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Hwa-Bock Lee
- Gwangmyeong Mental Health Welfare Center, 613 Ori-ro, Gwangmyeong-si, Gyungki-do, 14303, Republic of Korea
| | - Do Hoon Kim
- Mind-neuromodulation Laboratory and Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, Gangwon-Do, 24253, Republic of Korea
| | - Sang-Kyu Lee
- Mind-neuromodulation Laboratory and Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, Gangwon-Do, 24253, Republic of Korea
| | - Daeyoung Roh
- Mind-neuromodulation Laboratory and Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, Gangwon-Do, 24253, Republic of Korea.
| |
Collapse
|
27
|
|
28
|
Rigby BR, Davis RW. Should Exercise Be Prescribed Differently Between Women and Men? An Emphasis on Women Diagnosed With Parkinson's Disease. Front Physiol 2018; 9:1040. [PMID: 30116203 PMCID: PMC6082968 DOI: 10.3389/fphys.2018.01040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/12/2018] [Indexed: 01/18/2023] Open
Affiliation(s)
- Brandon R Rigby
- Department of Kinesiology, Texas Woman's University, Denton, TX, United States
| | - Ronald W Davis
- Department of Kinesiology, Texas Woman's University, Denton, TX, United States
| |
Collapse
|
29
|
Amateis AL, Boesel CL, Ehnert BP, Evans AS, Hurst KE, Marek KL, Sullivan AC, Zalewski KR, Huddleston WE. The need for mapping personal goals to exercise dosage in community-based exercise programs for people with Parkinson’s disease. Physiother Theory Pract 2018; 35:1250-1258. [DOI: 10.1080/09593985.2018.1476942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Allison L. Amateis
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Chelsea L. Boesel
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Bryan P. Ehnert
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Abby S. Evans
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Katheryn E. Hurst
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Katie L. Marek
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Amanda C. Sullivan
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Kathryn R. Zalewski
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Wendy E. Huddleston
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| |
Collapse
|
30
|
Ferrazzoli D, Ortelli P, Madeo G, Giladi N, Petzinger GM, Frazzitta G. Basal ganglia and beyond: The interplay between motor and cognitive aspects in Parkinson's disease rehabilitation. Neurosci Biobehav Rev 2018; 90:294-308. [PMID: 29733882 DOI: 10.1016/j.neubiorev.2018.05.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/28/2018] [Accepted: 05/03/2018] [Indexed: 02/08/2023]
Abstract
Parkinson's disease (PD) is characterized by motor and cognitive dysfunctions, affecting the motor behaviour. We summarize evidence that the interplay between motor and cognitive approaches is crucial in PD rehabilitation. Rehabilitation is complementary to pharmacological therapy and effective in reducing the PD disturbances, probably acting by inducing neuroplastic effects. The motor behaviour results from a complex integration between cortical and subcortical areas, underlying the motor, cognitive and motivational aspects of movement. The close interplay amongst these areas makes possible to learn, control and express habitual-automatic actions, which are dysfunctional in PD. The physiopathology of PD could be considered the base for the development of effective rehabilitation treatments. As the volitional action control is spared in early-medium stages of disease, rehabilitative approaches engaging cognition permit to achieve motor benefits and appear to be the most effective for PD. We will point out data supporting the relevance of targeting both motor and cognitive aspects in PD rehabilitation. Finally, we will discuss the role of cognitive engagement in motor rehabilitation for PD.
Collapse
Affiliation(s)
- Davide Ferrazzoli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Via Pelascini, 3, Gravedona ed Uniti, 22015, Como, Italy.
| | - Paola Ortelli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Via Pelascini, 3, Gravedona ed Uniti, 22015, Como, Italy.
| | - Graziella Madeo
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Via Pelascini, 3, Gravedona ed Uniti, 22015, Como, Italy.
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Centre, Sieratzki Chair in Neurology, Sackler School of Medicine, Sagol School for Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.
| | - Giselle M Petzinger
- Department of Neurology, University of Southern California, Los Angeles, CA, 90033, United States; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, 90033, United States.
| | - Giuseppe Frazzitta
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Via Pelascini, 3, Gravedona ed Uniti, 22015, Como, Italy.
| |
Collapse
|
31
|
Movement Disorders. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
32
|
The effect of the rehabilitation program on balance, gait, physical performance and trunk rotation in Parkinson's disease. Aging Clin Exp Res 2016; 28:1169-1177. [PMID: 26661467 PMCID: PMC5099372 DOI: 10.1007/s40520-015-0506-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 11/18/2015] [Indexed: 10/31/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a progressive, neurodegenerative disease which leads to postural and gait disorders, limitation in mobility, activities of daily living and disability. AIMS The aim of the study is to assess the effects of the rehabilitation program on balance, gait, motor performance and trunk rotations in PD patients. METHODS Sixty-four patients with 1.5-3.0 stage PD in the Hoehn and Yahr scale were randomly allocated to rehabilitation and control groups. Sixty-one patients completed the study. Patients were assessed three times, at month intervals. Between the first and second assessments, the rehabilitation group participated in a rehabilitation training program focused on mobility, balance and gait exercises, consisting of 28 sessions. Balance was assessed with tandem stance and the Pastor test (shoulder tug). Gait was assessed with a 10 m walk at preferred speed and 360° turn. Motor performance was evaluated by means of the Physical Performance Test (PPT) and timed motor activities. The trunk rotations were measured in the lumbar and thoraco-lumbar spine with a tape measure. RESULTS The rehabilitation group significantly improved (p < 0.05) in balance and gait outcomes, PPT score, timed activities and trunk rotations both in comparison to the control group and baseline results. The positive effects of the exercise program maintained for at least 1 month. CONCLUSION The 4-week rehabilitation training program focused on mobility, balance and gait exercises improved balance, gait, physical performance and trunk rotations in patients with PD.
Collapse
|
33
|
Effects of Health Qigong Exercises on Relieving Symptoms of Parkinson's Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:5935782. [PMID: 27891159 PMCID: PMC5116525 DOI: 10.1155/2016/5935782] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/19/2016] [Accepted: 10/04/2016] [Indexed: 12/23/2022]
Abstract
The purpose of this study was to investigate the effects of Health Qigong on the treatment and releasing symptoms of Parkinson's disease (PD). Fifty-four moderate PD patients (N = 54) were randomly divided into experimental and control groups. Twenty-eight PD patients were placed in the experimental group in which the prescribed medication plus Health Qigong exercise will be used as intervention. The other 26 PD patients as the control group were treated only with regular medication. Ten-week intervention had been conducted for the study, and participants completed the scheduled exercises 5 times per week for 60 minutes each time (10 minutes for warm-up, 40 minutes for the exercise, and 10 minutes for cooldown). Data which included the muscle hardness, one-legged blind balance, physical coordination, and stability was collected before, during, and after the intervention. Comparisons were made between the experimental and control groups through the Repeated Measures ANOVA. The results showed that PD patients demonstrate a significant improvement in muscle hardness, the timed “up and go,” balance, and hand-eye coordination (the turn-over-jars test). There were no significant differences between the two groups in gender, age, and course of differences (P < 0.05). The study concluded that Health Qigong exercises could reduce the symptoms of Parkinson's disease and improve the body functions of PD patients in both the mild and moderate stages. It can be added as an effective treatment of rehabilitation therapy for PD.
Collapse
|
34
|
Swank C, Shearin S, Cleveland S, Driver S. Auditing the Physical Activity and Parkinson Disease Literature Using the Behavioral Epidemiologic Framework. PM R 2016; 9:612-621. [PMID: 27777097 DOI: 10.1016/j.pmrj.2016.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/04/2016] [Accepted: 10/07/2016] [Indexed: 11/26/2022]
Abstract
Motor and nonmotor symptoms associated with Parkinson disease place individuals at greater risk of sedentary behaviors and comorbidities. Physical activity is one modifiable means of improving health and reducing the risk of morbidity. We applied a behavioral framework to classify existing research on physical activity and Parkinson disease to describe the current evolution and inform knowledge gaps in this area. Research placed in phase 1 establishes links between physical activity and health-related outcomes; phase 2 develops approaches to quantify physical activity behavior; phase 3 identifies factors associated with implementation of physical activity behaviors; phase 4 assesses the effectiveness of interventions to promote activity; and phase 5 disseminates evidence-based recommendations. Peer-reviewed literature was identified by searching PubMed, Google Scholar, and EBSCO-host. We initially identified 287 potential articles. After further review, we excluded 109 articles, leaving 178 included articles. Of these, 75.84% were categorized into phase 1 (n = 135), 10.11% in phase 2 (n = 18), 9.55% into phase 3 (n = 17), 3.37% into phase 4 (n = 6), and 1.12% into phase 5 (n = 2). By applying the behavioral framework to the physical activity literature for people with Parkinson disease, we suggest this area of research is nascent with more than 75% of the literature in phase 1. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Chad Swank
- School of Physical Therapy, Texas Woman's University, 5500 Southwestern Medical Ave, Dallas, TX 75235-7299(∗).
| | - Staci Shearin
- Department of Physical Therapy, University of Texas Southwestern School of Health Professions, Dallas, TX(†)
| | | | - Simon Driver
- Baylor Institute for Rehabilitation, Dallas, TX(§)
| |
Collapse
|
35
|
Tamir R, Dickstein R, Huberman M. Integration of Motor Imagery and Physical Practice in Group Treatment Applied to Subjects With Parkinson’s Disease. Neurorehabil Neural Repair 2016; 21:68-75. [PMID: 17172556 DOI: 10.1177/1545968306292608] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Purpose. The application of motor imagery practice in the treatment of Parkinson’s disease (PD) is a novel treatment approach for improving motor function. The purpose of this study was to compare group treatment using a combination of physical and motor imagery practice with group treatment using only physical practice in subjects with PD. Methods. Of 23 patients with idiopathic PD, 12 received combined therapy, whereas 11 received physical therapy alone. Exercises for both groups were applied during 1-h sessions held twice a week for 12 weeks. Comparable motor tasks provided to both groups included callisthenic exercises, functional tasks, and relaxation exercises. However, the experimental group was treated with both imagery and real practice, whereas the control group received only physical exercises. Outcome measures included the time required to complete sequences of movements, the performance of balance tasks, impairment and functional scores on the Unified Parkinson’s Disease Rating Scale (UPDRS), and specific cognitive abilities (Stroop and clock drawing tests). Results. Following the intervention, the combined treatment group exhibited significantly faster performance of movement sequences than the control group. In addition, the experimental subjects demonstrated higher gains in the mental and motor subsets of the UPDRS and in the cognitive tests. Both groups improved on the activities of daily living scale. Conclusions. The combination of motor imagery and real practice may be effective in the treatment of PD, especially for reducing bradykinesia. The implementation of this treatment regimen allows for the extension of practice time with negligible risk and low cost.
Collapse
Affiliation(s)
- Ruth Tamir
- Department of Physical Therapy, Sapir Center, Meir General Hospital, Kfar Saba, Israel.
| | | | | |
Collapse
|
36
|
Nair P, Bohannon RW, Devaney L, Maloney C, Romano A. Reliability and Validity of Nonradiologic Measures of Forward Flexed Posture in Parkinson Disease. Arch Phys Med Rehabil 2016; 98:508-516. [PMID: 27373746 DOI: 10.1016/j.apmr.2016.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 05/06/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the intertester reliability and validity of 5 nonradiologic measures of forward flexed posture in individuals with Parkinson disease (PD). DESIGN Cross-sectional observational study. SETTING University outpatient facility and community centers. PARTICIPANTS Individuals (N=28) with PD with Hoehn and Yahr scores of 1 through 4. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Occiput to wall status, tragus to wall distance, C7 to wall distance, photographically derived trunk flexion angle, and inclinometric kyphosis measure. RESULTS Participants were older adults (mean, 69.7±10.6y) with a 14-month to 15-year (mean, 5.9±3.5y) history of PD. Intertester reliability was excellent for all measures (κ=.89 [cued condition] and 1.0 [relaxed condition] for occiput to wall status; intraclass correlation coefficients, .779-.897 for tragus to wall distance, C7 to wall distance, flexion angle, and inclinometric kyphosis measure). Convergent validity was supported for all measures by significant correlations between the same measures obtained during relaxed and cued conditions (eg, occiput to wall relaxed and cued) and for most measures by significant correlations between measures obtained under the same condition (eg, occiput to wall cued and tragus to wall cued). Significant correlations between tragus to wall distance, C7 to wall distance, flexion angle, and inclinometric kyphosis measure and the Unified Parkinson Disease Rating Scale item 28 (posture) also supported convergent validity. Significant differences between tragus to wall distance, C7 to wall distance, and inclinometric kyphosis measure values under relaxed and cued conditions supported known condition validity. Known group validity was demonstrated by significant differences in tragus to wall distance, C7 to wall distance, and inclinometric kyphosis measure obtained from individuals able and individuals unable to touch their occiput to wall when cued to stand tall. CONCLUSIONS Tragus to wall distance, C7 to wall distance, and inclinometric kyphosis measure are reliable and valid nonradiologic measures of forward flexed posture in PD.
Collapse
Affiliation(s)
- Prajakta Nair
- Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT.
| | - Richard W Bohannon
- Department of Physical Therapy, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC
| | - Laurie Devaney
- Physical Therapy Program, Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT
| | - Catherine Maloney
- Physical Therapy Program, Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT
| | - Alexis Romano
- Physical Therapy Program, Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT
| |
Collapse
|
37
|
Brichetto G, Pelosin E, Marchese R, Abbruzzese G. Evaluation of physical therapy in parkinsonian patients with freezing of gait: a pilot study. Clin Rehabil 2016; 20:31-5. [PMID: 16502747 DOI: 10.1191/0269215506cr913oa] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Freezing of gait is a frequently disabling symptom in Parkinson's disease, poorly responding to dopaminergic treatment. We investigated the short-term effectiveness of a rehabilitation protocol in parkinsonian patients with freezing of gait. Design: Prospective, uncontrolled pilot study with open label design. Setting: Outpatient service for rehabilitation of neurological disorders. Subjects: Twelve patients (8 male, 4 female; aged 59-78 years; Hoehn-Yahr stage: 2-3; mean disease duration: 14.29±SD 4.1 years). Interventions: Patients attended three (45 min) sessions every week, over a six-week period, of physical therapy focused to improve balance, postural control and walking, and to learn new strategies for overcoming freezing of gait. Main outcome measures: Patients were evaluated before (T0), at the end (T1), and one month after (T2) rehabilitation by means of clinical rating scales (Unified Parkinson Disease Rating Scale-Motor Section; Freezing of Gait Questionnaire; Parkinson Disease Quality of Life Score) and gait parameters (number of strides, stride length and velocity) during a standardized walking test. Results: The scores of Freezing of Gait Questionnaire and of Parkinson Disease Quality of Life Questionnaire (but not of the Unified Parkinson Disease Rating Scale-Motor Section) were significantly improved after treatment (T1). Gait parameters were significantly improved at T1 and T2. Conclusions: We showed the potential short-term efficacy of a rehabilitative approach to freezing of gait in Parkinson's disease. The positive outcome was documented by clinical rating scales and objective gait evaluation. The rapid reversibility of the clinical benefit suggests that further studies are needed to better define the optimal frequency and duration of treatment.
Collapse
Affiliation(s)
- G Brichetto
- Department of Neurosciences, Ophthalmology and Genetics, University of Genoa, Italy
| | | | | | | |
Collapse
|
38
|
Sedaghati P, Daneshmandi H, Karimi N, Barati AH. A Selective Corrective Exercise to Decrease Falling and Improve Functional Balance in Idiopathic Parkinson's Disease. Trauma Mon 2016; 21:e23573. [PMID: 27218051 PMCID: PMC4869417 DOI: 10.5812/traumamon.23573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 02/10/2015] [Accepted: 03/03/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Posture instability and unsteady gait disorders in Parkinson's Disease (PD) usually contribute to fall-related fractures. Fall-related trauma in PD is the most common reason for injury. Despite providing modern care for PD patients (PP) in the recent years, anti-PD drugs have no effect on falling. There is an urgent need to administer exercise interventions to reduce falls and related injuries in the rehabilitation program of PP. OBJECTIVES To explore the effect of a selective 10-week corrective exercise with an emphasis on gait training activities (GTA) on the number of falls (NOFs), fear of falling, functional balance, timed up and go (TUG) test among PD patients. PATIENTS AND METHODS A purposeful sampling was performed on PP who had fallen or were at risk of falling in 2014. The study intervention consisted of a 10-week (3 sessions each week, each lasting 60 min) corrective exercise program. Participants were randomly allocated to control and two exercise groups; the exercise group with balance pad (EGBP) or exercise group with no balance pad (EGNBP). The analysis of variance (ANOVA) and paired t-test were used for comparison between the groups (P ≤ 0.05). RESULTS Administrating a selective corrective exercise in exercise group with balance pad (EGBP) showed a significant difference in number of falls (NOF), Fall Efficacy Scale-international (FES-I), Berg balance scale (BBS) (and timed up and go) TUG (P = 0.001); while administrating the same exercise in exercise group with no balance pad (EGNBP) showed no significant difference in NOF (P = 0.225) and a significant difference in FES-I (P = 0.031), BBS (P = 0.047) and TUG (P = 0.012). The control group showed no significant difference in each of the dependent variables. CONCLUSIONS Performing a selective corrective exercise on balance pad improves falling and functional balance in idiopathic PD.
Collapse
Affiliation(s)
- Parisa Sedaghati
- Department of Sport Injuries and Corrective Exercise , University of Guilan, Rasht, IR Iran
| | - Hassan Daneshmandi
- Department of Sport Injuries and Corrective Exercise , University of Guilan, Rasht, IR Iran
- Corresponding author: Hassan Daneshmandi, Department of Sport Injuries and Corrective Exercise, University of Guilan, Rasht, IR Iran. Tel: +98-7644433661, Fax: +98-7644433661, E-mail:
| | - Noureddin Karimi
- Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Amir-Hossein Barati
- Department of Exercise Physiologies, Shahid Rajaee Teacher Training University, Tehran, IR Iran
| |
Collapse
|
39
|
Exercise and medication effects on persons with Parkinson disease across the domains of disability: a randomized clinical trial. J Neurol Phys Ther 2015; 39:85-92. [PMID: 25742370 DOI: 10.1097/npt.0000000000000086] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Hypokinesia and bradykinesia as movement deficits of Parkinson disease are thought to be mediated by both basal ganglia dysfunction and a loss of muscle mass and strength commensurate with aging and decreased levels of physical activity. For these reasons, we sought to utilize resistance training as a means to increase muscle force and minimize hypokinesia and bradykinesia in persons with Parkinson disease and examine the effects of exercise and medication on Body Structure and Function (muscle force production and muscle cross-sectional area), Activity (mobility), and Participation (Health Status) outcomes. METHODS Forty-two participants were enrolled in a 12-week randomized clinical trial that compared 2 active exercise interventions: a standard care control group (Active Control) and an experimental group that underwent Resistance Exercise via Negative Eccentric Work (RENEW). RESULTS Participants in both groups improved in muscle force production and mobility as a result of exercise and medication (P < 0.02). There were no significant interaction or between-group differences and no significant changes in muscle cross-sectional area or health status were observed. Effect sizes for exercise and medication combined exceeded the effect sizes of either intervention in isolation. DISCUSSION AND CONCLUSIONS Taken together, these results point to the complementary effects of exercise and medication on the Body Structure and Function and Activity outcomes but little effect on Participation outcomes.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A92).
Collapse
|
40
|
Nair P, W. Bohannon R, Devaney L, Livingston J. Measurement of anteriorly flexed trunk posture in Parkinson's disease (PD): a systematic review. PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x15y.0000000022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
41
|
Psychological Benefits of Nonpharmacological Methods Aimed for Improving Balance in Parkinson's Disease: A Systematic Review. Behav Neurol 2015; 2015:620674. [PMID: 26236107 PMCID: PMC4508472 DOI: 10.1155/2015/620674] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/07/2015] [Accepted: 06/10/2015] [Indexed: 01/20/2023] Open
Abstract
Parkinson's disease (PD) is a serious condition with a major negative impact on patient's physical and mental health. Postural instability is one of the cardinal difficulties reported by patients to deal with. Neuroanatomical, animal, and clinical studies on nonparkinsonian and parkinsonian subjects suggest an important correlation between the presence of balance dysfunction and multiple mood disorders, such as anxiety, depression, and apathy. Considering that balance dysfunction is a very common symptom in PD, we can presume that by its management we could positively influence patient's state of mind too. This review is an analysis of nonpharmacological methods shown to be effective and successful for improving balance in patients suffering from PD. Strategies such as general exercise, robotic assisted training, Tai Chi, Qi Gong, Yoga, dance (such as tango or ballet), box, virtual reality-based, or neurofeedback-based techniques and so forth can significantly improve the stability in these patients. Beside this physical outcome, many methods have also shown effect on quality of life, depression level, enjoyment, and motivation to continue in practicing the method independently. The purpose of this review is to provide information about practical and creative methods designed to improve balance in PD and highlight their positive impact on patient's psychology.
Collapse
|
42
|
van der Kolk NM, Overeem S, de Vries NM, Kessels RPC, Donders R, Brouwer M, Berg D, Post B, Bloem BR. Design of the Park-in-Shape study: a phase II double blind randomized controlled trial evaluating the effects of exercise on motor and non-motor symptoms in Parkinson's disease. BMC Neurol 2015; 15:56. [PMID: 25880966 PMCID: PMC4418070 DOI: 10.1186/s12883-015-0312-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background Parkinson’s disease (PD) is a neurodegenerative disorder with a wide range of motor and non-motor symptoms. Despite optimal medical management, PD still results in a high disability rate and secondary complications and many patients lead a sedentary lifestyle, which in turn is also associated with a higher co-morbidity and mortality. Exercise has been explored as a strategy to reduce secondary complications and results suggests that it not only provides general health benefits, but may also provide symptomatic relief. If this holds true exercise would be a very attractive addition to the therapeutic arsenal in PD. The supportive evidence remains incomplete. Here, we describe the design of the Park-in-Shape study, which primarily aims to evaluate whether aerobic exercise affords clinically relevant improvements in motor symptoms in sedentary PD patients. A specific new element is the introduction of gaming to optimize compliance to the exercise intervention. Methods/Design The Park-in-Shape study is a randomized controlled, assessor- and patient-blinded single center study. Two parallel groups will include a total of 130 patients, receiving either aerobic exercise on a home trainer equipped with gaming elements (“exergaming”), or a non-aerobic intervention (stretching, flexibility and relaxation exercises). Both groups are supported by a specifically designed motivational app that uses gaming elements to stimulate patients to exercise and rewards them after having completed the exercise. Both interventions are delivered at home at least 3 times a week for 30–45 minutes during 6 months. Eligible patients are community-dwelling, sedentary patients diagnosed with mild-moderate PD. The primary outcome is the MDS-UPDRS motor score (tested in the off state) after 6 months. Secondary outcomes include various motor and non-motor symptoms, quality of life, physical fitness, and adherence. Discussion This Park-in-Shape study is anticipated to answer the question whether high intensity aerobic exercise combined with gaming elements (“exergaming”) provides symptomatic relief in PD. Strong elements include the double-blinded randomized controlled trial design, the MDS-UPDRS as valid primary outcome, the large sample size and unique combination of home-based pure aerobic exercise combined with gaming elements and motivational aspects. Trial registration Dutch trial register NTR4743
Collapse
Affiliation(s)
- Nicolien M van der Kolk
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Sebastiaan Overeem
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Nienke M de Vries
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Roy P C Kessels
- Department of Medical Psychology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Rogier Donders
- Department of Health Evidence, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | - Marc Brouwer
- Department of Cardiology, Radboudumc, Nijmegen, the Netherlands.
| | - Daniela Berg
- Department of Neurodegeneration, Center for Neurology and Hertie-Institute for Clinical Brain Research, Tübingen, Germany.
| | - Bart Post
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Bas R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| |
Collapse
|
43
|
Abstract
<LEAP> highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness of appropriate interventions—medications, surgery, education, nutrition, exercise—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.1Each article in thisPTJseries summarizes a Cochrane review or other scientific evidence on a single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on an adult patient with relatively early Parkinson disease.Can physical therapist intervention strategies improve his physical functioning and help him reach his goal of engaging in an exercise program to prevent decline related to progressive Parkinson disease?
Collapse
|
44
|
Movement Disorders. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_73-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
45
|
Liao YY, Yang YR, Cheng SJ, Wu YR, Fuh JL, Wang RY. Virtual Reality-Based Training to Improve Obstacle-Crossing Performance and Dynamic Balance in Patients With Parkinson's Disease. Neurorehabil Neural Repair 2014; 29:658-67. [PMID: 25539782 DOI: 10.1177/1545968314562111] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obstacle crossing is a balance-challenging task and can cause falls in people with Parkinson's disease (PD). However, programs for people with PD that effectively target obstacle crossing and dynamic balance have not been established. OBJECTIVE To examine the effects of virtual reality-based exercise on obstacle crossing performance and dynamic balance in participants with PD. METHODS Thirty-six participants with a diagnosis of PD (Hoehn and Yahr score ranging 1 to 3) were randomly assigned to one of three groups. In the exercise groups, participants received virtual reality-based Wii Fit exercise (VRWii group) or traditional exercise (TE group) for 45 minutes, followed by 15 minutes of treadmill training in each session for a total of 12 sessions over 6 weeks. Participants in the control group received no structured exercise program. Primary outcomes included obstacle crossing performance (crossing velocity, stride length, and vertical toe obstacle clearance) and dynamic balance (maximal excursion, movement velocity, and directional control measured by the limits-of-stability test). Secondary outcomes included sensory organization test (SOT), Parkinson's Disease Questionnaire (PDQ39), fall efficacy scale (FES-I), and timed up and go test (TUG). All outcomes were assessed at baseline, after training, and at 1-month follow-up. RESULTS The VRWii group showed greater improvement in obstacle crossing velocity, crossing stride length, dynamic balance, SOT, TUG, FES-I, and PDQ39 than the control group. VRWii training also resulted in greater improvement in movement velocity of limits-of-stability test than TE training. CONCLUSIONS VRWii training significantly improved obstacle crossing performance and dynamic balance, supporting implementation of VRWii training in participants with PD.
Collapse
Affiliation(s)
- Ying-Yi Liao
- Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan National Yang-Ming University, Taipei, Taiwan
| | - Yea-Ru Yang
- National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jung Cheng
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yih-Ru Wu
- Department of Neurology, Chang-Gung Memorial Hospital, Linkou, Taiwan Chang-Gung University College of Medicine, Linkou, Taiwan
| | - Jong-Ling Fuh
- National Yang-Ming University, Taipei, Taiwan Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | | |
Collapse
|
46
|
Shujaat F, Soomro N, Khan M. The effectiveness of Kayaking exercises as compared to general mobility exercises in reducing axial rigidity and improve bed mobility in early to mid stage of Parkinson's disease. Pak J Med Sci 2014; 30:1094-8. [PMID: 25225533 PMCID: PMC4163239 DOI: 10.12669/pjms.305.5231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 06/06/2014] [Accepted: 06/08/2014] [Indexed: 11/24/2022] Open
Abstract
Objective: To determine the effectiveness of kayaking exercises in the management of axial rigidity, improve bed mobility by improving trunk rotation in Parkinson’s patients. Methods: Experimental randomized controlled trail conducted at Physiotherapy department of IPM&R, DUHS and neurology Outpatient Department of Civil Hospital Karachi. Sample size of 48 was calculated with the use of openEpi. After baseline assessment 24 participants were assigned to each Kayaking exercise and general mobility exercise groups. Both groups received treatment for 75 minutes, 6 days a week for 4 weeks. Pre and post treatment measurements were determined by goniometer that assessed the cervical and thoracolumbar rotations whereas bed mobility was assessed by Modified Parkinson’s Activity Scale (MPAS). Results: In Kayaking group mean cervical spine left rotation increased from 32.95+ 9.66 to 47.25 + 10.58, right side cervical spine rotation increased from 34.00 + 10.32 to 47.58 + 11.96, left side thoracolumbar rotation increased from 23.67 + 4.70 to 28.16 + 3.44, right side thoracolumbar rotation increased from 20.79 + 5.34 to 26.45 + 4.62. In control group mean cervical spine left rotation increased from 34.66+ 9.26 to 43.08 + 8.70, right side cervical spine rotation increased from 35.37 + 9.77 to 43.83 + 9.59 , left side thoracolumbar rotation increased from 23.70 + 4.77 to 26.87 + 3.73, right side thoracicolumbar rotation increased from 21.16 + 5.29 to 24.95 + 4.53 (P value <0.001).. Bed mobility on MPAS scale also showed significant improvements (P value <0.001). Conclusion: Both Kayaking and general exercises resulted in significant improvements after 4 weeks of treatment. However, Kayaking exercises were slightly more beneficial than general exercises.
Collapse
Affiliation(s)
- Faiza Shujaat
- Faiza Shujaat, MSPT, Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences Karachi Pakistan
| | - Nabila Soomro
- Dr. Nabila Soomro, FCPS, Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences Karachi Pakistan
| | - Muhammad Khan
- Muhammad Khan, MSc.PT, Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences Karachi Pakistan
| |
Collapse
|
47
|
Peacock CA, Sanders GJ, Wilson KA, Fickes-Ryan EJ, Corbett DB, von Carlowitz KPA, Ridgel AL. Introducing a multifaceted exercise intervention particular to older adults diagnosed with Parkinson's disease: a preliminary study. Aging Clin Exp Res 2014; 26:403-9. [PMID: 24347123 DOI: 10.1007/s40520-013-0189-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIM With a substantial increase in diagnosed Parkinson's disease, it is of great importance to examine tolerance and physical measures of evolving exercise interventions. Of particular importance, a multifaceted exercise intervention combining active-assisted cycling and resistance training to older adults diagnosed with Parkinson's disease is being assessed. METHODS Fourteen older adults diagnosed with Parkinson's disease and ten healthy older adults (67.5 ± 7.9 years of age) engaged in an 8-week, 24-session, multifaceted exercise protocol. The protocol consisted of both active-assisted cycling and resistance training. Tolerance was measured, as well as multiple indicators of health-related physical fitness. These indicators examined improvements in cardiovascular performance, muscular strength, muscular endurance, and flexibility. RESULTS Twenty-two older adults and older adults diagnosed with Parkinson's disease tolerated the intervention by completing all 24 sessions. Repeated-measures analysis of variance demonstrated significant (P ≤ 0.003) improvements in cardiovascular performance, muscular strength, muscular endurance, and flexibility for both groups of individuals. DISCUSSION AND CONCLUSION The multifaceted intervention is the first to combine both active-assisted cycling and resistance training. The older adult and the older adult diagnosed with Parkinson's disease exhibited both tolerance and health-related improvements in physical fitness following the intervention.
Collapse
|
48
|
Prodoehl J, Rafferty MR, David FJ, Poon C, Vaillancourt DE, Comella CL, Leurgans SE, Kohrt WM, Corcos DM, Robichaud JA. Two-year exercise program improves physical function in Parkinson's disease: the PRET-PD randomized clinical trial. Neurorehabil Neural Repair 2014; 29:112-22. [PMID: 24961994 DOI: 10.1177/1545968314539732] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The progressive resistance exercise (PRE) in Parkinson's disease trial (PRET-PD) showed that PRE improved the motor signs of PD compared to a modified Fitness Counts (mFC) program. It is unclear how long-term exercise affects physical function in these individuals. Objective. To examine the effects of long-term PRE and mFC on physical function outcome measures in individuals with PD. Methods. A preplanned secondary analysis was conducted using data from the 38 patients with idiopathic PD who completed the PRET-PD trial. Participants were randomized into PRE or mFC groups and exercised 2 days/week up to 24 months. Blinded assessors obtained functional outcomes on and off medication at baseline, 6 and 24 months with the Modified Physical Performance Test, 5 times sit to stand test, Functional Reach Test, Timed Up and Go, Berg Balance Scale, 6 minute walk test (6MWT), and 50-ft walking speed (walk speed). Results. The groups did not differ on any physical function measure at 6 or 24 months (Ps > .1). Across time, all physical function measures improved from baseline to 24 months when tested on medication (Ps < .0001), except for 6MWT (P = .068). Off medication results were similar except that the 6MWT was now significant. Conclusions. Twenty-four months of supervised and structured exercise (either PRE or mFC) is effective at improving functional performance outcomes in individuals with moderate PD. Clinicians should strive to include structured and supervised exercise in the long-term plan of care for individuals with PD.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Wendy M Kohrt
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel M Corcos
- Rush University Medical Center, Chicago, IL, USA Northwestern University, Chicago, IL, USA
| | | |
Collapse
|
49
|
Ajimsha MS, Majeed NA, Chinnavan E, Thulasyammal RP. Effectiveness of autogenic training in improving motor performances in Parkinson's disease. Complement Ther Med 2014; 22:419-25. [PMID: 24906579 DOI: 10.1016/j.ctim.2014.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 03/23/2014] [Accepted: 03/31/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Relaxation training can be an important adjunct in reducing symptoms associated with Parkinson's disease (PD). Autogenic Training (AT) is a simple, easily administered and inexpensive technique for retraining the mind and the body to be able to relax. AT uses visual imagery and body awareness to promote a state of deep relaxation. OBJECTIVE To investigate whether AT when used as an adjunct to Physiotherapy (PT) improves motor performances in PD in comparison with a control group receiving PT alone. DESIGN Randomized, controlled, single blinded trial. SETTING Movement Disorder Clinic and Department of Physiotherapy, Sree Chithira Thirunal Institute of Medical Sciences and Technology in Trivandrum, Kerala, India. PARTICIPANTS Patients with PD of grade 2 or 3 of Hoehn & Yahr (H&Y) scale (N = 66). INTERVENTIONS AT group or control group. The techniques were administered by Physiotherapists trained in AT and consisted of 40 sessions per patient over 8 weeks. MAIN OUTCOME MEASURE Motor score subscale of Unified Parkinson's Disease Rating Scale (UPDRS) was used to measure the motor performances. The primary outcome measure was the difference in Motor score subscale of UPDRS scores between Week 1 (pretest score), Week 8 (posttest score), and follow-up at Week 12 after randomization. RESULTS The simple main effects analysis showed that the AT group performed better than the control group in weeks 8 and 12 (P < .005). Patients in the AT and control groups reported a 51.78% and 35.24% improvement, respectively, in their motor performances in Week 8 compared with that in Week 1, which persisted, in the follow-up (Week 12) as 30.82% in the AT group and 21.42% in the control group. CONCLUSIONS This study provides evidence that AT when used as an adjunct to PT is more effective than PT alone in improving motor performances in PD patients.
Collapse
Affiliation(s)
- M S Ajimsha
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar.
| | - Nisar A Majeed
- Faculty of Physiotherapy, School of Medical Education, India
| | | | | |
Collapse
|
50
|
van der Kolk NM, King LA. Effects of exercise on mobility in people with Parkinson's disease. Mov Disord 2013; 28:1587-96. [DOI: 10.1002/mds.25658] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 06/26/2013] [Accepted: 08/08/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Laurie A. King
- Department of Neurology; Oregon Health & Science University; Portland Oregon USA
| |
Collapse
|